Association of Anxiety, Depression, and Somatization with Menstrual Problems among North Korean Women Defectors in South Korea

OBJECTIVE: North Korean women defectors have suffered from anxiety, depression, and somatization after defection. Also they have had many menstrual problems like amenorrhea. This study was done to identify the correlations of anxiety, depression, and somatization to menstrual problems among North Korean woman defectors in South Korea. METHODS: The participants in this study were 126 women from 5 government resettlement centers throughout South Korea. Questionnaires which included State-Trait Anxiety Inventory (STAI), Center for Epidemiological studies-Depression Scale (CED-S), and Symptom Checklist-90-Revised (SCL-90-R) were used to identify anxiety and somatization. Data were collected between June and September, 2012. RESULTS: The women reported the following problems; amenorrhea (9.5%), hypomenorrhea (13.6%), menorrhagia (19.8%), polymenorrhea (13.5%), oligomenorrhea (4.8%), changes in amount of menstrual discharge (4.0%), and changes in amount of blood clot (9.5%). Anxiety (r=0.20, p=0.002), depression (r=0.25, p=0.005), and Somatization (r=0.35, p<0.001) were correlated with number of menstrual problems. CONCLUSION: The results of this study indicate that mental health services need to be taken into account in interventions for North Korean woman defectors to improve their reproductive health including addressing menstrual problems.

Effect of Oral Health Education on Oral Health Knowledge, Oral Health Behavior and Oral Hygiene Status in Children from North Korea

PURPOSE: The purpose of this study was to investigate the effects of oral health education on oral health knowledge, oral health behavior, and oral hygiene status of children from North Korea. METHODS: Participants were 32 North Korean children defectors (15 in the education group, 17 in the control group). The oral health education program, including theoretical training and toothbrush training, was done once a week for 4 weeks. Effects of the education program were assessed for oral health knowledge, oral health behavior, and oral hygiene status at pretest, 0, and 4 weeks after the intervention. Data were analyzed using repeated measures ANCOVA with the SAS program. RESULTS: Children in the education group showed increased oral health knowledge and behavior over time compared to the control group and an improvement in oral hygiene status including significantly decreased S-PHP and Snyder test for oral micro-organism. CONCLUSION: Results indicate that oral health education is effective in improving oral health knowledge, oral health behavior and oral hygiene status. These improvements could lead to a better quality of life for North Korean children defectors.

Development and Effects of a Health Education Program for North Korean Preschool Defectors

PURPOSE: This study was conducted to develop a health education program for preschoolers who have defected from North Korea with their mothers, and to evaluate the effects on health knowledge and behavior. METHODS: A non-equivalent control group pre-post test design was used with 58 preschoolers who were assigned to either the experimental or control group (29 for each group). The program was composed of five sessions in health education and contracts. To test the effectiveness of the intervention, health knowledge and behaviors, and total bacterial colony counts on hands were measured at one pretest and two post tests (1 week and 4 weeks after the intervention ended). Data were analyzed using the SAS program. RESULTS: Health knowledge and behavior in the experimental group increased significantly compared to the control group. The effects of the intervention were evident even at 4 weeks after the intervention ended. Total bacterial colony counts in the experimental group decreased significantly at the 1 and 4 week posttest intervention compared to the control group. CONCLUSION: Results indicate that this program is effective in improving health knowledge and behavior in these children and therefore can be utilized to ensure efficient management their health care.

Relationship between Physical Illness and Depression in North Korean Defectors / 정신신체의학

OBJECTIVES: The present study aims to investigate the effects of physical illness on depression in North Korean Defectors. METHODS: One hundred forty-four North Korean Defectors(20 males, 124 females) and 376 South Koreans 133 males, 243 females) in Incheon Metropolitan areas participated the present study. Face-to-face interview was conducted for demographic information including presence of physical illnesses. To investigate depressive symptoms, all participants were required to complete the Center for Epidemiologic Studies-Depression scale (CES-D). RESULTS: After controlling gender, age, marital status, educational year, employment status and physical illness, North Korean Defectors showed higher CES-D score than South Koreans(beta=0.449, p<0.001). Within North Korean Defectors, the presence of physical illnesses independently was related to higher CES-D score(beta=0.243, p<0.001). However, within South Koreans, the presence of physical illnesses did not significantly predict CES-D score. North Korean Defectors with physical illness have higher CES-D score than North Korean Defectors without physical illness(26.8+/-13.8 versus 19.7+/-12.7). However, there was no significant differences of CES-D score between South Koreans with physical illness and South Koreans without physical illness(10.3+/-9.8 versus 9.3+/-8.8). CONCLUSION: Compared to South Koreans, North Korean Defector showed higher depressive symptoms independently from gender, age, education, employment, marriage. In addition, only North Korean Defectors showed the relationship between depression and physical illness. Our study suggests that depression should be assessed when North Korean Defectors have physical illness.

