Relationship Between Trauma, Discrimination, and Suicidal Ideation Among North Korean Defectors

Kyungho Lim; Jiwon Baek; Hokon Kim; Ocksim Kim; Sang Hui Chu; Young-Chul Jung

doi:10.30773/pi.2023.0351

Psychiatry Investig > Volume 21(11); 2024 > Article

Lim, Baek, Kim, Kim, Chu, and Jung: Relationship Between Trauma, Discrimination, and Suicidal Ideation Among North Korean Defectors

Original Article

Psychiatry Investigation 2024;21(11):1203-1210.

Published online: November 18, 2024

DOI: https://doi.org/10.30773/pi.2023.0351

Relationship Between Trauma, Discrimination, and Suicidal Ideation Among North Korean Defectors

Kyungho Lim^1,²

, Jiwon Baek³

, Hokon Kim⁴

, Ocksim Kim⁴

, Sang Hui Chu^3,^4,⁵

, Young-Chul Jung^1,^2,⁵

¹Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea

²Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

³Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea

⁴Department of Nursing, Yonsei University College of Nursing and Brain Korea 21 FOUR Project, Seoul, Republic of Korea

⁵Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea

Correspondence: Young-Chul Jung, MD, PhD Department of Psychiatry, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea Tel: +82-2-2228-1620, E-mail: eugenejung@yuhs.ac

Correspondence: Sang Hui Chu, RN, PhD Department of Nursing, Yonsei University College of Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea Tel: +82-2-2228-3257, E-mail: SHCHU@yuhs.ac

Received February 20, 2024 Revised July 24, 2024 Accepted August 16, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

This study aimed to explore the relationship between suicidal ideation and specific trauma and social discrimination among North Korean defectors.

Methods

A total of 448 North Korean defectors were recruited from online and offline communities and counseling centers. Participants provided sociodemographic and psychiatric history information via an online survey. Various assessment tools, including the Traumatic Event Checklist for North Korean Defectors, International Trauma Questionnaire, Experiences of Discrimination Scale, UCLA Loneliness Scale (short-form), and World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF), were employed. Multiple logistic regression analysis was used to examine the association between suicidal ideation and different types of trauma and discrimination.

Results

Among participants, 38.4% reported experiencing suicidal ideation. The most prevalent trauma was “unwanted separation from spouse, parent, or sibling” (69.4%), and the primary form of discrimination was “unfairness during employment” (35.7%). After adjusting for relevant variables, experiencing “extreme life-threatening hardship,” “unwanted separation from a child,” and “discrimination in income” significantly increased the likelihood of suicidal ideation. Importantly, unlike other refugee groups, interpersonal violence like torture or sexual abuse did not significantly contribute to suicidal ideation in this population. These findings highlight the unique vulnerabilities of North Korean defectors and suggest that income-related discrimination, unwanted separation from children, and life-threatening hardships are critical factors influencing suicidal ideation. Limitations such as recall biases and the cross-sectional nature of the data should be acknowledged.

Conclusion

This study underscores the need for tailored psychiatric support for North Korean defectors, recognizing their distinctive needs compared to other refugee populations.

Keywords: Refugees, Suicidal ideation, Trauma, Discrimination, Democratic People’s Republic of Korea

INTRODUCTION

The global refugee crisis is a significant issue impacting millions of individuals worldwide. Data from the United Nations High Commissioner for Refugees indicates that as of 2021, there were 89.3 million people who were forcibly displaced, with 27.1 million of these individuals being classified as refugees [1]. Refugees often experience significant levels of violence, trauma, displacement, and disruption to their lives due to the unstable circumstances they face [2]. Studies have shown that refugees have an increased burden of suicidal ideation and suicide attempts after migration compared to the general population [3]. This can be attributed to factors such as trauma exposure, social isolation, acculturative stress, and limited access to mental health services [4].

