Bhutanese Refugees Research Articles

Profiles of community support and challenges associated with insomnia symptoms: Findings from the pilot Bhutanese Community of Central Ohio Health Study

Study objectivesWe investigated profiles of community support and challenges in relation to insomnia symptoms among the Bhutanese living in the United States. MethodsUsing data from the pilot Bhutanese Community of Central Ohio Health Study (N = 495; 51.5% men, 69.8% aged 18-44years), we used latent class analysis to identify distinct profiles of neighborhood social cohesion, social support, and community challenges (e.g., limited access to healthcare services and transportation, crime and safety issues, substance use, intimate partner violence) and their associations with insomnia symptoms. Insomnia symptoms were self-reported as difficulty falling and staying asleep and dichotomized as “not at all” vs. “some to always.” Identified classes/profiles were further differentiated by self-reported sociodemographic, socioeconomic, health, acculturative, and discrimination factors. ResultsLatent class analysis revealed four distinct classes/profiles. The High Cohesion (class 1) profile (30.1% of sample) had the lowest likelihood of insomnia symptoms at 6.5%, followed by class 2 or High Support (23.6%) with a 15.3% likelihood. Class 3 or High Challenges profile (11.5%) had a moderate likelihood of insomnia symptoms at 49%. Class 4 or the Low Cohesion/Support profile (34.7%) had a 100% likelihood of reporting insomnia symptoms. Class 4 when compared to class 1 was more likely to report cardiometabolic conditions, experiences of everyday discrimination, limited English linguistic proficiency, and not using telehealth. ConclusionCommunity social cohesion and support may play an important role in mitigating insomnia symptoms among Bhutanese refugees. Further investigations are warranted.

Aligned and shifting identities in distant diasporas: a multigenerational examination

ABSTRACT The diaspora literature regularly examines identity shifts and remakings through experiences of displacement. Multigenerational diasporas, however, complicate these shifts due to differing contexts of education, history and resettlement experience between younger and older generations. How does diaspora identity continue across generations, and where does it shift in distant diasporas? This article examines the ways that the identities of former Bhutanese refugees have been sustained and shifted in the context of mass resettlement. It compares radio interviews with younger and older generation diaspora members broadcast on Radio Pahichan, a Nepali-language radio show produced in South Australia. We examine diaspora members who have participated in these public expressions of identity through the overlapping thematic lenses of stories, language, culture, success, and memory. Through an analysis of this material, we show how some aspects of identity serve as a bridge between generations, while others show shifts and breaks in previously similar identities.

Nepali Translation, Validity and Reliability Study of the Cohen-Hoberman Inventory of Physical Symptoms for Utilization With Bhutanese Refugees.

Language-appropriate outcome measurements help to improve health equity. The purpose of this study was to translate and validate the Cohen-Hoberman Inventory of Physical Symptoms (CHIPS) in Nepali for Bhutanese refugee utilization. English-Nepali forward and back translations of CHIPS were completed by an official translator and evaluated by three content experts. A scaled rubric measured the following constructs: neurogenic stress response (NSR), somatic stress response (SSR), and visceral stress response (VSR). Data were analyzed using SPSS 26.0. The Nepali version of CHIPS reported good content validity, strong internal consistency (Cronbach's α =.94), and inter-rater reliability (ICC=0.91). Kappa statistic reported 88% to 96% agreement. Constructs of NSR (0.91), SSR (0.94), and VSR (0.94) reported strong internal consistency. The Nepali translated version of CHIPS showed strong validity and reliability for utilization in the Bhutanese refugee population and improves health access to outcome measurements for a vulnerable population.

Conceptualisations of pain amongst resettled Nepali-speaking Bhutanese adults in rural and regional Australia.

Nepali-speaking Bhutanese refugees have been subject to one of the largest resettlement programs in the world and experience higher rates of chronic pain when compared to the general population. The purpose of this study was to explore qualitative conceptualisations of chronic pain among a group of Nepali-speaking Bhutanese adults with a refugee background who relocated to rural and regional Australia. Participants included 22 individuals (females n=15) with chronic pain, who took part in structured qualitative focus groups exploring their experiences of chronic pain. Data were analysed using thematic analysis and five main themes were developed. The themes were: (1) pain is persistent and creates suffering, (2) pain is subjective and poorly understood, (3) pain is a biomedical problem that needs to be solved, (4) pain is complex and more than a biomedical problem, and (5) coping with pain is multi-faceted.Some participants viewed pain through a predominantly biomedical lens, and some recognised social and psychological factors as contributors to pain. Overwhelmingly, the participants believed pain is complex and multifaceted, requiring active and passive strategies for management, some of which are culturally informed. The experiences of resettled Nepali-speaking Bhutanese refugees living with pain are important to elucidate to improve healthcare inequalities among this marginalised group. This research will inform future assessment guidelines and treatment programs for Nepali-speaking Bhutanese adults living with chronic pain.

