Trauma Exposure,Social Networks,and Suicide Risk Among North Korean Refugee Women in South Korea

Abstract

Exposure to adverse life events renders North Korean (NK) refugee women vulnerable to mental health problems, suicide risk being one of the most concerning. We examined bonding and bridging social networks as potential moderators of suicide risk among NK refugee women (N = 212). We found that exposure to traumatic events significantly increased suicidal behavior, but its impact was alleviated if they had a stronger bonding social network. The findings suggest that the negative impact of trauma on suicide can be reduced by strengthening bonding between people with similarities (i.e., family, individuals with the same country of origin).

Keywords

suicide risk trauma exposure North Korean refugee women social networks bonding and bridging networks

Get full access to this article

View all access options for this article.

References

Bebbington

P. E.

Cooper

Minot

Brugha

T. S.

Jenkins

Meltzer

Dennis

(2009). Suicide attempts, gender, and sexual abuse: Data from the 2000 British Psychiatric Morbidity Survey. American Journal of Psychiatry, 166(10), 1135–1140. https://doi.org/10.1176/appi.ajp.2009.09030310

Belik

S. L.

Cox

B. J.

Stein

M. B.

Asmundson

G. J.

Sareen

(2007). Traumatic events and suicidal behavior: Results from a national mental health survey. The Journal of Nervous and Mental Disease, 195(4), 342–349. https://doi.org/10.1097/01.nmd.0b013e318060a869

Bogic

Njoku

Priebe

(2015). Long-term mental health of war-refugees: A systematic literature review. BMC International Health and Human Rights, 15(1), 1–41. https://doi.org/10.1186/s12914-015-0064-9

Burt

R. S.

(2017). Structural holes versus network closure as social capital. In Social capital (pp. 31–56). edited by Nan Lin, Karen Cook, and Ronald S. Burt. Routledge.

Bwesige

M. M.

Snider

(2021). Despair and suicide-related behaviours in Palorinya refugee settlement, Moyo, Uganda. Intervention, 19(2), 224. https://doi.org/10.4103/INTV.INTV_12_21

CDC (Centers for Disease Control and Prevention). (2015). Strategic direction for the prevention of suicidal behavior: Promoting individual, family, and community connectedness to prevent suicidal behavior . Atlanta: CDC.

Chan

K. L.

Straus

M. A.

Brownridge

D. A.

Tiwari

Leung

W. C.

(2008). Prevalence of dating partner violence and suicidal ideation among male and female university students worldwide. Journal of Midwifery & Women’s Health, 53(6), 529–537. https://doi.org/10.1016/j.jmwh.2008.04.016

Cho

Y. A.

(2011). The effect of perceived discrimination on psychological distress among North Korean refugees. Korean Journal of Counseling, 12(1), 1–19. https://doi.org/10.15703/kjc.12.1.201103.1

Cho

Y. A.

Jeon

W. T.

J. J.

J. S.

(2005). Predictors of depression among North Korean defectors: A 3-year follow-up study. Korean Journal of Counseling and Psychotherpy, 17(2), 467–484.

10.

Choi

J. H.

Park

S. M.

(2014). The effects of characteristics of social networks of North-Korean refugees on their residential choice. Journal of the Korean Urban Geographical Society, 17(2), 83–98.

11.

Coffé

Geys

(2007). Toward an empirical characterization of bridging and bonding social capital. Nonprofit and Voluntary Sector Quarterly, 36(1), 121–139. https://doi.org/10.1177/0899764006293181

12.

Czyz

E. K.

Liu

King

C. A.

(2012). Social connectedness and one-year trajectories among suicidal adolescents following psychiatric hospitalization. Journal of Clinical Child & Adolescent Psychology, 41(2), 214–226. https://doi.org/10.1080/15374416.2012.651998

13.

Durkheim

(2005). Suicide: A study in sociology. Routledge.

14.

Ellis

B. H.

Lankau

E. W.

Benson

M. A.

Miller

A. B.

Shetty

,…& Cochran

(2015). Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior. American Journal of Orthopsychiatry, 85(1), 43. https://doi.org/10.1037/ort0000028

15.

