This study aims to provide alternative care plans for mental health of North Korean refugees who are in protective facilities in China.
Personality Assessment Inventory (PAI) was utilized to measure the presence/absence of post traumatic stress disorder (PTSD) among 65 North Korean refugees.
The gender differences in PAI t-scores showed that women exhibited meaningfully higher scores largely in anxiety (m=61.85), depression (m=65.23), and schizophrenia (m=60.98). In different age groups, schizophrenia in the 30 age bracket (m=65.23) was meaningfully higher than the teens (m=48.11). Aggression among the treatment features was the highest in the 20 age group (m=59.19) showing higher t-scores than the teens (m=39.67). Duration in the facility affected mental health in that the 3-5 years group (m=63.91) reported the highest in paranoia. Groups of under 1 year and less than 1-3 years showed meaningfully higher scores in nonsupport. The PTSD (including partial PTSD) rate of the group recorded 9.2%. Correlation between the PTSD and PAI scores showed that the full-PTSD group demonstrated higher average scores in negative impression, somatic complaints, anxiety, anxiety-related disorder, depression, paranoia, schizophrenia, antisocial features, suicide ideation, and treatment rejection than the non-PTSD group.
Mental health of North Korean refugees in China was worse in women, the thirties, and less than 3-5 years in the facility, and it deteriorated as the duration prolonged. To promote better psychological health of North Korean refugees in China, the attention and aid from the protection facilities and domestic and international interests are required.
The number of defecting North Koreans since 1990s has significantly increased due to the collapse of socialist system and North Korean economic crisis. North Korean refugees in South Korea have reached over 10,000,
Therefore, this study was conducted to find out the mental health conditions of North Korean refugees in China. The significance of this study lies in that it reflects the experiences and traumas they encounter in the process of traveling through North Korea, third country, and refugee status declaration. The target population of this study was North Korean refugees who came of the danger of being repatriated by North Korean and/or Chinese police but have not reached final place of refuge, hence in transitional. Since 2005, Chinese government strategically increased the time of encampment in protective facilities to subdue the massive escape of North Korean refugees. Therefore, North Korean refugees in protective facilities had to face longer separation from their families and serious psychological health problems. Kinzie et al. reported in their study with 13 North Korean refugees in the United States who experienced an imprisonment period in Cambodia that all refugees exhibited depression, somatic complaints, attention disorder, sleep disorder, loss of appetite, and other symptoms despite the lapse of time of trauma.
According to studies on North Korean refugee mental health in South Korea done by Doctors without Borders with 476 North Korean refugees, 37.6% experienced psychological problems. Among these, 18.2% experienced PTSD, 18.8% complained of anxiety disorder, and 22.2% suffered from depression.
This research initially targeted 71 North Korean refugees over 15 years of age who were in the protective facilities in China under the South Korean government protection. The purpose and contents of the study were explained to all 71 North Korean refugees prior to conducting any survey. In the end, the total number of 65 North Korean refugees agreed to participate in the study.
This research was conducted in April 21-25, 2006 and in June 1-10, 2006 in the areas of Chinese cities A and B.
The survey questions were divided largely in three parts. The first part made up of demographic details of North Korean refugees in protective facilities in China. The details included in this part were age, gender, types of residence in North Korea, time of departure from North Korea, duration of stay in China, accompaniment of family members, families in North Korea, China, and South Korea, marital status, employment, military experience, and party membership. The second part tested the mental health of North Korean refugees in China. For objective personality measurement, Morey's Personality Assessment Inventory (PAI) was utilized.
In gender differences, women scored higher in anxiety, depression, and schizophrenia (
In terms of depression, the participants whose t-score was above 65 were 19 (29%), and among them women were 17 (89%). This result signifies that women tend to suffer more from depression, and the causes of depression originated from the separation from the family and her child(ren) in North Korea or China and subsequent fears for them.
According to the PAI validity scales among different age groups of North Korea refugees, inconsistency, infrequency, negative impression, and positive impression did not show meaningful differences. However, in clinical scales, the age differences in schizophrenia showed meaningful differences (
In the PAI treatment scales for different age groups, the t-scores for teens (m=39.67) was much lower than the twenties (m=59.19), thirties (m=56.85), and the forties (m=55.44) which showed meaningful differences in all age groups. According to the interpersonal scales among the age groups, the teens scored lowest in dominance (m=42.67) and warmth (m=39.56).
The correlation between PAI scales and duration of stay in China of North Korean refugees showed meaningful results only in paranoia and nonsupport (
The affectability of individual age, duration of stay in China, and duration under protection to the PAI scales were investigated. Negative impression scale was negatively related to duration under protection (-0.270), and warmth was positively correlated with duration of stay in China (0.268) (
According to the test for PTSD level among participating North Korean refugees in protective facilities in China, 9.2% showed symptoms of PTSD, including partial-PTSD. The result of χ2 validation for PTSD between genders showed no meaningful differences. The test revealed that 1 male (5.3%) and 2 female (4.3%) were diagnosed with full-PTSD, and 2 males (10.5%) and four females (8.7%) were diagnosed with partial-PTSD.
