Bhutanese refugees who had resettled in the United States were more likely to contemplate suicide if they reported ever having mental health problems such as posttraumatic stress disorder or had difficulties adjusting, such as finding employment or providing for their families, according to the CDC.
In a Morbidity and Mortality Weekly Report, researchers stressed the need for the development of “culturally appropriate community-based interventions for suicide prevention” and standard monitoring of suicidal behavior among those who fled the impoverished South Asian country.
The annual suicide rate among those who had resettled in the US could be as high as 24.4 per 100,000, exceeding the estimated global suicide rate (16 per 100,000) and that among US residents (12.4 per 100,000).
In collaboration with the Massachusetts Department of Public Health’s Refugee Health Technical Assistance Center, the CDC surveyed randomly selected refugees living in four states with large Bhutanese refugee populations to assess risk factors associated with suicidal ideation.
Results indicated that 36% of the refugees surveyed experienced four to seven traumatic events or significant stressors after resettling in the US, and 34% reported eight or more traumatic events or stressors. The most common stressors were a lack of nationality or citizenship (90%), having to flee suddenly (54%) and lack of freedom of movement (52%). Language barriers (62%), lack of choice (46%) and concerns about family members left behind (39%) were common difficulties among refugees.
According to the researchers, 4% of participants reported ever having been diagnosed with a mental health disorder, but there was a much higher prevalence of current depression (21%), anxiety (19%) and psychological distress symptoms (17%), suggesting undiagnosed mental illnesses among the cohort.
Thirty percent of Bhutanese refugees had known someone who committed suicide, and 18% of those had been emotionally close to the deceased. Researchers said 3% of the refugees had expressed suicidal ideation.
Refugees who did not provide for their families were more likely to report suicidal ideation compared with those who were providers (adjusted OR=6.6; 95% CI, 1.4-31.9). Anxiety (aOR=38.1; 95% CI, 7.9-185.1), distress (aOR=15; 95% CI, 3.9-57.1) and depression (aOR=11.2; 95% CI, 2.9-42.1) were strongly associated with suicidal ideation. Those who reported PTSD symptoms also were at increased risk for suicidal ideation (aOR=9.3; 95% CI, 2.1-41). Family conflict (aOR=22.6; 95% CI, 5.5-92.6) and difficulty finding employment (aOR=11.1; 95% CI, 2.4-51.5) were problems that had contributed to suicidal ideation after resettling in the US.
Based on the findings, the researchers recommended strategies to curb suicidal behavior in the Bhutanese refugee community, including following up with affected families immediately after a suicide, engaging “cultural brokers” to liaise with mental health care services and the community, and following the CDC’s plan for the prevention of suicide clusters.
For more information:
CDC. MMWR. 2013;62:533-536.
CDC. MMWR. 1988;37:1-12.
Disclosure: The researchers report no relevant financial disclosures.