According to the Ministry of Unification in South Korea, the number of North Korean defectors entering South Korea increased rapidly since the mid-‘90s, and currently, about 33,882 North Korean defectors reside in South Korea [5]. The number of North Korean defectors entering South Korea constantly increased for the last 20 years, but since Kim Jung Un’s regime began in 2012, border protection has been reinforced causing attenuation to this trend [6]. North Korean defectors suffer exorbitant stress due to traumatic events such as natural disasters, human trafficking, sexual violence, and social discrimination throughout their lifetime [7]. Despite sharing the same ethnicity as South Koreans, North Korean refugees in South Korea also have faced significant discrimination due to the country’s historical emphasis on monoculturalism, leading to challenges in their overall adaptation and integration [8]. North Korean defectors additionally face unique challenges that set them apart from other war refugees; they experience a higher tendency of consistent and repetitive food shortages, unwanted separation from family members, and forced repatriation [7,9].

North Korean defectors are reported to show a much higher prevalence of suicidal thoughts compared to the general population in South Korea [10]. Recent surveys showed that approximately 13.3% of North Korean defectors reported suicidal ideation and the most prevalent reason for having suicidal ideation was due to low economic status (26.8%), followed by physical and psychiatric illness (25.8%), and loneliness (16.4%) [11].

The high prevalence of suicidal ideation among North Korean defectors is significantly associated with traumatic experiences, consistent with findings from studies of other populations [6,12]. Such studies have shown that exposure to traumatic events and the number of such events experienced by an individual increases the risk of suicidal ideation and behavior [13-16]. Prior research also suggests that there is a correlation between suicidal ideation and exposure to certain types of traumatic events, with the most significant link being associated with sexual and interpersonal violence, regardless of whether the individual has post-traumatic stress disorder (PTSD) [17].

Perceived discrimination has also been related to an increased risk of suicidal ideation [18]. Post-migration discrimination is thought to be the most significant post-migration stressor for refugees. It explains mental health outcomes like PTSD and depression as much as or more than traumatic experiences before migration [19-22]. Also, perceived discrimination after the migration is known to be associated with increased risk of suicidal ideation in North Korean refugees, as well as other ethnic minorities [18,23,24].

Although several studies have investigated the factors associated with suicidal ideation of North Korean defectors, studies about the relationships between suicidal ideation and each specific type of traumatic event and social discrimination in North Korean defectors were not done before. Understanding the specific types of traumas and discriminations associated with suicidal ideation among North Korean defectors, given their unique characteristics compared to other refugee groups, can enhance the effectiveness of the psychiatric intervention. In this study, we aimed to explore the relationship between suicidal ideation and each specific type of trauma, and social discrimination in North Korean defectors.

METHODS

Patients and protocol

Participants who are North Korean defectors over the age of 19 living in South Korea were recruited through online and offline communities and centers providing psychological counseling for North Korean defectors. The online survey link was distributed to participants via a smartphone messaging application to collect information about sociodemographic characteristics. Before accessing the questionnaire, all participants signed an electronic informed consent form.

Between August 25, 2022, to October 1, 2022, 537 participants were recruited and 17 were excluded because the survey response time was less than 10 minutes (n=8) and poor data quality (n=9). After excluding 72 participants who did not finish the Experiences of Discrimination Scale (EOD), a total of 448 participants were valid.

Measurements

Through the online survey, information about participants’ gender, age, years in South Korea, educational attainment level in North Korea, educational attainment level in South Korea, whether one is religious, economic level satisfaction, employment, whether one is living alone, whether one stayed in intermediary countries during defection, years living in intermediary countries during defection, loneliness, psychiatric medical history, the existence of suicidal ideation was collected.

Participants’ suicidal ideation was assessed by answering the “yes/no” questionnaire asking whether one experienced suicidal ideation in the last 7 days. Loneliness was measured numerically using the Korean version of the UCLA Loneliness Scale (short-form; ULS-6) [25,26]. ULS-6 assesses loneliness by answering six items on a 4-point Likert scale; “I lack companionship,” “I feel part of a group of friends,” “I feel left out,” “I feel isolated from others,” “I am unhappy being so withdrawn,” and “People are around me but not with me.” The score for each item of ULS-6 ranges from “1” (not at all) to “4” (extremely) and the total score ranges from 1 to 24, with higher values representing higher loneliness. The Cronbach’s alpha of this scale was 0.84.