Gender Based Violence in Bhutanese Refugee Camps in Nepal: A Study of Sanischare Refugee Camp

Gender Based Violence in Bhutanese Refugee Camps in Nepal: A Study of Sanischare Refugee Camp

Transitions without Justice: Bhutanese Refugees in Nepal

ABSTRACT∞ Typically, human rights abusers are widely condemned by the international community in the context of transitional justice. But what happens when the transition to democracy generates refugees that are not permitted to return to what appears to now be a stable, peaceful democracy? This is the case of Bhutan, who forcefully expelled its largest minority community during a period of nation building, then successfully transitioned to democracy without any accountability for the crimes that occurred during that process. While approximately 100,000 Bhutanese refugees in camps awaited some measure of justice and hoped for repatriation, the international community provided them with a democratically grounded education to raise awareness of their rights. But this education was not matched by any pathways to exercise those rights or achieve justice. This article examines how particular challenges to transitional justice are experienced by refugee and diaspora communities, and how current justice structures frequently fail to meet their needs.

Abstract MP42: Insomnia Symptoms Are Associated With Poor Cardiometabolic Health Among Bhutanese Refugees in the United States

Introduction: The prevalence of insomnia symptoms is higher among refugees globally compared to the general population, and poor sleep is a risk factor for poor cardiometabolic health. The resettled Bhutanese refugee community is the third-largest refugee group in the United States (US) and appears to be-based on a few existing studies-particularly susceptible to sleep disturbances such as insomnia symptoms as well as cardiometabolic conditions such as hypertension, and type 2 diabetes. No prior studies have investigated associations between insomnia symptoms and cardiometabolic conditions in this community. Hypothesis: We hypothesized that participants reporting insomnia symptoms will have a higher prevalence of cardiometabolic conditions. Methods: We used data from the 2021-2022 Bhutanese Community of Central Ohio Health Study (N=495) to examine associations between insomnia symptoms and cardiometabolic health. Insomnia symptoms, measured by self-reports of difficulty falling/staying asleep, were categorized as “not at all,” “sometimes,” and “often/all the time.” A cardiometabolic condition was based on self-reported medical diagnosis/treatment of one or more of the following conditions: hypertension, dyslipidemia, and type 2 diabetes. Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of cardiometabolic conditions among participants with insomnia symptoms compared to participants without insomnia symptoms while adjusting for sociodemographic characteristics and body mass index (using criteria for Asians). Results: The sample was mainly aged between 18-44 years (69.8%), 51% were male, and most lived in the US for ≥11 years (60.2%). Insomnia symptoms prevalence was 56.4% for “not at all”, 30.7% for “sometimes,” and 12.9% for “often/all the time.” Overall, 12.9% of participants had at least 1 cardiometabolic condition, 10.8% had at least 2 conditions, and 6.3% had all 3 conditions. Compared to not having insomnia symptoms, having insomnia symptoms sometimes was associated with a higher prevalence of type 2 diabetes [PR=2.15, 95%CI: 1.19-3.87], hypertension [PR=1.86, 95%CI: 1.24-2.79], dyslipidemia [PR=1.73, 95%CI: 1.01-2.96], and 1 or more cardiometabolic conditions [PR=1.67, 95%CI: 1.20-2.32]. Similarly, compared to not having insomnia symptoms, having insomnia symptoms often/all the time was associated with a higher prevalence of type 2 diabetes [PR=2.18, 95%CI: 1.04-4.54], hypertension [PR=1.71, 95%CI: 1.06-2.74], dyslipidemia [PR=3.03, 95%CI: 1.67-5.47], and 1 or more cardiometabolic conditions [PR=1.68, 95%CI: 1.15-2.47]. Conclusions: In conclusion, the burden of both insomnia symptoms and cardiometabolic health conditions were prevalent among the US Bhutanese refugee population, and the insomnia-cardiometabolic health associations were strong.

