Moore, L., Sager, D., Keopraseuth, K., Chao, L., Riley, C., and Robinson, E. (2001). Rheumatological Disorders and Somatization in U.S. Mien and Lao Refugees with Depression and Post-Traumatic Stress Disorder: A Cross-Cultural Comparison. Transcultural Psychiatry, 38(4), 481.
Summary by CVT Intern David Heuer
As the title suggests, this study involved the relationship between depression and Post-Traumatic Stress Disorder (PTSD), and Mien and Lao refugees living in America. This study was a continuation of one from 1991, written by some of the same authors that noted a discrepancy between Mien and Lao patients who offered emotional complaints when describing their symptoms to professionals. Where the Lao would voluntarily describe emotional complaints and other psychiatric symptoms consistent with mental disorders, the Mien would only do so when specifically asked. Prior studies also noted that Mien patients were often noncompliant with medication when compared to other regional ethnic groups that were more familiar with western medicine. This study looked at statistics in the general population that suggest, “People with fibromyalgia (FM) seeking treatment have been found to have significantly greater anxiety and depression, psychological and overall (but not physical) impairment” and that they often report loss of parents or family violence, physical and sexual abuse and increased rates of somatization. This was based on the assumption that “FM may involve a progression from chronic sleep disturbances to muscle pain and fatigue related to an inability to fully relax muscles and an inability to quiet the mind, whether due to pain, sleep apnea, stress, or PTSD”.
The authors expected to find a higher rate of FM in the Mien because of their high prevalence of widespread pain while the Lao would have a lower rate, due to their lower reporting of pain to clinicians. This study was done with patients from the Indochinese Psychiatric Program (IPP) at the Oregon Health and Science University (OHSU) and began with 70 Mien patients (reduced to 59 because of refusal to have blood drawn) and 30 Lao patients. The procedure began with patients noting where they experienced pain, numbness, tingling or swelling on a drawing of a body, followed by an examination from a rheumatologist using the 1190 ACR criteria for FM.
While the Mien group was older than the Lao, no difference was found in the distribution of sex between the two, although there was a significant difference in marital status (more Mien were married, none divorced), 95% of all patients expressed at least one chronic pain event in the last year, and all of them suffered from depression, either alone or with PTSD and psychotic symptoms. These results were unexpected in both populations, and may be because the pool of patients who were previously receiving some form of treatment. The authors offer some possible explanations, the first is cultural alienation, shared traumatic history, social isolation, and the degree of psychopathy. The second are dissociative elements where they note one Mien woman who lost nine first-degree relatives, including two husbands and three infants. Finally, the possibility of somatic complaints connected to psychiatric disorders not yet identified.
When the authors looked at the cultures of the two groups, they noted that Lao subjects were generally more receptive to western medical practices because of greater contact with the outside world. Because of their traditional location, the Mien did not have as contact with outsiders and developed an insular belief system that can “shield them from effects of western treatment”. Many of the Mien patients suggested to the practitioners that “guardian spirits might be interfering with the effectiveness of medications” as well as the “belief they were born with bad luck…predetermined by the behavior of their ancestors or past events beyond their control.” This led the team to suggest “that physical responses are part of the normative reaction to trauma and distress but that cultures communicate about the physical and emotional aspects of distress in different ways.”
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