Suicide and Suicide-Related Behavior Among Bhutanese Refugees Resettled in the United States

Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper identification of risk factors for suicide saves lives; however, if risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to occur. In this review, we examine specific cultural factors related to psychopathology and suicide among Bhutanese refugees. To contextualize the current suicide crisis among Bhutanese refugees, we propose an integration of the interpersonal psychological theory of suicide (Joiner, 2005) and the cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010). We provide recommendations for preventing suicide from a systems framework and discuss practical lessons from a preliminary study designed to test a culturally responsive model of suicide in Bhutanese refugees. What is the public significance of this article? Bhutanese refugees have a suicide rate roughly twice that of the general U.S. population but a suicidal ideation rate that is roughly half that of the U.S. population. Proper culturally responsive screening based on an ideation-to-action framework and a systems-based approach to prevention may be effective tools for reducing the number of suicides among Bhutanese refugees living in the United States.