1. Abstract
PTSD among North Korean Defectors in South Korea: Comorbidity and Risk Factors
Minsu Kim,BA1; Kristen F. Sun, MA2, & Lisa M. Brown, PhD1
1Palo Alto University, 2University of California, Berkeley
This research focuses specifically on North Korean (NK) defector mental health status as a unique subgroup from refugees or migrants. Similar to refugees and migrants, defectors displayed high rates of depression and anxiety. However, due to the political nature of defection, North Korean defectors displayed high occurrences of post-traumatic stress disorder (PSTD).
This study expands on existing literature by analyzing the risk factors and level of comorbidity between PTSD and depression/anxiety among North Korean defectors.
Using both qualitative and quantitative methods, this study 1) examined the relationships between traumatic experiences and expression of symptoms and 2) explored other factors that contributed to traumatic symptoms.
Among 11 risk factors extracted from qualitative interviews and demographic information of NK defectors, experience of being caught during defection significantly and positively correlated with presenting PTSD symptoms while no other factor (including being tortured and witnessing massacre) significantly contributed to PTSD symptoms among NK defectors. However, experience of torture significantly predicted current high levels of depressive symptoms and symptoms of anxiety.
Fear for being caught without actual imprisonment or forced repatriation was significantly and negatively correlated with PTSD symptoms as well as being marred and having children.
Introduction
Results
Table 1
Figure 1
Korea remains distinct in the world today as one of the few remaining divided countries from the Cold War period, with North Korea functioning as a juche totalitarian state and South Korea as a constitutional republic. The imposition of the Demilitarized Zone (DMZ) since the end of the Korean War in 1953 has enforced the division of the peninsula.
However, with South Korea becoming one of the highest developed nations in East Asia since the 1980s in contrast to North Korea, the presence of North Korean defectors has continued to rise (more than 20,000) in South Korea. Furthermore, prevalence of PTSD among NK defectors is significantly higher than in the general population.
Due to the nature of defection and refugee migration, defectors face significant difficulties. South Korean government policies restricting freedom of residential mobility and emigration, and discrimination and prejudice against North Koreans result in substandard or exploitative living and working conditions. NK defectors also fear imprisonment and forced repatriation.
Previous research about NK defectors tend to focus on their adjustment problems in South Korea, contrasting the unevenness of development between the two nations as a root cause for maladjustment. Even among the few studies on mental health of NK defectors, most focus on effects of social support to the population rather than investigating on risk factors of their psychological problems, such as PTSD. This study seeks to fill this gap in the literature.
Mean SD
Cohen’s Kappa
Family Detachment
.47
.505
.674**
Tortured
.29
.394
.846**
Witnessing Massacre
.23
.427
.705**
Social Discrimination
.21
.412
.632**
Loneliness
.05
.213
.645**
Fear for being Caught
.16
.374
.536**
Cultural Difference
.382*
Caught
.33
.474
.730**
Raped
.02
.152
1.00**
Bombing
Car Accident
The average age of North Korean defectors was years (range from 20 to 80; SD 14.97). The average year from defection was 6.89 years (range from 2 to 16; SD 3.02).
Depression and anxiety scores from HSCL-25 significantly correlated with all three subscales of PTSD (i.e., avoidance, intrusion, and hyperarousal) in IES-R-K as well as Part 4 (PTSD symptom severity) in HTQ. Based on Cohen’s Kappa, all 11 risk factors displayed moderate to substantial agreement.
3 Types of events/features related to PTSD (table 2).
Traumatic experiences, which are related to PTSD (TE PTSD)
Traumatic experiences, which are not related to PTSD (TE XPTSD)
Current situation/emotion, which is related to PTSD (CSE PTSD)
Moreover,
Being caught vs. Fear for being caught
Correlation between fear for being caught and intrusive PTSD symptoms was not significant when experience of being caught was controlled (r=-.337, p<.05 r=-.311, p=.054); however, correlation between being caught experience and non of PTSD subcategories was not significantly influenced by fear for being caught (avoidance: r=.389, p<.05 r=.354, p<.05; hyperarousal: r=.371, p<.05 r=.326, p<.05)
Being tortured
Being tortured experience was not significant correlated with anxiety and depression when being caught experience was controlled (.352, p<.05; .333, p<.05  .308, p=.056; .250, p=.124).
Marriage and Children
Both Marriage and Children are protective factors regarding PTSD.
Fear for being caught was a Suppressor of being caught experience in terms of relation with avoidance PTSD symptom. When it was included in the Regression model, R2 improved: F(1, 38) = 5.317, p < .05, R2 = .151 F(2, 37) = 4.498, p < .05, R2 = .196.
Note. Scree Plot in Factor Analysis including Intrusive, Avoidance, Hyperarousal, HTQ Part4, experience of being caught, fear for being caught, marriage, and children. 2-factor model best fitted the dataset. Considering the high correlation among PTSD, depression, and anxiety, and given the fact that all these variables displayed significant correlation with PTSD, the first factor can be interpreted as PTSD.
Note. SD: standard deviation. All risk factors extracted from qualitative interviews display significant inter-rater reliability based on Cohen’s Kappa
* p < .01. ** p < .001.
Method
Table 2
Conclusion
Experience of being caught is the only exclusive factor which positively influences on PTSD symptoms. Except for this factor, no other potentially traumatic experiences (including being tortured, witnessing massacre, being raped, adjustment problems, social discrimination) significantly predicts and correlates with presenting PTSD symptoms.
It was initially hypothesized that experience of being tortured would most likely predict PTSD symptoms; however, it only correlates and predicts presenting depressive symptoms and symptoms of anxiety rather than PTSD symptoms.
This study revealed that past fear for being caught during defection surprisingly plays a role as a protective factor as well as being married and having children. In other words, NK defectors who have not been caught but have fear for being caught would be less likely to have PTSD symptoms.
The results of this research may indicate that NK defectors who have suppressed, denied, and/or been reluctant to report their fear for being caught, despite their actual experiences of being caught, ironically predict greater PTSD symptoms.
Participants:
43 North Korean defectors (33 females; 10 males) were recruited through the Committee for the Democratization of North Korea in South Korea. Data was collected from June 2014 to March 2015.
Measures:
This research administered three instruments including Hopkins Symptom checklist-25 (HSCL-25) for depressive symptoms and symptoms of anxiety; Impact of Event Scale-Revised-Korean (IES-R-K) and the Harvard Questionnaires (HTQ) for PTSD symptoms.
Risk Factors based on Qualitative Interview:
11 risk factors (table 1) were extracted and categorized based on qualitative interviews in HTQ Part 2. Inter-rater reliability among two different researchers, who are fluent in both Korean and English, was investigated for each traumatic event by Cohen’s Kappa.
Data Analysis:
Using SPSS, Correlation, ANOVA, Multiple Regression Model, and Factor Analysis were conducted in order to research on the relationships among demographic features, risk factors, and symptoms of depression, anxiety, and PTSD.
Positive
Negative
Measure
TE PTSD
Past experience of being caught
(avoidance and hyperarousal)
Past fear for being caught
(intrusive and hyperarousal)
IES-R-K
HTQ Part4
TE XPTSD
Experience of being tortured was not correlated with PTSD ; However it correlated with depression and anxiety
HSCL-25
HTQ Part1
CSE PTSD -
Marriage and Children (protective factors)
picture retrieved from:
Note. TE PTSD: traumatic experiences, which are related to PTSD; TE XPTSD: traumatic experiences, which are not related to PTSD; CSE PTSD:: current situation/emotion, which is related to PTSD.