Troubled Cambodian Refugees Likely to Seek Help for Mental Health Problems, RAND Study Says

A RAND Corporation survey of Cambodian refugees in California found that nearly 70 percent of those with mental health disorders sought medical help for emotional or psychological problems in the previous year, contradicting the common belief that Asians are less likely to seek mental health services.

What is surprising is that the study found that the Cambodians who were the most economically and socially vulnerable — those who lacked English proficiency, who were unemployed or had little pre-immigration education — were the most likely to have had contact with a medical provider in the previous 12 months.

“Although Asian cultures tend to attribute mental illness to individual weakness, moral transgressions and genetic heritability, Cambodian refugees were the survivors of genocidal atrocities that were largely beyond their control,” the study notes. For that reason, the Cambodian refugees may be more likely to attribute their mental health problems to external sources, lessening the stigma of seeking mental health services, the study suggested.

In addition, researchers for RAND — a nonprofit research organization — concluded that any sense of personal shame associated with mental illness may be reduced by the fact that large numbers of Cambodian refugees are similarly suffering.

The individuals interviewed for the survey by RAND Health were all from Long Beach, Calif., which has the largest single concentration of Cambodian refugees in the United States.

A total of 339 of 490 people interviewed met diagnostic criteria for post-traumatic stress disorder, major depressive disorder or alcoholism, and had lived in Cambodia at some point during the rule of the Khmer Rouge regime.

“Social service agencies seem to have done a very good job of reaching out to Cambodian refugees with mental health problems. This is not a small accomplishment,” said Grant Marshall, a RAND psychologist and lead author of the study. Titled “Rates and Correlates of Seeking Mental Health Services Among Cambodian Refugees,” the study is featured in the October issue of the American Journal of Public Health.

Cambodia had an estimated 7.1 million people in 1975 when the Khmer Rouge seized power and ruled the nation for four years. About 3 million Cambodians subsequently lost their lives in the turmoil of civil wars and mass killings ordered by the Khmer Rouge.

Another RAND study by Marshall, published last year in the Journal of the American Medical Association, found that nearly two-thirds of Cambodian refugees suffered from post-traumatic stress disorder and more than half had major depression.

Almost all of the 490 adult refugees in the earlier study reported experiencing near-death due to starvation in Cambodia, 90 percent had a friend or family member killed by the Khmer Rouge, and 54 percent said they had been tortured in Cambodia. In addition, 70 percent said they had been exposed to violence, such as being robbed, after they arrived in the United States.

“Cambodian refugees were exposed to horrific atrocities, and it is not surprising that many would still be having difficulties even after many years,” Marshall said. “Exposure to violence can lead to mental health problems that are very intractable and long-lasting.”

Unlike many other Asian Americans, many Cambodians were immediately integrated into the social services network when they arrived in the United States as refugees, which also may have lowered barriers to seeking help.

The study did not examine whether the refugees actually received mental health services nor did it evaluate the nature, duration and scope of the services received.

“Providing services to this community is very challenging and is often done with very modest resources.” Marshall said. “We need to know much more than we do to understand how best to help these people overcome the consequences of having been exposed to such trauma.”

The study was funded by grants from the National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism. Other authors of the study include S. Megan Berthold, Terry L. Schell, Marc N. Elliott and Katrin Hambarsoomians of RAND, and Chi-Ah Chun of the Department of Psychology at California State University, Long Beach.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and delivery, among other topics.