Project Overview
The “Montagnards” (“mountain people” in the French language) represent a diverse array of cultures originating in the highlands of Vietnam. Largely isolated farmers or hunter-gather communities, the Montagnards were recruited by, and fought with, the American Special Forces throughout the Vietnam War. When the war ended with the fall of Saigon in 1975, the Montagnards were especially persecuted in the new regime. Montagnard individuals began arriving in the US as refugees in the mid-1980’s and family reunification efforts have continually brought more refugees here to the present day. There are over 12,000 Montagnards living in Greensboro, North Carolina, representing several cultures and distinct languages, with a majority of them in Guilford County. This makes the Piedmont the largest Montagnard community outside of southeast Asia. This study aims to document access to mental health care across four distinct generations of Montagnard community members, in an effort to identify potential mental health concerns that may be unique to each generation.
When considering the overall health of Montagnards, both physical and mental, it is important to consider former experiences in Vietnam like starvation, trauma, and chemical exposure, and also the experience of being a refugee and an immigrant living in the United States. The immigrant health paradox is the idea that oftentimes, even if a migrant arrives to the United States relatively healthy, their health tends to get poorer the longer they remain in the U.S. Prior studies looking at the immigration experience of Vietnamese found them to be disadvantaged in several indicators of mental health, and refugees in the U.S. have been observed to have an elevated burden of chronic disease.
The first generation Montagnard elders (born by 1970), spent the most time in Vietnam and experienced trauma and persecution firsthand. Many are preoccupied by concerns of family members that got left behind in Vietnam. The second generation of Montagnards (born 1971-1985) directly experienced the trauma of Montagnard life post-1975, but unlike the first generation, they were young children when these events unfolded. The third generation (born 1985-1995) is, in many ways, in between. They are the link between the young and the old, and both Montagnard and American cultures. The fourth generation (born after 1995), or the youngest of the Montagnards, have a radically different experience and perspective from those of the older generations. Many members of this generation speak fluent English and were born and educated in the United States. Montagnard researchers have concerns about suicide in this population. The youngest Montagnards are faced with the challenge of reconciling their Montagnard and American identities.
Health access is a known issue in the Montagnard community, and it is not hard to imagine how sociocultural, political, and economic variables can help to further compound and explain negative health outcomes. Five aspects of health access are studied in this project via a framework analysis of five dimensions of health services provision: approachability, acceptability, availability/accommodation, affordability, and appropriateness.
Data Collection Overview
This data are from the results of a qualitative research study about access to mental health care in the Montagnard population in North Carolina. Semi-structured interviews were conducted with Montagnard individuals, and interviews were then transcribed and analyzed using Dedoose software.
The study included 26 participants, with 2 participants in the first generation, 3 in the second generation, 12 in the third generation, and 9 in the fourth generation. The participants had to be at least 18 years old to participate in the study. For participants born in the US, age was determined by official US-issued government documents, such as a driver’s license or government ID. For individuals born in Vietnam, particularly in the oldest generation, birth dates given on governmental identification (i.e., immigration documents or driver’s licenses) are often incorrect since their birth dates were never known or documented officially. In these cases, the placement of an individual in a particular generation depended on their memories of the pivotal year (1975) and what they were doing at that time (i.e., were they a young child, or a soldier, etc.). All participants had to speak a language that can be translated by one of the available translators. There are many distinct languages within the Montagnard communities and we were only able to interview those individuals with whom we can be confident of the verbal and later transcribed translation.
Due to the COVID-19 pandemic, we shifted data collection to a virtual format. All interviews beginning with the third participant were conducted virtually. Data collection occurred from March 2020 through August 2020.
The virtual data collection consisted of two portions. First, participants were sent an online Qualtrics survey. This survey included the consent form and virtual signatures, as well as the mental health screen (which asked questions about depression (PHQ-9), anxiety (GAD-7), PTSD (PC-PTSD), and alcohol abuse (AUDIT); see p. 4 of the shared combined Survey Instruments file). The final page of the online survey displayed local resources that participants could contact if they felt in need of support for their mental health, and the phone number for the National Suicide Prevention Lifeline. Once participants completed the online consent and mental health screen, we planned a time to conduct an interview with them over phone or video chat. In the interview we asked participants about their access to mental health care. With consent of the participant, the interview audio was recorded so that it could later be transcribed.
Shared Data Organization
The shared data (under controlled access) consist of the de-identified transcripts from 26 individuals and the resulting code counts from analyzing the transcripts, organized by participant and selected covariates. The documentation files included consist of the full survey instruments, the information sheet and consent script used, as well as the codebook with definitional of the thematic codes used to analyze the transcripts. The documentation also includes two videos that were created to share the findings of the research back to the community, available in English and Jorai, and a corresponding transcript available in English.
