Trauma experience of North Korean refugees in China

Association Between Atopic Dermatitis and Suicidal Behaviors in North Korean Adolescent Defectors From 2011 to 2019

OBJECTIVE

To evaluate the association between atopic dermatitis (AD) and suicidal behaviors in adolescent defectors among residents who escaped from North Korean (adolescent defectors, n=423) and adolescents with South Korean parents (Korean adolescents, n=540,265).

METHODS

The study used data from the Korea Youth Risk Behavior Survey conducted from 2011 to 2019. Differences in general characteristics, health behaviors, suicidal ideation, suicide plans, suicide attempts, and AD between adolescent defectors and Korean adolescents were examined. Multiple logistic regression analysis was used to determine the association between AD and suicidal behaviors.

RESULTS

The adolescent defectors group had lower AD (16.3% vs. 24.2%), poorer subjective health (10% vs. 6%), smoked more (47% vs. 18%), drank more (60% vs. 43%), lived with family less frequently (56% vs. 96%), and were more than twice as likely to have depression (42% vs. 27%), suicidal ideation (30% vs. 14%), a suicide plan (23% vs. 5%), or have made a prior suicide attempt (19% vs. 3%) compared with the Korean adolescent group (p<0.001). The adjusted odds ratio for the adolescent defectors group compared to the Korean adolescent group was 1.66 for suicidal ideation, 3.59 for suicide plans, and 4.34 for suicide attempts (p<0.001). AD was found to be associated with suicide plans and attempts in adolescent defectors and associated with suicidal ideation in Korean adolescents.

CONCLUSION

AD was significantly associated with suicide plans and suicidal attempts among adolescent defectors and suicidal ideation in Korean adolescents, based on a random sample of middle- and high-school students.

Polyvictimization and Psychological Outcomes Among North Korean Refugee Women

Korean refugee women are at risk of multiple violent victimizations throughout the migration phases. However, migration's association with mental health outcomes has received little scholarly attention. This study examined North Korean refugee women's exposure to polyvictimization-exposure to both gender-based violence (GBV) and intimate partner violence (IPV)-and explored whether polyvictimization is associated with an increased risk of psychological symptoms. Data from a snowball sample of 212 North Korean refugee women were analyzed. Polyvictimization was operationalized as No victimization (0), Only GBV (1), Only IPV (2), and Both GBV and IPV (3). The associations between polyvictimization and depression, suicidal ideation, suicide attempt, and alcohol use disorder were analyzed with multivariate analyses. Results demonstrated that 46.2% experienced GBV in either North Korea or intermediary countries, and 30.9% were victims of IPV from their current intimate partner in South Korea. Approximately 25% were victims of both GBV and IPV. Multivariate analyses revealed that GBV was the most critical factor for mental health outcomes. North Korean refugee women with only GBV or GBV and IPV had significantly higher depressive symptoms and suicidal ideation severity than those without violence victimization. Risk of suicide attempt was also significantly higher among those with only GBV (OR = 16.52, p = .015) or both GBV and IPV (OR = 9.96, p = .048) than those without any violence victimization. Implications for future research and interventions among North Korean refugee women are also discussed.

Polyvictimization Risk Among North Korean Refugee Women in South Korea

North Korean (NK) refugee women living in South Korea are known to be vulnerable to interpersonal violence, but little is known about the possible link between or co-occurrence of acts of sexual violence (SV) and intimate partner violence (IPV) perpetrated against NK refugee women. This study examined the prevalence of polyvictimization and explored the association between SV in different settings (i.e., North Korea, intermediate countries, and South Korea) and various types of IPV. A convenience sample of 140 adult NK refugee women was analyzed, and logistic regression analyses were conducted to examine the link between SV and polyvictimization in IPV. NK refugee women with a history of SV reported a significantly higher rate of IPV over the previous 12 months (51.2%) compared to those without a history of SV (20.4%). NK refugee women with a history of SV are significantly more likely to become victims of most forms of IPV. SV victimization in intermediate countries significantly increased the odds of being physically victimized by their male partners in South Korea (OR = 3.31, p =.05). An SV victimization history in North Korea (OR = 4.50, p =.04) and SV victimization experienced outside their intimate relationship in South Korea significantly increased the odds of sexual IPV from their current intimate partner (OR = 4.74, p =.03). This study showed that victims of human trafficking and sexual assault during their journey to South Korea were at a greater risk of IPV in South Korea. Male partners of NK refugee women with a history of SV may shame and physically sanction NK refugee women for "breaching honor." Therefore, screening for potential risk of physical and sexual IPV among NK refugee women with a prior exposure to SV is needed to develop programs in safety planning for NK refugee women experiencing SV and IPV.

Global prevalence of anxiety and PTSD in immigrants: a systematic review and meta-analysis

BACKGROUND

A systematic and meta-analysis of the prevalence of anxiety and posttraumatic stress disorder (PTSD) in immigrants was conducted.

METHODS

Based on the keywords, scientific databases were systematically searched to identify articles. The search included the three databases PubMed, Google Scholar and Research Gate until June 2020. The analysis was performed to assess the prevalence of anxiety and PTSD; subgroups were examined based on anxiety disorders.

RESULTS

The prevalence of agoraphobia, PTSD, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), social phobia and specific phobia were 4, 25, 9, 4, 3, 5 and 8%, respectively.

CONCLUSIONS

Considering the findings of the present study regarding the significant prevalence of anxiety and PTSD in the immigrant population, it is necessary to pay special attention to the mental health of this population.

Factors associated with posttraumatic growth among North Korean defectors in South Korea

Refugees experience various kinds of trauma during the migration process, which can cause psychiatric problems such as posttraumatic stress disorder. However, in the process of overcoming traumatic experiences, they may also experience posttraumatic growth (PTG). This study examined the level of PTG and its associated factors among North Korean defectors, including posttraumatic stress symptoms (PTSS). In total, 212 North Korean defectors completed self-report questionnaires measuring PTG (PTG inventory), PTSS (Posttraumatic Stress Disorder Checklist, PCL-5), quality of life (WHOQOL-BREF), and various sociodemographic variables. Participants completed the survey online, from July 27 to August 4, 2020. Participants reported a moderate level of PTG scores (51.7 ± 15.4, range 0–80). To determine the impact of PTSS on PTG among North Korean defectors, we conducted a hierarchical multiple regression analysis. In the final model, several sociodemographic factors (years in South Korea, education in North Korea, religion, and employment status), overall quality of life (β = 0.321, p < 0.001), and PTSS (β = 0.162, p = 0.035) were positively associated with PTG, whereas living with family (β = − 0.1261, p = 0.040) and loneliness (β = − 0.401, p < 0.001) were negatively associated with PTG, accounting for 36.6% of the variance in PTG scores (p < 0.001). This is the first large-scale study describing the level of PTG and its associated factors among North Korean defectors residing in South Korea. Further, our study provides suggestions for future research in this area, and interventions for improving PTG among this group.

