|PTSD, Depression Epidemic Among Cambodian
More than two decades after they fled the Khmer Rouge
reign of terror, most Cambodian refugees who resettled
in the United States remain traumatized, a study funded
by the National Institutes of Health’s (NIH) National
Institute of Mental Health (NIMH) and National Institute
on Alcohol Abuse and Alcoholism (NIAAA) has found. Sixty-two
percent suffered from Post Traumatic Stress Disorder
(PTSD) and 51 percent from depression in the past year — six-to-seventeen
times the national average for adults. The more trauma
they endured, the worse their symptoms. In the August
3, 2005 edition of the Journal of the American Medical
Association (JAMA), the RAND Corporation’s Grant Marshall,
Ph.D., and colleagues report on their survey in the
nation’s largest Cambodian community.
An estimated three million of Cambodia’s seven million
people died during the repression and civil wars of
the l970s and most of those who survived suffered multiple
traumas. Moreover, even after two decades in the U.S.,
the majority of the refugee community speak little or
no English, are at income levels below poverty, and
rely on public assistance.
Since previous studies of such refugee populations
have been criticized for possibly overestimating rates
of mental disorders, Marshall and colleagues set out
to allay such concerns by employing a more conservative
approach. Native Khmer speakers conducted highly structured
two-hour interviews with 490 randomly-selected former
refugees, ages 35-75, in their Long Beach, CA homes,
beginning in 2003. They used standardized questionnaires
for gauging levels of violence exposure and alcohol
use disorder and standardized diagnostic interviews
to determine the prevalence of PTSD and depression.
On average, the refugees reported experiencing 15 of
35 types of pre-migration traumas assessed. For example,
99 percent nearly starved to death, 96 percent were
enslaved into forced labor, 90 percent had a family
member or friend murdered and 54 percent were tortured.
Even after arriving in the U.S.; 34 percent said they
had seen a dead body in their Long Beach neighborhood.
Fewer than a third were spared from the psychiatric
disorders assessed. Rates of PTSD and depression tended
to be highest among those who were older, poorer, weaker
English speakers, and unemployed. Forty-two percent
had both disorders, and severity of the disorders increased
with trauma exposure. The risk factors that predicted
depression were so similar to those that predicted PTSD
that the researchers suggest that both disorders may,
in fact, reflect “a single continuum of posttraumatic
The 62 percent of those surveyed who had PTSD in the
past year compares to a prevalence rate of 3.6 percent
in the general adult population. The 51 percent who
met criteria for major depression compares to a rate
of 9.5 percent of U.S. adults.
Rates of alcohol abuse among the refugees were much
lower than in the general population and were not associated
with PTSD, likely reflecting the influence of cultural
factors. The study did not assess the extent to which
participants sought treatment for their disorders, but
the interviewers gave them information about local mental
health clinics. Still, the study “raises questions about
the adequacy of existing mental health resources in
this community,” noted the researchers. They also suggested
that the U.S. has not succeeded in its goal of promoting
the long-term health and well-being of the refugees.
Also participating in the research were: Drs. Terry
Schell, Marc Elliott, Megan Berthold, Rand Corporation;
and Dr. Chi-Ah Chun, California State University.
NIMH and NIAAA are part of the National Institutes
of Health (NIH), the Federal Government's primary
agency for biomedical and behavioral research. NIH
is a component of the U.S. Department of Health and
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It is the primary Federal agency for conducting and
supporting basic, clinical, and translational medical
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and cures for both common and rare diseases. For more
information about NIH and its programs, visit www.nih.gov.