The correlations between PTSD level and PAI scales showed that the full-PTSD group showed meaningfully higher scores in negative impression (m=68.67), positive impression (m=33.67), somatic complaints (m=71.33), anxiety (m=80.33), anxiety-related disorder (m=73.33), depression (m=69.67), paranoia (m=70.00), schizophrenia (m=68.67), borderline features (m=73.67), antisocial features (m=65.00), suicide ideation (m=74.33), and treatment rejection (m=28.00) than the non-PTSD group. Particularly depression (m=80.33) was the highest, and related to somatic complaints, dependency on treatment was strong (
Secondly, the average value of PAI scales and PTSD level, including partial-PTSD, was calculated. Compared to non-PTSD group, partial PTSD group exhibited higher level of anxiety (m=73.50), anxiety-related disorder (m=67.00), and drug problems (m=71.00). Other scales that showed differences, although not significant, were somatic complaints (m=65.50), borderline disorder (m=62.00), and suicide ideation (m=62.33).
The study results revealed that the North Korean refugees in protective facilities in China sowed the highest scores in drug problems (m=60.59) scale, the lowest scores in treatment rejection (m=38.38) scale, and in all scales showed under 60 points in t-scores. These results indicate the tendency to highly depend on drugs due to somatic complaints of North Korean refugees. Similar results were found in the PAI results Park et al. found in a study with prisoners under sentence.
The PAI results of North Korean refugees in this study according to age differentials showed that the teens (m=48.11) and the 30s (m=65.23) exhibited significant differences in schizophrenia. In Kim's study, the ages did not contribute to any significant differences, but the teens showed the lowest average t-scores, which was similar in this study.
Analysis on correlation between the PAI scales and duration of stay in China revealed that in the 3-5 year group higher level of paranoia (m=63.91) and nonsupport (m=54.18) were found. More specifically among 21 scales, the 3-5 year group exhibited the worst mental health status, even though the result was not significant. On the other hand, Chae reported in his study with North Korean refugees in South Korea that as the duration of stay in China lengthened, the tendency to prefer South Korean culture increased.
The PTSD level of the participants in this study was 9.4%, including partial PTSD. According to gender differentials, males (10.5%) exhibited higher level of PTSD than females (8.7%). Jeon reported in the Hanawon study that the PTSD level including partial PTSD was 8.1%. The gender differentials showed that males (2.9%) showed lower level of PTSD than females (14.3%). In comparison with this study, the overall percentage of illness was similar, but the level of PTSD among females was significantly higher in Hanawon. In addition, Hong reported in his study that the partial PTSD level among North Korean refugees with one-year-experience in South Korea was 31.8% and full PTSD was 27.2%.
To summarize these results, in case of North Korean refugees in China, females in gender, the thirties in age bracket, 3-5 years in duration of stay in China, and longer period in protective facilities showed poor mental health.
This study contains limitations. First, participants of this study were selected from facilities that allowed this study. Currently the overseas protective facilities are located in China, Thailand, Mongolia, and Russia. Therefore, it is hard to normalize this study to mental health report of all North Korean refugees in protective facilities. Another limitation has to do with inconsistency of administration and environment of these facilities. The protective facilities are under Chinese government surveillance, and due to special relations with North Korea, the facilities are not in a systematic structure. In addition, the administrative methods, human resources structure, and duration of protection are dissimilar, so it is hard to generalize this study. Third, the interviews and survey were conducted in rest areas and/or living areas rather than in a conference room due to infrastructural problems. It is suspected that the interviewees may not have responded honestly due to an environmental factor. Fourth, the duration of the researcher at the facilities was not sufficient to participate and observe interactions among North Korean refugees in protective facilities in China. Despite these shortcomings, the significance of the study lies in that first, this is the first North Korean refugees mental health study conducted in protective facilities in China. Second, this study offers foundational data through examining mental health status of North Korean refugees in different stages of their sojourn which can be used as the basis for mental health promotion among the refugees in South Korea. Even though this study could not cover all North Korean refugees in protective facilities in China, this study is meaningful in that it provided mental health status of North Korean refugees in different stages of refuge. Third, this research can be utilized as mental health support data in case of development of refugee camps if a large number of North Korean refugees stream into China in the future.
*The reason for using unidentifiable names for the location of the study was due to security reasons for protecting areas, facilities, size, and administrative details.
Gender differences and the Personality Assessment Index (PAI) scale
*p<0.05
PAI scales for age groups
*p<0.05, †‡Subset for alpha=0.05
PAI scales according to duration of stay in China
*p<0.05, †‡Subset for alpha=0.05
Correlations between PAI scales and age, duration in China, and duration under protection
*Correlation is significant at the 0.05 level (2-tailed). PAI: Personality Assessment Inventory
Correlation between PTSD level and PAI scales
*p<0.05. PTSD: post trauma stress disorder, PAI: Personality Assessment Inventory