Quality of life was measured through the Korean version of The World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) [27]. This instrument is made of 26 items in four domains: physical health, psychological, social relationships, and environment. Participants were asked to answer “how much,” “how completely,” “how good or how satisfied,” or “how often” they experienced each item in the past 2 weeks using a 5-point scale, ranging from ‘1 (not at all)’ to ‘5 (completely).’ Total score ranges from 0 to 100, with higher scores indicating a better quality of life.

The traumatic experience was measured through 19 “yes or no” questionnaires asking whether the participant experienced each specific type of trauma [28]. Nineteen types of traumatic events were grouped into five categories: disaster and accident-related, disease- and death-related, violence-related, family-related, and threat- and cultural shock-related trauma.

Discriminatory experiences were measured using a modified version of the ‘‘EOD” scale. EOD checks whether one has ever experienced discrimination in each of eight situations: in getting hired, in receiving income, in training, in getting promoted, in being fired, in obtaining higher education, at home, and in general social activities [29].

Statistical analysis

Through the descriptive statistical analysis, frequencies and ratios or means and standard deviations for demographic data were derived. For continuous variables, the normality of the distribution was confirmed through the Kolmogorov-Smirnov test. Independent two-sample t-test and Mann-Whitney U test were used to assess whether each variable has a significant association with suicidal ideation. For categorical variables, the chi-square test, Fisher’s exact test, and linear-by-linear association were used to assess whether each variable has a significant association with suicidal ideation.

Multiple logistic regression analysis was conducted to determine which type of trauma and the discriminative experience was related to suicidal ideation after controlling for sociodemographic and psychosocial variables. The variables included in the final model were selected by the backward elimination process to ensure that we considered as many potential influencing factors as possible while controlling for confounding variables. In all statistical tests, p<0.05 was considered statistically significant and all analyses were conducted using IBM SPSS Statistics 25 (IBM Corp., Armonk, NY, USA).

Ethics

This study was approved by the Institutional Review Board (IRB) of Yonsei Medical University (IRB No. 4-2023-0330).

RESULTS

From the total 448 participants, 172 (38.4%) participants reported suicidal ideation (mean age=49.9, 88.4% female), and 276 (61.6%) participants reported no suicidal ideation (mean age=44.2, n=226 [81.9%] female). This percentage falls within the range of reported ratios of having suicidal ideation in the past year, which have been reported as high as 46% [6,7,12,18]. The mean age of participants was 46.4 years (SD=12.9; range 19-79) and 378 (84.4%) were female. The average number of years living in South Korea was 10.8 years (SD=5.2; range 0-21), average overall quality of life score was 3.1 (SD=0.8; range 1-5, higher score indicates a higher level of quality of life), an average number of traumatic event experiences was 7.9 (SD=4.3; range 0-18), and an average number of discriminating experiences was 1.1 (SD=1.5; range 0-8). Suicidal ideations were compared according to demographic variables using the chi-square test, Fisher’s exact test, student t-test, and Mann-Whitney U test with a p-value of 0.05 (Table 1).

Suicidal ideations did not show a significant difference between male and female (p=0.066), years living in South Korea (p=0.347), educational level in North Korea (p=0.469), whether one is religious (p=0.277), and history of forced repatriation (p=0.071). However, suicidal ideations differed significantly according to age (p<0.001), number of trauma types one experienced (p<0.001), satisfaction with monthly income (p<0.001), ULS-6 score (p<0.001), number of discrimination types one experienced (p=0.003), whether one stayed in intermediary countries during defection (p=0.002), years living in intermediary countries during defection (p=0.036), overall quality of life (p<0.001), whether one is living alone (p<0.001), educational level in South Korea (p<0.001), employment status (p<0.001), whether one had received psychiatric treatment in last 6 months (p<0.001), and whether one is currently taking psychiatric medication (p<0.001) (Table 1).

