Trauma, Healthcare Access, and Health Outcomes Among Southeast Asian Refugees in Connecticut

Abstract

Objective Mental health problems among Southeast Asian refugees have been documented. However, longer term health consequences of mass violence as re-settled refugees age are less well described. This study investigated relationships among trauma symptoms, self-reported health outcomes, and barriers to healthcare among Cambodian and Vietnamese persons in Connecticut. Methods An internet phone directory was used to generate a list of names that was compared to 2000 census data to estimate the proportion of the population in each group. From these lists, 190 telephone listings were selected at random. Interviewers telephoned selected listings to screen for eligible participants and obtain an appointment for interview. Surveys were administered through face-to-face interviews during home visits conducted in Khmer or Vietnamese. The Harvard Trauma Questionnaire assessed trauma symptoms. Questions regarding the presence of physician diagnosed heart disease, hypertension, diabetes, and chronic pain were adapted as written from the Health Interview Survey. Healthcare access and occurrence were measured with questions regarding cost and access, patient-provider understanding, and interpretive services. Hierarchical modeling was used to account for respondent nesting within family. Analyses controlled for age, sex, and country of origin. Results Individuals who reported greater trauma symptoms were more likely to report heart disease by a factor of 1.82, hypertension by a factor of 1.41, and total count of diseases by a factor of 1.22, as well as lower levels of subjective health. Greater trauma symptoms were also associated with greater lack of understanding, cost and access problems, and the need for an interpreter. Conclusions Although the majority of Southeast Asian immigrants came to the United States as refugees approximately 20–30 years ago, there continues to be high levels of trauma symptoms among this population which are associated with increased risk for disease and decreased access to healthcare services.

Autism Spectrum Disorders and Race, Ethnicity, and Nativity: A Population-Based Study

“…Women from Central American nations (Guatemala, El Salvador) who migrated seeking asylum in the 1980s may have a history of trauma from civil war, violence, and displacement. [45][46][47] Maternal life event stress and psychiatric disorders, possibly related to experiences of escaping wars and disasters, as well as nutritional deficiencies from famine, may be possible explanations for the increased risks observed in Central American, Vietnamese, and some African immigrant groups, [48][49][50][51][52][53] and are considered risk factors for lowfunctioning autism in offspring. 54,55 Dietary factors such as folic acid and vitamin D deficiencies, common among US black and Hispanic women 56,57 and in women from Vietnam and the Philippines, 58,59 could explain some of the increased risk of AD and AD-MR. [60][61][62][63] In comparison, folic acid [1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006], gestational age (,37 weeks or $37 weeks), birth weight (,2500, 2500-4500, or .4500 g), trimester start of prenatal care (no care, first, second, or third trimester), and any pregnancy complication (hypertension, renal, lung, or cardiac disease, asthma, pyelonephritis, diabetes, gestational diabetes, Rh sensitivity, hemoglobinopathy, uterine bleeding, hydramnios, incomplete cervix, sexually transmitted diseases, hepatitis B, rubella, other infections, prenatal tobacco use, and large fibroids).…”

Diabetes and Cardiovascular Disease Risk in Cambodian Refugees

“…In addition, most studies of refugee physical health have focused on acute infectious diseases in the immediate post-resettlement period 6,7 rather than on long-term physical health issues. Of investigations examining long-term refugee physical health, the majority are limited either by focusing on self-rated health and disability, 8,9 or on convenience samples seeking medical treatment. 10 …”

Medical Approach to the Management of Traumatized Refugees

“…In another survey of Vietnamese and Cambodian individuals with greater trauma symptoms as reported on the Harvard Trauma Questionnaire, heart disease was increased by a factor of 1.82 and hypertension by a factor of 1.41. 24 Multiple biological changes are found in individuals with PTSD, and evidence indicates that increased sensitivity of the noradrenergic system may leave the individual in a hyperaroused, vigilant, sleep-deprived, and sometimes explosive state. 25 Noradrenergic hyperactivity may be 1 factor that contributes to cardiovascular disease.…”