Prevalence and Correlates of Suicidal Thoughts and Behaviors among North Korean Defectors

OBJECTIVE: Despite the increasing number of North Korean defectors, research on their mental health conditions and suicidal thoughts and behaviors has not been conducted systematically. We examined the prevalence and risk factors of suicidal thoughts and behaviors in North Korean defectors. METHODS: This study focused on 300 North Korean defectors recruited from regional resettlement centers in South Korea. In-person interviews based on the North Korean version of the Composite International Diagnostic Interview were conducted to diagnose mental disorders and assess suicidal thoughts and behaviors. Logistic regression analyses were performed to evaluate the association between suicidal thoughts and behaviors and socio-demographic variables, and DSM-IV mental disorders. RESULTS: Lifetime prevalence of suicidal ideation, plans, and attempts were 28.3, 13.3, and 17.3%, respectively. Female sex (OR: 2.0, 95% CI: 1.0–3.9), presence of health problems in the past year (2.6, 95% CI: 1.4–4.6), and absence of both South Korean acquaintances (1.9, 95% CI: 1.0–3.4) and North Korean family (1.7, 95% CI: 1.0–2.9) were associated with higher odds of suicidal thoughts and behaviors, after adjusting for participant age, sex, and education. Presence of a mental disorder was associated with a significantly increased odd of suicide ideation, plan, and attempt. Of all mental disorder categories, agoraphobia had the strongest association with suicidal ideation (6.5, 95% CI: 2.0–21.6), plans (7.7, 95% CI: 2.5–23.2) and attempts (12.0, 95% CI: 3.5–40.8). CONCLUSION: Suicidal thoughts and behaviors among North Korean defectors are higher than the general population in South Korea, especially show high rates in transit countries. Further study should focus on the changes in suicidal thoughts and behaviors according to the settlement process and early prevention.

Somatic Symptoms as Mediating Factors between the Perceived Social Support and the Health-Related Quality of Life in North Korean Defectors

OBJECTIVE: This study was conducted to examine the mediating effect of somatic symptoms between perceived social support and health-related quality of life among North Korean defectors living in South Korea. METHODS: A total of 200 North Korean defectors were assessed using the Multidimensional Scale of Perceived Social Support, the Short-Form 8-Item Health Survey, the Patient Health Questionnaire 15, the PTSD Checklist Civilian Version and the Patient Health Questionnaire 9. RESULTS: Somatic symptoms accounted for physical health-related quality of life after controlling for PTSD and depressive symptoms, but did not for mental health-related quality of life. Moreover, somatic symptoms mediated the relationship between perceived social support and physical and mental health-related quality of life, indicating that perceived social support indirectly affects physical and mental health-related quality of life through somatic symptoms in North Korean defectors. CONCLUSION: The results of this study suggest that not only intervention for PTSD or depressive symptoms but also for somatic symptoms might be effective to improve physical and mental health-related quality of life for North Korean defectors, especially those who have a lack of perceived social support.

Relationship between Perceived Stigma for Psychological Helps and Depression in North Korean Defectors / 신경정신의학

OBJECTIVES: This study was implemented for North Korean defectors to understand the relationship between perceived stigma for psychological helps and depression. METHODS: Two hundred defectors from North Korea were subjects in this study, including 28 males and 172 females. Both self-questionnaires and interviews were conducted. Patient Health Questionnaires-9 (PHQ-9) was used to measure depression scores. Stigma Scale for Receiving Psychological Help (SSRPH) for stigma and Multidimensional Scale of Perceived Social Support (MSPSS) were used to determine social supportive levels that they recognize. RESULTS: In the initial analysis, SSRPH was associated with PHQ-9. Multiple regression analysis to identify the relationship of stigma for subjects' psychological helps on depression showed that staying longer than five years in the third country, working, high MSPSS score, and low SSRPH were negatively associated with the PHQ-9. CONCLUSION: The stigma among North Korean defectors for psychological help is positively associated with depression. Perceived stigma may act as a barrier to the initiation and maintenance of psychiatric treatment who subjects in need of psychological help. Understanding the relationship between perceived stigma for psychological help and depression is important.

