Knowledge of psychology in Cambodia: Exploring the relationships to demographics, psychopathology, and idioms of distress.

Rates of mental health disorders in Cambodia are markedly higher than in other low- or middle-income countries. Despite these high rates, mental healthcare resources remain scarce and mental health stigma is pervasive, particularly for vulnerable populations of young women and individuals of low socioeconomic status. To address this gap, teaching Western mental health treatments and using a mental healthcare framework are recommended within the Cambodian context. However, Western frameworks do not address cultural syndromes or idioms of distress and operate from an individualistic perspective that does not address cultural values and beliefs. The present study employs a mental health literacy framework in an exploratory analysis of rates of psychological knowledge in a nationally representative sample of Cambodian adults (N = 2,690). To address recommendations for increasing mental healthcare, we designed a survey to investigate Cambodians' knowledge about mental health constructs. Results indicated that only 18.9% of Cambodians knew about psychology, and chi-square analyses revealed that women, individuals in rural areas, and individuals with significant distress due to cultural symptoms and syndromes reported knowing about psychology significantly less than their male and non-distressed counterparts. Additionally, those who reported higher income and higher levels of education indicated significantly higher rates of psychological knowledge, as did those with clinically significant rates of PTSD, at a rate of knowledge approaching significance. Implications for this study include the need to tailor interventions and resources to vulnerable populations, to assess the fit of current recommendations for the Cambodian context, and to further emphasize the need for culturally responsive interventions that address all presentations of Cambodian distress and align with understandings of mental health within the nation.

Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation.

In a large national survey in Cambodia (N = 2689), the present study investigated the prominence of certain culturally salient symptoms and syndromes in the general population and among those with anxious-depressive distress (as determined by the Hopkins Symptom Checklist-25, or HSCL). Using an abbreviated Cambodian Symptom and Syndrome Addendum (CSSA), we found that the CSSA complaints were particularly elevated among those with anxious-depressive distress. Those with anxious-depressive distress had statistically greater mean scores on all the CSSA items as well as severity of endorsement analyzed by percentage: among those with HSCL caseness, 75.3% were bothered "quite a bit" or "extremely" by "thinking a lot" (vs. 27.5% without caseness); 53.8% were bothered by "standing up and feeling dizzy" (vs. 13.8%); and 45.6% by blurry vision (vs. 16.8%). In a logistic regression analysis to predict anxious-depressive distress, 51% of the variance was accounted for by five predictors: "weak heart," "thinking a lot," dizziness, "khyâl hitting up from the stomach," and sleep paralysis. Using ROC analysis, a cut-off score of 1.81 on the CSSA was optimal as a screener to indicate anxious-depressive distress, giving a sensitivity of 0.86. The study results suggest that to avoid category truncation (i.e., the omission of key complaints that are part of an assessed distress domain) when profiling anxious-depressive distress among Cambodia population that items other than those in standard psychopathology measures should be assessed such as "thinking a lot," "weak heart," "blurry vision," and "dizziness upon standing up."

Exploring Contextual Trauma in Cambodia: A Sociointerpersonal Perspective on Posttraumatic Stress Disorder.

Trauma literature has proposed multiple theories of trauma development, maintenance, and transmission, which has led to a lack of clarity surrounding trauma in individuals, families, and communities. We investigated the impact of community-level trauma experiences on individual posttraumatic stress disorder (PTSD) symptoms using a sociointerpersonal model of PTSD (Maerker & Horn, 2013). A nationally representative sample (N = 2, 690) of Cambodian households across all regions of the country was surveyed regarding individual trauma experiences during and after the Khmer Rouge regime, symptoms of PTSD, and current stressors. Individual experiences of war trauma and current stressors were aggregated based on the district in which each individual lived. District mean and individual war trauma and current stressors were included in a multilevel model as predictors of individual levels of PTSD. Findings indicated that mean trauma experiences, ß = .05, p < .001, and current stressors, ß = .10, p < .001, in the district in which individuals live were positively and significantly associated with their individual PTSD symptoms. Individual war trauma, ß = .02, p < .001, and current stressors, ß = .08, p < .001, were also positively and significantly associated with individual PTSD symptoms. District trauma experiences accounted for 7% of the variance in individual PTSD symptoms, R2 Level 1 = .21, R2 Level 2 = .80. Additionally, current stressors at both the individual and district levels had a greater impact on individual PTSD symptoms than war trauma at either level of the model. Implications for policy and intervention are presented.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Explorando el trauma contextual en Camboya: Una perspectiva socio-interpersonal del TEPT TRAUMA CONTEXTUAL EN CAMBOYA La literatura sobre el trauma ha propuesto teorías múltiples del desarrollo, la mantención, y la transmisión del trauma, lo cual ha llevado a una carencia de claridad en torno al trauma en los individuos, las familias, y las comunidades. Estudiamos el impacto de las experiencias del trauma a nivel comunitario en los síntomas del trastorno de estrés postraumático (TEPT) a nivel individual usando el modelo sociointerpersonal del TEPT (Maerker & Horn, 2013). Una muestra representativa a nivel nacional (N = 2.690) de los hogares de Camboya en todas las regiones del país fue encuestada con respecto a las experiencias individuales de trauma durante y luego del régimen de Khmer Rouge, síntomas del TEPT y estresores actuales. Las experiencias individuales de traumas por conflictos armados y los estresores actuales fueron agregados basados en el distrito en el cual cada individuo vivía. La media por distrito y trauma individual por conflictos armados y estresores actuales fueron incluidos en un modelo multinivel como predictores de los niveles individuales del TEPT. Los hallazgos indicaron que las experiencias de trauma media, ß = .05, p < .001, y los estresores actuales, ß = .10, p < .001, en el distrito en que los individuos vivían se asociaron positiva y significativamente con sus síntomas individuales del TEPT. El trauma por conflictos armados a nivel individual, ß = .02, p < .001, y los estresores actuales, ß = .08, p < .001, se encontraron también positiva y significativamente asociados con los síntomas individuales del TEPT. Las experiencias de trauma del distrito explicaron un 7% de la varianza de los síntomas individuales del TEPT, R2 Nivel 1 = .21, R2 Nivel 2 = .80. Adicionalmente, los estresores actuales tanto a nivel individual como a nivel del distrito tuvieron un impacto más alto en los síntomas individuales del TEPT que el trauma por los conflictos armados en cada nivel del modelo. Se presentan las implicaciones para las políticas y la intervención.

