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

BACKGROUND: North Korean defectors (NKDs) have often been exposed to traumatic events. However, there have been few studies of neural alterations in NKDs with post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD). AIMS: To investigate neural alterations in NKDs with PTSD and cPTSD, with a specific focus on alterations in resting-state functional connectivity networks, including the default mode network (DMN). METHOD: Resting-state functional connectivity was assessed using brain functional magnetic resonance imaging in three groups of NKDs: without PTSD, with PTSD and with cPTSD. Statistical tests were performed, including region of interest (ROI)-to-ROI and ROI-to-voxel analysis, followed by post hoc correlation analysis. RESULTS: In the ROI-to-ROI analysis, differences in functional connectivity were found among the components of the DMN, as well as in the thalamus and the basal ganglia. Right hippocampus-left pallidum and right amygdala-left lingual gyrus connectivity differed between groups in the ROI-to-voxel analysis, as did connectivity involving the basal ganglia. The post hoc analysis revealed negative correlations between Coping and Adaptation Processing Scale (CAPS) score and left posterior cingulate cortex-right pallidum connectivity and between CAPS score and right putamen-left angular gyrus connectivity in the control group, which were not observed in other groups. CONCLUSIONS: The results suggest that there are alterations in the functional connectivity of the DMN and the limbic system in NKDs with PTSD and cPTSD, and that these alterations involve the basal ganglia. The lower correlations of CAPS score with right basal ganglia-DMN functional connectivity in patients compared with controls further implies that these connectivities are potential targets for treatment of PTSD and cPTSD.

The moderating role of neighborhood social cohesion in the mediation effects of the loneliness between acculturation stress and post-traumatic growth among female North Korean defectors.

Loneliness negatively predicts post-traumatic growth (PTG) among North Korean defectors (NKD), one of the representative groups of refugees. Additionally, evidence also suggests that females, who account for 70% of NKDs entering South Korea, are vulnerable not only to past trauma but also to the current acculturation stress and loneliness affected by neighborhood social cohesion. This study explores whether the mediating effect of loneliness on the relationship between acculturation stress and PTG was moderated by the neighborhood social cohesion among female NKDs. In this study, the data of 166 female NKDs who completed an online survey regarding acculturation stress, PTG, loneliness, and neighborhood social cohesion were used. Moderated mediation analysis was conducted using SPSS PROCESS macro program. Loneliness was associated with PTG (B = - 1.896, p < 0.001), and mediated the association between acculturation stress and PTG (indirect effect = - 0.278, 95% LLCI - 0.403, 95% ULCI - 0.166). Neighborhood social cohesion moderated the mediation effect of loneliness on the association between acculturation stress and PTG (B = - 0.016, 95% LLCI 0.001, 95% ULCI 0.035). The indirect effect of acculturation stress on PTG through loneliness was notably high for those with low neighborhood social cohesion. Therefore, increasing neighborhood social cohesion would reduce loneliness caused by acculturation stress and support the positive growth among female NKDs. This represents the most effective approach to aiding female NKDs in achieving growth, even after suffering trauma.

Properties of Patient-Reported Outcome Measures for Post-Traumatic Stress Disorder in North Korean Defectors: A Scoping Review.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is highly prevalent among North Korean defectors. This scoping review aimed to appraise the measurement properties of patient-reported outcome measures (PROMs) that assess PTSD among North Korean defectors. METHODS: A systematic search was conducted using Research Information Sharing Service, ScienceON, PubMed, and Embase from their inception up to September 15, 2022. Each measurement properties of the included PROMs were evaluated using COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) methodology. First, the methodological quality of each study on measurement properties was evaluated using the COSMIN Risk of Bias checklist. Second, the result of each single study on a measurement property was rated against the updated criteria for good measurement properties. RESULTS: After screening the articles, nine instruments from 40 studies were included. Among these instruments, Impact of Event ScaleRevised was the most frequently used (13 studies [38.1%]), followed by the Trauma Scale for North Korean Refugees, PTSD Checklist, and Posttraumatic Diagnostic Scale. The theoretical basis of all PROMs was secure in terms of content validity. The most frequently tested characteristics in measurement properties for internal structure were internal consistency, criterion validity, and convergent validity. No study reported sufficient structural validity as confirmatory factor analysis results with a model fit. CONCLUSION: There is insufficient evidence to support the recommendation of a specific PROM for use among North Korean defectors with PTSD.

