Publikation

This study reports on the first large-scale investigation of mental health in Cambodia. A randomized sample of 2690 adults from 9 provincesacross Cambodia was interviewed about mentalhealth and mental disorders, addictive and violent behaviours, suicidal tendency, traumatic events, and culturally influenced symptoms related to mental health. In addition, the Harvard-Trauma Questionnaire (HTQ), the Hopkins Symptoms Checklist (HSCL-25) and the Cambodian Addendum of Culturally Sensitive Items (now C-SSI) were administered to all respondents.
Results indicate high rates of children ́s problems, especially aggressive behaviour in the families (11.5%) (for comparison in India a rate of 12.8% was found for child and adolescent disorders), child abuse experienced by males (10.6%) and by females (8%) (as compared to 10.2% of cases of maltreated children in the USA), suicide (0.8% of the households, 42.35 suicides estimated per 100,000 per year 2011 compared to worldwide numbers with an average of 16 suicides per 100,000 population per year (WHO, 2011a) and a Thai rate of less than one fifth of the Cambodian rate) and suicide attempts (115 respondents, 4.3% of respondents, 1.7% of males, 5.5% of females). Probable schizophrenic disorders were estimated at 0.6% for the male and 0.2% for the female population (based on individuals being chained or put in a cage).
The HTQ-Symptom scale results found 3.1% of women and 1.6% of men suffering from probable PTSD. From the HSCL-25, estimates were that 31.7% of women and 18.4% of men suffer from probable anxiety disorder and 19.7% of women and 10.2% of men suffer from probable depressive disorders. The most common depressive symptoms were worrying, difficulty sleeping and low energy.
Physical forms of domestic violence were committed twice as frequently by women as compared to men, whereas financial and sexual forms of domestic violence were more frequently committed by men. The percentage of male respondents committing domestic violence under the influence of alcohol was about 6 times higher compared to females. Of the respondents 64.1% had experienced the period of Civil War. Of these 92.3% had experienced at least one traumatic event, with a mean of 7.0. Traumatic events were also reported among those younger respondents who did not experience the Civil War, where 70.2% experienced at least one traumatic event (with a mean of 1.3). Most of these younger respondents (94.4%) had experienced one to 12 other stressful experiences such as death or severe illness of close family members, marital, problems or financial worries. In the full sample, 87.9% had experienced some traumatic event, 86% suffered from financial worries and 15.9% reported fear of landmines.
Scores on scales of depression, anxiety, and trauma showed significant correlations with demographic data variables such as age, sex and years of education. Traditionally culturally- influenced symptoms of Cambodians were as- sessed by including an abbreviated form of the Cambodian Symptom and Syndrome Inventory (C-SSI). Scores on the C-SSI increased most with higher age and lower education. Genderdependence was high for all of the scales with significantly higher proportions of women suffering from psychological symptoms. Increasing poverty is associated with increasing depressive symptoms, anxiety and trauma.
Only 24.1% of the respondents had ever sought help for the symptoms discussed in these interviews. Some had approached a health center (62.3%), some sought help within their family (50.7%) some at pharmacies (34.1%) and some contacted traditional, spiritual and Buddhist resources (47.7%). Nearly all (97.2%) wished for a mental health service at their local health center and 35.7% stated they would see a psychologist.
Major limitations of this study were that in approximately 50% of the interviews complete privacy couldn ́t be obtained. Due to the planting season the randomized sampling led to an overrepresentation of female respondents (66%). Because the survey was conducted by interviews based on self-reports of respondents and no clinical/psychiatric examination took place, prevalence rates are estimations for probable disorders.
In summary a high percentage of mental disorders especially among the female population was found. Problems that need to be addressed with priority are suicidal behaviour, children and adolescent mental health, mental health and poverty issues as well as human rights, with an urgent need for improvement of access to treatment by psychiatrists and psychologists and of mental health literacy among the population.