The Long-Term Mental Health Effects of Pre-Migration Trauma and Post-Resettlement Factors for Southeast Asian Refugees

Background & Purpose

Southeast Asians migrated to the U.S. in substantial numbers as a result of the Vietnam War, and since 1980, Vietnamese and Cambodians together remain the largest refugee population in the U.S. (Chan, 2004). Studies during the early years of resettlement found Vietnamese and Cambodian refugees reported high rates of trauma-related psychiatric disorders (Sack et al., 1993). Although some research suggests the negative effects of conflict-based trauma diminish over time, others argue the nature of trauma is complex and can be compounded by post-migration stressors (Miller & Rasmussen, 2010). However, few studies have examined the relative importance of war trauma and post-resettlement stressors in predicting mental health decades after resettlement (Kim, 2016). Additionally, less is known about potential protective factors in the long-term mental health of refugees. The current study examined the relative importance of pre-migration trauma and post-resettlement risk and resilience factors for Vietnamese and Cambodian refugee women’s long-term mental health.

Methodology

Data/sample: Data come from the final wave of a 5-year longitudinal study of Vietnamese (n=145) and Cambodian (n=139) refugee women (total n=284). Participants had a mean age of 46 years (SD=7.7) and lived in the U.S. for an average of 17.39 years (SD=5.28). More than half (51.68%) of the women were U.S. citizens; 52.91% were married. Most were employed (67.28%) with others indicating status as homemakers (12.84%), unemployed (3.06%), or disabled (8.26%).

Measures. Mental health outcomes included PTSD symptoms (HTQ; Mollica et al., 1992) and depressive symptoms (HSCL; Khuon & Lavelle, 1987). Exposure to traumatic events was assessed with the Harvard Trauma Questionnaire (HTQ, Mollica et al., 1992). Post-migration factors included everyday discrimination (Williams, et al. 1997), a single item evaluating self-rated overall health, and four items assessing ethnic neighborhood support.

Analysis: Descriptive statistics described all measures. Multivariate analyses by ethnic group examined the associations between traumatic exposure and post-migration stressors on mental health outcomes. All analyses controlled for age, length of time in the U.S., citizenship status, employment, and marital status.

Results

Cambodian refugees reported significantly higher levels of PTSD symptoms, trauma exposure, and discrimination than their Vietnamese counterparts. Among Vietnamese refugees, PTSD symptoms were associated with being divorced (b=.14), disabled (b=.26), and greater trauma exposure (b=.14), discrimination (b=.29), and poor overall health (b=-.23), respectively. Enhanced ethnic support significantly reduced PTSD symptoms (b=-.14). In addition, depressive symptoms were associated with being divorced (b=.18), greater discrimination (b=.21), and diminished overall health (b=-.31). Among Cambodian refugees, PTSD symptoms were associated with being widowed (b=.15), disabled (b=.27), and having greater trauma exposure (b=.27), discrimination (b=.26), and poor overall health (b=-.25), respectively. Additionally, depressive symptoms were associated with shorter length of stay in the U.S. (b=-.17), disabled status (b=.23), discrimination (b=.20), and poor physical health (b=-.27).

Conclusion & Implications

Overall, the results indicate both pre-migration trauma and post-migration factors are robust predictors of long-term on mental health for Vietnamese and Cambodian refugees. The findings underscore the importance of being attune to ethnic and contextual distinctions that prompted refugee migration for understanding the mental health of diverse refugee groups.