The Indochinese refugee: an overview

Structural interventions and social suffering: Responding to amphetamine-type stimulant use among female entertainment and sex workers in Cambodia

BACKGROUND

In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of amphetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination.

METHODS

Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory.

RESULTS

In addition to increasing occupational functionality, ATS were used to control pervasive feelings of 'sadness' in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use.

CONCLUSION

In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.

The Mental Health of Refugee Children and Their Cultural Development

A large proportion of Indochinese refugees are children. This article suggests that uprooted children may experience powerful grief, not only in response to personal loss of loved ones, but also to loss of their culture. It is further postulated that personal bereavement and cultural bereavement are complementary, which can be an important factor in a refugee child's adjustment. These children are vulnerable to “disrupted development time” and so earlier losses of family and culture can seed problems which can emerge after resettlement.

Comparing Judgements of Social, Behavioural, Emotional and School Adjustment Functioning for Korean, Korean American and Caucasian American Children

Social, emotional, behavioural and school adjustment functioning among Korean, Korean American and Caucasian American children was examined with the Behavior Assessment System for Children (BASC) Self-Report of Personality (SRP) and the Parent Rating Scale (PRS). One hundred and twenty Korean, Korean-American and Caucasian-American children, ages 8 to 11, and their parents participated in this study. Generally, the Korean children were perceived as behaving in a more controlled, less self-reliant and internalizing manner than were the American children. The Korean American children were rated to have more adjustment difficulties. The notion of Korean family collectivism versus western individualism and the inherent conflict in these cultural values was used to discuss the results. Practitioners should be aware that ratings with the BASC PRS and SRP scales of Korean and Korean American children can be influenced by culture to a significant degree. Also it appears that the BASC SRP and PRS are sensitive to conflict created in children and families caught between cultures, particularly related to demands for rapid Americanization.

The Multidimensional Loss Scale: validating a cross-cultural instrument for measuring loss

The Multidimensional Loss Scale (MLS) represents the first instrument designed specifically to index Experience of Loss Events and Loss Distress across multiple domains (cultural, social, material, and intrapersonal) relevant to refugee settlement. Recently settled Burmese adult refugees (N = 70) completed a questionnaire battery, including MLS items. Analyses explored MLS internal consistency, convergent and divergent validity, and factor structure. Cronbach alphas indicated satisfactory internal consistency for Experience of Loss Events (0.85) and Loss Distress (0.92), reflecting a unitary construct of multidimensional loss. Loss Distress did not correlate with depression or anxiety symptoms and correlated moderately with interpersonal grief and trauma symptoms, supporting divergent and convergent validity. Factor analysis provided preliminary support for a five-factor model: Loss of Symbolic Self, Loss of Interdependence, Loss of Home, Interpersonal Loss, and Loss of Intrapersonal Integrity. Received well by participants, the new scale shows promise for application in future research and practice.

How are new refugees doing in Canada? Comparison of the health and settlement of the Kosovars and Czech Roma

BACKGROUND

In 1999, a group of Kosovars arrived in Hamilton, Ontario, with a coordinated international pre-migration plan, as part of the United Nations Humanitarian Evacuation Program. Since 1997, a substantial number of Roma refugees from the Czech Republic also arrived in Hamilton, with no special pre-migration planning. This study examined whether the organized settlement efforts led to better adaptation and perceived health for the Kosovars, using the Czech Roma as a comparison group.

METHODS

Adult members of 50 Kosovar (n=157 individuals) and 50 Czech Roma (n=76 individuals) randomly selected families completed a questionnaire on sociodemographics, health, well-being, and perceived adaptation to Canada. Differences between groups were examined using univariate and multivariate analyses. Comparison was made to the Ontario population where possible.

RESULTS

There were more Kosovars than Czech Roma over the age of 50 (22.1% vs 10.5%, p=0.03). Nearly one quarter (21.7%) of the Kosovars had a score indicating post-traumatic stress disorder (PTSD) on the Harvard Trauma Questionnaire (HTQ), compared to none of the Roma (p<0.001). After adjustment for age and PTSD, the Kosovars were significantly more likely to report fair or poor adaptation to Canada (OR=10.5, 95% CI=3.6-31.2) and that life is somewhat or very stressful (OR=3.9, 95% CI=2.1-7.4). Differences for other measures were no longer significant after adjustment.

CONCLUSIONS

The health and adaptation of the Kosovars was not better than that of the Czech Roma. Reasons for this finding may include differences in demographics, the presence of PTSD, and differing length of time since arrival in Canada.

