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North Korea: Witness to Transformation

Further Insights into the Mental Health of Female Refugees

by | September 9th, 2013 | 06:30 am

A recurrent theme in this blog is the ongoing psychological trauma evident in the North Korean refugee population. Women are particularly vulnerable. They appear to be especially prone to guilt and anxiety associated with the separation from family members that many have experienced, many have been exposed to sexual exploitation in a variety of forms, and many bear the “double burden” of childcare and financial responsibilities in particularly challenging circumstances. It is not surprising that they are stressed and depressed, and that many have been diagnosed with post-traumatic stress disorder (PTSD).

In a forthcoming paper in Health Care for Women International, “Mental Health and PTSD in Female North Korea Refugees,” Gisoo Shin and Suk Jeong Lee of the Chung-Ang University School of Nursing, extend the existing literature (for a quick review see Witness to Transformation) by examining the level of cytokines, a major group of stress hormones, in the refugees’ blood.

Shin and Lee surveyed 97 female refugees between December 2008 and August 2009 who had recently passed through the Hanawon entry center. The sample was generated by the “snowball method,” i.e. one respondent leads them to others, and they note that the sample may not be representative of some general population. However the results that they obtain, unusually high scores on depression and anxiety indicators, are consistent with numerous previous studies.

Their statistical analysis of these results is not entirely persuasive. The respondents are generally poor by South Korean standards, and only a small minority is employed full-time. The correlation between economic and employment status and mental health is not surprising. However, Shin and Lee don’t control for marital status so it is unknown whether this has an independent effect, and it is not clear whether the income variable is measuring personal or household income. They obtain the result that residence in a third country prior to arrival in South Korea is associated with worse mental health status, and try to differentiate between China and other countries such as Thailand or Russia.  But they don’t control for duration of residence in third countries, so again, we don’t know if this omission is confounding the results that they do report.

When it comes to analyzing the presence of cytokines, the analysis does not generate any evidence to support the links among various demographic controls, cytokines, and mental health. The authors argue that these results may be confounded by unreported exposure to communicable diseases such as hepatitis, tuberculosis, and STDs among the respondents.

However, Shin and Lee make an observation in passing that could be relevant to how we think about food security issues in North Korea. They observe relatively delayed onset of menarche among their respondents: the average age of first period for these refugees was 16.4 years, compared to 12 years for South Koreans. One can back out the average date of birth of their respondents (1973) and thus the average date of onset of menarche (1989).  If this represents delayed onset, then it implies that the nutritional conditions that contributed to this development pattern pre-dated the famine era of the 1990s. A variety of indicators suggest that the North Korean economy began experiencing problems in the mid-1980s; this new evidence would be consistent with this or even an earlier emergence of poor conditions, at least among the socioeconomic groups represented in this sample.