Depression in North Korean refugees: a mixed methods study

Loneliness and social isolation amongst refugees resettled in high-income countries: A systematic review

Refugees encounter multiple psychosocial stressors post-resettlement which increases their risk of developing a mental illness. Loneliness and social isolation are commonly reported in the refugee population and have been demonstrated to be associated with multiple physical and mental health comorbidities in the general population. However, no study to date has systematically reviewed how loneliness and social isolation may affect refugees who have resettled in high-income countries. This systematic review aims to study the prevalence, risk factors, consequences, and interventions for loneliness and social isolation among refugees who have resettled in high-income countries. Systematic searches on five electronic databases yielded 2950 papers, of which 69 were deemed eligible following a double-blinded review by title and abstract then later by full text. From the included studies, it was found that the reported range of prevalence rates of loneliness (15.9-47.7%) and social isolation (9.8-61.2%) were higher than population norms. Risk factors associated with loneliness and social isolation included family separation, acculturative stress, being female or a parent and a current diagnosis of a mental illness. Loneliness and social isolation were found to be associated with depression, post-traumatic stress disorder (PTSD), psychological distress as well as physical health problems. Only three interventions addressing loneliness and social isolation were identified which demonstrates the importance of integrating social support in refugee psycho-social support programs. In summary, loneliness and social isolation were reported by a large proportion of refugees who have resettled in high-income countries. Whilst certain risk factors were pre-migratory and static, most were post-migratory in nature and were found to adversely affect mental and physical health. Thus, interventions focused on reducing loneliness and social isolation that are guided by the needs of refugee communities are urgently required.

The moderating role of neighborhood social cohesion in the mediation effects of the loneliness between acculturation stress and post-traumatic growth among female North Korean defectors

Loneliness negatively predicts post-traumatic growth (PTG) among North Korean defectors (NKD), one of the representative groups of refugees. Additionally, evidence also suggests that females, who account for 70% of NKDs entering South Korea, are vulnerable not only to past trauma but also to the current acculturation stress and loneliness affected by neighborhood social cohesion. This study explores whether the mediating effect of loneliness on the relationship between acculturation stress and PTG was moderated by the neighborhood social cohesion among female NKDs. In this study, the data of 166 female NKDs who completed an online survey regarding acculturation stress, PTG, loneliness, and neighborhood social cohesion were used. Moderated mediation analysis was conducted using SPSS PROCESS macro program. Loneliness was associated with PTG (B = - 1.896, p < 0.001), and mediated the association between acculturation stress and PTG (indirect effect = - 0.278, 95% LLCI - 0.403, 95% ULCI - 0.166). Neighborhood social cohesion moderated the mediation effect of loneliness on the association between acculturation stress and PTG (B = - 0.016, 95% LLCI 0.001, 95% ULCI 0.035). The indirect effect of acculturation stress on PTG through loneliness was notably high for those with low neighborhood social cohesion. Therefore, increasing neighborhood social cohesion would reduce loneliness caused by acculturation stress and support the positive growth among female NKDs. This represents the most effective approach to aiding female NKDs in achieving growth, even after suffering trauma.

Exploring trajectories of depressive symptoms in North Korean defectors: A latent class mixed analysis

BACKGROUND

North Korean defectors (NKDs) are known to be vulnerable to depression due to the influence of various psychosocial factors during their settlement process. Therefore, this study aimed to explore different trajectories of depressive symptoms in NKDs and identify predictors of the worsening of depressive symptoms. In particular, the focus was on whether posttraumatic stress disorder (PTSD) functions as a significant predictor.

METHODS

Participants consisted of 300 NKDs who settled in South Korea within 3 years of entering in the country. Five waves of longitudinal data collected from 2016 to 2019 were used. In this study, the North Korean Composite International Diagnostic Interview (NK-CIDI), a diagnostic interview tool, was conducted at baseline and depressive symptoms were measured at each wave. Trajectory identification was based on latent class mixed modeling. Logistic regression was used to extract the significant factors predicting a high/increasing depressive symptom trajectory.

RESULTS

Two trajectories of depressive symptoms were identified: "low/stable symptom" (76.7% of participants) and "high/increasing symptom" (23.3% of participants). Predictors of the high/increasing symptom group were being female and a low use of mental health services. Generalized anxiety disorder, social phobia, and alcohol dependence acted as significant predictors. Although PTSD was not a significant predictor, self-reported PTSD symptom scores were high in the high/increasing symptom group.

CONCLUSIONS

Identifying the trajectories of depressive symptoms in NKDs helps identify the risk factors of clinically vulnerable groups. In the process of establishing government-level interventions, it may be helpful to create a therapeutic environment. In addition, when evaluating initial psychiatric problems, it is important to primarily consider NKDs' anxiety levels and alcohol problems. There should also be an appropriate consideration of PTSD symptoms.