Jai Subedi still doesn't know why Mitra Mishra killed himself. Subedi, a case manager for Bhutanese refugees at Interfaith Works Center for New Americans in Syracuse, NY, was with the 20-year-old Mishra at Schiller Park the evening of July 3, 2010.
"We played soccer just the previous day until 6 p.m. and he was totally fine," Subedi said of Mishra, who was not a client of the center. "He played with me and I drove him back to his home. There wasn't any indication. Nothing was wrong."
On Independence Day, early morning walkers found Mishra's body hanging from a tree at the soccer field.
Laxmi Dulal received the news of his childhood friend's death by phone. Dulal, now 21 and studying at Penn State, was still in Timai refugee camp in eastern Nepal, where Mishra had lived next door before leaving for Syracuse with his grandmother almost a year before. Mishra's father had died and his mother had remarried in Nepal. Dulal's own move to the U.S. with his family was looming. Dulal had no idea his friend had been struggling. "I was in Nepal and he only sometimes used to call me and he never shared [those] things [with] me," Dulal says. "What's going to happen to their family after that, I was thinking. He was the only person who spoke English in their family."
Post-migration difficulties offer clues about their possible motivations for comitting suicide. Many are unable to communicate with their host communities, plagued by worries about family back home, or unemployed.
Mishra's death is part of a troubling pattern among Bhutanese refugees resettled in the U.S. In August of 2010, about a month after Mishra's death, Dan Maya Gurung committed suicide in Buffalo, according to the Bhutan News Service. Gurung was in her late 30s and had been in the country just two weeks. The next month, Nirmala Niroula, 35, also living in Buffalo, hung herself in her apartment. Niroula had moved to the U.S. three months earlier. That December, 20-year-old Menuka Poudel was found dead in her Phoenix apartment, hanging from a noose fashioned from the shawl Bhutanese women wear with their traditional clothing. She had been in the States just two months.
The federal Office of Refugee Resettlement (ORR) began to notice a pattern. Ultimately, 16 suicides were confirmed among U.S. resident Bhutanese refugees as of February 2012. The International Organization for Migration (IOM) had noticed a similar trend among the Bhutanese in the camps in Nepal. IOM documented 67 suicides and 64 attempts between 2004 and 2010. The numbers were high, but without a statistical comparison, it was hard to know how bad the problem was.
ORR tasked the Center for Disease Control and Prevention and the Refugee Health Technical Assistance Center of the Massachusetts Public Health Department with investigating. By interviewing close contacts of the deceased (typically family members), the study team performed "psychological autopsies" on 14 of the 16 U.S. suicide victims. They also did a broader survey of the general Bhutanese refugee population to determine the rates of suicidal thinking and mental health conditions.
The study team confirmed the government's suspicions; the problem was endemic. The global suicide rate per 100,000 people--how suicide rates are calculated--is 16, and the rate for the general U.S. population is 12.4. The Bhutanese rate is much higher: 20.3 among U.S. resettled refugees and 20.7 among the refugee camp population. A handful of suicides were reported among other refugee groups during the same period as the CDC study, but nothing like the number among the Bhutanese.
The rate of depression among the Bhutanese surveyed was 21 percent, nearly three times that of the general U.S. population (6.7 percent). In addition to depression, risk factors for suicide included not being the family's provider, feelings of limited social support, and having family conflict after resettlement. Most of the suicides were within a year of resettlement to the U.S. and, in all cases, the victims hanged themselves.
Hanging might be common because few other methods are accessible to a poor immigrant with little English literacy. Firearms are too difficult to obtain. Medications are too, and they require a knowledge of the English language few of the victims likely had.
Sharmila Shetty, one of the study's lead authors, says the study can't pinpoint why the suicides are happening, per se, but it did shed light on the reasons for suicidal thinking.
Post-migration difficulties that the victims faced offer clues about their possible motivations. Most are unable to communicate with their host communities. Many were also plagued by worries about family back home and over the difficulty of maintaining cultural and religious traditions. Most of the victims were unemployed. While few had previous mental health diagnoses, mental health conditions were probably significantly under-diagnosed in the camps where medical care was basic at best.
But few refugee camps anywhere boast high levels of medical care. And most refugees face language and cultural barriers. Still, it seems the Bhutanese community is unique in how many choose this irreversible decision.