A study on the mental health of North Korea refugee youth in South Korea. Yeunhee J. Kim, Ph.D Dept. of Social Welfare Daegu University

Table of contents

1. Purpose of the study To estimate prevalence of mental health problems among North Korean youth To investigate determining factors To generate policy and practice recommendations

Steady increase in the influx of NK refugees in the past decade Official count at over 21,000 in 2011 Shift in demographic composition from male adults to women, families with children, unaccompanied children No study on mental health status of NK children and youth yet Background

Previous mental health research focused on NK adult population Descriptive studies on NK Youth documenting trauma, school adjustment Acculturation issues Indications for high mental health problems among NK youth Background

2. Literature Review Predictive factors for mental health of general youth population –Gender –Intrapersonal characteristics such as self-esteem, optimism, resilience –Quality of family relationship –SES of family –Adversities in life such as abuse, loss –Health (Yang, Lee, and Lee, 2006; Lee, 2007; Ahn, 2006; ???)

Predictive factors for mental health of refugee population –Pre-migration trauma level –Acculturation stress-discrimination, culture shock, lack of social support, survivor guilt –Presence of intimate family –Language proficiency of the host country –Employment –Gender & age (Kim, 2006; Cho, Kim & Jeon, 2009; Mollica et al., 1998; Beiser & Hyman, 1997; Miller et al., 2002) Literature Review

Predictive factors for NK youth adjustment –Trauma exposure level –Acculturation stress –Separation from Family –Length of stay in the South –Self-esteem, resilience (Yang & Hwang, 2008; Keum, Kwon & Lee, 2004; Kim, Cho, Kim, 2009) Literature Review

3. Research Methodology Convenience sampling Efforts made to recruit a sample that is similar to NK youth population Total of 200 N. K youth and 339 S. Korean youth Self-administered questionnaire

Dependent variables –Depression/anxiety measured by HSCL –PTSD symptoms measured by PDS Predictive variables –Gender, age, health –Trauma exposure & acculturation stress –Living with family, resilience Variables & Measures

Descriptive statistics VariablesFrequency(%)VariablesMean(SD) genderM92 (46)Age18.18(2.60) F104(54)Length of stay in the South29.56(25.83) residenceROC39 (19.5)duration of migration23.61(31.25) Community161(80.5)total yrs of ed.96 (mo) Family compositio n Both parents52(26)Ed. In NK60(mo) Single parent103(51.5)Ed. In SK25.15(mo) w/ relatives20(10.0)Ed. in 3 rd country11.19(mo) alone17(5.0)Trauma events2.54(0.18) Subjective Health l evel Poor20(10.0)Resilience34.42(6.37) Average93(46.5)Acculturation stress20.31(8.64) Good87(43.5)PTSD9.89(SD=9.25) HSCL14.90(11.37)Severe(≥36)4(2.0) Clinical7(3.5)severe to moderate(35~21)22(11.0) Non-clinical193(96.5)Moderate(20~11)46(23.0) Low(≤10)128(64.0)

4. Findings Even distribution of gender Mean age=18 Length of stay in South=30 mo. Migration period=24 mo. Family composition –Both parents (26%) –Single parent (51.5%) –Relatives (10.0%) –Alone (5%)

3.5% prevalence of clinical depression/anxiety 13% prevalence of PTSD Findings

Trauma exposure eventsFrequen(%) 1Serious accident, fire, or explosion49 (24.5) 2Natural disaster: flood, landslide, earthquake, typhoon56 (28.0) 3Violence by family members, relative or acquaintance59 (29.5) 4Violence by strangers35 (17.5) 5Sexual assault by family, relatives or acquaintance10 ( 5.0) 6Sexual assault by strangers9 ( 4.5) 7Sexual relationship before 18 with one 5 years or more older10 ( 5.0) 8Incarceration(imprisonment, being taken hostage, abduction)45 (22.5) 9Being tortured22 (11.0) 10Having a life-threatening serious illness55 (27.5) 11Witnessing traumatic incident involving family members(death, arrest etc)72 (36.0) 12Hearing about traumatic incident involving family members75 (37.5) 13Other traumatic events(eg_________________________)11 ( 5.5)

71% of respondents report trauma exposure Average 2.5 events of trauma Most common trauma incidents –Witnessing and hearing about death and arrest of family –Violence and abuse by family/acquaintance Findings

Clinical profile by gender variablesgenderMeanSDt/F test Trauma exposure M *** F Resilience level M F Acculturation stress M F PTSD M F HSCL M F Males report higher trauma exposure level No difference in clinical profiles by gender

variablesfamilyMeanSDt test Trauma exposure Yes No Resilience level Yes No Acculturation stress Yes No PTSD Yes ** No HSCL Yes ** no Clinical profile by family presence Absence of family associated w/ HSCL and PTSD levels

variablesTrauma levelMeanSDt/F test Resilience level High low Acculturation stress High low PTSD High *** low HSCL High * low Clinical profile by trauma level High trauma exposure associated with HSCL & PTSD

variables Subjective he alth MeanSDF test Trauma expos ure Good a ** a<c Average b2.76 Poor c Resilience lev el Good * Average poor Acculturation stress Good *** a<c Average poor PTSD Good ** a<c Average poor HSCL Good *** a<c Average poor Clinical profile by subjective health Subjective assessment of health associated with all clinical profiles

variablesHSCL-25PTSD ßSEβß β constant Gender Age Subjective health † Family presence * * Trauma exposure * *** Resilience * Acculturation stress *** *** Adjusted R² F 7.95***6.26*** n 200 Regression on HSCL and PTSD

Findings Acculturation stress is strongest predictor for depression/anxiety Demographic variables not significant predictors Risk & protective factors significant predictors –Living with family –Trauma exposure –Personal resilience –Subjective health assessment

Discussions NK youth faring better than expected Interpretation of the results with caution Trauma exposure and acculturation stress as markers for early identification of at-risk groups for mental health Integrated approach to health and mental health Policies and programs to alleviate acculturation stress