As survivors of war and violence, many Cambodian-Americans need psychological help, in order to prevent their trauma from leading to chronic disease. Health professionals say not many of them do, however.
Even after three decades, many Cambodian ex-refugees in the US experience severe psychological distress and mental health distress, including post-traumatic stress disorder, depression, and trauma. These have a strong link with chronic diseases, such as high blood pressure, diabetes, and high cholesterol, according to studies.
Maren Pin, a Khmer Rouge survivor, is a case in point. She suffers high blood pressure, high cholesterol, and type-2 diabetes. She lost her father and nearly starved under the regime, before making it to the US. “Sometimes I still have nightmares, dreaming that they caught me,” she said. “This stays with me, and you can’t get rid of that.”
“These things are linked,” said Julie Wagner, a community health professor at the University of Connecticut. “If you have depression or you have depressive episodes in your life, you are twice as likely to develop toward type-2 diabetes.”
Malnutrition during the Khmer Rouge, social isolation, and social determinants of health, including socioeconomic status and limited English proficiency, can contribute to increased likelihood of chronic disease.
Cambodians in the US have twice the rate of type-2 diabetes, seven times the rate of depression, and fifteen times the rate of PTSD than the standard US population. However, not many of those who need an interpreter are provided one when they seek mental health care, said Megan Berthold, a professor at the UConn of Social Worker and mental health professional, who has more than 30 years of experience with Cambodian-Americans.
“This is alarming, and it’s a big problem, when people who have these high rates of these conditions aren’t able to effectively communicate with their health providers,” she said.
In Cambodian culture, discussing mental health is associated with weakness and shame, and this can cause stigmatization. This, plus the lack of access to culturally appropriate healthcare, can prevent them from asking for mental health help in the early phases.
“The lack of being able to communicating with your health providers makes the situation extremely challenging and dangerous,” Berthold said.
Strong social support, previous education and other skills can make it easier to integrate into a new society, leading to better health, she said.
“Having a job is a very extremely important part of the recovery, the healing, the resiliency of the Southeast Asians,” she said.
On average, Cambodian-Americans tend to have higher employment rates than other groups, despite a lower level of education. Still, many have to worry each day about eating and sending their children to school, or paying the high costs of US healthcare.
“The folks here are survivors of violence, so they are strong,” Berthold said, “but it’s very, very hard to be resilient, no matter how much support one has, no matter one’s sense of purpose.”