Stress, mental disorders, and its treatment approach for North Korean refugee youth : A special focus on treatment of PTSD, depression, and insomnia

In displaced populations who have fled their homeland because of persecution, violence, and political oppression, both children and adults have been affected by a variety of traumatic experiences. In addition, refugee children and adolescents are often exposed to violence in the home. The experiences of family violence may contribute to the psychopathology of refugee children, apart from traumatic experiences related to war or flight. However, little is known, so far, about the exposure to family violence and its relation to mental health in North Korean refugee youth affected by political violence. Experiencing the various forms and types of trauma increases the probability of developing mental disorders such as posttraumatic stress disorder (PTSD) in refugees. Further, PTSD often occurs with other mental health symptoms and also seems to have a relation to the comorbid symptoms in multiple trauma-affected populations. However, to our knowledge, the relation of PTSD to comorbid mental disorders among North Korean refugee youth has not been fully understood. The present thesis investigated family violence and its relation to mental health in North Korean refugee youth. Furthermore, the relationships between PTSD and comorbid mental health symptoms were examined in North Korean refugee youth who have experienced multiple trauma. Subsequently trauma-focused intervention – Narrative Exposure Therapy (NET) – was tested in order to reduce trauma-related mental health problems in North Korean refugee youth.The first article investigated exposure to violence and trauma, and mental disorders of North Korean refugee youth compared to South Korean youth who share similar ethnicity, language, and cultural norms but differ in the political context. Results revealed that North Korean refugee youth reported higher rates of family violence as well as organized violence and general traumatic events, and higher levels of mental health symptoms than South Korean youth. Furthermore, experiencing family violence and the number of experienced traumatic events were found to be a risk factor that increases the likelihood of PTSD and depression in North Korean refugee youth.The second article revealed that high comorbidity rates of PTSD, depression, and insomnia were found in North Korean refugee youth who have been exposed to multiple trauma. The overall symptoms and four cluster symptoms of PTSD correlated strongly with insomnia in addition to depression. Path analyses demonstrated that PTSD affected insomnia only through depression.The third article investigated the effectiveness of NET on posttraumatic symptoms by comparing it to treatment as usual (TAU) in North Korean refugee youth with PTSD. This study focused on changes in sleep problems in addition to PTSD and depression. Results revealed that NET significantly reduced all clinical symptoms (effect size g = 3.6) and sleep problems, i.e. insomnia and sleep quality (effect size g = 2.1), but TAU did not. The substantial symptom reduction of the NET group was observed two weeks after treatment completion, and this effect was stable for at least 6 months posttreatment. The substantial improvement of sleep in the NET group was associated with reduced PTSD and depression.Results revealed that North Korean refugee youth are a more vulnerable population for experiencing family violence in addition to organized violence and general traumatic events, which place them at higher risk of developing PTSD and depression. Further, PTSD and depression among North Korean refugee youth were linked to insomnia. The greater levels of PTSD suffer, the greater the likelihood for developing sleep problems via depression. NET appeared to be more effective than the non-trauma-focused treatment for addressing both clinical symptoms and sleep problems of North Korean refugee youth with PTSD. NET can be a promising approach for treating traumatized North Korean refugee youth and may be effective also for the treatment of sleep problems relating to traumatic experiences.publishe