摘要：Objectives. We assessed the rates and correlates of seeking mental health services among a probability sample of Cambodian refugees who needed such services. Methods. Interviewers conducted face-to-face interviews with a representative sample drawn from the largest US community of Cambodian refugees. The analytic sample included 339 persons who met past 12-month criteria for posttraumatic stress disorder, major depression disorder, or alcohol use disorder. Respondents described contact with service providers for psychological problems during the preceding 12 months. We examined bivariate and multivariate predictors of seeking services. Results. Respondents reported high rates of contact with both medical care providers (70%) and mental health care providers (46%). Seeking services from both types of providers was associated with lack of English-speaking proficiency, unemployment, 3 or fewer years of preimmigration education, and being retired or disabled. Women, individuals with health insurance, and persons receiving government assistance also were more likely to seek services. Conclusions. Cambodian refugees with mental health problems had high rates of seeking service for psychological problems during the preceding 12 months. Research is needed to examine the effectiveness of services received by Cambodian refugees. Cambodian refugees have high rates of post-traumatic stress disorder (PTSD) and major depression disorder 2 decades after being subjected to one of the most brutal and traumatic conflicts of the past century. A recent household survey of the largest US community of Cambodian refugees reported high past 12-month prevalence rates: 62% for PTSD and 51% for major depression. 1 These rates are much greater than those found among the general population (PTSD= 3.5%; major depression = 6.7%), 2 which suggests a substantial need among Cambodian refugees for mental health services. Yet, little is known about Cambodian refugees’ help-seeking behavior. Because depression is a key component of overall disease burden, 3 and because PTSD is a notable contributor to disease burden, especially in countries wracked by violence, 4 understanding the help-seeking behavior of refugees afflicted with these disorders is a significant public health issue. Numerous studies have reported that Asian Americans in general tend to underuse mental health services 5 – 8 Although these observations do not in themselves indicate an unmet need for psychiatric services, such findings typically support a hypothesis that Asian Americans with mental health problems are less likely than their non-Asian counterparts to contact health service providers for assistance. 9 Moreover, at least 1 investigation of data from the Epidemiological Catchment Area Study suggested that Asian Americans were less likely than White Americans to talk with a physician or mental health professional about mental health problems, even after the investigators adjusted for unmet need. 10 Similarly, Cambodian refugees are often viewed as underusing mental health services despite considerable unmet need, although virtually all data are from small samples or from samples where representativeness is uncertain. 11 , 12 In perhaps the most rigorous examination of this issue, Blair found that, despite the high prevalence of PTSD and major depression, only 9% of 124 Cambodian refugees who resided in Utah in 1991 reported receipt of mental health treatment of any kind. 11 Because these data are 15 years old and were obtained from a sample of individuals who lived in a relatively small and isolated Cambodian refugee community, additional research is needed. Much attention has been paid to understanding the sociodemographic correlates of unmet need for mental health services. 13 For example, Kessler found that women were more likely than men to seek treatment for mental health problems. 14 Additional research has suggested that younger adults are more likely than older adults to seek assistance for a mental health problem 15 , 16 and that uninsured individuals are less likely than insured individuals to seek care. 17 Unmet mental health need also is associated with a lack of English-speaking proficiency 18 and low education levels. 19 By contrast with the growing literature on the correlates of unmet need and mental health service use among the general population, no research has studied the factors associated with service use among Cambodian refugees. Although empirical data are lacking, patterns of seeking service among Cambodian refugees may not follow those of other US-born or immigrant Asian Americans because of the unique history of the Cambodian refugee community. The estimated population of Cambodia was 7.1 million in 1975, when the Khmer Rouge took power, and as many as 2 million Cambodians died during the 4-year Khmer Rouge reign. 20 Approximately 1 million more were killed during the civil wars before and after this period. 21 Because of the high prevalence of mental health problems, 1 Cambodian refugees likely have a considerably greater need for mental health services compared with other US-born or immigrant Asian Americans. Moreover, the most recent census data show that Cambodian refugees rely far more heavily on public assistance compared with the general public and most other Asian Americans. 22 Finally, unlike the general population and many other Asian Americans, Cambodian refugees—by virtue of having been granted refugee status—had more extensive contact with social service agencies upon arrival in the United States. Our goal was to identify the rates and correlates of seeking mental health services among a representative sample of Cambodian refugees drawn from the largest community of Cambodian refugees in the United States.
