Here, you can find a list of our publications. If you would like to read any of them in full, feel free to send us an email and we can send a copy to you.

Barriers to Mental Health Care Utilization for U.S. Cambodian Refugees

Author(s): S. Megan Berthold, Eunice C. Wong, Grant N. Marshall, Terry L. Schell, Marc N. Elliott, Katrin Hambarsoomians, Chi-Ah Chun
Keywords: Cambodian, refugees, Asian Americans, mental health, treatment, barriers

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community.

Comorbid Mental and Physical Health and Health Access in Cambodian Refugees in the US

Authors: S. Megan Berthold, Sengly Kong, Richard F. Mollica, Theanvy Kuoch, Mary Scully, Todd Franke

Little research has been conducted on the prevalence of physical health problems in Cambodian refugees and the relationship between their mental and physical health. We identified the relationship between mental and physical health problems and barriers to healthcare access in Cambodian refugee adults. We used a cross-sectional survey design with a snowball sample of 136 Cambodian refugee adult residents of Connecticut and Western Massachusetts. 61% reported being diagnosed with three or more physical conditions and 73% with depression, posttraumatic stress disorder (PTSD) or both. Language and transportation problems were the primary barriers to accessing care. Participants with probable comorbid PTSD and depression had 1,850 times more physical health problems than those without either condition (p > .001; CI 1.334-2.566).  Age moderated this relationship. Participants who had been diagnosed with both depression and PTSD reported a consistent number of health conditions across the age span while those who had no mental health conditions or only one of the two reported fewer health conditions when they were younger and more when they were older. These two groups were significantly different from the group reporting both. There is a significant relationship between chronic comorbid mental and physical health diseases affecting Cambodian refugees resettled in the US. Having comorbid depression and PTSD puts Cambodian refugees at risk for physical health problems no matter their age. It is vital that those treating Cambodian genocide survivors identify and treat their prevalent comorbid health conditions. Language and transportation barriers must be addressed to improve access to mental and physical health care in this population.

Diabetes Among Refugee Populations: What Newly Arriving Refugees Can Learn From Resettled Cambodians

Authors: Julie Wagner, S. Megan Berthold, Thomas Buckley, Sengly Kong, Theanvy Kuoch, Mary Scully

A growing body of literature suggests that cardiometabolic disease generally and type 2 diabetes specifically are problems among refugee groups. This paper reviews rates of cardiometabolic disease and type 2 diabetes among refugees and highlights their unique risk factors including history of malnutrition, psychiatric dis-orders, psychiatric medications, lifestyle changes toward urbanization and industrialization, social isolation, and a poor profile on the social determinants of health. Prom-ising interventions are presented for preventing and treating diabetes in these groups. Such interventions emphasize well-coordinated medical and mental health care delivered by cross-cultural and multidisciplinary teams including community health workers that are well integrated into the community. Finally, recommendations for service, policy, and research are made. The authors draw on local data and clinical experience of our collective work with Cambodian American refugees whose 30-year trajectory illustrates the consequences of ignoring diabetes and its risk factors in more recent, and soon to be arriving, refugee cohorts.

Diabetes and Cardiovascular Disease Risk in Cambodian Refugees

Grant N. Marshall, RAND Corporation, Santa Monica, CA
Terry L. Schell, RAND Corporation, Santa Monica, CA
Eunice C. Wong, RAND Corporation, Santa Monica, CA
S. Megan Berthold, RAND Corporation, Santa Monica, CA; University of Connecticut, West Hartford, CT
Katrin Hambarsoomian, RAND Corporation, Santa Monica, CA
Marc N. Elliott, RAND Corporation, Santa Monica, CA
Barbara H. Bardenheier, Centers for Disease Control, Atlanta, GA
Edward W. Gregg, Centers for Disease Control, Atlanta, GA

Background: To determine rates of diabetes, hypertension, and hyperlipidemia in Cambodian refugees, and to assess the proportion whose conditions are satisfactorily managed in comparison to the general population.

Health Beliefs About Chronic Disease and its Treatment Among Aging Cambodian Americans

Authors: Julie Wagner, Theanvy Kuoch, Heang Kim Tan, Mary Scully, Thiruchandurai V. Rajan

The National Cambodian American Town Hall Meeting, held in December 2009, was the second national meeting of Cambodian communities convened for the purpose of addressing the issues of diabetes, cardiovascular disease and serious psychological distress. Content of the Meeting centered around the EAT, WALK, SLEEP for Health program (National Cambodian American Diabetes Project 2010). The bilingual, manualized program was developed by the National Cambodian American Diabetes Project, funded by the National Diabetes Education Program, and has also been adapted for use with Burmese refugees (Haley et al. 2011, Haley et al. 2012). The meeting was held by bridged videoconferencing in 10 sites, with another 5 joining by webcast, to allow for national participation. This paper reports baseline findings regarding health beliefs, health status, and health behaviors among participants of the Meeting.

Mental Health of Cambodian Refugees 2 Decades After Resettlement in the United States

Authors: Grant N. Marshall, PhD; Terry L. Schell, PhD; Mare N. Elliott, PhD; S. Megan Berthold, PhD; Chi-Ah Chun, PhD

Context: Little is known about the long-term mental health of trauma-exposed refugees years after permanent resettlement in host countries.
Objectives: To assess the prevalence, comorbidity, and correlates of psychiatric disorders in the US Cambodian refugee community.

