John Neider

Psychosocial Adjustment of Hmong Refugees during Their First Decade in the United States: A Longitudinal Study

Over their first decade in the United States, 100 Hmong refugees were studied on three occasions. Data included demographic characteristics, acculturation skills, traditional affiliations and pastimes, material acquisitions, psychosocial problems, and self-rating scales. In addition to a description of the data changes, a multiple regression analysis was performed. Changes demonstrated considerable evidence of acculturation, psychiatric care seeking, and greatly reduced symptom levels for several symptom complexes. However, a large minority of subjects remain illiterate, unable to speak English, generally involved with other Hmong but not with the majority society, and/or have high symptom levels on self-rating scales. Regarding symptom changes, depression, somatization, phobia, and selfesteem symptoms improved the most with time and acculturation. On the contrary, anxiety, hostility, and paranoid symptoms changed little. Multiple regression analyses indicated that strong traditional ties (e.g., large household size, being an herbal healer), older age, marital problems, and medical complaints were most associated with high symptom levels

Acculturation and mental health: A study of Hmong refugees at 1.5 and 3.5 years postmigration

This study of Hmong refugees at 1.5 and 3.5 years following arrival in the United States showed considerable improvement on psychiatric self-rating scales. Social changes over the 2 year interim (including a high unemployment rate) were few. Earlier premigration and postmigration variables correlated with high symptom levels at 1.5 years were not correlated with these symptoms at 3.5 years. Events in the acculturation process which accompany, and perhaps account for some of these observations are indicated.

Migration and mental health among Hmong refugees. Association of pre- and postmigration factors with self-rating scales.

To date there have been no epidemiological studies of a refugee population using selfrating scales. This method was used in a study of Hmong refugees in Minnesota. Self- reported symptoms were compared with premigration and postmigration factors to assess those characteristics associated with increased symptom reporting. Relatively few premigration factors influenced these self-reports, whereas several postmigration factors were significantly correlated with symptoms. These findings suggest certain interventions which might enhance the adjustment of subsequent refugees.

Refugees who do and do not seek psychiatric care an analysis of premigratory and postmigratory characteristics

Social psychiatric research can provide information about the role of interpersonal and societal factors in the genesis of psychiatric disorder. This discipline relies heavily on “experiments in nature” which expose a large number of people to a potentially pathological social stimulus. It also depends in large part upon the study of nonpatients to serve as a comparative group for patients. Both conditions are met in this study of Hmong refugees from Indochina. While the population and the event are esoteric to some extent, their experiences of sudden sociocultural change, geographic migration, role discontinuity, identity crisis, and massive loss are common experiences among many psychiatric patients, regardless of then: origin. Thus this study contributes to our understanding regarding the social genesis of psychiatric disorder. This prospective study of refugees to the United States was undertaken among the Hmong population in Minnesota (N = 97) during 1977. Subsequently 17 of this group became psychiatric patients over a 12-month period. Premigration and postmigration factors associated with patient status are described. Hypotheses are offered regarding those post- migration experiences or social strategies which favored or prevented psychiatric status.

Welfare status and psychosocial adjustment among 100 Hmong refugees

Although the mental health of recently employed persons has been well studied, the mental health of welfare recipients is not well understood. Among our increasing refugee population, many receive welfare benefits at some point. The Hmong are among those who are highly represented among welfare recipients in several areas of the United States. Do psychiatrists have anything to contribute toward the resolution of high welfare rates? This question is especially relevant in refugee populations who are at increased risk for several psychiatric disorders, including depression, paranoia, and adjustment disorders. This study was undertaken among 100 Hmong refugees who had been in the United States for 8 years. Indices of mental health included two rating scales (the Zung Depression Scale and the SCL-90), five-axis DSM-III diagnoses, Hamilton Anxiety and Depression Scales, Global Assessment Scale, Brief Psychiatric Rating Scale, Inpatient Multidimensional Scale, and Mini-Mental State Exam. These indices were compared with current welfare status and the duration of time on welfare. Other comparisons with welfare included demographic characteristics, material possessions, acculturation characteristics, health and social problems, and nonoccupation avocations. Results indicate that welfare recipients show lower acculturation and elevated psychiatric symptom levels. Suggestions for ameliorating this situation are extrapolated from studies in the literature on chronically unemployed persons.