The validity of ICD-11 PTSD and complex PTSD in North Korean defectors using the International Trauma Questionnaire.

Background: The International Trauma Questionnaire (ITQ) is a self-report assessment focused on the core features of Post-Traumatic Stress Disorder (PTSD) and complex Post-Traumatic Stress Disorder (CPTSD). It is consistent with the organizing principles of the 11th revision to the WHO's International Classification of Diseases (ICD-11). Since the 1990s, the number of North Korean defectors (NKD) entering South Korea to escape human rights violations has been increasing rapidly, with 33,815 NKD settled by 2021. The South Korean government faces an important challenge in supporting NKD to successfully adapt and settle in South Korean society. NKD experience various traumatic events during the process of defecting and repatriation. Therefore, it is essential to understand the psychological disorders of NKD, especially PTSD and CPTSD. Objective: This study aimed to test the validity of the ITQ assessment and explore the differences in symptoms and quality of life between PTSD and CPTSD. Method: The study sample comprised 503 trauma-exposed NKD. Confirmatory factor analysis (CFA) and latent class analysis (LCA) were used to evaluate the validity of ITQ. One-way analysis of variances and post-hoc analyses revealed the difference in the Depression and Somatic Symptoms Scale (DSSS) and WHOQOL-BREF results among PTSD and CPTSD symptom LCA classes. Results: The CFA and LCA results supported the ICD-11 conceptualization of PTSD and CPTSD in NKD. The CFA results confirmed that both the first- and second-order models were statistically fit, but for community-dwelling NKD the first-order model had better model fit than the second-order model. The LCA findings revealed a four-class model with 'PTSD', 'CPTSD', 'DSO', and 'low symptom' classes. Compared to the PTSD class, CPTSD class had higher levels of depression and somatic symptoms and a lower quality of life. Conclusion: This study provided evidence that ITQ is a valid tool to assess PTSD or CPTSD in community-dwelling NKD.

Antecedentes: El Cuestionario Internacional de Trauma (ITQ en su sigla en inglés) es una evaluación de autoreporte focalizado en las características principales del Trastorno de Estrés Postraumático (TEPT) y del Trastorno de Estrés Postraumático complejo (TEPT-C). Es consistente con los principios organizadores de la onceava revisión de la Clasificación International de las Enfermedades (CIE-11) de la OMS. Desde 1990, ha aumentado rápidamente el número de desertores de Corea del Norte (NKD en su sigla en inglés) que han entrado a Corea del Sur para escapar de las violaciones a los derechos humanos, con 33,815 NKD instalados hasta 2021. El gobierno de Corea del Sur enfrenta un desafío importante en apoyar a los NKD para adaptarse e instalarse en la sociedad de Corea del Sur. Los NKD experimentan varios eventos traumáticos durante el proceso de deserción y repatriación. Por lo tanto, es esencial entender los trastornos psicológicos de NKD, especialmente TEPT y TEPT-C.Objetivo: Este estudio busca evaluar la validez de la evaluación ITQ y explorar las diferencias en los síntomas y la calidad de vida entre TEPT y TEPT-C.Método: La muestra del estudio estuvo compuesta de 503 NKD expuesto a trauma. Se usaron el análisis factorial confirmatorio (CFA en su sigla en inglés) y análisis de clases latentes (LCA en su sigla en inglés) para evaluar la validez de ITQ. Los análisis de una vía de las varianzas y los análisis post-hoc revelaron la diferencia en los resultados de la Escala de los Síntomas somáticos y Depresión (DSSS en su sigla en inglés) y WHOQOL-BREF entre los síntomas TEPT y TEPT-C de las clases de los LCA.Resultados: Los resultados de CFA y LCA apoyan la conceptualización del TEPT y TEPT-C de la CIE-11 en NKD. Los resultados del CFA confirmaron que tanto los modelos de primer y de segundo orden fueron estadísticamente adecuados, pero para los NKD viviendo en residencias comunitarias, el modelo de primer orden tuvo un mejor ajuste que el modelo de segundo orden. Los hallazgos del LCA revelaron un modelo de cuatro clases con las clases 'TEPT', 'TEPT-C', 'DSO', y 'baja sintomatología'. En comparación con la clase TEPT, la clase TEPT-C tuvo niveles más altos de síntomas somáticos y depresión y una calidad de vida más baja.Conclusión: Este estudio proporciona evidencia que el ITQ es una herramienta válida para evaluar TEPT o TEPT-C en NKD viviendo en residencias comunitarias.

