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STUDY OBJECTIVES: We investigated profiles of community support and challenges in relation to insomnia symptoms among the Bhutanese living in the United States. METHODS: Using 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. RESULTS: Latent 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. CONCLUSION: Community social cohesion and support may play an important role in mitigating insomnia symptoms among Bhutanese refugees. Further investigations are warranted.
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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.
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COVID-19 , Brecha Digital , Refugiados , Humanos , COVID-19/epidemiología , Bután/epidemiología , PandemiasRESUMEN
Despite the rapidly growing need to understand mental health challenges faced by refugee subpopulations, there is a dearth of literature exploring mental health conceptualization through the unique refugee lens. Guided by historical trauma theory, we gathered data using a two-phase explanatory sequential mixed-methods study (quantitative: n = 40; qualitative: n = 6) in a Midwestern U.S. region to understand mental health conceptualization from the Bhutanese refugee perspective by examining the cultural meaning and perception of mental health, describing experiences of mental health problems, and examining cultural protective factors and coping strategies. We argue that recognition of refugees' conceptualization of mental health and identification of cultural protective factors is paramount to healing. Findings emphasize the need to understand historical and cultural perspectives in cross-cultural contexts for the development and implementation of culturally responsive services. Our study also contributes to emerging knowledge on methodological rigor in research among understudied, hard-to-reach, small populations.
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Refugiados , Adaptación Psicológica , Bután , Humanos , Salud Mental , Refugiados/psicologíaRESUMEN
This study examined perceptions toward mental health and seeking psychological care among Bhutanese refugees in a large Midwestern U.S. city. Bhutanese adults (n = 201) completed a community health needs assessment. Survey questions addressed beliefs toward mental health and seeking psychological care. Perceptions toward mental illness and receiving psychological help were generally negative among participants. Over 71% believed others would look unfavorably on a person who sought out a counselor. Participants who had less than a high school education, were 35 years and older, and lived in refugee camps for more than 20 years had significantly greater negative beliefs toward mental illness. Over one-third (34.8%) of participants reported access to counseling services as being somewhat of a problem or a serious problem. These findings may inform future research and interventions aimed at improving mental health among Bhutanese refugees.