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Many Cambodians Still Bears Scars of Khmer Rouge

More than two decades after fleeing war-torn country, they struggle with emotional problems

TUESDAY, Aug. 2, 2005 (HealthDay News) -- Many Cambodian refugees living in the United States who fled the brutal Khmer Rouge regime more than two decades ago remain traumatized, a new study finds.

Almost two-thirds (62 percent) of Cambodians surveyed suffered from post-traumatic stress disorder (PTSD), and 51 percent suffered from depression in the past year. This was six to 17 times higher than the national average for adults, according to the report in the Aug. 3 issue of the Journal of the American Medical Association.

This edition of JAMA is a themed issue on human rights and violence.

"The traditional observation is that mental illness is really a huge problem in developing countries," said Farris Tuma, chief of the traumatic stress research program at the National Institute of Mental Health. "This paper makes it very clear that the global burden of mental illness is alive and well on our shores. This is not a problem only for developing countries."

Tuma's division funded the new study.

Some 150,000 Cambodians have resettled in the United States since 1975, the year the Khmer Rouge came to power. As many as 2 million Cambodians were killed while the Khmer Rouge ruled, and another 1 million perished during the civil war that preceded the regime's takeover, according to background information from the study.

Health experts were concerned that previous studies on the burden of mental illness among Cambodian refugees had overstated the problem because they relied on refugees who were already in the mental health system.

The researchers involved in this latest study went to Long Beach, Calif., the largest Cambodian community in the United States, and knocked on doors, to get a representative sample of the community.

Some 87 percent of the people approached agreed to be interviewed, said study author Grant Marshall, a senior behavioral scientist at the Rand Corp.

In all, Native Khmer speakers conducted face-to-face interviews with 490 randomly selected Cambodian adults aged 35 to 75. All of those interviewed had lived in Cambodia during the Khmer Rouge's reign of terror.

All of the participants had been exposed to trauma before immigrating. Almost all (99 percent) said they had nearly starved to death, 96 percent were enslaved into forced labor, and 90 percent had a family member or friend murdered. A majority (70 percent) reported being exposed to violence after arriving in the United States, and 54 percent said they had been tortured before leaving Cambodia.

Cases of post-traumatic stress disorder and depression tended to overlap, with 42 percent of respondents reporting both. The more trauma they had endured, the worse their symptoms, the study found.

People who were older, poor, unemployed, retired or disabled and who spoke English poorly were more likely to have post-traumatic stress disorder and major depression.

Despite the high prevalence of PTSD and depression, there were low rates of alcohol use disorder, possibly a result of cultural factors, the researchers said.

"This tells you something about the need that may be unnoticed or unaddressed," Tuma said. "It puts to rest somewhat the idea that the problems experienced by refugees and immigrants from conflict-ridden areas are temporary. Being able to look at such a long period of time makes the case that we're talking about potentially lifelong problems which, if unaddressed, have substantial implications not only for the individual's health but also for the ability of that community to function and contribute to the society they're in."

This study did not look specifically at what mental-health resources are available for these refugees, Marshall said. "It appears as though either they have such pernicious symptoms that are challenging our conventional ways of treating these kinds of illnesses or we're not devoting the kind of resources that we might," he said.

The implication for these and other groups of displaced refugees is clear, Marshall said. "Refugees have special needs, and it's not enough merely to remove them from the life-threatening situations," he said.

A second study in the same issue of JAMA found that economic, social and cultural conditions both before and after a person is displaced have a great impact on his or her mental health.

Indeed, this finding seemed to be borne out by the Cambodian experience, where people who spoke less English and were less educated tended to suffer more from psychiatric disorders.

Finally, a third study found that, among 1,358 war survivors from the former Yugoslavia, post-traumatic stress disorder and depression appeared to occur regardless of whether the person felt that justice had been addressed. Fear and loss of control had a stronger association with the onset of these disorders, the study found.

More information

The Southeast Asia Resource Action Center has more on Cambodian refugees.

SOURCES: Grant Marshall, Ph.D., senior behavioral scientist, Rand Corp., Santa Monica, Calif.; Farris Tuma, Sc.D., chief, traumatic stress research program, National Institute of Mental Health, Bethesda, Md.; Aug. 3, 2005, Journal of the American Medical Association
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