After the Escape: Physical Abuse of Offspring, Posttraumatic Stress Disorder, and the Legacy of Political Violence in the DPRK

Spillover of macro-level violence to parental physical abuse of children in low- and middle-income countries

BACKGROUND

Through violence socialization processes, exposure to higher rates of violence in the macro context may spill over to family violence, including caregivers' use of physical child abuse.

OBJECTIVE

This study examined the associations of violence occurring in macro contexts with parental physical abuse, after accounting for norms justifying women's exposure to intimate partner violence (IPV) and parental physical punishment against children.

METHODS

We used data from 435,131 households with a reference child aged 1 to 17 years across 43 countries from rounds 4 and 5 of the UNICEF Multiple Indicator Cluster Surveys. We employed multilevel logistic regression to estimate the extent to which country-level violence-measured by rates of terrorism and political conflict, homicide, and women's exposure to IPV-was associated with the use of severe and moderate physical abuse. The models controlled for norms justifying IPV and physical punishment, as well as socio-demographic factors.

RESULTS

Results indicated that greater endorsement of IPV (OR = 1.024, p < .001) and attitudes supporting the use of physical punishment with children (OR = 1.016, p < .05) were both associated with higher odds of severe physical abuse after controlling for covariates. The association of terrorism and political violence with severe physical abuse was mediated by norms that legitimize IPV (indirect b = 0.027, p < .01).

CONCLUSION

Interventions aimed at reducing abusive parenting practices in LMICs may benefit from efforts to reduce social norms that support IPV and physical punishment of children. These interventions should incorporate trauma-informed approaches that recognize the effects of macro-level violence.

Parental Resilience in Contexts of Political Violence: A Systematic Scoping Review of 45 Years of Research

Families suffer in particular ways during the violence and targeted deprivation of freedom and resources within political violence (PV), which includes wars, armed conflicts, and military occupations. While evidence is accumulating about the disproportionate impacts of PV on parents and children, we lack a clear, globally integrated understanding of how families suffer-and survive-PV. There is an urgent need to synthesize existing work to refine our understanding of parental experiences within PV-with particular attention to both how PV creates suffering for parents, and how parents strategize, caring for their families within the most horrendous of circumstances. In this systematic scoping review, authors explore how political violence impacts parenting. Using predetermined search strategies and inclusion criteria (peer-reviewed, empirical articles, published in English), searches within multiple databases, and tests of interrater reliability, 112 articles (quantitative, qualitative, and mixed method) were identified. Authors organized and coded findings, determined common themes, and built a conceptual model connecting and integrating findings. Findings point to two crucial areas of parenting within PV: parenting efficacy and parenting practices, demonstrating how these are simultaneously compromised by and amplified within PV. Results uncover how much parenting within PV is intertwined with parental psychological and social well-being, and that parents cope with a variety of internal and external resources, including culture, community, religion, activism, flight, and emotional and logistical reconfiguration. Implications include that, within and after PV, interventions must focus on parental well-being, as well as the social and political situatedness of parents.

Properties of Patient-Reported Outcome Measures for Post-Traumatic Stress Disorder in North Korean Defectors: A Scoping Review

OBJECTIVE

Posttraumatic stress disorder (PTSD) is highly prevalent among North Korean defectors. This scoping review aimed to appraise the measurement properties of patient-reported outcome measures (PROMs) that assess PTSD among North Korean defectors.

METHODS

A systematic search was conducted using Research Information Sharing Service, ScienceON, PubMed, and Embase from their inception up to September 15, 2022. Each measurement properties of the included PROMs were evaluated using COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) methodology. First, the methodological quality of each study on measurement properties was evaluated using the COSMIN Risk of Bias checklist. Second, the result of each single study on a measurement property was rated against the updated criteria for good measurement properties.

RESULTS

After screening the articles, nine instruments from 40 studies were included. Among these instruments, Impact of Event ScaleRevised was the most frequently used (13 studies [38.1%]), followed by the Trauma Scale for North Korean Refugees, PTSD Checklist, and Posttraumatic Diagnostic Scale. The theoretical basis of all PROMs was secure in terms of content validity. The most frequently tested characteristics in measurement properties for internal structure were internal consistency, criterion validity, and convergent validity. No study reported sufficient structural validity as confirmatory factor analysis results with a model fit.

CONCLUSION

There is insufficient evidence to support the recommendation of a specific PROM for use among North Korean defectors with PTSD.

Caregivers' perceptions of informal social control practices to reduce child neglect: A qualitative study in Ghana

BACKGROUND

Rational choice deterrence theory suggests that caregiving behavior, which includes abusive and neglectful behavior, can be influenced or manipulated via informal social control strategies enacted by neighbors, family members and friends in the social network. The literature identifies two forms of informal social control that have the potential to influence maltreating caregiver behavior, protective vs punitive, with the latter having more contrasting evidence related to its influence on maltreating caregiving practices.

OBJECTIVE

To examine the perceptions and meanings female caregivers associate with protective and punitive informal social control strategies that have been enacted against them.

METHODS

17 female caregivers from Ghana, who self-reported their involvement in neglectful acts, were purposively selected to engage in river of life oral history narrative interviews. Narrative accounts from the caregivers were analyzed thematically using Taguette software package.

RESULTS

The findings showed that protective informal social control in child neglect are interpreted via values and norms of childcare that have been institutionalized in the community. Caregivers perceived protective informal social control to have impact on their level of respect/influence, authority in the family or community, and to elicit internal consequences: shame, guilty feelings and embarrassment. Punitive informal social control approaches were considered as misplaced interventions that had ulterior motives of satisfying the neighbors' hatred/dislike of the perpetrator and quest for revenge.

CONCLUSION

The findings suggest that the development of a fruitful theoretical framework to explain the effectiveness of informal social control should prioritize the social values and legitimate norms of the community. Implications for practice and theory development are discussed.

Violence Against North Korean Refugee Women: Doubly Victimized By Repatriation and Premigration Traumatic Experiences

This study investigates the influence of traumatic events on the mental health of North Korean refugee women by examining the prevalence and severity of posttraumatic stress disorder (PTSD), depression, and anxiety in comparison with their male counterparts (women = 496; men = 131). Our results suggest that women are at greater risk of developing mental health problems than men. In particular, symptoms of PTSD and anxiety were higher among women who experienced forced repatriation to North Korea, which is operationalized as a constellation of gendered traumatic incidents such as sexual abuse, rape, witnessing infanticides, and forced abortion. The policy implications of our results and suggestions for future studies are discussed.

Trauma History and Mental Health of North Korean Defectors

Purpose of Review

This study aimed to review the mental health status of North Korean defectors (NKDs) and related factors. Interventions to promote their mental health and issues to be dealt with are also reviewed.

Recent Findings

NKDs are often exposed to multiple severely traumatic events, both in North Korea and surrounding their defection. Furthermore, they face sociocultural barriers in adapting to a new society. Past exposure to traumatic events, longer defection periods, forced repatriation, psychological factors, and acculturative stress such as perceived discrimination, low income, family violence, and health complaints contribute to negative effects on mental health and obstruct their adaptation to life in the Republic of Korea.

Summary

It is necessary to develop evidence-based programs to promote NKDs’ mental health and help them to adapt to their new society. An NKD cohort study would be helpful to reveal their long-term mental health prognoses and interactions with pre- and post-migration factors.