Demographic and Psychosocial Factors Associated with Suicidal Ideation among Resettled Bhutanese Refugees

Abstract

This study aims to identify socio-demographic and psychosocial characteristics associated with the suicidal ideation among resettled Bhutanese refugees in the United States. Structured interviews were conducted with 200 resettled Bhutanese refugees in Columbus, Ohio. Multivariable logistic regression analysis was conducted to identify variables associated with suicidal ideation. Most participants were male (59.0%), married (77.9%), 55% reported no formal education, 12% were of Dalit (“lower”) caste, and 6.2% reported suicidal ideation. Multivariable logistic regression analysis included four variables that were significant at p < 0.05 in bivariate analyses: caste, post-settlement difficulties, mental health diagnosis, and social support. Higher odds of suicidal ideation were linked to mental health diagnosis [adjusted odds ratio (AOR): 8.7], low social support (AOR: 23.6), and post-settlement difficulties (AOR: 1.4). In the multivariable model, untouchable caste had elevated odds of suicidal ideation but statistically not significant. Culturally competent mental health services are needed to support individuals at risk for suicidal ideation.

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References

  1. 1.

    Cultural Orientation Resource Center. Bhutanese refugees in Nepal. 2007. http://www.culturalorientation.net/learning/backgrounders. Accessed 12 Dec 2018.

  2. 2.

    Komproe I, Cardeña E, de Jong JT. The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression. J Trauma Stress. 2002;15(5):415–21. https://doi.org/10.1023/A:1020141510005.

    Article  PubMed  Google Scholar 

  3. 3.

    Van Ommeren M, de Jong JT, Sharma B, Komproe I, Thapa SB, Cardeña E. Psychiatric disorders among tortured Bhutanese refugees in Nepal. Arch Gen Psychiatry. 2001;58(5):475–82. https://doi.org/10.1001/archpsyc.58.5.475. Erratum in: Arch Gen Psychiatry. 2001;58:707.

    Article  PubMed  Google Scholar 

  4. 4.

    Mills E, Singh S, Roach B, Chong S. Prevalence of mental disorders and torture among Bhutanese refugees in Nepal: a systemic review and its policy implications. Med Conflict Survival. 2008;24(1):5–15. https://doi.org/10.1080/13623690701775171.

    Article  Google Scholar 

  5. 5.

    United Nations. Press statement—US Ambassador Randy Berry visits Bhutanese refugee settlements. 26 April 2019. http://un.org.np/headlines/press-statement-us-ambassador-randy-berryvisits-bhutanese-refugee-settlements. Accessed 31 Aug 2020.

  6. 6.

    Ao T, Taylor E, Lankau E, Sivilli TI, Blanton C, Shetty S, et al. An investigation into suicides among Bhutanese refugees in the US 2009–2012: stakeholders report: Centers for Disease Control and Prevention; 2012.

  7. 7.

    Vonnahme LA, Lankau EW, Ao T, Shetty S, Cardozo BL. Factors associated with symptoms of depression among Bhutanese refugees in the United States. J Immigr Minor Health. 2015;17(6):1705–14. https://www.ncbi.nlm.nih.gov/pubmed/25348425

    Article  Google Scholar 

  8. 8.

    Hagaman AK, Sivilli TI, Ao T, Blanton C, Ellis H, Cardozo BL, Shetty S. An investigation into suicides among Bhutanese refugees resettled in the United States between 2008 and 2011. J Immigr Minor Health. 2016;18:819.

    Article  Google Scholar 

  9. 9.

    Centers for Disease Control and Prevention. Suicide and suicidal ideation among Bhutanese refugees—United States. MMWR. 2013;62(26):533–6.

    Google Scholar 

  10. 10.

    National Center for Health Statistics, Centers for Disease Control and Prevention. Suicide mortality by state. https://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm). Accessed 11 Sept 2020.

  11. 11.

    Kohrt BA, Speckman RA, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, Sharma VD, Nepal MK, Worthman CM. Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol. 2009;36(3):261–80. https://doi.org/10.1080/03014460902839194.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Centers for Disease Control and Prevention. Refugee health profiles: Bhutanese refugees. https://www.cdc.gov/immigrantrefugeehealth/profiles/bhutanese/background/index.html#caste. Accessed 26 Aug 2020.

