Skip to main content

Advertisement

SpringerLink
Log in

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hutt M. Unbecoming citizens: culture, nationhood, and the flight of refugees from Bhutan. Oxford: Oxford University Press; 2003.

    Google Scholar 

  2. US Department of State, Bureau of Population, Refugees, and Migration (PRM), Worldwide Refugee Admissions Processing System (WRAPS). http://www.cdc.gov/immigrantrefugeehealth/pdf/bhutanese-health-profile.pdf.

  3. Centers for Disease Control Prevention. Suicide and suicidal ideation among bhutanese refugees—United States, 2009–2012. MMWR Morb Mortal Wkly Rep. 2013;62(26):533.

    Google Scholar 

  4. Ao T, Taylor E, Lankau E, Sivilli TI, Blanton C, Shetty S, Lopes-Cardozo B. An Investigation into Suicides among Bhutanese Refugees in the US 2009–2012 Stakeholders Report. Center for Disease Control and Prevention. http://www.refugeehealthta.org/files/2011/06/Bhutanese-Suicide-Stakeholder_Report_October_22_2012_Cleared_-For_Dissemination.pdf.

  5. Miret M, Ayuso-Mateos JL, Sanchez-Moreno J, Vieta E. Depressive disorders and suicide: epidemiology, risk factors, and burden. Neurosci Biobehav Rev. 2013;37(10):2372–4.

    Article  PubMed  Google Scholar 

  6. Schinina G, Sharma S, Gorbacheva O, Mishra AK. Who am I? Assessment of psychosocial needs and suicide risk factors among bhutanese Refugees in Nepal and after third country resettlement. Geneva: International Organization for Migration (IOM); 2011.

    Google Scholar 

  7. Tondo L, Isacsson G, Baldessarini RJ. Suicidal behaviour in bipolar disorder. CNS Drugs. 2003;17(7):491–511.

    Article  CAS  PubMed  Google Scholar 

  8. Undurraga J, Baldessarini RJ, Valenti M, Pacchiarotti I, Vieta E. Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry. 2012;73(6):778–82.

    Article  PubMed  Google Scholar 

  9. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA J Am Med Assoc. 2005;294(5):571–9.

    Article  CAS  Google Scholar 

  10. Beswick S. “If You Leave Your Country You Have No Life!” Rape, suicide, and violence: the voices of Ethiopian, Somali, and Sudanese female refugees in Kenyan refugee camps. Northeast Afri Stud. 2001;8(3):69–98.

    Article  Google Scholar 

  11. Hansson EK, Tuck A, Lurie S, McKenzie K. Rates of mental illness and suicidality in immigrant, refugee, ethnocultural, and racialized groups in Canada: a review of the literature. Can J Psychiatry. 2012;57(2):111–21.

    PubMed  Google Scholar 

  12. Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA J Am Med Assoc. 2005;294(5):602–12.

    Article  CAS  Google Scholar 

  13. Procter NG. ‘They first killed his heart (then) he took his own life’. Part 1: a review of the context and literature on mental health issues for refugees and asylum seekers. Int J Nurs Pract. 2005;11(6):286–91.

    Article  PubMed  Google Scholar 

  14. Rahman A, Hafeez A. Suicidal feelings run high among mothers in refugee camps: a cross-sectional survey. Acta Psychiatr Scand. 2003;108(5):392–3.

    Article  CAS  PubMed  Google Scholar 

  15. Papadopoulos R. Systemic challenges in a refugee camp. Context. 2008;98:16–9.

    Google Scholar 

  16. Tinghög P, Hemmingsson T, Lundberg I. To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors? Soc Psychiatry Psychiatr Epidemiol. 2007;42(12):990–6.

    Article  PubMed  Google Scholar 

  17. Hansen KL, Sørlie T. Ethnic discrimination and psychological distress: a study of Sami and non-Sami populations in Norway. Transcult Psychiatry. 2012;49(1):26–50.

    Article  PubMed  Google Scholar 

  18. Ferrada-Noli M, Asberg M, Ormstad K. Suicidal behavior after severe trauma. Part 2: the association between methods of torture and of suicidal ideation in posttraumatic stress disotrder. J Trauma Stress. 1998;11(1):113–24.

