The desire to be dead among Bhutanese refugees resettled in the United States: Assessing risk.

Bhutanese refugees are at elevated risk for suicide, but culturally inflexible suicide risk models may hinder accurate risk detection in this population. This cross-sectional study aimed to use a theoretical model based on the interpersonal psychological theory of suicide and the cultural model of suicide to improve suicide risk-assessment among Bhutanese refugees. Participants included 60 Bhutanese refugees (31 males and 29 females), aged 18 to 65, resettled in Vermont. Suicidal ideation (n = 4, 6.7%) was low, but 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. Neither desire to be dead nor suicidal ideation was significantly related to suicide attempt history. Results highlight that including assessments of desire to be dead in addition to assessments of suicidal ideation may address the problem of underidentification of Bhutanese refugees at risk for suicidal behavior, particularly those who do not present with suicidal ideation. Public Policy Relevance Statement Suicide risk assessments that exclusively rely on the presence of suicidal ideation are likely to underestimate true levels of risk among Bhutanese refugees. Incorporating the abstract desire to be dead into risk assessments with Bhutanese refugees may provide a more culturally responsive alternative approach to suicide risk assessment.