Intangible Cultural Heritage and the Protection of Refugees and Refugee Camps

Abstract The Intangible Cultural Heritage Convention was established to recognize and protect non-material aspects of culture. Through an analysis of the experience of Bhutanese refugees, we argue that the Convention could be used to aid, protect, and acknowledge refugees in the absence of other mechanisms. Bhutanese refugees began living in camps in 1991, and a population remains in camps without formal international or national support. During this residency, the culture and identity of the Bhutanese refugees were transformed. As sites of cultural meaning and transformation for the refugees, the camps should be protected. Unfortunately, the current state-centric process for nominating intangible cultural heritage for protection excludes stateless and minority groups, such as refugees. Consequently, the nomination process should be amended to allow for bottom-up, community-led nominations.

Role of Social Support on Mental Health Among Resettled Bhutanese Refugees in Ohio.

More than 80% of Bhutanese refugees have resettled in the United States. Social support can lead to better resilience against poor mental health outcomes among this population. This study assessed the role of social support on mental health among the resettled Bhutanese adults in Central Ohio. This study used data collected by the Ohio Department of Mental Health and Addiction Services on 200 Bhutanese adults in Columbus. Social support was measured using a 12-item perceived social support scale. The 25-item Hopkins Symptoms Checklist was used to quantify depression and anxiety experienced in the past month. One-in-three participants reported mental health problems. Compared to participants with high social support, those with medium (OR 5.28, 95% CI 2.09-13.37) and low social support (OR 10.94, 95% CI 2.53-47.33) had more than 5- and 10-fold increased odds of mental health problems respectively. Future studies could further explore the role of social support on mental health during relocation, resettlement, and acculturation processes.

Towards a Spatial Analysis of Refugees Working Outside Camps

ABSTRACT In Nepal, Bhutanese refugees sought economic opportunities outside the UNHCR-operated refugee camps. While both males and females experienced exploitation, distance from the camps was a key variable when determining vulnerability to exploitation. Where victimization occurred was more indicative of vulnerability to trafficking than gender. This article proposes that Zones of Vulnerability help understand risk in relation to human trafficking for refugee residents in camps. This has direct application to the design of existing and future refugee camps in relation to neighboring communities. A spatial consideration of vulnerability can also help broaden understanding of who victims of trafficking or labor exploitation are and reduce the current stigma that female trafficking victims face when attempting to reintegrate into their communities.

Emotions in Crisis: Consequences of Ceremonial Refugee Camp Visits to Bhutanese Refugee Camps in Nepal

Research on refugee resettlement frequently overlooks the larger context of the experience of forced migration. As a result, the micro-level interactions between refugees and the bureaucrats who make resettlement decisions are obscured. We can better understand the socio-political dynamics between refugees and the officials deciding their resettlement cases if we approach encounters between refugees and migration officials during ceremonial visits as sites of emotional exchange. This article examines the complex socio-political emotional exchanges of power and vulnerability that underpin the refugee resettlement process through an ethnographic analysis of Bhutanese refugee camps in Nepal.

P20-033-23 Functional Potential of the Gut Microbiome in NH Bhutanese Refugee Adults With Glycemic Impairment

P20-033-23 Functional Potential of the Gut Microbiome in NH Bhutanese Refugee Adults With Glycemic Impairment

Prevalence of Diabetes in Nepali-Speaking Bhutanese Americans Living in the Greater Harrisburg Area.

