Trauma, healthcare access, and health outcomes among Southeast Asian refugees in Connecticut

Wagner J, Burke G, Kuoch T, Scully M, Armeli S, Rajan TV.

Published in Journal of Immigrant and Minority Health December 2013.

Abstract

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 proportion 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.

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