Key expressions of trauma-related distress in Cambodian children: A step toward culturally sensitive trauma assessment and intervention

Abstract

More than half of all children in Cambodia experience direct abuse and over 70% experience other traumatic events, which significantly increase their risks for a range of physical and mental health problems. Additionally, Cambodian children face longstanding sociopolitical, intergenerational, and cultural factors that compound the impact of other trauma. As a result, rates of posttraumatic stress symptoms among Cambodian youth are high. However, care providers often rely on Western-based nosology that does not account for culturally specific expressions of trauma. A greater understanding of culturally-salient expressions of distress can help inform diagnostic assessment accuracy and treatment effectiveness and monitoring. The current study utilized a qualitative design to interview 30 Cambodian caregivers of children with trauma experiences and 30 Cambodian children (ages 10–13 years) with trauma experiences to identify key local expressions of trauma. Findings reveal certain PTSD symptoms and culturally-specific frequent and severe trauma-related problems for Cambodian children and domains of functioning impacted by trauma. Certain symptoms seem particularly important to evaluate in this group, such as anger, physical complaints (e.g., headache and palpitations), and cognitive-focused complaints (in particular, “thinking too much”). All caregivers and children reported physical health as impacted by trauma-related problems, highlighting a particularly salient domain of functioning for this population. Expressions of distress explored in the current study are discussed in the context of assessment and intervention development to inform diagnostic and clinical efforts for those working with trauma-exposed Cambodian children.

Adaptive Functioning Behaviors for Trauma-Affected Children in the Cambodian Context

“…Religio-cultural practices, teachings, and ceremonies permeate child and caregiver responses in the current sample, including how children conceptualize, express, and cope with adverse life experiences and distress. This fits within a large body of cultural research in Cambodia and with Cambodian refugees that highlight religio-cultural belief systems as central to how Khmer people understand and express mental health problems (Bertrand, 2005; Chhim, 2013; Figge et al, 2020a; Hinton et al, 2002, 2005, 2019). For older populations, the reinstitution of Khmer Buddhist practices and beliefs is critical for shared healing following elimination of Buddhism and widespread violations of Buddhist rituals during the Khmer Rouge era (Kent, 2006), which is reflected in the various roles children in the current sample play in religio-cultural ceremonies and practices.…”

“…Current data were collected as part of a larger study of child posttraumatic stress symptoms and clinician perspectives in Cambodia (Figge et al, 2020a). All study materials and procedures were approved by DePaul University’s Institutional Review Board.…”

“…This often leads to misidentification, diagnostic underestimates, and the possibility of “category truncation” (Hinton, Reis, et al, 2019). Culturally specific distress expressions in Cambodian children have included idioms of distress such as easily angered or mour mao and “thinking too much” or kit chraern , and somatic symptoms, such as palpitations or beh-dong doeu nyaob (Figge et al, 2020a; Hinton et al, 2012, 2015, 2016). Thus, it is critical that mental health intervention efforts incorporate and measure change in contextually and culturally salient expressions of distress and adaptive functioning behaviors specific to Khmer children with IPV and other trauma experiences.…”

Development of mental healthcare in Cambodia: barriers and opportunities

“…Studies focusing on child and adolescent mental health in Cambodia have shown high rates of depressive symptoms in young people [40] and high exposure to trauma [41]. The prevalence of epilepsy in a cross-sectional study was found to be 5.8 per 1000 [42].…”

“…In Cambodia, significant work has taken place to describe Cambodian culture-bound syndromes and idioms of distress, particularly relating to trauma in both adults [ 43 – 45 ] and children [ 41 , 46 ]. Examples described in Cambodia include “baksbat” (broken courage) [ 47 ] “kut chraen” (thinking too much) [ 21 , 41 , 47 , 48 ] “mour mao” (easily angered) in children [ 41 ] and “khyal” (windlike substance) attacks (in Cambodian refugees) [ 49 ]. The importance of contextualised mental health research has been highlighted as crucial to developing accurate diagnostic criteria, effective interventions and appropriate long-term follow up [ 43 , 45 , 47 , 50 ].…”