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.

Seroprevalence of Hepatitis C Virus Infection in North Korean Defectors Residing in Korea.

BACKGROUND: This study aimed to investigate the prevalence rate of hepatitis C virus (HCV) infection and identify the demographic, and sociological characteristics and changes in awareness of HCV infection by participating the study for North Korean defectors residing in South Korea. METHODS: This study prospectively enrolled participants. Demographic, sociological and clinical data, and questionnaire surveys focused on awareness of HCV infection were collected. RESULTS: In total, 211 North Korean defectors participated in this study from September 2020 until June 2021. There were 174 women (82.5%), and the overall mean age was 48.9 years (range, 20 to 80 years). Of these participants, 112 (53.1%) had immigrated to South Korea since 2011. The overall prevalence of anti-HCV antibody among North Korean defectors was 1.9%. Thirty participants (14.2%) had hepatitis B surface antigens. A huge lack of awareness regarding HCV infection has been observed among North Korean defectors. CONCLUSION: This is the first prospective study to investigate the prevalence rate of HCV infection among North Korean defectors residing in South Korea. As North Korean defectors are a vulnerable group concerning HCV infection, they may benefit from HCV screening policies and educational interventions for HCV infection.

A Three-Year Longitudinal Study of Risk Factors for Suicidality in North Korean Defectors.

BACKGROUND: This longitudinal study examined risk factors for future suicidality among North Korean defectors (NKDs) living in South Korea. METHODS: The subjects were 300 NKDs registered with a regional adaptation center (the Hana Center) in South Korea. Face-to-face interviews were conducted using the North Korean version of the World Health Organization's Composite International Diagnostic Interview to diagnose mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Subjects were also asked about sociodemographic and clinical factors at baseline. At follow-up after three years, the NKDs (n = 172 respondents) were asked to participate in an online survey, responding to self-questionnaires about suicidality. Logistic regression analyses were used to explore associations between baseline variables and future suicidality among NKDs. RESULTS: Thirty (17.4%) of the 172 survey respondents reported suicidality at follow-up. The presence of health problems over the past year, any prior suicidality at baseline, a higher score on a trauma-related scale, and a lower score on a resilience scale at baseline were associated with greater odds of suicidality at follow-up after adjusting for age, sex, and educational level. Of all mental disorder categories, major depressive disorder, dysthymia, agoraphobia, and social phobia were also associated with significantly increased odds of suicidality at follow-up after adjusting for age, sex, educational level, and prior suicidality at baseline. CONCLUSION: Resilience, a previous history of suicidality, and the presence of lifetime depressive disorder and anxiety disorder should be given consideration in mental health support and suicide prevention in NKDs.

Standardized Suicide Prevention Program for Gatekeeper Intervention of North Korean Defectors in South Korea.

OBJECTIVE: North Korean defectors (NKDs) have experienced substantial difficulties during the migration and settlement in South Korea. They have a high prevalence of depression, post-traumatic stress disorder, and suicidal behaviors. The high prevalence of mental disorders among NKDs can lead to a high suicide rate. However, there are no suicide prevention programs for NKDs. This study aims to customize a suicide prevention program with content suitable for NKDs' particular circumstances. METHODS: A multidisciplinary research team developed this program based on domestic and international gatekeeper training programs for suicide prevention and articles related to suicide prevention. RESULTS: We developed a multi-part gatekeeper training program, "Suicide CARE for NKDs." In the "Introduction," trainees learn about the need for the program and its importance. In "Careful observation," trainees learn to recognize linguistic, behavioral, and situational signals of suicide risk. In "Active listening," trainees learn how to ask about suicidal thoughts and to listen empathetically. In "Risk evaluation and expert referral," trainees learn to evaluate suicide risk and to connect NKDs with institutes or services. CONCLUSION: We expect this program to become useful for training gatekeepers to prevent suicide among NKD. A future follow-up study is needed to confirm the efficacy of the program.

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.

"When I Sing, I Feel Peaceful": Experiences of Older Choral Singers From North Korea.

North Korean (NK) defectors fled their homeland and traveled thousands of miles in search of a better life. This qualitative study explored the experiences of older NK defectors who were part of a serious leisure choral group. In-depth interviews were conducted with eight NK defector members of a South Korean choir group, from which four central themes emerged: (a) conquering adversity and promoting health; (b) making good friends and having great adventures; (c) providing an arena to develop a new identity; and (d) developing proficiency through vigorous efforts. Involvement in choral singing as a serious leisure activity assisted the members in overcoming the various adversities they were facing, promoted their physical and mental health, and helped them develop comradery and new social identities.