  13. 13.

    Pariya M. Travelling castes: Nepalese immigrants in Australia. South Asian Diaspora. 2019;11(1):89–103. https://doi.org/10.1080/19438192.2018.1523091.

    Article  Google Scholar 

  14. 14.

    Adhikari SB, Yotebieng K, Acharya JN, Kirsch J. Epidemiology of mental health, suicide and post-traumatic stress disorder among Bhutanese refugees in Ohio. Ohio Department of Mental Health and Addiction Services, Community Refugee and Immigration Services; 2015. https://mha.ohio.gov/Portals/0/assets/ResearchersAndMedia/Data%20and%20Reports/Reports/Bhutanese-Refugee-MH-Suicide-PTSD-Report-April2015.pdf. Accessed 18 Aug 2020.

  15. 15.

    Mollica RF, Caspi Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard trauma questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180:111–6.

    CAS  Article  Google Scholar 

  16. 16.

    Cutrona CE. Objective determinants of perceived social support. J Pers Soc Psychol. 1986;50:349–55.

    CAS  Article  Google Scholar 

  17. 17.

    Ao T, Shetty S, Sivilli T, Blanton C, Ellis B, Geltman P, et al. Suicidal ideation and mental health of Bhutanese refugees in the United States. J Immigr Minor Health. 2016;18:828–35.

    Article  Google Scholar 

  18. 18.

    Ellis BH, Lankau EW, Ao T, Benson MA, Miller AB, Shetty S, et al. Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior. Am J Orthop. 2015;85(1):43–55.

    Article  Google Scholar 

  19. 19.

    National Institute on Mental Health. Suicidal thoughts and behaviors among U.S. adults. 2019. https://www.nimh.nih.gov/health/statistics/suicide.shtml. Accessed 30 Jan 2019.

  20. 20.

    Kaiser Family Foundation. The Ohio health care landscape. https://www.kff.org/medicaid/fact-sheet/the-ohio-health-care-landscape/#:~:text=The%20Ohio%20Health%20Care%20Landscape%20Published%3A%20Aug%2001%2C,options%20that%20are%20impacting%20Americans%20across%20the%20country. Accessed 10 Sept 2020.

  21. 21.

    Cavanagh JTO, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33:395–405.

    CAS  Article  Google Scholar 

  22. 22.

    de Beurs D, Ten Have M, Cuijpers P, de Graaf R. The longitudinal association between lifetime mental disorders and first onset or recurrent suicide ideation. BMC Psychiatry. 2019;19(1):345. https://doi.org/10.1186/s12888-019-2328-8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Kleiman EM, Liu RT. Social support as a protective factor in suicide: findings from two nationally representative samples. J Affect Disord. 2013;150(2):540–5. https://doi.org/10.1016/j.jad.2013.01.033. (Epub 2013 Mar 5)

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Dressler WW. Extended family relationships, social support, and mental health in a southern black community. J Health Soc Behav. 1985;26(1):39–48.

    CAS  Article  Google Scholar 

  25. 25.

    Panta S, Resurrección BP. Gender and caste relations amidst a changing political situation in Nepal: insights from a farmer-managed irrigation system. Gend Technol Dev. 2014;18(2):219–47.

    Article  Google Scholar 

  26. 26.

    Goldstein MC, Beall CM. Family change, caste, and the elderly in a rural locale in Nepal. J Cross Cult Gerontol. 1986;1(3):305–16.

    CAS  Article  Google Scholar 

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Funding

This study was supported by Ohio Department of Mental Health and Addiction Services (Grant No. 14.1298).

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Correspondence to Surendra Bir Adhikari.

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Adhikari, S.B., Daniulaityte, R. & Bhatta, D.N. Demographic and Psychosocial Factors Associated with Suicidal Ideation among Resettled Bhutanese Refugees. J Immigrant Minority Health (2021). https://doi.org/10.1007/s10903-021-01149-z

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Keywords

  • Suicidal ideation
  • Resettled refugees
  • Dalit caste
  • Mental health
  • Post-settlement difficulties