IRRI Brief Report Publication No. 2016-1
March 2016
Burmese
Community
Behavioral Health
Survey
A Report of Preliminary Results
Isok Kim, PhD LCSW
Mary Keovisai, MA
Immigrant and Refugee Research Institute
School of Social Work, University at Buffalo
219 Parker Hall, Buffalo NY 14214-8004
Phone: 716-829-3991; Fax: 716-829-3992
IRRI Brief Report Publication No. 2016-1
Table of Contents
Summary of Findings ...................................................................................................................... 2
Overview ......................................................................................................................................... 3
Sample............................................................................................................................................. 3
Data Collection Procedures............................................................................................................. 4
Results ............................................................................................................................................. 4
Burmese refugees are recent arrivals to Buffalo ......................................................................... 4
Burmese community in Buffalo consists of diverse subgroups .................................................. 5
Burmese refugees have high unemployment and low household income .................................. 6
Burmese refugees have spent multiple years in refugee camps .................................................. 7
Concerns about Burmese behavioral health is real ..................................................................... 9
Many Burmese refugees are not satisfied with their primary care doctors or clinic .................. 9
Conclusion .................................................................................................................................... 10
Acknowledgement ........................................................................................................................ 10
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IRRI Brief Report Publication No. 2016-1
Summary of Findings
This report provides preliminary findings from the Burmese Community Behavioral Health
Survey (BCBHS). The study is being conducted in collaborative partnership with the Burmese
Community Support Center and Burmese Community Services as a community-based research
project. The preliminary findings reported here are based on the first 151 surveys collected
between March 2015 and February 2016. Key initial findings from the study include:

Burmese refugees are recent arrivals to Buffalo. Almost all (92.7%) of Burmese
refugees in the study arrived in the United States within the past 10 years.

Burmese community consists of diverse subgroups. The community is made up of
at least eight different ethnic groups1, with a subsection with multiple ethnic
backgrounds. Refugees from Burma speak various different languages based on their
ethnicity. This diversity is important when understanding and working with the
community.

Burmese have low household income. While the majority of Burmese refugees are
employed, eighty-four percent of those employed make less than $2000 per month.

Burmese refugees have spent multiple years in refugee camps. Eighty-five
percent of Burmese refugees have spent more than a year in a refugee camp and some
for over 20 years.

Concerns about their behavioral health are real. While the majority of Burmese
refugees self-report as having good/excellent physical (69.2%) and mental (70.9%)
health, results of behavioral health related measures highlight areas where further
intervention is warranted:
o Seventy-eight participants (51.7%) reported high enough trauma-related
symptoms (RHS-15) that may require mental health specialist referrals.
o Twenty-five participants (16.6%) reported high enough anxiety and
depression symptoms (HSCL) that warrant mental health specialist referrals.
o Twenty participants (13.3%) were identified as having alcohol related
problems (AUDIT), who could benefit from addiction specialist referrals.
o Eleven participants (7.3%) were identified as having moderate to severe
problem gambling (PGSI).