Geirsdottir

Mittendorfer-Rutz

Amin

(2021). Risk of suicide attempt and suicide in young adult refugees compared to their Swedish-born peers: A register-based cohort study. Social Psychiatry and Psychiatric Epidemiology, 56(12), 1–11. https://doi.org/10.1007/s00127-021-02099-5

16.

Gerritsen

A. A.

Bramsen

Devillé

van Willigen

L. H.

Hovens

J. E.

Van Der Ploeg

H. M.

(2006). Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 41(1), 18–26. https://doi.org/10.1007/s00127-005-0003-5

17.

Gorst-Unsworth

Goldenberg

(1998). Psychological sequelae of torture and organised violence suffered by refugees from Iraq: Trauma-related factors compared with social factors in exile. The British Journal of Psychiatry, 172(1), 90–94. https://doi.org/10.1192/bjp.172.1.90

18.

Harpham

Grant

Rodriguez

(2004). Mental health and social capital in Cali, Colombia. Social Science & Medicine, 58(11), 2267–2277. https://doi.org/10.1016/j.socscimed.2003.08.013

19.

Hong

C. H.

Jeon

W. T.

Lee

C. H.

Kim

D. K.

Han

Min

S. K.

(2005). Relationship between traumatic events and posttraumatic stress disorder among North Korean refugees. Journal of Korean Neuropsychiatric Association, 44(6), 714–720.

20.

Ingabire

C. M.

Richters

(2020). Suicidal ideation and behavior among Congolese refugees in Rwanda: Contributing factors, consequences, and support mechanisms in the context of culture. Frontiers in Psychiatry, 11, 299. https://doi.org/10.3389/fpsyt.2020.00299

21.

Jannesari

Hatch

Prina

Oram

(2020). Post-migration social–environmental factors associated with mental health problems among asylum seekers: A systematic review. Journal of Immigrant and Minority Health, 22(5), 1055–1064. https://doi.org/10.1007/s10903-020-01025-2

22.

Joiner

T. E.

(2005). Why people die by suicide. Harvard University Press.

23.

Jung

(2018). A phenomenological study on the discriminatory experience as perceived by North Korean refugee youth. Studies on Korean Youth, 29(4), 113–147. https://doi.org/10.14816/sky.2018.29.4.113

24.

Kanas

Van Tubergen

Van der Lippe

(2009). Immigrant self-employment: Testing hypotheses about the role of origin-and host-country human capital and bonding and bridging social capital. Work and Occupations, 36(3), 181–208. https://doi.org/10.1177/0730888409340128

25.

Kanas

Van Tubergen

Van der Lippe

(2011). The role of social contacts in the employment status of immigrants: A panel study of immigrants in Germany. International Sociology, 26(1), 95–122. https://doi.org/10.1177/0268580910380977

26.

Kim

Yun

Jun

J. Y.

Park

W. S.

(2019). Pre-migration trauma, repatriation experiences, and PTSD among North Korean refugees. Journal of Immigrant and Minority Health, 21(3), 466–472. https://doi.org/10.1007/s10903-018-0742-5

27.

Kim

J. Y.

Choi

K. H.

Chae

J. H.

Hwang

H. J.

(2013). Life stress, social support and suicidal ideation of North Korean refugee women in South Korea. Korean Journal of Social Welfare Studies, 44(2), 33–56. https://doi.org/10.16999/kasws.2013.44.2.33

28.

Kim

Y. H.

Jeon

W. T.

Cho

Y. A.

(2010). A study on the prevalence and the influencing factors of the mental health problems among recent migrant North Koreans: A focus on 2007 entrants. International Journal of Korean Unification Studies, 19(2), 141–174.

29.

Kirmayer

L. J.

Narasiah

Munoz

Rashid

Ryder

A. G.

Guzder

Pottie

(2011). Common mental health problems in immigrants and refugees: General approach in primary care. Canadian Medical Association Journal, 183(12), E959–E967. https://doi.org/10.1503/cmaj.090292

30.

Korea Institute for National Unification. (2015). 2015 white paper on human rights in North Korea. Korea Institute for National Unification.