Members of the Nepali-speaking Bhutanese refugee community had resettled in the United States beginning in 2008 after previously being settled in United Nations (UN) refugee camps in Nepal. Due to the recency of their resettlement, there has been little research regarding diabetes in the Nepali-speaking Bhutanese American community. This study sought to identify the prevalence of diabetes in Nepali-speaking Bhutanese Americans living in the Greater Harrisburg Area and whether this community was at a higher risk of developing diabetes due to changes in diet and physical activity lifestyle behaviors. This study was conducted using an anonymous online survey. Anyone over the age of 18 and a self-identified member of the Nepali-speaking Bhutanese American community living in the Greater Harrisburg Area was included, regardless of their diabetes status. This study excluded individuals under the age of 18, those found outside the limits of the targeted region, and those who do not self-identify as members of the Nepali-speaking Bhutanese American community. Through this survey, data regarding demographics (age and gender), length of stay in the US, diabetes status (present or absent), consumption of rice (increased or decreased post-resettlement), and physical activity status (increased or decreased post-resettlement) were collected. The current prevalence of diabetes in this population was compared against the one reported by the CDC before migration and against the prevalence of diabetes in the general population of the United States of America (USA). The association between rice consumption, physical activity, and diabetes was analyzed using the odds ratio. The survey yielded responses from 81 participants. Results showed a 2.29 times higher prevalence of diabetes in the Bhutanese-speaking Nepali population of the Greater Harrisburg Area, Pennsylvania, compared to the general population of the USA. Results indicated a 37 times higher prevalence of diabetes after resettlement in the USA compared to the population's self-reported prevalence before the resettlement. The data showed that increased rice consumption or decreased physical activity alone did not significantly increase the risk of developing diabetes. However, the combination of decreased physical activity and increased rice consumption significantly increased the risk of diabetes, with an odds ratio of 5.94 (CI: 1.27 to 27.56, p-value: 0.01). The higher prevalence of diabetes in this community justifies diabetes education around causes, symptoms, treatments, and preventative healthcare methods. Greater awareness of the issue among the members of this community, as well as their healthcare providers, paves the way for future studies to identify all possible risk factors for diabetes in this community. Once risk factors are identified, early interventions and screening tools can be implemented to mitigate the onset of disease in this population in the future.

Association between inflammation, lipopolysaccharide binding protein, and gut microbiota composition in a New Hampshire Bhutanese refugee population with a high burden of type 2 diabetes.

South Asian refugees experience a high risk of obesity and diabetes yet are often underrepresented in studies on chronic diseases and their risk factors. The gut microbiota and gut permeability, as assessed through circulating lipopolysaccharide binding protein (LBP), may underlie the link between chronic inflammation and type 2 diabetes (T2D). The composition of the gut microbiota varies according to multiple factors including demographics, migration, and dietary patterns, particularly fiber intake. However, there is no evidence on the composition of the gut microbiota and its relationship with metabolic health in refugee populations, including those migrating to the United States from Bhutan. The objective of this study was to examine glycemic status in relation to LBP, systemic inflammation fiber intake, and gut microbiota composition in Bhutanese refugee adults residing in New Hampshire (n = 50). This cross-sectional study included a convenience sample of Bhutanese refugee adults (N = 50) in NH. Established bioinformatics pipelines for metagenomic analysis were used to determine relative genus abundance, species richness, and alpha diversity measures from shallow shotgun sequences. The relationships between inflammatory markers, gut microbiota composition, dietary fiber, and glycemic status were analyzed. We identified a substantial chronic disease burden in this study population, and observed a correlation between glycemic status, LBP, and inflammation, and a correlation between glycemic status and gut microbiome alpha diversity. Further, we identified a significant correlation between proinflammatory taxa and inflammatory cytokines. SCFA-producing taxa were found to be inversely correlated with age. To date, this is the most comprehensive examination of metabolic health and the gut microbiome in a Bhutanese refugee population in NH. The findings highlight areas for future investigations of inflammation and glycemic impairment, in addition to informing potential interventions targeting this vulnerable population.

Exploring the Digital Divide among the Bhutanese Refugee Community during COVID-19: Engaged Research in Action

The digital divide proved a critical barrier to accessing information and healthcare during the COVID-19 pandemic and negatively impacted the Bhutanese refugee community. Moving beyond a technological model of the digital divide that highlights a lack of access to computers and the internet, we engaged the community to co-produce a dynamic approach that identifies the impact of socio-cultural and socio-environmental factors as well. Our paper reports on our community-academic research partnership and explores how the digital divide exacerbates health disparities in a midwestern Bhutanese refugee community. Combining the efforts of the community, anthropologists and social workers, this paper reports on the health disparities that confront the community as well as interventions designed to mitigate social inequities.

The Importance of Education on Bhutanese Refugees and their Personal Incomes

In this paper, I look to find the personal income rates of Bhutanese Refugees. I have been looking to find how variables like a refugee's educational attainment, poverty rate, and family situation affect how much money they make. Through the usage of Integrated Public Use Microdata Series(IPUMS) quantitative data, I took a sample of the specific year 2018 to visit the causation behind these variables and the result. An increase in the educational attainment of a Bhutanese Refugee will lead to an increase in their personal income and with a larger family, they will make more money. This means that the actions of the variables, whether they increase or decrease, have an effect on the personal income rates of a refugee.