Fear of Crime among Female North Korean Defectors in South Korea

Although some studies have focused on immigrants' fear of crime in the United States, it is important to point out that the number of North Korean defectors to South Korea has rapidly increased since the 1990s. Therefore, understanding factors associated with fear of crime for North Korean immigrants, especially female defectors, is important for ensuring their successful transitions into South Korean culture. The present study used existing survey data from a sample of female North Korean defectors to explore factors related to fear of crime. Results indicate that the number of North Korean friends, language proficiency, and patriarchal attitudes toward gender were significant predictors of fear of crime for the North Korean female defectors. Findings are described and discussed as a potential source for policymaking to reduce North Korean immigrants' acculturative stress and fear of crime and to encourage smooth transitions into new cultures.

The Effect of Postmigration Factors on Quality of Life among North Korean Refugees Living in South Korea

North Korean refugees have not only endured traumatic experiences in North Korea and during defection but have also undergone an adaptation process after arrival in South Korea. Their quality of life (QoL) is likely to be affected by these traumatic life events, leading to subsequent posttraumatic stress disorder (PTSD), or postmigration adaptation-related stress, which involves a sense of dislocation with the culture, language, and people in South Korea. We investigated which aspects predicted the QoL of refugees from North Korea. Fifty-five participants currently living in South Korea completed a checklist about personal characteristics and traumatic experiences before, during and after migration. Diagnosis and symptom severity of PTSD, depressive mood, anxiety, and QoL were also assessed. A multiple regression analysis was performed to evaluate associations between QoL and other variables of interest. Overall, QoL was associated with previous economic status in North Korea, present occupation in South Korea, difficulty interacting with South Koreans, depressed mood, and state–trait anxiety. Finally, QoL was explained by having difficulty interacting with South Koreans, depressed mood, and state anxiety, with the model accounting for 51.3% of the variance. Our findings suggest that QoL among North Korean refugees in South Korea is influenced by the current level of their anxiety and depressed mood, and post-migration adaptation-related stress resulting from trying to integrate with South Koreans after settlement.

Weight Gain Predicts Metabolic Syndrome among North Korean Refugees in South Korea

Previous cross-sectional studies showed that immigrants from low-income to high-income countries have higher risk of cardiovascular disease and type 2 diabetes mellitus. We investigated the association between weight gain during the resettlement in South Korea and risk of metabolic syndrome (MetS) among North Korean refugees (NKRs) in this cross-sectional study. In total, 932 NKRs aged 20-80 years in South Korea voluntarily underwent health examination from 2008 to 2017. We compared the risk of MetS and its components between the weight gain group (gained ≥5 kg) and the non-weight gain group (gained <5 kg, maintained or lost body weight) during resettlement in South Korea after defection from North Korea. Multiple logistic regression analysis predicted odds ratio of MetS on the basis of weight change, adjusting for covariates and current body mass index (BMI). We also evaluated the difference in body composition of NKRs between two groups. The prevalence of MetS in the weight gain group was 26%, compared to 10% in the non-weight gain group (p-value < 0.001). The weight gain group had a two-fold higher risk of MetS than the non-weight gain group after adjusting for current BMI (odds ratio 1.875, p-value = 0.045). The prevalence of central obesity, impaired fasting glucose, elevated blood pressure, and hypertriglyceridemia were higher in the weight gain group than the non-weight gain group (36% vs. 12%, p-value < 0.001; 32% vs. 19%, p-value < 0.001; 34 vs. 25%, p-value = 0.008; 19% vs. 13%, p-value = 0.025, respectively). The analysis of body composition showed that the percentage of body fat in the weight gain group was higher than in the non-weight gain group, indicating increased fat mass rather than muscle mass in the weight gain group as their body weight increased during resettlement (33.4 ± 6.53% vs. 28.88 ± 7.40%, p < 0.005). Excess weight gain after defection from North Korea increased the risk of MetS among NKRs in South Korea. It is necessary to monitor weight change among NKRs and their effect on their metabolic health in the long term.

A combination sampling approach for epidemiologic research in humanitarian settings: a case analysis of a study of depressive disorder prevalence among refugees in Greece

BACKGROUND

Understanding the burden of common mental health disorders, such as depressive disorder, is the first step in strengthening prevention and treatment in humanitarian emergencies. However, simple random sampling methods may lead to a high risk of coercion in settings characterized by a lack of distinction between researchers and aid organizations, mistrust, privacy concerns, and the overarching power differential between researchers and populations affected by crises. This case analysis describes a sampling approach developed for a survey study of depressive disorder in a Syrian refugee camp in Greece (n = 135).

DISCUSSION

Syrian refugees face an extraordinarily high burden of depressive disorder during the asylum process (43%), necessitating population screening, prevention, and treatment. In order to preserve the informed consent process in this refugee camp setting, the research team developed a two-phase sampling strategy using a map depicting the geographical layout of the housing units within the camp. In the first phase, camp management announced a research study was being undertaken and individuals were invited to volunteer to participate. The participants' container (housing) numbers were recorded on the map, but were not linked to the survey data. Then, in the second phase, the camp map was used for complementary sampling to reach a sample sufficient for statistical analysis. As a result of the two phases of the sampling exercise, all eligible adults from half the containers in each block were recruited, producing a systematic, age- and sex-representative sample.

CONCLUSIONS

Combining sampling procedures in humanitarian emergencies can reduce the risk of coerced consent and bias by allowing participants to approach researchers in the first phase, with a second phase of sampling conducted to recruit a systematic sample. This case analysis illuminates the feasibility of a two-phase sampling approach for drawing a quasi-random, representative sample in a refugee camp setting.

The Effect of Traumatic Experiences of North Korean Adolescent Refugees upon Their Negative Health Perception: Focusing on Multiple Moderating Effect of Problem-Focused versus Social Support-Focused Coping Strategies

The health problems of North Korean (NK) refugees living a new life after surviving the dangers of life and death traumas is an issue that must be taken very seriously. Adolescent refugees may be particularly vulnerable to adverse physical and mental health issues because of major physical, cognitive, and psychosocial developmental changes during adolescence. This study examines the positive roles two active coping strategies—problem-focused coping and social support-focused coping—can play in NK refugee adolescents’ health self-awareness. The analysis found that “social support-focused coping” alleviates the negative relationship between traumatic experience and health perception, acting as a protective factor. Contrary to our prediction, the protective effect of adopting “problem-focused coping” in this study was not verified. The findings suggest that providing interventions for developing appropriate coping strategies help them live healthier, both physically and mentally, in South Korean society.