Needs Assessment on Southeast Asian Population in Connecticut: June 2014

Author: Asian Pacific American Affairs Commission

The 2010 U.S. Census reported APAs as one of the fastest growing minority populations, indicating APAs comprised 4.4% (157,088) of Connecticut population, growing from 2.4% (95,368) in 2000. APAs represent up to 50 countries sharing some similarities and having great diversity among the ethnic groups. The APAAC recognized the lack of APA data nationally and locally. In APAACs efforts to gather critical APA information, APAAC conducted its first Needs Assessment on the APA population. Due to limited funding, staff, and resources APAAC concentrated on three Southeast Asian communities (Cambodian, Laotian, and Vietnamese), which represent about 16% of the APAs in Connecticut. In order to address the rising concerns of the APAs, APAAC partnered with local community organizations to conduct a survey that provided important information to help APAAC advocate on behalf of APAs.

Patient Reported Outcomes of Eat, Walk, Sleep: A Cardiometabolic Lifestyle Program for Cambodian Americans Delivered by Community Health Workers

Authors: Julie Wagner, PhD; Sengly Kong, PhD; Theanvy Kuoch, MA, LPC; Mary F. Scully, MA, APRN, BC; Heang Kim Tan, BS; Angela Bermudez- Millan, PhD, MPH

This study investigated a community health worker-delivered life-style intervention for prevention of cardiometabolic disease, called Eat, Walk, Sleep. It was designed for traumatized, low-literacy Cambodian American refugees.

Pulse Pressure in Cambodian Americans: Relationships to Weight and Mental Health

Authors: Julie Wagner, Thiruchandurai V. Rajan, Theanvy Kuoch, Mary Scully

Few studies have explored interrelationships among mental health and health status in refugees using objective, clinical data. Pulse pressure (PP) has recently emerged as an easily obtained, strong, independent determinant of mortality. We conducted a chart review of electronic records for 24 consecutive months to investigate PP among Cambodian refugees receiving services at a community clinic in Connecticut, USA. 301 patients charts were retrieved, 41 contained complete data for all variables. We found high rates of cardiovascular, anthropometric, and mental health problems. Among women, higher weight was related to higher PP. Among men, higher mental health symptom scores were marginally related to higher PP. Findings held after controlling for age. Discussion: Adiposity and mental health symptoms, which are known to be related to trauma history, contribute to elevated PP in this resettled refugee population. Given that PP may be modifiable through lifestyle intervention, further investigation of these problems in this needy population is warranted.

Rates and Correlates of Seeking Mental Health Services Among Cambodian Refugees

Authors: Grant N. Marshall, PhD, S. Megan Berthold, PhD, Terry L. Schell, PhD, Marc N. Elliott, PhD, Chi-Ah Chun, PhD, and Katrin Hambarsoomians, MS

Objectives: We assessed the rates and correlates of seeking mental health services among a probability sample of Cambodian refugees who needed such services.

Trauma, Healthcare Access, and Health Outcomes Among Southeast Asian Refugees in Connecticut

Authors: Julie Wagner, Georgine Burke, Theanvy Kuoch, Mary Scully, Stephen Armeli, Thiruchandurai V. Rajan

Mental health problems among Southeast Asian refugees have been documented. However, longer term health consequences of mass violence as re-settled refugees age are less well described. This study investigated relationships among trauma symptoms, self-reported health outcomes, and barriers to healthcare among Cambodian and Vietnamese persons in Connecticut. An internet phone directory was used to generate a list of names that was compared to 2000 census data to estimate the pro-portion of the population in each group. From these lists, 190 telephone listings were selected at random. Interviewers telephoned selected listings to screen for eligible participants and obtain an appointment for interview. Surveys were administered through face-to-face interviews during home visits conducted in Khmer or Vietnamese. The Harvard Trauma Questionnaire assessed trauma symptoms. Questions regarding the presence of physician diagnosed heart disease, hypertension, diabetes, and chronic pain were adapted as written from the Health Interview Survey. Healthcare access and occurrence were measured with questions regarding cost and access, patient-provider understanding, and interpretive services. Hierarchical modeling was used to account for respondent nesting within family. Analyses controlled for age, sex, and country of origin. Individuals who reported greater trauma symptoms were more likely to report heart disease by a factor of 1.82, hypertension by a factor of 1.41, and total count of diseases by a factor of 1.22, as well as lower levels of subjective health. Greater trauma symptoms were also associated with greater lack of understanding, cost and access problems, and the need for an interpreter. Although the majority of Southeast Asian immigrants came to the United States as refugees approximately 20–30 years ago, there continues to be high levels of trauma symptoms among this population which are associated with increased risk for disease and decreased access to healthcare services.

U.S. Cambodian Refugees’ Use of Complementary and Alternative Medicine for Mental Health Problems

S. Megan Berthold, Ph. D., L.C.S.W.
Eunice C. Wong, Ph.D.
Terry L. Schell, Ph.D.
Grant N.Marshall, Ph.D.
Marc N. Elliott, Ph.D.
David Takeuchi, Ph.D.
Katrin Hambarsoomians, M.S.

This study examined U.S. Cambodian refugees’ use of com-plementary and alternative medicine and Western sources of care for psychiatric problems. Analyses assessed the extent to which complementary and alternative medicine was used in the absence of Western mental health treatment and whether use of complementary and alternative medicine was associated with decreased use of Western services.