title: The relationship of PTSD to key somatic complaints and cultural syndromes among Cambodian refugees attending a psychiatric clinic: the Cambodian Somatic Symptom and Syndrome Inventory (CSSI).
abstract: This article describes a culturally sensitive questionnaire for the assessment of the effects of trauma in the Cambodian refugee population, the Cambodian Somatic Symptom and Syndrome Inventory (CSSI), and gives the results of a survey with the instrument. The survey examined the relationship of the CSSI, the two CSSI subscales, and the CSSI items to posttraumatic stress disorder (PTSD) severity and self-perceived functioning. A total of 226 traumatized Cambodian refugees were assessed at a psychiatric clinic in Lowell, MA, USA. There was a high correlation of the CSSI, the CSSI somatic and syndrome scales, and all the CSSI items to the PTSD Checklist (PCL), a measure of PTSD severity. All the CSSI items varied greatly across three levels of PTSD severity, and patients with higher levels of PTSD had very high scores on certain CSSI-assessed somatic items such as dizziness, orthostatic dizziness (upon standing), and headache, and on certain CSSI-assessed cultural syndromes such as khyâl attacks, "fear of fainting and dying upon standing up," and "thinking a lot." The CSSI was more highly correlated than the PCL to self-perceived disability assessed by the Short Form-12 Health Survey (SF-12). The study demonstrates that the somatic symptoms and cultural syndromes described by the CSSI form a central part of the Cambodian refugee trauma ontology. The survey indicates that locally salient somatic symptoms and cultural syndromes need be profiled to adequately assess the effects of trauma.
authors: Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. devon_hinton@hms.harvard.edu
authors: Devon E
authors: DE
authors: Hinton
authors: M Alexandra
authors: MA
authors: Kredlow
authors: Vuth
authors: V
authors: Pich
authors: Eric
authors: E
authors: Bui
authors: Stefan G
authors: SG
authors: Hofmann
mesh_terms: D000328:Adult; D002160:Cambodia / Q000208:ethnology; D003469:Culture; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000208:ethnology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012036:Refugees; D012647:Self-Assessment; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis / Q000208:ethnology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000208:ethnology*; D011795:Surveys and Questionnaires; D013577:Syndrome
keywords: Cambodian Somatic Symptom and Syndrome Inventory; PTSD; assessment; cultural syndromes; refugees; somatization