Silent Trauma: Diabetes, Health Status, and the Refugee Southeast Asians in the United States

The impact of type 2 diabetes on Southeast Asian (SEA) communities in the United States-a group that includes Cambodians, Hmong, Laotians, and Vietnamese-is driven by cultural, historical, and logistical factors. Understanding these factors is a fi rst step in identifying potential interventions. Though there is great diversity within the SEA subgroup, its members are united by a strong sense of their respective communities and a reverence for local leaders. Effective programs to overcome barriers to type 2 diabetes prevention and control must capitalize on these strengths, while taking into account the unique requirements of this population. The purpose of this paper is to: 1. Increase awareness among health care providers, decision makers, and organizations serving Asian Americans of the risk for type 2 diabetes in SEAs and potential impacting factors. 2. Highlight data collection issues, barriers to care, and special health care needs, and introduce successful models in reaching Southeast Asian populations. 3. Identify resources available to organizations, government agencies, health care providers, and others who work with SEAs in the United States. This monograph discusses the following: The data on diabetes prevalence, rates of complications, and health care quality measures among SEAs are limited; Overweight as a risk factor for type 2 diabetes in SEAs-and Asian Americans in general-is underrecognized. The risk for type 2 diabetes increases at a lower body mass index for Asians than for other ethnic groups. Qualitative evidence from focus groups with Asian Americans indicates many Asians believe themselves to be at lower risk for type 2 diabetes because of smaller average body build; SEAs experience major obstacles to diabetes diagnosis and management, including inadequate access to culturally appropriate health care, lack of insurance coverage, and language barriers. For example, many SEAs are unaware of their federally mandated right to interpreter services and do not request these services; Low cultural acceptance of preventive health services among SEAs reduces opportunities for risk assessment, opportunistic testing, timely diabetes diagnosis, and interventions for diabetes prevention and management; Diagnosis and culturally appropriate treatment of concomitant mental health disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) are key in diabetes management; Mental health conditions such as PTSD (resulting from trauma and torture), anxiety, and depression are highly prevalent among SEAs and further complicate diabetes self-care; and Cultural competency among health care providers who treat SEAs is critical to successful interventions for diabetes prevention and control.