title: Shattered Shangri-la: differences in depressive and anxiety symptoms in students born in Tibet compared to Tibetan students born in exile.
abstract: OBJECTIVE
  As a result of ongoing political tensions within Tibetan regions of the People's Republic of China, several thousand Tibetans escape across the Himalayas every year to seek refuge in India and Nepal. Prior studies have found a high prevalence of depressive and anxiety symptoms in these refugees, many of whom are young and have been exposed to significant trauma. However, it is not known whether depressive and anxiety symptoms are more prevalent in these refugees than in ethnic Tibetans born and raised in the relative political and social stability of exile communities in North India and Nepal.
  
  
  METHODS
  We conducted a cross-sectional survey of a convenience sample of 319 students attending school at the Tibetan Children's Villages in Northern India to test the a priori hypothesis that adolescents and young adults who escaped from Tibet to India would demonstrate increased depressive and anxiety symptoms when compared to ethnic Tibetans born and raised in exile. The Hopkins Symptom Checklist-25 (HSCL-25) was used to measure depressive and anxiety symptoms. In addition, demographic information on age, sex, country of birth and frequency of family contact was collected.
  
  
  RESULTS
  Students born in Tibet had higher mean HSCL-25 depressive and anxiety symptom scores than did ethnic Tibetans born in exile. Female students demonstrated higher depressive and anxiety scores, as did those with limited contact with immediate family. After adjusting for sex, age and frequency of family contact, being born in Tibet was associated with increased HSCL-25 depressive and anxiety symptom scores (depression: F[2, 316] = 29.96, P < 0.0001; anxiety: F[4, 316] = 43.57, P < 0.0001).
  
  
  CONCLUSIONS
  The experience of being raised in Tibet and escaping to India appears to be a risk factor for increased depressive and anxiety symptoms when compared to being born and raised within an exile community in India or Nepal.
authors.affiliation: Institute of Human Rights, Emory University, Atlanta, GA, USA.
authors.forename: Dabney
authors.initials: D
authors.lastname: Evans
authors.forename: David C
authors.initials: DC
authors.lastname: Buxton
authors.forename: Andrey
authors.initials: A
authors.lastname: Borisov
authors.forename: Amita K
authors.initials: AK
authors.lastname: Manatunga
authors.forename: Dawa
authors.initials: D
authors.lastname: Ngodup
authors.forename: Charles L
authors.initials: CL
authors.lastname: Raison
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001008:Anxiety Disorders / Q000208:ethnology / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000208:ethnology / Q000523:psychology*; D005195:Family Relations / Q000208:ethnology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D011569:Psychiatric Status Rating Scales; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D013315:Stress, Psychological / Q000208:ethnology / Q000523:psychology; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D018609:Tibet / Q000208:ethnology