Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Pablo Bose


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 2 times higher than the general United States population. Proper identification of risk factors for suicide saves lives and prevents suicides (Mann et al., 2005); however, if suicide risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to needlessly grow. In a community sample of Bhutanese refugees resettled in Vermont (N=60), the current study aims to (1) test elements of a comprehensive conceptual model of incremental risk factors for suicide – adapted from the interpersonal psychological theory of suicide (IPTS; Joiner, 2005) – including suicidal desire, suicidal ideation, thwarted belongingness, and perceived burdensomeness and (2) test the relative contributions of suicidal desire and suicidal ideation as risk factors for suicidal behavior.

Participants attended a single study visit at which they completed self-report measures administered in an interview format via an interpreter, if needed. Key measures included the Beck Scale for suicidal ideation (BSS; Beck & Steer, 1991), Interpersonal Needs Questionnaire (INQ; Van Orden et al., 2012), Wish to be Dead Scale (WDS; Lester, 2013), Refugee Health Screener – 15 (RHS-15; Hollifield et al., 2013), Postmigration Living Difficulties checklist (PmLD; Laban et al., 2005), Brief Biosocial Gambling Screen (BBGS; Gebauer et al., 2010), basic demographics questions, and qualitative questions about suicide within the Bhutanese refugee community. The analytic approach relied on the use of hurdle models, Fisher’s exact tests, hierarchical logistic regression, and independent samples t-tests to assess the relationships among aspects of our conceptual model.

Although endorsement of suicidal ideation (n = 4, 6.7%) and suicidal behavior (n = 2, 3.3%; measured by combining the planning and concealment subscales of the BSS) was low in the sample, a substantial minority (n = 29, 48.3%) endorsed some desire to be dead. Perceived burdensomeness, but not thwarted belongingness, was significantly associated with both suicidal ideation and the desire to be dead. There was no evidence that the desire for death contributed additional risk of suicidal behavior, above and beyond suicidal ideation. Of participants with a history of suicide attempts (n = 4), none reported any suicidal ideation and 3 reported some desire to be dead. Neither desire to be dead nor suicidal ideation was significantly related to suicide attempt history.

These findings have implications for suicide detection and prevention among resettled Bhutanese refugees. The cultural responsiveness of suicide screening in this population could be improved by assessing two constructs not typically assessed: desire to be dead (e.g., the WDS) and perceived burdensomeness (e.g., INQ). Explicit evaluation of these two constructs in Bhutanese refugees may increase the sensitivity of risk assessments without sacrificing specificity in comparison to assessments exclusively focused on self-reported suicidal ideation.



Number of Pages

102 p.