Trauma and Poor Mental Health in Relation to Economic Status: The Case of Cambodia 35 Years Later

Abstract

BackgroundCambodia is one of the poorest countries in south-east Asia and is still emerging from the events of the Khmer Rouge reign. It has been suggested that the atrocities experienced by the Cambodian population can explain why Cambodia continues to lag behind its neighbours in economic outcomes. The purpose of this study is to investigate whether there is an association between exposure to past trauma and/or current poor mental health and current economic status in Cambodia.MethodA newly conducted survey performed in two regions (north-west and south-east Cambodia) collected information on trauma exposure, psychiatric symptoms, self-rated health outcomes and socio-economic information for 3200 persons aged 18–60. Economic outcomes were measured as household debt and poverty status and whether the respondent was economically inactive. All models were analysed using logistic regression.ResultsNo association was found between high exposure to conflict-related or civilian trauma and any economic outcomes save for a negative association between civilian trauma and poverty in the south-east. Current post-traumatic stress was related solely to poverty status. All other measures of current mental health status, however, were found to be strongly negatively associated with all measures of economic status. Thus, mental health interventions could potentially be utilised in poverty reduction strategies, but greater efficacy is likely to be achieved by targeting current mental health status rather than previous trauma exposure.

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

“…The findings from this study are consistent with previous findings from adult samples that have indicated differences in PTSD symptoms and mental health outcomes depending on the region of Cambodia (Cantor Graae et al., ; Jarl et al., ). However, these previous studies were conducted with samples from only two of Cambodia's unique geographic regions and did not account for individuals nested within those regions.…”

“…Testimonial therapy has been previously used in Cambodia and has served as an opportunity for communal and individual healing (Agger, Igreja, Kiehle, & Polatin, 2012). As the model demonstrated that current stressors at individual and community levels were more salient than previous war traumas in impacting PTSD symptoms, such interventions need to be combined with a focus on alleviating poverty and providing more accessible mental and physical health care (Jarl et al, 2015;Seponski, Lewis, & Megginson, 2014).…”

“…The years following the KR regime included periods of political instability that, in some regions, may have resulted in similar trauma exposure as was experienced during the regime (Jarl et al, 2015). Many participants were not old enough to have experienced or be able to recall traumatic events during the KR regime, but they may have been old enough to experience or recall events in years following the regime.…”

“…Communal experiences of trauma have differed depending on the region in which Cambodians live (Cantor-Graae et al, 2014;Jarl, Cantor-Graae, Chak, Sunbaunat, & Larsson, 2015). Specifically, individuals in northwestern regions of the country are more likely to have experienced longer periods of war and political instability (Jarl et al, 2015).…”

“…Communal experiences of trauma have differed depending on the region in which Cambodians live (Cantor-Graae et al, 2014;Jarl, Cantor-Graae, Chak, Sunbaunat, & Larsson, 2015). Specifically, individuals in northwestern regions of the country are more likely to have experienced longer periods of war and political instability (Jarl et al, 2015). Likewise, a comparison of Cambodians living in Cambodia and Thailand revealed distinct differences in trauma experiences and rates of PTSD (Mollica, Brooks, Tor, Lopes-Cardozo, & Silove, 2014).…”