Availability of Data and Material
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Author Contributions
Conceptualization: Sang Hui Chu. Data curation: Ocksim Kim, Kyoung-A Kim. Formal analysis: Ocksim Kim, Kyoung-A Kim. Investigation: Ocksim Kim, Kyoung-A Kim. Methodology: Ocksim Kim, Kyoung-A Kim. Supervision: Sang Hui Chu. Writing—original draft: Ocksim Kim, Kyoung-A Kim. Writing—review & editing: Sang Hui Chu.
Funding Statement
This research was supported by the Basic Science Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Education (2019R1I1A2A01058746). Ocksim Kim received a scholarship from the Brain Korea 21 FOUR Project funded by the National Research Foundation (NRF) of Korea, Yonsei University College of Nursing.
Study | Sample size | Age (yr) | Spent time in South Korea (yr) | PROMs | PTSD prevalence (%) | Place | |
---|---|---|---|---|---|---|---|
1 | Hu et al., [50] (2008) | 145 | 34 | Less than 3 months | Trauma Scale for NKR (Kang, 2001) | - | Hanawon (Settlement Support Center) |
CPTSD (van der Kolk, 2007) | |||||||
2 | Rho and Won [61] (2009) | 105 | Not reported (20–50 ≤) | - | PDS (Foa et al., 1997) | - | G city Counseling Support Center |
3 | Park and Ann [28] (2009) | 115 | 33.5±12.8 | - | PDS (Foa et al., 1997) | - | Seoul, Inchen |
4 | Lee et al., [51] (2010) | 105 | 35.5±6.2 | Less than 3 months | PDS (Foa et al., 1997) | 25.7 | Hanawon (Settlement Support Center) |
5 | Kim et al., [29] (2011) | 105 | Not reported (20–50 ≤) | - | PDS (Foa et al., 1997) | - | Gwangju Metropolitan City |
6 | Song et al., [56] (2011) | 32 | 50.2±14.8 | 3.7±3.0 | MMPI-PTSD-K (Kang, 1997) | - | National Medical Center |
7 | Choe and Son [30] (2011) | Case=6 | Not reported | 2.1±3.4 | Trauma Scale for NKR (Kang, 2001) | - | Jeonju |
Control=7 | |||||||
8 | Kim and Choi [52] (2013) | Case=32 | Case=37.1 | Less than 3 months | IES-R-K (Eun et al., 2005) | - | Hanawon (Settlement Support Center) |
Control=38 | Control=36.6 | ||||||
9 | Hu et al., [31] (2013) | 14 | 26.5 | 4.3 | Trauma Scale for NKR (Kang, 2001) | - | Seoul |
CPTSD (van der Kolk, 2007) | |||||||
10 | Chang and Son [9] (2014) | 81 | 35.9±13.1 | 2.4±0.2 | PDS (Foa et al., 1997) | 40.7* | Gumi, Daegu, Gyeongbuk |
CPTSD-Interview (Ouimette et al., 1996) | |||||||
11 | Kim [27] (2014) | 531 | 34.6±8.6 | Less than 3 months | PDS (Foa et al., 1997) | 14.6 | Hanawon (Settlement Support Center) |
CPTSD- Interview (Ouimette et al., 1996) | 11.3* | ||||||
12 | Park et al., [33] (2015) | 199 | 38.6±12.3 | - | IES-R-K (Eun et al., 2005) | - | Community |
13 | Jun et al., [32] (2015) | 201 | 38.8±12.2 | 4.2±2.7 | IES-R-K (Eun et al., 2005) | - | Community |
14 | Kim and Lee [34] (2015) | 78 | Not reported (20–60) | - | Post-Traumatic Stress Symptom Scale-NKR (Yoon et al., 2007) | 11.5* | Seoul, Gyeonggi, Inchen |
15 | Lee et al., [35] (2016) | 177 | 38.2±10.3 | 4.1±2.6 | IES-R-K (Eun et al., 2005) | 40.1 | Community |
16 | Kim and Kim [37] (2016) | 145 | Not reported (20–50≤) | - | IES-R-K (Eun et al., 2005) | - | Community |
17 | Koo [38] (2016) | 55 | 34.9±10.4 | - | Trauma Scale for NKR (Kang, 2001) | 43.6 | Busan, Daegu, Seoul |
18 | Lee et al., [36] (2016) | 45 | 35.44±12.1 | 5.2±2.7 | IES-R-K (Eun et al., 2005) | - | Seoul |