Factors associated with posttraumatic growth among North Korean defectors in South Korea.

Refugees experience various kinds of trauma during the migration process, which can cause psychiatric problems such as posttraumatic stress disorder. However, in the process of overcoming traumatic experiences, they may also experience posttraumatic growth (PTG). This study examined the level of PTG and its associated factors among North Korean defectors, including posttraumatic stress symptoms (PTSS). In total, 212 North Korean defectors completed self-report questionnaires measuring PTG (PTG inventory), PTSS (Posttraumatic Stress Disorder Checklist, PCL-5), quality of life (WHOQOL-BREF), and various sociodemographic variables. Participants completed the survey online, from July 27 to August 4, 2020. Participants reported a moderate level of PTG scores (51.7 ± 15.4, range 0-80). To determine the impact of PTSS on PTG among North Korean defectors, we conducted a hierarchical multiple regression analysis. In the final model, several sociodemographic factors (years in South Korea, education in North Korea, religion, and employment status), overall quality of life (ß = 0.321, p < 0.001), and PTSS (ß = 0.162, p = 0.035) were positively associated with PTG, whereas living with family (ß = - 0.1261, p = 0.040) and loneliness (ß = - 0.401, p < 0.001) were negatively associated with PTG, accounting for 36.6% of the variance in PTG scores (p < 0.001). This is the first large-scale study describing the level of PTG and its associated factors among North Korean defectors residing in South Korea. Further, our study provides suggestions for future research in this area, and interventions for improving PTG among this group.

Mothers' experience of caring for home-quarantined children after close contact with COVID-19 in Korea: an exploratory qualitative study.

Purpose: The world saw a shift into a new society consequent to the coronavirus disease 2019 (COVID-19), which made home quarantine mandatory for a person in close contact with those who tested positive. For children, however, home quarantine was not limited only to themselves but parents, especially mothers were involved and required to quarantine. This qualitative study aimed to explore and understand mothers' experience and their related psychosocial issues while caring for their school-aged children in Korea, who had to home quarantine after coming in close contact with COVID-19 positive individuals. Methods: Data were collected from October 2020 to January 2021 via in-depth, semi-structured interviews with nine mothers of children who had to home quarantine. Interviews were conducted face-to-face in an independent space near the participant's home or workplace (n=5) or via online platforms or telephone (n=4). The data were analyzed using thematic analysis through several iterative team meetings. Results: Thematic analysis revealed the following four themes: "Unable to be relieved due to uncertain situations surrounding me," "Blame and hurt toward me, others, and one another," "Pulling myself together for my children in my broken daily life," and "Changes in the meaning of life amid COVID-19." Conclusion: The narratives show that mothers experienced psychosocial difficulties while caring for their children during home quarantine. It is necessary to reduce the social stigma toward individuals in home quarantine and establish policies to ensure work-family compatibility for such mothers.