According to the survey answers, the most frequently experienced trauma was “unwanted separation from spouse, parent or sibling” (70.1%). The chi-square test between each type of trauma and suicidal ideation suggested that every type of trauma except “natural disaster,” “threats to personal security,” “physical and emotional abuse and neglect by parents in childhood,” and “unwanted separation from spouse, parent or sibling” were significantly associated with suicidal ideation. The most frequently experienced type of discrimination was “during employment” (n=160, 35.7%). The chi-square test suggested that discrimination in getting hired, receiving income, and at home was significantly associated with suicidal ideation (Table 2).

The relationships between suicidal ideation and each type of traumatic and discriminatory experience that showed a significant relationship with suicidal ideation by the bivariate analysis were examined by controlling other variables associated with suicidal ideation using multiple logistic regression. Multiple logistic regression suggested that among traumatic experiences, “extreme hardship that can risk one’s life”(p<0.001) and “unwanted separation from a child”(p=0.001) was related to suicidal ideation. Among discriminatory experiences, discrimination in receiving income was significantly related to suicidal ideation (p=0.002) (Table 3).

DISCUSSION

This is the first study exploring the relationship between North Korean defectors’ suicidal ideation and specific type of trauma and discrimination. We conducted a two-step analysis. The univariate analysis was used as a preliminary step before conducting multivariate regression analysis to identify initial associations between individual variables and suicidal ideation. This analysis was used to screen potential candidate variables for the multivariate logistic regression model, highlighting variables such as various types of traumas and discriminations for further examination (Table 2). Via multivariate logistic regression model, we found out that North Korean defectors’ suicidal ideation was significantly associated with discrimination in receiving income and “unwanted separation from a child” and “extreme hardship that can risk one’s life.”

This result is consistent with the survey result done by the Hana Foundation, which showed that the most prevalent reason for having suicidal ideation is because of financial difficulties [11]. However, the fact that economic level satisfaction was not significantly related to suicidal ideation in the final regression model implies that the ‘financial difficulties’ in the Hana Foundation survey do not mean economic income or subjective economic level satisfaction per se. Rather, according to our study’s results, it may be plausible to think that the relative and unjustified difference in financial income is a more important and core factor in suicidal ideation. Furthermore, while discrimination in income was significantly associated with suicidal ideation, discrimination in getting hired or fired was not. This outcome can be partially explained by the continuous rise in employment and re-employment rates among North Korean defectors [11]. As employment opportunities increase, the direct impact of discrimination during hiring or firing may be mitigated by the availability of other job opportunities. However, ongoing financial discrimination, which affects their daily economic stability and income, remains a significant stressor contributing to suicidal ideation. Additionally, only 2.3% of North Korean defectors reported unemployment issues as the reason for suicidal ideation, whereas 28.5% reported financial difficulty, further highlighting that financial discrimination is a more pressing issue than employment status [11].

In contrast to previous studies about suicidal ideations in refugees indicating associations between suicidal ideation and interpersonal violence such as torture or sexual violence, no such associations were identified in this study [17]. The distinguishing feature of North Korean Defectors, such as a higher tendency of a consistent, repetitive pattern of food shortages, unwanted separation from their family members, and forced repatriation, might be the reason why “unwanted separation from a child” and “extreme hardship that can risk one’s life” are significantly related to suicidal ideation, unlike other war refugee groups. “Unwanted separation from a child” might also be significantly related to North Korean defectors’ suicidal ideation because of the typical pattern of North Koreans’ defection process. Usually, North Korean refugees tend to bring their surviving family members to South Korea after a few of them have already escaped. In this process, family members remaining in North Korea may face severe consequences such as questioning, abuse, and imprisonment in labor camps by North Korean authorities [30]. The profound sense of guilt associated with separation from their children and the consequences their children might face may contribute to the high rates of suicidal ideation among North Korean defectors. “Extreme hardship that can risk one’s life” refers to hardships such as famine or cold waves that North Korean defectors might experience before, during, or after migration. 265 participants experienced this type of trauma in North Korea and 35 participants experienced this type of trauma in an intermediary country, whereas only 11 participants experienced this type of trauma in South Korea. The connection between suicidal thoughts and extreme hardships among North Korean defectors may be explained by several factors, including the severe famine that occurred in the mid-1990s in North Korea and recent reports by Radio Free Asia of increasing rates of death by starvation and hypothermia among North Koreans [31,32]. Other than traumatic experiences and discrimination, history of psychiatric treatment in the last 6 months, overall quality of life, living alone, and loneliness were significantly related to suicidal ideation, which was consistent with previous literature.

