Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence
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 a Thai 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.
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The research and application of behavioral treatments for PTSD in populations exposed to extreme stressors such as ethnic conflict are currently in their infancy.
“the research and application of behavioral treatments in this context are currently in their infancy (de Jong et al., 2001; Mollica, McInnes, Poole, & Tor, 1998).”
From Sudanese Refugees in Cairo, Egypt: A Randomized Controlled Trial of Interpersonal Psychotherapy for Trauma, Depression and Interpersonal Violence: (517292011-807) (2009) · cites this paper as Mollica, McInnes, Poole, & Tor, 1998
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Self-citationDenov, M. S., Fennig, M., Rabiau, M. A., & Shevell, M. C. (2019) · Journal of Family Social Work · doi:10.1080/10522158.2019.1546810 · Cited by 93 · see citing works
Huijts, I., Kleijn, W. C., van Emmerik, A., Noordhof, A., & Smith, A. J. M. (2012) · Journal of Traumatic Stress · doi:10.1002/jts.21665 · Cited by 93 · see citing works
Posttraumatic Symptoms and Disability in Paramedics
Regehr, C., Goldberg, G., Glancy, G., & Knott, T. F. (2002) · The Canadian Journal of Psychiatry · doi:10.1177/070674370204701007 · Cited by 92 · see citing works
Determinants of Postconflict Symptoms in Albanian Kosovars
Eytan, A., Gex‐Fabry, M., Toscani, L., DeRoo, L. A., Loutan, L., & BOVIER, P. A. (2004) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000142029.96703.57 · Cited by 88 · see citing works
SCIENCE-BASED POLICY FOR PSYCHOSOCIAL INTERVENTIONS IN REFUGEE CAMPS
Mollica, R. F., Cui, X., McInnes, D. K., & Massagli, M. P. (2002) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200203000-00004 · Cited by 86 · see citing works
Self-citationPTSD and the "building block" effect of psychological trauma among West Nile Africans
Schauer, M., Neuner, F., Karunakara, U. K., Klaschik, C., Robert, C., & Elbert, T. R. (2003) · KOPS (University of Konstanz) · Cited by 86 · see citing works
Public Mental Health, Traumatic Stress and Human Rights Violations in Low-Income Countries
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Trauma-focused cognitive behavioral therapy with unaccompanied refugee minors: a case series
Unterhitzenberger, J., Eberle-Sejari, R., Rassenhofer, M., Sukale, T., Rosner, R., & Goldbeck, L. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0645-0 · Cited by 77 · see citing works
Lindert, J., Brähler, E., Wittig, U., Mielck, A., & Priebe, S. (2008) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-2008-1067358 · Cited by 77 · see citing works
de Fouchier, C., Blanchet, A., Hopkins, W. G., Bui, É., Aoudia, M. A., & Jehel, L. (2012) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v3i0.19225 · Cited by 76 · see citing works
Psychiatric disorders and other health dimensions among Holocaust survivors 6 decades later
Sharon, A., Levav, I., Brodsky, J., Shemesh, A. A., & Kohn, R. (2009) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.108.058784 · Cited by 76 · see citing works
- Authors
- Mollica, R. F., McInnes, K., Pool, C., & Tor, S.
- Affiliations
- Harvard University (US)
- Boston University (US)
- Corresponding author
- Mollica, Richard F.
- ORCID
- Mollica, Richard F.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 1998-12
- Volume
- 173
- Issue
- 6
- Pages
- 482-488
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2115904192
- Cited by
- 425
- References
- 20
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 11 · 2023: 19 · 2022: 8 · 2021: 18 · 2020: 14 · 2019: 11 · 2018: 20 · 2017: 21 · 2016: 13 · 2015: 16 · 2014: 22 · 2013: 23 · 2012: 19
- FWCI
- 8.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- cumulative trauma, dose-response relationship, major depressive disorder, post-traumatic stress disorder, Cambodian refugees, dissociative symptoms, avoidance symptoms, refugee mental health
- MeSH terms
- Adolescent, Adult, Aged, Anxiety, Cambodia, Depressive Disorder, Dissociative Disorders, Humans, Middle Aged, Stress Disorders, Post-Traumatic, Survival, Violence
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