1
|
Lee H, An JH, Chang H, Jun JY, Hong JP. A Three-Year Longitudinal Study of Risk Factors for Suicidality in North Korean Defectors. J Korean Med Sci 2023; 38:e218. [PMID: 37463689 DOI: 10.3346/jkms.2023.38.e218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This longitudinal study examined risk factors for future suicidality among North Korean defectors (NKDs) living in South Korea. METHODS The subjects were 300 NKDs registered with a regional adaptation center (the Hana Center) in South Korea. Face-to-face interviews were conducted using the North Korean version of the World Health Organization's Composite International Diagnostic Interview to diagnose mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Subjects were also asked about sociodemographic and clinical factors at baseline. At follow-up after three years, the NKDs (n = 172 respondents) were asked to participate in an online survey, responding to self-questionnaires about suicidality. Logistic regression analyses were used to explore associations between baseline variables and future suicidality among NKDs. RESULTS Thirty (17.4%) of the 172 survey respondents reported suicidality at follow-up. The presence of health problems over the past year, any prior suicidality at baseline, a higher score on a trauma-related scale, and a lower score on a resilience scale at baseline were associated with greater odds of suicidality at follow-up after adjusting for age, sex, and educational level. Of all mental disorder categories, major depressive disorder, dysthymia, agoraphobia, and social phobia were also associated with significantly increased odds of suicidality at follow-up after adjusting for age, sex, educational level, and prior suicidality at baseline. CONCLUSION Resilience, a previous history of suicidality, and the presence of lifetime depressive disorder and anxiety disorder should be given consideration in mental health support and suicide prevention in NKDs.
Collapse
Affiliation(s)
- Hyerin Lee
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyun An
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyein Chang
- Department of Psychology, Sungkyunkwan University, Seoul, Korea
| | - Jin Yong Jun
- Department of Psychiatry, National Center for Mental Health, Seoul, Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Nam B, Kim J, Kim JY, Lee Y. Depression, Alcohol Misuse, and Suicide Attempt Among North Korean Refugee Women Exposed to Gender-Based Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2023:8862605231161290. [PMID: 36942848 DOI: 10.1177/08862605231161290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
North Korean (NK) refugee women report a disproportionately high rate of suicide compared to the general South Korean (SK) population. NK refugee women's exposure to gender-based violence (GBV) is a risk factor for adverse mental health symptoms. However, the association between GBV exposure and mental health has received less scholarly attention. This study examined NK refugee women's exposure to GBV (i.e., sexual violence, human trafficking, and forced sex work) and explored whether it is associated with an increased risk of depression, alcohol misuse, and suicide attempts. A three-way interaction between depression, alcohol misuse, and suicide attempts among GBV-exposed NK refugee women was examined. Data from a snowball sample of 180NK refugee women were analyzed for this study. Findings show that 47.8% experienced GBV in either NK or intermediary countries. Multivariate analyses revealed that depression (OR = 1.13, p < .05) and alcohol misuse (OR = 3.01, p < .01) was significantly associated with suicide attempts in GBV-exposed groups. Results from the three-way interaction (GBV victimization × Depression × Alcohol misuse) suggest that GBV exposure and higher levels of depression were significantly associated with suicide attempts among NK refugee women with greater severity of alcohol misuse (OR = 1.75, p < .05). The findings indicate that NK refugee women with GBV exposure, depression, and alcohol misuse are at increased risk for suicide attempts. Study limitations included the use of snowball sampling and cross-sectional data. This study discusses implications for future research and targeted, trauma-informed treatments focused on GBV and mental health symptoms among NK refugee women.
Collapse
Affiliation(s)
- Boyoung Nam
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Joonbeom Kim
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Yop Kim
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Yujin Lee
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
3
|
Barbati A, Geraci A, Niro F, Pezzi L, Sarchiapone M. Do Migration and Acculturation Impact Somatization? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16011. [PMID: 36498084 PMCID: PMC9737361 DOI: 10.3390/ijerph192316011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Somatization is a phenomenon in which the individual experiences physical symptoms attributable to mental projections. It is a widely used term in common parlance to figuratively describe a stressful situation. Syndromes directly related to the mind have been described; pathologies are influenced by somatization. However, the extent of somatization is also related to social and cultural factors. In fact, each culture expresses varying levels of somatization characteristic of the country of origin. A disease can even manifest with different symptoms in different ethnic groups. The migration process arises from the need for change on the part of those who undertake it and culminates in the integration of the person in the host country. This process induces changes in the person of a psychological nature, which also affects somatization. In fact, the most integrated subjects show levels of somatization comparable to those of the host country. These considerations support the thesis that psychological changes are an integral part of health and can affect the development of organic and somatized pathologies.
