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Journal of Immigrant and Minority Health

, Volume 18, Issue 4, pp 819–827 | Cite as

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

  • Ashley K. Hagaman
  • Teresa I. Sivilli
  • Trong Ao
  • Curtis Blanton
  • Heidi Ellis
  • Barbara Lopes Cardozo
  • Sharmila Shetty
Original Paper

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.

Keywords

Suicide Refugee Psychological autopsy Mental health 

Notes

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.

References

  1. 1.
    Hutt M. Unbecoming citizens: culture, nationhood, and the flight of refugees from Bhutan. Oxford: Oxford University Press; 2003.Google Scholar
  2. 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. 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. 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. 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.CrossRefPubMedGoogle Scholar
  6. 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. 7.
    Tondo L, Isacsson G, Baldessarini RJ. Suicidal behaviour in bipolar disorder. CNS Drugs. 2003;17(7):491–511.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 15.
    Papadopoulos R. Systemic challenges in a refugee camp. Context. 2008;98:16–9.Google Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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. 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. 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. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Cavanagh JT, Carson AJ, Sharpe M, Lawrie S. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395–405.CrossRefPubMedGoogle Scholar
  29. 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.Google Scholar
  30. 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. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.CrossRefPubMedGoogle Scholar
  38. 38.
    Alley JC. Life-threatening indicators among the Indochinese refugees. Suicide Life Threat Behav. 1982;12(1):46–51.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefPubMedGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 41.
    Radhakrishnan R, Andrade C. Suicide: an Indian perspective. Indian J Psychiatry. 2012;54(4):304.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Widger T. Suffering, frustration, and anger: class, gender and history in Sri Lankan suicide stories. Cult Med Psychiatry. 2012;36(2):225–44.CrossRefPubMedGoogle Scholar
  43. 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. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 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.CrossRefGoogle Scholar
  47. 47.
    Warren KD. “We Do What We Can” Creating success in a New England Refugee Resettlement Agency. 2013.Google Scholar
  48. 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. 49.
    Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20(1):247–56.CrossRefGoogle Scholar
  50. 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.CrossRefPubMedGoogle Scholar
  51. 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.CrossRefGoogle Scholar
  52. 52.
    Chase L. Psychosocial resilience among resettled Bhutanese refugees in the US. Forced Migr Rev. 2012;40:47.Google Scholar
  53. 53.
    Marecek J. Culture, gender, and suicidal behavior in Sri Lanka. Suicide Life Threat Behav. 1998;28(1):69–81.PubMedGoogle Scholar
  54. 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.CrossRefPubMedGoogle Scholar
  55. 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.CrossRefPubMedGoogle Scholar
  56. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York (Outside USA) 2016

Authors and Affiliations

  • Ashley K. Hagaman
    • 1
  • Teresa I. Sivilli
    • 2
  • Trong Ao
    • 3
  • Curtis Blanton
    • 4
  • Heidi Ellis
    • 5
  • Barbara Lopes Cardozo
    • 4
  • Sharmila Shetty
    • 6
  1. 1.School of Human Evolution and Social ChangeArizona State UniversityTempeUSA
  2. 2.Garrison InstituteGarrisonUSA
  3. 3.Center for Global Health, Division of Global Health Protection, Global Disease Detection BranchCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Division of Global Health Protection, Emergency Response and Recovery BranchCenters for Disease Control and PreventionAtlantaUSA
  5. 5.Department of PsychiatryBoston Children’s Hospital and Harvard Medical SchoolBostonUSA
  6. 6.Division of Global Migration and Quarantine Division of Global Migration and Quarantine, Immigrant Refugee and Migrant Health BranchCenters for Disease Control and PreventionAtlantaUSA

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