Academic journal article European Journal of Psychotraumatology

Mental Health Status of North Korean Refugees in South Korea and Risk and Protective Factors: A 10-Year Review of the Literature

Academic journal article European Journal of Psychotraumatology

Mental Health Status of North Korean Refugees in South Korea and Risk and Protective Factors: A 10-Year Review of the Literature

Article excerpt

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1.Introduction

The number of North Korean refugees (NKRs) who have settled in South Korea exceeded 30,000 in 2016 (Ministry of Unification, 2017). The population consists of individuals across a wide age range, particularly young and middle-aged adults, with an approximate women's ratio of 0.8. According to the census data, the most frequent drives for their defection include food shortage, economic difficulty, and political repression or threat in North Korea, and family accompaniment in South Korea (Korea Hana Foundation, 2017). In most cases, NKRs take an escape route through a third country to reach South Korea, mainly Southeast Asian countries or China (Haggard & Marcus, 2006), and about 70% of NKRs reported to have stayed in the third country, half of whom stayed more than five years (Korea Hana Foundation, 2017).

Similar to other refugee populations (Fazel, Wheeler, & Danesh, 2005; Hollifield, Warner, & Lian et al., 2002), NKRs are often exposed to traumatic events while in North Korea and during their escape (Jeon, Yu, Cho, & Eom, 2008). Even after a successful escape, they tend to experience difficulties in adapting to the unfamiliar culture of the country in which they settle (Jeon, Min, Lee, & Lee, 1997). For instance, a quarter of NKRs who settled in South Korea reported experiencing discrimination, mostly due to cultural differences in language use, lifestyle, and attitudes (Korea Hana Foundation, 2017). Therefore, NKRs might be a mentally vulnerable group. Although an increasing number of studies have examined the mental health of NKRs, to our knowledge, there have been no systematic reviews integrating the existing knowledge of this topic. Thus, in an effort to produce such an integrative understanding, we reviewed prior studies on the mental health status of NKRs and the associated risk and protective factors. We could not conduct a meta-analysis because of the methodological and clinical heterogeneity of the studies. Thus, we instead systematically searched the studies using particular selection criteria, summarized the prevalence of psychiatric symptoms among NKRs, and identified consistent risk and protective factors. This study first categorized a wide array of risk and protective factors into environmental and personal factors, and further divided the environmental factors according to the different phases of the refugee experience into pre- and post-settlement factors, as has been done in other review studies of refugee populations (Lustig et al., 2004; Porter & Haslam, 2005).

2.Methods

2.7. Inclusion and exclusion criteria

We included quantitative studies using new empirical data on the mental health of NKRs in South Korea. We selected studies published in the last 10 years, with a minimum sample size of 25. As such, qualitative studies, reviews, and unpublished findings were excluded from our review. Furthermore, we excluded studies on physical health, efficacy of intervention, general adaptation, and the development and validation of psychological assessments. We searched only for studies written in English or Korean.

2.2.Search strategy

We searched for empirical studies conducted in the last 10 years in six online databases (international journals: Embase, PubMed, Scopus, Web of Science; Korean journals: DBpia, KMbase) that are published up to June 2017. As search terms, we used the combinations of keywords relating to mental health (psychiatr·, psycholog·, mental, anxiety, depression, trauma, traumatic, psychosocial, wellbeing, recovery, resilience, adjustment, adaptation, emotion, and behavior) and North Korean refugees (North Korean defector and North Korean refugee) in each database language. The search strategy was adjusted for each database. With these search terms, 513 studies were initially identified. After excluding duplicate or irrelevant studies by reviewing titles and abstracts, a total of 56 studies were ultimately included (Figure 1). …

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