Collapse
Affiliation(s)
- Antonello Barbati
- Department of Medicine and Health Science, University of Molise, 86100 Campobasso, Italy
| | | | - Fabiana Niro
- Department of Pathology, Federico II University of Naples, 80138 Naples, Italy
| | - Letizia Pezzi
- Rehabilitation Unit, ASST Cremona-Ospedale di Cremona, 26100 Cremona, Italy
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, 86100 Campobasso, Italy
| |
Collapse
|
4
|
Park S, Surkan PJ, Winch PJ, Kim JW, Gittelsohn J. 'I worked until my body was broken': an ethnomedical model of chronic pain among North Korean refugee women. ETHNICITY & HEALTH 2022; 27:1188-1206. [PMID: 33190516 DOI: 10.1080/13557858.2020.1841886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES While increasing numbers of North Korean refugees (NKRs) are migrating to South Korea, different understandings of physical pain between NKR patients and the South Korean healthcare providers may create miscommunication and less satisfaction with their care management. To identify strategies to improve care, this study elicits and presents an ethnomedical model of chronic pain among NKR women. DESIGN Twenty semi-structured individual interviews were conducted with NKR women with chronic pain living in South Korea. Inductive and deductive thematic analysis was performed on three types of data: interview transcripts, field notes created after each interview, and memos written during the analysis. RESULTS Participants reported that pain started after a certain period of resettlement and expressed frustration when there was no definite diagnosis for pain. They identified physical factors (e.g. excessive labor, exposure to violence, and poor diet) as the primary causes, while psychological factors (e.g. loneliness, rumination, and financial burden of sending remittances to North Korea) were viewed as collateral or contributing causes. Several participants indicated emotional discomfort when they were referred to psychiatrists for unceasing pain. Physical treatment (injections, medications, or acupuncture) and providers' sincere attitudes were expectations of care considered capable of addressing both physical and emotional distress. CONCLUSIONS Findings highlight the need to understand NKR women's ethnomedical model of chronic pain, which is distinct from illness model of healthcare providers. These preliminary findings could be used to improve care strategies based on NKRs' care needs.
Collapse
Affiliation(s)
- Soim Park
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jin-Won Kim
- Department of Korean Medicine, National Medical Center, Seoul, South Korea
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
5
|
Feyissa IF, Noh Y, Yoon MS. Post-Migration Life Adversity and Mental Health of Refugees and Asylum Seekers: The Mediating Role of Resilience between Perceived Discrimination, Socio-Economic Strains, Structural Strains, and Mental Health. Behav Sci (Basel) 2022; 12:bs12070208. [PMID: 35877278 PMCID: PMC9311976 DOI: 10.3390/bs12070208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
This study made a claim that perceived discrimination, socio-economic strain, and structural strain on displaced people have an adverse impact on their mental health. Our claim also acknowledges that these people potentially have a unique set of strengths and abilities that they rely on to overcome their immediate and future problems. The aim of this study is thus to examine the relationship between post-migration life adversity and mental health problems, and assess the potential mediating role of resilience among asylum seekers and refugees (219 asylum seekers and 42 recognized refugees) living in South Korea. Structural equation modelling was used to examine hypothesized pathways between post-migration life adversity, mental health and resilience. Fit indices showed adequate to excellent fit of the examined models with mental health as the outcome. Mental health was positively regressed on PMLA and negatively regressed on R. In addition, R partially mediated the association between PMLA and MH. In addition to providing the academic contributions of this study to the ongoing study of resilience and its social welfare implications, the result of the study indicated the necessity of improving the present and future socio-environmental factors that foster resilience among refugees and asylum seekers.