Four decades following the Khmer rouge: sociodemographic factors impacting depression, anxiety and PTSD in Cambodia.

BACKGROUND: Reliable population-based epidemiological data of Cambodian mental health is lacking. AIMS: This study identifies the prevalence of and factors associated with anxiety, depression and PTSD in Cambodian adults. METHODS: A nationally representative sample of Cambodian adults (N = 2690) was interviewed utilizing the Harvard Trauma Questionnaire (assessment of PTSD symptoms) and the Hopkins Symptom Checklist-25 (assessment of symptoms of anxiety and depression). RESULTS: Respondents expressed high rates of anxiety (27.4%), depression (16.7%) and PTSD (7.6%). Correlations between symptoms and sociodemographic markers varied in significance. Women had significantly higher rates of mental health symptoms than men. Women who were in debt, widowed or divorced and had low levels of education were the most likely to report symptoms. CONCLUSIONS: These findings can inform Cambodian mental health policies and development strategies, especially targeting the most vulnerable groups.

Family, Health, and Poverty Factors Impacting Suicide Attempts in Cambodian Women.

BACKGROUND: Our recent report demonstrates that 5.5% of Cambodian women have previously attempted suicide. Despite these high rates and critical need for intervention, research on suicide attempts in Cambodia is lacking, and life-saving information on suicide prevention is therefore unknown. AIMS: This study explores factors impacting Cambodian women suicide attempts. METHOD: A total of 1,801 women participated in the large national survey during which 100 of these women (5.5%) reported at least one suicide attempt. Of the 100 participants 76 provided qualitative reasons for the suicide attempts. Only the 76 who provided the reasons for suicide attempt were included for analysis in this study. RESULTS: Four major themes emerged: (1) family conflict, (2) emotional distress, (3) poverty, and (4) illness. Family conflict, emotional distress, poverty, and illness were all interrelated with each other; for example, women without money were unable to pay for treatment of otherwise treatable illnesses. LIMITATIONS: Owing to the nature of the data collection, member checking could not be conducted. CONCLUSION: Cumulative and intertwined personal, interpersonal, and contextual-level factors impacting suicide attempts included emotional distress, illness, family conflict, and poverty. Findings highlight points of intervention at individual, familial, and contextual levels to prevent suicide.

Family, Health, and Poverty Factors Impacting Suicide Attempts in Cambodian Women.

BACKGROUND: Our recent report demonstrates that 5.5% of Cambodian women have previously attempted suicide. Despite these high rates and critical need for intervention, research on suicide attempts in Cambodia is lacking, and life-saving information on suicide prevention is therefore unknown. AIMS: This study explores factors impacting Cambodian women suicide attempts. METHOD: A total of 1,801 women participated in the large national survey during which 100 of these women (5.5%) reported at least one suicide attempt. Of the 100 participants 76 provided qualitative reasons for the suicide attempts. Only the 76 who provided the reasons for suicide attempt were included for analysis in this study. RESULTS: Four major themes emerged: (1) family conflict, (2) emotional distress, (3) poverty, and (4) illness. Family conflict, emotional distress, poverty, and illness were all interrelated with each other; for example, women without money were unable to pay for treatment of otherwise treatable illnesses. LIMITATIONS: Owing to the nature of the data collection, member checking could not be conducted. CONCLUSION: Cumulative and intertwined personal, interpersonal, and contextual-level factors impacting suicide attempts included emotional distress, illness, family conflict, and poverty. Findings highlight points of intervention at individual, familial, and contextual levels to prevent suicide.

Mental Health Indicators of Suicide in Cambodian Women.

Global suicide rates are steadily increasing, and suicide completions in Asia outnumber those in Western countries. Young females are especially at risk, with higher rates of completion and lack of suicide support because of familial and cultural stigma and constraints. Lack of infrastructure to systematically record suicide deaths and attempts makes studying suicide in low- and middle-income countries challenging. Given the critical public health need for suicide intervention and prevention, research on suicide is crucial. The present study adds to the lack of information regarding suicide in Cambodia by exploring reports of attempted suicide by women from a nationally representative sample of Cambodian women (N = 1813). In a series of logistic regression models, findings indicate that a culturally salient measure of Cambodian syndromes, symptoms of depression, and posttraumatic stress disorder contributed to increased odds of attempting to commit suicide. Implications for policymakers and interventionists within Cambodia and Asian contexts are discussed.