A study on the mental health of North Korea refugee youth in South Korea

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

Dept. of Social WelfareDaegu University

Table of contents

1. Purpose of the study

3. Research Methodology

4. Findings

2. Literature Review

5. Discussion

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 recom-

mendations

• 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 chil-dren, 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 document-ing trauma, school adjustment

• Acculturation issues• Indications for high mental health prob-

lems among NK youth

Background

2. Literature Review

• Predictive factors for mental health of general youth population– Gender– Intrapersonal characteristics such as self-esteem, op-

timism, 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 adjust-ment– 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 statisticsVariables Frequency(

%)Variables Mean(SD)

gender M 92 (46) Age 18.18(2.60)

F 104(54) Length of stay in the South 29.56(25.83)

residence ROC 39 (19.5) duration of migration 23.61(31.25)

Community 161(80.5) total yrs of ed. 96 (mo)

Family compo-sition

Both parents 52(26) Ed. In NK 60(mo)

Single parent 103(51.5) Ed. In SK 25.15(mo)

w/ relatives 20(10.0) Ed. in 3rd country 11.19(mo)

alone 17(5.0) Trauma events 2.54(0.18)

Subjective Health level

Poor 20(10.0) Resilience 34.42(6.37)

Average 93(46.5) Acculturation stress 20.31(8.64)

Good 87(43.5) PTSD 9.89(SD=9.25)

HSCL 14.90(11.37)

Severe(≥36) 4(2.0)

Clinical 7(3.5) severe to moderate(35~21) 22(11.0)

Non-clinical 193(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 depres-sion/anxiety

• 13% prevalence of PTSD

Findings

Trauma exposure

events Frequen(%)

1 Serious accident, fire, or explosion 49 (24.5)

2 Natural disaster: flood, landslide, earthquake, typhoon 56 (28.0)

3 Violence by family members, relative or acquaintance 59 (29.5)

4 Violence by strangers 35 (17.5)

5 Sexual assault by family, relatives or acquaintance 10 ( 5.0)

6 Sexual assault by strangers 9 ( 4.5)

7 Sexual relationship before 18 with one 5 years or more older 10 ( 5.0)

8 Incarceration(imprisonment, being taken hostage, abduction) 45 (22.5)

9 Being tortured 22 (11.0)

10 Having a life-threatening serious illness 55 (27.5)

11 Witnessing traumatic incident involving family members(death, arrest etc)

72 (36.0)

12 Hearing about traumatic incident involving family members 75 (37.5)

13 Other 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/acquain-tance

Findings

Clinical profile by gender

variables gender Mean SD t/F test

Trauma exposure M 3.18 2.85 3.48***F 1.96 2.08

Resilience levelM 35.02 6.92

1.35F 33.80 5.78

Acculturation stressM 19.53 9.07

-1.17F 20.97 8.27

PTSDM 9.85 9.24

-.130F 10.02 9.28

HSCLM 14.70 12.00

-2.73F 15.15 10.86

• Males report higher trauma exposure level

• No difference in clinical pro-files by gender

variables family Mean SD t test

Trauma exposure

Yes 2.40 2.47 1.66No 3.47 2.98

Resilience level

Yes 34.16 6.28 .811No 35.47 7.19

Accultura-tion stress

Yes 19.93 8.63 1.27No 22.76 9.69

PTSD Yes 9.38 8.74 2.46**No 15.00 11.31

HSCL Yes 14.39 10.96 2.55**no 21.76 15.09

Clinical profile by family presence

• Absence of family associ-ated w/

HSCL and PTSD levels

variables Trauma

level

Mean SD t/F test

Resilience level

High 34.67 6.28 -.489

low 34.22 6.45

Accultura-tion stress

High 20.79 7.81 -.690

low 19.93 9.22

PTSD High 7.71 8.51 -3.97***

low 12.78 9.43

HSCL High 16.96 11.58 -2.25*

low 13.34 10.99

Clinical profile by trauma level

• High trauma expo-sure associated with HSCL & PTSD

variables Subjective

health

Mean SD F test

Trauma ex-posure

Good a 2.00 2.18 5.22**a<c Average b 2.76 2.76

Poor c 3.85 3.29

Resilience level

Good 53.60 9.03 3.19*Average 50.60 10.19

poor 48.80 9.77

Accultura-tion stress

Good 30.81 14.63 8.92***a<cAverage 38.39 14.28

poor 42.65 14.07

PTSDGood 8.00 8.83 6.43**

a<cAverage 10.37 8.72

poor 15.85 10.92

HSCLGood 11.40 10.43 8.55***

a<cAverage 17.02 11.61

poor 20.25 9.98

Clinical profile by subjective health

• Subjective assessment of health as-sociated with all clinical profiles

variables HSCL-25 PTSDß SE β ß SE β

constant 28.58 10.22 14.25 8.32Gender .31 1.64 .01 .49 1.34 .03

Age -.08 .33 -.02 -.29 .27 -.08Subjective health -1.61 .97 -.12† -1.01 .79 -.09Family presence -6.37 2.91 -.15* -4.71 2.37 -.14*Trauma exposure .73 .35 .16* .94 .28 .26***

Resilience -.29 .13 -.16* .01 .11 .01Acculturation

stress.35 .10 .27*** .26 .08 .25***

Adjusted R² .213 .170

F 7.95*** 6.26***

n 200 200

Regression on HSCL and PTSD

Findings

• Acculturation stress is strongest predictor for depression/anxiety

• Demographic variables not significant pre-dictors

• Risk & protective factors significant predic-tors– 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 men-tal health

• Policies and programs to alleviate accul-turation stress

Q&A

THANK YOU