Influences of Trauma and Health on Mental Health Among Karen Refugees from Burma

Background and Purpose: Depression is a leading cause of mental health difficulties and affects about 3.1% of the population in the United States. Symptoms of depression and other mental health problems in the refugee population may be more challenging to identify because these symptoms may be confused with other life challenging difficulties. Unrecognized and thus undiagnosed and untreated depression can cause significant problems in people’s lives and certainly diminish the quality of life. Refugee populations are particularly vulnerable to developing depression-related symptoms due to their trauma experiences before and after resettled in the host country (Kim & Kim, 2014). However, most literature on mental health of refugees largely focuses on trauma symptoms related to war experiences and during refugee camp stay. In addition to past traumatic experiences, life after resettlement in a host country, they may develop depressive symptoms due to life difficulties. Using the Social Determinants of Mental Health approach (SDMH; Fisher & Baum, 2010), the purpose of this study was to investigate social determinants of depression among Karen refugees from Burma residing in Buffalo, NY.

Method: Using a convenience method, 201 Karen ethnic adult refugees from Burma were interviewed in Karen language. Depression was assessed using Kessler Psychological Distress Scale (Kessler et al., 2002; range 10-50). We conducted linear regression analysis to examine SDMH factors associated with the level of depression based on the Social Determinants of Mental Health framework. We included demographic information including age (range 18-65), sex (female=1), marital status (married =1), employment (employed=1) and years of education (0-16). As immigrant-related factors, we included years lived in the United States (range 1-15) and English language proficiency (range: 1-5). As health correlates, we included trauma (RHS 15; screen-in=1), the number of chronic health conditions (range: 0-6), and self-rated physical health (SRPH; 1-5). As social integration factors, we included social support and religious participation. Social support was measured by Lubben Social Network Scale (Lubben, 1988; range 0-30) and religious participation was measured by a question asking how often individuals participated in religious services in the past 12 months (0=none thru6=daily).

Results: Descriptive analysis showed that 20.4% of the sample scored 20 or higher in depression. About 64% were women, 53% employed, 81% married and 32% did not receive any formal education. Linear regression analysis results showed that depression is associated with being younger (p<0.05) in demographic factors, having trauma (p<0.001), less healthy (p<0.01), and more chronic health conditions (p<0.05) in health factors, and more religious participation (p <0.01) in social integration factor. The final regression model explained approximately 39% of the variance for depression symptoms in the sample.

Conclusion and Implication: The results suggest that trauma and health conditions are important factors of depression among Karen ethnic refugees. In demographic characteristics, younger participants, who might be more acculturated, tend to be more depressed. The results of this study highlighted the importance of examining the unique social determinants in mental health, depending on specific refugee groups in a specific environment.