One of the limitations of this study is that there may be recall biases with traumatic events, psychiatric medical history, and years living in intermediary countries during defection due to the nature of a retrospective study. Second, the participants of this study might have had a misunderstanding of questionnaires because of variations in their North Korean dialect. Third, our cross-sectional data cannot reveal causality between traumatic experiences, discrimination, and suicidal ideation. For instance, a North Korean defector who answered to have experienced suicidal ideation 1 week before the assessment might have suffered from suicidal ideation before being separated from a child. Future research should focus on identifying a causal association between the variables and suicidal ideation, using longitudinal data. However, it is challenging, nearly impossible to collect data from North Korean residents or North Korean defectors residing in the intermediary country, due to security issues related to their illegal stay. Fourth, the recruitment strategy used in this study might have prevented the generalization of study findings to all North Korean defectors living in South Korea, because ones who cannot utilize mobile applications for various reasons (e.g., low economic status) or who are not fluent enough in South Korean dialect would have been excluded. Finally, since the participants’ average number of years living in South Korea varied from a range of 0 to 21 years, this heterogenous nature of the group might have affected the results.

Despite these limitations, the findings of this study represent an important contribution to the literature. The result of this study clearly states that the suicidal ideation of North Korean defectors is high, compared to the general population of South Korea. According to our study, North Korean defectors’ profile of factors associated with suicidal ideation is different from other war refugees. We believe that this is vital information in providing sufficient psychiatric support to North Korean defectors because it provides a tailored way of approach regarding the nature of North Korean defectors that differs from other war refugees. Also, the fact that discrimination in income has a significant association with suicidal ideation of North Korean defectors implies that not only traumatic events from the past but also the current everyday life struggles affect the mental health of North Korean defectors.

According to the position statement of the Royal College of Psychiatrists, public policy that minimizes the impact of social factors on mental illness is suggested to prevent suicide in refugees, and counseling and provision of emotional support at the time of arrival may have additional value [4]. The fact that the longer North Korean defectors reside in South Korea, the more they thought about suicide also underscores the importance of suicide screening and assessment in the early stage of resettlement [12]. Currently, the Hana Foundation is providing a settlement support course for 12 weeks and a shelter protection program for 5 years to North Korean defectors and working to prevent suicidal behaviors among North Korean defectors through case management of those at high risk of suicide. Despite current policies aimed at supporting North Korean defectors, there is evidence of a consistently higher prevalence of suicidal thoughts and behavior among this population. This suggests that there is still room for improvement in the current policies and interventions that are being offered to support the mental health and well-being of North Korean defectors [6,10,12]. Based on the results of our study, it seems that providing counseling to North Korean defectors that specifically addresses the feelings of hopelessness that they may have experienced during extreme hardships like famine or cold wave, as well as the guilt that they may feel from losing a child, could be an effective way to prevent suicidal thoughts in this population. Interventions focusing on providing comprehensive mental health support that addresses the trauma and psychological scars from these experiences, such as trauma focused cognitive behavioral therapy, eye movement desensitization and reprocessing therapy, continuous psychological counseling, and support groups for defectors can be considered as a promising candidate. Additionally, early provision of economic activity and consistent social efforts to resolve hostility and discrimination, specifically discrimination in income, against North Korean defectors is vital for decreasing the post-migration difficulties and hence, preventing suicidal ideation among North Korean defectors [33]. Ensuring fair employment practices, protecting defectors from economic exploitation, and providing financial literacy programs can help mitigate the impact of financial discrimination.

