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Contents
- Abstract
- Background
- Method
- Design
- Participants
- Procedure
- Data Analysis
- Results
- Participants
- Risk Themes
- Individual-Level Factors
- Psychological Distress and Vulnerability
- Substance Use
- Family/Relational-Level Factors
- Social and Familial Discord
- Interpersonal Violence
- Community-Level Factors
- Isolation/Thwarted Belongingness
- Societal-Level Factors
- Postmigration Stressors
- Other
- Protective Factors
- Individual-Level Factors
- Low Substance Use
- Family/Relational-Level Factors
- Community-Level Factors
- De-Stigmatization of Mental Health
- Community Cohesion and Social Connection
- Societal-Level Factors
- Reduction of Postmigration Stressors
- Increased Access to Mental Health Assessment and Treatment
- Increased Community Awareness of Refugee-Related Issues
- Other
- Unknown
- Discussion
- Socio-Ecological Levels
- Individual
- Family
- Community
- Society
- Limitation and Future Directions
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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.
In order to effectively address a major public health crisis such as the suicide epidemic among Bhutanese refugees, it is imperative that...