Journal of Immigrant and Minority Health

, Volume 17, Issue 6, pp 1705–1714 | Cite as

Factors Associated with Symptoms of Depression Among Bhutanese Refugees in the United States

  • Laura A. VonnahmeEmail author
  • Emily W. Lankau
  • Trong Ao
  • Sharmila Shetty
  • Barbara Lopes Cardozo
Original paper


Refugees are at risk for psychiatric morbidity, yet little is known about their mental health conditions. We identified factors associated with depression symptoms among Bhutanese refugees in the US. We randomly selected adult Bhutanese refugees (N = 386) to complete a cross-sectional survey concerning demographics, mental health symptoms, and associated risk factors. The case definition for depression symptoms was ≥1.75 mean depression score on the Hopkins Symptom Checklist-25. More women (26 %) than men (16 %) reported depression symptoms (p = 0.0097). Higher odds of depression symptoms were associated with being a family provider, self-reported poor health, and inability to read and write Nepali (OR 4.6, 39.7 and 4.3, respectively) among men; and self-reported poor health and inability to read and write Nepali (OR 7.6, and 2.6 respectively) among women. US-settled Bhutanese refugees are at risk for depression. Providers should be aware of these concerns. Culturally appropriate mental health services should be made more accessible at a local level.


Refugees Mental health Depression Refugee health 



This study was partially supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement U60/CCU007277. We want to express sincere appreciation to the Bhutanese refugee community, community leaders, interviewers and the resettlement agencies and refugee health programs in the cities of the investigation for their vital assistance with this project. Additionally, we would like to acknowledge the following individuals from the US Centers for Disease Control and Prevention for their assistance with this project: Dr. Eboni Taylor, Curtis Blanton and Teri Sivilli.

Conflict of interest


Supplementary material

10903_2014_120_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 20 kb)
10903_2014_120_MOESM2_ESM.docx (23 kb)
Supplementary material 2 (DOCX 23 kb)