Heart Rate Variability after Treatment for Depression in North Korean Defectors

North Korean Defectors (NKDs) are known to experience multiple psychological symptoms such depression and anxiety. Heart rate variability (HRV) has been implicated in various psychiatric disorders, including posttraumatic stress disorder (PTSD) and depression. No studies have prospectively evaluated HRV parameters in NKDs. We recruited 34 NKDs (2 men, 32 women; age range 25-58 years) who were diagnosed with major depressive disorder. We evaluated psychiatric symptoms using the Korean version of the Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale, and PTSD checklist civilian version. We also performed HRV measurements before and after 12 weeks of antidepressant treatment. In the baseline, HDRS item 14 and 15 showed statistically significant positive correlation with LF/HF ratio. At the endpoint, HDRS item 5 and 8 were found to have positive correlations with some HRV parameters. We found that the sum of fatigue-related HDRS symptoms scores (number 7 and 13) showed significant positive correlation with LF. HDRS total scores also showed significant positive correlations with LF and HF. When the severity of depression was decreased and only the PTSD symptoms persisted at the endpoint, the relationships between HRV and clinical measures were more clearly revealed. This study shows the possibility of using HRV as an objective neurobiological index of autonomic nervous system disorder and reaction to stress in NKDs.

Depression in North Korean refugees: a mixed methods study

OBJECTIVE

The objective of this study is to investigate beliefs and experiences about depression in North Korean refugees (NKRs) using both quantitative and qualitative methods.

STUDY DESIGN

We used an exploratory sequential mixed methods study design with a quantitative survey followed by an in-depth individual interview.

METHODS

We surveyed 329 NKRs who had been in South Korea for at least a year. Eleven participants were selected from the survey sample to complete an additional individual in-depth interview to obtain further understanding about depression among NKRs in their own words and context.

RESULTS

About 44% of the sample had mild to severe depression; only 16% indicated that they were being treated for mood disorder. Individual in-depth interviews yielded key themes related to NKRs' depression beliefs and experiences: recognizing depression, factors contributing to depression, overcoming depression, and barriers to seeking help and treatment. Integration of quantitative and qualitative data revealed that although loneliness was one of the prominent subthemes contributing to depression, strong self-determination was noted as being critical to overcoming depression among those who had moderate to moderately severe depression but had no social support.

CONCLUSIONS

Future efforts should be directed toward an enhanced support network and targeted education about the South Korean healthcare system, particularly in relation to mental health treatment.

Prevalence of DSM-IV Major Psychiatric Disorders among North Korean Defectors in South Korea

OBJECTIVE

The aim of this study was to estimate the prevalence of major psychiatric disorders among North Korean defectors (NKD) settled in South Korea.

METHODS

The study population consisted of 294 North Korean defectors, aged 18 to 64 years settled in South Korea for 3 years or less. Between June 1, 2016 and October 31, 2016, face-to-face interviews were conducted using the North Korean version of the WHO-Composite International Diagnostic Interview (NK-CIDI) to diagnose DSM-IV psychiatric disorders.

RESULTS

The lifetime prevalence of any DSM-IV psychiatric disorders was 62.2% in NKD and 25.0% in the general Korean population. The prevalence of specific disorders in NKD and general Korean population was as follows: 22.3% and 4.9% for major depressive disorder (MDD), 12.2% and 1.4% for post-traumatic stress disorder (PTSD), 18.0% and 4.8% for nicotine dependence, and 14.5% and 11.2% for alcohol abuse. The incidence of every single psychiatric disorder varied in each country. For instance, the generalized anxiety disorder, specific phobia, and alcohol use disorder occurred more frequently in North Korea whereas PTSD was more prevalent in other countries.

CONCLUSION

The prevalence of psychiatric disorders among NKD was quite higher than in the general population of South Korea.

Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

BACKGROUND

Despite the need for mental health surveillance in humanitarian emergencies, there is a lack of validated instruments. This study evaluated a sequential screening process for major depressive disorder (MDD) using the two- and eight-item Patient Health Questionnaires (PHQ-2 and PHQ-8, respectively).

METHODS

This study analyzed data collected during a cross-sectional survey in a Syrian refugee camp in Greece (n = 135). The response rate for each instrument was assessed, and response burden was calculated as the number of items completed. The sequential screening process was simulated to replicate the MDD classifications captured if the PHQ-2 was used to narrow the population receiving the full PHQ-8 assessment. All respondents were screened using the PHQ-2. Only respondents scoring ≥ 2 are considered at risk for symptoms of MDD and complete the remaining six items. The positive and negative percent agreement of this sequential screening process were evaluated.

RESULTS

The PHQ-2, PHQ-2/8 sequential screening process, and PHQ-8 were completed by 91%, 87%, and 84% of respondents, respectively. The sequential screening process had a positive percent agreement of 89% and a negative percent agreement of 100%, and eliminated the need to complete the full PHQ-8 scale for 34 (25%) respondents.

CONCLUSIONS

The benefits of the sequential screening approach for the classification of MDD presented here are twofold: preserving classification accuracy relative to the PHQ-2 alone while reducing the response burden of the PHQ-8. This sequential screening approach is a pragmatic strategy for streamlining MDD surveillance in humanitarian emergencies.

Systematic review of evidence on public health in the Democratic People's Republic of Korea

Background

Engaging in public health activities in the Democratic People’s Republic of Korea (DPRK, also known as North Korea) offers a means to improve population health for its citizens and the wider region. Such an engagement requires an understanding of current and future needs.

Methods

We conducted a systematic search of five English and eight Korean language databases to identify available literature published between 1988 and 2017. A narrative review of evidence was conducted for five major categories (health systems, communicable diseases (CDs), non-communicable diseases (NCDs), injuries, and reproductive, maternal, newborn and child health (RMNCH) and nutrition).

Findings

We found 465 publications on the DPRK and public health. Of the 253 articles that addressed major disease categories, we found under-representation of publications relative to proportion of disease burden for the two most significant causes: NCDs (54.5% publications vs 72.6% disability adjusted life years (DALYs)) and injuries (0.4% publications vs 12.1% DALYs), in comparison to publications on the third and fourth largest disease burdens, RMNCH and nutrition (30.4% publications vs 8.6% DALYs) and CDs (14.6% publications vs 6.7% DALYs) which were over-represented. Although most disease category articles were on NCDs, the majority of NCD articles addressed mental health of refugees. Only 165 articles addressed populations within the DPRK and among these, we found publication gaps on social and environmental determinants of health, CDs, and NCDs.

Conclusion

There are gaps in the public health literature on the DPRK. Future research should focus on under-studied, significant burdens of disease. Moreover, establishing more precise estimates of disease burden and their distribution, as well as analysis on health systems responses aimed at addressing them, can result in improvements in population health.

Medical Expenses of North Korean Defectors with Post-Traumatic Stress Disorder

OBJECTIVE

The purpose of this study was to establish the prevalence of PTSD among North Korean defectors who visited the National Medical Center, Seoul, South Korea over a period of approximately 10 years by examining their medical records and to examine differences in the medical service usage patterns of patients with and without PTSD.

