Mental Health Among Hmong Population in the U.S.: A Systematic Review of the Influence of Cultural Factors

Background and Purpose: Refugees exposed to war, forced migration, and other traumatic factors are at higher risk than the general population for a range of psychiatric disorders, including PTSD, depression, and somatic symptoms (Kirmaayer et al., 2012). Additionally, evidence suggests the persistence of psychiatric disorders related to trauma in refugees even after prolonged period of time in the United States (Marshall et al., 2005). As refugees of the Vietnam War, Hmong experienced various trauma related to the death of loved ones, violence, and imprisonment among other distressing occurrences (Tatman, 2004). While majority of the Hmong have called the United States home for close to 40 years, limited and small studies have focused on Hmong and their mental health since their early arrival as refugees (Vang, 2014). This systematic review presents the empirical studies on Hmong and mental health with the purpose to identify the role of cultural factors.

Methods: The articles were identified through PsycINFO, PsycARTICLES, Social Services Abstracts, Web of Science, and PubMED by using various combinations of the keywords: Hmong, Southeast Asian, and mental health. The method of reviewing the articles from each database included reviewing article titles and abstracts, removing duplicates from the final review, full article reviews, and checking the citations of relevant articles for additional articles that could meet the criteria of this systematic review. The inclusion of studies for our review were met on the basis of the following criteria: (a) they explicitly stated having Hmong participants; (b) focused on mental health; (c) study conducted in the United States; (d) articles were in English; and (e) they were published in peer-reviewed journals through 2015. We included empirical studies that were quantitative, qualitative, and mixed-methods designs. The exclusion criteria included articles that were: non-empirical, case studies, focused specifically on other Southeast Asian or refugee populations, focused specifically on youth and children only (17 years and under), conducted outside of the United States, and was not focused on mental health. The review of the databases resulted in 446 articles. Thirty-seven studies were included in the final systematic review.    

Results: Twenty-eight studies used quantitative design, five studies used qualitative designs, and four studies used a mixed methods approach. Highlighting the role of cultural factors, the themes were categorized into the following: psychiatric symptoms and diagnosis (e.g., depression, anxiety, PTSD,), treatment and interventions implemented to clinical and non-clinical Hmong populations, and barriers to mental health care.

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Conclusions and Implications: The results of this systematic review informs social work practice and policy with Hmong in the U.S. Social workers working directly with the Hmong population should be cognizant of potential cultural factors that may lead to adverse mental health outcomes. Furthermore, policies aimed at Hmong and other refugee groups should inform the development of programs designed to promote their mental health and well-being by taking into account their traumatic experiences and limited knowledge with mental health.