Abstract
Background: Most refugees live in low-income countries. More than one hundred thousand Bhutanese refugees have been living in Nepal for several years. The association of torture and psychiatric morbidity with disability among such refugees is unknown. It is also important to understand how they perceive mental illness and disability.
Objectives: (a) To compare disability between tortured and non-tortured Bhutanese refugees living in Nepal, (b) to investigate psychiatric comorbidity and its association with disability among tortured Bhutanese refugees, (c) to identify predictors of psychiatric disability among Bhutanese refugees living in Nepal, and (d) to assess their knowledge, attitude and practices regarding mental illness and disability
Design and participants: Cross-sectional survey was carried out on a sample of 418 tortured and 392 non-tortured refugees, matched on age and sex. Furthermore, focus group discussions were conducted with 14 mentally ill or disabled refugees, 16 family members and 12 traditional healers in addition to 10 in-depth interviews.
Settings: Bhutanese refugee camps in eastern Nepal. Main Outcome Measure: Composite International Diagnostic Interview-2.1, and Psychiatric Disability Assessment Schedule-Short (WHO DAS-S) were used to measure psychopatholgy and disability respectively.
Results: Disability among tortured and non-tortured Bhutanese refugees was not significantly different (21% vs 24%, p = 0.407). Comorbidity of PTSD with persistent pain, specific phobia and dissociative disorders among tortured refugees were significantly associated with disability. Posttraumatic stress disorder (OR 2.0, 95% CI of 1.2-3.5), specific phobia (OR 2.2, 95% CI of 1.2-3.8), and present physical illness(OR 2.0, 95% CI of 1.1-3.8) were identified as predictors of disability for tortured refugees. On the other hand, generalized anxiety disorder (OR 3.3, 95% CI 1.2-9.3), older age (OR 2.3, 95% CI 1.1-5.1), and present illness (OR 2.9, 95% CI 1.7-5.2)
were identified as predictors of disability for non-tortured refugees.
Bhutanese refugees have specific ways of understanding and explaining mental illness and disability. Both mental illness and disability are associated with stigma in this community. Furthermore, most of them believe that mental illness could lead to disturbances in different
roles.
Conclusion: Disability was associated with different risk factors for tortured and nontortured refugees. Comorbidity increased odds for disability. Further studies are needed to generalize findings beyond the Bhutanese refugee population. A combination of quantitative and qualitative research provides a more in-depth picture of the nature and extent of disorders and disability than either research method is
able to provide alone.