Collapse
Affiliation(s)
- Israel Fisseha Feyissa
- School of Global Studies, Global Migration Research Canter, Kyungsung University, Busan 48434, Korea; or
| | - Yeop Noh
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Korea;
| | - Myeong Sook Yoon
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Korea;
- Correspondence:
| |
Collapse
|
6
|
Lai H, Due C, Ziersch A. The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies. SSM Popul Health 2022; 18:101075. [PMID: 35601219 PMCID: PMC9118911 DOI: 10.1016/j.ssmph.2022.101075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/05/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background For the general population, the positive effects of paid employment on health and wellbeing are well established. However, less is known for people from refugee and asylum-seeking backgrounds. This review aims to systematically summarise the quantitative literature on the relationship between employment and health and wellbeing for refugees and asylum seekers. Method A search strategy was conducted in online databases, including MEDLINE, PsychINFO, EMCARE, SCOPUS, CINHAL, ProQuest and Web of Science. Articles were screened against inclusion and exclusion criteria. Studies published in English between 2000 to October 2021 were included if they used quantitative methods to consider the relationship between employment and health for refugees and asylum seekers in resettlement countries. Study quality was assessed using The Joanna Briggs Institute's Critical Appraisal Tools. Findings were synthesised using a narrative approach. Results Seventy-two papers were identified. The majority of papers (N = 58, 81%) examined the association between employment and mental health outcomes. Overall, while there were inconsistencies in the findings, employment had a positive effect on mental health particularly in reducing levels of psychological distress and depression. Though more limited in number, the papers examining physical health suggest that people who are employed tend to have better physical health than unemployed persons. There was some evidence to support the bi-directional relationship between employment and health. Poor mental and physical health negatively impacted the odds of employment and occupational status of refugees. Conclusion Good quality employment is an essential component of refugee resettlement and this review found that in general employment is also beneficial for refugee health, particularly aspects of mental health. More research regarding the effects of employment on physical health is required. The effects of refugee-specific factors such as gender roles, torture, and trauma on the relationship between employment and health also require further investigation.
Collapse
Affiliation(s)
- Huyen Lai
- College of Medicine and Public Health, Flinders University, Australia
| | - Clemence Due
- College of Medicine and Public Health, Flinders University, Australia
- School of Psychology, Adelaide University, Australia
| | - Anna Ziersch
- College of Medicine and Public Health, Flinders University, Australia
- Flinders Health and Medical Research Institute, Flinders University, Australia
| |
Collapse
|
7
|
Modeling the relationship between mentoring and depression symptoms among adolescent North Korean refugees. J Sch Psychol 2022; 92:121-135. [DOI: 10.1016/j.jsp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022]
|
8
|
Choi J, Hack T, Lee J. Fear of Crime among Female North Korean Defectors in South Korea. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:227-248. [PMID: 33533270 DOI: 10.1177/0306624x21992362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Tay Hack
- Angelo State University, San Angelo, TX, USA
| | - Julak Lee
- Chung-Ang University, Seoul, South Korea
| |
Collapse
|
9
|
Hu N, Shi T, Xu L, Pan G, Hu Z. The influence of empty-nest living on the health of the older people living in the rural areas of Lishui, China: A cross-sectional study. Medicine (Baltimore) 2022; 101:e28691. [PMID: 35089223 PMCID: PMC8797498 DOI: 10.1097/md.0000000000028691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
The empty-nest older people are becoming a significant social phenomenon in the rural of China. Most studies on the health of the empty-nest older people contain these older people who have no children or dead children. The emotional experience of the older people with and without children is quite different, our study only chose the empty-nest older people who had children in the rural of Lishui, China. The purpose of this study is to explore the differences of the health conditions between empty-nest and non-empty-nest older people living in the rural areas of China, including items of chronic metabolic diseases, fall injury, and mental health. Our research found that empty-nest older people had higher incidence of fall injury (17.00% vs 6.31%, P = .006) and suffer more severe depression (P = .015) than the non-empty-nest older people. The adjusted odds ratio of fall injury and depression for empty-nest older people compared with the non-empty-nest older people were 2.76 (95% CI, 1.17-6.48) and 2.25 (95% CI, 1.36-3.67), respectively. Our results suggest that empty-nest older people are more likely to suffer from depression and fall injury than non-empty-nest older people living in the rural of China.
Collapse
Affiliation(s)
- Naibao Hu
- School of Public Health and Management, Binzhou Medical University, 346 Guanhai Road, Yantai, China
| | - Tala Shi
- School of Public Health and Management, Binzhou Medical University, 346 Guanhai Road, Yantai, China
| | - Lanlan Xu
- School of Public Health and Management, Binzhou Medical University, 346 Guanhai Road, Yantai, China
| | - Guotao Pan
- Department of Occupational and Environmental Health, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, China
| | - Zhiyong Hu
- School of Public Health and Management, Binzhou Medical University, 346 Guanhai Road, Yantai, China
| |
Collapse
|
10
|
The Effect of Postmigration Factors on Quality of Life among North Korean Refugees Living in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111036. [PMID: 34769554 PMCID: PMC8582807 DOI: 10.3390/ijerph182111036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
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.
