War Trauma and Strength: A Qualitative Study of Participants in the Vietnamese Insights into Cognitive Aging Program

Abstract

Objectives

Vietnamese Americans are the fourth largest Asian subgroup in the United States, but little qualitative work has been done on their war and migration experiences. In this study, we delineated the war-related traumas and strength in participants of the Vietnamese Insights into Cognitive Aging Program (VIP).

Methods

VIP is a longitudinal study of 548 Vietnamese Americans aged 65+ years living in Northern California. During Visit 1, a semi-structured interview was conducted on participants’ life and experiences in Vietnam and immigration to the United States. Using data at one of the recruitment sites, interviews of participants having the highest total self-reported traumas were transcribed in Vietnamese (n = 43) for coding and analysis following a thematic approach.

Results

Participants were 73.2 years old on average (SD = 5.48). Most were male (67.4%) and had attempted to escape Vietnam by boat at least once (67%). Two major themes were found: (1) experiences of adversity and suffering, which included subthemes on tough life experiences during the war, imprisonment and hard life after the war, escaping by boat and living in the refugee camps, witnessing or hearing about others’ traumas during the war and escape, and experiences of loss, and (2) personal fortitude and gratitude, which included subthemes on fortitude and endurance, personal skills to cope and navigate, and perceived “luck and blessings.”

Discussion

Results from this study revealed various traumas and aspects of strength. These findings can contribute to future VIP research on cognitive aging and inform research and practice on health disparities.

Evidence has indicated that early-life traumatic events are associated with an increased risk of poor physical and mental health outcomes, up to six decades after the initial experience of adversity (Carr, 2019). Among many kinds of traumas and adversities, exposure to war is a significant determinant of life expectancy and multiple morbidities. Traumatic wartime experiences in childhood or early adulthood, such as separation from family, can have lasting effects on health decades later (Alastalo et al., 2009). Other wartime exposures in early life, such as witnessing death, fearing death, intense bombing, stressful living conditions, and sleep disruption during wartime, were associated with higher frailty and worse health in later life across various health outcomes, such as mental distress, chronic pain, physical functioning, somatic symptoms, and post-traumatic stress symptoms (Zimmer et al., 2021, 2022). Although studies with veterans and soldiers have well-documented post-traumatic stress disorder (PTSD), depression, psychiatric disorders, poor self-rated health, cardiovascular disease, and cognitive issues as outcomes of exposure to war stressors (Brown et al., 2014; Durai et al., 2011; Johnson et al., 2010), research on war exposure among civilians has often been neglected.

Exposure to trauma, however, can also be associated with positive outcomes, such as higher resilience and self-esteem 15 years later (Radan, 2007), higher psychological strength later in life (Elder, 1986), or lower mortality rates and higher life expectancy (Sagi-Schwartz et al., 2013). These findings may suggest that early-life trauma exposure also fosters psychological strength and resilience to later-life stressors.

Compared to other large Asian American groups, Vietnamese Americans, who are the fourth largest Asian subgroup in the United States, numbering over 2 million, disproportionately suffer from early-life adversity, war- and immigration-related trauma, PTSD, depression, and low socioeconomic status (SES), all which are risk factors for cognitive impairment and Alzheimer’s disease and related dementias (ADRD) (Barnes et al., 2012; Flatt et al., 2018; Juster et al., 2010; Meyer et al., 2015; Yaffe et al., 2013), yet little research has focused on this population. Vietnamese Americans have a distinct social context in that all older Vietnamese living today grew up surrounded by civil unrest and war, in which, if fighting in the battlefield on the Southern side, they faced and suffered from many of the Viet Cong’s guerrilla tactics, such as surprise attacks, use of ambushes, tunnels, small and large holes camouflaged with spikes, grenades, and foliage, local terrain, and quick withdrawal (BBC, n.d.-a, b; Central Intelligence Agency, 2002), which might have intensified the stress and injury levels. Furthermore, the close of war in 1975 started a large and long refugee crisis; those who were left in the country faced torture and re-education, while those escaping the country faced various dangers including death, not being welcomed or recognized as refugees by most regional countries, and having to wait for months or even years in refugee camps before being screened for resettlement (BBC, 2019; Roos, 2023). Because immigration patterns vary among Vietnamese older adults, an understanding of early life and immigration experiences of this population could provide insight into risk and resilience factors for ADRD.

