Effects of Psychiatric Symptoms on Attention in North Korean Refugees

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder

Approximately 10%-30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans (n = 374 at baseline and n = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; n = 275), brain morphology (hippocampal subfield volume and cortical thickness; n = 280), neurocognitive functioning (n = 337), and genetic variation (n = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus (p = .015; adjusted-p [padj] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume (p = .010-.034; padj = .032-.053); worse self-monitoring (p = .018; padj = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene (p = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Effects of Inhumane Treatment in North Korean Detention Facilities on the Posttraumatic-Stress Disorder Symptoms of North Korean Refugees

OBJECTIVE

The study investigated the effects of severe human rights abuses in North Korean on Posttraumatic-stress disorder (PTSD) in North Korean Refugees (NKRs).

METHODS

The study included 300 NKRs (245 females and 55 males) who completed self-report questionnaires that assessed PTSD, experiences of imprisonment, and exposure to inhumane treatment, by authorities in North Korea. A moderation analysis was conducted using a hierarchical multiple regression model to determine whether a moderation effect existed. In the next step, a post-hoc probing procedure of the moderation effect was performed using multiple regression models that included conditional moderator variables.

RESULTS

The influence of the frequency of being imprisoned on PTSD varied as a function of recurrent exposure to inhumane treatment or punishment by authorities. Experiences of imprisonment were associated with PTSD only among those who were exposed to recurrent violence, such as beating or torture, by North Korean authorities.

CONCLUSION

The present findings highlight the significant effects of human rights violations, such as the inhumane treatment of prisoners in North Korea, on the PTSD of NKRs.

Polysomnographic Sleep and Attentional Deficits in Traumatized North Korean Refugees

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.

The HTQ-5: revision of the Harvard Trauma Questionnaire for measuring torture, trauma and DSM-5 PTSD symptoms in refugee populations

BACKGROUND

The Harvard Trauma Questionnaire (HTQ) was developed 25 years ago as a cross-cultural screening instrument to document trauma exposure, head trauma and trauma-related symptoms in refugees. This article aims to: (i) outline the process of revision of Part IV of the HTQ to (a) include the new DSM-5 diagnostic criteria for PTSD, and (b) separate out and more fully develop the refugee-specific functioning items; and (ii) promote a consistent approach to the validation of the HTQ-5 when adapted for use in other cultures and language groups.

METHODS

Our process involved item mapping; expert consultations; generating items according to the new DSM-5 criteria; and drafting, refinement and finalization of the revised measure focusing closely on issues of meaning, future translation into multiple languages and comprehension amongst groups with low literacy and little or no exposure to Western trauma concepts. Validity and reliability testing of the new HTQ-5 is underway.

RESULTS

The HTQ symptom checklist was modified consistent with current DSM-5 diagnostic criteria to identify those refugees at risk for mental health and other symptoms associated with traumatic life events, disability and dysfunction.

CONCLUSIONS

Accurate screening of post-traumatic distress and dysfunction enables those working with refugees to triage them more effectively to scarce health and mental health resources. When developing screening measures to inform public health policy and practice, it is vital that these measures can bridge the gap between western (etic) nosologies and indigenous (emic) understandings of traumatic stress.

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.

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.

Mental health status of North Korean refugees in South Korea and risk and protective factors: a 10-year review of the literature

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.