Khmer Rouge trials may affect post-traumatic stress disorder symptoms among Cambodian survivors

August 04, 2009

The so-called "Khmer Rouge trials" now underway are likely to have an impact on the mental health of many Cambodians, according to a new study published in the August 5 issue of JAMA, a theme issue on violence and human rights.

"Millions of Cambodians suffered profound trauma during the Khmer Rouge era (1975 to 1979)," according to background information provided by the authors. "It is estimated that between one million and two million people (approximately 20 percent of the Cambodian population) died during that epoch, and millions of survivors were forced into slave labor under harsh conditions." The authors note that many previous studies suggest that the psychological effects among the population include a high prevalence of posttraumatic stress disorder (PTSD) and other mental and physical disabilities. A joint United Nations-Cambodian tribunal (the "Khmer Rouge trials") began hearings earlier this year to try the senior leadership of the Khmer Rouge.

Jeffrey Sonis, M.D., M.P.H., from the School of Medicine at the University of North Carolina at Chapel Hill, and colleagues analyzed data from face-to-face interviews of a national probability sample of 1,017 adult Cambodians to determine the prevalence of PTSD symptoms and disability and associations with perceived justice, desire for revenge and knowledge of and attitudes toward the trials. The population sample included 813 adults older than 35 years who had lived through the Khmer Rouge era and 204 adults ages 18 to 35 years who had not been exposed to the regime. A substantial percentage of the older adults reported being exposed to trauma during the Khmer Rouge era with about half (50.1 percent or 391) telling the interviewers that they had been close to death during that time and 243 respondents (31.4 percent) reported physical or mental torture. The interviews were conducted before the Khmer Rouge trials began.

"The prevalence of current probable PTSD was 11.2 percent overall and 7.9 percent among the younger group and 14.2 percent in the older group," the researchers report. That figure (11.2 percent) is almost five times higher than a current estimated PTSD prevalence figure of 2.3 percent in the United States, according to the researchers.

"Probable PTSD was significantly associated with mental disability (40.2 percent vs. 7.9 percent) and physical disability (39.6 percent vs. 20.1 percent)." More of the respondents in the older group were aware of the Khmer Rouge trials than those in the younger group. "Although Cambodians were hopeful that the trials would promote justice, 87.2 percent (681) of those older than 35 years believed that the trials would create painful memories for them." The researchers also found that respondents with high levels of perceived justice for violations during the Khmer Rouge era were less likely to have probable PTSD.

"The crucial question is whether the Khmer Rouge trials will reduce symptoms of PTSD by increasing feelings of justice or increase PTSD symptoms by reviving traumatic memories of survivors without providing an opportunity to process and reframe these memories." In conclusion the researchers write, "... longitudinal research is needed to determine the impact of the trials on Cambodians' mental health."
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(JAMA. 2009;302[5]:527-536. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This study was supported by a grant from the United States Institute of Peace. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For More Information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA or email: mediarelations@jama-archives.org.

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