The Present Study

This study constitutes the qualitative component of the Vietnamese Insights into Cognitive Aging Program (VIP) and is based on a unique sample of Vietnamese individuals who experienced high levels of traumatic experiences during wartime and immigration to the United States. An enhanced understanding of early-life adversity and trauma exposures may lead to the identification of experiences linked with various health outcomes in later life, including cognitive outcomes. The aim of this study is to provide a detailed narrative of participants’ traumatic experiences related to the Vietnam War while also understanding their strength going through those experiences. The goal is to aid future research in cognitive aging as well as studies from the VIP on the nuanced association between war trauma and cognitive outcomes in Vietnamese people.

Method

Sample and Design

The VIP is a prospective cohort study that collects survey data on a wide range of health outcomes and life experiences of 548 Vietnamese Americans aged 65 and older living in either Santa Clara County or Sacramento County in Northern California (Meyer et al., 2023). In this study, only data from the Sacramento site were analyzed due to availability of qualitative data at the time of this analysis, in June 2023, or into the second year of data collection. Part of the full VIP assessment included an approximately 20-minute semi-structured interview in which participants were queried about their early life with particular exploration into war and immigration experiences. Trained bilingual Vietnamese staff interviewed participants about their backgrounds starting from when they were children, how they and their families left Vietnam, and the process of coming to the United States. The list of all interview questions and prompts used during the interview can be found in Supplementary Material. Examples of the questions include: “If [leaving the country] by boat, did you encounter pirates?” “What were the most challenging things that you experienced or witnessed?” “Which refugee camp(s) did you stay at?”

The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.” In this study, we focused on war-related traumatic events participants directly experienced or witnessed happening to other people. Table 1 lists 20 types of trauma exposures participants reported in the surveys about their early life, war, and immigration experiences, which were part of the quantitative data collected at their baseline visit. The trauma types were adapted from the War-Related Traumatic Events Scale (WTES; Young et al., 2021) that the Vietnam Health and Aging Study (Korinek et al., 2019) developed with modifications from the National Vietnam Veterans Readjustment Study (Kulka et al., 1988), Deployment Risk and Resilience Inventory (King et al., 2006), and Combat Exposure Scale (Keane et al., 1989). We then calculated the total count of their traumatic exposures, as shown in Table 2 for participants at the Sacramento site.

With the aim to narrate traumatic experiences, we selected participants whose self-reported total trauma count was among the highest or in the top one-third group, which made a subgroup of 53 individuals who had experienced 8–12 reported traumas. Within this subgroup, there were a total of 44 audible recordings from consenting participants. However, one interview did not reference traumatic or adverse experiences so was excluded, making a final list of 43 interviews in this study.

Procedure and Data Analysis

We conducted the interviews in Vietnamese due to limited English proficiency of many participants. Initially, research staff translated the interviews directly into English during transcription. However, for this study, all 43 interview recordings were eventually transcribed verbatim in Vietnamese. Study staff who translated were native Vietnamese and bilingual speakers, and the accuracy of the translation was confirmed by other study staff members, who were also native Vietnamese and bilingual speakers, through verifying each English transcript against the recordings and verbatim transcripts in Vietnamese. Regarding the Vietnamese transcription, 59% were transcribed verbatim by VIP study staff and the rest by a professional transcription company. We de-identified the data before sharing the files with the company, and upon receiving the transcripts, VIP research staff thoroughly verified each transcript against its recording.

