Contributor(s): Rebecca Chen, MD | Swedish Medical Center

Reviewer(s): Dr. Duncan Reed, MD, | Harborview Medical Center; James Sherrell, MPH | Harborview Medical Center

Community Reviewer(s): Jennifer Huong, Cambodian Caseworker Cultural Mediator | Harborview Medical Center

dark photo with a man looking out a window, the photo has vibes of depression
Photo by Damir Samatkulov © Creative Commons

The devastation wrought by the Khmer Rouge regime led to an international Cambodian diaspora, including resettlement of close to 150,000 people in the United States since 1975. Cambodian refugees started new communities in California, Washington, Massachusetts, and Minnesota (1). These communities have developed to include cultural centers such as Khmer Buddhist temples where refugees and their families could teach the next generation their language and traditions.

Medical literature has shown that Cambodian refugees have high rates of depression and post-traumatic stress disorder (PTSD) (2,3). Ethnographic research also shows evidence of disrupted family dynamics and dependence on substances such as alcohol (3, 4). These problems persist decades after the resettlement of Cambodian refugees in the United States and affect new generations of Cambodian-Americans as well. A lack of culturally responsive mental health treatments is noted in many studies that investigate the continued mental health needs of Cambodian refugees (3, 5, 6).

Culturally responsive mental health treatment is difficult to pursue as it requires dedicated time to understand a community’s perspective on mental health issues and adequate resources to develop and implement an appropriate response. However, this time and resource allocation is clearly needed to address the underrated mental health needs of the Cambodian community. In one study, 97-100% of Cambodian refugees who had seen a doctor for mental health concerns were prescribed a psychotropic medication with limited use of trauma-focused psychotherapy (7). The first-line standard of care for PTSD, which many Cambodian refugees have, is psychotherapy, yet Cambodian refugees’ use of pharmacotherapy is nearly double that of White Americans and 6 times that of other Asian American groups. Furthermore, Cambodian people may be prescribed medications but not adhere to treatment in a way that would enable them to see therapeutic effects. Cambodian cultural navigator Jeniffer Huong reports that during her home visits, “Nobody takes” the medications prescribed, and “only when I have a headache” or other problem acutely come up would somebody reach for a medication (8). She understands that community members are not used to taking a medication daily for ongoing chronic disease.

A target for intervention is community-based programs to improve understanding of mental health disorders and implement long-term, sustainable efforts to improve the mental health of the Cambodian refugee community. One such community-based program was successfully implemented in Lowell, Massachusetts, an area with the second-largest concentration of Cambodian Americans in the United States (9). Their community health center integrated Cambodian staff members to explain health concepts and consulted with Buddhist monks; this health center saw an improvement in depression screening scores over the course of the program. Cambodian Americans in Seattle believe that using Buddhism studies and classes at temple will help connect the second generation to their parents’ experience and grapple with the ongoing mental health needs of refugees and their families (10). Another program that improved mood, the Cambodian Health Promotion Program in Massachusetts, used five health educational sessions to provide culturally tailored health promotion education wherein an American mental health practitioner and a Cambodian community health worker co-lead small group sessions (11).

Piloting a program based on the Cambodian Health Promotion Program would be an achievable and impactful project to improve PTSD and depression in the Cambodian community. The curriculum is available on request, and sessions could be modified to address health topics like trauma and heightened emotions, which was not in the original curriculum. As EthnoMed has a contingent of community health workers already, deploying this curriculum in a community-based setting such as a Buddhist temple or Cambodian gathering space would be an effective strategy to promote mental health in the Seattle Cambodian community.

Sources

  1. https://asiasociety.org/cambodian-diaspora
  2. Marshall, G. N., Schell, T. L., Elliott, M. N., Berthold, S. M., & Chun, C.-A. (n.d.). Mental Health of Cambodian Refugees 2 Decades After Resettlement in the United States. www.jama.com
  3. Mak, C., & Wieling, E. (2024). Mental Health and Relational Needs of Cambodian Refugees after Four Decades of Resettlement in the United States: An Ethnographic Needs Assessment. Behavioral Sciences, 14(7). https://doi.org/10.3390/bs14070535
  4. Mak, C., & Wieling, E. (2024). Intergenerational transmission of traumatic stress and relational disruptions among Cambodian refugee families in the United States. Journal of Health Psychology, 29(14), 1614–1628. https://doi.org/10.1177/13591053241245098
  5. Bitterfeld, L., Ozkaynak, M., Denton, A. H., Normeshie, C. A., Valdez, R. S., Sharif, N., Caldwell, P. A., & Hauck, F. R. (2025). Interventions to Improve Health Among Refugees in the United States: A Systematic Review. Journal of Community Health, 50(1), 130–151. https://doi.org/10.1007/s10900-024-01400-2
  6. Wong, E. C., Marshall, G. N., Schell, T. L., Elliott, M. N., Hambarsoomians, K., Chun, C. A., & Berthold, S. M. (2006). Barriers to mental health care utilization for U.S. Cambodian refugees. Journal of Consulting and Clinical Psychology, 74(6), 1116–1120. https://doi.org/10.1037/0022-006X.74.6.1116
  7. Wong, E. C., Marshall, G. N., Schell, T. L., Berthold, S. M., & Hambarsoomians, K. (2015). Characterizing the mental health care of U.S. Cambodian refugees. Psychiatric Services, 66(9), 980–984. https://doi.org/10.1176/appi.ps.201400368
  8. Reid, D (Host). (13 October 2024). From Phnom Penh to Harborview – The Journey of Jeniffer Huong (19). [Audio podcast episode]. In The EthnoMed Podcast. https://www.buzzsprout.com/2510538/episodes/18007675. 
  9. Grigg-Saito, D., Liang, S., Sou, L., Najarian, L., Peou, S., Och, S., Toof, R., & Silka, L. (2010). Long-term development of a “whole community” best practice model to address health disparities in the cambodian refugee and immigrant community of Lowell, Massachusetts. American Journal of Public Health, 100(11), 2026–2029. https://doi.org/10.2105/AJPH.2009.177030
  10. Jenny Chhim, phone interview, 16 August 2025.
  11. Berkson, S. Y., Tor, S., Mollica, R., & Lavelle, J. (2014). An Innovative Model of Culturally Tailored Health Promotion Groups for Cambodian Survivors of Torture. In TORTURE (Vol. 24, Issue 1).