19 | Choi et al., [39] (2017) | 211 | 38.5±12.2 | - | IES-R-K (Eun et al., 2005) | - | Seoul |
20 | Kim and Kim [40] (2017) | Non-PTSD=79 | Non-PTSD=33.8±8.9 | - | IES-R-K (Eun et al., 2005) | 37.8 | Hana center |
PTSD=48 | PTSD=36.1±8.1 | ||||||
21 | Shin et al., [58] (2017) | 53 | PTSD=47.0±7.0 | 4.8±3.0 | MMPI-PTSD (Keane et al., 1984) | - | National Medical Center |
Non-PTSD=44.6±10.4 | |||||||
22 | Won et al., [25] (2017) | 200 | 47.6±11.1 | - | PCL–C-NKR (Oh et al., 2014) | 14.0 | National Medical Center |
23 | Emery et al. [41] (2018) | 204 | Not reported | - | IES-R-K (Eun et al., 2005) | 63.2 | Community |
24 | Lee et al., [11] (2018) | 300 | PTSD=39.9±11.3 | - | IES-R-NKR (Won et al., 2015) | 15.3** | Hana center |
Non-PTSD=38.5±12.0 | |||||||
25 | Kim et al., [53] (2019) | 702 | 36.0±11.0 | Less than 3 months | IES-R-K (Eun et al., 2005) | 44.9 | Hanawon (Settlement Support Center) |
26 | Lee and Kim [60] (2019) | 103 | 25.9±3.0 | 5.1±3.8 | Trauma Scale for NKR (Kang, 2001) | - | Online survey |
27 | Kim [42] (2020) | 285 | 40.2±8.39 | - | Trauma Scale for NKR (Kang, 2001) | - | Community |
28 | Jeon et al., [59] (2020) | 38 | Case=38.9 | - | IES-R-K (Eun et al., 2005) | - | Myongji Hospital |
Control=36.9 | |||||||
29 | Chang et al., [54] (2021) | 545 | Not reported (35–50≤) | Less than 3 months | PDS-K (Nam et al., 2010) | 6.8 | Hanawon (Settlement Support Center) |
30 | Jeong et al., [43] (2021) | NKR=50 | NK PTSD=40.3±11.5 | - | IES-R-K (Lim et al., 2009) | - | Community |
SK=51 | NK control=30.9±8.1 | ||||||
SK=36.6±11.2 | |||||||
31 | Kim and Jhone [44] (2021) | 300 | Normal=56.6±18.8 | 7.3±4.4 | PCL–C-NKR (Oh et al., 2014) | 51.7 | 2017 National Human Rights Commission |
PTSD=49.5±18.1 | |||||||
Depression=57.9±20.3 | |||||||
Comorbidity=52.9±15.9 | |||||||
32 | Lee et al., [46] (2021) | 300 | Not reported (19–60≤) | 6.8±4.4 | PCL–C-NKR (Oh et al., 2014) | 49.3 | Community |
33 | Lee et al., [47] (2021) | NKR=32 | NKR=33.8±14.3 | - | IES-R-K (Eun et al., 2005) | - | Community |
SK=39 | SK=35.0±11.1 | ||||||
34 | Lee et al., [45] (2021) | 34 | 43.8±9.4 | - | PCL–C-NKR (Oh et al., 2014) | - | National Medical Center |
35 | Park et al., [48] (2021) | 300 | 38.7±11.9 | - | IES-R-NKR (Won et al., 2015) | - | Hana centers |
36 | Shim et al., [57] (2021) | 34 | NKR=43±9.4 | - | PCL–C-NKR (Oh et al., 2014) | - | National Medical Center |
SK=41±9.9 | |||||||
37 | Yun and Kim [26] (2021) | 642 | Repatriated=38.0±10.0 | Less than 3 months | IES-R-K (Eun et al., 2005) | Repatriated= 71.0 | Hanawon (Settlement Support Center) |
Not Repatriated=35.6±9.0 | Not repatriated= 60.0 | ||||||
38 | Lee et al., [49] (2022) | 212 | 41.5±11.9 | - | PCL-5-K (Kim et al., 2017) | 43.9 | Online survey |
39 | Lee [62] (2022) | 299 | 52.8±15.9 | - | PCL–C-NKR (Oh et al., 2014) | - | 2017 National Human Rights Commission |
40 | Kim et al., [55] (2022) | 627 | Not reported (20–60≤) | Less than 3 months | IES-R-K (Eun et al., 2005) | - | Hanawon (Settlement Support Center) |
PROMs, patient-reported outcome measurements; PTSD, posttraumatic stress disorder; CPTSD, complex PTSD; PDS, Posttraumatic Diagnosis Scale; MMPI-PTSD-K, Minnesota Multiphasic Personality Inventory-PTSD-Korean; IES-R-K, Impact of Event Scale Revised-Korean; NKR, North Korean Refugees; PCL–C-NKR, PTSD Checklist Civilian-North Korean Refugees; IES-R-NKR, Impact of Event Scale Revised-North Korean Refugees; PDS-K, PDS-Korean; NK, North Korean; SK, South Korean