Collapse
|
11
|
Lee J, Jeon S, Kim S, Seo Y, Park J, Lee YJ, Kim SJ. Polysomnographic Sleep and Attentional Deficits in Traumatized North Korean Refugees. Nat Sci Sleep 2021; 13:635-645. [PMID: 34079408 PMCID: PMC8163968 DOI: 10.2147/nss.s308968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Attentional deficits and sleep problems are common in refugees who have experienced trauma. In the present study, we used polysomnography (PSG) to investigate the relationship between attentional deficits and objective measures of sleep structure in traumatized North Korean refugees. METHODS We recruited 32 North Korean refugees (mean age = 33.78 ± 14.33 years) and 39 South Korean participants (mean age = 35.03 ± 11.08 years). Sustained attention and divided attention were assessed using the Computerized Attention Test. We conducted an overnight PSG to objectively assess sleep structure. The participants also completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Impact of Event Scale-Revised (IES-R), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI). RESULTS The North Korean refugees showed more commission errors (CEs, p < 0.05) and a larger standard deviation (SD) of the reaction time (RT) (p < 0.05) in the sustained attention task compared to the South Korean participants. Furthermore, the North Korean refugees showed a shorter period of wake after sleep onset (WASO, p < 0.01), less time spent in N1 (p < 0.05), and more time spent in N2 (p < 0.05). The larger SD of RT in the sustained attention task in the North Korean refugees was positively correlated with WASO (r = 0.62, p < 0.01) and N1 stage (r = 0.47, p < 0.05) after controlling for age, sex, BDI, BAI, and IES-R. CONCLUSION The North Korean refugees showed poorer performance on the sustained attention task. Nocturnal PSG revealed shorter WASO and time spent in N1 in this population, which are independently associated with the preservation of attentional capacity. These data suggest that traumatized refugees may compensate for attentional deficits induced by their traumatic experiences via increased sleep continuity.
Collapse
Affiliation(s)
- Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sehyun Jeon
- Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Somin Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yumin Seo
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jinme Park
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| |
Collapse
|
12
|
Lee MS, Seo YE, Mok YE, Lee SH. Heart Rate Variability after Treatment for Depression in North Korean Defectors. Appl Psychophysiol Biofeedback 2020; 46:11-18. [PMID: 33074464 DOI: 10.1007/s10484-020-09491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, College of medicine, Guro-gu, Seoul, 08308, Republic of Korea
| | - Yae Eun Seo
- Department of Psychiatry, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Republic of Korea
| | - Young Eun Mok
- Department of Psychiatry, Korea University Guro Hospital, College of medicine, Guro-gu, Seoul, 08308, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Republic of Korea.
| |
Collapse
|
13
|
Kim HW, Jeon WT. Research output on mental health problems in North Korea between 2006 and 2017: A bibliographic analysis of North Korean medical journal articles. Asian J Psychiatr 2020; 53:102228. [PMID: 32593086 DOI: 10.1016/j.ajp.2020.102228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
Despite the continuing interests in political, economic, and public health issues of North Korea, little is known about mental health problems in North Korea. To gain a glimpse into this area of interest, we aimed to explore the characteristics of mental health research in North Korea and to identify the emphasis therein. In this context, four North Korean medical journals were selected from the Information Center on North Korea, with publication dates 2006-2017 (inclusive). For this bibliographic study's scope, we targeted studies on psychiatric problems in humans. We first selected articles based on their titles, and then finalized the study sample after reviewing the full text of primary sample articles. For main outcome measures, we used the absolute number and proportion of mental health research articles relative to total publications and the distribution of papers by research themes as defined by ICD-10 categories. Collectively, four journals published 162 mental health research articles from 2006 to 2017. The yearly volume and proportion varied between two and twenty-four and between 0.3 % and 2.7 %, respectively. The most frequently addressed ICD-10 category was F40-48, namely 'Neurotic, stress-related and somatoform disorders,' and the most frequently investigated condition was somatoform disorders. In conclusion, there has been a slow but steady increase in the research volume of psychiatry and mental health problems since 2011. The finding that the highest amount of research was conducted on somatoform disorders may suggest that mental disorder symptoms may be represented differently under the influence of socialism in North Korea.
Collapse
Affiliation(s)
- Hae Won Kim
- Department of Medical Education, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Woo Taek Jeon
- Department of Medical Education, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
14
|
Depression in North Korean refugees: a mixed methods study. Public Health 2020; 185:283-289. [PMID: 32711242 DOI: 10.1016/j.puhe.2020.05.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 11/21/2022]
Abstract
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.