METHODS

Data from North Korean defectors who used outpatient services at the National Medical Center during a period of 10 years and 3 months (January 1 2006 to February 28, 2016) were analyzed. The general characteristics of the defectors were analyzed by frequency analyses, and descriptive statistics were generated. Additionally, independent t-tests and chi square analyses were performed to examine differences between PTSD patients and those without PTSD. Linear regression analysis was performed to examine factors affecting the mental health of North Korean defectors suffering from PTSD.

RESULTS

This study assessed the correlations between PTSD, the average number of outpatient visits, and the total revenue. The regression analysis showed a relationship between PTSD and the average number of outpatient visits. There was also a correlation between PTSD and total revenue. The average number of outpatient visits was 41.8 for PTSD patients, whereas it was 33.2 for those without PTSD. The total revenue visit was 953.6 USD for PTSD sufferers and 231.1 USD for those without PTSD.

CONCLUSION

This study found that the majority of North Korean defectors visit psychiatry departments, and that PTSD patients use outpatient services more frequently and have higher total revenue than those without PTSD. Additionally, patients with PTSD used a greater variety of medical services. Considering the high medical care expenses of North Korean defectors residing in South Korea, future investigations should examine the medical service usage patterns of such patients, especially those diagnosed with PTSD, in greater detail.

Cervical Cancer Screening and Its Associated Factors Among North Korean Defectors Living in South Korea

North Korean defectors (NKD) have many health problems related to insufficient nutrition, trauma from escaping, and being exposed to infectious diseases, but little research exists on their cancer screening. A total of 638 NKD participated in this cross-sectional survey. South Korean natives (SKN) who participated in the Korean National Health and Nutrition Examination Survey V were selected using age matching to each NKD. Fisher's exact tests and logistic regression were used for data analysis. The cervical cancer screening rate of NKD was significantly lower than for SKN (42 and 70 %, respectively; P < .001). The adjusted proportions of cervical cancer screening for NKD in all age groups under 60 years (P < .01) and having education beyond high school (P < .001) were significantly lower than that of SKN. NKD who had education under a high school level were more likely to have cervical cancer screening compared to NKD with education beyond a high school level (OR 1.81, 95 % CI 1.12-2.93). NKD were less likely to receive appropriate cervical cancer screening compared to SKN, especially those aged 30-39 years or married. Tailored interventions for NKD are needed to improve cervical cancer screening compliance.

Psychiatric Disorders in Refugees and Internally Displaced Persons After Forced Displacement: A Systematic Review

Background: Protracted armed conflicts not only shape political, legal, and socio-economic structures, but also have a lasting impact on people's human migration. In 2017, the United Nations High Commissioner for Refugees reported an unprecedented number of 65.6 million individuals who were displaced worldwide as a result of armed conflicts. To date, however, little is known about these people's mental health status. Therefore, we conducted a systematic review of the prevalence of psychiatric disorders among forcibly displaced populations in settings of armed conflicts. Methods: We undertook a database search using Medline, PsycINFO, PILOTS, and the Cochrane Library, using the following keywords and their appropriate synonyms to identify relevant articles for possible inclusion: "mental health," "refugees," "internally displaced people," "survey," and "war." This search was limited to original articles, systematic reviews, and meta-analyses published after 1980. We reviewed studies with prevalence rates of common psychiatric disorders-mood and anxiety disorders, psychotic disorders, personality disorders, substance abuse, and suicidality-among adult internally displaced persons (IDPs) and refugees afflicted by armed conflicts. Results: The search initially yielded 915 articles. Of these references 38 studies were eligible and provided data for a total of 39,518 adult IDPs and refugees from 21 countries. The highest prevalence were for reported for post-traumatic stress disorder (3-88%), depression (5-80%), and anxiety disorders (1-81%) with large variation. Only 12 original articles reported about other mental disorders. Conclusions: These results show a substantial lack of data concerning the wider extent of psychiatric disability among people living in protracted displacement situations. Ambitious assessment programs are needed to support the implementation of sustainable global mental health policies in war-torn countries. Finally, there is an urgent need for large-scale interventions that address psychiatric disorders in refugees and internally displaced persons after displacement.

Human Rights as Political Determinants of Health: A Retrospective Study of North Korean Refugees

INTRODUCTION

The gravity, scale, and nature of human rights violations are severe in North Korea. Little is known about the mental health consequences of the lifelong exposures to these violations.

METHODS

In 2014-2015, a retrospective study was conducted among 383 North Korean refugees in South Korea using respondent-driven sampling to access this hidden population. This study collected information on the full range of political and economic rights violations and measured post-traumatic stress disorder, anxiety and depression symptoms, and social functioning by standard instruments. Multivariate regression analysis was performed with the adjustment of political, economic, and demographic variables in 2016-2017.

RESULTS

The results indicate elevated symptoms of anxiety (60.1%, 95% CI=54.3%, 65.7%), depression (56.3%, 95% CI=50.8%, 61.9%), and post-traumatic stress disorder (22.8%, 95% CI=18.6%, 27.4%), which are significantly associated with exposures to political rights violations (ten to 19 items versus non-exposure: anxiety AOR=16.78, p<0.001, depression AOR=12.52, p<0.001, post-traumatic stress disorder AOR=16.71, p<0.05), and economic rights violations (seven to 13 items versus non-exposure: anxiety AOR=5.68, p<0.001, depression AOR=4.23, p<0.01, post-traumatic stress disorder AOR=5.85, p<0.05). The mean score of social functioning was also lower in those who were exposed to political (adjusted difference= -13.29, p<0.001) and economic rights violations (adjusted difference= -11.20, p<0.001).

CONCLUSIONS

This study highlights mental health consequences of lifelong human rights violations in North Korea. Beyond the conventional approach, it suggests the need for a collaborative preventive response from global health and human rights activists to address human rights in regard to mental health determinants of the 20 million people in North Korea.

Health literacy and use of preventive health services among North Korean defectors in the Republic of Korea

It is known that some groups of immigrants can have low health literacy and it may affect their health. Although the number of North Korean defectors in the Republic of Korea has increased, little is known about their health literacy and health behavior. Adult North Korean defectors (n = 399) in this study were surveyed on health literacy, using the Korean Health Literacy Scale, and on the use of preventive services. Those with better health literacy scores were more likely to have vaccination than the lower scoring group (adjusted OR = 2.44; 95% CI, 1.19–5.00). However, undergoing medical check-up may not be associated with health literacy. In subgroup analysis, among defectors who lived alone (P = 0.032) or who had longer time in other countries before entering (P = 0.007), the vaccination coverage was associated with their health literacy scores. This study provides evidence for an association between health literacy and influenza vaccination coverage among North Korean defectors even though they may have fewer language barriers than other immigrants. Further research is needed to develop interventions for improving health literacy and their preventive health behavior.