Smoking habits and nicotine dependence of North Korean male defectors

BACKGROUND/AIMS: The smoking rates and patterns in the North Korean population are not well known. More than 20,000 North Korean defectors have settled in South Korea; thus, we can estimate the current North Korean smoking situation using this group. METHODS: All North Korean defectors spend their first 3 months in a South Korean facility learning to adapt to their new home. We retrospectively analyzed the results from a questionnaire conducted among North Korean male defectors in this facility from August 2012 to February 2014. RESULTS: Of 272 men, 84.2% were current smokers, 12.5% were ex-smokers, and 3.3% were non-smokers. The mean age of this group was 35.9 ± 11.3 years, and smoking initiation occurred at a mean age of 18.2 ± 4.7 years. Among the subjects, 78.1% had a family member who smoked. Of the 221 current smokers, 67.4% responded that they intended to quit smoking. Fagerström test and Kano test for social nicotine dependence (KTSND) results for current smokers were 3.35 ± 2.26 and 13.76 ± 4.87, respectively. Question 9 on the KTSND (doctors exaggerate the ill effects of smoking) earned a significantly higher score relative to the other questions and a significantly higher score in current smokers compared with non-smokers. CONCLUSIONS: The smoking rate in North Korean male defectors was higher than that indicated previously. However, interest in smoking cessation was high and nicotine dependence was less severe than expected. Further investigation is needed to identify an efficient method for North Korean smokers to stop smoking.

Clinical Characteristics of Defectors from North Korea Visiting a Single Tertiary Hospital in South Korea / 대한내과학회지

BACKGROUND/AIMS: There are increasing numbers of North Korean defectors, and their health status differs from that of the South Korean population. This study was performed to investigate the clinical characteristics of North Korean defectors visiting a single tertiary hospital in South Korea. METHODS: The medical records of North Korean defectors who visited Dankook University Hospital, Cheonan, South Korea from 1 February 2006 to 30 April 2014 were retrospectively reviewed. Their comorbidities, main reasons for the visit, and most common diseases were investigated. RESULTS: A total of 169 North Korean defectors (163 females, 6 males) visited our hospital. Sixty-eight patients (40.24%) had comorbidities, the most common of which was tuberculosis (13.60%), followed by chronic hepatitis B (10.06%) and chronic hepatitis C (9.47%). North Korean refugees visited the department of ophthalmology (15.71%) most frequently, followed by gastroenterology (15.18%). Cataracts, chronic hepatitis C, chronic hepatitis B, and pulmonary tuberculosis were the most common reasons for the hospital visit. Chronic hepatitis B and chronic hepatitis C were diagnosed in 19.32% and 17.58% of the patients, respectively. Sixteen patients (9.47%) were diagnosed with tuberculosis, and eight of these patients showed multidrug resistance. Of all 169 patients, 17 underwent colonofibroscopy or stool examination, and parasites (Trichuris trichiura, n = 6; Clonorchis sinensis, n = 1) were found in 7 patients (41.18%). CONCLUSIONS: Most North Korean defectors who visited this tertiary hospital in South Korea were female, and they mainly visited the departments of ophthalmology, gastroenterology, and pulmonology. Compared with South Koreans, they showed high rates of chronic hepatitis B, chronic hepatitis C, pulmonary tuberculosis with multidrug resistance, and parasite infection.

Stigma of Mental Illnesses as Perceived by North Korean Defectors Living in South Korea

OBJECTIVE: This study aims to provide the information of the stigmas of mental illness such as psychosis, alcoholism, attempt suicide, and depression among North Korean defectors. METHODS: We examined stigma for the mental illnesses of 639 North Korean defectors aged 19 to 65 years who live in the Settlement Support Center for North Korean Refugees. The stigmas of mental illnesses were assessed using the Perceived Devaluation-Discrimination Scale We directly compared the stigma level between North Korean defectors and the general population of South Korea. RESULTS: North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Perceived stigma associated with attempted suicide was similar for North Korean defectors and South Koreans. Only marital status in sociodemographic variables had associations with higher perceived stigma of psychosis, alcoholism, and depression in the North Korean defectors. North Korean defectors, who spent more than one year in transit country, had associations with lower perceived stigma of psychosis and alcoholism. North Korean defectors, who had the experience of compulsory repatriation to North Korea or North Korean family in South Korea, had an association with higher perceived stigma of depression. CONCLUSION: North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Further studies are needed to document serial changes in stigmas for mental illnesses associated with the receipt of education at the Settlement Support Center for North Korean defectors.