PROMs | Language | Total (N) |
Population |
Instrument administration |
|||
---|---|---|---|---|---|---|---|
Age (yr) | Gender (%) | Setting | Cutoff score (sensitivity, specificity) | Original Translated version | |||
IES-R-K (Eun et al., 2005) [63] | South Korean | 105 | 10–50 | Men=42.9 | University hospital, General hospital, Private hospital | 24/25 (1.00, 0.60) | Translated |
Women=57.1 | |||||||
IES-R-K (Lim et al., 2009) [64] | South Korean | PTSD=93 | 44.9±15.7 | Men=51.6 | St. Mary’s Hospital, The Catholic University of Korea, and the 17 other collaborating centers | 22 (0.95, 0.80) | Translated |
psychiatric=73 | 44.6±14.6 | Men=37.5 | |||||
Normal=88 | 43.0±13.2 | Men=56.8 | |||||
IES-R-NKR (Won et al., 2015) [65] | North Korean defectors | 207 | Men: 38.0±11.9 | Men=21.7 | Hana center (Settlement Help Agency) | - | Translated |
Women: 41.1±13.5 | Women=78.3 | ||||||
MMPI-PTSD-K (Kang, 1997) [66] | South Korean | PTSD=68 | N/R | Men=61.2 | Mental Health Hospital | 17 | Translated |
Psyciatric=68 | Women=38.3 | ||||||
Normal=122 | |||||||
PCL–C-NKR (Oh et al., 2014) [67] | North Korean defectors | PTSD=32 | PTSD: 70.1±2.7 | Men=13.0 | National Medical Center | 56 (0.88, 0.50) | Translated |
Non-PTSD=37 | Non-PTSD: 70.3±3.4 | Women=87.0 | |||||
PCL-5-K (Kim et al., 2017) [68] | South Korean | PTSD=42 | PTSD: 42.2±9.4 | Veterans Health Service Medical Center (Vietnam War participants) | 37 (0.88, 0.96) | Translated | |
Non-PTSD=162 | Non-PTSD: 47.2±12.2 | ||||||
PDS-K (Nam et al., 2010) [70] | South | PTSD=21 | PTSD: 47.6±13.5 | Men=74.4 | Vietnam War participants, Combat police, Medical centers, Sexual Violence Relief Center, Traffic Disabled Association | 20 (1.00, 0.84) | Translated |
Korean | Subthreshold=26 | Subthreshold: 41.1±20.1 | Women=25.5 | ||||
Post-Traumatic Stress Symptom Scale-NKR (Yoon et al., 2007) [71] | North Korean defectors | PTSD=46 | 31.6 | Men=26.7 | Hanawon (Settlement Education Agency) | - | Original |
Psyciatric=29 | Women=72.3 | ||||||
Normal= 31 | Unresponsive=1.0 | ||||||
Trauma Scale for NKR (Kang, 2001) [69] | North Korean defectors | PTSD=26 | 35.2 | Men=65.2 | Hanawon (Settlement Education Agency) | 17 (0.69, 0.64) | Original |
Non-PTSD=69 | Women=29.5 | ||||||
Unresponsive=5.3 |
Values are presented as mean±standard deviation, number, or percentage. PTSD, posttraumatic stress disorder; PROMs, patient-reported outcome measurements; IES-R-K, Impact of Event Scale Revised-Korean; IES-R-NKR, Impact of Event Scale Revised-North Korean Refugees; MMPI-PTSD-K, Minnesota Multiphasic Personality Inventory-PTSD-Korean; PCL-C-NKR, PTSD Checklist civilian version-North Korean Refugees; PCL-5-K, PTSD Checklist-5-Korean; PDS-K, Posttraumatic Diagnostic Scale-Korean; N/R, not reported
PROMs |
Content validity |
Structural validity | Internal consistency | Reliability | Criterion validity |
Hypothesis testing |
|||||
---|---|---|---|---|---|---|---|---|---|---|---|
R | Cv | Cb | Convergent validity | Discriminative validity | Known-groups validity | ||||||
