Ethnic Differences in Behavioral Health Status: Burman Vs. Karen Refugees

Background: Burma (also known as Myanmar) has been experiencing a protracted political and economic instability since its independence from Britain in 1948. Generally speaking, ethnic Karens have been persecuted due to their ethnic minority status in Burma throughout its history, while many ethnic Burmans were persecuted due to their participation in prodemocracy movements in recent decades. Both groups have endured constant threat of physical and psychological violence by Burmese military junta government for their anti-government stance, which have forced them to flee their country. Given this background, it is crucial to address their behavioral health conditions. However, there exists little to no empirical data on behavioral health conditions of this significant and growing refugee community in the United States. Thus, this study aimed to examine behavioral health conditions among refugees from Burma and to examine ethnic differences in these conditions.

Methods: Using a convenience sampling method, 256 adult refugees from Burma were interviewed, either in Burmese or Karen language, by the trained community interviewers between March 2015 and October 2016. Four behavioral health conditions were examined as outcome variables: depression and anxiety (Hopkins Symptom Checklist); post-traumatic stress disorder (PTSD; Refugee Health Screener-15); alcohol use disorders (AUD; Alcohol Use Disorder Identification Test). The ethnic comparisons focused on two major ethnic groups: Burman (n=84) and Karen (n=100). To examine ethnic differences among these behavioral health conditions, a series of logistic regressions were conducted, while adjusting for age, sex, marital status, and education.

Results: The mean ages of Burman and Karen participants were 42.4 (SD=12.7) and 39.0 (SD=14.4) years old, respectively. There were 38 (45.2%) Burman and 69 (69.0%) Karen females. Fifty-five (65.5%) of Burmans and 67 (67.0%) of Karens were married. The mean years of education were 8.9 (SD=4.9) for Burmans and 5.5 (SD=4.8) for Karens. Thirty-five (41.7%) Burmans and 99 (99.0%) Karens have stayed at refugee camps. On average, Burmans stayed at refugee camp for 81.5 (SD=83.3) months, while Karens for 124 (SD=77.0) months. The results of adjusted logistic regression analyses, which examined ethnic differences, revealed that ethnic Karens were 3.6 times more likely to have depression; 2.54 times more likely to have anxiety; and 2.77 times more likely to have PTSD than the ethnic Burmans. There was no ethnic difference in AUD.

Implications: Despite all participants shared refugee background, ethnic Karens had a significantly higher likelihood of having depression, anxiety, and PTSD when compared with their Burman counterparts. In addition, the result indicated that the prevalence of alcohol use disorder was not significantly different across two groups, and the rates for Burman (9.8%) were higher than U.S. average (7.0%). Having empirical behavioral health data is imperative in developing targeted intervention programs. This study results suggest that ethnic groups from Burma may have different behavioral health concerns, to which primary care providers should pay closer attention.