Exploring Contextual Trauma in Cambodia: A Sociointerpersonal Perspective on Posttraumatic Stress Disorder

Abstract

Trauma literature has proposed multiple theories of trauma development, maintenance, and transmission, which has led to a lack of clarity surrounding trauma in individuals, families, and communities. We investigated the impact of community‐level trauma experiences on individual posttraumatic stress disorder (PTSD) symptoms using a sociointerpersonal model of PTSD (Maerker & Horn, 2013). A nationally representative sample (N = 2, 690) of Cambodian households across all regions of the country was surveyed regarding individual trauma experiences during and after the Khmer Rouge regime, symptoms of PTSD, and current stressors. Individual experiences of war trauma and current stressors were aggregated based on the district in which each individual lived. District mean and individual war trauma and current stressors were included in a multilevel model as predictors of individual levels of PTSD. Findings indicated that mean trauma experiences, β = .05, p < .001, and current stressors, β = .10, p < .001, in the district in which individuals live were positively and significantly associated with their individual PTSD symptoms. Individual war trauma, β = .02, p < .001, and current stressors, β = .08, p < .001, were also positively and significantly associated with individual PTSD symptoms. District trauma experiences accounted for 7% of the variance in individual PTSD symptoms, R2Level 1 = .21, R2Level 2 = .80. Additionally, current stressors at both the individual and district levels had a greater impact on individual PTSD symptoms than war trauma at either level of the model. Implications for policy and intervention are presented.

Pathways of Resilience and Recovery from Trauma for Cambodian Young People

“…The majority of psychological research on the effects of childhood trauma in Cambodia and internationally, whether on children, adolescents or adults, tends to focus on negative outcomes of trauma such as PTSD and mental illness (Agger, 2015;Armes et al, 2019;Bremner, 2006;Kinzie et al, 1998;Steinert et al, 2015). This is in contrast to a growing body of trauma research that focuses on the concept of resilience, or an individual's ability to overcome, as the explanatory mechanism driving recovery from trauma (Antonovsky, 1987;Miles & Thomas, 2007;Overland, 2013;Van de Put & Eisenbruch, 2002).…”

Prevalence and concordance of International Classification of Diseases-11th Revision and Diagnostic and Statistical Manual-Fifth Edition posttraumatic stress diagnostics among Northern Irish military veterans.

“…Additionally, the context and demographics of these data, and implication thereof, should be acknowledged. The focus on military veterans in NI was made explicitly due to the presence of potentially complex traumatic exposure (Armes et al, 2019). Further, the sample is noted to comprise majority status groups, i.e., white ethnicity and male gender.…”

“…Comparatively evidence suggests that rates of PTSD among U.K. military veterans range from 3.6% to 5.7% for those while experience of deployment and combat respectively (Hunt et al, 2014). Existing evidence has suggested that the effects of “contextual trauma,” or traumatic stress en-masse such as experiences of civil conflict, may result in widespread incidence of PTSD beyond that accounted for by individually experienced stressors (Armes et al, 2019). A lack of definitive pre- and posttraumatic context in such cases is thought to contribute to chronicity and complexity of outcomes (Armes et al, 2019).…”

Introduction to the Special Issue: Disproportionate trauma, stress, and adversities as a pathway to health disparities among disenfranchised groups globally

“…Globally, low‐income and disenfranchised groups are disproportionately exposed to traumatic events, severe stressors, and extreme adversities (Anderson & Stevenson, 2019; Armes et al., 2019; Awad et al., 2019; Comas‐Diaz et al., 2019; de Jong et al., 2015; Fazel & Betancourt, 2018; Shea et al., 2019; Skewes & Blume, 2019; Williams et al., 2019). The effects of political conflict and forced displacement, the impact of exposure to community violence, and the aftermath of natural disasters are a few examples of situations that might be the most taxing to communities that lack resources and political and economic power.…”