IES-R-K (Eun et al., 2005) [63] | ○ | ○ | ○ | 4 factors: PCA confirmed: oblique rotation (N=105) | Cronbach α: | 2 week (N=N/R) | CAPS: r=0.69 | BDI: r=0.61 | |||
Avoidance=0.70 | r=0.89 | STAI-I: r=0.59 | |||||||||
Hyperarousal=0.87 | Spearman-Brown coefficient=0.71 | MMPI-PTSD: r=0.66 | STAI-II: r=0.54 | ||||||||
Total variance 46.9% | Intrusion=0.63 | ||||||||||
Total scale=0.83 | |||||||||||
IES-R-K (Lim et al., 2009) [64] | ○ | ○ | 4 factors: PCA confirmed: orthogonal rotation (N=254) | Cronbach α: | 2 weeks (N=51) | CAPS: r=0.92 | BDI: r=0.81 | STAI-S: r=0.30 | a: PTSD | ||
Total scale=0.93 | Cronbach α=0.93 | STAI-T: r=0.67 | b: Psychiatric | ||||||||
c: Normal | |||||||||||
Total variance 68.8% | r=0.91 | a>b, a>c (p<0.001) | |||||||||
IES-R-NKR (Won et al., 2015) [65] | ○ | ○ | ○ | Cronbach α: | 1week (N=143) | BPSI-NKR-PTSD: | CES-D-NKR: | AUDIT-NK: r=0.15 | |||
Total scale=0.94 | Men: r=0.46 | Men: r=0.72 | Men: r=0.48 | BPSI-Alcohol: r=0.17 | |||||||
Women: r=0.75 | Women: r=0.71 | Women: r=0.64 | |||||||||
BPSI-Depression: r=0.55 | |||||||||||
MMPI-PTSD-K (Kang, 1997) [66] | ○ | ○ | 7 factors PCA confirmed: varimax rotation (N=266) | Cronbach alpha: | 1week (N=122) | Mississippi-PTSD: r=0.77 | a: PTSD | ||||
Total scale=0.86–0.90 | r=0.83 | b: Psychiatric | |||||||||
PTSD=0.90 | c: Normal | ||||||||||
Total variance 34.9% | Psyciatric=0.87 | a>b, a>c (p<0.01) | |||||||||
Normal=0.86 | |||||||||||
PCL-C-NKR (Oh et al., 2014) [67] | ○ | ○ | Cronbach α: | CAPS: r=0.47 | BDI: r=0.83 | a: PTSD | |||||
Re-experience=0.89 | MMPI-PTSD: r=0.61 | STAI-T: r=0.73 | b: Non-PTSD | ||||||||
Avoidance=0.87 | STAI-S: r=0 .61 | a>b (p<0.01) | |||||||||
Hyperarousal=0.81 | |||||||||||
Total scale=0.93 | |||||||||||
PCL-5-K (Kim et al., 2017) [68] | ○ | ○ | 4 factors PCA confirmed: varimax rotation (N=204) | Cronbach α: | 1 month over (N=30) | SCID: r=0.82 | CES-K: r=0.48 | a: PTSD | |||
Total scale=0.97 | Cronbach α=0.96 | IES-R-K: r=0.87 | b: Non-PTSD | ||||||||
Total variance 66.9% | r=0.96 | a>b (p<0.001) | |||||||||
PDS-K (Nam et al., 2010) [70] | ○ | ○ | Cronbach α: | 2 week (N=12) | SCID: r=0.84 | BDI: r=0.69 | a: PTSD | ||||
Re-experience=0.90 | r=0.81 | BAI: r=0.69 | b: Non-PTSD | ||||||||
Avoidance=0.87 | IES-R-K: r=0.70 | a>b (p<0.001) | |||||||||
Hyperarousal=0.81 | |||||||||||
Total scale=0.95 | |||||||||||
Post-Traumatic Stress Symptom Scale-NKR (Yoon et al., 2007) [71] | ○ | ○ | ○ | 4 factors CFA confirmed: Medel fit N/R (N=206) | Cronbach α: | Mississippi-PTSD: r=0.65 | MMPI: | MMPI: | a: PTSD | ||
Re-experience=0.84 | Depression: r=0.38 | Masculinity/Femininity: r=0.06 | b: Psychiatric | ||||||||
Avoidance=0.81 | Paranoia: r=0.31 | Hypomania: r=0.08 | c: Normal | ||||||||
Hyperarousal=0.89 | Psychasthenia: r=0.43 | a>b, a>c (p<0.05) | |||||||||
Complex PTSD=0.80 | Schizophrenia: r=0.45 | ||||||||||
Total scale=0.93 | |||||||||||
Trauma Scale for NKR (Kang, 2001) [69] | ○ | ○ | ○ | Cronbach α: | CES-D: t=2.34 (p<0.05) | a: PTSD | |||||
Total scale=0.87 | STAI: t=2.94 (p<0.01) | b: Non-PTSD | |||||||||
a>b |
