Working the Margins: Precarious Employment, Mental Well-Being and Suicidal Ideation Among Bhutanese Refugees

Background & Purpose: Bhutanese refugees in the United States often encounter labor market barriers, including limited job opportunities, language constraints, discrimination, and occupational downgrading. These structural conditions commonly result in precarious employment, marked by low wages, increased exposure to unfair treatment, and restricted opportunities for advancement. Although precarious employment is widespread among refugees, prior research has tended to focus on singular dimensions of precarity, such as wage inadequacy or job instability, rather than adopting a holistic, multidimensional perspective. In addition, Bhutanese refugees experience disproportionately high rates of mental health concerns, including anxiety, depression, and suicidality. However, limited research has examined the role of employment conditions in shaping these outcomes among this population. This study aimed to address this gap by examining the relationship between multidimensional employment precariousness and depression, anxiety, and suicidal ideation among Bhutanese refugees in the United States.

Methods: This study draws on quantitative data from a larger mixed-methods study conducted with the Bhutanese refugee community in a Midwestern U.S. city. Using purposive and snowball sampling, survey data were collected from 135 adult Bhutanese refugees. Grounded in structural vulnerability theory, the survey included measures of employment conditions, mental well-being, job satisfaction, and discrimination. Mental well-being was assessed using three indicators: suicidal ideation, depression, and anxiety. Suicidal ideation was measured using the Wish to Be Dead Scale and dichotomized such that endorsement of any of the 11 items indicated the presence of suicidal ideation. Anxiety and depression symptoms were measured using the Hopkins Symptom Checklist-25 (HSCL-25). Employment precariousness was assessed using the Employment Precariousness Scale (EPRES), capturing six domains: vulnerability, rights at work, ability to exercise rights, disempowerment, temporariness, and wage adequacy. Job satisfaction and everyday discrimination were also included as independent variables. Multivariate binary logistic regression analyses were conducted to examine associations between employment precariousness and suicidal ideation, controlling for length of U.S. residence, English proficiency, employment status, and gender.

Results: One fifth of participants reported experiencing suicidal ideation. The mean HSCL-25 score was 1.32 (SD = .41), with mean anxiety and depression subscale scores of 1.33 (SD = .42) and 1.31 (SD = .43), respectively. Bivariate logistic regression analyses indicated that anxiety (OR = 8.70), depression (OR = 12.61), several domains of precarious employment (including vulnerability, inability to exercise rights, and wage inadequacy), lower job satisfaction, and higher everyday discrimination were significantly associated with increased odds of suicidal ideation. However, in the fully adjusted multivariate model, only the inability to exercise workplace rights (OR = 1.27) remained a significant predictor.

Conclusions & Implications: Findings highlight the salience of employment-related powerlessness in shaping suicidal ideation among Bhutanese refugees. Beyond economic insecurity, limited ability to exercise workplace rights may exacerbate psychological distress by reinforcing feelings of helplessness and marginalization. Interventions aimed at improving refugee mental health should therefore extend beyond clinical services to include labor protections, rights-based education, and advocacy. Policies promoting fair workplace practices and empowering refugees to assert their labor rights may play a critical role in reducing suicidality and supporting long-term integration.