Skip to main content
Top
Published in: Journal of Immigrant and Minority Health 4/2016

01-08-2016 | Original Paper

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011

Authors: Ashley K. Hagaman, Teresa I. Sivilli, Trong Ao, Curtis Blanton, Heidi Ellis, Barbara Lopes Cardozo, Sharmila Shetty

Published in: Journal of Immigrant and Minority Health | Issue 4/2016

Login to get access

Abstract

An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.
Literature
1.
go back to reference Hutt M. Unbecoming citizens: culture, nationhood, and the flight of refugees from Bhutan. Oxford: Oxford University Press; 2003. Hutt M. Unbecoming citizens: culture, nationhood, and the flight of refugees from Bhutan. Oxford: Oxford University Press; 2003.
3.
go back to reference Centers for Disease Control Prevention. Suicide and suicidal ideation among bhutanese refugees—United States, 2009–2012. MMWR Morb Mortal Wkly Rep. 2013;62(26):533. Centers for Disease Control Prevention. Suicide and suicidal ideation among bhutanese refugees—United States, 2009–2012. MMWR Morb Mortal Wkly Rep. 2013;62(26):533.
5.
go back to reference Miret M, Ayuso-Mateos JL, Sanchez-Moreno J, Vieta E. Depressive disorders and suicide: epidemiology, risk factors, and burden. Neurosci Biobehav Rev. 2013;37(10):2372–4.CrossRefPubMed Miret M, Ayuso-Mateos JL, Sanchez-Moreno J, Vieta E. Depressive disorders and suicide: epidemiology, risk factors, and burden. Neurosci Biobehav Rev. 2013;37(10):2372–4.CrossRefPubMed
6.
go back to reference Schinina G, Sharma S, Gorbacheva O, Mishra AK. Who am I? Assessment of psychosocial needs and suicide risk factors among bhutanese Refugees in Nepal and after third country resettlement. Geneva: International Organization for Migration (IOM); 2011. Schinina G, Sharma S, Gorbacheva O, Mishra AK. Who am I? Assessment of psychosocial needs and suicide risk factors among bhutanese Refugees in Nepal and after third country resettlement. Geneva: International Organization for Migration (IOM); 2011.
7.
go back to reference Tondo L, Isacsson G, Baldessarini RJ. Suicidal behaviour in bipolar disorder. CNS Drugs. 2003;17(7):491–511.CrossRefPubMed Tondo L, Isacsson G, Baldessarini RJ. Suicidal behaviour in bipolar disorder. CNS Drugs. 2003;17(7):491–511.CrossRefPubMed
8.
go back to reference Undurraga J, Baldessarini RJ, Valenti M, Pacchiarotti I, Vieta E. Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry. 2012;73(6):778–82.CrossRefPubMed Undurraga J, Baldessarini RJ, Valenti M, Pacchiarotti I, Vieta E. Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry. 2012;73(6):778–82.CrossRefPubMed
9.
go back to reference Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA J Am Med Assoc. 2005;294(5):571–9.CrossRef Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA J Am Med Assoc. 2005;294(5):571–9.CrossRef
10.
go back to reference Beswick S. “If You Leave Your Country You Have No Life!” Rape, suicide, and violence: the voices of Ethiopian, Somali, and Sudanese female refugees in Kenyan refugee camps. Northeast Afri Stud. 2001;8(3):69–98.CrossRef Beswick S. “If You Leave Your Country You Have No Life!” Rape, suicide, and violence: the voices of Ethiopian, Somali, and Sudanese female refugees in Kenyan refugee camps. Northeast Afri Stud. 2001;8(3):69–98.CrossRef
11.
go back to reference Hansson EK, Tuck A, Lurie S, McKenzie K. Rates of mental illness and suicidality in immigrant, refugee, ethnocultural, and racialized groups in Canada: a review of the literature. Can J Psychiatry. 2012;57(2):111–21.PubMed Hansson EK, Tuck A, Lurie S, McKenzie K. Rates of mental illness and suicidality in immigrant, refugee, ethnocultural, and racialized groups in Canada: a review of the literature. Can J Psychiatry. 2012;57(2):111–21.PubMed
12.