Collapse
|
15
|
Lee KE, Moon CS, An JH, Lee HC, Kim DE, Park S, Lee M, Chang HI, Hong JP. Prevalence of DSM-IV Major Psychiatric Disorders among North Korean Defectors in South Korea. Psychiatry Investig 2020; 17:541-546. [PMID: 32450622 PMCID: PMC7324740 DOI: 10.30773/pi.2019.0217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/08/2020] [Indexed: 11/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Kyoung Eun Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Carolyn Seungyoun Moon
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ji Hyun An
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyo Chul Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Da Eun Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Minji Lee
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Hye In Chang
- Department of Psychology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| |
Collapse
|
16
|
Yoon MS, Feyissa IF, Jung EH. The Long Way to Refugee Status Acquisition and Mental Health in Post-Migration: Based on Asylum Seekers and Refugees in South Korea. Psychiatr Q 2020; 91:403-416. [PMID: 31950331 DOI: 10.1007/s11126-020-09714-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Apart from North Korean defectors, South Korea is becoming a destination for Asylum seekers from all over the world. However, 1 out of 220 asylum applicants receives recognition through long and arduous administration and litigation process while being underrepresented in any kind of support services.This particular study comparatively tested the mental health status of recognized refugees(n = 45) and Asylum applicants (n = 55) to determine if the acquisition of refugee status could make a difference in their overall quality of life. We first employed the Depression, Anxiety and Stress Test and then applied an independent t-test using SPSS 22 software.As a result, there is a statistically significant difference in the mean scores of depression and anxiety. However, the stress scale did not show a statistical significance--indicating there are still lingering stressing factors even after the acquisition of refugee status. Ways and preconditions to improve the mental health service for asylum seekers and refugees are suggested at the end of the paper.
Collapse
Affiliation(s)
- Myeong Sook Yoon
- Department of social welfare, Jeonbuk national university, Jeonju City, South Korea
| | | | - Eun Hye Jung
- Department of social welfare, Jeonbuk national university, Jeonju City, South Korea
| |
Collapse
|
17
|
Cha J, Surkan PJ, Kim J, Yoon IA, Robinson C, Cardozo BL, Lee H. Human Rights as Political Determinants of Health: A Retrospective Study of North Korean Refugees. Am J Prev Med 2018; 55:271-279. [PMID: 29934018 PMCID: PMC6257994 DOI: 10.1016/j.amepre.2018.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/07/2018] [Accepted: 04/02/2018] [Indexed: 10/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jiho Cha
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Pamela J Surkan
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaeshin Kim
- Dankook Center for Dispute Resolution, Dankook University, Yongin, Gyeonggi, Republic of Korea
| | - Isabel A Yoon
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
| | - Courtland Robinson
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara Lopes Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hayoung Lee
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Social Development, Korea International Cooperation Agency, Seongnam, Gyeonggi, Republic of Korea
| |
Collapse
|
18
|
An JH, Lee KE, Lee HC, Kim HS, Jun JY, Chang HI, Kim SS, Lee-Tauler SY, Hong JP. Prevalence and Correlates of Suicidal Thoughts and Behaviors among North Korean Defectors. Psychiatry Investig 2018; 15:445-451. [PMID: 30504749 PMCID: PMC5976004 DOI: 10.30773/pi.2017.11.08.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/30/2017] [Accepted: 11/08/2017] [Indexed: 11/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ji Hyun An
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyoung Eun Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyo Chul Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hae Soo Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin Yong Jun
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Hye In Chang
- Department of Psychology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Suk Sun Kim
- College of Nursing, Ewha Woman’s University, Seoul, Republic of Korea
| | - Su Yeon Lee-Tauler
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jin Pyo Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| |
Collapse
|
19
|
Park S, Lee Y, Jun JY. Trauma and Depression among North Korean Refugees: The Mediating Effect of Negative Cognition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040591. [PMID: 29587408 PMCID: PMC5923633 DOI: 10.3390/ijerph15040591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 12/03/2022]
Abstract
North Korean refugees experience adaptation difficulties, along with a wide range of psychological problems. Accordingly, this study examined the associations between early traumatic experiences, negative automatic thoughts, and depression among young North Korean refugees living in South Korea. Specifically, we examined how different factors of negative automatic thoughts would mediate the relationship between early trauma and depressive symptoms. A total of 109 North Korean refugees aged 13–29 years were recruited from two alternative schools. Our path analysis indicated that early trauma was positively linked with thoughts of personal failure, physical threat, and hostility, but not with thoughts of social threat. The link with depressive symptoms was only significant for thoughts of personal failure. After removing all non-significant pathways, the model revealed that early traumatic experiences were positively associated with depressive symptoms (ß = 0.61, 95% CI = 0.48–0.73) via thoughts of personal failure (ß = 0.17, 95% CI = 0.08–0.28), as well as directly (ß = 0.44, 95% CI = 0.27–0.59). Interventions that target negative cognitions of personal failure may be helpful for North Korean refugees at risk of depression.
