Many Cambodian Refugees Still in Trauma, Study Says

More than two decades after resettling in the United States, Cambodian refugees still suffer high rates of mental illness related to the civil war in their home country, researchers report in a study published in today’s edition of the Journal of the American Medical Assn.

The study found that the refugees had six times the rate of major depression and 17 times the rate of post-traumatic stress disorder compared with the general population.

Most of the 150,000 refugees admitted to the U.S. since 1975 speak little or no English, live below poverty level and depend on welfare, the study said.

“This community is suffering inordinately,” said Grant N. Marshall, a researcher at Rand Corp., a Santa Monica-based think tank, who was the study’s lead author.

Earlier studies had showed that most of the Cambodian refugees admitted to the U.S. suffered psychological trauma related to the reign of the Khmer Rouge from 1975 to 1979, during which an estimated 2 million Cambodians died -- about one-quarter of the population.

The studies have been criticized as possibly overestimating rates of mental disorders because they were based on questionnaires in which refugees might overstate their trauma to win asylum or social service benefits.

Marshall found the previous estimates to be essentially correct.

He and colleagues interviewed 586 Cambodian immigrants in four census tracts in Long Beach, where 10% of all U.S. Cambodian refugees live.

The interviews, which lasted about two hours, were conducted from October 2003 and to February 2005 with adults aged 35 to 75 years who lived in Cambodia during the Khmer Rouge reign.

On average, the refugees reported experiencing 15 of 35 types of trauma.

For example, 99% nearly starved to death, 96% were pressed into forced labor and 90% had a family member or friend murdered.

The study also showed that their tribulations by no means ended after their resettlement. Seventy percent, for example, reported exposure to violence after settling in the U.S. in the early 1980s.

“The refugees we interviewed were removed from immediate danger but clearly weren’t prepared to succeed in their new homes,” Marshall said.

Lavinia Limon, who directed the Office of Refugee Resettlement during the Clinton administration, said the continuing problems among Cambodian refugees raised questions about U.S. refugee resettlement policies.

“What they went through is not something you bounce back from without a lot of tailored and targeted and expensive help, especially if you’re a non-Western peasant,” she said.

The study was accompanied by a related piece that looked at 1,358 people who had been forced to leave their homes in the former Yugoslavia between 1991 and 1995.

The study investigated whether war-crime tribunals helped reduce war-related trauma by providing victims with a sense of justice.

The study concluded that the tribunals had no effect in lowering rates of major depression and post-traumatic stress disorder.