go back to reference Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA J Am Med Assoc. 2005;294(5):602–12.CrossRef Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA J Am Med Assoc. 2005;294(5):602–12.CrossRef
13.
go back to reference Procter NG. ‘They first killed his heart (then) he took his own life’. Part 1: a review of the context and literature on mental health issues for refugees and asylum seekers. Int J Nurs Pract. 2005;11(6):286–91.CrossRefPubMed Procter NG. ‘They first killed his heart (then) he took his own life’. Part 1: a review of the context and literature on mental health issues for refugees and asylum seekers. Int J Nurs Pract. 2005;11(6):286–91.CrossRefPubMed
14.
go back to reference Rahman A, Hafeez A. Suicidal feelings run high among mothers in refugee camps: a cross-sectional survey. Acta Psychiatr Scand. 2003;108(5):392–3.CrossRefPubMed Rahman A, Hafeez A. Suicidal feelings run high among mothers in refugee camps: a cross-sectional survey. Acta Psychiatr Scand. 2003;108(5):392–3.CrossRefPubMed
15.
go back to reference Papadopoulos R. Systemic challenges in a refugee camp. Context. 2008;98:16–9. Papadopoulos R. Systemic challenges in a refugee camp. Context. 2008;98:16–9.
16.
go back to reference Tinghög P, Hemmingsson T, Lundberg I. To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors? Soc Psychiatry Psychiatr Epidemiol. 2007;42(12):990–6.CrossRefPubMed Tinghög P, Hemmingsson T, Lundberg I. To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors? Soc Psychiatry Psychiatr Epidemiol. 2007;42(12):990–6.CrossRefPubMed
17.
go back to reference Hansen KL, Sørlie T. Ethnic discrimination and psychological distress: a study of Sami and non-Sami populations in Norway. Transcult Psychiatry. 2012;49(1):26–50.CrossRefPubMed Hansen KL, Sørlie T. Ethnic discrimination and psychological distress: a study of Sami and non-Sami populations in Norway. Transcult Psychiatry. 2012;49(1):26–50.CrossRefPubMed
18.
go back to reference Ferrada-Noli M, Asberg M, Ormstad K. Suicidal behavior after severe trauma. Part 2: the association between methods of torture and of suicidal ideation in posttraumatic stress disotrder. J Trauma Stress. 1998;11(1):113–24.CrossRefPubMed Ferrada-Noli M, Asberg M, Ormstad K. Suicidal behavior after severe trauma. Part 2: the association between methods of torture and of suicidal ideation in posttraumatic stress disotrder. J Trauma Stress. 1998;11(1):113–24.CrossRefPubMed
19.
go back to reference Ferrada-Noli M, Asberg M, Ormstad K, Lundin T, Sundbom E. Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. J Trauma Stress. 1998;11(1):103–12.CrossRefPubMed Ferrada-Noli M, Asberg M, Ormstad K, Lundin T, Sundbom E. Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. J Trauma Stress. 1998;11(1):103–12.CrossRefPubMed
20.
go back to reference Pradhan A, Poudel P, Thomas D, Barnett S. A review of the evidence: suicide among women in Nepal. Kathmandu: National Health Sector Support Program, Ministry of Health and Population; 2011. p. 117. Pradhan A, Poudel P, Thomas D, Barnett S. A review of the evidence: suicide among women in Nepal. Kathmandu: National Health Sector Support Program, Ministry of Health and Population; 2011. p. 117.
21.
go back to reference Suvedi BK, Pradhan A, Barnett S, Puri M, Chitrakar SR, Poudel P, Sharma S, Hulton L. Nepal maternal mortality and morbidity study 2008/2009: summary of preliminary findings. Kathmandu: Family Health division, Department of Health Services, Ministry of Health, Government of Nepal; 2009. Suvedi BK, Pradhan A, Barnett S, Puri M, Chitrakar SR, Poudel P, Sharma S, Hulton L. Nepal maternal mortality and morbidity study 2008/2009: summary of preliminary findings. Kathmandu: Family Health division, Department of Health Services, Ministry of Health, Government of Nepal; 2009.
