The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia Border Camps

City University of New York - Bernard M. Baruch College, New York, New York, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/1993; 270(5):581-6. DOI: 10.1001/jama.270.5.581
Source: PubMed


To assess the long-term impact of trauma and confinement on the functional health and mental health status of Cambodian displaced persons living on the Thailand-Cambodia border.
Household survey of 993 adults randomly selected from household rosters. Household sample selection by multistage area probability sample.
Site 2, the largest Cambodian displaced-persons camp on the Thailand-Cambodia border.
Adults 18 years of age and older selected at random within households; 98% of eligible persons selected agreed to participate.
From 1975 through 1979 (Khmer Rouge regime), more than 85% reported lack of food, water, shelter, and medical care, brainwashing, and forced labor; 54% reported murder of a family member or friend; 36% reported torture; 18% reported head injury; and 17% reported rape or sexual abuse. During the refugee period between 1980 and 1990, 56% reported lack of food or water, 44% reported lack of shelter, 28% reported lack of medical care, 24% reported brainwashing, and 8% reported torture. Since 1980, reports of murder of a family member, head injury, and rape/sexual abuse have decreased to 5%. Reports of experiencing combat situations and shelling attacks have remained consistent between the two time periods, approximately 44% and 30%, respectively. From 1989 to 1990, 25% reported experiencing lack of food or water, and 5% to 10% reported serious injury, combat, and shelling conditions. More than 80% said they were in fair or poor health, felt depressed, and had a number of somatic complaints despite good access to medical services. Fifty-five percent and 15% had symptom scores that correlate with Western criteria for depression and posttraumatic stress disorder, respectively. Fifteen percent to 20% reported health impairments limiting activity, and moderate or severe bodily pain. Despite reported high levels of trauma and symptoms, social and work functioning were well preserved in the majority of respondents.
Reports of extensive trauma, poor health status, and depressive symptoms of this population are of concern in predicting future morbidity and mortality. The health and mental health needs of Cambodian displaced persons and their impact on social and economic behavior should be addressed now that the Cambodians have been repatriated.

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    • "De Jong, Scholte, Koeter, and Hart (2000) reported that 50% of the refugees in Rwandan and Burundese camps had serious mental health problems. A study of Cambodian refugees living in the ThailandÁ Cambodia border camp indicated that 55% had depression and 15% had PTSD (Mollica et al., 1993). However, studies evaluating the efficacy of psychological treatments for PTSD carried out in refugee camps are very rare (Nickerson, Bryant, Silove, & Steel, 2011). "
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    ABSTRACT: The most common mental health problems among refugees are depression and posttraumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD. However, no previous randomized controlled trial (RCT) has been published on treating PTSD symptoms in a refugee camp population. Examining the effect of EMDR to reduce the PTSD and depression symptoms compared to a wait-list condition among Syrian refugees. Twenty-nine adult participants with PTSD symptoms were randomly allocated to either EMDR sessions (n=15) or wait-list control (n=14). The main outcome measures were Impact of Event Scale-Revised (IES-R) and Beck Depression Inventory (BDI-II) at posttreatment and 4-week follow-up. Analysis of covariance showed that the EMDR group had significantly lower trauma scores at posttreatment as compared with the wait-list group (d=1.78, 95% CI: 0.92-2.64). The EMDR group also had a lower depression score after treatment as compared with the wait-list group (d=1.14, 95% CI: 0.35-1.92). The pilot RCT indicated that EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees located in a camp. Larger RCTs to verify the (cost-) effectiveness of EMDR in similar populations are needed.
    European Journal of Psychotraumatology 04/2015; 6. DOI:10.3402/ejpt.v6.27414 · 2.40 Impact Factor
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    • "Respondents were asked whether they were bothered by each symptom " not at all " (1), " a little " (2), " quite a bit " (3), or " extremely " (4) in the past week. Both instruments have been widely translated and used in a number of studies among diverse cultural groups [30] [31] [32] [33] [34] and validated against clinical diagnoses [27] [35] [36] [29] [37]. Scale cutoff points for the HSCL-25 and HTQ for depression and PTSD are greater than or equal to 1.75 and 2.50, respectively [35] [37] [38]. "
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    ABSTRACT: Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n=337) and a non-THI, non-ex-detainee comparison group (n=82) were surveyed. Seventy-eight percent of the ex-political detainees had experienced THI; 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than in the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose-effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD=22.4; 95% CI: 3.0-165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture.
    Comprehensive Psychiatry 04/2014; 55(7). DOI:10.1016/j.comppsych.2014.04.014 · 2.25 Impact Factor
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    • "Summing scores under each subsection and dividing, respectively, by 10 and 15 gives the mean intensity of the distress. Although we are aware that the validity of the cutoff scores commonly used to specify the clinical significance of symptoms may be questionable (Ertl et al., 2010), we applied the most commonly recommended cutoff score of 1.75 (Mollica et al., 1993; Silove, Sinnerbrink, Field, Manicavasagar, & Steel, 1997) to obtain a rough estimate of depression and anxiety diagnoses in this study. The Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) is one of the most widely used psychiatric structured diagnostic interview instruments. "
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    ABSTRACT: Adverse life experiences are a major risk factor for psychopathology. Studies from industrialized countries have consistently shown the detrimental effects of child maltreatment on the mental health of the victims. Research in war-affected populations, however, has mostly been restricted to the psychological damage caused by the war. Both war trauma and child maltreatment have rarely been studied simultaneously. In a comparative study of 2 generations living in severely war-affected regions in Northern Uganda, we determined the relationship between both trauma types and posttraumatic stress disorder (PTSD), anxiety, depression, and suicide ideation. A total of 100 adolescents, 50 with and 50 without a history of abduction by the rebel army with both their parents (100 mothers and 100 fathers) living in camps in northern Uganda were interviewed. The study showed that both generations were severely affected by war and child maltreatment. Both trauma types were independently correlated with psychological disorders in the adolescent group. Only child maltreatment, however, not war violence, accounted for PTSD symptoms in the parent group (β = .253, p = .002). We conclude that, even in the context of severe war, the impact of child maltreatment on psychological disorders surpasses the damage of war trauma.
    Journal of Traumatic Stress 02/2014; 27(1). DOI:10.1002/jts.21892 · 2.72 Impact Factor
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