Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor DE, Malaysia.
Soc Psychiatry Psychiatr Epidemiol. 2021 Mar;56(3):497-512. doi: 10.1007/s00127-020-01962-1. Epub 2020 Oct 4.
This study investigated if Rohingya refugee people resettled in camps in rural Bangladesh and urban locations in Malaysia had different levels of trauma, mental health and everyday functioning. The study also examined if direct and indirect exposure to traumatic events could predict PTSD, depression, generalized anxiety, and everyday functioning in the two groups separately. An attempt was also made to see if the relations between trauma and mental health were different across the two settings.
This was a cross-sectional study, for which we conveniently recruited 100 adult Rohingyas, 50 from each country; the majority was males. Rohingyas in Bangladesh fled Myanmar's Rakhine State following a major military crackdown in 2017, whereas Rohingyas in Malaysia fled Rakhine gradually over the last three decades because of recurrent violence and military operations. We assessed trauma (cumulative trauma, direct trauma, and indirect trauma), PTSD, depression, generalized anxiety, and everyday functioning of the participants using traumatic event questionnaire, PTSD-8, PHQ-9, GAD-7, and WHODAS-2.0.
The Bangladeshi cohort experienced more types of traumatic events (i.e., cumulative trauma) than did the Malaysian cohort (d = 0.58). Although the two cohorts did not differ in terms of indirect exposure to traumatic incidents (i.e., indirect trauma), the Malaysian cohort had direct exposure to traumatic events (i.e., direct trauma) more frequently than did the Bangladeshi cohort (d = 1.22). The Bangladeshi cohort showed higher PTSD (d = 1.67), depression (d = 0.81), generalized anxiety (d = 1.49), and functional impairment (d = 2.51) than those in Malaysia. Hierarchical linear regression analyses showed that after controlling for demographic variables, both direct and indirect trauma significantly predicted PTSD, depression, and functional impairment among Rohingyas in Bangladesh, with direct trauma being the stronger predictor. However, similar analyses showed that only indirect trauma predicted PTSD among Rohingyas in Malaysia, while all other effects were nonsignificant. The results also showed that the predictive relationship between direct trauma and PTSD was different across the two countries. With the same level of direct trauma, a participant from Malaysia would score 0.256 points lower in PTSD than a participant from Bangladesh.
The recently experienced direct and indirect trauma have impaired mental health and everyday functioning among the Bangladeshi cohort. However, only indirect trauma was active to cause PTSD in the Malaysian cohort as direct trauma was weakening due to the time elapsed since migration. We discuss the results in the context of the current theories of trauma and mental health and suggest therapeutic interventions for the refugee population.
本研究旨在调查在孟加拉国农村难民营和马来西亚城市地区重新安置的罗兴亚难民的创伤、心理健康和日常功能是否存在差异。本研究还分别检查了直接和间接接触创伤性事件是否可以预测 PTSD、抑郁、广泛性焦虑和两组的日常功能。还试图了解创伤与心理健康之间的关系在两种环境下是否不同。
这是一项横断面研究，我们方便地招募了 100 名成年罗兴亚人，每个国家 50 人；大多数是男性。孟加拉国的罗兴亚人在 2017 年缅甸发生大规模军事镇压后逃离若开邦，而马来西亚的罗兴亚人则在过去三十年中因反复发生暴力和军事行动而逐渐逃离若开邦。我们使用创伤事件问卷、PTSD-8、PHQ-9、GAD-7 和 WHODAS-2.0 评估了参与者的创伤（累积创伤、直接创伤和间接创伤）、创伤后应激障碍、抑郁、广泛性焦虑和日常功能。
孟加拉国队列经历的创伤性事件类型（即累积创伤）多于马来西亚队列（d=0.58）。尽管两个队列在间接接触创伤事件方面没有差异（即间接创伤），但马来西亚队列比孟加拉国队列更频繁地直接接触创伤事件（d=1.22）。孟加拉国队列的 PTSD（d=1.67）、抑郁（d=0.81）、广泛性焦虑（d=1.49）和功能障碍（d=2.51）均高于马来西亚队列。分层线性回归分析显示，在控制人口统计学变量后，直接和间接创伤均显著预测了孟加拉国罗兴亚人的 PTSD、抑郁和功能障碍，其中直接创伤是更强的预测因素。然而，类似的分析表明，只有间接创伤预测了马来西亚罗兴亚人的 PTSD，而其他影响均不显著。结果还表明，直接创伤与 PTSD 之间的预测关系在两个国家之间存在差异。在相同水平的直接创伤下，来自马来西亚的参与者的 PTSD 得分比来自孟加拉国的参与者低 0.256 分。
最近经历的直接和间接创伤损害了孟加拉国队列的心理健康和日常功能。然而，只有间接创伤对马来西亚队列造成 PTSD，因为自移民以来，直接创伤的强度减弱。我们根据当前的创伤和心理健康理论讨论了结果，并为难民人口提出了治疗干预措施。