Psychological distress through immigration: the two-phase temporal pattern?

A large community sample, cross-sectional and in part longitudinal design, and comparison groups was used to determine the timing of psychological distress among immigrants. A total of 2,378 adult immigrants from the former Soviet Union to Israel completed the self-administered questionnaire Talbieh Brief Distress Inventory. The aggregate levels of distress and six psychological symptoms--obsessiveness, hostility, interpersonal sensitivity, depression, anxiety, and paranoid ideation--were compared at 20 intervals covering 1 to 60 months after resettlement. The level of psychological distress was significantly higher in the immigrants than that of Israeli natives but not in the potential immigrant controls. A two-phase temporal pattern of development of psychological distress was revealed consisting of escalation and reduction phases. The escalation phase was characterized by an increase in distress levels until the 27th month after arrival (a peak) and the reduction phase led to a decline returning to normal levels. The 1-month prevalence rate was 15.6% for the total sample, and for highly distressed subjects it reached 24% at the 27th month after arrival, and it declined to 4% at the 44th month. The time pattern of distress shared males and females, married and divorced/widowed (but not singles), as well as subjects of all age groups (except for immigrants in their forties). The two-phase pattern of distress obtained according to cross-sectional data was indirectly confirmed through a longitudinal way. Claims of early euphoric or distress-free period followed by mental health crisis frequently referred to in the literature on migration was not supported by this study.

Changing patterns of distress during the adjustment of recent immigrants: a 1-year follow-up study

A sample of 419 recent immigrants from the former Soviet Union to Israel was assessed, with a 1-year follow-up of 199 of these subjects. The Immigration Related Stressors Scale, Talbieh Brief Distress Inventory and Multidimensional Scale of Perceived Social Support were employed to measure the level and sources of distress, as well as the sources of social support. Three major patterns of change in distress level were distinguished, and their 1-year prevalence rates were established. In total, 44% of the respondents demonstrated the 'normal' pattern, with a permanent low distress level, 33% displayed the 'positive' pattern, with either persistent moderate or decreasing distress, and 23% displayed the 'negative' pattern, with either persistent high or increasing distress. Among the immigrants who demonstrated the positive pattern of change in distress, rates of stressors such as 'anxiety about the future', 'uncertainty in the present', 'depressive state', 'insufficient knowledge of Hebrew' and 'malevolence of Israelis' decreased during the study period. In those who showed the negative pattern, rates of stressors such as 'personality characteristics' and 'lack of acceptance of the host culture/mentality' have increased. Immigrants who showed the normal and positive patterns had greater total social support than those who showed the negative pattern. The level of family support tended be higher among immigrants with the normal pattern, while support by friends tended to be greater among those with the positive pattern of change in distress.

Illness aetiology constructs, health status and use of health services among Cambodians in New Zealand

OBJECTIVE

The objectives of this study were to determine, among all adult Cambodians living in Dunedin: prevalence of illness aetiology beliefs; psychiatric and physical health status; pattern of use of health services; relationships between use of health services and demographic factors, illness aetiology constructs and health status; and problems encountered and improvements desired in the local health services.

METHOD

223 (i.e. 93.3% of all) adult Cambodians living in Dunedin were assessed, using a structured interview, in relation to their sociodemographic status, illness aetiology beliefs, physical health status and use of health services. The 28-item version of the General Health Questionnaire was used to assess psychiatric status.

RESULTS

Subjects held multiple indigenous and Western illness aetiology constructs. Psychiatric morbidity using the 28item of the General Health Questionnaire (GHQ28) cutoff of 3/4 was 15.7%; despite this only six subjects had ever used specialist psychiatric services. Malaria, intestinal parasitic infestations and heart conditions were the three most frequently reported physical problems. Most subjects had used traditional services in Cambodia but very few had used them in New Zealand. Health service was related to duration of stay in New Zealand. Socio-economic status, both physical and psychiatric health status and some illness aetiology constructs. One hundred and forty-two (63.7%) subjects reported problems with use of health services in Dunedin.

CONCLUSION

Despite methodological limitations, some useful preliminary data on factors pertaining to use of and satisfaction with health services among Cambodians were collected. Future research should examine family characteristics and the decision-making processes that determine service use.

Prevalence of psychiatric symptoms and their relation to adjustment among Chinese-American youth

OBJECTIVE

The primary purpose of this investigation is to assess psychiatric symptoms of Chinese-American children using Achenbach's Child Behavior Checklist (CBCL) and to determine the impact of acculturation on these symptoms.