Prevalence and Correlates of Suicidal Thoughts and Behaviors among North Korean Defectors

OBJECTIVE

Despite the increasing number of North Korean defectors, research on their mental health conditions and suicidal thoughts and behaviors has not been conducted systematically. We examined the prevalence and risk factors of suicidal thoughts and behaviors in North Korean defectors.

METHODS

This study focused on 300 North Korean defectors recruited from regional resettlement centers in South Korea. In-person interviews based on the North Korean version of the Composite International Diagnostic Interview were conducted to diagnose mental disorders and assess suicidal thoughts and behaviors. Logistic regression analyses were performed to evaluate the association between suicidal thoughts and behaviors and socio-demographic variables, and DSM-IV mental disorders.

RESULTS

Lifetime prevalence of suicidal ideation, plans, and attempts were 28.3, 13.3, and 17.3%, respectively. Female sex (OR: 2.0, 95% CI: 1.0-3.9), presence of health problems in the past year (2.6, 95% CI: 1.4-4.6), and absence of both South Korean acquaintances (1.9, 95% CI: 1.0-3.4) and North Korean family (1.7, 95% CI: 1.0-2.9) were associated with higher odds of suicidal thoughts and behaviors, after adjusting for participant age, sex, and education. Presence of a mental disorder was associated with a significantly increased odd of suicide ideation, plan, and attempt. Of all mental disorder categories, agoraphobia had the strongest association with suicidal ideation (6.5, 95% CI: 2.0-21.6), plans (7.7, 95% CI: 2.5-23.2) and attempts (12.0, 95% CI: 3.5-40.8).

CONCLUSION

Suicidal thoughts and behaviors among North Korean defectors are higher than the general population in South Korea, especially show high rates in transit countries. Further study should focus on the changes in suicidal thoughts and behaviors according to the settlement process and early prevention.

The Effects of Discrimination Experience on Life Satisfaction of North Korean Refugees: Mediating Effect of Stress

OBJECTIVE

This study investigated the mediation effect of stress between the experience of discrimination and life satisfaction among North Korean refugees who resettled in South Korea. The findings of the current study provide empirical evidence for the need of social interventions to mitigate adverse effects of stress on North Korean refugees who are subject to social discrimination on a daily basis.

METHODS

In this study, we included 500 subjects among 2,138 North Korean refugees who took refuge in South Korea in 2007. The interview started from April 6th 2009 and finished on May 25th 2009. We conducted moderator effect analysis with Path analysis was conducted because we confirm the experience of discrimination was affected by life satisfaction and stress can affected life satisfaction as a moderator.

RESULTS

The experience of discrimination significantly affects stress and stress significantly affects life satisfaction. However, the experience of discrimination was not directly related to life satisfaction. The more stress the study respondents experienced, the lower the life satisfaction they reported.

CONCLUSION

The present finding suggests that the effects of discriminating experiences on the life satisfaction of North Korean refugees in South Korea were mediated by their own perceived stress.

Association between memory impairment and brain metabolite concentrations in North Korean refugees with posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) had experiences of enormous psychological stress that can result in neurocognitive and neurochemical changes. To date, the causal relationship between them remains unclear. The present study is to investigate the association between neurocognitive characteristics and neural metabolite concentrations in North Korean refugees with PTSD. A total of 53 North Korean refugees with or without PTSD underwent neurocognitive function tests. For neural metabolite scanning, magnetic resonance spectroscopy of the hippocampus and anterior cingulate cortex (ACC) has been conducted. We assessed between-group differences in neurocognitive test scores and metabolite levels. Additionally, a multiple regression analysis was carried out to evaluate the association between neurocognitive function and metabolite levels in patients with PTSD. Memory function, but not other neurocognitive functions, was significantly lower in the PTSD group compared with the non-PTSD group. Hippocampal N-acetylaspartate (NAA) levels were not different between groups; however, NAA levels were significantly lower in the ACC of the PTSD group than the non-PTSD group (t = 2.424, p = 0.019). The multiple regression analysis showed a negative association between hippocampal NAA levels and delayed recall score on the auditory verbal learning test (β = -1.744, p = 0.011) in the non-PTSD group, but not in the PTSD group. We identified specific memory impairment and the role of NAA levels in PTSD. Our findings suggest that hippocampal NAA has a protective role in memory impairment and development of PTSD after exposure to traumatic events.

Post-Traumatic Stress Disorder, Depression and Anxiety among North Korean Refugees: A Meta-Analysis

OBJECTIVE

Post-traumatic stress disorder is common among North Korean refugees who have fled their country for economic, financial and humanitarian reasons. Co-morbid depression and anxiety are also common among North Korean refugees, due to the difficulties they have faced within their country and during their escape journey. Depression and anxiety complicate treatment for post-traumatic stress disorder, and lead to poorer outcomes. Thus, the aim of the present study was to provide a meta-analysis of studies investigating post-traumatic stress disorder, depression, and anxiety among North Korean refugees.

METHODS

Selected articles were published in English, and included measures of post-traumatic stress, and/or depression and anxiety. 10 studies were included in the depression meta-analysis, and 6 in the anxiety meta-analysis.

RESULTS

A random-effects model revealed strong, significant associations between post-traumatic stress and depression, r=0.63, 95% CI (0.51, 0.72), p<0.001, z=8.33, and anxiety, r=0.51, 95% CI (0.36, 0.63), p<0.001, z=6.07. The relationships between post-traumatic stress, depression and anxiety were higher among adults and those with more than five years outside of North Korea.

CONCLUSION

Depression appears to be an important treatment focus for North Korean refugees with post-traumatic stress.

Not at All Effective: Differences in Views on the Causes of Prescription Non-adherence Between North Korean Defectors and Medical Providers in South Korea

By focusing on North Korean defectors' medical experiences in South Korea and their medical providers' experiences treating the defectors, this article considers the differences between the views of these two groups in regard to the causes of prescription non-adherence. The results suggest that (a) whereas the defectors tended to see their symptoms as being physical in nature, the medical providers often ascribed symptoms to psychological/socio-cultural influence; (b) whereas the defectors tended to trust in their ability to self-diagnose and in their belief systems established in North Korea, the medical providers tended not to place trust in these aspects; (c) whereas the defectors tended to view the available medical treatment as inappropriate for them, the medical providers often noted the presence of tolerant bacterial strains as causes of treatment failure; and (d) whereas the defectors felt that the treatment they received was slow and ineffective and attributed this to capitalism, the medical providers felt that the defectors failed to understand the concept of staged treatments. Based on the findings, some solutions are suggested to address the complex issue of North Korean defectors' prescription non-adherence in terms of subjective/objective health assessments and patient-centered care. North Korean defectors' established health beliefs/lack of medical knowledge based on their previous medical and cultural experiences gave rise to beliefs and practices associated with medicine that differ significantly from those of the health providers and that have the potential to severely compromise the defectors' health. Therefore, therapy negotiation and appropriate education are suggested as possible solutions, and as an agenda, the notion of civic friendship is addressed. Implications for medical practice, prevention, and intervention are also discussed.