Collapse
Affiliation(s)
- Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul 04933, Korea.
| | - Yeeun Lee
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul 04933, Korea.
| | - Jin Yong Jun
- Department of Social Psychiatry and Rehabilitation, National Center for Mental Health, Seoul 04933, Korea.
| |
Collapse
|
20
|
Kim HK, Kim HS, Kim SJ. Association of Anxiety, Depression, and Somatization with Menstrual Problems among North Korean Women Defectors in South Korea. Psychiatry Investig 2017; 14:727-733. [PMID: 29209375 PMCID: PMC5714713 DOI: 10.4306/pi.2017.14.6.727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/23/2016] [Accepted: 12/18/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE North Korean women defectors have suffered from anxiety, depression, and somatization after defection. Also they have had many menstrual problems like amenorrhea. This study was done to identify the correlations of anxiety, depression, and somatization to menstrual problems among North Korean woman defectors in South Korea. METHODS The participants in this study were 126 women from 5 government resettlement centers throughout South Korea. Questionnaires which included State-Trait Anxiety Inventory (STAI), Center for Epidemiological studies-Depression Scale (CED-S), and Symptom Checklist-90-Revised (SCL-90-R) were used to identify anxiety and somatization. Data were collected between June and September, 2012. RESULTS The women reported the following problems; amenorrhea (9.5%), hypomenorrhea (13.6%), menorrhagia (19.8%), polymenorrhea (13.5%), oligomenorrhea (4.8%), changes in amount of menstrual discharge (4.0%), and changes in amount of blood clot (9.5%). Anxiety (r=0.20, p=0.002), depression (r=0.25, p=0.005), and Somatization (r=0.35, p<0.001) were correlated with number of menstrual problems. CONCLUSION The results of this study indicate that mental health services need to be taken into account in interventions for North Korean woman defectors to improve their reproductive health including addressing menstrual problems.
Collapse
Affiliation(s)
- Hyun Kyoung Kim
- Department of Nursing, Korea Christian University, Seoul, Republic of Korea
| | - Hee Sook Kim
- Department of Nursing, Dongnam Health University, Suwon, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, College of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| |
Collapse
|
21
|
Noh JW, Park H, Kwon YD, Kim IH, Lee YH, Kim YJ, Kim SG. Gender Differences in Suicidal Ideation and Related Factors among North Korean Refugees in South Korea. Psychiatry Investig 2017; 14:762-769. [PMID: 29209379 PMCID: PMC5714717 DOI: 10.4306/pi.2017.14.6.762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/29/2016] [Accepted: 03/25/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE According to previous social survey, a high number of North Korean refugees (NKRs) in South Korea had suicidal ideation. The purpose of this study is to examine the related factors for suicidal ideation among NKRs by gender in South Korea. METHODS We examined the sample of NKRs, 701 subjects (men=160, women=-541) residing in South Korea, the participants were enrolled from October 2008 to May 2014. The related factors with suicidal ideation in NKRs were analyzed via a logistic regression analysis. RESULTS Refugee women were more likely to have suicidal ideation than men were. Although thoughts of suicide do not necessarily mean that they will follow through, however, there is an association that the higher rate of suicide also results in a higher rate of attempted suicide. In both genders, they tended to think more frequently about suicide who had stayed in South Korea for more than 5 years. In addition, higher frequencies of suicidal ideation also associated with higher level of perceived stress in both genders. CONCLUSION The gender difference should be addressed when designing suicide prevention interventions among the North Korean population in South Korea.
