Physical disorders among Southeast Asian refugee outpatients with psychiatric disorders.

OBJECTIVE: The study assessed the prevalence and duration of axis III physical disorders and the resulting level of disability among Southeast Asian refugee outpatients with axis I psychiatric disorders. METHODS: A total of 266 consecutive patients who were evaluated in a psychiatric outpatient clinic were assessed for the presence of axis III conditions through questions about physical symptoms, a medical history and review of records, physical examination, and laboratory screening. The sample included 158 Hmong, 58 Laotian, 43 Vietnamese, and seven Cambodian patients. RESULTS: Fifty-five percent of the patients had one or more axis III disorders, most of which were chronic and were not associated with extreme disability. Neurological conditions were most common, and the sequelae of war-related trauma were prominent. No associations were found between the presence of axis III conditions and age, gender, marital status, or ethnic group. In 48 cases, the axis III condition may have caused or exacerbated the axis I condition. CONCLUSIONS: Routine medical history and a physical examination, including a neurological examination, are recommended for all psychiatric patients, including outpatients.

Substance disorder among 100 American Indian versus 200 other patients.

The purpose of this study was to examine the demographic and clinical characteristics among American Indian (AI) patients and other patients with Psychoactive Substance Use Disorders (PSUD). The study was conducted at a university-based, alcohol-drug program in the Upper Midwest. One hundred AI patients presenting sequentially with PSUD were contrasted with 200 other patients (selected at random from 620 patients) presenting at the same clinical facility during the same period with PSUD. Data included demographic characteristics, current DSM-III-R PSUD diagnoses, previous treatment for PSUD, and family history of PSUD. Findings indicated several special aspects of PSUD among AI patients, which have implications for program planning and treatment evaluation.

Substance abuse and associated psychiatric disorder among 100 adolescents.

One hundred adolescents aged 14 to 20 were studied in treatment programs located in two states (Minnesota and Oklahoma). The purpose of the study was to assess the course of substance use, number and type of substance disorder diagnoses, severity of substance disorder, treatment history for substance disorder, and psychiatric comorbidity. Duration of course, frequency of substance use, abuse vs. dependence, types of substances used, and associated problems are described as a function of age. Areas of psychiatric and social assessment included: (1) psychiatric self rating scales in those 17 years and older (BDI and SCL-90); (2) psychiatrist rated scales (Hamiltons for anxiety and depression, BPRS, GAS); (3) psychosocial status (Hollingshead and Redlich SES, DSM-III Axes 3 and 4); (4) associated Axis 1 psychiatric diagnoses; (5) family history of mood and other psychiatric disorder; (6) childhood history; and (7) history of previous psychiatric treatment. These data confirm the severity of substance use among younger adolescents presenting to clinical facilities with substance disorder, but further reveal progressive substance disorder severity as these adolescents age. Both self rated and psychiatrist rated scales showed increased depressive symptoms with increasing age. Eating Disorders occurred more often among older adolescents. Loss of either parent in childhood was associated with younger current age.

Substance use and other psychiatric disorders among 100 American Indian patients.

One hundred American Indian patients with a Psychoactive Substance Use Disorder (PSUD) were studied with special reference to associated psychiatric disorders. This clinical sample was divided into three groups: PSUD only, PSUD plus an Organic Mental Disorder (OMD), and PSUD plus any other psychiatric disorder. OMD diagnoses included primarily Delirium Tremens and Alcoholic Hallucinosis; cases of Alcohol Amnestic Disorder, Alcohol Dementia, and trauma-induced OMD were also encountered. Other psychiatric disorders included primarily Major Depression and Anxiety Disorder, with smaller numbers of Schizophrenia, Conduct, Sexual, and other Disorders. Demographic and clinical characteristics were compared among these three groups. Those with PSUD+OMD tended to be older, male, and have more DSM-III Axis 3 disorders (American Psychiatric Association 1980) as compared to other patients; those with PSUD+other diagnoses tended to be single and younger. Education and occupational status were not related to the three diagnostic groups. The data were also subjected to MANOVA analysis. Even when corrected for sex, types of substance being abused, Axis 3 health status, and other factors, the three diagnostic groups still bore a significant relationship to age. Those with PSUD+Other psychiatric diagnoses besides OMD tended to be youngest. Those with PSUD-only were intermediate by age, while those with PSUD+OMD tended to be the oldest.

Welfare status and psychosocial adjustment among 100 Hmong refugees.