A Study on Reliability and Validity of the Impact of Event Scale-Revised-North Korea (IES-R-NK) / 신경정신의학

OBJECTIVES: This study was conducted to translate the Impact of Event Scale-Revised (IES-R) into North Korean language and confirm its reliability and validity. METHODS: A total of 207 North Korean defectors recruited from the Call Center for North Korean Defectors participated in this study. Psychiatrists and psychiatric residents interviewed the participants individually and made psychiatric diagnosis. Subsequently, they completed the Brief Psychological State Inventory for North Korean Refugees (BPSI-NKR), the Center for Epidemiologic Studies Depression Scale-North Korea (CES-D-NK), and the Alcohol Use Disorders Identification Test-North Korea (AUDIT-NK) as well as the Impact of Event Scale-Revised-North Korea (IES-R-NK). Of the original participants, 143 subjects participated in test-retest reliability study after one week. RESULTS: The internal consistency using Cronbach's alpha was superior in both male and female from North Korea. In addition, the temporal stability was also satisfactory. A good convergent validity was clearly shown by significant correlations with BPSI-PTSD and CES-D-NK, respectively. On the other hand, IES-R-NK had no or weak correlations with AUDIT-NK and BPSI-NKR-alcohol, demonstrating its satisfactory discriminant validity. CONCLUSION: IES-R-NK might be considered as a short and valid screening tool for identification of PTSD symptoms in North Korean defectors.

Predictors of PTSD among North Korean Defectors Visited Psychiatric Department of North Korean Defectors Treatment Center / 신경정신의학

OBJECTIVES: This study was conducted to evaluate post-traumatic stress disorder (PTSD), the quality of life and social adjustment of North Korean refugees who consulted psychiatric clinics. METHODS: A total of 66 North Korean refugees who consulted a psychiatric clinic were included in the analysis. A psychiatrist conducted interviews with the subjects, and PTSD was diagnosed using the clinician-administered PTSD Scale. The quality of life of the subjects was evaluated using the World Health Organization Quality of Life Scale. RESULTS: Thirty five (53%) were diagnosed with PTSD. Quality of life was found to show association with understanding the language in South Korea, difficulty interacting with South Koreans, and experience or feeling of neglect. Quality of life of the PTSD group was lower than in the Non-PTSD group. Difficulty adapting to South Korean society was also higher in the PTSD group. Experience or feeling of neglect was negatively correlated with the quality of life in the PTSD group. CONCLUSION: The results of this study may be helpful in providing a specific direction for psychiatric intervention strategies to improve overall quality of life and adaptation to life in South Korea.

Reliability and Validity of the Korean Version of the PTSD Checklist Civilian Version in North Korean Defectors / 신경정신의학

OBJECTIVES: This study was conducted for development of the Korean version of the Posttraumatic stress disorder (PTSD) Checklist civilian version (PCL-C) by evaluating its reliability and validity for the North Korean defectors population. METHODS: A total of 69 North Korean defectors participated in this study. All patients were recruited from the psychiatric outpatient or inpatient ward. We categorized the participants into two groups according to the Clinician-Administered PTSD Scale (CAPS) diagnosis of PTSD (PTSD, n=32 ; Non-PTSD, n=37). All Subjects completed psychometric assessments, including the PCL-C, Minnesota Multiphasic Personality Inventory (MMPI-PTSD), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). RESULTS: Findings provided support for psychometric properties of the Korean version of the PCL-C. The PCL-C showed good internal consistency (Cronbach alpha=0.93), and a significantly positive correlation with CAPS and MMPI-PTSD (r=0.47, r=0.61, respectively). The optimal cutoff point of PCL-C for the North Korean defectors was at a total score of 56 with sensitivity and specificity of 0.88, and 0.50, respectively. CONCLUSION: Overall, the Korean version of the PCL-C appears to be a valid and reliable measure of PTSD symptoms among the North Korean defectors.

Children's Mental Health in Multicultural Family and North Korean Defectors in South Korea

South Korea is changing into a multi-cultural society, due to an increase in international marriage, foreign workers and transcultural immigration. In addition, the number of North Korean defectors entering South Korea has increased and now, there are approximately 25000. Therefore, this review have focused on a research that pertains to adaptation and mental health concerns of their children. Children who have immigrated themselves or whose parents have immigrated, might experience language barriers, difficulties in school adjustment, identity confusion and mental health problems. However, their academic performance and developmental status are known to be variable and be affected by socioeconomic status and their parents' educational level. Studies that evaluated the psychological problems of North Korean adolescent refugees' indicated the need for interests in both emotional and behavioral problems. The risk factors of North Korean adolescent refugees' mental health are suggested to be past traumatic experiences, long duration of defection and short period of adaptation. When mental health professionals provide assessment and treatment, they should consider the pre- and post-migration experiences & cultural background that affect the illness behaviors and attitudes toward mental illnesses. Lastly, the majority of children with multi-cultural background are still under an adolescent period and we should follow up with long-term perspectives.