Many in the Burmese community are not satisfied with their primary care
doctors or clinic. About one in four Burmese refugees (25.8%) are either not at all
or not very satisfied with the medical care they are receiving from their primary
doctor/clinic. Given high prevalence rates of trauma and other behavioral health
symptoms, doctors as well as clinic staff must learn to develop trusting relationships
with Burmese refugee patients.
1
Eight major ethnic groups officially recognized by the Burmese government are Barmar, Chin, Kachin, Kayin
(Karen), Kayah (Karenni), Mon, Rakhine, and Shan. Rohingya people, who are one of the most discriminated
groups in Burma currently, are not recognized by the Burmese government as one of the 135 ethnic groups.
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IRRI Brief Report Publication No. 2016-1
Overview
Decades of political turmoil in Burma has resulted in massive displacement of several ethnic
groups from Burma. More than half a million people were reported to have lived in designated
refugee camps along the western Thailand border at some point (Barron et al., 2007). Of those,
approximately 121,100 refugees from Burma entered the United States between 2002 and 2013
(Office of Refugee Resettlement, 2012; Refugee Processing Center, 2014), making them the
largest refugee group resettled in the United States since 2000.
The city of Buffalo is home to between 8,000 and 10,000 refugees from Burma, who
significantly contributed to an increase of city population for the first time in more than three
decades (Schulman, 2016, January 14). The Burmese refugee community is a critical component
in revitalization for the City of Buffalo. At the same time, Burmese refugees themselves have
begun to raise concerns about the overall status of their community’s well-being. In particular,
there exists little to no empirical information regarding behavioral health conditions on this
important and growing segment of Buffalo residents.
Behavioral health problems refer to mental and emotional concerns and/or choices and actions
that affect individuals’ overall well-being (Substance Abuse and Mental Health Services
Administration, 2012). Symptoms of mental illnesses, substance misuses, intimate partner
violence, and gambling problems are examples of behavioral health concerns that might impact
community members’ overall sense of well-being. The BCBHS study was proposed to narrow
the knowledge gap in these problem areas by gathering data through survey interviews. It is the
first systematic effort to collect empirical data in trying to understand behavioral health
conditions among the Burmese refugee community in Buffalo, NY.
This study employs the social determinants of health (SDH) framework, which indicates that the
current structural, sociocultural, and individual circumstances altogether shape and influence
physical and psychosocial adjustment patterns of people in a society (Commission on Social
Determinants of Health, 2008; Galea & Steenland, 2011; Solar & Irwin, 2007). This is
especially true for refugees resettled in the United States, who are trying to adjust to a new
cultural and built environment while not knowing the language. The SDH framework provides a
useful platform in examining sociocultural dimensions, such as language and minority status, as
critical factors in shaping long-term behavioral health outcomes among refugee populations in
the United States (Kim & Kim, 2014). CSDH set priority for undoing social injustices that
create differential physical and mental health statuses for underserved populations. This also
includes responding to various behavioral health needs of refugees resettling in a geographically,
culturally, and linguistically foreign environment.
Sample
Using a convenience sampling method, community interviewers have been recruiting
participants at community-based agencies, religious institutions, and through various community
networks. The eligibility criteria to participate in this pilot study are as follows: (a) be a refugee
from Burma; (b) be at least 18 years old; and (c) be a resident of Erie County.
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IRRI Brief Report Publication No. 2016-1
Preliminary sample consists of 151 community members. A little over half (57.6%) of the
participants are female. Their age ranges from 19 to 75, with an average age of 39.7 (SD=10.7).
The majority (66.9%) of the participants are married or in a domestic partnership. Four out of
five participants (79.8%) have less than a high school education. Almost all of the participants
are able to speak and understand their native language, but a smaller majority (71.4%) are able to
read and write well in their native language.
Data Collection Procedures
Considering a high rate of illiteracy in the population, face-to-face interviews were conducted by
the trained bilingual community interviewers using the survey questionnaires, which were
translated in Burmese language. In addition, due to severe logistic limitations of translating the
entire survey into Karen languages, interviewers who are proficient in both Karen and Burmese
were recruited and trained to interview participants who communicate in Karen. Informed
consent was obtained, which explained their basic rights regarding interview participation,
including the right to refuse and withdraw at free will at any time during the interview.
Results
Burmese refugees are recent arrivals to Buffalo
Years in the United States
11 years or more
6-10 years
0-5 years
7.3%
35.1%
57.6%
Burmese refugee resettlement is a newly emerging development in Buffalo. 92.7 percent of
Burmese refugees surveyed arrived in the United States within the past 10 years. Furthermore,
over half of these refugees have been in the United States for less than 5 years. With these recent
arrivals, the city of Buffalo is still adjusting to better understand their needs.
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IRRI Brief Report Publication No. 2016-1
Burmese community in Buffalo consists of diverse subgroups
Burmese refugees in Buffalo are comprised
of several different ethnic groups. Karen
and Barmar are the two largest ethnic
groups reflected in this survey, followed by
Karenni, Rakhine, and Chin, which
approximately mirrors the current ethnic
makeup of the Burmese community in the
city of Buffalo.
Ethnic Background
Shan Multiple
Rakhine
3%
4%
7%
Mon
3%
Barmar
28%
Karenni
12%
Chin
3%
Kachin
1%
Karen
39%
Similarly, the majority (52.4%) can speak
Burmese, but several groups of people
identified other ethnic languages as their
native language. In total, the study revealed
