Torture, War Trauma and Mental Health Outcomes of Aging Karen Refugees
Background and Purpose:
Karen people are a minority ethnic group from Burma and have faced a long history of severe persecution by the military government in Burma. Many have fled Burma as refugees and lived in camps on the Thailand-Burma border for decades. Currently, resettlement of this group is one of the largest resettlement efforts in the world. Research has linked trauma histories with increased risks for mental disorders, which can be enduring and debilitating, as well as chronic disease and mortality. This abstract looks at long term mental health vulnerability of Karen refugees from Burma with a focus on people over the age of 35 and women. It reports on the prevalence of depression, PTSD and somatic symptoms as compared to a larger Karen sample. It also documents the specific pre-migration torture and trauma experiences that may affect health and mental health outcomes.
Methods:
During the initial refugee health screening, participants were invited to participate in the study. A 32-item mental health screening tool was used to assess total distress, depression, posttraumatic stress, and somatic symptoms. It also included 4 semi-structured and open-ended questions that asked about lifetime experiences of primary and secondary war trauma. Primary and secondary torture and war trauma survivors were determined using the US definition of torture and APA definition of extreme trauma. Content of torture and war trauma responses were coded using an existing human rights documentation system, HURIDOCS. Additional codes were added to describe unique experiences reported.
Results:
A total of 179 participants were interviewed. Age was significantly related to Total Distress, Depression, Posttraumatic Stress (PTS), and Somatic item scores, r (179) = .405, p < .01, r (179) = .235, p < .01, r (179) = .298, p < .01,and r (178) = .461, p < .01, respectively. Women reported significantly higher symptoms than men on Total, Depression, PTS, and Somatic scores, r (179) = .254, p < .01, r (179) = .210, p < .01, r (179) = .198, p < .01, and r (178) = .2545, p < .01, respectively. Thirty HURIDOCS codes fit the torture experiences reported and 6 new codes were created to capture experiences that may be unique to the Karen context. Twenty-two HURIDOCS codes fit war trauma experiences reported and 7 new codes were created. Experiences that seem to be particularly characteristic of the Karen experience include forced portering, forced to be a human landmine sweep, widespread community fear, and destruction/burning of house or village.
Conclusions and Implications:
This paper describes the torture and war trauma experiences and the associated mental health and somatic outcomes in a sample of Karen refugees from Burma. People over the age of 35 and women may be especially vulnerable to poor mental health outcomes as a result of their trauma histories. Karen people have been resettled in 49 states in the U.S. and the District of Columbia. This paper provides important for providers who are working with this population in health, mental health, and resettlement settings.