Shattered Shangri-la: differences in depressive and anxiety symptoms in students born in Tibet compared to Tibetan students born in exile
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As a result of ongoing political tensions within Tibetan regions of the People’s Republic of China, several thousand Tibetans escape across the Himalayas every year to seek refuge in India and Nepal. Prior studies have found a high prevalence of depressive and anxiety symptoms in these refugees, many of whom are young and have been exposed to significant trauma. However, it is not known whether depressive and anxiety symptoms are more prevalent in these refugees than in ethnic Tibetans born and raised in the relative political and social stability of exile communities in North India and Nepal.
We conducted a cross-sectional survey of a convenience sample of 319 students attending school at the Tibetan Children’s Villages in Northern India to test the a priori hypothesis that adolescents and young adults who escaped from Tibet to India would demonstrate increased depressive and anxiety symptoms when compared to ethnic Tibetans born and raised in exile. The Hopkins Symptom Checklist-25 (HSCL-25) was used to measure depressive and anxiety symptoms. In addition, demographic information on age, sex, country of birth and frequency of family contact was collected.
Students born in Tibet had higher mean HSCL-25 depressive and anxiety symptom scores than did ethnic Tibetans born in exile. Female students demonstrated higher depressive and anxiety scores, as did those with limited contact with immediate family. After adjusting for sex, age and frequency of family contact, being born in Tibet was associated with increased HSCL-25 depressive and anxiety symptom scores (depression: F[2, 316] = 29.96, P < 0.0001; anxiety: F[4, 316] = 43.57, P < 0.0001).
The experience of being raised in Tibet and escaping to India appears to be a risk factor for increased depressive and anxiety symptoms when compared to being born and raised within an exile community in India or Nepal.
Key wordsrefugees exile Tibet trauma depression anxiety
Dabney Evans contributed to study design, data collection and management and manuscript preparation. David C. Buxton contributed to study design and data collection and management. Andrey S. Borisov contributed to data interpretation and manuscript preparation. Amita K. Manatunga contributed to study design and data interpretation. Dawa Ngodup contributed to data collection. Charles L. Raison contributed to study design, data interpretation and manuscript preparation. All authors had full access to the data and reviewed the manuscript. Charles L. Raison had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dabney Evans, David C. Buxton, Andrey S. Borisov, Amita Manatunga and Dawa Ngodup have no conflicts of interest to disclose. Charles L. Raison has served as a consultant/advisory board member for Wyeth, Lilly and Schering Plough and serves on the speakers’ bureau for Wyeth and Lilly. The authors would like to thank Mrs. Jetsun Pema, major-general Sushil K. Nanda (retired), and Nitin Nanda, M.D., for aiding with the logistics of conducting this study in Dharamsala, India. This work was supported by a Vernacular Modernities Undergraduate Foreign Project Summer Scholarship and a Patrick Stewart Human Rights Scholarship to D.C.B. C.L.R. received support from the Emory Tibet Science Initiative. Funding to D.C.B. and C.L.R. allowed collection of data in Dharamsala, India.
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