The two coders for the transcripts had a good understanding of Vietnamese language and culture. The lead author was born, raised, and educated largely in Vietnam and therefore was very fluent in Vietnamese. The Principal Investigator (PI) was born and raised in the United States; her first language was Vietnamese, and although she took a community college class in Vietnamese as an adult, her literacy in English was better than Vietnamese. For this reason, initially, the lead author and the PI coded the transcripts in English to develop the codebook. This study followed an approach guided by the work of Kiger and Varpio (2020) on thematic analysis of qualitative data and Ryan and Bernard’s (2003) techniques to identify themes.

The two coders first familiarized themselves with two English transcripts by reading line by line before coding each one independently. We specifically looked for phrases, sentences, or passages in the text about wartime traumatic experiences to assign a descriptive label to while at the same time noticing positive comments scattered in the data. The coding process followed an inductive approach in which all codes were grounded in the data. We independently coded the text, then compared, discussed, and reconciled the codes that were in disagreement. We repeated this process three times, each time coding two new English transcripts, until no disagreement or new codes showed up in the data. Our initial codebook of 78 codes was refined to 46 codes and categorized into different time phases and events.

In the next step, the lead author used the codebook as a coding scheme to code the 43 transcripts in Vietnamese using Dedoose qualitative software (SocioCultural Research Consultants, 2015). The Vietnamese versions of the six English transcripts were also coded in Dedoose. At the end of the coding process, we determined categories or major events based on the outstanding magnitude of the codes’ distributions in comparison with others. The identifying of themes was based on answering the question, “What is this expression an example of?” (Ryan & Bernard, 2003, p. 87). We found that each category or major event was an expression of either adversity or strength. Therefore, two themes were identified from the data, under which subthemes were set.

Results

Sample

The 43 participants had a mean age of 73.2 years (SD = 5.48, range: 65–86). Twenty-nine were male (67.4%), and 27 among them served in the military of the previous South Vietnam government (27/29 = 93.1%). Thirty-nine percent finished high school; 32.6% had a primary school education, and 28.2% had at least some college. Approximately 67% reported having attempted to escape Vietnam by boat at least once (Table 3). Participants reported having experienced 8–12 traumas in total (Table 4) with an average of 9.47 traumas (SD = 1.18).

Major Themes

We identified two major themes from the data. Specifically, the theme experiences of adversity and suffering included five subthemes: tough life experiences during the war, imprisonment and life after the war, escaping by boat and experiences in the refugee camps, witnessing or hearing about others’ trauma during the war and escape, and experience of loss. The theme personal fortitude and gratitude consisted of three subthemes: fortitude and endurance, personal skills to cope and navigate, and gratitude.

Theme 1: experiences of adversity and suffering

1. Tough life experiences during the war

Many male participants mentioned harsh military experiences on the battlefield, including diseases, sickness (e.g., malaria), and injuries to their head and all over their body caused by shrapnel. It was also common to get lost and disconnected from their unit, or be besieged and have no access to food or water: “It was noon, so sunny, we had finished the water, and we were getting lost. We couldn’t find any source of water. Too thirsty, I peed into the canteen and drank from that. It was so bitter” (male, aged 70).

Even people who did not join the military were affected. One person shared about their house being bombed and burned down:

I will never forget the stinky, molded shelter we had to squeeze in because of the gun fires, and bombing. People ran, screamed, and yelled at us to run. We watched our house burn and my parents started crying. I held on to my parents and cried (female, aged 67).

Some experienced a major relocation from North to South Vietnam in their childhood or adolescence because their parents or families participated in the 1954–1955 Great Migration to South Vietnam to avoid the Communist rule. They left behind their homes, farms, lands, and cattle when war and bombing came to their village. The journey was sometimes difficult and treacherous because they had to hide and walk among the farms and fields instead of on the main road. Others reported being born into a poor or farming family, having many siblings, and quitting school at the elementary or secondary level to work to help support their family or raise their younger siblings.

