Correlates of Depression Among North Korean Refugees Adapting to South Korean Society: The Moderating Role of Prejudice in the Host Country

Background: Although high prevalence (30%-50%) of depression among North Korean (NK) refugees living in South Korea have been found, little is known about the correlates of depression among this population. Coming from an isolated country where human rights are routinely violated, NK refugees continue to face multiple hardships during their adaptation process in South Korea, which can adversely affect their mental health. Despite having the same original ethnicity and race, more than 60 years of separation has created a wide sociocultural gap between North and South Korea, and South Korea’s short history of immigration has caused prejudicial attitudes against NK refugees. However, to our knowledge, no empirical research exists to date on depression in the context of adaptation or the role of prejudice in the host country. To fill this gap, the current study explored two questions: (1) Do sociocultural adaptation and experiencing prejudice in the host country predict depression among NK refugees who live in South Korea? (2) Does prejudice from South Koreans moderate the association between sociocultural adaptation and depression among NK refugees?

Methods: A sample of NK refugees in South Korea (n=261) was recruited nationally from August to October 2010 as part of a larger study. NK refugees had to be 19 years old or older and married or cohabiting with a partner to participate. All responses were based on self-reports. Depression was assessed using the 20-item Center for Epidemiologic Studies Depression Scale. Sociocultural adaptation was measured by the 8-item Sociocultural Adaptation to South Korean Society Scale. Host-country prejudice was assessed by a self-report of being prejudiced against by South Koreans. An ordinary least square regression was conducted to assess associations between sociocultural adaptation, host-country prejudice, and depression, while controlling for age, gender, income, duration in South Korea, family functioning, and health status. Then, the moderation effect of prejudice on sociocultural adaptation to depression was examined.

Results: Respondents' mean age was 41 (SD=9.11) and they had lived in South Korea for 5 years on average (SD=2.63). 63.98% of the sample was women and almost half (49.43%) of participants lived under the poverty line. The mean score of sociocultural adaptation was 28.25 (SD=7.42) and that of depression was 22.02 (SD=9.75). 43.30% of NK refugees reported being prejudiced against by South Koreans. Depression was negatively associated with high sociocultural adaptation (β=-0.492, p<.001) and positively associated with host-country prejudice (β=0.121, p<.05). The interaction term of host-country prejudice and sociocultural adaptation was positively associated with depression (β=0.156, p<.05).

Conclusions: This study has important implications for developing interventions for NK refugees who face various challenges during the adaption process. We found that better-adapted NK refugees were less likely to be depressed and those who experienced prejudice were more depressed. More importantly, prejudice attenuated the negative association between better adaption and lower depression, when compared to no prejudice. These findings highlight the importance of educating South Koreans to become accepting hosts and the need to improve NK refugees’ adaptation and integration as well as their psychological well-being in a culturally appropriate manner.