that there are at least seven different
languages spoken by Burmese refugees.
Providing appropriate interpretation and
translation services is a crucial part of
service delivery, so this linguistic diversity
within the community is noteworthy when
assessing an organization’s ability to
effectively communicate with those they
serve.
Native Language
19.9%, Multi
(Burmese +
Others)
0.7%,
Shan
32.5%,
Burmese
9.9%,
Karenni
1.3%,
Rakhine
1.3%,
Chin
32.5%,
Karen
2.0%,
Kachin
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IRRI Brief Report Publication No. 2016-1
Burmese refugees have high unemployment and low household income
Employment Status
No. of Participants
Employed
Student
Unemployed, seeking work
Unemployed, not seeking work
Homemaker
76
8
24
8
34
Percentage
50.7%
5.3%
16.0%
5.3%
22.7%
The unemployment rate (16.0%) of the Burmese refugees is significantly higher than in the
Buffalo-Niagara Metro area as a whole, which saw an annual unemployment rate of 5.6 percent
in 2015 (New York State Department of Labor, 2016). In addition, those who are able to find
employment are earning less than $2000 per month as a household and the majority (56.9%) earn
between $1000 and $2000 per month. Aside from language barriers, educational, vocational, or
professional degrees earned in Burma are not accepted as equivalent degrees in the U.S. job
market, which may contribute to underemployment and limit their earning potential. A fair
number of refugees (22.7%) are also homemakers, which limits the number of workers per
household and thus the total household income.
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IRRI Brief Report Publication No. 2016-1
Monthly Household Income
35.0%
28.8%
30.0%
28.1%
25.0%
20.0%
15.0%
10.0%
13.0%
8.6%
7.9%
5.8%
5.0%
5.0%
1.4%
1.4%
<$3500
$3500 +
0.0%
None
<$500
<$1000
<$1500
<$2000
<$2500
<$3000
Burmese refugees have spent multiple years in refugee camps
Length of Camp Stay
20 years or more
8.5%
10-20 years
29.9%
5-10 years
21.5%
1-5 years
Less than a year
25.2%
15.0%
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IRRI Brief Report Publication No. 2016-1
A large portion of the refugees in the study (85%) spent over a year in a refugee camp. The
mean length of stay in a refugee camp was 9 years and 2 months. While living in camps,
refugees are limited in their ability to move freely outside of the camps and resources can
sometimes be scarce inside the camps (Capps et al., 2015). Protracted stay, along with safety
and security problems, in the camps can add additional stress to refugees who have escaped
violence and persecution in their country of origin. In addition, lack of food and sanitation in the
camps contribute to developing various medical problems and exacerbating pre-existing medical
conditions. Finally, uncertainty surrounding their fate while surviving in the camps can further
worsen their already tenuous emotional and psychological status.
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IRRI Brief Report Publication No. 2016-1
Concerns about Burmese behavioral health is real
Behavioral Health Measures
No. of participants
Percentage
Trauma
Symptoms2
Anxiety
& Depression3
Alcohol
Problems4
Gambling
Problems5
78
25
20
11
51.7%
16.6%
13.3%
7.3%
While the majority of Burmese refugees self-report as having good/excellent physical (69.2%)
and mental (70.9%) health, results of behavioral health related measures highlight areas where
further intervention is warranted. A significant portion of the Burmese refugees in the study
reported high symptoms of trauma-related symptoms (RHS-15), anxiety and depression (HSCL),
and alcohol related problems (AUDIT). More than seven percent of the participants were also
identified as having moderate to severe problem gambling (PGSI). As a newly arrived group,
early behavioral health intervention is key to ensuring the continuing well-being of the
community.
Many Burmese refugees are not satisfied with their primary care doctors or clinic
Primary Care Physician Satisfaction
No. of participants
Percentage
Not At All
Satisfied
Not
Very Satisfied
Somewhat
Satisfied
Very
Satisfied
1
33
85
13
0.8%
25.0%
64.4%
9.9%
Over a quarter of all participants indicated that they are not satisfied with their primary care
physician. Past literature suggests that Asian Americans in general have relatively lower
satisfaction with the primary care (Murray-Garcia, Selby, Schmittdiel, Grumbach, &
Quesenberry, 2000; Ngo-Metzger, Legedza, & Phillips, 2004). What we do not yet know clearly
is the rate of physician satisfaction among refugees generally, and with Burmese refugees in
particular. This level of dissatisfaction with their physicians may contribute to refugees’
decisions not to seek services from their primary care physician. Nearly 17 percent of those in
the study did not visit their primary care physician in the past year, in spite of having high rates
of medical insurance.
Refugee Health Screener – 15 (Hollifield et al., 2013)
Hopkins Symptom Checklist (Hesbacher, Rickels, Morris, Newman, & Rosenfeld, 1980)
4
Alcohol Use Disorder Identification Test (Saunders, Aasland, Babor, De La Fuente, & Grant, 1993)
5
Problem Gambling Severity Index (Ferris & Wynne, 2001)
2
3
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IRRI Brief Report Publication No. 2016-1
Conclusion
This report highlights some of the important preliminary findings from the ongoing BCBHS
study. These initial findings begin to confirm many of the real concerns aired by the Burmese
community, such as trauma, language barriers, and alcohol problems, which have initiated this
study in the first place. On the other hand, the findings so far failed to confirm community
members’ other concerns, such as domestic violence incidences. By Spring 2017, a final report
is anticipated with comprehensive results of the BCBHS study, which will be finishing its data
collection phase in December 2016.
Acknowledgement
The BCBHS project has been generously funded by the University at Buffalo Civic Engagement
& Public Policy Research Fellowship and the UB School of Social Work Les Brun Research
Endowment Fund Pilot Program. We want to thank the Burmese Community Support Center
and the Burmese Community Services, Inc., as well as a number of key community
representatives, for their continuing partnership and support for this project. Finally, we thank
the countless number of individuals from the community who graciously agreed to participate in
this survey.
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IRRI Brief Report Publication No. 2016-1
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