A new study led by Emory University School of Medicine researcher Charles L. Raison, MD, is the first to show that depression and anxiety are more prevalent in Tibetan refugees than they are in ethnic Tibetans born and raised in the comparative stability of exile communities in Northern India and Nepal. The study findings were reported in the April 2008, on-line version of the journal Social Psychiatry and Psychiatric Epidemiology.
"As political tensions within Tibet continue to erupt, it is estimated that approximately 2,500 Tibetan refugees per year cross the Himalayas into Nepal, seeking asylum there or in India," explains Raison, an assistant professor in Emory's Department of Psychiatry and Behavioral Sciences.
"One-third of these refugees are children and ninety percent of those children are without parents. Not only have these children been victimized in an environment lacking in respect for human rights, but their escape from Tibet to India through the perilous Himalayas is full of risk and trauma."
The study was conducted in the Indian State of Himachal Pradesh at both the Upper Dharamsala and Bir campuses of the Tibetan Children's Villages (TCV). TCV serves as the primary school system for ethnic Tibetans in exile in India and Nepal.
The Hopkins Symptom Checklist-25 (HSCL-25), a questionnaire widely used to measure depression and anxiety symptoms in refugee groups around the world, was completed by 319 student volunteers in grades 9 through 12 and by older students in grades 7 and 8. The students also were asked to provide demographic information such as place of birth, age and availability of family support in India.
Students born in Tibet demonstrated significantly higher depression and anxiety scores than Tibetans born in exile in either India or Nepal. Students who left Tibet at an older age or who had been in India for a shorter period of time had higher depression and anxiety scores, suggesting that experiences in Tibet may have promoted depression and anxiety, whereas time spent in India may have promoted an improvement of symptoms.
Other risk factors for depression and anxiety in the group as a whole included being female and having limited family contact; however, these factors did not account for the association between being born in Tibet and having increased anxiety and depression.
"It is very concerning that Tibetan refugees exhibited such significant depressive and anxiety symptoms," says Raison. "Also worrisome is that we discovered even the ethnic Tibetans born in exile had relatively high depressive and anxiety symptoms.
"These findings highlight the cost of the ongoing human rights crisis within Tibet in human emotional suffering. This is especially true for people born in Tibet who risk the hardships of escape to freedom in India. But even Tibetans born and raised in exile appear to be paying an emotional price for the loss of their homeland."
Raison concludes that there is a need for continued support for refugee communities, even after prolonged periods of what seems to be successful adaptation in an exile environment. He suggests that providing increased international resources toward the improvement of emotional functioning for these adolescents and young adults could make a significant difference.
Raison, who is corresponding author, received support for the study from the Emory Tibet Science Initiative, Emory University. Raison is director of the Behavioral Immunology Clinic, clinical director of the Mind-Body Program and co-director of Emory's Collaborative for Contemplative Studies.
Vernacular Modernities Undergraduate Foreign Project Summer Scholarship and a Patrick Stewart Human Rights Scholarship provided funding for this study to David C. Buxton, Medical College of Virginia, who contributed to the study design and data collection and management.