Fear of Crime among Female North Korean Defectors in South Korea.

Although some studies have focused on immigrants' fear of crime in the United States, it is important to point out that the number of North Korean defectors to South Korea has rapidly increased since the 1990s. Therefore, understanding factors associated with fear of crime for North Korean immigrants, especially female defectors, is important for ensuring their successful transitions into South Korean culture. The present study used existing survey data from a sample of female North Korean defectors to explore factors related to fear of crime. Results indicate that the number of North Korean friends, language proficiency, and patriarchal attitudes toward gender were significant predictors of fear of crime for the North Korean female defectors. Findings are described and discussed as a potential source for policymaking to reduce North Korean immigrants' acculturative stress and fear of crime and to encourage smooth transitions into new cultures.

The association of education in a new society and social support from the education with the health of North Korean defectors: a cross-sectional study.

BACKGROUND: The number of North Korean defectors (NKDs) escaping to South Korea has increased. The health status of NKDs is an essential factor for a successful settlement into South Korean society. However, no studies have been conducted on the health status of NKDs in terms of education and social support. The aim of this study was to determine the associations of education and social support with the self-rated health status among NKDs. METHODS: This study utilized data gained from face-to-face interviews with 126 NKDs. A multivariable logistic regression and path analysis were performed to assess the effects of education in South Korea and social support on their self-rated health status and to explore the complex relationships between direct and indirect effects of the variables. RESULTS: NKDs who did not experience regular education in South Korea responded that they were in poor health compared to their counterpart (OR = 5.78). Although a direct association between education in South Korea and self-rated health was not shown, there was an indirect path from education in South Korea to self-rated health through social support. CONCLUSIONS: Participation in regular education in South Korea is important for the health status of NKDs. Moreover, social support has an important role in the association between education and self-rated health. Social policies and NKD assistance programs should consider and reflect the combination of education and social support interventions relevant to the health status of NKDs.

Prevalence of DSM-IV Major Psychiatric Disorders among North Korean Defectors in South Korea.

OBJECTIVE: The aim of this study was to estimate the prevalence of major psychiatric disorders among North Korean defectors (NKD) settled in South Korea. METHODS: The study population consisted of 294 North Korean defectors, aged 18 to 64 years settled in South Korea for 3 years or less. Between June 1, 2016 and October 31, 2016, face-to-face interviews were conducted using the North Korean version of the WHO-Composite International Diagnostic Interview (NK-CIDI) to diagnose DSM-IV psychiatric disorders. RESULTS: The lifetime prevalence of any DSM-IV psychiatric disorders was 62.2% in NKD and 25.0% in the general Korean population. The prevalence of specific disorders in NKD and general Korean population was as follows: 22.3% and 4.9% for major depressive disorder (MDD), 12.2% and 1.4% for post-traumatic stress disorder (PTSD), 18.0% and 4.8% for nicotine dependence, and 14.5% and 11.2% for alcohol abuse. The incidence of every single psychiatric disorder varied in each country. For instance, the generalized anxiety disorder, specific phobia, and alcohol use disorder occurred more frequently in North Korea whereas PTSD was more prevalent in other countries. CONCLUSION: The prevalence of psychiatric disorders among NKD was quite higher than in the general population of South Korea.

Perceived Trajectories of Past, Present, and Future Life Satisfaction of North Korean Defectors.

This study compared perceived trajectories of life satisfaction (LS) between North Korean defectors' (NKDs') and the general South Korean population and examined psychosocial factors associated with future LS. Data were obtained from 300 NKDs residing in South Korea and 5089 South Koreans using self-questionnaires and face-to-face interviews. LS values from 5 years ago (3.46 vs. 6.18) and at present (5.30 vs. 5.91) were lower in NKDs than the control group, but the inverse was true for expected LS score in 5 years (7.82 vs. 6.87). NKDs' LS trajectory showed a more statistically positive trend than that of the control group. Among NKDs, subjective sense of loneliness and satisfaction with one's sense of autonomy were associated with expected future LS. NKDs experience higher life satisfaction and expect an optimistic future relative to the control group. Social policies and therapeutic approaches to loneliness and improving a sense of autonomy may be beneficial.

