Community-engagement preventive intervention promotes mental health of Bhutanese families in Western Massachusetts

After years of working with Bhutanese community members in Western Massachusetts, a team led by a University of Massachusetts Amherst researcher has developed a peer-led, family-centered preventive intervention to reduce stress, anxiety and depressive symptoms and promote mental health among immigrants in the U.S.

In a paper published in the journal BMJ Open, Kalpana Poudel-Tandukar and colleagues lay out details of the pilot, randomized controlled trial with Bhutanese adults that will assess the effectiveness of a psychological intervention developed by the World Health Organization, known as problem management plus (PMP), which trained laypeople can deliver.

Poudel-Tandukar, associate professor in the Elaine Marieb College of Nursing, led efforts to adapt PMP as a preventive intervention and develop the program for immigrants (PMP-I) using psychoeducation, problem-solving, behavior activation and mind-body exercise to address immigrants' multiple stressors. She works with a team of UMass Amherst colleagues in the Elaine Marieb College of Nursing, School of Public Health and Health Sciences and College of Natural Sciences, and Vanderbilt University's Department of Psychology, in collaboration with their community partner, the Bhutanese Christian Society of Western Massachusetts.

"Stress is linked with almost all diseases, and anxiety and depression," says Poudel-Tandukar, who years ago worked with Bhutanese refugees in Nepal, where she then lived and was a clinician. "Members of this group are at high risk for mental health problems due to their exposure to multiple stressors, such as limited language and socio-cultural skills required for acculturation in a new culture. Our baseline study reported a high prevalence of depression (24.0%) and anxiety (34.2%) in this Bhutanese population. I understand their language and their culture. We are working together to address their mental health needs using problem-solving approaches, managing stress and sharing preventive strategies."

About 90,000 Bhutanese families have been resettled in the U.S. from refugee camps in Nepal since 2008. Beginning in 2015, Poudel-Tandukar worked with Bhutanese community members resettled in Western Massachusetts in collaboration with Bhutanese community leaders.

Poudel-Tandukar started her intervention research with 44 Bhutanese immigrants, 10 of whom were then trained as community interventionists to help other refugees manage stress during a weekly social and emotional well-being program that lasted for five weeks and included 50 families.

Results from her intervention studies published in the Health and Social Care in the Community and Community Mental Health Journal were so promising, showing significantly reduced rates of anxiety and depression among participants, that Poudel-Tandukar received a three-year, $732,144 grant from the National Institutes of Health to implement the program on a larger scale in a pilot, randomized controlled trial.

"Their coping and family conflict resolution skills were improved, and their social networking was improved after intervention," Poudel-Tandukar says.

Four Bhutanese community members who completed the initial intervention are now working as community interventionists/research assistants and are studying nursing. "They can see their strengths, and they are so much more confident now. They are role models in their communities to inspire and bring young adults into the nursing and health workforce. I am so very proud of them," Poudel-Tandukar adds.

The research was complicated by the COVID-19 pandemic, but by 2024, trial results are expected from the larger intervention program with 116 families. "In Nepal, they struggled for the opportunity," Poudel-Tandukar says. "Now, I share with them that they are in the land of opportunity. They are in the fruit garden surrounded by lots of fruit. They have to decide what fruit to pick, when and how many."

Poudel-Tandukar and colleagues are hopeful that the PMP-1 program they are testing will be expanded around the country to help other immigrant groups. "We plan to replicate the program and network with other refugee organizations, including Ukrainian and Afghani," Poudel-Tandukar says.

For her "outstanding community-engaged, applied and translational research," Poudel-Tandukar was honored recently with the UMass Amherst Provost Office's 2022 Distinguished Community Engagement Award for Research.

"I am so inspired and motivated to work more to address the mental health needs of immigrant and refugee communities nationally and globally," she says.