Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Feb;60(1):6-20.
doi: 10.1177/0020764012471597. Epub 2013 Feb 7.

The enduring mental health impact of mass violence: a community comparison study of Cambodian civilians living in Cambodia and Thailand

Richard F Mollica  1 , Robert Brooks, Svang Tor, Barbara Lopes-Cardozo, Derrick Silove
Affiliations
Comparative Study

The enduring mental health impact of mass violence: a community comparison study of Cambodian civilians living in Cambodia and Thailand

Richard F Mollica et al. Int J Soc Psychiatry. 2014 Feb.

Abstract

Background: No population-based studies have directly compared the long-term health and mental health outcomes of conflict- versus non-conflict-affected communities from the same ethnic background.

Aims: To identify and compare levels of psychiatric morbidity between a traumatized and non-traumatized civilian community; to investigate the long-term impact of mass violence.

Methods: Double-stratified community surveys in Siem Reap and Surin provinces were conducted by highly qualified Cambodian interviewers using culturally validated survey instruments with known psychometric properties. These included Cambodian versions of the Hopkins Symptom Checklist-25, the Harvard Trauma Questionnaire and the Medical Outcome Study Short Form.

Results: Siem Reap and Surin respondents experienced 12,266 and 621 major trauma events, respectively; 745 (76.2%) Siem Reap respondents and six (0.6%) Surin respondents reported torture events; 499 (49.5%) Siem Reap respondents and 203 (19.7%) Surin respondents met the clinical threshold for depression (OR 4.01, 95% CI 3.29-4.88); 204 (20.6%) Siem Reap respondents and 23 (2.2%) Surin respondents met the clinical threshold for post-traumatic stress disorder (PTSD) (OR 11.39, 95% CI 7.3-17.7). The MOS physical disability was higher in Siem Reap versus Surin respondents (74 (7.5%) vs 13 (1.3%), χ(2) = 47.4 df = 1, p < .001). Health status was poorest among Siem Reap respondents when compared with Surin respondents (mean score 1.59 vs 0.59, respectively; t = 19.85 df = 2018, p < .001). Path analysis reveals that recent and past extreme violence are associated with the health and mental health status of the Siem Reap community.

Conclusion: After 25 years, the Khmer civilian population that experienced the Pol Pot genocide continues to suffer psychiatric morbidity and poor health.

Keywords: Cambodian mental health; Genocide; structural equation modelling; traumatic experience.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Mean depression by age and community.
Figure 2
Figure 2
Mean post-traumatic stress score by age and community.
Figure 3
Figure 3
Structural model for examining relationship between within-era trauma events (PTEs) and current mental health in Siem Reap, Cambodia (N = 989).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. APA (American Psychological Association) Diagnostic and statistical manual of mental disorders version IV (DSM-IV) APA; Washington, DC: 1994.
    1. Barrett P. Structural equation modeling: Adjudging model fit. Personality and Individual Differences. 2007;42:815–824.
    1. Belford A. Cambodia’s mental health crisis gets little attention and money. The Cambodia Daily. 2010:14.
    1. Berntsen D, Rubin DC. When a trauma becomes a key to identity: Enhanced integration of trauma memories predicts posttraumatic stress disorder symptoms. Applied Cognitive Psychology. 2006;21:417–431.
    1. Bolton P, Neugebauer R, Ndongoni L. Prevalence of depression in rural Rwanda based on symptom and functional criteria. Journal of Nervous Mental Disorders. 2002;190:631–637. - PubMed

Publication types

MeSH terms