Maternal Health Understandings and Experiences of Bhutanese Refugee Women Pre- and Post-Settlement: A Qualitative Case Study

Refugee maternal health is an under-studied area in health science research since refugee women have complex health histories that consistently change throughout their resettlement journey. This study examined setting-based maternal health understanding among Bhutanese refugee women resettled in Greensboro, NC. We utilized qualitative case-study methods to examine n = 12 interviews within three different cases based on birth settings. Themes around women’s experiences of familial support, impact of setting-based maternal health access, and quality of care experienced were significant findings. Study aims were to help providers improve patient-provider interaction in relaying adequate care information and assess women’s pre-settlement health history for appropriate care.

Resettlement Divorce: The Hidden Costs of Family Separation During Refugee Resettlement

Refugee resettlement is a solution to provide safety and security to individuals left vulnerable from displacement. However, some refugees who intermarry with non-refugees are barred from resettling with their intact family unit. This article utilizes an in-depth ethnographic analysis of the everyday life of refugees in mixed nationality marriages living in Nepal to argue that the right to family unity is denied to some refugees. Refugees in mixed-nationality marriages must choose between divorcing a loving and stable partner to resettle in a third country and remaining encamped in Nepal, where opportunities for safety, security, and advancement are severely limited. This analysis indicates that “resettlement divorces” became a way that mixed-marriage refugee couples managed to navigate the offer of resettlement for Bhutanese refugees in Nepal and the ways that resettlement structured their everyday lives. Implications exist for interrogating which families are granted the right to “unity,” patterns of refugee resettlement, and the resettlement outcomes of single refugee mothers.

Investigating Outcomes of a Family Strengthening Intervention for Resettled Somali Bantu and Bhutanese Refugees: An Explanatory Sequential Mixed Methods Study.

Pre- and post-migration stressors can put resettled refugee children at risk of poor mental health outcomes. The Family Strengthening Intervention for Refugees (FSI-R) is a peer-delivered preventative home visiting program for resettled refugees that aims to draw upon families’ strengths to foster improved family communication, positive parenting, and caregiver-child relationships, with the ultimate goal of reducing children’s risk of mental health problems. Using an explanatory sequential mixed methods design, this study draws upon qualitative interviews with caregivers (n = 19) and children (n = 17) who participated in a pilot study of the FSI-R intervention in New England, as well as interventionists (n = 4), to unpack quantitative findings on mental health and family functioning from a randomized pilot study (n = 80 families). Most patterns observed in the quantitative data as published in the pilot trial were triangulated by qualitative data. Bhutanese caregivers and children noted that children were less shy or scared to speak up after participating in the FSI-R. Somali Bantu families spoke less about child mental health and underscored feasibility challenges like language barriers between caregivers and children. Interventionists suggested that families with higher levels of education were more open to implementing behavior change. In both groups, families appreciated the intervention and found it to be feasible and acceptable, but also desired additional help in addressing broader family and community needs such as jobs and literacy programs.

'You don't compare horrors, you just don't do that': Examining assumptions and extending the scope of comparative victim beliefs.

Social psychological research on collective victimhood has often focused on comparisons between the ingroup's and outgroups' collective victimization (i.e. comparative victim beliefs such as competitive victimhood or inclusive victim beliefs). This qualitative study examines how people in different contexts of collective victimization and its aftermath make sense of items commonly used to assess comparative victim beliefs, and how they extend or challenge these constructs and their underlying assumptions. We used thematic analysis to analyse eight focus group discussions among four minority groups in the United States with historical or more recent experiences of collective victimization (Armenian Americans, Burundian refugees, Jewish Americans and Nepali-speaking Bhutanese refugees). Findings extend commonly assessed comparative victim beliefs and reveal participants' critical perspectives on these constructs. The findings also highlight the dialectical structure of collective victim beliefs: Participants not only endorsed but also rejected comparative victim beliefs, and relatedly described both ingroup power and outgroup power in the context of their group's victimization. These findings extend existing social psychological literature on comparative victim beliefs and intergroup relations.