Psychiatric Disorders of North Korean Defectors in South Korea : Four Case Report / 신경정신의학

OBJECTIVES: Cases of psychiatric disorders are reported with a review of literature on mental health problems in North Korean defectors in South Korea. METHODS: Four patients who were admitted to a psychiatric hospital with major depression, schizophrenia, bipolar affective disorder, or mixed disorder of conduct and emotions of adolescent were studied. RESULTS: The most common precipitating factor was the separation from close persons they had been dependent on. Defector-specific stress included unfamiliar culture of South Korea, lack of ability to adapt to South Korean society, uselessness of past education and professional skills, stress with regard to being identified or discriminated as a North Korean defector, and guilt feeling for leaving their family behind in North Korea. North Korean defector-specific clinical findings were noted; these included reluctance to expose themselves as North Koreans, negative emotional reaction to discrimination of South Korean neighbors, submissive and passive attitude, loneliness, anxiety for the future related to refugee status, and strong stigma related to psychiatry. CONCLUSION: This case report suggests that an individualized or tailored treatment that considers their unique psychosocial situation, which especially focuses on discrimination and social support, is needed for North Korean defectors with mental disorders.

Post-Traumatic Stress Disorder, Depression, and Heart-Rate Variability among North Korean Defectors

OBJECTIVE: This study evaluated the symptoms of post-traumatic stress disorder (PTSD) among North Korean defectors and their level of suicidal ideation and the correlation between these and heart-rate variability (HRV) to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder. METHODS: A total of 32 North Korean defectors (nine men, 23 women) were selected as subjects, and their HRV was measured after they completed the Minnesota Multiphasic Personality Inventory-PTSD (MMPI-PTSD) scale and the Beck Depression Inventory (BDI). RESULTS: 1) Low-frequency (LF)/high-frequency (HF) ratios in the HRV index and MMPI-PTSD scores were correlated (r=0.419, p<0.05), as were BDI item 9 (suicidal ideation) and MMPI-PTSD scores (r=0.600, p<0.01). 2) A regression analysis of LF/HF ratios and MMPI-PTSD scores revealed an R-value of 13.8% (Adj. R2=0.138, F=4.695, p=0.041), and a regression analysis of BDI item 9 and MMPI-PTSD scores showed an R-value of 32.8% (Adj. R2=0.328, F=11.234, p=0.003). In other words, the LF/HF ratio (beta=0.419) and BDI item 9 (beta=0.600) appear to be risk factors in predicting MMPI-PTSD scores. CONCLUSION: The LF/HF ratio, a standard index of autonomic nervous system activity, can be used as an objective neurobiological index to analyze PTSD among North Korean defectors presenting with various mental and physical symptoms, and the approximate level of suicide -ideation can act as a predicting factor for PTSD.

Prevalence and Correlates of Psychiatric Symptoms in North Korean Defectors

OBJECTIVE: The aim of the present study is to assess the prevalence of psychiatric symptoms and associated factors in North Korean Defectors (NKDs). METHODS: One hundred forty-four NKDs (male: 20; female: 124; average age: 40.4+/-11.7 yrs.) completed the Symptom Checklist-90-Revised (SCL-90-R) and the Center for Epidemiologic Studies Depression scale (CES-D). A stepwise logistic regression analysis was conducted to evaluate factors associated with the psychiatric symptoms of the participants. RESULTS: NKDs mainly reported somatization (42.4%) and depressive symptoms (38.9%). Female NKDs showed higher prevalence of somatization (p=0.001), anxiety (p=0.020), hostility (p=0.026) and psychoticism (p=0.022) than males. The presence of physical illness was strongly related to most psychiatric symptoms on the SCL-90-R including somatization (p<0.001), obsessive-compulsive symptoms (p=0.020), interpersonal sensitivity (p=0.031), depression (p<0.001), anxiety (p<0.001), hostility (p=0.011), paranoid ideation (p=0.015) and psychoticism (p<0.001). Younger age, unemployment, lower income, and longer duration of defection were found to be the risk factors of psychiatric symptoms. In regard to mental health service utilization, we found that most (83.3%) of the participants had not received any form of psychiatric help. CONCLUSION: Somatization and depression were the most prevalent psychiatric symptoms in NKDs. Our results suggest that psychiatric symptoms accompany certain sociodemographic and clinical characteristics that are associated with susceptibility to acculturation stressors. An understanding of these factors will be helpful providing appropriate mental health services to NKDs.

