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Grant N. Marshall, PhD; Terry L. Schell, PhD; Marc N. Elliott, PhD; S. Megan Berthold, PhD; Chi-Ah Chun, PhD

JAMA. 2005;294:571-579.

Context  Little is known about the long-term mental health of trauma-exposed refugees years after permanent resettlement in host countries.

Objective  To assess the prevalence, comorbidity, and correlates of psychiatric disorders in the US Cambodian refugee community.

Design, Setting, and Participants  A cross-sectional, face-to-face interview conducted in Khmer language on a random sample of households from the Cambodian community in Long Beach, Calif, the largest such community in the United States, between October 2003 and February 2005. A total of 586 adults aged 35 to 75 years who lived in Cambodia during the Khmer Rouge reign and immigrated to the United States prior to 1993 were selected. One eligible individual was randomly sampled from each household, with an overall response rate (eligibility screening and interview) of 87% (n = 490).

Main Outcome Measures  Exposure to trauma and violence before and after immigration (using the Harvard Trauma Questionnaire and Survey of Exposure to Community Violence); weighted past-year prevalence rates of posttraumatic stress disorder (PTSD) and major depression (using the Composite International Diagnostic Interview version 2.1); and alcohol use disorder (by the Alcohol Use Disorders Identification Test).

Results  All participants had been exposed to trauma before immigration. Ninety-nine percent (n = 483) experienced near-death due to starvation and 90% (n = 437) had a family member or friend murdered. Seventy percent (n = 338) reported exposure to violence after settlement in the United States. High rates of PTSD (62%, weighted), major depression (51%, weighted), and low rates of alcohol use disorder were found (4%, weighted). PTSD and major depression were highly comorbid in this population (n = 209; 42%, weighted) and each showed a strong dose-response relationship with measures of traumatic exposure. In bivariate analyses, older age, having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty were also associated with higher rates of PTSD and major depression. Following multivariate analyses, premigration trauma remained associated with PTSD (odds ratio [OR], 2.08; 95% CI, 1.37-3.16) and major depression (OR, 1.56; 95% CI, 1.24-1.97); postmigration trauma with PTSD (OR, 1.65; 95% CI, 1.21-2.26) and major depression (OR, 1.45; 95% CI, 1.12-1.86); and older age with PTSD (OR, 1.76; 95% CI, 1.46-2.13) and major depression (OR, 1.47; 95% CI, 1.15-1.89).

Conclusion  More than 2 decades have passed since the end of the Cambodian civil war and the subsequent resettlement of refugees in the United States; however, this population continues to have high rates of psychiatric disorders associated with trauma.

Author Affiliations: RAND, Santa Monica (Drs Marshall, Schell, Elliott, and Berthold); The Program for Torture Victims, Los Angeles (Dr Berthold); and California State University, Long Beach (Dr Chun), Calif.

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