PTSD, posttraumatic stress disorder; PROMs, patient-reported outcome measurements; R, relevance; Cv, comprehensiveness; Cb, comprehensibility; IES-R-K, Impact of Event Scale Revised Korean; IES-R-NKR, Impact of Event Scale Revised-North Korean Refugees; MMPI-PTSD-K, Minnesota Multiphasic Personality Inventory-PTSD-Korean; PCL–C-NKR, PTSD Checklist civilian version-North Korean Refugees; PCL-5-K, PTSD Checklist-5-Korean; PDS-K, Posttraumatic Diagnostic Scale-Korean; PCA, principal component analysis; CFA, confirmatory factor analysis; CAPS, Clinician-Administered PTSD Scale; BPSI, Brief Psychological State Inventory; MMPI, Minnesota Multiphasic Personality Inventory; CES-D, Center for the Epidemiological Studies of Depression; STAI, State-Trait Anxiety Inventory; STAI-T, State-Trait Anxiety Inventory-Trait version; STAI-S, State-Trait Anxiety Inventory-State version; DSM, the Diagnostic and Statistical Manual of Mental Disorders; SCID-5, Structured clinical interview for DSM-5; BDI, Beck Depression Inventory; AUDIT, Alcohol Use Disorders Identification Test; CES-K, Combat Exposure Scale-Korean; NK, North Korean; N/R, not reported
PROMs |
Content validity |
Structural validity |
Internal consistency |
Reliability |
Convergent validity |
Hypothesis testing |
|||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Criterion validity |
Discriminative validity |
Known-groups validity |
|||||||||||||
Results (rating) | MQ | Results (rating) | MQ | Results (rating) | MQ | Results (rating) | MQ | Results (rating) | MQ | Results (rating) | MQ | Results (rating) | MQ | Results (rating) | |
IES-R-K (Eun et al., 2005) [63] | + | Adequate | - | Very good | + | Adequate | + | Very good | - | Very good | + | N/R | N/R | N/R | N/R |
IES-R-K (Lim et al., 2009) [64] | ± | Adequate | + | Doubtful | + | Adequate | + | Very good | + | Very good | + | Very good | - | Very good | + |
IES-R-NKR (Won et al., 2015) [65] | + | N/R | N/R | Doubtful | + | Adequate | + | Inadequate | + | Very good | + | Very good | + | N/R | N/R |
MMPI-PTSD-K (Kang, 1997) [66] | ± | Adequate | - | Very good | + | Adequate | + | Inadequate | + | N/R | N/R | N/R | N/R | Very good | + |
PCL-C-NKR (Oh et al., 2014) [67] | ± | N/R | N/R | Very good | + | N/R | N/R | Very good | - | Very good | + | N/R | N/R | Very good | + |
PCL-5-K (Kim et al., 2017) [68] | ± | Adequate | + | Doubtful | + | Adequate | + | Very good | + | Very good | - | N/R | N/R | Very good | + |
PDS-K (Nam et al., 2010) [70] | ± | N/R | N/R | Very good | + | Adequate | + | Very good | + | Very good | + | N/R | N/R | Very good | + |
Post-Traumatic Stress Symptom Scale–NKR (Yoon et al., 2007) [71] | + | Very good | ? | Very good | + | N/R | N/R | Inadequate | - | Very good | - | Very good | + | Very good | + |
Trauma Scale for NKR (Kang, 2001) [69] | + | N/R | N/R | Doubtful | + | N/R | N/R | N/R | N/R | Very good | + | N/R | N/R | Very good | + |
“+”: Sufficient. “−”: Insufficient. “?”: Indeterminate. “±”: Inconsistent. PTSD, posttraumatic stress disorder; PROMs, patient-reported outcome measurements; MQ, methodological quality; IES-R-K, Impact of Event Scale Revised-Korean; IES-R-NKR, Impact of Event Scale Revised-North Korean Refugees; MMPI-PTSD-K, Minnesota Multiphasic Personality Inventory-PTSDKorean; PCL-C-NKR, PTSD Checklist civilian version-North Korean Refugees; PCL-5-K, PTSD Checklist-5–Korean; PDS-K, Posttraumatic Diagnostic Scale-Korean; NKR, North Korean refugees; N/R, not reported