Over 100,000 ethnically Nepalese, "Lhotshampa," people experienced systematic oppression, disenfranchisement, and violence during the latter part of the 20th 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.

中文翻译：

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对不丹难民自杀风险和保护因素认知的定性研究。


20 世纪后半叶，超过 10 万尼泊尔族“Lhotshampa”经历了系统性的压迫、剥夺公民权和暴力。 Lhotshampa 人被迫逃离不丹南部的家园，进入尼泊尔的难民营长达 20 多年。截至撰写本文时，大多数不丹难民已在其他国家（主要是美国、加拿大和澳大利亚）重新安置。随着剩下的两个尼泊尔难民营准备关闭，许多不丹难民中正在出现日益严重的自杀危机。在美国重新定居的不丹难民的自杀率大约是美国普通人口的两倍。从不丹难民本身的角度定性地审视风险和保护因素的性质至关重要。我们的研究包括从社区样本中招募的 15 名不丹难民（8 名男性，7 名女性），作为审查文化响应自杀风险评估的母项目的一部分。男女平均年龄均为 38.4 岁（范围为 22-55 岁）。我们的研究参与者被问及有关自杀风险和预防的开放式问题。我们进行了主题分析，综合了风险和保护主题，并对数据应用了社会生态框架。我们发现风险主题包括心理困扰和脆弱性、药物滥用、社会和家庭不和谐、人际暴力、孤立和移民后压力源。保护主题包括低水平的物质使用、消除心理健康问题的污名化、牢固的社会联系、减少移民后压力源、增加获得精神卫生保健的机会以及东道社区对移民相关挑战的强烈认识。