2. Imprisonment and hard life after the war

After the Fall of Saigon in 1975, most individuals who served in the former Republic of Vietnam were incarcerated in “re-education” camps (see note in Table 1). The time length and location of imprisonment varied, from a few months to over 12 years, from local prisons to penal servitude in remote labor camps. Participants reported having endured daily hard labor, hunger, fatigue, and sickness including dysentery and malaria. Prisoners recalled that they were divided into teams to work on heavy tasks, such as digging a canal, chopping down trees, farming, breeding, or making furniture: “Life in the camps was extremely difficult… We did hard labor for the whole day but had only a bowl of rice or cassava” (male, aged 83).

Besides hard labor, a few participants suffered physically and psychologically. They reported having to walk barefoot, hands tied to one another, through long distant regions in the North or were kept in iron containers in the heat of the day and cold temperatures at night. Psychologically, these participants were lectured on Leninism and Marxism and made to encourage one another to stop pursuing other ideologies: “They said America and its government had turned me into an animal, and they were there to educate me to become a human being. That was why so many people became crazy and died” (male, aged 79).

The difficulty was not confined to prison or the participants themselves but continued upon being released and extended to their family members. Participants said they continued to be monitored, denied permission to travel for more than 2 hours, and denied the right to receive government rations of food and clothing:

[After being released,] I returned to Saigon, but they didn’t leave me alone. I was monitored and couldn’t leave my place for more than two hours. Every week, I had to sign a form reporting what I did during the week. […] When I was forced to labor in Rach Gia, every time I used the restroom, they waited for me outside… (male, aged 78).

When a political issue arose locally, the ex-prisoners were the first people suspected as the cause of the issue. Many individuals, including those who held high-ranking officer positions in the previous regime, restarted their livelihoods as construction workers, farmers, cart/tricycle drivers, street vendors, and other low-wage jobs. A few people stated that their valuables were confiscated, and family members were arrested. Some shared that they were forcibly relocated with their family to the “new economic zones” in the uninhabited forested or mountainous areas where livelihoods were challenging. Due to harsh conditions in these zones, some participants’ family members died.

Besides being in jail for serving in the military under the previous government, participants also talked about being arrested and imprisoned for attempts to escape the country by boat or on foot.

3. Escaping by boat and living in the refugee camps

To many participants in this study, escaping the country by boat was a life and death decision. The journey involved great fear and various dangers at sea. Escaping the country was considered treason and people who were caught could be sentenced to jail for several years. Thus, people were fearful that they would be caught by the coastal police.

Common adversities at sea included facing water and food deprivation, “There were more than ten days left but none of us had any food left” (female, aged 66). One person shared that her throat bled due to thirst. Seasickness and fatigue were also common. Situations became very perilous when they hit stormy weather or rocks. Women faced unique challenges if they were pregnant or nursing during the trip; some were sexually assaulted by the pirates, “I used my hands to brush him away, but I was afraid. If I made him angry, he might push me into the ocean, and I would die” (female, aged 72). The hardships continued in the refugee camp for some:

In the refugee camp, [the guard] beat me. My living space was 2 feet [wide]. Everybody shared a total of 8 liters of water per day, and there was not enough rice. I had to find single [unmarried] people who didn’t have a family, to combine my portion of rice with theirs to make it enough (male, aged 65).

4. Witnessing or hearing about others’ traumas during the war and escape

Another salient subtheme that emerged from the data was witnessing or hearing about others’ deaths and killings. In wartime, many participants serving in the military had to carry injured fellow soldiers or their corpses. Living in war zones generally exposed participants to witnessing horrific scenes, “My area [in Saigon] got bombed a few times […]. Houses near ours collapsed, burned down, people died. I still remember. I was very scared of the bombs” (male, aged 70). On escaping from Vietnam, participants also witnessed death, “Many died on the boat due to old age or sickness. They were wrapped in nylon and thrown into the ocean” (female, aged 66). Lack of food and starvation were so common that there were stories of humans eating the flesh of fellow passengers who died on the boats. Some shared that they knew about killing and death in the refugee camps, where women were raped and left on the railroads to be killed by trains.

