Why “Suicide CARE” Is Required for North Korean Defectors in South Korean Society?

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Psychiatry Investig. 2023;20(5):391-392
Publication date (electronic) : 2023 May 25
doi : https://doi.org/10.30773/pi.2023.0115
1Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
2Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
Correspondence: Seon-Cheol Park, MD, PhD Department of Psychiatry, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea Tel: +82-31-560-2273, Fax: +82-31-554-2599, E-mail: psc76@hanyang.ac.kr
Received 2023 April 12; Accepted 2023 April 16.

“Suicide CARE, version 2.0,” comprises careful observation, active listening, risk evaluation, and expert referral, was developed as an evidence-based gatekeeper training program to reduce suicide completion in Koreans. Based on the diversified demand for education programs according to age, sex, and other factors, “Suicide CARE, version 2.0,” was initially developed for young, middle, and old adult groups. Based on the psychological autopsy interview report 2015–2018 in Korea, the three main pathways from employment-related problems, a slump in business, or retirement to suicide completion have been listed as the video clips of the linguistic, behavioral, and situational signals of people at risk of suicide in “Suicide CARE, version 2.0,” respectively [1]. To cover children and adolescents as well as young, middle, and old adults, “Suicide CARE, version 2.0” for middle and high school students has been developed.

In addition, the reasons why “Suicide CARE” is also required for North Korean defectors are as follows: first, posttraumatic embitterment disorder (PTED), a potential diagnostic entity clinically manifested by the experiences of injustice and violation of fundamental beliefs, and high levels of embitterment and intrusion in a type of pathological reaction to adverse life events. PTED was first suggested as a diagnostic entity to describe the symptomatic presentation of unemployed immigrants due to social and financial inequality after Germany’s reunification. Although PTED has not been listed as a formal diagnostic entity in either the Diagnostic and Statistical Manual of Mental Disorders 5th edition text revision or the International Classification of Disease and Related Health Problems 11th revision (ICD-11), it has been suggested that the clinical presentation of PTED is comparable to those of hwa-byung [2]. North Korea is one of the most totalitarian societies under the influence of the Juche Ideology, consistent with socialism and Marxism-Leninism. North Korean defectors may suffer from the disruption of their fundamental beliefs and experience severe forms of embitterment and intrusion during the settlement process in South Korean society. Second, North Korean defectors usually experience severe and life-threatening trauma during painful and long-term migration from North to South Korea through a third country. Most North Korean defectors experience various levels of trauma-related symptoms. Finally, the stigma of depressive disorder is prevalent in North Korean psychiatry, similar to the lack of a diagnostic code in the previous Soviet version of the ICD-7. North Korean defectors are reluctant to manage and treat their depression using psychiatric care services. Therefore, North Korean defectors must be more proactively cared for than South Koreans to reduce suicide risk [3].

Thus, the contents of “Suicide CARE for North Korean Defectors” have developed with two distinctive features from other versions of “Suicide CARE.” First, in the “careful observation” section, the comments for death and somatic symptoms are regarded as characteristic linguistic signs for North Korean defectors. Second, mental and physical health, job-related, and economic problems are essential situational difficulties for North Korean defectors in the settlement process in South Korean society [4].

With its economical and political development, South Korea has become a multicultural society. More specialized and focused psychiatric care for social, cultural, and ethnic minorities is required in South Korean society. “Suicide CARE for North Korean Defectors” can be an excellent example of more specialized care for minorities in South Korean psychiatry. Soon, “Suicide CARE for North Korean Defectors” may be revised and enriched with the addition of the embitterment during the acculturation process in South Korean society and the network analysis-based focused on mental and physical symptoms of North Korean defectors at suicide risk [5].


Conflicts of Interest

Seon-Cheol Park, a contributing editor of the Psychiatry Investigation, was not involved in the editorial evaluation or decision to publish this article.

Funding Statement



I express my sincere gratitude to Professor Se-Won Lim for his dedication to the development of the “Suicide CARE” Version 1.0 and 1.6.


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5. Park SC, Kim D. The centrality of depression and anxiety symptoms in major depressive disorder determined using network analysis. J Affect Disord 2020;271:19–26.

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