Parental Loss and Mental Health in Post-Khmer-Rouge Cambodia.

Adverse childhood events (ACE) may have lasting consequences throughout the life course. We focus on one particular type of ACE, parental loss in Cambodia-a country that lost nearly 25% of its population during the 1975-79 Khmer-Rouge regime-and on mental health disorders, one of the potential mechanisms through which ACE may have long-term consequences. Self-reports of symptoms that map on to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) criteria for anxiety, depression, and post-traumatic stress disorder (PTSD) were collected from 4,405 adults aged 20 and over. We first assess exposure to traumatic events and the prevalence of anxiety, depression, and PTSD using the DSM and alternative criteria. Based on the DSM criteria and previously validated Likert-scale thresholds, we find a high prevalence of anxiety (56.0%), depression (42.8%), and PTSD (2.3%), and even higher levels even among KRR survivors. We then use logit models to analyze the effect of parental loss before age 20 on the likelihood of having experienced traumatic events and experiencing mental health disorders. We find the loss of one parent increases the likelihood of full-PTSD symptoms, but the loss of both parents does not. These findings may result from positive selection into better-off households for orphans whose parents have both died but may also reflect the grief-related difficulties faced by the surviving parent of paternal or maternal orphans. While alternative thresholds for PTSD produced higher prevalence estimates, these measures did not perform better for assessing the effect of parental loss on mental health.