5. Experiences of loss

The experience of losing significant loved ones and losing property happened during the war, in the escape from the country, as well as in the refugee camp. Participants talked about their family members passing away either in the war, in the “re-education” camps and refugee camps, or were killed due to other political reasons. Some had to leave some of their children in Vietnam because they were not able to bring all of them in the escape. Often, participants discussed finding out later that these children had died due to various harsh conditions. Loss of property and valuables happened mainly after the collapse of Saigon in 1975. For those who were sent to the new economic zones or left the country, their houses and lands were either confiscated or coerced to “sell” to the government at a low price. Regarding losing money and valuables, a few participants reported losing money to the trip organizers who charged in advance but failed to make the trip happen. Most people who hid gold, diamonds, and jewelry in their clothes and bodies reported being robbed during their escape.

Theme 2: Personal fortitude and gratitude

Despite the traumas and adversities, participants shared about their fortitude, endurance, coping skills, and thankfulness during their tough times.

1. Fortitude and endurance

Data revealed that some participants had confidence in their skills and were not afraid of the tough life after being released from the “re-education” camps. “God gave me a mind and two hands. I could fix clocks and do everything. I did blacksmithing although I had never done that before. I made knives, machetes, and sickles” (male, aged 76).

During the escape by boat, some participants demonstrated mental fortitude through accepting challenges. They accepted the peril and potential death associated with the escape, but maintained a conviction that it offered a better alternative than their living condition. When they were caught and put into jail, they recalled their past adversity to be more endurant, “I can endure hardships because I was young and had lost my mom” (male, aged 75).

In the refugee camps, participants accepted minimal living conditions, understanding their status as refugees and recognizing the stay was temporary, “In the refugee camp […] a big family lived in a small room. But that doesn’t matter because we were refugees, we had to accept the difficulties” (male, aged 83).

2. Personal skills to cope and navigate

Participants’ skills, talents, and shrewdness allowed them to navigate challenging circumstances and survive. Among various tactics employed, one was to lie about one’s identity or service to the previous government. One participant shared about his trick to reduce his sentence in prison after the collapse of Saigon:

I declared that I was a driver, holding no important positions, so they released me early [after a month in the “re-education” camp]. If I had said I was an artillery soldier, which was [considered] a serious crime, they would have put me in jail for a very long time (male, aged 71).

Another person recalled using another person’s business permit to safely pass the coast guard station, which was her first successful start in escaping the country by boat.

Besides lying or hiding their true identity, another strategy was to offer skills and help in critical moments to potential harm causers to gain benefits, peace, and life. For example, at sea, the wife of a participant helped a Thai sailor with his wound care and operation, resulting in their boat being pulled closer to the Thailand border; one participant offered food and gifts to her English teacher at the refugee camp so that she could safely skip the class to work and earn more money to raise her children; a female participant offered her tailoring skills to the refugee camp officers as a way to maintain her life:

I was quick to comply with them [the refugee camp guards] as a tailor. I sewed pants and shirts and taught students. They made money from those. I made clothes for them so… they didn’t kill me. They thought they could still make a profit from me (female, aged 71).

3. Perceived “luck and blessings”

Some participants shared that they were grateful for being imprisoned for a shorter time (after the collapse of Saigon in 1975) than they had feared, and not getting malaria during the imprisonment time. One shared about his perceived luck after being released from the prison:

In 1978, I drove a cyclo and had a Dutch customer who worked in forest protection in the Mekong River Delta. [He knew] I could speak some English, so he asked me to come help his family as a household manager. He treated me very well. At that time, I made 100 USD per month, which made a pretty good life for my family (male, aged 71).