A Seven-Year Panel Study on North Korean Defectors Perception and Satisfaction on Life in South Korea / 신경정신의학

OBJECTIVES: North Korean defectors' comprehension of South Korean society and satisfaction with their lives in South Korea both symbolize their adaptation to their new society. The current report is an analysis of three serial panel studies of 200 North Korean defectors who entered South Korea in 2000. METHODS: From February 2009 to March 2009, we interviewed 121 defectors face-to-face. RESULTS: The results showed that the participant's satisfaction level had been relatively well-maintained, and their understanding of the South Korean culture and language had increased. However, their attitudes toward fellow North Korean defectors had worsened. Their satisfaction level with government support for medical care was very low. Gender, age, level of education in North Korea, Communist Party membership, completion of military service, and current employment status had significant influences on their interpretation and understanding of South Korea. CONCLUSION: The results suggest creating North Korean defector self-help groups, strengthening the medical support system, developing programs tailored according to defectors' different backgrounds, gender, age, and educational levels, as well as increasing South Koreans' awareness of these North Koreans through a appropriate campaign, will be necessary for the peaceful unification of the Korean Peninsula.

Quality of Life of North Korean Defectors in South Korea : Three Years Follow-Up Study / 신경정신의학

OBJECTIVES: This study evaluated the quality of life (QoL) of North Korean defectors in South Korean society in the year 2007 for purposes of comparing it to their QoL in 2004 and identifying demographic variables that influence QoL. METHODS: We used the Korean version of WHOQoL-BREF to evaluate the QoL of 106 North Korean defectors. Other instruments included a questionnaire for discerning demographic data, life experiences, and physical health. RESULTS: For last 3 years, more defectors had higher education, married, and higher income. However, their unemployment numbers did not decrease, while their number of believers in a religion did decrease. QoL scores remained low in the areas of negative feelings, financial resources, dependence on treatment and drugs, recreation and leisure activities, and opportunities for new information and skills, but were high in areas of cognitive mental functions, personal beliefs, work capacity, self-esteem, and transportation. Path analysis suggested that the psychological domain influenced overall QoL while other domains influenced overall QoL indirectly, through the psychological domain. Since 2004, defectors' QoL in the physical domain and in opportunities for education and transportation had improved, while QoL with regard to pain and discomfort, mobility, and negative feelings had worsened. Variables that were negatively correlated with QoL included male sex, higher age, being married, experiencing army service in North Korea, and shorter stays in third countries. In South Korea, QoL was negatively correlated with current physical illness but positively correlated to having a family, a stable job, higher income, and someone to talk with. CONCLUSION: These results suggest that defectors' QoL would be improved by tailored services according to their sex and age, focusing on educational programs to provide new information and skills, support for building families, health services, and community support.

Primary Health Care for Vulnerable Population / 가정의학회지

Although vulnerable population such as cancer survivors, terminal patients, caregivers and immigrants have greater health needs, they don't receive enough health care services in our health care system. Continuous advances in cancer treatment have led to a marked improvement in cure rates and thus, an increased population of long-term cancer survivors. Due to both original and treatment-related risk factors, survivors are at increased risk for second primary cancers. In addition, pre-diagnosis smoking, alcohol, obesity and insulin resistance, which are well-known risk factors for cancer development, also appear to affect cancer outcome. To improve the health promotion of cancer survivors, developing shared care model between oncologist and primary care physician is needed. Chronic disease has not only a great effect on the affected patients but also on their caregivers. Caregiving burden was associated with impaired physical function and increased emotional distress. Caregiving burden also increase the risk of cardiovascular disease incidence among caregivers. More attention should be focused on these caregivers to improve their health. Recently, as increasing social needs to develop the health care system for terminal patients, Korean Government began to support palliative care units with implementing the National Cancer Control Program for Terminal Cancer Care. With these social movements, the needs for human resources in the area of palliative care are continuosly increasing, and active participation of primary care physician is needed. Due to rapid changes of population structure in South Korea, the number of multi-cultures family has continuously increased. Especially, more than 15,000 North Korean defectors settled in South Korea in 2008. North Korean defectors are more likely to have unhealthy behaviors, poor quality of life and comorbidities, while they have poor primary care accessibility.

