Hostname: page-component-6bf8c574d5-8gtf8 Total loading time: 0 Render date: 2025-02-20T06:47:24.007Z Has data issue: false hasContentIssue false
  • English
  • Français

Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence

Published online by Cambridge University Press:  03 January 2018

Richard F. Mollica ,
Keith McInnes ,
Charles Pool  and
Svang Tor
Richard F. Mollica*
Affiliation:
Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School
Keith McInnes
Affiliation:
Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School
Charles Pool
Affiliation:
Department of Epidemiology and Biostatistics, Boston University School of Public Health
Svang Tor
Affiliation:
Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School
*
Richard F. Mollica, Director, Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School, 8 Story Street, Third Floor, Cambridge, MA 02138. Tel: (617) 496-5550; Fax: (617) 496-5530
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The dose – effect relationships of cumulative trauma to the psychiatric symptoms of major depression and post-traumatic stress disorder (PTSD) in a community study of Cambodian survivors of mass violence were evaluated.

Method

In 1990, a survey of 1000 households was conducted in aThai refugee camp (Site 2) using a multi-stage random sampling design. Trauma history and psychiatric symptoms were assessed for two time periods. Analysis used linear dose – response regression modelling.

Results

993 Cambodian adults reported a mean of 14 Pol Pot era trauma events and 1.3 trauma events during the past year. Symptom categories of depression, PTSD, dissociative and culturally dependent symptoms exhibited strong dose – effect responses with the exception of avoidance. All symptom categories, except avoidant symptoms, were highly correlated.

Conclusions

Cumulative trauma continued to affect psychiatric symptom levels a decade after the original trauma events. The diagnostic validity of PTSD criteria, with the notable exception of avoidance, was supported. Inclusion of dissociative and culturally dependent symptoms increased the cultural sensitivity of PTSD.

Type
Papers
Information
The British Journal of Psychiatry , Volume 173 , Issue 6 , December 1998 , pp. 482 - 488
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatrie Association (1987) Diagnostic and Statistical Meanual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
American Psychiatrie Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.Google Scholar
Blank, A. S. (1994) Clinical detection, diagnosis, and differential diagnosis of post-traumatic stress disorders. Psychiatric Clinics of North America, 17, 351–383.Google Scholar
Breslau, N., Davis, G. C. & Andreski, P. (1995) Risk factors for PTSD-related traumatic events: a prospective analysis. American Journal of Psychiatry, 152, 529–535.Google ScholarPubMed
Brett, E. A. & Ostroff, R. (1985) Imagery and posttraumatic stress disorder: An overview. American Journal of Psychiatry, 142, 417–424.Google ScholarPubMed
Carlson, E. B. & Rosser-Hogan, R. (1991) Trauma experiences, posttraumatic stress, dissociation, and depression in Cambodian refugees. American Journal of Psychiatry, 148, 1548–1551.Google Scholar
Eisenbruch, M. (1992) Toward a culturally sensitive DSM: cultural bereavement in Cambodian refugees and the traditional healer as taxonomist. Journal of Nervous and Mental Disease, 180, 8–10.CrossRefGoogle Scholar
Eitinger, L. (1961) Pathology of the concentration camp syndrome. Archives of General Psychiatry, 5, 371–379.CrossRefGoogle ScholarPubMed
Horowitz, M. J. (1993) Stress-response syndromes; a review of posttraumatic stress and adjustment disorders. In International Handbook of Traumatic Stress Syndromes (eds Wilson, J. P. & Raphael, B.), pp. 49–60. New York: Plenum Press.Google Scholar
Kardiner, A. (1941) The Traumatic Neuroses of War. New York: Hoeber.Google Scholar
Kinzie, J. D., Boehnlein, J. K., Leung, P. K., et al (1990) The prevalence of posttraumatic stress disorder and its clinical significance among Southeast Asian refugees. American Journal of Psychiatry, 147, 913–917.Google Scholar
Levav, I. (1998) Individuals under conditions of maximum adversity. In Adversity, Stress and Psychopathology (ed. Dohrenwend, B. P.). New York: Oxford University Press.Google Scholar
Matussek, P. (1975) Interment in Concentration Camps and its Consequences. New York: Springer-Verlag.CrossRefGoogle Scholar
American Psychiatrie Association (1985) The effects of stressful life events and disasters: Research and theoretical issues. Australian and New Zealand Journal of Psychiatry, 19, 409–421.CrossRefGoogle Scholar
American Psychiatrie Association (1992) Avoidance and intrusion in posttraumatic stress disorder. Journal of Nervous and Mental Disease, 180, 439–445.Google Scholar
Mollica, R. F., Wyshak, G., de Marneffe, D., et al (1987) Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. American Journal of Psychiatry, 144, 497–500.Google ScholarPubMed
Mollica, R. F. & Caspi-Yavin, Y. (1991) Measuring torture and torture-related symptoms. Psychological Assessment. Journal of Consulting and Clinical Psychology, 3, 1–7.Google Scholar
Mollica, R. F., Caspi-Yavin, Y., Bollini, P., et al (1992) The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease. 180, 111–116.Google Scholar
Mollica, R. F., Donelan, K., Tor, S., et al (1993) The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand – Cambodia border camps. Journal of the American Medical Association. 270, 581–586.CrossRefGoogle ScholarPubMed
Mollica, R. F., Poole, C. & Tor, S. (1998) Symptoms, functioning and health problems in a massively traumatized population: the legacy of the Cambodian tragedy. In Adversity. Stress and Psychopathology (ed. Dohrenwend, B. P.). New York: Oxford University Press.Google Scholar
Smith-Fawzi, M. C., Murphy, E., Pham, T., et al (1997) The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners. Acta Psychiatrica Scandinavica, 95, 87–93.Google Scholar
Willis, G. B. & Gonzalez, A. (1998) Methodological issues in the use of survey questionnaires to assess the health effects of torture. Journal of Nervous and Mental Disease. 186, 283–289.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.