They were also thankful for escaping the country successfully even at the eighth attempt, passing the police station without problems during the escape, not encountering pirates, as well as not losing their children on the boat trip, “I was so thankful so now I can’t do anything against my conscience. My kid jumped down [from a higher floor of a Thai boat]. I caught her and ran away” (female, aged 71). Although most were robbed of their possessions in the escape, they felt lucky they were not killed. Even though they feared and expected the worst conditions at sea, participants felt lucky for the times they evaded danger to themselves and their families. Additionally, they spoke about being helped and rescued when facing adverse situations during the escape, “At dawn, our boat drifted to Palawan. The villagers approached us [...] I thought they were pirates. But they were not. These guys asked other villagers to bring us cocoa, coffee, and coconut” (male, aged 83). Some participants were grateful that their boats did not sink, and they eventually arrived at the refugee camp.

Although conditions in the refugee camps were challenging, some participants felt blessed, recognizing life had been even harsher before then:

Compared to our lives before, the living conditions in the refugee camp were precious. We had food and water. We felt our lives had changed and we were no longer afraid. In general, we were not hungry anymore. We had all kinds of medication (male, aged 72).

Amidst recounting their traumatic life stories, participants shared that they felt lucky and blessed for being alive and arriving in the United States. Some felt lucky that they were able to bring money to the United States.

Discussion

This study describes experiences of trauma and strength in a subset of VIP participants. We found one theme about participants’ traumas, namely adversity and suffering, and another about participants’ strength, namely personal fortitude and gratitude. The findings on adversity and suffering were aligned with results from qualitative research on war trauma among refugees from Burma, Liberia, and Arab countries. Specifically, Karen refugees (from Burma) in Cook et al.’s (2015) large-scale qualitative study experienced fear, injury, exposure to dead bodies, harm, killings, and destruction of houses and village in wartime. Young Liberian refugees in Ghana from Nyarko and Punamaki’s (2020) study also shared their experiences of losing close relationships, witnessing horrific scenes, threats to life, and fleeing for one’s life. However, the experience of escaping by boat and staying in refugee camps were unique to the Vietnamese people. Cramping families in small boats that were made for sailing near shore was the only option for many families who were mostly farmers and fishermen. Additionally, the escape was full of danger: among the estimated 1.5 million people escaping, about 150,000 never made landfall due to drowning, piracy, dehydration, or other causes of death (Sansonia, 2019). “Boat people” might also face crisis due to the rejection or hostility of neighboring countries where they sought “first asylums” and would stay temporarily until being screened and given entrance to countries like the United States or Canada. As indicated in previous studies, facing significant hardships like those in early life may leave a lasting effect on Vietnamese’s physical and mental health in later life (Alastalo et al., 2009; Carr, 2019).

The theme of fortitude and gratitude was aligned with findings on resilience and positive growth of people from Arab countries in Hamadeh et al.’s (2024) meta-synthesis study, who coped with trauma from war and conflict in the Middle East. The difference, however, involves Vietnamese participants’ instances of gratitude and feeling blessed, which were expressed over 50 years after the traumatic events. It is possible that the mechanisms of flourishing and post-traumatic growth are relevant here (Confino et al., 2023; Dell’Osso et al., 2022; Tedeschi & Calhoun, 1996; VanderWeele, 2017). While many Vietnamese experienced trauma and adversity when arriving as refugees in the United States in the beginning, a few decades after the war, they have gained success personally, socially, and financially, such as becoming U.S. citizens, helping their families and communities, and contributing to the economic industry (Campi, 2005). These achievements could be indicative of their personal growth, mastery of the new environment, optimistic outlook, positive relationships, or having purpose and meaning in life—key components of flourishing and post-traumatic growth—that might help them be better prepared for later-life stressors.

