Perceived social stigma, self‐concealment, and suicide risk among North Korean refugee women exposed to traumatic events

Abstract

Introduction: Suicide among North Korean (NK) refugee women is one of the most concerning public health problems in South Korea. Pre-resettlement trauma exposure and post-resettlement factors can contribute to suicide risk among NK refugee women; however, few studies have explored these associations.Methods: This study aimed to assess suicidal ideation and suicide attempts among NK refugee women in South Korea (N = 212) and to examine the impact of pre-resettlement trauma exposure on suicide risk. Perceived social stigma and self-concealment in the post-resettlement phases were investigated as moderating factors for suicide risk related to trauma exposure using multiple regression analyses. Results:Trauma exposure significantly increased suicidal ideation severity and the risk of suicide attempt. Furthermore, perceived social stigma significantly moderated this relationship such that the impact of trauma exposure in the preresettlement phases was amplified as perceived social stigma increased. Conclusion:Based on our study findings, professionals working with refugee populations should assess for perceived social stigma and exposure to traumatic events to reduce and prevent suicidal ideation and attempts.

Depression, Alcohol Misuse, and Suicide Attempt Among North Korean Refugee Women Exposed to Gender-Based Violence

“…Although depression and alcohol misuse are considered as key factors for suicide risk, the presence of depression or alcohol misuse alone is not considered a factor that leads to suicide attempts (Gonzalez & Hewell, 2012;Langhinrichsen-Rohling et al, 2011;Nam et al, 2021). The ideation-toaction framework in suicide suggests that certain factors differentiate suicide attempts from ideation (Klonsky & May, 2015), and the IPTS (Joiner, 2005) emphasizes the co-existence of multiple risk factors in suicide attempts.…”

“…Approximately 1,500 NK refugees have arrived in SK every year since 2006, of which 80% are women (Korea Hana Foundation, 2019). Crossing the border into China and surviving in intermediate countries such as China, Mongolia, and Vietnam are among the most common escape strategies of NK citizens (Korea Hana Foundation, 2019;Nam et al, 2021). These refugees stay in the intermediate countries for 2 to 5 years on average and often encounter life-threatening events until they enter SK (H. Kim et al, 2011).…”

“…These refugees stay in the intermediate countries for 2 to 5 years on average and often encounter life-threatening events until they enter SK (H. Kim et al, 2011). Surviving in intermediate countries is often more challenging for women than for men (Jung & Choi, 2017;Nam et al, 2021).…”

“…Suicide is a serious public health concern in South Korea (SK), and suicide rates in the country remain the highest among developed countries for the last several years (OECD, 2021). In particular, North Korean (NK) refugee women living in SK are among the most vulnerable groups to attempt suicide (Nam et al, 2021). A recent survey revealed that 13.0% of NK refugees in SK had suicidal ideation during the past 12 months (Korean Hana Foundation, 2021).…”

Trauma and mental health among North Korean refugees living in South Korea: The role of acculturative stress

“…Recruiting from the NK refugee population can be difficult given NK refugees’ tendency not to disclose their identity in South Korean society (Nam et al., 2021). NK refugees hide in part to protect their families left behind in North Korea, who live with political stigma.…”