Collapse
Affiliation(s)
- Jin-Won Noh
- Department of Healthcare Management and Institute of Global Healthcare Research, Eulji University, Seongnam, Republic of Korea
| | - Hyunchun Park
- Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, the Catholic University of Korea, Seoul, Republic of Korea
| | - In Hye Kim
- Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea
| | - Yo Han Lee
- Department of Public Healthcare Services, Seoul Bukbu Hospital, Seoul, Republic of Korea
| | - Yoon Jung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
22
|
Ryang S. A critique of medicalisation: three instances. Anthropol Med 2017; 24:248-260. [DOI: 10.1080/13648470.2017.1389169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sonia Ryang
- Chao Center for Asian Studies, Rice University, Houston, TX, USA
| |
Collapse
|
23
|
Taylor BE, Chekaluk E, Bennett J. Post-Traumatic Stress Disorder, Depression and Anxiety among North Korean Refugees: A Meta-Analysis. Psychiatry Investig 2017; 14:550-561. [PMID: 29042879 PMCID: PMC5639122 DOI: 10.4306/pi.2017.14.5.550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/26/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Eugene Chekaluk
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Joanne Bennett
- Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
24
|
Factors Affecting Depressive Symptoms among North Korean Adolescent Refugees Residing in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080912. [PMID: 28805719 PMCID: PMC5580615 DOI: 10.3390/ijerph14080912] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
Abstract
We examined factors affecting the depressive symptoms and the relationship between depression and quality of life among 131 North Korean adolescent refugees aged 12–24 years. We compared sociodemographic, social, and individual characteristics and perceived the quality of life between participants with and without depression. Thirty-seven refugees (28.2%) had clinically significant depressive symptoms. The refugees with depression were younger (t = 2.67; p = 0.009), more likely to be male (χ2 = 6.98; p = 0.009), and more likely to have a Chinese father (χ2 = 9.05; p = 0.003) than those without depression. The refugees with depression had lower levels of psychological social support (t = 2.96; p = 0.004) and resilience (t = 4.24; p < 0.001) and higher levels of alcohol problems (t = −2.08; p = 0.043), aggression (t = −3.15; p = 0.003), and post-traumatic stress disorder (PTSD; t = −2.89; p = 0.004). They also reported lower levels of life satisfaction (t = 3.31; p = 0.001) and had a more negative view of their future (t = 2.68; p = 0.010). Interventions to increase resilience, to decrease the impact of traumatic events, and to provide psychological support may be helpful for North Korean adolescent refugees at risk of depression.
Collapse
|
25
|
Lee Y, Lee M, Park S. Mental health status of North Korean refugees in South Korea and risk and protective factors: a 10-year review of the literature. Eur J Psychotraumatol 2017; 8:1369833. [PMID: 29038687 PMCID: PMC5632770 DOI: 10.1080/20008198.2017.1369833] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022] Open
Abstract
Background: North Korean refugees (NKRs) are often exposed to traumatic events in North Korea and during their defection. Furthermore, they face sociocultural barriers in adapting to the new society to which they have defected. Objective: To integrate previous findings on this mentally vulnerable population, we systematically reviewed articles on the mental health of NKRs in South Korea. Method: We searched for empirical studies conducted in the last 10 years in six online databases (international journals: Embase, PubMed, Scopus, Web of Science; Korean journals: DBPIA, KMbase) through June 2017. Only quantitative studies using new empirical data on the mental health of NKRs were included. We summarized the 56 studies ultimately selected in terms of NKRs' mental health status and three domains of associated factors: pre- and post-settlement factors and personal factors. Results: NKRs had a high prevalence and severity of psychiatric symptoms, particularly post-traumatic stress disorder and depression. We identified nine risk factors consistently found in previous studies, including traumatic experience, longer stay periods in third country, forced repatriation, acculturative stress, low income, older age, poor physical health, and female and male sex, as well as four protective factors, including educational level in North Korea, social support, family relationship quality, and resilience. Conclusions: We suggest that future studies focus on the causal interactions between different risk and protective factors and mental health outcomes among NKRs from a longitudinal perspective. Furthermore, comprehensive policies for NKRs' psychological adaptation are needed, particularly the development of evidence-based mental health interventions.
Collapse
Affiliation(s)
- Yeeun Lee
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea
| | - Minji Lee
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea
| | - Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea
| |
Collapse
|
26
|
Mental health and related influencing factors among the empty-nest elderly and the non-empty-nest elderly in Taiyuan, China: a cross-sectional study. Public Health 2016; 141:210-217. [DOI: 10.1016/j.puhe.2016.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/13/2016] [Accepted: 09/06/2016] [Indexed: 11/17/2022]
|
27
|
Lee YJ, Jun JY, Park J, Kim S, Gwak AR, Lee SH, Yoo SY, Kim SJ. Effects of Psychiatric Symptoms on Attention in North Korean Refugees. Psychiatry Investig 2016; 13:480-487. [PMID: 27757125 PMCID: PMC5067341 DOI: 10.4306/pi.2016.13.5.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/24/2016] [Accepted: 01/28/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We investigated the performance of North Korean refugees on attention tasks, and the relationship between that performance and psychiatric symptoms. METHODS Sustained and divided attention was assessed using the computerized Comprehensive Attention Test in North Korean refugees and in South Koreans. All participants also completed the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale-Revised and the Dissociative Experiences Scale-II (DES-II). RESULTS The North Korean refugees showed slower reaction times (RTs) on the visual sustained attention task compared to the South Koreans after controlling for age and sex. North Korean refugees had a greater number of omission errors (OEs) on the divided attention task and a higher standard deviation (SD) of RT. Total DES-II scores of the North Korean refugees were associated with the number of OEs and the SD of RT on the sustained attention task, and with the number of OEs on the divided attention task. CONCLUSION North Korean refugees showed poorer performance on computerized attention tasks. In addition, attention deficit among North Korean refugees was associated with their dissociative experiences. Our results suggest that refugees may have attention deficits, which may be related to their psychiatric symptoms, particularly dissociation.