In conclusion, the suicidal ideation of North Korean defectors is high, and the ones who experienced “extreme hardship that can risk one’s life,” “unwanted separation from a child,” or discrimination in receiving income showed significantly higher rates of suicidal ideation. This is a different pattern of results compared to other studies regarding war refugees’ suicidal ideation and we hypothesize this is because of the differing nature of North Korean defectors.

Notes

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: Kyungho Lim, Young-Chul Jung. Data curation: Kyungho Lim, Young-Chul Jung. Formal analysis: Kyungho Lim. Funding acquisition: Sang Hui Chu. Investigation: Hokon Kim, Ocksim Kim. Methodology: Kyungho Lim, Young-Chul Jung. Project administration: Jiwon Baek. Resources: Kyungho Lim, Young-Chul Jung. Software: Kyungho Lim. Supervision: Young-Chul Jung, Sang Hui Chu. Validation: Kyungho Lim, Young-Chul Jung. Visualization: Kyungho Lim. Writing—original draft: Kyungho Lim. Writing—review & editing: Kyungho Lim, Young-Chul Jung.

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).

ACKNOWLEDGEMENTS

None

Table 1.

Sociodemographic characteristics of the study sample stratified by suicidal ideation

	Participants with suicidal ideation, N=172 (38.4%)	Participants without suicidal ideation, N=276 (61.6%)	p	Total, N=448
Age	49.9±12.4	44.2±12.8	<0.001	46.4±12.9
Years living in South Korea	11.0±5.1	10.6±5.2	0.347	10.8±5.2
Years living in intermediary country	4.2±4.5	3.3±4.2	0.036	3.7±4.3
No. of discrimination types experienced	1.4±1.6	0.9±1.4	0.003	1.1±1.5
No. of trauma types experienced	9.5±4.3	6.9±4.0	<0.001	7.9±4.3
Loneliness^*	51.4±7.4	42.2±7.7	<0.001	45.7±8.9
Overall quality of life	2.7±0.8	3.4±0.8	<0.001	3.1±0.8
Economic level satisfaction	1.8±0.9	2.3±0.9	<0.001	2.1±0.9
Gender			0.066
Male	20 (11.6)	50 (18.1)		70 (15.6)
Female	152 (88.4)	226 (81.9)		378 (84.4)
History of staying in intermediary countries during defection			0.002
Yes	156 (90.7)	220 (79.7)		376 (83.9)
No	16 (9.3)	56 (20.3)		72 (16.1)
Education in North Korea			0.469
None	2 (1.2)	2 (0.7)		4 (0.9)
Elementary/middle school	9 (5.2)	15 (5.4)		24 (5.3)
High school	102 (59.3)	167 (60.5)		269 (60.0)
College or higher	59 (34.3)	92 (33.3)		151 (33.7)
Education in South Korea			<0.001
None	106 (61.6)	122 (44.2)		228 (50.9)
Elementary/middle school	2 (1.2)	3 (1.1)		5 (1.1)
High school	15 (8.7)	38 (13.8)		53 (11.8)
College or higher	49 (28.5)	113 (40.9)		162 (36.2)
Religious			0.277
Yes	64 (37.2)	117 (42.4)		181 (40.4)
No	108 (62.8)	159 (57.6)		267 (59.6)
Employment status			<0.001
Yes	66 (38.4)	164 (59.4)		230 (48.7)
No	106 (61.6)	112 (40.6)		218 (51.3)
History of psychiatric treatment in last 6 months			<0.001
Yes	75 (43.6)	15 (5.4)		90 (20.1)
No	97 (56.4)	261 (94.6)		358 (79.9)
Current psychiatric medication history			<0.001
Yes	83 (48.3)	19 (6.9)		102 (22.8)
No	89 (51.7)	257 (93.1)		346 (77.2)
History of forced repatriation			0.071
Yes	49 (28.5)	58 (21.0)		107 (23.9)
No	123 (71.5)	218 (79.0)		341 (76.1)
Living alone			<0.001
Yes	85 (49.4)	79 (28.6)		164 (36.6)
No	87 (50.6)	197 (71.4)		284 (63.4)

Data are presented as mean±standard deviation or number (%).