Symptom Change over Time among Hmong Refugees: Psychiatric Patients versus Nonpatients

Most Hmong refugees in Minnesota were assessed in September, 1977, using two self-rating scales (Zung Scale for Depression and 90-item Symptom Checklist). The same group was restudied two years later. During 12 months of 1977-78, psychiatric services were offered to this population. Those seeking psychiatric care were compared with those who did not. These data indicate that the patients reported considerably more symptoms than nonpatients in 1977 prior to receiving care. The patients showed more improvement than the nonpatients between 1977 and 1979.

Substance Use and Abuse among Mentally Retarded Persons: A Comparison of Patients and a Survey Population

Substance abuse among mentally retarded persons, first described 55 years ago, has received little or no attention by specialists in mental retardation. With deinstitutionalization, this problem has reappeared, often followed by victimization (i.e., assault, rape, robbery). In this study the demographic characteristics, family and childhood history, substance use patterns, and substance-related problems of 40 mild mentally retarded persons are compared with those of 40 mild mentally retarded persons without substance abuse. Similarities with substance abusers who are not mentally retarded are noted. Recommendations for alleviating this serious problem among mentally retarded persons are made.

Opium Addiction among Indochinese Refugees in the United States: Characteristics of Addicts and Their Opium Use

The Problem Opium addiction was prevalent in the United States from the early 1800s to the early 1900s, when about 250,000 opiate-dependent persons lived in the United States [1]. After the Narcotic Act of 1914, opium addiction essentially disappeared from the United States until it reappeared among Indochinese refugees during the last decade [2]. This paper reports on the demographic characteristics and opium use patterns in a group of Asian opium addicts presenting voluntarily for assessment and treatment.

Cultural affiliation among American Indian alcoholics: correlations and change over a ten-year period.

Cultural affiliation has been identified as an important factor in maintaining mental health (Dean, 1977; Garrison, 1978; Westermeyer. 1973; Allison, 1%8; Jilek, 1974). Its role in alcoholism is not known, however. On one hand it might be argued that, since ethnic origin is a major etiologic factor in alcoholism, greater ethnic affiliation (that is, ones current ethnic ties and behaviors) may be associated with greater pathologic disorder. Or, if it is the absence of ethnic affiliation (rather than only ones particular ethnic origin) that is pathogenic, perhaps greater ethnic affiliation is associated with less disorder. Alternatively, affiliation with a particular culture might have no influence on the course of alcoholism. These hypotheses were tested among native American persons treated for alcoholism, using a sample from those admitted to University of Minnesota hospitals. This particular group has two advantages for such a study. First, the rate of alcoholrelated problems among Indian people in Minnesota is high (Westermeyer and Brantner, 1972). Normative drinking involves ingestion of large volumes over many hours (Westermeyer, 1972). Second, it was possible to distinguish skills derived from specific Indian cultural affiliation from general coping skills in American society, given the unique characteristics of native American culture. Data were collected on the same subjects at two points in time, 10 years apart. This permitted the assessment of cultural affiliation over time. Since some subjects continued to have alcohol-related problems while others did not, it was also possible to examine the association between ethnic affiliation and either continued alcoholic abuse or recovery.

Variability in opium dosage: Observations from Laos, 1965–1975

Opiate addicts are generally believed to consume a fairly constant level of drug. These data indicate that, for most addicts over time, there is considerable variability in dosage. This variability occurs not only amongst addicts, but also in most individual addicts over time. Extreme constancy in dosage does prevail for some addicts over prolonged periods, but this is not the norm. Factors influencing dosage include age, gender, ethnicity, socioeconomic status, duration of addiction, drug cost and drug availability. Distributions in dosage patterns are presented in this report.