Collapse
Affiliation(s)
- Yu Jin Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Yong Jun
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soohyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ah Reum Gwak
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - So Young Yoo
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| |
Collapse
|
28
|
Shin HY, Lee H, Park SM. Mental Health and Its Associated Factors Among North Korean Defectors Living in South Korea. Asia Pac J Public Health 2016; 28:592-600. [PMID: 27456227 DOI: 10.1177/1010539516660192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Hyun-Young Shin
- 1 Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, Korea
| | - Haewon Lee
- 2 Seoul National University College of Medicine, Seoul, Korea
| | - Sang Min Park
- 3 Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Lee YJG, Jun JY, Lee YJ, Park J, Kim S, Lee SH, Yu SY, Kim SJ. Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms. Psychiatry Investig 2016; 13:67-73. [PMID: 26766948 PMCID: PMC4701687 DOI: 10.4306/pi.2016.13.1.67] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/22/2015] [Accepted: 04/15/2015] [Indexed: 11/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Yu-Jin G. Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Jin Yong Jun
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soohyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - So Young Yu
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Center for Medicine and Korean Reunification, Seoul National University of College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
30
|
Um MY, Chi I, Kim HJ, Palinkas LA, Kim JY. Correlates of depressive symptoms among North Korean refugees adapting to South Korean society: The moderating role of perceived discrimination. Soc Sci Med 2015; 131:107-13. [DOI: 10.1016/j.socscimed.2015.02.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Ahn JH, Kim WH, Choi HJ, Jeon JY, Song IG, Bae JN. Stigma of mental illnesses as perceived by north korean defectors living in South Korea. Psychiatry Investig 2015; 12:9-15. [PMID: 25670940 PMCID: PMC4310926 DOI: 10.4306/pi.2015.12.1.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/04/2014] [Accepted: 03/27/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims to provide the information of the stigmas of mental illness such as psychosis, alcoholism, attempt suicide, and depression among North Korean defectors. METHODS We examined stigma for the mental illnesses of 639 North Korean defectors aged 19 to 65 years who live in the Settlement Support Center for North Korean Refugees. The stigmas of mental illnesses were assessed using the Perceived Devaluation-Discrimination Scale We directly compared the stigma level between North Korean defectors and the general population of South Korea. RESULTS North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Perceived stigma associated with attempted suicide was similar for North Korean defectors and South Koreans. Only marital status in sociodemographic variables had associations with higher perceived stigma of psychosis, alcoholism, and depression in the North Korean defectors. North Korean defectors, who spent more than one year in transit country, had associations with lower perceived stigma of psychosis and alcoholism. North Korean defectors, who had the experience of compulsory repatriation to North Korea or North Korean family in South Korea, had an association with higher perceived stigma of depression. CONCLUSION North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Further studies are needed to document serial changes in stigmas for mental illnesses associated with the receipt of education at the Settlement Support Center for North Korean defectors.
Collapse
Affiliation(s)
- Ji-Hoon Ahn
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Hye-Jin Choi
- Department of Psychiatry, Gyeonggi Provincial Medical Center Suwon Hospital, Suwon, Republic of Korea
| | - Jin-Yong Jeon
- Department of Psychiatry, Settlement Support Center for North Korean Refugees, Anseong, Republic of Korea
| | - In-Gyu Song
- Graduate School of Public Health Seoul National University, Seoul, Republic of Korea
| | - Jae-Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| |
Collapse
|
32
|
Park YS, Park SM, Jun JY, Kim SJ. Psychiatry in former socialist countries: implications for north korean psychiatry. Psychiatry Investig 2014; 11:363-70. [PMID: 25395966 PMCID: PMC4225199 DOI: 10.4306/pi.2014.11.4.363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/16/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Young Su Park
- Department of Anthropology, Stanford University, Stanford, CA, USA
| | - Sang Min Park
- Center for Medicine and Korean Reunification, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Yong Jun
- Department of Psychiatry, Settlement Support Center for North Korean Refugee, Ministry of Unification, Anseong, Republic of Korea
| | - Seog Ju Kim
- Center for Medicine and Korean Reunification, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|