Identifying Behavioral Health Issues Among Burmese Refugee Community in Buffalo

Background: As of January 2016, there are estimated 8,000 refugees from Burma living in Buffalo, NY.  The Burmese refugee community is instrumental in population revival for the city. With their growing size and relevance in the region, the community expressed concerns about various behavioral health problems (e.g., trauma, alcohol, and gambling) witnessed in their community.  However, there exists little to no empirical data regarding behavioral health conditions on this significant and growing segment of Buffalo residents. The purpose of the study was to narrow the knowledge gap in this area by gathering empirical baseline behavioral health data through community-based participatory research (CBPR). It is the first systematic effort to collect empirical data on various behavioral health conditions among any refugee group residing in Buffalo.

Methods: The CBPR approach was employed to conduct the survey. Six community members, who speaks Burmese and/or Karen languages, were recruited as community researchers and collaboratively compiled a set of existing behavioral health measures including the Refugee Health Screener 15 (RHS-15) for symptoms of post-traumatic stress disorder, the Hopkins Symptom Checklist (HSCL) for depression/anxiety, the Alcohol Use Disorder Identification Test (AUDIT), and the Problem Gambling Severity Index (PGSI). Community researchers then translated the survey into Burmese and were trained to administer it. Using a convenience sampling method, community researchers interviewed 151 participants between March 2015 and February 2016. The eligibility criteria to participate in this study were as follows: (a) be a refugee from Burma; (b) be at least 18 years old; and (c) be a resident of Erie County, NY.

Results: The Burmese refugee community in Buffalo represents more than eight different ethnic groups with as many different ethnic languages. The study sample consists of 87 (57.6%) female with average age of 39.7. One hundred sixteen (77.9%) have less than high school education, and 24 (16.0%) are unemployed. Average monthly family income is between $1500-$2000. For those who stayed at a refugee camp, the average stay was nine years and two months. Average age at U.S. arrival is 33.2 years old and average length of U.S. stay is 5.5 years. One hundred one (69.2%) and 107 (70.9%) reported having good/excellent physical and mental health, respectively. Nonetheless, the study sample scored high on various behavioral health measures: 78 (51.7%) reported high enough trauma-related symptoms to warrant mental health specialist referrals; 25 (16.6%) met the diagnostic thresholds for both anxiety and depression; 20 (13.3%) were identified as having alcohol-related problems; and 11 (7.3%) met the threshold for moderate to problem gambling.

Implications: Having empirical behavioral health data is imperative in developing targeted intervention programs. More importantly, having key Burmese community members be active participants in all aspects of CBPR is critical in envisioning a community-driven intervention program to address high prevalence of PTSD, alcohol, gambling problems identified through this study. The CBPR approach provides the Burmese community in Buffalo with the ownership of the data, as well as a sense of agency and empowerment to forge ahead with community-driven intervention programs that are culturally and linguistically appropriate.