S. Megan Berthold

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

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.

The effects of exposure to community violence on Khmer refugee adolescents

The aim of the study was to examine the relationship between exposure to violence and mental health outcomes among Khmer refugee adolescents. Seventy-six Khmer junior and senior high school students and their parents participated in a cross-sectional survey study. Half of the adolescents survived violence directed at them, and two thirds witnessed violence. Although approximately one quarter either partially or fully met the criteria for posttraumatic stress disorder (PTSD), most were functioning adequately. Ordinary least squares regression analyses indicated that the number of violent events they were exposed to in their lifetime significantly predicted their level of functioning and PTSD. Recommendations for future research and implications for clinicians and educators working with Khmer and other refugee adolescents are discussed.

Rates and Correlates of Seeking Mental Health Services Among Cambodian Refugees

OBJECTIVESnWe assessed the rates and correlates of seeking mental health services among a probability sample of Cambodian refugees who needed such services.nnnMETHODSnInterviewers conducted face-to-face interviews with a representative sample drawn from the largest US community of Cambodian refugees. The analytic sample included 339 persons who met past 12-month criteria for posttraumatic stress disorder, major depression disorder, or alcohol use disorder. Respondents described contact with service providers for psychological problems during the preceding 12 months. We examined bivariate and multivariate predictors of seeking services.nnnRESULTSnRespondents reported high rates of contact with both medical care providers (70%) and mental health care providers (46%). Seeking services from both types of providers was associated with lack of English-speaking proficiency, unemployment, 3 or fewer years of preimmigration education, and being retired or disabled. Women, individuals with health insurance, and persons receiving government assistance also were more likely to seek services.nnnCONCLUSIONSnCambodian refugees with mental health problems had high rates of seeking service for psychological problems during the preceding 12 months. Research is needed to examine the effectiveness of services received by Cambodian refugees.

Spiritism as a Form of Psychotherapy: Implications for Social Work Practice

THE CONCEPTS OFF ILLNESS AND HEALTH have various meanings in different cultures. Symptoms that in some cultures indicate sickness are within the healthy range in other cultures. Diagnostic labels of illness given to clients in any system are certainly relative to cultural belief and social norms.’ Thus diagnostic labels given by spiritists would be rejected by practitioners who follow the medical model. Throughout the world, but primarily in Latin America and the United States, more than 100 million people practice Santeria, a spiritist tradition. Studies indicate that approximately one third of adult Puerto Ricans go to a medium for help at some point in their lives.2 In working with clients whose belief systems are different from their own, social workers and other mental health practitioners need to be aware of and to respect alternative models of healing and crite-

Diabetes and Cardiovascular Disease Risk in Cambodian Refugees

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. Self-report and laboratory/physical health assessment data obtained from a household probability sample of U.S.-residing Cambodian refugees (Nxa0=xa0331) in 2010–2011 were compared to a probability sample of the adult U.S. population (Nxa0=xa06,360) from the 2009–2010 National Health and Nutrition Examination Survey. Prevalence of diabetes, hypertension and hyperlipidemia in Cambodian refugees greatly exceeded rates found in the age- and gender-adjusted U.S. population. Cambodian refugees with diagnosed hypertension or hyperlipidemia were less likely than their counterparts in the general U.S. population to have blood pressure and total cholesterol within recommended levels. Increased attention should be paid to prevention and management of diabetes and cardiovascular disease risk factors in the Cambodian refugee community. Research is needed to determine whether this pattern extends to other refugee groups.

Characterizing the Mental Health Care of U.S. Cambodian Refugees

OBJECTIVEnThis study examined U.S. Cambodian refugees utilization of mental health services across provider types, levels of minimally adequate care, and mode of communication with providers.nnnMETHODSnFace-to-face household interviews about mental health service use in the past 12 months were conducted as part of a study of a probability sample of Cambodian refugees. The analytic sample was restricted to the 227 respondents who met past 12-month criteria for posttraumatic stress disorder (PTSD) or major depressive disorder or both. Analyses were weighted to account for complex sampling design effects and for attrition.nnnRESULTSnFifty-two percent of Cambodian refugees who met diagnostic criteria obtained mental health services in the past 12 months. Of those who obtained care, 75% visited a psychiatrist and 56% a general medical provider. Only 7% had obtained care from other mental health specialty providers. Virtually all respondents who had seen a psychiatrist (100%) or a general medical doctor (97%) had been prescribed a psychotropic medication. Forty-five percent had received minimally adequate care. Most relied on interpreters to communicate with providers.nnnCONCLUSIONSnCambodian refugees rates of mental health service utilization and minimally adequate care were comparable to those of individuals in the general U.S.nnnPOPULATIONnCambodian refugees obtained care almost entirely from psychiatrists and general medical doctors, and nearly all were receiving pharmacotherapy; these findings differ from rates seen in a nationally representative sample. Given this pattern of utilization, and the persistently high levels of PTSD and depression found among Cambodian refugees, treatment improvements may require identification of creative approaches to delivering more evidence-based psychotherapy.

A comparison of Cambodian-American adolescent substance use behavior to national and local norms

INTRODUCTIONnThis study was designed to compare rates of alcohol, marijuana, and cigarette use in Cambodian-American adolescents with norms from nationally- and regionally-representative peers.nnnMETHODSnSubstance use data from 439 10th grade Cambodian-American adolescents in Long Beach, California were compared to grade- and gender-matched nationally representative data from the Monitoring the Future study and data from the California Healthy Kids Survey of students within the same school district.nnnRESULTSnOverall, the Cambodian-American youth were less likely than nationally- and regionally-representative youth to use alcohol, marijuana, and cigarettes. Specifically, relative to estimates obtained for the general population and students attending school in the same school district, Cambodian-American youth were significantly less likely to use alcohol and marijuana. Cambodian-American youth were also less likely than youth in the general population to smoke cigarettes, but did not differ statistically from youth within their same school district.nnnCONCLUSIONSnAs a group, Cambodian-American youth may not be at especially high risk for substance use. As is the case with virtually all populations, some individuals within the Cambodian-American group are likely to have more difficulty than others with substance use concerns. Thus, additional research is needed to identify factors that might help to identify high users with potential service needs.