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Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence

Published online by Cambridge University Press:  03 January 2018

Richard F. Mollica ,
Keith McInnes ,
Charles Pool  and
Svang Tor
Richard F. Mollica*
Affiliation:
Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School
Keith McInnes
Affiliation:
Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School
Charles Pool
Affiliation:
Department of Epidemiology and Biostatistics, Boston University School of Public Health
Svang Tor
Affiliation:
Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School
*
Richard F. Mollica, Director, Harvard Program in Refugee Trauma, Harvard School of Public Health, Harvard Medical School, 8 Story Street, Third Floor, Cambridge, MA 02138. Tel: (617) 496-5550; Fax: (617) 496-5530
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Abstract

Background

The dose – effect relationships of cumulative trauma to the psychiatric symptoms of major depression and post-traumatic stress disorder (PTSD) in a community study of Cambodian survivors of mass violence were evaluated.

Method

In 1990, a survey of 1000 households was conducted in aThai refugee camp (Site 2) using a multi-stage random sampling design. Trauma history and psychiatric symptoms were assessed for two time periods. Analysis used linear dose – response regression modelling.

Results

993 Cambodian adults reported a mean of 14 Pol Pot era trauma events and 1.3 trauma events during the past year. Symptom categories of depression, PTSD, dissociative and culturally dependent symptoms exhibited strong dose – effect responses with the exception of avoidance. All symptom categories, except avoidant symptoms, were highly correlated.

Conclusions

Cumulative trauma continued to affect psychiatric symptom levels a decade after the original trauma events. The diagnostic validity of PTSD criteria, with the notable exception of avoidance, was supported. Inclusion of dissociative and culturally dependent symptoms increased the cultural sensitivity of PTSD.

Type
Papers
Information
The British Journal of Psychiatry , Volume 173 , Issue 6 , December 1998 , pp. 482 - 488
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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