Cambodian torture survivors in the United States have high rates of mental health and chronic physical conditions associated with their trauma. A conceptual model of multidisciplinary care and a heuristic model of risk factors for type 2 diabetes among refugees (see Figures 1 and 2) will be shared. Findings from a two-panel epidemiological study and a cross-sectional study with Cambodian survivors that contributed to the development of these models will be presented. We will advocate for an approach to rehabilitation that is holistic in assessing risk and resilience, is community-based, and targets co-occurring mental and chronic physical health conditions.
Two studies will be presented: 1. RAND STUDY: A two-panel study of the prevalence of PTSD, major depression, diabetes, and cardiovascular risk was conducted with Cambodian refugee survivors of the Khmer Rouge genocide. Face-to-face interviews were completed in Khmer with a random household sample of 490 survivors and 5-year follow-up data were obtained from 331 of these. The Composite International Diagnostic Interview (version 2.1) was employed to obtain past-year PTSD and depression rates. Licensed phlebotomists obtained dried blood spot (DBS) samples via finger stick and blood pressure readings.
Rates of diabetes, hypertension and hyperlipidemia were compared to a probability sample of the adult U.S. population (N = 6,360) from the 2009--2010 National Health and Nutrition Examination Survey. 2. REACH STUDY: A cross-sectional survey de- sign was employed to examine the relationship between self-reported mental and physical health problems and barriers to healthcare access in a snowball sample of 136 Cambodian adult torture survivors residing in Connecticut and Western Massachusetts in the United States. All subjects participated with informed, voluntary, written consent, and the research was completed in accordance with the Helsinki Declaration. The institutional review boards (IRBs) of RAND and the Western Institutional Review Board approved the protocols.
High rates of PTSD (62%, weighted) and major depression (51%, weighted) were found in the RAND study, both with a strong dose-response relationship with trauma exposure. Forty-two percent (weighted) had comorbid PTSD and depression. The prevalence of diabetes (27.6%), hypertension (47.9%) and hyperlipidemia (38%) in Cambodian survivors was much greater than that in the age- and gender-adjusted U.S. population. In the REACH study, 61% reported being diagnosed with three or more physical conditions and 73% with depression, PTSD, or both. Language and transportation problems were the primary barriers to accessing care. Participants with probable comorbid PTSD and depression had 1.850 times more physical health problems than those without either condition (p > .001; CI 1.334--2.566). Age moderated this relationship. It is vital that those treating torture survivors identify and treat both mental and physical health conditions within a multidisciplinary model of care that is linguistically and culturally accessible.
Funding & No Conflicts Declaration
Funding was received from the National Institute of Mental Health and Centers for Disease Control and Prevention. The authors report no conflicts.