Psychological distress and health behaviours among Cambodian Americans at risk for developing diabetes

Abstract

This paper reports secondary data analysis of associations between psychological distress and health behaviours among Cambodian Americans. Data are from baseline assessments from a diabetes prevention trial. All participants met stucriteria for depression and were free of diabetes. Participants (n = 191) completed surveys, a food frequency assessment, and wore sleep and physical activity actigraphy devices for 7 days. A factor analysis of symptoms of post-traumatic stress, baksbat (a Cambodian culture-bound syndrome), depression, and anxiety yielded a single factor named 'psychological distress'. Multivariate models controlling for psychotropic medications were run for the following outcomes: sleep actigraphy, selfreported sleep, physical activity actigraphy, self-reported physical activity, nutrition, and substance use. For actigraphy, higher distress was associated with lower moderate/vigorous physical activity and higher mean variability of 24 h total sleep time. Higher distress was also associated with worse self-reported sleep quality as indicated by standard, and culturally-specific, sleep indicators. Higher distress was also associated with lower use of food labels, lower carbohydrate consumption, and higher alcohol consumption as a coping mechanism. Interventions to mitigate diabetes risk in high-distress populations may benefit from strategies to decrease psychological distress. The sequelae of complex trauma may transcend discrete psychiatric diagnoses.

Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep

“…This is the first randomized trial specifically designed to reduce risk for diabetes in refugees with depression [ 16 ]. Lifestyle change for refugees must consider the psychological experiences of hunger and starvation as they pertain to nutrition, forced labor as it pertains to physical activity, and trauma symptoms and nightmares as they pertain to sleep [ 36 ].…”

Lay health worker research personnel for home-based data collection in clinical and translational research: Qualitative and quantitative findings from two trials in hard-to-reach populations

“…Behavioral data included physical activity actigraphy that entailed wearing a monitor on a strap around the waist, like a belt, as well as a watch-like sleep actigraphy device on the wrist for 7 days [22]. Validity criteria for sleep and physical activity methods have been detailed elsewhere [23].…”

“…Highly sensitive psychosocial surveys included personal history of starvation during the Pol Pot genocide and current symptoms of trauma [22]. We also asked survey questions about Khmer culture-bound symptoms including baksbat , which uses folk idioms to describe a condition similar to post-traumatic stress disorder and kmoach sanghkat , a sleep disturbance related to trauma that describes sleep paralysis.…”