    Article  CAS  PubMed  Google Scholar 

  19. Ferrada-Noli M, Asberg M, Ormstad K, Lundin T, Sundbom E. Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. J Trauma Stress. 1998;11(1):103–12.

    Article  CAS  PubMed  Google Scholar 

  20. Pradhan A, Poudel P, Thomas D, Barnett S. A review of the evidence: suicide among women in Nepal. Kathmandu: National Health Sector Support Program, Ministry of Health and Population; 2011. p. 117.

    Google Scholar 

  21. Suvedi BK, Pradhan A, Barnett S, Puri M, Chitrakar SR, Poudel P, Sharma S, Hulton L. Nepal maternal mortality and morbidity study 2008/2009: summary of preliminary findings. Kathmandu: Family Health division, Department of Health Services, Ministry of Health, Government of Nepal; 2009.

    Google Scholar 

  22. World Health Organization. Preventing suicide: a global imperative. Luxembourg: World Health Organization; 2014. http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/.

  23. Hendin H, Phillips MR, Vijayakumar L, Pirkis J, Wang H, Yip P, Wasserman D, Bertolote JM, Fleischmann A. Suicide and suicide prevention in Asia. Geneva: World Health Organization; 2008.

    Google Scholar 

  24. Jordans MJ, Kaufman A, Brenman NF, Adhikari RP, Luitel NP, Tol WA, Komproe I. Suicide in South Asia: a scoping review. BMC Psychiatry. 2014;14(1):358.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Vijayakumar L, Nagaraj K, Pirkis J, Whiteford H. Suicide in developing countries. Frequencies, distribution, and association with socioeconomic indicators. Crisis. 2005;26(3):104–11.

    Article  PubMed  Google Scholar 

  26. Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case-control study in India. Acta Psychiatr Scand. 1999;99(6):407–11.

    Article  CAS  PubMed  Google Scholar 

  27. Bertolote JM, Fleischmann A, Butchart A, Besbelli N. Suicide, suicide attempts and pesticides: a major hidden public health problem. Bull World Health Organ. 2006;84:260.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cavanagh JT, Carson AJ, Sharpe M, Lawrie S. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395–405.

    Article  CAS  PubMed  Google Scholar 

  29. Clark DC, Horton-Deutsch SL. Assessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides. In: Maris RW, Berman AL, Maltsberger JT, Yufit RI, editors. Assessment and prediction of suicide. New York, NY: Guilford Press; 1992. p. 144–182.

  30. Gajalakshmi V, Peto R. Suicide rates in rural Tamil Nadu, south India: verbal autopsy of 39,000 deaths in 1997–98. Psychiatr Epidemiol. 2007;36:203–7.

    Google Scholar 

  31. Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet. 2002;360(9347):1728–36.

    Article  PubMed  Google Scholar 

  32. Appleby L, Cooper J, Amos T, Faragher B. Psychological autopsy study of suicides by people aged under 35. Br J Psychiatry. 1999;175(2):168–74.

    Article  CAS  PubMed  Google Scholar 

  33. Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.

    Article  PubMed  Google Scholar 

  34. Kleijn W, Hovens J, Rodenburg J. Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins symptom Checklist-25 in different languages. Psychol Rep. 2001;88(2):527–32.

    Article  CAS  PubMed  Google Scholar 

  35. Mollica RF, McInnes K, Sarajlić N, Lavelle J, Sarajlić I, Massagli MP. Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA J Am Med Assoc. 1999;282(5):433–9.

    Article  CAS  Google Scholar 

  36. Fawzi S, Murphy E, Pham T, Lin L, Poole C, Mollica R. The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners. Acta Psychiatr Scand. 1997;95(2):87–93.

    Article  Google Scholar 

  37. Mollica RF, Caspi-Yavin 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(2):111–6.

    Article  CAS  PubMed  Google Scholar 

  38. Alley JC. Life-threatening indicators among the Indochinese refugees. Suicide Life Threat Behav. 1982;12(1):46–51.

    Article  CAS  PubMed  Google Scholar 

  39. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.