23.
go back to reference Hendin H, Phillips MR, Vijayakumar L, Pirkis J, Wang H, Yip P, Wasserman D, Bertolote JM, Fleischmann A. Suicide and suicide prevention in Asia. Geneva: World Health Organization; 2008. Hendin H, Phillips MR, Vijayakumar L, Pirkis J, Wang H, Yip P, Wasserman D, Bertolote JM, Fleischmann A. Suicide and suicide prevention in Asia. Geneva: World Health Organization; 2008.
24.
25.
go back to reference Vijayakumar L, Nagaraj K, Pirkis J, Whiteford H. Suicide in developing countries. Frequencies, distribution, and association with socioeconomic indicators. Crisis. 2005;26(3):104–11.CrossRefPubMed Vijayakumar L, Nagaraj K, Pirkis J, Whiteford H. Suicide in developing countries. Frequencies, distribution, and association with socioeconomic indicators. Crisis. 2005;26(3):104–11.CrossRefPubMed
26.
go back to reference Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case-control study in India. Acta Psychiatr Scand. 1999;99(6):407–11.CrossRefPubMed Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case-control study in India. Acta Psychiatr Scand. 1999;99(6):407–11.CrossRefPubMed
27.
go back to reference Bertolote JM, Fleischmann A, Butchart A, Besbelli N. Suicide, suicide attempts and pesticides: a major hidden public health problem. Bull World Health Organ. 2006;84:260.CrossRefPubMedPubMedCentral Bertolote JM, Fleischmann A, Butchart A, Besbelli N. Suicide, suicide attempts and pesticides: a major hidden public health problem. Bull World Health Organ. 2006;84:260.CrossRefPubMedPubMedCentral
28.
go back to reference Cavanagh JT, Carson AJ, Sharpe M, Lawrie S. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395–405.CrossRefPubMed Cavanagh JT, Carson AJ, Sharpe M, Lawrie S. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395–405.CrossRefPubMed
29.
go back to reference Clark DC, Horton-Deutsch SL. Assessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides. In: Maris RW, Berman AL, Maltsberger JT, Yufit RI, editors. Assessment and prediction of suicide. New York, NY: Guilford Press; 1992. p. 144–182. Clark DC, Horton-Deutsch SL. Assessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides. In: Maris RW, Berman AL, Maltsberger JT, Yufit RI, editors. Assessment and prediction of suicide. New York, NY: Guilford Press; 1992. p. 144–182.
30.
go back to reference Gajalakshmi V, Peto R. Suicide rates in rural Tamil Nadu, south India: verbal autopsy of 39,000 deaths in 1997–98. Psychiatr Epidemiol. 2007;36:203–7. Gajalakshmi V, Peto R. Suicide rates in rural Tamil Nadu, south India: verbal autopsy of 39,000 deaths in 1997–98. Psychiatr Epidemiol. 2007;36:203–7.
31.
go back to reference Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet. 2002;360(9347):1728–36.CrossRefPubMed Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet. 2002;360(9347):1728–36.CrossRefPubMed
32.
go back to reference Appleby L, Cooper J, Amos T, Faragher B. Psychological autopsy study of suicides by people aged under 35. Br J Psychiatry. 1999;175(2):168–74.CrossRefPubMed Appleby L, Cooper J, Amos T, Faragher B. Psychological autopsy study of suicides by people aged under 35. Br J Psychiatry. 1999;175(2):168–74.CrossRefPubMed
33.
go back to reference Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.CrossRefPubMed Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.CrossRefPubMed
34.
go back to reference Kleijn W, Hovens J, Rodenburg J. Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins symptom Checklist-25 in different languages. Psychol Rep. 2001;88(2):527–32.CrossRefPubMed Kleijn W, Hovens J, Rodenburg J. Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins symptom Checklist-25 in different languages. Psychol Rep. 2001;88(2):527–32.CrossRefPubMed
35.