Mental Health and Its Associated Factors Among North Korean Defectors Living in South Korea

This study aimed to compare current mental health status between North Korean defectors and South Korean natives. The proportions of depression/anxiety and the experience of suicidal ideation from 593 North Korean defectors were compared with South Koreans (n = 2372). Logistic regression analyses were conducted to determine the associated variables. As a result, the rates of depression/anxiety and suicidal ideation were significantly higher among North Korean defectors. North Koreans also had more than twice the number of escape attempts associated with high rates of depression/anxiety, and being female and single, longer durations of stay abroad, more than twice the number of escape attempts, and longer durations after entrance to South Korea were related to high rates of suicidal ideation. From these results, additional efforts are needed to identify the North Korean defectors who are at high risk for poor mental health and to provide appropriate medical services and social support.

Prevalence of metabolic syndrome and its related factors among North Korean refugees in South Korea: a cross-sectional study

OBJECTIVES

To determine the prevalence of metabolic syndrome (MetS) and its related factors among North Korean refugees (NKR) in South Korea.

DESIGN

Cross-sectional study conducted using a questionnaire and anthropometric and biochemical data on NKR in South Korea.

SETTING

Seoul, South Korea.

PARTICIPANTS

A sample of NKR who voluntarily underwent medical examinations in Anam Hospital of Korea University, Seoul, South Korea (N=708, consisting of 161 males and 547 females). To compare the prevalence of MetS, 1416 age- and gender-matched individuals from the South Korean population (SKP, at a ratio of 1:2 to NKR) were randomly selected from the fifth Korean National Health and Nutrition Examination Survey.

MAIN OUTCOME MEASURES

The prevalence of MetS and its related factors among NKR in South Korea and comparison with its prevalence among the general SKP.

RESULTS

The prevalence of MetS among male and female NKR in South Korea was 19.7% and 17.2%, respectively. Although obesity is more prevalent in South than in North Korea, we found no difference in the prevalence of MetS between the female NKR and SKP groups (17.2% vs 16.6%, respectively; p=0.830). As regards the males, the small sample size of the NKR group yielded insufficient evidence of any difference in MetS prevalence between the NKR and SKP groups (19.7% vs 26.2%, respectively; p=0.134). We found that excess weight gain (≥5%) in South Korea was significantly associated with MetS among NKR.

CONCLUSIONS

The prevalence of MetS among NKR did not differ from that in the SKP group despite the lower prevalence of obesity in NKR than in the general SKP. The fact that excess weight gain in South Korea was associated with the risk of MetS suggests that public health policy makers should focus on preventing excess weight gain in NKR during resettlement in South Korea.

Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms

OBJECTIVE

We investigated the prevalence of insomnia and its clinical characteristics in North Korean refugees.

METHODS

North Korean refugees living in South Korea (48 males, 129 females; mean age 38.22±12.24 years) and South Koreans (112 males, 203 females; mean age 39.48±10.32 years) completed the following questionnaires: the Self-reported Questionnaire on Insomnia, Center for Epidemiological Studies-Depression Scale (CES-D), Trauma Exposure Check List for North Korean Refugees, and the Impact of Event Scale-Revised (IES-R).

RESULTS

North Korean refugees had insomnia more often than South Koreans did (38.42% vs. 8.89%). Depression combined with insomnia was also more prevalent in North Korean refugees (28.25% vs. 3.17%). Compared with South Koreans with insomnia, North Korean refugees with insomnia showed higher CES-D scores. The North Korean refugees with insomnia had experienced a larger number of traumatic events, and had higher CES-D and IES-R scores compared to North Korean refugees without insomnia. Insomnia in North Korean refugees was also associated with the presence of significant depressive and post-traumatic stress disorder (PTSD) symptoms.

CONCLUSION

Insomnia was common in North Korean refugees and was closely associated with depressive and PTSD symptoms. Our study suggests that complaints of insomnia may indicate more severe psychopathology, especially in refugees.

Influenza Vaccination Coverage and Its Associated Factors among North Korean Defectors Living in the Republic of Korea

This study aimed to examine influenza vaccination coverage of North Korean defectors (NKD) in the Republic of Korea (Korea) and explore the factors affected the vaccination coverage. Total 378 NKD were analyzed. Four Korean control subjects were randomly matched by age and gender from the Korea National Health and Nutrition Examination Survey V (n = 1,500). The adjusted vaccination coverage revealed no statistical difference between the defectors group and indigenous group (29.1% vs. 29.5%, P = 0.915). In the aged under 50 group, the vaccination coverage of NKD was higher than that of Korean natives (37.8% vs. 25.8%, P = 0.016). However in the aged 50 yr and over group, the vaccination coverage of North Korean defectors was lower than that of the natives (28.0% vs. 37.6%, P = 0.189). Even the gap was wider in the aged 65 yr and over group (36.4% vs. 77.8%, P = 0.007). Gender and medical check-up experience within 2 yr showed association with the vaccination coverage of NKD. Influenza vaccination coverage of aged defectors' group (aged 50 yr and over) was lower than indigenous people though overall vaccination coverage was similar. Further efforts to increase influenza vaccination coverage of this group are needed.

Factors associated with the frequency of physician visits among North Korean defectors residing in South Korea: a cross-sectional study

BACKGROUND

Since the mid-1990s, a growing number of North Korean defectors have been arriving in South Korea, many of whom have various somatic and mental disorders. The health status of defectors is an important predictor of their successful resettlement. Therefore, this study examined the frequency of physician visits among North Korean defectors residing in South Korea, as well as the factors associated with this frequency.

METHODS

The data used in this study were collected through survey questionnaires and interviews conducted from April 6 to May 20, 2009, and involving 500 North Korean defectors who entered South Korea in 2007. This study used three domains of independent variables: 'health-related factors,' 'special characteristics of North Korean defectors,' and 'demographic and socio-economic factors'. Nested multivariable linear regression analysis was conducted in order to determine the factors related to the frequency of physician visits between January 1 and December 31, 2008.

RESULTS

The average number of physician visits made by the participants during 2008 was 15.3; 14.5% of participants did not have physician visits. The number of physician visits was largely associated with health-related variables including disability, chronic disease and self-rated health status. The frequency of physician visits was higher among those with a disability, chronic disease, lower self-rated health score, a greater number of traumatic experiences during their escape, lower annual family income, and among females.

CONCLUSIONS

This study confirmed that the number of defectors' physician visits was related with objective and subjective health status, traumatic experiences during their migration, economic, and demographic variables. The results serve useful understanding of medical utilization characteristics among North Korean defectors in South Korea.