31.

Korea Ministry of Health and Welfare. (2019). Status about recipient of national basic livelihood guarantees. Korea Ministry of Health and Welfare.

32.

Korean Ministry of Gender Equality and Family (2012). Customized support plan for victimized North Korean female refugees. Korean Ministry of Gender Equality and Family.

33.

Kroenke

Spitzer

R. L.

(2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515. https://doi.org/10.3928/0048-5713-20020901-06

34.

Laban

C. J.

Gernaat

H. B.

Komproe

I. H.

Van der Tweel

De Jong

J. T.

(2005). Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. The Journal of Nervous and Mental Disease, 193(12), 825–832. https://doi.org/10.1097/01.nmd.0000188977.44657.1d

35.

Lancee

(2010). The economic returns of immigrants’ bonding and bridging social capital: The case of the Netherlands. International Migration Review, 44(1), 202–226. https://doi.org/10.1111/j.1747-7379.2009.00803.x

36.

Lancee

(2016). Job search methods and immigrant earnings: A longitudinal analysis of the role of bridging social capital. Ethnicities, 16(3), 349–367. https://doi.org/10.1177/1468796815581426

37.

Lee

J. S.

(2018). Social networks formation, social capital, and economic adaptation of North Korean defectors in Busan. Korean Journal of Humanities and Social Sciences, 21, 9(2), 307–320. https://doi.org/10.22143/HSS21.9.2.25

38.

May

A. M.

Klonsky

E. D.

(2016). What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology: Science and Practice, 23(1), 5. https://doi.org/10.1037/h0101735

39.

Meyerhoff

Rohan

K. J.

Fondacaro

K. M.

(2018). Suicide and suicide-related behavior among Bhutanese refugees resettled in the United States. Asian American Journal of Psychology, 9(4), 270. https://doi.org/10.1037/aap0000125

40.

Nam

Kim

J. Y.

DeVylder

Kim

(2021). Suicidal ideation and attempt among North Korean refugee women in South Korea: factors that distinguish suicide attempt from suicidal ideation. Suicide and Life-Threatening Behavior. 51(3), 564–571. https://doi.org/10.1111/sltb.12742

41.

National Human Rights Commission of Korea (NHRCK) (2010). Survey on human rights violations of North Korean refugee women in the process of escape and settlement. National Human Rights Commission of Korea.

42.

Nichter

Hill

Norman

Haller

Pietrzak

R. H.

(2020). Impact of specific combat experiences on suicidal ideation and suicide attempt in US military veterans: Results from the National Health and Resilience in Veterans Study. Journal of Psychiatric Research, 130, 231–239. https://doi.org/10.1016/j.jpsychires.2020.07.041

43.

OECD. (2019). Suicide rates. https://data.oecd.org/healthstat/suicide-rates.htm

44.

OECD. (2021). Employment rates. https://data.oecd.org/emp/employment-rate.htm?context=OECD

45.

Olshen

McVeigh

K. H.

Wunsch-Hitzig

R. A.

Rickert

V. I.

(2007). Dating violence, sexual assault, and suicide attempts among urban teenagers. Archives of Pediatrics & Adolescent Medicine, 161(6), 539–545. https://doi.org/10.1001/archpedi.161.6.539

46.

Paek

Y. O.

(2002). Research on the actual conditions of the North Korean female refugees in China and aids policies for them. North Korean Studies Review, 6(1), 241–264.

47.

Park

S. H.

Hong

J. P.

J. H.

Lee

H. R.

Kim

M. H.

Chang

(2021). Longitudinal trajectories of mental health among North Korean defectors: A four-year follow-up study of loneliness, depression, and life satisfaction. Anxiety and Mood, 17(2), 49–58. https://doi.org/10.24986/anxmod.2021.17.2.001

48.

Porter

Haslam

(2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. JAMA, 294(5), 602–612. https://doi.org/10.1001/jama.294.5.602

49.

Posner

Brent

Lucas

Gould

Stanley

Brown

Mann

(2008). Columbia-suicide severity rating scale (C-SSRS). Columbia University Medical Center, 10.

50.