go back to reference Mollica RF, McInnes K, Sarajlić N, Lavelle J, Sarajlić I, Massagli MP. Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA J Am Med Assoc. 1999;282(5):433–9.CrossRef Mollica RF, McInnes K, Sarajlić N, Lavelle J, Sarajlić I, Massagli MP. Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA J Am Med Assoc. 1999;282(5):433–9.CrossRef
36.
go back to reference Fawzi S, Murphy E, Pham T, Lin L, Poole C, Mollica R. The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners. Acta Psychiatr Scand. 1997;95(2):87–93.CrossRef Fawzi S, Murphy E, Pham T, Lin L, Poole C, Mollica R. The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners. Acta Psychiatr Scand. 1997;95(2):87–93.CrossRef
37.
go back to reference Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180(2):111–6.CrossRefPubMed Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180(2):111–6.CrossRefPubMed
38.
go back to reference Alley JC. Life-threatening indicators among the Indochinese refugees. Suicide Life Threat Behav. 1982;12(1):46–51.CrossRefPubMed Alley JC. Life-threatening indicators among the Indochinese refugees. Suicide Life Threat Behav. 1982;12(1):46–51.CrossRefPubMed
39.
go back to reference Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.CrossRefPubMed Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.CrossRefPubMed
40.
go back to reference Pyakurel R, Sharma N, Paudel D, Coghill A, Sinden L, Bost L, Larkin M, Burrus CJ, Roy K. Cause of death in women of reproductive age in rural Nepal obtained through community-based surveillance: is reducing maternal mortality the right priority for women’s health programs? Health Care Women Int. 2015;36(6):655–62. doi: 10.1080/07399332.2014.908193.CrossRefPubMed Pyakurel R, Sharma N, Paudel D, Coghill A, Sinden L, Bost L, Larkin M, Burrus CJ, Roy K. Cause of death in women of reproductive age in rural Nepal obtained through community-based surveillance: is reducing maternal mortality the right priority for women’s health programs? Health Care Women Int. 2015;36(6):655–62. doi: 10.​1080/​07399332.​2014.​908193.CrossRefPubMed
42.
go back to reference Widger T. Suffering, frustration, and anger: class, gender and history in Sri Lankan suicide stories. Cult Med Psychiatry. 2012;36(2):225–44.CrossRefPubMed Widger T. Suffering, frustration, and anger: class, gender and history in Sri Lankan suicide stories. Cult Med Psychiatry. 2012;36(2):225–44.CrossRefPubMed
43.
go back to reference Chua JL. In pursuit of the good life: aspiration and suicide in globalizing south India. Berkeley: University of California Press; 2014. Chua JL. In pursuit of the good life: aspiration and suicide in globalizing south India. Berkeley: University of California Press; 2014.
44.
go back to reference Marecek J. Young women’s suicide in Sri Lanka: cultural, ecological, and psychological factors. Asian J Couns. 2006;13(1):63–92. Marecek J. Young women’s suicide in Sri Lanka: cultural, ecological, and psychological factors. Asian J Couns. 2006;13(1):63–92.
45.
go back to reference Kohrt BA, Speckman RA, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, Sharma VD, Nepal MK, Worthman CM. Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol. 2009;36(3):261–80.CrossRefPubMedPubMedCentral Kohrt BA, Speckman RA, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, Sharma VD, Nepal MK, Worthman CM. Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol. 2009;36(3):261–80.CrossRefPubMedPubMedCentral
46.
go back to reference Bruffaerts R, Demyttenaere K, Hwang I, Chiu WT, Sampson N, Kessler RC, Alonso J, Borges G, de Girolamo G, de Graaf R. Treatment of suicidal people around the world. Br J Psychiatry J Ment Sci. 2011;199(1):64–70.CrossRef Bruffaerts R, Demyttenaere K, Hwang I, Chiu WT, Sampson N, Kessler RC, Alonso J, Borges G, de Girolamo G, de Graaf R. Treatment of suicidal people around the world. Br J Psychiatry J Ment Sci. 2011;199(1):64–70.CrossRef