Psychiatry in former socialist countries: implications for north korean psychiatry

Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea.

Factors associated with self-rated health among North Korean defectors residing in South Korea

BACKGROUND

The number of North Korean refugees entering South Korea has increased recently. The health status of refugees is a significant factor in determining their success in resettlement; therefore, this study examined both the self-rated health status of North Korean defectors who have settled in South Korea and the factors associated with their self-rated health status.

METHODS

This study utilized data gained from face-to-face interviews with 500 North Korean defectors who arrived in South Korea in 2007. The interviews were structured and conducted by 'Yonsei University Research Team for North Korean defectors'. A stepwise multivariable linear regression was performed to determine the factors associated with their self-rated health status.

RESULTS

North Korean defectors who were female, elderly, or had low annual household income, disability or chronic diseases reported lower health status. However, self-rated health status was higher among those who had settled in South Korea for 18 months or more, who were satisfied with government support or their current life, and who had experienced more traumatic events in North Korea.

CONCLUSIONS

Government policies and refugee assistance programs should consider and reflect the factors relevant to the health status of North Korean defectors.

Mental health and PTSD in female North Korean refugees

This study was conducted to identify mental health status, post-traumatic stress disorder (PTSD), and psychophysiological change in female North Korean refugees. Data were collected using questionnaires and symptom checklists that measured PTSD and the psychosomatic state of the subjects. As many as 97 subjects, who had settled in and around Seoul, South Korea, were selected by snowball sampling. Mental health and PTSD levels of the participants were above a moderate level. We conclude that health care professionals need to provide female North Korean defectors with services to improve mental health and make the sociocultural transition successfully.

A 7-year follow-up study on the mental health of North Korean defectors in South Korea

This study was conducted to describe the relationship of past trauma and current stress on the mental health of North Korean (NK) defectors living in South Korea 7 years after a baseline assessment. Of the 200 who participated in the initial study, 106 participated in follow-up. Previous data regarding past traumatic events experienced in North Korea and during defection, past posttraumatic stress disorder (PTSD), and their current stress levels were correlated with the participants' current mental health status including depression, anxiety, and PTSD. The rate of PTSD in the sample and the scores on the PTSD symptom scale decreased significantly from the baseline. The participants' current mental health was negatively related to previous traumatic experiences in North Korea and past symptoms of PTSD, but unrelated to previous trauma experienced during defection. In addition, although current mental health was negatively related to only current culture-related stress, it was unrelated to the level of current ordinary life stress. The results of this study suggest that PTSD symptoms decreased during the 7 years between assessments, and that current culture-related stress is the most important variable related to the mental health of NK defectors living in South Korea.

Post-Traumatic Stress Disorder, Depression, and Heart-Rate Variability among North Korean Defectors

OBJECTIVE

This study evaluated the symptoms of post-traumatic stress disorder (PTSD) among North Korean defectors and their level of suicidal ideation and the correlation between these and heart-rate variability (HRV) to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder.

METHODS

A total of 32 North Korean defectors (nine men, 23 women) were selected as subjects, and their HRV was measured after they completed the Minnesota Multiphasic Personality Inventory-PTSD (MMPI-PTSD) scale and the Beck Depression Inventory (BDI).

RESULTS

1) Low-frequency (LF)/high-frequency (HF) ratios in the HRV index and MMPI-PTSD scores were correlated (r=0.419, p<0.05), as were BDI item 9 (suicidal ideation) and MMPI-PTSD scores (r=0.600, p<0.01). 2) A regression analysis of LF/HF ratios and MMPI-PTSD scores revealed an R-value of 13.8% (Adj. R(2)=0.138, F=4.695, p=0.041), and a regression analysis of BDI item 9 and MMPI-PTSD scores showed an R-value of 32.8% (Adj. R(2)=0.328, F=11.234, p=0.003). In other words, the LF/HF ratio (β=0.419) and BDI item 9 (β=0.600) appear to be risk factors in predicting MMPI-PTSD scores.

CONCLUSION

The LF/HF ratio, a standard index of autonomic nervous system activity, can be used as an objective neurobiological index to analyze PTSD among North Korean defectors presenting with various mental and physical symptoms, and the approximate level of suicide -ideation can act as a predicting factor for PTSD.

Social network effects on post-traumatic stress disorder (PTSD) in female North Korean immigrants

OBJECTIVES

The goal of this paper is to examine the social network effects on post-traumatic sdress disorder (PTSD) in female North Korean immigrants who entered South Korea in 2007. Specifically, it attempts to verify if the density and composition of networks make a difference after controlling for the network size.

METHODS

A multivariate logistic regression is used to probe the effects of social networks using the North Korean Immigrant Panel data set. Because the data set had only completed its initial survey when this paper was written, the analysis was cross-sectional.

RESULTS

The size of the support networks was systematically related to PTSD. Female North Korean immigrants with more supporting ties were less likely to develop PTSD, even after controlling for other risk factors (odds-ratio for one more tie was 0.8). However, once we control for the size of the network, neither the density nor the composition of the networks remains statistically significant.

CONCLUSIONS

The prevalence of the PTSD among female North Korean immigrants is alarmingly high, and regardless of the characteristics of supporting network members, the size of the supporting networks provides substantial protection. This implies that a simple strategy that focuses on increasing the number of supporting ties will be effective among North Korean immigrants who entered South Korea in recent years.

Anxiety and depression among North Korean young defectors in South Korea and their association with health-related quality of life

PURPOSE

This study examined anxiety and depression among 108 North Korean adolescent and young adult (age, 12-29 years) defectors who settled in South Korea, and evaluated the relationship between their mental health and health-related quality of life (HRQoL).

MATERIALS AND METHODS

Subjects completed a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), the Short Form with 36 questions (SF-36; consists of mental and physical health components) for measuring HRQoL, and items related to the period of time since defection and settlement and socio-demographic variables.

RESULTS

Among the participants, 53.7% scored ≥ 8 on the anxiety measure questionnaire, and 22.2% scored ≥ 11; 36.1% of the participants scored ≥ 8 on the depression measure questionnaire and 14.8% scored ≥ 11. Both anxiety and depression subscales were associated with lower scores of total SF-36, physical component and mental component score. Depressive symptom appeared more frequently among the subjects who had lived in South Korea for < 1 year than among the subjects who had lived in South Korea for 2 year or longer (odds ratio=3.77, 95% confidence intervals=1.12 to 12.70).

CONCLUSION

Among North Korean adolescent and young adult defectors, anxiety and depression were associated with lower HRQoL. Therefore, it is needed to develop strategies to screen for mental health and intervene to reduce anxiety and depression during their early resettlement stage.