Although the mental health of recently employed persons has been well studied, the mental health of welfare recipients is not well understood. Among our increasing refugee population, many receive welfare benefits at some point. The Hmong are among those who are highly represented among welfare recipients in several areas of the United States. Do psychiatrists have anything to contribute toward the resolution of high welfare rates? This question is especially relevant in refugee populations who are at increased risk for several psychiatric disorders, including depression, paranoia, and adjustment disorders. This study was undertaken among 100 Hmong refugees who had been in the United States for 8 years. Indices of mental health included two rating scales (the Zung Depression Scale and the SCL-90), five-axis DSM-III diagnoses, Hamilton Anxiety and Depression Scales, Global Assessment Scale, Brief Psychiatric Rating Scale, Inpatient Multidimensional Scale, and Mini-Mental State Exam. These indices were compared with current welfare status and the duration of time on welfare. Other comparisons with welfare included demographic characteristics, material possessions, acculturation characteristics, health and social problems, and nonoccupation avocations. Results indicate that welfare recipients show lower acculturation and elevated psychiatric symptom levels. Suggestions for ameliorating this situation are extrapolated from studies in the literature on chronically unemployed persons.

An epidemic of opium dependence among Asian refugees in Minnesota: characteristics and causes.

After several decades absence, opium smoking has reappeared in the U.S. Introduced by Indochinese refugees in the early 1980's, it has spread to several regions of the country. In this report the characteristics of refugee opium addicts is described. In addition, the factors contributing to a fertile situation for opium addiction are presented. Finally, implications of these findings and remedial recommendations are suggested.

Psychosocial adjustment of Hmong refugees during their first decade in the United States. A longitudinal study.

Over their first decade in the United States, 100 Hmong refugees were studied on three occasions. Data included demographic characteristics, acculturation skills, traditional affiliations and pastimes, material acquisitions, psychosocial problems, and self-rating scales. In addition to a description of the data changes, a multiple regression analysis was performed. Changes demonstrated considerable evidence of acculturation, psychiatric care seeking, and greatly reduced symptom levels for several symptom complexes. However, a large minority of subjects remain illiterate, unable to speak English, generally involved with other Hmong but not with the majority society, and/or have high symptom levels on self-rating scales. Regarding symptom changes, depression, somatization, phobia, and self-esteem symptoms improved the most with time and acculturation. On the contrary, anxiety, hostility, and paranoid symptoms changed little. Multiple regression analyses indicated that strong traditional ties (e.g., large household size, being an herbal healer), older age, marital problems, and medical complaints were most associated with high symptom levels.

Somatization among refugees: an epidemiologic study.

Somatization has been widely reported among refugee psychiatric patients since World War II, and some psychological theorists have viewed somatization as an alternative to depression. These and other theories were tested in a population survey of 97 Hmong refugees who had lived in the U.S. for several years. Four different measures of somatization were employed, including a 12-item self-rating scale, a single-item global rating based on the total interview, and somatic subscales of the two Hamilton interview-rating scales. These data demonstrate that somatization accompanies certain demographic characteristics that are associated with failure to acculturate. Somatization in this non-patient, refugee population was associated with treatment seeking and self-identified "medical problems" and with psychiatric symptoms and disorders, but not with objective evidence of medical disorder.

Social networks and psychopathology among substance abusers.

The authors studied the social networks and psychopathology of 168 patients with diagnoses of substance abuse. Small network size was correlated with higher scores on the Modified Michigan Alcohol-Drug Screening Test, higher symptom reports on the SCL-90 and the Beck Depression Inventory, and more observed psychopathology according to the Brief Psychiatric Rating Scale. Larger network size was correlated with better functioning according to the Global Assessment Scale and DSM-III axis V. The authors conclude that such symptom complexes as paranoia and phobia may undermine the social networks of substance abusers more than such symptom complexes as anxiety and depression.

Substance use and abuse among mentally retarded persons: a comparison of patients and a survey population.

Substance abuse among mentally retarded persons, first described 55 years ago, has received little or no attention by specialists in mental retardation. With deinstitutionalization, this problem has reappeared, often followed by victimization (i.e., assault, rape, robbery). In this study the demographic characteristics, family and childhood history, substance use patterns, and substance-related problems of 40 mild mentally retarded persons are compared with those of 40 mild mentally retarded persons without substance abuse. Similarities with substance abusers who are not mentally retarded are noted. Recommendations for alleviating this serious problem among mentally retarded persons are made.

Predicting treatment outcome after ten years among American Indian alcoholics.