Medical Expenses of North Korean Defectors with Post-Traumatic Stress Disorder.

OBJECTIVE: The purpose of this study was to establish the prevalence of PTSD among North Korean defectors who visited the National Medical Center, Seoul, South Korea over a period of approximately 10 years by examining their medical records and to examine differences in the medical service usage patterns of patients with and without PTSD. METHODS: Data from North Korean defectors who used outpatient services at the National Medical Center during a period of 10 years and 3 months (January 1 2006 to February 28, 2016) were analyzed. The general characteristics of the defectors were analyzed by frequency analyses, and descriptive statistics were generated. Additionally, independent t-tests and chi square analyses were performed to examine differences between PTSD patients and those without PTSD. Linear regression analysis was performed to examine factors affecting the mental health of North Korean defectors suffering from PTSD. RESULTS: This study assessed the correlations between PTSD, the average number of outpatient visits, and the total revenue. The regression analysis showed a relationship between PTSD and the average number of outpatient visits. There was also a correlation between PTSD and total revenue. The average number of outpatient visits was 41.8 for PTSD patients, whereas it was 33.2 for those without PTSD. The total revenue visit was 953.6 USD for PTSD sufferers and 231.1 USD for those without PTSD. CONCLUSION: This study found that the majority of North Korean defectors visit psychiatry departments, and that PTSD patients use outpatient services more frequently and have higher total revenue than those without PTSD. Additionally, patients with PTSD used a greater variety of medical services. Considering the high medical care expenses of North Korean defectors residing in South Korea, future investigations should examine the medical service usage patterns of such patients, especially those diagnosed with PTSD, in greater detail.

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.

Cervical Cancer Screening and Its Associated Factors Among North Korean Defectors Living in South Korea.

North Korean defectors (NKD) have many health problems related to insufficient nutrition, trauma from escaping, and being exposed to infectious diseases, but little research exists on their cancer screening. A total of 638 NKD participated in this cross-sectional survey. South Korean natives (SKN) who participated in the Korean National Health and Nutrition Examination Survey V were selected using age matching to each NKD. Fisher's exact tests and logistic regression were used for data analysis. The cervical cancer screening rate of NKD was significantly lower than for SKN (42 and 70 %, respectively; P < .001). The adjusted proportions of cervical cancer screening for NKD in all age groups under 60 years (P < .01) and having education beyond high school (P < .001) were significantly lower than that of SKN. NKD who had education under a high school level were more likely to have cervical cancer screening compared to NKD with education beyond a high school level (OR 1.81, 95 % CI 1.12-2.93). NKD were less likely to receive appropriate cervical cancer screening compared to SKN, especially those aged 30-39 years or married. Tailored interventions for NKD are needed to improve cervical cancer screening compliance.

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.

Differences in the relationship between traumatic experiences, self-esteem, negative cognition, and Internet addiction symptoms among North Korean adolescent defectors and South Korean adolescents: A preliminary study.

North Korean adolescent defectors experience adaptation difficulties along with a wide range of psychosocial problems, but no study has yet examined their Internet addiction symptoms. We compared early traumatic experiences, self-esteem, negative cognition, and Internet addiction symptoms, as well as the relationships between these variables, between North Korean adolescent defectors and South Korean adolescents. Fifty-six North Korean adolescent defectors and 112 age- and sex- matched South Korean adolescents participated. The analyses examined the relationship between traumatic experiences and Internet addiction symptoms, with negative automatic thoughts or low self-esteem as mediators of these relations. North Korean adolescent defectors tended to have higher levels of negative automatic thoughts and more severe Internet addiction symptoms, as well as better self-esteem, than did South Korean adolescents. Furthermore, only among North Korean adolescent defectors, traumatic experiences were positively associated with Internet addition symptoms via increasing negative automatic thoughts. North Korean adolescent defectors are more susceptible to Internet addiction, negative cognitions, and early traumatic experiences compared to South Korean adolescents. However, the cross-sectional design of this study precludes consideration of the causality of these relationships. Interventions aiming to correct negative cognitions and increase self-esteem may be helpful for North Korean adolescent defectors with problematic Internet use.

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.

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.

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.

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.

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.