A qualitative study of perceptions of risk and protective factors for suicide among Bhutanese refugees.

Abstract

Over 100,000 ethnically Nepalese, "Lhotshampa," people experienced systematic oppression, disenfranchisement, and violence during the latter part of the twentieth century. The Lhotshampa people were forced to flee their homes in southern Bhutan and enter refugee camps in Nepal for over 20 years. As of this writing, most Bhutanese refugees have been resettled in other countries (primarily the United States, Canada, and Australia). As the two remaining Nepalese refugee camps prepare to close, a growing suicide crisis is developing among many Bhutanese refugees. Bhutanese refugees resettled in the United States are dying by suicide at approximately twice the rate of the general U.S. population. It is crucial to examine, qualitatively, the nature of both risk and protective factors from the perspective of Bhutanese refugees, themselves. Our study included 15 Bhutanese refugees (8 men, 7 women) recruited from a community sample as part of a parent project examining culturally responsive suicide risk assessment. Mean age across both genders was 38.4 years (range of 22-55 years). Participants in our study were asked open-ended questions about suicide risk and prevention. We conducted a thematic analysis, synthesized risk and protective themes, and applied a socio-ecological framework to the data. We found risk themes included psychological distress and vulnerability, substance use, social and familial discord, interpersonal violence, isolation, and postmigration stressors. Protective themes included low levels of substance use, de-stigmatization of mental health concerns, strong social connections, reduced postmigration stressors, increased access to mental health care, and strong awareness within the host community of migration-related challenges. What is the public significance of this article?In order to effectively address a major public health crisis such as the suicide epidemic among Bhutanese refugees, it is imperative that the perspectives and views of affected community members be incorporated into preventive interventions. Qualitative data highlights Bhutanese refugee community members' perspectives on contributors to suicide risk and preventive interventions that protect against suicide.

Investigating Outcomes of a Family Strengthening Intervention for Resettled Somali Bantu and Bhutanese Refugees: An Explanatory Sequential Mixed Methods Study

“…This increased risk of adult suicide has been associated with perceiving oneself as a burden and a lack of a sense of belonging, which are in turn linked to struggles obtaining employment, poor health, and family conflict [33]. Other risk factors for suicide include unemployment, substance use, family discord, isolation and family separation [34,35]. One study of resettled Bhutanese found that three-quarters believed other people would look down on them if they pursued mental health counseling, and this was more common amongst participants without a secondary education [36].…”

Introduction to special issue on promoting health and well-being in forcibly displaced asian populations.

“…Reflecting the current humanitarian crisis in Myanmar, half of the papers in this collection focus on refugees from that country: the Chin living in Malaysia (Cowling & Anderson, 2021; Gosnell et al, 2021), the Karen and Burman living in Thailand (Haroz et al, 2021), and the Rohingyas living in Bangladesh (Mozumder & Islam, 2021). Other papers in this collection focus on Lhotshampa Bhutanese refugees living in the United States (Meyerhoff et al, 2021) and on Sri Lankan populations both internally displaced due to war and tsunami (Demaske et al, 2021; Wessells & Kostelny, 2021) and living abroad as refugees (in Canada; Pandalangat & Kanagaratnam, 2021).…”

“…In addition, a subset of articles in this collection draws attention to factors that protect forcibly displaced Asian populations against poor psychosocial outcomes. Meyerhoff et al (2021) also identify factors that protect Lhotshampa Bhutanese refugees in the United States against suicide—these include low levels of substance use, destigmatization of mental health concerns, strong social connections, reduced postmigration stressors, increased access to mental health care, and better awareness of migration-related challenges among those providing services to their community. Demaske et al (2021) examine a particular aspect of resilience, personal growth initiative (PGI)—the tendency to deliberately engage in actions that are valued—in internally displaced war-affected Sri Lankans, and find that after controlling for depression, wartime experiences, and demographic factors, PGI is positively associated with life satisfaction (but interestingly not functional impairment, as has been found in other war-affected populations).…”

“…Here, locally derived causes and consequences of suicide and potential points for intervention are identified through workshops with local informants. Meyerhoff et al (2021) uses qualitative data to identify risk factors for suicide in Lhotshampa Bhutanese refugees residing in the United States; these risk factors include psychological distress and vulnerability, substance use, social and familial discord, interpersonal violence, isolation, and postmigration stressors such as lack of employment and inability to speak English.…”