Risk Factors Associated with Ptsd and Major Depression Among Cambodian Refugees in Utah

The study reported in this article is a secondary analysis of data collected from a random sample of 124 Cambodian adults, ages 18 to 76 years. Participants were interviewed about their mental health status and factors associated with a diagnosis of posttraumatic stress disorder (PTSD) or major depression. From analysis of the data, the following risk factors were identified with PTSD and depression: experiencing a greater number of war traumas increased the risk of both PTSD and major depression; experiencing a greater number of resettlement stressors during the past year increased the risk of both PTSD and major depression; and having financial stress increased the risk of major depression. Refugees frequently experience many problems adapting to the new systems and cultures of their host countries. This adaptation is made more difficult when the refugee has experienced horrific trauma in his or her native country. The Cambodian refugees surveyed in this study survived extreme conditions of death and destruction brought about by the Khmer Rouge regime from 1975 until 1979 (Hein, 1995). After the reign of Khmer Rouge regime, nearly all participants in this study were forced to relocate for varying periods in squalid refugee camps abroad and finally were resettled in Utah. Cambodians' resettlement in the United States has been foreign and strange in terms of language, cultural customs, weather, food, and religion. Many have endured racial discrimination and a struggle for basic survival. According to Hein (1995), most Cambodian refugees in the United States have experienced "severe antagonism" and "perceive extensive prejudice and discrimination" (p. 153). Earlier studies indicated that despite living in the United States for some years, PTSD and major depression were still rampant among the Cambodian population. Carlson and Rosser-Hogan (1993), incorporating random sampling, reported that 86 percent of the Cambodians in their sample met the modified criteria of the DSM-III-R for PTSD, and 80 percent met the criteria for depression. Clarke, Sack, Ben, Lanham, and Him (1993); Kroll et al. (1989); and Sack et al. (1994) also have found high rates of PTSD and major depression among Cambodian refugees in the United States. The amount and extent of traumas experienced by these refugees during the Khmer Rouge regime and subsequently in refugee camps appear to be the most likely reason for the high rates of PTSD and major depression. Mollica, Wyshak, and Lavelle (1987), in a study of Indochinese refugees, noted that the Cambodian population was the most traumatized of the refugees and had experienced an average of 16 traumatic events, including deprivation, physical injury or torture, incarceration or re-education camps, and witnessing killing or torture. Although not specific to Cambodian refugees, Lipton (1994) and Zeiss and Dickman (1989) supported the relationship between traumas and PTSD by noting that the more severe and long lasting the trauma, the more severe the symptoms of PTSD. Although earlier research indicates that greater numbers of traumas result in greater vulnerability to PTSD, only a few studies have examined the specific types of traumas that create the greatest vulnerability. Mollica et al. (1987) and Kroll et al. (1989) noted that the loss of a spouse among Cambodian women increased vulnerability to PTSD and other psychopathology. In addition to higher levels of trauma, Cheung (1994) noted that postmigration stressors increased the risk of PTSD among Cambodian refugees. Conversely, Kinzie, Fredrickson, Ben, Fleck, and Ken (1984) reported that current stressors appeared to trigger rather than cause PTSD symptoms. According to Kinzie et al., PTSD may be a chronic condition capable of being reactivated by current stressors reminiscent of the original trauma. Few studies have examined the specific risk factors associated with Cambodian refugees and their vulnerability to major depression. …