Cited by 425Posttraumatic Stress Disorder ResearchMigration, Health and TraumaChild Abuse and Trauma

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

Mollica, Richard F., McInnes, Keith, Pool, Charles, Tor, Svang·1998·British Journal of Psychiatry

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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 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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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
DOI: 10.1192/bjp.173.6.482
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
Licence: www.cambridge.org/core/terms (unspecified, 6973 d)
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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Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence

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