Exposure to family and organized violence and associated mental health in north Korean refugee youth compared to south Korean youth

Abstract

Background: Studies on populations affected by organized violence have shown elevated levels of family violence against children. This form of violence has been found to contribute to children's psychopathology independently of traumatic experiences related to war, persecution or flight. Little is known, so far, about the exposure to family violence and its relation to mental health in North Korean refugee youth affected by political violence. The aim of this study was to examine the amount of organized and family violence and associated psychopathology in a sample of North Korean refugee youth living in South Korea compared to their South Korean peers. Methods: Sixty-five North Korean refugee youth and 65 South Korean youth were recruited. Trained researchers conducted the survey in group meetings of five to ten participants. Using questionnaires researchers assessed traumatic experiences, family and organized violence, PTSD symptoms, depressive symptoms and other mental health problems. Results: Higher rates of violence and trauma, and higher levels of mental health problems were found in the North Korean sample compared to the South Korean sample. Linear regression analyses including the various types of trauma as potential predictors showed that the severity of PTSD and depressive symptoms in the North Korean sample were associated with the amount of traumatic events and family violence but not with higher levels of organized violence. Conclusions: The findings suggest that in a context of organized violence, abusive experiences by family members constitute an important problem that is strongly linked to the psychopathology of adolescents. Our data suggest that psychological treatment and prevention approaches for North Korean refugees should be carefully tailored to fit the specific requirements of this population and address the mental health of the individual as well as potential problems at the family level.

Trauma History and Mental Health of North Korean Defectors

“…Considering the considerable stigma surrounding mental illness and the low health literacy of NKDs residing in South Korea, it is necessary to provide community-based information to vulnerable groups to promote knowledge of mental illness and ensure the safe use of medications. [20,22,37] • Repatriation experiences [38] • Long staying periods after entrance [21,22,44] • Perceived discrimination [10] • Low income [13,46,47] • Family relationships (family violence, family cohesion) [17,48,49] • Physical illnesses [19,51] • Alexithymia [31] • Emotion regulation strategy [40] • Thoughts of personal failure [41] • Resilience [42]…”

“…Regarding the prevalence of various forms of family violence in their lifetime, compared with young SKNs, young NKDs had significantly higher rates of neglect (25.8% vs. 6.2%) and physical abuse (32.3% vs. 10.8%), whereas psychological abuse did not vary between these two groups. The authors observed that the severity of depressive symptoms and PTSD in young NKDs was associated with the number of family violence and traumatic events, but not with higher levels of organized violence [17]. These findings suggest that abusive experiences by family members are strongly linked to the psychopathology of NKD adolescents in the context of organized violence.…”

“…Exposure to organized violence prior to entry into South Korea was reported by more than half of young NKDs (59.7%), whereas no one reported being exposed to this type of violence in the SKN youth sample [17]. The three most common types of systematic violence were starvation (43.5%), witnessing public execution or torture (27.4%), and imprisonment (21%).…”

“…Recent findings have revealed that 44-46% of NKDs exhibited depressive symptoms [12,13] and 43-54% of NKDs exhibited symptoms of anxiety [14,15]. When using self-reported scales, PTSD symptoms were observed in 40-52% of adult NKDs [12,16] and 13-30% of adolescent NKDs [17,18]. However, studies using the Structured Clinical Interview for DSM (SCID) found that the prevalence of PTSD among NKDs was lower, at 4~5% [19,20].…”

“…Around 95% of adult NKDs have reported at least one exposure to trauma, while 90% report having experienced different types of trauma, which most frequently included witnessing public executions, personally experiencing lifethreatening starvation, witnessing the deaths of friends or family members from starvation, witnessing serious physical assaults, and escaping arrest following defection [31]. Adolescent NKDs are no exception, 88.7% of the young NKDs had experienced at least one traumatic event that met the DSM-5 A criteria [17,32]. Additionally, 45.2% reported having experienced between two and four traumatic events and 30.6% had experienced more than five traumatic events.…”