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The British Journal of Psychiatry (2002) 181: 339-347
© 2002 The Royal College of Psychiatrists

Psychiatric effects of traumatic brain injury events in Cambodian survivors of mass violence

RICHARD F. MOLLICA, MD, DAVID C. HENDERSON, MD and SVANG TOR, BA

Harvard Program in Refugee Trauma, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts, USA

Correspondence: David C. Henderson, MD, Harvard Program in Refugee Trauma, Massachusetts General Hospital, 22 Putnam Street, Cambridge, MA 02138, USA. Tel: (617) 876-7879; fax: (617) 496-2360; e-mail: dchenderson{at}partners.org

Declaration of interest None.

Funding detailed in Acknowledgements.

Background The prevalence of brain injury and its effects in populations exposed to war violence has not been studied in recent years.

Aims To examine the association between traumatic brain injury events and psychiatric symptoms of major depression and post-traumatic stress disorder (PTSD) in Cambodian survivors of mass violence.

Method The population comprised a multi-stage random sample of Cambodian refugees living in a Thai refugee camp. The main results analysed the relationship between six categories of trauma events and psychiatric symptoms of depression and PTSD during two time periods.

Results Almost 15 000 trauma events were reported (n=13 481, Pol Pot period; n=1249, past year). Traumatic brain injury was most common in the highly educated and in individuals with the highest levels of cumulative trauma. Of all trauma categories, traumatic brain injury revealed the strongest association with symptoms of depression, and a weaker association with PTSD. Brain injury represented 4% of the total number of traumatic events for both time periods, contributing 20% of the total symptom score for depression and 8% of that for PTSD.

Conclusions Clinical identification and treatment of traumatic brain injuries in highly traumatised populations must be maintained in order to develop a new public health model for their treatment.




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