  1. 1.
    Marcus M, et al. Depression: a global public health concern, in WHO 2012.Google Scholar
  2. 2.
    Gotlib IH, Hammen CL. Handbook of depression. 2nd ed. New York City: The Guilford Press; 2010.Google Scholar
  3. 3.
    Cardozo BL, et al. Karenni refugees living in Thai–Burmese border camps: traumatic experiences, mental health outcomes, and social functioning. Soc Sci Med. 2004;58:2637–44.CrossRefGoogle Scholar
  4. 4.
    Mollica RF, et al. The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand–Cambodia border camps. JAMA. 1993;270(5):581–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365:1309–14.CrossRefPubMedGoogle Scholar
  6. 6.
    WRITENET. The exodus of ethnic Nepalis from southern Bhutan; 1995.Google Scholar
  7. 7.
    Worldwide Refugee Admission Processing System (WRAPS).Google Scholar
  8. 8.
    IOM. Who Am I? Assessment of psychological needs and suicide risk factors among Bhutanese refugees in Nepal and after Third Country Resettlement;2011.Google Scholar
  9. 9.
    Laban CJ, et al. Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis. 2005;193(12):825–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Cutrona C. Ratings of social support by adolescents and adult informants: degree of correspondence and prediction of depressive symptoms. J Pers Soc Psychol. 1989;57(4):723–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Amirkhan JH. A factor analytically derived measure of coping: the coping strategy indicator. J Pers Soc Psychol. 1990;59(5):1066–74.CrossRefGoogle Scholar
  12. 12.
    Mollica R, et al. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.CrossRefPubMedGoogle Scholar
  13. 13.
    Mollica RF, et al. 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.CrossRefPubMedGoogle Scholar
  14. 14.
    Principle component analysis. SAS/IML (R) Studio 12.3 User’s Guide.
  15. 15.
    Sabin M, et al. Factors associated with poor mental health among Guatemalan refugees living in Mexico 20 years after civil conflict. JAMA. 2003;290(5):635–42.CrossRefPubMedGoogle Scholar
  16. 16.
    Wong E, Miles JV. Prevalence and correlates of depression among new U.S. immigrants. J Immigr Minor Health. 2014;16(3):422–8.Google Scholar
  17. 17.
    Desai HD, Jann MW. Major depression in women: a review of the literature. J Am Pharm Assoc. 2000;40(4).Google Scholar
  18. 18.
    Vijayakumar L, Jotheeswaran AT. Suicide in refugees and asylum seekers. In: Bhugra D, Craig T, Bhui K, editors. Mental health of refugees and asylum seekers. New York: Oxford University Press; 2010. p. 195-2011.Google Scholar
  19. 19.
    Ferrada-Noli M, et al. Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. J Trauma Stress. 1998;11(1):103–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Husain F, et al. Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka. JAMA. 2011;306(5):522–31.CrossRefPubMedGoogle Scholar
  21. 21.
    Mollica R, et al. The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group. J Nerv Ment Dis. 1998;186(9):543–53.CrossRefPubMedGoogle Scholar
  22. 22.
    Cardozo B, et al. Mental health, social functioning, and attitudes of kosovar albanians following the war in kosovo. JAMA. 2000;284(5):569–77.CrossRefGoogle Scholar
  23. 23.
    Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Am J Med. 1982;72(1):127–35.CrossRefPubMedGoogle Scholar
  24. 24.
    Ommeren MV, et al. Trauma and loss as determinants of medically unexplained epidemic illness in a Bhutanese refugee camp. Psychol Med. 2001;31:1259–67.PubMedGoogle Scholar
  25. 25.
    Pumariega A, Rothe E, Pumariega J. Mental health of immigrants and refugees. Community Ment Health J. 2005;41(5):581–97.CrossRefPubMedGoogle Scholar
  26. 26.
    Bhugra D. Migration and depression. Acta Psychiatr Scand. 2003;108(s418):67–72.CrossRefGoogle Scholar
  27. 27.
    Ao T. Suicide and suicide ideation among Bhutanese refugees—United States, 2009–2012. MMWR. 2013;62(26):533–6.Google Scholar
  28. 28.
    CDC Immigrant and Refugee Health Branch. Guidelines for mental health screening during the domestic medical examination for newly arrived refugees; 2012.Google Scholar
  29. 29.
  30. 30.
    Muhwezi WW, Sam DL. Adaptation of urban refugees in Uganda: a study of their socio-cultural and psychological well being in Kampala City. J Psychol Afr. 2004;14(1):37–46.Google Scholar
  31. 31.
    Willems R. Coping with displacement: Social networking among urban refugees in an east African context. Status: published; 2005.Google Scholar
  32. 32.
    Ao T, et al. An investigation into suicides among Bhutanese refugees in the US 2009–2012; 2012.Google Scholar
  33. 33.
    Cardozo B, et al. Mental health, social functioning, and disability in postwar Afghanistan. JAMA. 2004;292(5):575–84.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York (Outside USA) 2014

Authors and Affiliations

  • Laura A. Vonnahme
    • 1
    • 3
    • 5
    • 6
    Email author
  • Emily W. Lankau
    • 1
    • 4
  • Trong Ao
    • 2
    • 4
  • Sharmila Shetty
    • 1
    • 5
  • Barbara Lopes Cardozo
    • 2
  1. 1.Division of Global Migration and QuarantineUS Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Division of Global Disease Detection and Emergency ResponseUS Centers for Disease Control and PreventionAtlantaUSA
  3. 3.CDC/CSTE Applied Epidemiology Fellowship ProgramAtlantaUSA
  4. 4.Epidemic Intelligence ServiceUS Centers for Disease Control and PreventionAtlantaUSA
  5. 5.United States Public Health ServiceWashingtonUSA
  6. 6.Quarantine and Border Health Services Branch, Division of Global Migration and QuarantineUS Centers for Disease Control and PreventionSeattleUSA

Personalised recommendations