Past trauma, resettlement stress, and mental health of older Bhutanese with a refugee life experience

Abstract

Objectives

Older displaced persons often receive limited attention from aid organizations, policy-makers and service providers in countries of resettlement. The objective of this study is to identify the relationship between experiencing traumatic events and stressors prior to resettlement, current resettlement stressors, social support, and mental health of older Bhutanese with a refugee life experience.

Method

Study participants were 190 older Bhutanese with a refugee life experience living in a metropolitan area in New England (US) and Ontario (Canada). We used structural equation modeling to determine the association between traumatic and stressful events in Bhutan and Nepal, current resettlement stressors, and symptoms of anxiety and depression, as measured by the GAD-7 and PHQ-9. We assessed the role of social support as an effect modifier in the relationship between these variables.

Results

Surviving torture was associated with anxiety (p=.006), and experiencing threats to physical wellbeing in Nepal was associated with both anxiety (p=.003) and depression (p=.002). The relationship between physical threats in Nepal and current mental health were partially mediated by resettlement stressors. Social support moderated the relationship between trauma, stress, and mental health.

Conclusion

Both past traumas and current resettlement stressors contribute to the current psychosocial functioning of older Bhutanese with a refugee life experience. Based on our findings, social support is critical in promoting mental health in this population.

Keywords:

• Aging
• refugees
• trauma
• resettlement stress
• Bhutanese
• mental health
• social support

Acknowledgements

The authors would like to thank all staff that assisted in data collection and provided critical contextual knowledge on the lives of Bhutanese with a refugee life experience, in particular Narad Adhikari, Durga Giri, and Brian Khadka. We would also like to thank the generosity of study participants for sharing their life stories. Haami yas anusandhan ma udaar bhayera hamilaii aafna jiwanka kathaharu sunaunubhayeka sahabhagiharulaii pani dhanyabaad din chahanchhaun.

Disclosure statement

The authors report no conflict of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Canadian Institutes of Health Research, or McGill University.

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Additional information

Funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number P30AG024409, the Canadian Institutes of Health Research under a Postdoctoral Training Fellowship Award, and a Fellowship Award from the Research Institute of the McGill University Health Centre.