Assessing Mental Illness Risk Among North Korean Refugees and Immigrants Resettled in South Korea

Abstract

ImportanceThe global increase in the numbers of refugees and immigrants has made mental health a major public concern. Although they are divided, North and South Korea share a common ethnic heritage.ObjectiveTo investigate mental illness risk among North Korean immigrants living in South Korea and compare it with that of the general South Korean population.Design, Setting, and ParticipantsThis retrospective, population-based cohort study was based on National Health Insurance claims data from 2007 to 2019, and North Korean immigrants and refugees (NKIRs) and age-matched and sex-matched members of the general population (GP) were included with a 1:3 ratio. Data were analyzed from March 2022 to August 2022.ExposureEmigration from North Korea to South Korea.Main Outcomes and MeasuresMental illness incidence and risk through a Cox proportional risk model adjusted for sex, age, disability, region, Charlson Comorbidity Index score, and insurance premium percentile.ResultsA total of 37 209 NKIRs and 111 627 members of the GP were enrolled. The final analysis examined 112 851 individuals (73 238 [64.9%] female, median [IQR] age 34 [19-47] years), with 90 235 (80.0%) in the GP and 22 616 (20.0%) in the NKIR group. The propensity score–matching population numbered 24 532 in total, with 12 266 each in the NKIR and GP groups. NKIR patients had a higher mental illness risk than the GP (hazard ratio [HR], 2.12; 95% CI, 2.04-2.21). The multivariable adjusted HRs (95% CI) for developing mental disorders were 4.91 (3.59-6.71) for posttraumatic stress disorder, 3.10 (2.90-3.30) for major depressive disorder, 2.27 (2.11-2.44) for anxiety and panic disorder, 2.03 (1.58-2.60) for bipolar affective disorder, 1.85 (1.53-2.24) for alcohol use disorder, and 1.89 (1.46-2.45) for schizophrenia.Conclusions and RelevanceIn this study, NKIR individuals showed a significantly higher risk of developing most mental disorders. Interventional strategies can prevent psychiatric morbidity and ensure adequate care for this population.

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North Korean defectors with PTSD and complex PTSD show alterations in default mode network resting-state functional connectivity

“… 4 A recent large-scale analysis that assessed over 22 000 NKDs with propensity score matching against 90 000 people in South Korea indicated that NKDs have higher risk of developing mental disorders than South Koreans, with a hazard ratio of 2.12. 5 Unsurprisingly, PTSD had the highest hazard ratio of 3.10, suggesting harmful effects of the traumatic experiences of displaced individuals, as emphasised in previous studies. 6 , 7 Difficulties in adapting to a new environment can be worsened by symptoms of PTSD in refugees.…”

“…Although they still have the same ethnicity and language, differences in culture, ideology, government regulations and socioeconomic status have grown significantly, making it difficult for NKDs to adapt and settle in South Korea 4 . A recent large-scale analysis that assessed over 22 000 NKDs with propensity score matching against 90 000 people in South Korea indicated that NKDs have higher risk of developing mental disorders than South Koreans, with a hazard ratio of 2.12 5 . Unsurprisingly, PTSD had the highest hazard ratio of 3.10, suggesting harmful effects of the traumatic experiences of displaced individuals, as emphasised in previous studies 6 , 7 .…”