Skip to main content

Advertisement

Log in

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

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

Abstract

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.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Adapted from a standard protocol developed by the Injury and Prevention Branch, CDC.

References

  1. Marcus M, et al. Depression: a global public health concern, in WHO 2012.

  2. Gotlib IH, Hammen CL. Handbook of depression. 2nd ed. New York City: The Guilford Press; 2010.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  6. WRITENET. The exodus of ethnic Nepalis from southern Bhutan; 1995.

  7. Worldwide Refugee Admission Processing System (WRAPS).

  8. IOM. Who Am I? Assessment of psychological needs and suicide risk factors among Bhutanese refugees in Nepal and after Third Country Resettlement;2011.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  11. Amirkhan JH. A factor analytically derived measure of coping: the coping strategy indicator. J Pers Soc Psychol. 1990;59(5):1066–74.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  14. Principle component analysis. SAS/IML (R) Studio 12.3 User’s Guide. http://support.sas.com/publishing/pubcat/chaps/55129.pdf.

  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.

    Article  PubMed  Google Scholar 

  16. Wong E, Miles JV. Prevalence and correlates of depression among new U.S. immigrants. J Immigr Minor Health. 2014;16(3):422–8.

  17. Desai HD, Jann MW. Major depression in women: a review of the literature. J Am Pharm Assoc. 2000;40(4).

  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.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  23. Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Am J Med. 1982;72(1):127–35.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  25. Pumariega A, Rothe E, Pumariega J. Mental health of immigrants and refugees. Community Ment Health J. 2005;41(5):581–97.

    Article  PubMed  Google Scholar 

  26. Bhugra D. Migration and depression. Acta Psychiatr Scand. 2003;108(s418):67–72.

    Article  Google Scholar 

  27. Ao T. Suicide and suicide ideation among Bhutanese refugees—United States, 2009–2012. MMWR. 2013;62(26):533–6.

    Google Scholar 

  28. CDC Immigrant and Refugee Health Branch. Guidelines for mental health screening during the domestic medical examination for newly arrived refugees; 2012.

  29. Pathways to wellness. The refugee health screener-15 (RHS-15) Packet 2011. http://refugeehealthta.org/webinars/mental-health-screening-and-care/tools-and-strategies-for-refugee-mental-health-screening-introducing-the-rhs-15-2/.

  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. Willems R. Coping with displacement: Social networking among urban refugees in an east African context. Status: published; 2005.

  32. Ao T, et al. An investigation into suicides among Bhutanese refugees in the US 2009–2012; 2012.

  33. Cardozo B, et al. Mental health, social functioning, and disability in postwar Afghanistan. JAMA. 2004;292(5):575–84.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Laura A. Vonnahme.

Additional information

Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Supplementary material 2 (DOCX 23 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vonnahme, L.A., Lankau, E.W., Ao, T. et al. Factors Associated with Symptoms of Depression Among Bhutanese Refugees in the United States. J Immigrant Minority Health 17, 1705–1714 (2015). https://doi.org/10.1007/s10903-014-0120-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-014-0120-x

Keywords

Navigation