Physical disorders among Southeast Asian refugee outpatients with psychiatric disorders

Trauma, healthcare access, and health outcomes among Southeast Asian refugees in Connecticut

Mental health problems among Southeast Asian refugees have been documented. However, longer term health consequences of mass violence as re-settled refugees age are less well described. This study investigated relationships among trauma symptoms, self-reported health outcomes, and barriers to healthcare among Cambodian and Vietnamese persons in Connecticut. An internet phone directory was used to generate a list of names that was compared to 2000 census data to estimate the proportion of the population in each group. From these lists, 190 telephone listings were selected at random. Interviewers telephoned selected listings to screen for eligible participants and obtain an appointment for interview. Surveys were administered through face-to-face interviews during home visits conducted in Khmer or Vietnamese. The Harvard Trauma Questionnaire assessed trauma symptoms. Questions regarding the presence of physician diagnosed heart disease, hypertension, diabetes, and chronic pain were adapted as written from the Health Interview Survey. Healthcare access and occurrence were measured with questions regarding cost and access, patient-provider understanding, and interpretive services. Hierarchical modeling was used to account for respondent nesting within family. Analyses controlled for age, sex, and country of origin. Individuals who reported greater trauma symptoms were more likely to report heart disease by a factor of 1.82, hypertension by a factor of 1.41, and total count of diseases by a factor of 1.22, as well as lower levels of subjective health. Greater trauma symptoms were also associated with greater lack of understanding, cost and access problems, and the need for an interpreter. Although the majority of Southeast Asian immigrants came to the United States as refugees approximately 20-30 years ago, there continues to be high levels of trauma symptoms among this population which are associated with increased risk for disease and decreased access to healthcare services.

HADStress screen for posttraumatic stress: replication in ethiopian refugees

Purpose was to assess whether a 4-symptom somatic screen, shown to correlate with current post-traumatic stress symptoms in 1 refugee group, could function as a screening instrument in another group of refugees. Sample consisted of 512 community-dwelling refugees from Ethiopia. Data collection included demography, types of torture and nontorture trauma experienced a decade earlier in Africa, and current posttraumatic stress symptoms. Somatic symptoms included headaches (H), appetite change (A), dizziness and faintness (D), and sleep problems (S), added with equal weighting into the HADStress Screen, ranging from 0 to 4. Results showed that age, gender, torture, and other trauma experiences from a decade ago, and current posttraumatic stress symptoms predicted current somatic symptoms on univariate analyses. On a negative binomial regression model, current posttraumatic stress symptoms, male gender, and number of torture types predicted a high HADStress score. Post hoc tests supported cut-off levels at 3 and at 4 symptoms. Conclusion is that the HADStress Screen can serve as an efficient, nonthreatening screen for posttraumatic stress symptoms among refugees.

The range of symptoms in refugees of war: the New Mexico Refugee Symptom Checklist-121

The range of symptoms experienced by refugees of war has not been empirically assessed. The New Mexico Refugee Symptom Checklist-121 (NMRSCL-121) was developed utilizing established guidelines and evaluated for its psychometric properties. Community-dwelling Kurdish and Vietnamese refugees reported 48 (SD = 31) persistent and bothersome somatic and psychological symptoms on the NMRSCL-121. Internal consistency and test-retest reliability for the total scale and for most subscales were acceptable, and construct and concurrent validity for the NMRSCL-121 data was shown. There were modest ethnic group differences on symptom severity and psychometric properties of NMRSCL-121 subscales. The NMRSCL-121 produces reliable and valid assessments of a wide range of symptoms in 2 broad community samples of displaced adult refugees.

Adherence With Hypertension Care Among Hmong Americans

To assess contexts of adherence with hypertension care among Hmong Americans, in-person interviews were conducted with a convenience sample of 323 adults using culturally adapted survey instruments. The mean age of participants was 58 years; 91% had no education, and 86% spoke no English. Although more than 90% had health insurance and were treated with medications, the rate of blood pressure control was low (27%). A majority (> 90%) suffered from psychological distress, and 46% lived with physical illness. Over 50% reported nonadherence with hypertension care. Respondents who were 50 years of age or older, had no physical illness, did not know that hypertension was preventable, or believed that American medicine was too strong, were more likely to report nonadherence with proper medication consumption. Findings suggest that adherence was not due to lack of health care coverage; instead, it may be due to gaps in health services.

Refugee experiences and Southeast Asian women's mental health

The wars in Southeast Asia displaced thousands of families from Cambodia, Laos, and Vietnam. The upheavals led to a number of waves of immigration to the United States. Current research supports hypotheses of post-traumatic stress disorder diagnoses in refugees from the wars in Vietnam but omits pertinent cultural factors. This phenomenological study of 19 women from Southeast Asia examines the meanings of their refugee experiences. Open-ended interviews with these women reveal themes of survival, despair, and isolation. Health care providers may notice cultural bereavement as opposed to post-traumatic stress disorder, reflecting a psychological resilience not extensively explored previously. Developing empathetic interactions and including important ethnic identity factors in caring for refugee women appear essential in providing appropriate health care.

Substance abuse among Southeast Asians in the U.S.: implications for practice and research

The literature on Asian-American substance use has shown a general increase in consumption and related problems due, in part, to the effects of acculturation toward U.S. drinking norms. Southeast Asians are the most recent of Asian groups to come to the U.S., and have done so following an immigration and refugee experience that was among the most traumatic in recent memory resulting in significant levels of psychosocial distress. The combined influences of mental health disorders, which frequently co-occur with substance abuse, and acculturation pressures suggest that a significant increase in substance abuse problems may be in progress for Southeast Asian immigrants. Preliminary evidence appears to bear out this hypothesis. The current article outlines the literature on substance abuse among Vietnamese, Cambodians and Laotians in the U.S., and makes tentative recommendations for assessment, treatment and future research.