8 - UtilizationASA3Fall2009

8 - UtilizationASA3Fall2009 - Asian American Studies 3...

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Unformatted text preview: Asian American Studies 3 Psychosocial Perspectives of Asian Americans PostPost-Traumatic Stress Disorder A. The person has been exposed to a traumatic event. B. The traumatic event is persistently reexperienced C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness D. Persistent symptoms of increased arousal (not present before the trauma) E. Duration of the disturbance is more than 1 month. Marshall et al. 2005 n Little is known about the long-term mental health of longtraumatrauma-exposed refu-gees years after permanent resettlement in host countries. Objective To assess the prevalence, comorbidity, and correlates of psychiatric dis-orders in the US Cambodian refugee community. Design: A cross-sectional, face -to-face interview crossface-tocon-ducted in Khmer language on a random sample of households from the Cambodian com-munity in Long Beach, Calif, the largest such community in the United States, between October 2003 and February 2005. A total of 586 adults aged 35 to 75 years who lived in Cambodia during the Khmer Rouge reign and immigrated to the United States prior to 1993 were selected. One eligible individual was randomly sampled from each house-hold, with an overall response rate (eligibility screening and interview) of 87% (n =490). n n 1 Main Outcome Measures n n n Exposure to trauma and violence before and after im-migration (using the Harvard Trauma Questionnaire and Survey of Exposure to Com-munity Violence) PastPast-year prevalence rates of posttraumatic stress disor-der (PTSD) and major depression (using the Composite International Diagnostic Interview version 2.1) Alcohol use disorder (by the Alcohol Use Disorders Identification Test). Results n All participants had been exposed to trauma before immigration. 99% experienced near-death due to starvation and 90% had a family member nearor friend murdered. Seventy percent reported expo-sure to violence after settlement in the United States. High rates of PTSD (62 %), major depression (51 %), and low rates of alcohol use disorder were found. PTSD and major depression were highly comorbid in this population and each showed a strong dosedoseresponse relationship with measures of traumatic exposure. Having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty were also associated with higher rates of PTSD and major depression. Premigration trauma remained associated with PTSD and major depression; postmigration trauma with PTSD and major depression; and older age with PTSD and major depression. Conclusion: More than 2 decades have passed since the end of the Cambodian civil war and the subsequent resettlement of refugees in the United States; however, this population continues to have high rates of psychiatric disorders associated with trauma. n n n U.S. Surgeon General David Satcher, APA Convention 2001 2 Surgeon General Report Themes n Disparities exist in mental health Culture counts Seek treatment n n Treated Case Method Study Sue & Sue, 1974 Population Students Measures MMPIMMPI critical items --------Ratings Diagnosis --------GAS Findings Underrep. More disturbed High dropout Underrep. Underrep. More disturbed Underrep. Underrep. No underrep. No greater dis. Low dropout Underrep. Longer stay Underrep. More disturbed Low dropout Kitano, 1969 Brown, 1973 Sue, 1977 Cheung, 1986 Gen. pop./inpt. Gen. pop./ inpt. Gen. pop. Gen. pop./nat. O’Sullivan/ 1989 Gen. pop. Snowden/1990 Inpt. Diagnosis Diagnosis Durvasula/Sue, 1996 Gen. pop. Utilization of Services l Nearly all studies indicate that Asian/PacificAsian/PacificAmericans underutilize mental health services - Regardless of group - Regardless of age - Regardless of gender - Regardless of geographic location 3 Severity of Disturbance l Severe disturbance among users of services Low utilization and greater severity among users l Reasons for Underutilization l Shame and stigma over using services l l Cameron House Face cultures l Different conceptions of mental health Organic Will power l Avoid morbid thinking l l l Cultural inadequacies in treatment Unresponsiveness of System n The Cook County public guardian, Patrick T. Murphy, filed a $5 million suit yesterday against the Illinois director of mental health and his predecessors, charging that they kept a Chinese immigrant in custody for twenty-seven years mainly because the man could not speak twentyEnglish. The federal court suit charged that the Illinois Department of Mental Health had never treated the patient, identified only as David T., for any mental disorders and had found a Chinese-speaking Chinesepsychologist to talk to him only after twenty-five years. The suit said twentythat David, who is in his fifties, was put in Oak Forest Hospital, then known as Oak Forest Tuberculosis Hospital…. He was transferred to a state mental hospital where doctors conceded they could not give him a mental exam because he spoke little English. But they diagnosed him as psychotic anyway. The suit said that a doctor who spoke no Chinese said David answered questions in an "incoherent and unintelligible manner." It was charged also that David was quiet and and caused little trouble but was placed in restraints sometimes because he would wander to a nearby ward that housed the only other Chinese-speaking Chinesepatient. 4 ...
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This note was uploaded on 04/19/2011 for the course ASA 3 taught by Professor Sue during the Fall '08 term at UC Davis.

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