    Article  PubMed  Google Scholar 

  40. Pyakurel R, Sharma N, Paudel D, Coghill A, Sinden L, Bost L, Larkin M, Burrus CJ, Roy K. Cause of death in women of reproductive age in rural Nepal obtained through community-based surveillance: is reducing maternal mortality the right priority for women’s health programs? Health Care Women Int. 2015;36(6):655–62. doi: 10.1080/07399332.2014.908193.

    Article  PubMed  Google Scholar 

  41. Radhakrishnan R, Andrade C. Suicide: an Indian perspective. Indian J Psychiatry. 2012;54(4):304.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Widger T. Suffering, frustration, and anger: class, gender and history in Sri Lankan suicide stories. Cult Med Psychiatry. 2012;36(2):225–44.

    Article  PubMed  Google Scholar 

  43. Chua JL. In pursuit of the good life: aspiration and suicide in globalizing south India. Berkeley: University of California Press; 2014.

    Google Scholar 

  44. Marecek J. Young women’s suicide in Sri Lanka: cultural, ecological, and psychological factors. Asian J Couns. 2006;13(1):63–92.

    Google Scholar 

  45. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bruffaerts R, Demyttenaere K, Hwang I, Chiu WT, Sampson N, Kessler RC, Alonso J, Borges G, de Girolamo G, de Graaf R. Treatment of suicidal people around the world. Br J Psychiatry J Ment Sci. 2011;199(1):64–70.

    Article  Google Scholar 

  47. Warren KD. “We Do What We Can” Creating success in a New England Refugee Resettlement Agency. 2013.

  48. Hefferan T. Bridging the gaps: faith-based organizations, neoliberalism, and development in Latin America and the Caribbean. Lexington: Lexington Books; 2009.

    Google Scholar 

  49. Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20(1):247–56.

    Article  CAS  Google Scholar 

  50. Terheggen MA, Stroebe MS, Kleber RJ. Western conceptualizations and Eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India. J Trauma Stress. 2001;14(2):391–403.

    Article  CAS  PubMed  Google Scholar 

  51. Chase LE, Welton-Mitchell C, Bhattarai S. “Solving Tension”: coping among Bhutanese refugees in Nepal. Int J Migr Health Soc Care. 2013;9(2):71–83.

    Article  Google Scholar 

  52. Chase L. Psychosocial resilience among resettled Bhutanese refugees in the US. Forced Migr Rev. 2012;40:47.

    Google Scholar 

  53. Marecek J. Culture, gender, and suicidal behavior in Sri Lanka. Suicide Life Threat Behav. 1998;28(1):69–81.

    CAS  PubMed  Google Scholar 

  54. Acharya L, Upadhya KD, Kortmann F. Mental health and psychosocial support aspects in disaster preparedness: Nepal. Int Rev Psychiatry. 2006;18(6):587–92.

    Article  PubMed  Google Scholar 

  55. Kohrt BA, Worthman CM. Gender and anxiety in Nepal: the role of social support, stressful life events, and structural violence. CNS Neurosci Ther. 2009;15(3):237–48.

    Article  PubMed  Google Scholar 

  56. Hollifield M, Verbillis-Kolp S, Farmer B, Toolson EC, Woldehaimanot T, Yamazaki J, Holland A, St Clair J, SooHoo J. The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry. 2013;35(2):202–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Author information

Authors and Affiliations

  1. School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA

    Ashley K. Hagaman

  2. Garrison Institute, Garrison, NY, USA

    Teresa I. Sivilli

  3. Center for Global Health, Division of Global Health Protection, Global Disease Detection Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Trong Ao

  4. Division of Global Health Protection, Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Curtis Blanton & Barbara Lopes Cardozo

  5. Department of Psychiatry, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Heidi Ellis

  6. Division of Global Migration and Quarantine Division of Global Migration and Quarantine, Immigrant Refugee and Migrant Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Sharmila Shetty

Authors
  1. Ashley K. Hagaman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Teresa I. Sivilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Trong Ao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Curtis Blanton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heidi Ellis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbara Lopes Cardozo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sharmila Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashley K. Hagaman.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hagaman, A.K., Sivilli, T.I., Ao, T. et al. An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011. J Immigrant Minority Health 18, 819–827 (2016). https://doi.org/10.1007/s10903-015-0326-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-015-0326-6

Keywords

Search

Navigation