This study was not without its limitations. While the use of semi-structured interviews was a strength, the data relied upon respondents’ memory and ability to recall. Thus, the accuracy of participants’ stories cannot be verified. The topic under discussion was personal and could be viewed as politically sensitive to some of the participants, which may have limited their willingness to reveal the most valuable information. The use of English transcripts to develop the initial codebook was the most practical, but could be a limitation, as there may have been minor meaning loss associated with the translated transcript. However, we believe the English codebook was useful and appropriate with the Vietnamese transcripts due to certain factors: the bilingual coders’ knowledge of the culture, the rigorous process of comparing, discussing, considering, negotiating, and reconciling differences in the codes and word choice of the codes, and the high quality of the English translations. Similar to other studies, it was valuable for the study team to have the English codebook, given the dissemination of VIP study results is mostly for an English-speaking audience (Oxley et al., 2017). This was also a select sample because we selected only interviews that had the highest trauma counts for the purpose of gaining an in-depth understanding of participants’ hardships. Moreover, as with the case in most research studies, participants were selected volunteers who were willing to enroll and share their life stories; thus, these results may not be generalizable to the general Vietnamese American aging population.

Despite these limitations, there were many strengths. First, the interviews were conducted in Vietnamese, allowing participants, of whom many were monolinguals, to share details of their life stories to the fullest extent possible. Second, the usage of verbatim transcripts in Vietnamese in coding and data analysis maximized the retaining of original data and meaning and allowed for depth and nuance in our analysis. Third, our data came from an ample sample size allowing the analysis to reach the “inductive thematic saturation” (Saunders et al., 2018) in which no new codes or themes were identified from the data, which enhanced the reliability and validity of the coding process and research results. Finally, the interactive nature of semi-structured interviews, with the ability for staff to probe and explore participants’ rich stories in an in-depth manner, enabled free responses from the participants (Kakilla, 2021).

Future Research and Implications

This study suggests that although the experiences of older Vietnamese refugees in the United States included exposure to many adversities and traumas, concepts of strength and positive outlook are important components of these experiences for this large but understudied population. Future studies investigating resilience in this population are needed to quantitatively understand the impact of trauma exposures on health outcomes in late life. Additionally, future research with refugee populations should explore wartime traumatic experiences in a mixed-methods research design to enrich findings in this area. For example, future models of cognitive aging should include fortitude and resilience as potential moderators of the association between early-life stressors and late-life cognitive outcomes. Our qualitative findings partially informed the decision to include measures of resilience and spirituality in Time 2 of VIP data collection. Last, using results from this qualitative study, future VIP analyses may consider collapsing closely related traumatic events presented in the survey list, such as combining property loss and family loss into an overarching variable of experiences of loss, to reduce the trauma list while retaining important variables in models examining effects of early-life trauma on dementia risk.

This study has multiple implications. As early-life adversity and trauma can have a lasting effect on later-life health outcomes, understanding Vietnamese people’s war trauma may provide insights into their psychological and physical health in later life. Findings from this study imply that Vietnamese people’s personal growth, strength, acceptance, appreciation of life, and positivity could be protective factors of later-life stressors and health issues. In that way, this study highlights the importance of including these aspects in future research to capture a holistic picture of Vietnamese older adults’ health. Being the first large qualitative study that provides a detailed description of Vietnamese trauma, coping strategies, and strength—factors not found at great length in existing literature—this study can inform future work in ADRD by including a population that is understudied. Last, understanding early life and immigration experiences could shed light into risk and resilience factors for ADRD among Vietnamese older adults as well as other immigrant and diverse groups.

Funding

This work was supported by grants from the National Institutes of Health (R01AG067542, P30AG072972, R24AG063718).

Conflict of Interest

None.

Data Availability

Requests for data and/or code from the Vietnamese Insights into Cognitive Aging Program will be considered on a case-by-case basis by the senior author and investigator team. This study was not preregistered.

Acknowledgments

We thank all staff at the VIP and Asian Resources, Inc. (ARI) for their assistance in the data collection and transcribing of the recordings for this study. We are also grateful to the VIP participants who agreed to participate in the study.

References