Prevalence and Correlates of Depressive Symptoms among North Korean Defectors Living in South Korea for More than One Year

OBJECTIVE: This study examined the prevalence and correlates of depressive symptoms in North Korean defectors who have been living in South Korea for more than one year. METHODS: We used questionnaires developed by the authors to collect sociodemographic data in addition to the Center for Epidemiologic Studies Depression Scale (CES-D), the Psychosocial Well-being Index to measure stress, and a social support scale. A total of 367 subjects were included in this study. RESULTS: The results showed that 30.5% of the men and 34.7% of the women reported depressive symptoms, and 33.1% of the men and 36.1% of the women exhibited signs of severe distress. Correlates of depressive symptoms were lack of occupation [odds ratio (OR)=2.198, 95% confidence interval (CI), 1.247-3.873], having escaped without family (OR=1.725, 95% CI, 1.006-2.959), and a poor subjective sense of health status (OR=3.111, 95% CI, 1.591-6.085). CONCLUSION: Continuing vocational training and career management, psychological support programs, and intensive physical health services are needed to improve the mental health of this population.

Divided Countries, Divided Mind 1: Psycho-Social Issues in Adaptation Problems of North Korean Defectors

A review of studies on the adaptation problems of North Korean defectors in South Korean society and studies of people's adaptation to political and cultural changes in other countries suggests that similar adaptation problems may occur in the process of and after unification. Defectors have various adaptation problems and some of them have psychiatric disorders such as depression and post-traumatic stress disorder (PTSD). The reasons for this were revealed to be the difference in the culture and personality between South and North Korea, which have developed for the last 60 years without any communication with each other, in spite of their common racial and cultural heritage. Economic factors including the lack of skills and knowledge for working at industrialized and competitive society like South Korean society, also aggravate the severity of such adaptation problems. Research on defectors' adaptation problems and on the differences in the culture and mentality between North and South Korea can provide useful information on what kinds of problems may arise during the process of and after unification and what should be done to achieve mutual adaptation and harmonious and peaceful unification.

Natural Killer Cell Activity in North Korean Defectors with PTSD / 신경정신의학

OBJECTIVES: The objective of this study was to evaluate an association between posttraumatic stress disorder (PTSD) and altered immunity in North Korean defectors who were more likely to develop medical conditions and other stress-related psychiatric disorders. METHODS: Twenty-four North Korean defectors with PTSD and twenty-two controls without PTSD were recruited from the resettlement and training center for North Korean defectors in South Korea. Peripheral T lymphocyte subsets, natural killer (NK) cells, NK cell activity and plasma hormones (ACTH and cortisol) were obtained from all subjects. We also applied the Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) for all subjects. RESULTS: We found NK cell activity was relatively lower than number of NK cells in North Korean defectors with PTSD. Subjects with PTSD had higher HAM-D and HAM-A scores than controls. However, there were no statistical differences in ACTH, cortisol, CD3, CD4, CD8, CD4/CD8 ratio, CD19 and CD56 between the two groups. CONCLUSION: These findings suggest North Korean defectors with PTSD show higher levels of depression, anxiety and impaired or weak immune function in NK cells.

The Symptom Expression and the Illness Behavior of North Korean Defectors: Toward an Effective Therapeutic Relationships

BACKGROUND: The North Korean defectors are suffering from multiple psychologic and physical health problems. However, because of their emotional maladaptation, noncooperation and suspiciousness and distrust toward others, it is difficult for South Korean doctors to build effective therapeutic relationships with them. Therefore, we made efforts to clarify the characteristics of North Korean defectors in symptom expressions and illness behaviors which would help South Korean doctors to gain rapport. METHODS: We performed qualitative study with focus group interview. Three focus groups were composed of 14 North Korean defectors and group interviews were performed twice for each group. The contents of each interview were analyzed and conclusions were drawn by extracting and arranging significant findings. RESULTS: The North Korean defectors showed psychologic symptoms such as anxiety, depression and various somatic symptoms. Among them, 'Laeng-Dol ('cold mass) and 'Jeog' mean subjective mass-feeling, such as globus sensation. And 'Tag-Gi-Byeong ('chicken heart disease')' means recurrent chest pain. These expressions reflect their anxious, depressive, and somatizing tendency. Among illness concept, 'Laeng-Byeong' ('cold related disease') means that they consider the cold weather to be the cause of various somatic symptoms. Characteristic illness behaviors include continuous complaining of recurrent symptoms, distrusting medical staffs and institutions, self-diagnosis, self- prescription, and reliance upon folk remedies. These illness behaviors were precipitated by the current breakdown of health-care system and economic crisis of the North Korea. CONCLUSION: South Korean doctors should be able to understand these characteristics of the North Korean defectors in order to build effective therapeutic relationship with them.