METHOD

One hundred eighty-one forms of a Chinese CBCL and a 10-item questionnaire on adjustment and ethnic patterns of socialization were completed by a parent or guardian of Chinese-American children attending a Chinese school in New York City.

RESULTS

The sample's total problem, internalizing, externalizing, total competence, activities, and social scores were significantly lower than Achenbach's American norms by age and sex. Favorable adjustment was correlated significantly with lower total problem and internalizing scores. Recent immigrants did not have higher symptom scores.

CONCLUSION

Lower scores of the Chinese-American children may be due to temperamental differences, underreporting by the respondent, or cultural intolerance of misbehavior.

Acculturation and psychiatric morbidity among Cambodian refugees in New Zealand

A community survey examining the relationship between acculturation and minor psychiatric morbidity among 223 Cambodians living in Dunedin, New Zealand was conducted. Most subjects would like to retain their parent culture but would also like to assimilate into the host culture, indicating a preference for an integrated mode of acculturation. Those who were older, widowed, less educated, had shorter duration of stay in New Zealand, and of lower socioeconomic status, were less acculturated. Overall, the least acculturated were found to have the highest rate of psychiatric morbidity. When age and sex were controlled, the association between acculturation and psychiatric morbidity remained significant only for women aged 31 to 50. Overall, the associations between psychiatric morbidity and acculturation held true for marital status, duration of stay in N.Z., educational level, and socioeconomic status. The relevant conceptual and methodological issues in acculturation studies were discussed.

Variations in therapeutic interventions for Cambodian and Chilean refugee survivors of torture and trauma: a pilot study

The treatment of refugee survivors of torture and trauma has attracted increasing clinical attention. The present study surveyed therapists concerning the emphasis that was placed on disclosure of previous traumatic experiences in therapy with refugees from Chile and Cambodia. Significant differences were found between the two groups with trauma story discussion being judged by therapists to be more important to treatment outcome in Chilean patients. The problem of potential therapist bias limits definitive conclusions, however we suggest that differences in cultural preparedness for psychotherapy aimed at uncovering previous traumatic experiences may be the main reason for variations in styles of therapy offered to these distinctive ethnic groups. Other possible explanations are differences in diagnostic profiles and types of previous traumatic experiences.

Influence of therapist ethnicity and language on therapy outcomes of Southeast Asian clients

The purpose of this study was to examine the relationship of Southeast Asian client-therapist ethnicity and language match on three therapy outcomes: number of sessions with primary therapist, dropout from therapy and admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 543 Southeast Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language and ethnicity match to the three outcome variables and to eight sociodemographic variables. Either therapist-client language or ethnicity match significantly increased the number of client sessions with the primary therapist. Dropout from therapy was significantly affected by a language match in the Cambodian sample only but the effect was to increase dropout. Neither ethnicity nor language match was significantly related to GAS score gain. Several possible explanations for these findings and their clinical significance were explored.

Transition from East to West: Vietnamese adolescents and their parents

A 28-item questionnaire assessing family values was completed by 191 Vietnamese and 639 Caucasian adolescents in Oklahoma City Public Schools and by about half their parents. Vietnamese refugee parents, regardless of time in the United States, strongly endorsed traditional family values. Vietnamese adolescents tended to reject traditional values. This generation gap increased with time in the United States and was greater for girls than for boys. Despite wholehearted endorsement of traditional family values, Vietnamese parents tended to approve certain adolescent privileges. The results suggest that Vietnamese adolescents may receive conflicting messages from their parents. On the one hand, parents endorsed such traditional values as absolute obedience to parental authority but on the other, they registered relative approval of adolescent freedom of choice regarding dating, marriage, and career. Such ambivalence suggests that Vietnamese refugee families may experience considerable strain while adjusting to American values.

A mental health survey of the Vietnamese refugee in Japan

A mental health survey was conducted using the Cornell Medical Index (CMI) on Vietnamese refugees who have resettled in Japan. 64.5% of the females and 37.2% of the males displayed emotional disturbance. The refugees with life-threatening and/or concentration camp experience had significantly higher CMI scores than those without it (t test, P less than 0.05). CMI scores of the group residing in Japan for 4-5 years are markedly lower than the group residing there for 2-3 years (F test, P less than 0.05).

Cultural explanation of a 'psychosis' in a Chinese woman living in Australia

This case report concerns a Malaysian-born Chinese woman living in the outback of Australia who was diagnosed as 'psychotic' and who recovered without drug treatment. A knowledge of her cultural background threw doubt on the assumption that her complaints were psychotic. The case shows the need to adopt cultural sensitivity in the practice of psychiatry.