Mental health and quality of life of North Korean defectors living in Japan

The aim of this study was to clarify the effect of migration of North Korean defectors to different host countries on the mental health and quality of life of the migrants by comparing three subject groups: North Korean defectors living in Japan, a group of Japanese workers living in Japan (for comparison), and North Korean defectors living in South Korea. The North Korean defectors living in Japan scored significantly higher on the Beck Depression Inventory, and also scored lower across all domains of the World Health Organization Quality of Life Assessment than the other two groups. However, no significant difference in the overall quality of life score was observed between the North Korean defectors living in Japan and the Japanese workers, while the North Korean defectors living in South Korea scored significantly higher as compared to both. These findings suggest that the insecurity of social factors because of poor fluency in the language of the host country, unemployment and unclear nationality, and the limited support system may contribute to the poor mental health and low quality of life of North Korean defectors living in Japan. Migration may promote a sense of achievement and improve the overall quality of life, but attention must be paid to the pervasive depression in these migrants.

Prevalence and Correlates of Depressive Symptoms among North Korean Defectors Living in South Korea for More than One Year

OBJECTIVE

This study examined the prevalence and correlates of depressive symptoms in North Korean defectors who have been living in South Korea for more than one year.

METHODS

We used questionnaires developed by the authors to collect sociodemographic data in addition to the Center for Epidemiologic Studies Depression Scale (CES-D), the Psychosocial Well-being Index to measure stress, and a social support scale. A total of 367 subjects were included in this study.

RESULTS

The results showed that 30.5% of the men and 34.7% of the women reported depressive symptoms, and 33.1% of the men and 36.1% of the women exhibited signs of severe distress. Correlates of depressive symptoms were lack of occupation [odds ratio (OR)=2.198, 95% confidence interval (CI), 1.247-3.873], having escaped without family (OR=1.725, 95% CI, 1.006-2.959), and a poor subjective sense of health status (OR=3.111, 95% CI, 1.591-6.085).

CONCLUSION

Continuing vocational training and career management, psychological support programs, and intensive physical health services are needed to improve the mental health of this population.

Depression and anxiety in labor migrants and refugees--a systematic review and meta-analysis

Prevalence rates of depression and anxiety among migrants (i.e. refugees, labor migrants) vary among studies and it's been found that prevalence rates of depression and anxiety may be linked to financial strain in the country of immigration. Our aim is to review studies on prevalence rates of depression and/or anxiety (acknowledging that Post-traumatic Stress Disorder (PTSD) is within that class of disorders), and to evaluate associations between the Gross National Product (GNP) of the immigration country as a moderating factor for depression, anxiety and PTSD among migrants. We carried out a systematic literature review in the databases MEDLINE and EMBASE for population based studies published from 1990 to 2007 reporting prevalence rates of depression and/or anxiety and or PTSD according to DSM- or ICD- criteria in adults, and a calculation of combined estimates for proportions using the DerSimonian-Laird estimation. A total of 348 records were retrieved with 37 publications on 35 populations meeting our inclusion criteria. 35 studies were included in the final evaluation. Our meta-analysis shows that the combined prevalence rates for depression were 20 percent among labor migrants vs. 44 percent among refugees; for anxiety the combined estimates were 21 percent among labor migrants vs. 40 percent among (n=24,051) refugees. Higher GNP in the country of immigration was related to lower symptom prevalence of depression and/or anxiety in labor migrants but not in refugees. We conclude that depression and/or anxiety in labor migrants and refugees require separate consideration, and that better economic conditions in the host country reflected by a higher GNP appear to be related to better mental health in labor migrants but not in refugees.

Divided countries, divided mind 1: psycho-social issues in adaptation problems of north korean defectors

A review of studies on the adaptation problems of North Korean defectors in South Korean society and studies of people's adaptation to political and cultural changes in other countries suggests that similar adaptation problems may occur in the process of and after unification. Defectors have various adaptation problems and some of them have psychiatric disorders such as depression and post-traumatic stress disorder (PTSD). The reasons for this were revealed to be the difference in the culture and personality between South and North Korea, which have developed for the last 60 years without any communication with each other, in spite of their common racial and cultural heritage. Economic factors including the lack of skills and knowledge for working at industrialized and competitive society like South Korean society, also aggravate the severity of such adaptation problems. Research on defectors' adaptation problems and on the differences in the culture and mentality between North and South Korea can provide useful information on what kinds of problems may arise during the process of and after unification and what should be done to achieve mutual adaptation and harmonious and peaceful unification.

The effect of unusual social experience on the global health of North Korean asylum seekers

OBJECTIVES

This study examined the risk factors associated with a negative self-rating of subjective health among North Korean asylum seekers, paying particular attention to the unusual social experiences of this population.

STUDY DESIGN

This study utilized the North Korean Health Care System Data Set (NKHCS). This data set is comprised of information on 221 North Korean asylum seekers (aged 20 years and over) who were housed in Hanawon, a South Korean government facility. We specifically examined the effect of three separate risk factors (major country of residence after exiting North Korea, duration of stay in country, and whom they were accompanied by during their migration event) associated with the unusual social experiences of North Korean asylum seekers on their global health.

METHODS

Multivariate logistic regression analyses were carried out in order to assess the consistency and validity of extant hypotheses and general expectations.

RESULTS

North Korean asylum seekers who entered South Korea within one year of their defection or were accompanied by non-family members tended to negatively self-report their health status. However, major intermediate country of residence after exiting North Korea showed no effect. Higher educational attainment and membership of the Labour Party of North Korea were negatively associated with the global health of this population, though this was not statistically significant.

CONCLUSIONS

We found that the unusual social experiences of North Korean asylum-seekers, particularly intermediate country duration and companionship characteristics, were significantly associated with their health. Future studies need to examine the relationship between diverse social experiences during residence in intermediate countries and the health of this population.

Correlation between traumatic events and posttraumatic stress disorder among North Korean defectors in South Korea

The number of North Korean defectors entering South Korea has been increasing rapidly since 1994. Two hundred North Korean defectors in South Korea were studied to identify their experiences of traumatic events in North Korea and during defection, and the correlation with Posttraumatic Stress Disorder (PTSD). Researchers conducted face-to-face interviews and assisted defectors in performing a self-report assessment of this survey. The study questionnaire consisted of demographic characteristics, the Traumatic Experiences Scale for North Korean Defectors, and the PTSD part of the Structured Clinical Interview for DSM-III-R Korean version. Prevalence rate of PTSD in defectors was 29.5%, with a higher rate for women. In factor analysis, the 25 items of traumatic events experienced in North Korea were divided into three factors: Physical Trauma, Political-Ideological Trauma, and Family-Related Trauma. In addition, the 19 items of traumatic events during defection were grouped into four factors: Physical Trauma, Detection and Capture-Related Trauma, Family-Related Trauma, and Betrayal-Related Trauma. In multifactorial logistic regression analysis, Family-Related Trauma in North Korea had a significant odds ratio.