The complexity of trauma response: a 4-year follow-up of adolescent Cambodian refugees

Abstract

Objective: The objective of this study was to document the psychosocial adjustment of young refugees during their adolescence and its association with the war-related trauma experienced by their family before migration.

Method: Data were collected on 57 young Khmer resettled in Montreal and followed from early to late adolescence. The associations between premigratory exposure to political violence and postmigratory mental health and social adjustment were estimated for early, mid-, and late adolescence.

Results: The associations between premigratory exposure to political violence and postmigratory psychosocial adjustment fluctuated over the adolescence period. Overall, the adolescents whose families were more highly exposed to political violence tended to report a more positive social adjustment and less mental health symptoms than those less exposed.

Conclusion: The high expectations of Cambodian parents towards their children and the preservation of traditional values despite the Khmer rouge attempts to eradicate them might contribute to explain the paradoxical association between the families’ exposure to political violence and the adolescents’ psychosocial adjustment in the host country. Although children and adult refugees seen in clinical setting are reminders of the negative effects of adversity, resilience should be more systematically explored in community samples to further our understanding of the long-term effects of trauma.

Résumé

French- and Spanish-language abstracts not available at time of publication.

Resumen

French- and Spanish-language abstracts not available at time of publication.

Introduction

A number of studies have been conducted to understand better the long-term effect of past exposure to political violence on the mental health of children and adolescents who were forced to migrate as refugees to various host countries, with or without their parents. Posttraumatic stress disorder has been found to be very prevalent in Khmer children and adolescents who have survived the Pol Pot regime (Hubbard, Realmuto, Northwood, & Masten, 1995; Kinzie, Sack, Angell, Manson, & Ben, 1986; Kinzie, Sack, Angell, Clarke, & Ben, 1989; Mollica, Poole, Son, Murray, & Tor, 1997; Sack, 1999; Sack, Clarke, & Seeley, 1996; Sack et al., 1994; Savin, Sack, Clarke, Meas, & Richart, 1996) and in their parents (Mollica et al., 1993).

A positive association was observed between children of war’s perception of their own efficacy and their self-confidence and self-esteem (Garbarino & Kostelny, 1996). Macksoud, Dyregrov, and Raundalen (1993) also noted that traumatized children tend to isolate themselves from their peers. Other studies have reported that children’s personal and social identity and moral development are affected when their world is disrupted by war (Macksoud et al., 1993, Martin-Baro, 1994, Richman, 1993).

In parallel to the vast literature on the negative impact of political violence on mental health, some studies show that in spite of all their psychological symptoms, the majority of severely traumatized children manage to become well-adjusted adults (Dalianis-Karambatzakis, 1994, Lyons, 1991, Sigal, 1998). Macksoud and Aber (1996) observed that different experiences of trauma and loss led to a wide range of emotional and behavioral responses in Lebanese children, including such positive effects as an increase in prosocial and planful behavior. Traumatized children also have been reported to maintain or improve their academic performance in spite of their trauma (Terr, 1983). Finally, in a study of Bosnian adolescents, Ferren (1999) demonstrated that the self-efficacy of traumatized boys was higher than that of their nontraumatized peers. He hypothesizes that in the Bosnian context, surviving traumatic experiences may have a steeling effect that helps maintain high self-efficacy levels.

In war, suffering occurs and is resolved in a social context, shaped by the meaning collectively and individually constructed around events (Summerfield, 1999). Exposure to political violence may lead to a wide array of trauma responses, going from building up a resiliency that may foster psychosocial adjustment to disrupting psycho-emotional balance for a number of years.

Between 1975 and 1995, 16,818 Cambodian refugees resettled in Canada (United Nations High Commissioner for Refugees, 2000). They were either selected by Canadian immigration officers in refugee camps or were sponsored by their families or religious organizations. In either case, they landed in Canada as permanent residents, a status that entitled them to basic financial support, health and social services, and training in the mainstream language (i.e., French in Quebec, English in other Canadian provinces). Nearly all refugees who have resettled in Quebec are living in or close to Montreal where migrants make up 20% of the population. Cambodian refugees appear to be ill-equipped to face the challenges of living in an industrialized setting. Most had been peasants or small underground business people with little or no education and had no knowledge of either French or English on arrival. A considerable number landed in Canada with some or all of their children, most of whom were born in refugee camps or in Cambodia shortly before the family fled the country.

The study reported here was designed to investigate the evolution of the effects of the family’s premigration exposure to political violence on the psychosocial adjustment of young Cambodian refugees from early to late adolescence. Analyses carried out at baseline and 2 years later suggest that premigration trauma experienced by a family prior to a child’s birth plays a steeling role at various times in the child’s adolescence. For boys, this translates in externalizing symptoms and risk behavior, and for girls, in social adjustment (Rousseau, Drapeau, & Platt, 1999). These reactions were interpreted as overcompensation on the part of the children of Pol Pot survivors, to whom the implicit duty of succeeding has been passed on.

In this paper, we report on analyses that were carried out, first, to verify whether the steeling effect of exposure to political violence on some dimensions of the psychosocial adjustment of young Cambodian showed up in early, mid-, and late adolescence of those who took part in the three phases of the study and, second, to explore the associations between exposure and how adolescents view themselves and others as they enter adulthood.