MDCT Findings of Biliary Ascariasis: a Case Report

Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. The migration of Ascaris lumbricoides into the biliary tree is an uncommon but well-known complication of intestinal ascariasis and often results in biliary colic. A case of acute common bile duct obstruction caused by a roundworm in a 37-year-old woman, a North Korean defector, is reported. Ultrasonography showed no specific abnormal findings except acute cholecystitis and an intrahepatic biliary stone. However, the MDCT clearly demonstrated a linear filling defect in the common bile duct that led to the correct diagnosis. Biliary ascariasis should be considered in the differential diagnosis of upper abdominal pain of patients in populations at risk.

Traumatic Experiences and Mental Health of North Korean Refugees in South Korea

OBJECTIVE: This study was conducted at Hanawon-a government sponsored educational facility for the settlement of North Korean refugees during their initial phase in South Korea-in 2004 to explore their mental health status and traumatic experiences in North Korea and during their escape period. METHODS: A survey was conducted in November 2004 with 62 North Korean refugees at Hanawon, and the Trauma Checklist was used to measure their traumatic experiences. To measure their psychological-mental health status, the Personality Assessment Inventory was administered. RESULTS: In comparison with the traumatic experiences of the North Korean refugees found in the study conducted in 2001 at Hanawon using the same methods, the current study showed a relatively lower frequency of traumatic experiences among the participants. The Personality Assessment Inventory results revealed that the study participants scored higher than average South Koreans in all clinical scales. Particularly, their mania (62.51) and schizophrenia (61.75) scores were above 60, a clinically meaningful score. In the gender comparison, the males exhibited meaningfully higher levels of alcohol problem, non-support, and warmth scale scores. CONCLUSION: Compared to the 2001 study, the overall traumatic experiences among North Korean refugees participated in this study. But continous support is necessary for their successful adaptation to South Korean Society have declined. The North Korean refugees at Hanawon experienced difficulties maintaining their mental health and the men in particular requested more intensive care and support for this purpose.

3-Year Follow up Study of the Way of Thinking and Satisfaction Level of North Korean Defectors in South Korea / 신경정신의학

OBJECTIVES: The aim of this study was to examine the change in attitudes and satisfaction level of North Korean defectors in South Korea over a 3 year period (2001-2004). METHODS: In our first study in 2001, a total of 200 defectors were interviewed. In the follow up study after 3 years, 151 defectors were re-interviewed by an in-person interview. RESULTS: The level of satisfaction to the governmental support policy to defectors decreased significantly. However, the general level of satisfaction increased slightly (from 3.52 to 3.56 ; 5-score scale). This shows that North Korean defectors are stably adapting to South Korean society. The level of satisfaction significantly correlated with the defectors' confusion of the different value systems, the defectors' understanding of the South Korean people, satisfaction with their physical and mental health, and the prejudice of South Korean people to defectors. In terms of the attitudes, the type of schooling, the military service and the communist party membership in North Korea were not related to the change in attitude. However, there was a significant correlation with gender and age. Women showed a greater change in attitude compared to men. Older people had difficulty in understanding the South Korean people, but they showed little psychological affiliation to North Korea. Moreover, they showed a high level of satisfaction with the economic situation in South Korea and had an optimistic viewpoint for their future than younger people. Even though many defectors attended churches, religion was not associated with the level of satisfaction or their change in attitude. CONCLUSION: The factors that influence the level of satisfaction and attitudes of North Korean defectors have changed over 3 years. Therefore, the government, nongovernmental organizations (NGOs) associated with defectors and the churches need to be more sensitive to these changes and make plans to support the adaptation of defectors to South Korean society.