Forty-five American Indian alcoholics were intensively studied in 1970-1971. In addition to the usual demographic characteristics, research scales included Alcoholism History Scale, Alcohol Withdrawal Scale, Indian Culture Affiliation Scale, Social Competence Scale, Legal Problems Scale, Psychiatric Problems Scale, Liver Dysfunction Scale, Malnutrition Scale, and Abnormal Laboratory Screening Scale. These findings in 1970-1971 were then correlated with a four-item outcome rating obtained in 1980-1981. Better outcome was associated with less parental loss, ever having been married, compliance with treatment recommendations, and having predominantly Indian rather than non-Indian friends. Women alcoholics were unlikely to deteriorate and still survive, although this was the most frequent pattern among the men. Higher Indian Culture Affiliation and more severe Liver Dysfunction in 1970-1971 were correlated with better outcome in 1980-1981. Possible explanations for these findings are considered.

Acculturation and mental health: a study of Hmong refugees at 1.5 and 3.5 years postmigration.

This study of Hmong refugees at 1.5 and 3.5 years following arrival in the United States showed considerable improvement on psychiatric self-rating scales. Social changes over the 2 year interim (including a high unemployment rate) were few. Earlier premigration and postmigration variables correlated with high symptom levels at 1.5 years were not correlated with these symptoms at 3.5 years. Events in the acculturation process which accompany, and perhaps account for some of these observations are indicated.

Symptom change over time among Hmong refugees: psychiatric patients versus nonpatients.

Most Hmong refugees in Minnesota were assessed in September, 1977, using two self-rating scales (Zung Scale for Depression and 90-item Symptom Checklist). The same group was restudied two years later. During 12 months of 1977-78, psychiatric services were offered to this population. Those seeking psychiatric care were compared with those who did not. These data indicate that the patients reported considerably more symptoms than nonpatients in 1977 prior to receiving care. The patients showed more improvement than the nonpatients between 1977 and 1979.

Refugees who do and do not seek psychiatric care. An analysis of premigratory and postmigratory characteristics.

Social psychiatric research can provide information about the role of interpersonal and societal factors in the genesis of psychiatric disorder. This discipline relies heavily on "experiments in nature" which expose a large number of people to a potentially pathological social stimulus. It also depends in large part upon the study of nonpatients to serve as a comparative group for patients. Both conditions are met in this study of Hmong refugees from Indochina. While the population and the event are esoteric to some extent, their experiences of sudden sociocultural change, geographic migration, role discontinuity, identity crisis, and massive loss are common experiences among many psychiatric patients, regardless of their origin. Thus this study contributes to our understanding regarding the social genesis of psychiatric disorder. This prospective study of refugees to the United States was undertaken among the Hmong population in Minnesota (N = 97) during 1977. Subsequently 17 of this group became psychiatric patients over a 12-month period. Premigration and postmigration factors associated with patient status are described. Hypotheses are offered regarding those postmigration experiences or social strategies which favored or prevented psychiatric status.

Migration and mental health among Hmong refugees. Association of pre- and postmigration factors with self-rating scales.

To date there have been no epidemiological studies of a refugee population using self-rating scales. This method was used in a study of Hmong refugees in Minnesota. Self-reported symptoms were compared with premigration and postmigration factors to assess those characteristics associated with increased symptom reporting. Relatively few premigration factors influenced these self-reports, whereas several postmigration factors were significantly correlated with symptoms. These findings suggest certain interventions which might enhance the adjustment of subsequent refugees.

Variability in opium dosage: observations from Laos, 1965-75.

Opiate addicts are generally believed to consume a fairly constant level of drug. These data indicate that, for most addicts over time, there is considerable variability in dosage. This variability occurs not only amongst addicts, but also in most individual addicts over time. Extreme constancy in dosage does prevail for some addicts over prolonged periods, but this is not the norm. Factors influencing dosage include age, gender, ethnicity, socioeconomic status, duration of addiction, drug cost and drug availability. Distributions in dosage patterns are presented in this report.

Alcoholism indicators: nonreliability of events partially related to alcohol abuse.

Certain events partially associated with alcohol abuse (e.g., all hepatic cirrhosis) as well as those wholly associated with alcohol abuse (e.g., alcoholic cirrhosis) have been used to assess changes in alcoholism rates over time. In this paper, events partially associated with alcohol abuse are compared with events wholly correlated with alcohol abuse. Location and time of the study was the state of Minnesota from 1965 to 1977. Taken as a whole, the partially related events fail to show an increase in alcoholism while the wholly related events point to an increase. The literature on these alcohol-related events is reviewed, and theories for the discrepancies between partially and wholly related events are offered.