Resilience and anxiety or depression among resettled Bhutanese adults in the United States

Int J Soc Psychiatry. 2019 Sep;65(6):496-506. doi: 10.1177/0020764019862312. Epub 2019 Jul 9.


Background: Resilience, or an individual's positive response in managing life's adversities, is of increasing interest in addressing the mental health disparities in refugees. Although the link between stressful life events and poor mental health is established, research on the role of resilience on the mental health of refugees is limited.

Aims: This study assessed the association between resilience and anxiety or depression in resettled Bhutanese adults in Western Massachusetts.

Methods: A cross-sectional survey was conducted among 225 Bhutanese (men: 113, women: 112) refugees aged 20-65 residing in Massachusetts. Resilience was measured with the 25-item Wagnild and Young's Resilience Scale including two constructs as follows: a 17-item 'personal competence' that measures self-reliance, independence, determination, resourcefulness, mastery and perseverance and an 8-item 'acceptance of self and life' that measures adaptability, flexibility and a balanced perspective of life. Higher total scores indicate greater resilience. The Hopkins Symptom Checklist-25 was used to measure anxiety (10-item) and depression (15-item) with a cutoff mean score of ⩾1.75 for moderate to severe symptoms. Associations of resilience with anxiety or depression scores were assessed using multiple-linear and logistic regression analyses.

Results: The proportion of participants with above threshold anxiety and depression were 34.2% and 24%, respectively. Resilience was inversely associated with both anxiety (beta for 1 unit change in resilience scores: β = -0.026; p = .037) and depression (β = -0.036, p = .041). 'Personal competence' resilience was inversely associated with both anxiety (β = -0.041 p = .017) and depression (β = -0.058, p = .019), but 'acceptance of self and life' resilience was not. Participants with the highest tertile of resilience scores had a significantly decreased risk of anxiety (ORs (95% CI): 0.13 (0.04-0.40)) and depression (0.16 (0.04-0.60)).

Conclusion: Higher resilience was associated with reduced anxiety and depression among Bhutanese with personal competence resilience accounting for most of the effects. These findings suggest the potential targets for mental-health intervention to improve resilience in refugees.

Keywords: Depression; anxiety; mental health; refugees; resilience.

MeSH terms

  • Adult
  • Anxiety / ethnology*
  • Bhutan / ethnology
  • Cross-Sectional Studies
  • Depression / ethnology*
  • Female
  • Humans
  • Linear Models
  • Logistic Models
  • Male
  • Massachusetts / epidemiology
  • Mental Health / ethnology*
  • Middle Aged
  • Multivariate Analysis
  • Psychiatric Status Rating Scales
  • Refugees / psychology*
  • Resilience, Psychological*
  • Social Support
  • Stress Disorders, Post-Traumatic / ethnology
  • Young Adult