^* total score of ULS-6.

ULS-6, UCLA Loneliness Scale

Table 2.

Prevalence of each specific type of traumatic and discriminative experience in North Korean defectors stratified by suicidal ideation

	Participants with suicidal ideation	Participants without suicidal ideation	Total	p
Trauma type
Natural disaster	73 (42.4)	112 (40.6)	185 (41.3)	0.697
Serious accident, fire, or explosion	68 (39.5)	70 (25.4)	138 (30.8)	0.002
Sudden death of a family member or close friend	126 (73.3)	168 (60.9)	294 (65.6)	0.007
Witnessing death of a family member or close friend	120 (69.8)	156 (56.5)	276 (61.6)	0.005
Witnessing death of someone who is not a family member or close friend	109 (63.4)	121 (43.8)	230 (51.3)	<0.001
Extreme hardship that can risk one’s life	134 (77.9)	142 (51.4)	276 (61.6)	<0.001
Threats to personal security	105 (61.0)	145 (52.5)	250 (55.8)	0.078
Imprisonment	82 (47.7)	96 (34.8)	178 (39.7)	0.007
Torture	67 (39.0)	69 (25.0)	136 (30.4)	0.002
Physical assault	54 (31.4)	44 (15.9)	98 (21.9)	<0.001
Domestic violence	49 (28.5)	49 (17.8)	98 (21.9)	0.008
Physical and emotional abuse and neglect by parents in childhood	43 (25.0)	50 (18.1)	93 (20.8)	0.081
Divorce	73 (42.4)	68 (24.6)	141 (31.5)	<0.001
Unwanted separation from a spouse, parent, or sibling	123 (71.5)	191 (69.2)	314 (70.1)	0.604
Unwanted separation from a child	101 (58.7)	97 (35.1)	198 (44.2)	<0.001
Betrayal	93 (54.1)	101 (36.6)	194 (43.3)	<0.001
Discrimination	87 (50.6)	107 (38.8)	194 (43.3)	0.014
Verbal abuse	72 (41.9)	79 (28.6)	151 (33.7)	0.004
Sexual assault	53 (30.8)	40 (14.5)	93 (20.8)	<0.001
Discrimination type
In getting hired	75 (43.6)	85 (30.8)	160 (35.7)	0.006
In receiving income	42 (24.4)	38 (13.8)	80 (17.9)	0.004
In training	7 (4.1)	9 (3.3)	16 (3.6)	0.635
In getting promoted	14 (8.1)	16 (5.8)	30 (6.7)	0.335
In being fired	23 (13.4)	23 (8.3)	46 (10.3)	0.870
In obtaining higher education	2 (1.2)	8 (2.9)	10 (2.2)	0.226
Currently at home	25 (14.5)	16 (5.8)	41 (9.2)	0.002
In general social activities	46 (26.7)	61 (22.1)	107 (23.9)	0.262

Data are presented as number (%)

Table 3.

Logistic regression model for the association of suicidal ideation with each specific type of traumatic and discriminative experience in North Korean defectors

	OR	95% CI
Trauma type
Extreme hardship that can risk one’s life	2.8^***	1.5-5.0
Unwanted separation from a child	1.8^*	1.0-3.1
Physical abuse	1.8	0.9-3.5
Discrimination type
In receiving income	4.6^*	1.7-12.1
Controlled variables
Overall quality of life	0.4^***	0.3-0.6
Living alone	1.8^*	1.0-3.0
Loneliness^†	1.1^***	1.1-1.2
History of psychiatric treatment in last 6 months	5.3^***	2.1-13.7
Current psychiatric medication history	2.2	0.9-5.2
No. of discrimination types experienced	0.8	0.6-1.0
Cox & Snell R2	0.421
Nagelkerkes R2	0.572

^* p<0.05;

^*** p<0.001;

^† total score of ULS-6.

OR, odds ratio; CI, confidecen interval; ULS-6, UCLA Loneliness Scale

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