The Way of Thinking and Satisfaction Level of North Korean Defectors in South Korea / 신경정신의학

OBJECTIVES: This study was performed to study the way of thinking and satisfaction level of North Korean defectors in South Korea on various topics and their relationship with each other. METHODS: Direct interview was performed for 553 North Korean defectors in South Korea. 44 items of life satisfaction were rated. Satisfaction level was rated on a 5 point scale (1-unsatisfactory and 5-fully satisfied). Factor analysis and correlation of the factors were performed. RESULTS: The average level of satisfaction was 3.39. Relatively high satisfaction items were adjustment of their children, family life, and residence area. But relatively low satisfaction items were psychological and mental area, leisure, and income. In governmental support systems, medical support was the most satisfactorily rated item, but financial support for settlement and support for employment or job training were the most dissatisfied. In the factor analysis, 44 items of satisfaction were grouped into 13 factors. The correlation of these factors showed that general satisfaction is significantly correlated with satisfaction with housing, economic status, governmental support and lower degree of confusion on the sense of value. Confusion on the sense of value was high when defectors do not have close friends, have difficulties in understanding South Korean people, and are not satisfied with their economic status. Religion did not have significant correlation with the their sense of value. And self and social consciousness of the defectors were strongly correlated with the their employment status. CONCLUSION: This result showed that the satisfaction of North Korean defectors is correlated not only with material aspects, but also psychological and mental aspects. The results of study should be considered in helping defector to adjust to living in South Korea.

Issues and problems of adaptation of North Korean defectors to South Korean society: an in-depth interview study with 32 defectors

The number of North Koreans defecting to South Korea is increasing rapidly. They are important people to South Korean society not only for humanitarian reasons, but also for their impact on the future Korean unification and the integration of the two different South and North Korean peoples. However, the defectors have experienced many difficulties in their adaptation to South Korean society due to their own characteristics and due to the misunderstandings of the South Korean people. To obtain comprehensive qualitative data about the characteristics and difficulties of North Korean defectors' adaptation to South Korean society, 58 semi-structured in-depth interviews were performed with 32 defectors who had entered South Korea from 1990 to 1997. Four categories of adaptation difficulties were encountered, which are related with the defectors' suspiciousness, different ways of thinking, searching for new sets of values, and with the prejudice of the South Korean people. Finally, three areas of suggestions for the more successful adaptation of the defectors to South Korean society were made; a need for more comprehensive perspectives on the defectors' adaptation, suggestions regarding educational programs and suggestions for educating the South Korean people.

HBsAg and anti-HBs prevalence in North Korean defectors

BACKGROUND: Hepatitis B is a worldwidely distributed disease. The hepatitis B prevalence of South East nations is reported to be higher than that of America or Europe. Korea is known to be one of high prevalent nation among Asia-Pacific nations. But hepatitis B prevalence in North Korea, separate from South Korea due to politics and ideology, is not reported. This study was performed using the data of North Korean defectors to estimate the prevalence of hepatitis B in North Korea. METHODS: We analyzed the data of 107 persons (98, mals, 9 females) who defected from North Korea and underwent screening exammination in a general hospital from July 1987 to March 1996. Twenty nine persons(25 males, 4 femals) were excluded because of incomplete data. The HBsAg test was carried out by reversed passive hemagglutination(RPHA) and the anti-HBs test was carried out by passive hemagglutination(PHA). The liver function tests were carried out by biochemical quantitative analysis method of Dimension. RESULTS: The study group were 73 males(93.6) and 5 females(6.4%). Mean age was 33.0+/-8.4 years and third decade was the largest as 35 persons(44.9%). The overall HBsAg positive rate was 15.4% and anti-HBs positive rate was 83.9%. Those who need vaccination was 51.4%. The only item amorg liver function tests which was statistically different by the hepatitis B viral marker groups was alkaline phosphatase. Mean total cholesterol was 176.4+/-38.0mg /dL. But no other item of liver function tests was statistically different in abnormal value by the hepatitis B viral marker groups. CONCLUSIONS: The overall HBsAg positive rate of North Korean defectors was much higher than that of South Korean and anti-HBs positive rate was much lower. So HBsAg positive rate of North Korean seems to be higher than that of South Korean. We think that a large study of hepatitis B for North Korean should be performed at every opportunity and take a measure to meet the situations.