Putnam

R. D.

(2000). Bowling alone: The collapse and revival of American community. Simon and Schuster.

51.

Putnam

R. D.

(2002). Bowling together. The American Prospect, 13(3), 20–22.

52.

Ren

You

Zhang

Huang

Conner

B. T.

Sun

Lin

M. P.

(2019). Differentiating suicide attempters from suicide ideators: The role of capability for suicide. Archives of Suicide Research, 23(1), 64–81. https://doi.org/10.1080/13811118.2018.1426507

53.

Shim

H. J.

Hwang

Y. S.

(2010). The relationship between micro-blogging service and social capital among the early adopters of twitter. Korean Journal of Journalism & Communication Studies, 54(5), 327–347.

54.

Simcock

Andersen

McLoughlin

L. T.

Beaudequin

Parker

Clacy

Hermens

D. F.

(2021). Suicidality in 12-year-olds: The interaction between social connectedness and mental health. Child Psychiatry & Human Development, 52(4), 619–627. https://doi.org/10.1007/s10578-020-01048-8

55.

Sorsdahl

Stein

D. J.

Williams

D. R.

Nock

M. K.

(2011). Associations between traumatic events and suicidal behaviour in South Africa. The Journal of Nervous and Mental Disease, 199(12), 928. https://doi.org/10.1097/NMD.0b013e3182392c39

56.

Stein

D. J.

Chiu

W. T.

Hwang

Kessler

R. C.

Sampson

Alonso

Nock

M. K.

(2010). Cross-national analysis of the associations between traumatic events and suicidal behavior: Findings from the WHO World Mental Health Surveys. PLoS One, 5(5), Article e10574. https://doi.org/10.1371/journal.pone.0010574

57.

Steinfield

Ellison

N. B.

Lampe

(2008). Social capital, self-esteem, and use of online social network sites: A longitudinal analysis. Journal of Applied Developmental Psychology, 29(6), 434–445. https://doi.org/10.1016/j.appdev.2008.07.002

58.

Stone

D. M.

Luo

Lippy

McIntosh

W. L.

(2015). The role of social connectedness and sexual orientation in the prevention of youth suicide ideation and attempts among sexually active adolescents. Suicide and Life-Threatening Behavior, 45(4), 415–430. https://doi.org/10.1111/sltb.12139

59.

Ullman

S. E.

Brecklin

L. R.

(2002). Sexual assault history and suicidal behavior in a national sample of women. Suicide and Life-Threatening Behavior, 32(2), 117–130. https://doi.org/10.1521/suli.32.2.117.24398

60.

M. Y.

Rice

Palinkas

L. A.

Kim

H. J.

(2020). Migration-related stressors and suicidal ideation in North Korean refugee women: The moderating effects of network composition. Journal of Traumatic Stress, 33(6), 939–949. https://doi.org/10.1002/jts.22549

61.

Van Orden

K. A.

Witte

T. K.

Cukrowicz

K. C.

Braithwaite

S. R.

Selby

E. A.

Joiner

T. E.

Jr (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575. https://doi.org/10.1037/a0018697

62.

World Health Organization (WHO). (2021). Suicide worldwide in 2019: global health estimates.

63.

You

Van Orden

K. A.

Conner

K. R.

(2011). Social connections and suicidal thoughts and behavior. Psychology of Addictive Behaviors, 25(1), 180. https://doi.org/10.1037/a0020936

64.

Youm

Kim

(2011). A study on the development and types of social networks among North Korean immigrants in South Korea. Korean Journal of Sociology, 45(2), 91–129.

65.

Young

Sweeting

Ellaway

(2011). Do schools differ in suicide risk? The influence of school and neighbourhood on attempted suicide, suicidal ideation and self-harm among secondary school pupils. BMC Public Health, 11(1), 1–15. https://doi.org/10.1186/1471-2458-11-874

66.

Chen

(2020). Relationship among social capital, employment uncertainty, anxiety, and suicidal behaviors: A chained multi-mediator mediation modeling analysis. Archives of Suicide Research, 26(1), 1–19. https://doi.org/10.1080/13811118.2020.1793044