Dr. Kalpana Poudel-Tandukar is an associate professor at the Elaine Marieb College of Nursing at University of Massachusetts Amherst and the principal investigator on the study "Mental health promotion among resettled Bhutanese adults in Massachusetts: Results of a peer-led family-centered Social and Emotional Well-being (SEW) intervention study", published in September of 2021 in the journal Health and Social Care in the Community. We approached her to explore the motivation, approach, and findings of this research, which took place among resettled Bhutanese refugees in Western Massachusetts, valued members of our own community.
Dr. Poudel-Tandukar has been studying mental health intervention research for two decades, but her work has primarily been in people living with HIV (PWH). After coming to UMASS in 2015, her focus turned to Bhutanese resettled in Massachusetts. In the late 1980s, a campaign of oppression against the Nepali-speaking minority in Southern Bhutan escalated to expulsion. Thousands of Bhutanese citizens were deported to Nepal, where they resettled for 20 years in refugee camps, before once again being uprooted and resettling in the United States. Today, Western Massachusetts has approximately 3,500 to 4,000 Bhutanese adults.
A generation of trauma contributes to a high burden of mental health concerns in Bhutanese refugees, including high prevalence of depression, suicidal ideation and suicide. Dr. Poudel-Tandukar was uniquely equipped to design a program that met these needs. Historically, she has had a strong relationship with the Bhutanese community, and her cultural understanding of the Bhutanese refugee population, as well as her mastery of the Nepali language, made her a valuable link between that community and the academic world. She used her experience and knowledge to implement a social and mental well-being intervention study and, alongside her colleagues, they evaluated the success of their public health program in their research.
The research team reached out to local church leaders, trusted community members who were able to reach local Bhutanese through their social activities. Ultimately, about 15 people were involved with this process, creating ownership and passion within the community for the program. With their help, the study recruited 103 participants who were willing to commit their time and participate in five weekly sessions of health education, mind-body exercises, and problem-solving. In fact, initial interest in program participation was so enthusiastic that there were not enough resources to cover everyone who wanted to take part.
Session activities were selected to create awareness around mental health and give participants a toolkit for stress management and conflict resolution. During the intervention design process, participants were evaluated to determine the social and emotional stressors and protective factors that were unique to them. This allowed each peer-led meeting to be tailored to the people participating. For example, some sessions focused on creating healthy family environments and encouraged participants to do exercises together, while other sessions focused on individuals completing breathing exercises and implementing yoga to manage stress.
After completing the program, participants reported decreases in stress, anxiety, and depression and improved their coping skills and community networking; community members left the program better equipped to manage the stress of their lives. Outside of the reach of the study, but certainly a reflection of the deep care and connection fostered through the process, Dr. Poudel-Tandukar reports that two community members were inspired to join the nursing field following their experience.
The implications of the study are significant, as it provides a pathway for populations with complex mental health needs to feel empowered and take steps to minimize and control their stress. On the large scale, it has policy implications for large public health organizations such as the CDC, but in the near future, the program's success has created several exciting opportunities. Dr. Poudel-Tandukar has already implemented three intervention programs and has started to submit proposals to expand the program to refugees from Ukraine and Afghanistan. The program is even preparing to cross oceans as she has received correspondence from India to implement the work in communities there.
Dr. Poudel-Tandukar hopes to expand her research into three areas: immigrant and refugee mental health through community engagement, mental health intervention in pregnant women, and self-management in the elderly population with chronic diseases and mental health struggles. Of course, this research is dependent on timing, committed team members, participants, and funding, but her recent research has demonstrated the great benefit that her work can bring to community mental health. Community members were encouraged to recognize their own strength. This data creates hope that more communities struggling with trauma can benefit from similar culturally informed mental health interventions, built on mutual trust and a strong evidence base. Dr. Poudel-Tandukar's work is an exciting effort to increase community cohesion and to improve mental health outcomes and quality of life for valued members of our community, re-settled individuals and their families.
About the Interviewers
Alyssa Gibbons '22 is a recent public health graduate from Wilmington, MA. She will begin pursuing a master’s degree in healthcare management this coming fall. She plans to work in the field of healthcare management and administration in the future.
Hannah Jones-Trudeau '23 is a rising senior public health major. She hopes to continue on to a graduate course of study in epidemiology and plans to apply to medical school in the future. Her areas of interest are infectious disease, global health, and risk communication.
Suzanne Wilson '22 is a recent public health graduate from Hanover, MA. She is working as a research enrollment coordinator at Massachusetts General Hospital after graduation and hopes to pursue a master’s degree in global health in the future.