47.
go back to reference Warren KD. “We Do What We Can” Creating success in a New England Refugee Resettlement Agency. 2013. Warren KD. “We Do What We Can” Creating success in a New England Refugee Resettlement Agency. 2013.
48.
go back to reference Hefferan T. Bridging the gaps: faith-based organizations, neoliberalism, and development in Latin America and the Caribbean. Lexington: Lexington Books; 2009. Hefferan T. Bridging the gaps: faith-based organizations, neoliberalism, and development in Latin America and the Caribbean. Lexington: Lexington Books; 2009.
49.
go back to reference Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20(1):247–56.CrossRef Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20(1):247–56.CrossRef
50.
go back to reference Terheggen MA, Stroebe MS, Kleber RJ. Western conceptualizations and Eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India. J Trauma Stress. 2001;14(2):391–403.CrossRefPubMed Terheggen MA, Stroebe MS, Kleber RJ. Western conceptualizations and Eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India. J Trauma Stress. 2001;14(2):391–403.CrossRefPubMed
51.
go back to reference Chase LE, Welton-Mitchell C, Bhattarai S. “Solving Tension”: coping among Bhutanese refugees in Nepal. Int J Migr Health Soc Care. 2013;9(2):71–83.CrossRef Chase LE, Welton-Mitchell C, Bhattarai S. “Solving Tension”: coping among Bhutanese refugees in Nepal. Int J Migr Health Soc Care. 2013;9(2):71–83.CrossRef
52.
go back to reference Chase L. Psychosocial resilience among resettled Bhutanese refugees in the US. Forced Migr Rev. 2012;40:47. Chase L. Psychosocial resilience among resettled Bhutanese refugees in the US. Forced Migr Rev. 2012;40:47.
53.
go back to reference Marecek J. Culture, gender, and suicidal behavior in Sri Lanka. Suicide Life Threat Behav. 1998;28(1):69–81.PubMed Marecek J. Culture, gender, and suicidal behavior in Sri Lanka. Suicide Life Threat Behav. 1998;28(1):69–81.PubMed
54.
go back to reference Acharya L, Upadhya KD, Kortmann F. Mental health and psychosocial support aspects in disaster preparedness: Nepal. Int Rev Psychiatry. 2006;18(6):587–92.CrossRefPubMed Acharya L, Upadhya KD, Kortmann F. Mental health and psychosocial support aspects in disaster preparedness: Nepal. Int Rev Psychiatry. 2006;18(6):587–92.CrossRefPubMed
55.
go back to reference Kohrt BA, Worthman CM. Gender and anxiety in Nepal: the role of social support, stressful life events, and structural violence. CNS Neurosci Ther. 2009;15(3):237–48.CrossRefPubMed Kohrt BA, Worthman CM. Gender and anxiety in Nepal: the role of social support, stressful life events, and structural violence. CNS Neurosci Ther. 2009;15(3):237–48.CrossRefPubMed
56.
go back to reference Hollifield M, Verbillis-Kolp S, Farmer B, Toolson EC, Woldehaimanot T, Yamazaki J, Holland A, St Clair J, SooHoo J. The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry. 2013;35(2):202–9.CrossRefPubMed Hollifield M, Verbillis-Kolp S, Farmer B, Toolson EC, Woldehaimanot T, Yamazaki J, Holland A, St Clair J, SooHoo J. The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry. 2013;35(2):202–9.CrossRefPubMed
Metadata
Title
An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011
Authors
Ashley K. Hagaman
Teresa I. Sivilli
Trong Ao
Curtis Blanton
Heidi Ellis
Barbara Lopes Cardozo
Sharmila Shetty
Publication date
01-08-2016
Publisher
Springer US
Published in
Journal of Immigrant and Minority Health / Issue 4/2016
Print ISSN: 1557-1912
Electronic ISSN: 1557-1920
DOI
https://doi.org/10.1007/s10903-015-0326-6

Other articles of this Issue 4/2016

Journal of Immigrant and Minority Health 4/2016 Go to the issue