Suicidal Ideation Among North Korean Refugees in South Korea: Exploring the Influence of Social Network Compositions By Gender

Background and Purpose: Rates of completed suicide among North Korean (NK) refugees are 3 times higher than those among their host country counterparts in South Korea (SK), which in turn are twice the average rate of all OECD countries. However, factors predicting suicidality among NK refugees are not well known. Social isolation has been found to be the strongest predictor for suicidality across various populations; hence, interventions using social connectedness are a promising avenue for suicide prevention. However, previous studies generally have measured social connectedness merely by aggregating them into social support scales, precluding our understanding of who provides support and the nature of their relationships relevant to suicidal behavior. To fill these research gaps, we examined how different social network compositions affect suicidal ideation among NK refugees in SK using egocentric (personal) network data.

Methods: 405 NK refugees living in SK and aged 19 or older were recruited during April-May 2014. Past-year suicidal ideation was assessed by a 5-item scale and was dichotomized. Social network compositions were operationalized as network diversity (number of different types of ties) and the intersection of types and functions of social ties. Intersections of types and functions of ties were created by intersecting these two characteristics (i.e., types and functions) and dichotomizing each variable to indicate the presence or absence of a tie. Kin, friend, and church ties were used for the types of ties and help-providing and trustworthy ties were used for the function of ties. Thus, social network variables used in this study were network diversity and kin-help, kin-trust, friend-help, friend-trust, church-help, and church-trust ties. Gender-stratified multivariable logistic regressions were performed.

Results: During the previous year, 25.0% of men and 34.4% of women reported contemplating suicide. Network diversity (OR=0.62; 95% CI=0.44, 0.88) decreased the odds of suicidal ideation among women only. Having at least one help-providing church-based tie (OR=5.07; 95% CI=1.34, 19.23) and trustworthy church-based tie (OR=4.84; 95% CI=1.23, 19.06) increased the odds of suicidal ideation among men. Having at least one help-providing kin tie (OR=0.44; 95% CI=0.24, 0.80), trustworthy kin tie (OR=0.47; 95% CI=0.26, 0.84), and trustworthy church tie (OR=0.43; 95% CI=0.19, 0.96) decreased the odds of suicidal ideation among women.

Conclusions and Implications: It is likely that women who had relationships with people in diverse social contexts and with kin ties received more resources and support to deal effectively with adversities in their lives. Because churches in SK provide tailored worship services and financial aid to NK refugees, women might receive emotional comfort through relationships with church ties who they can trust, whereas men might become distressed about being financially dependent on others, which contradicts cultural expectations of a traditional man’s role. Our findings have implications for practitioners serving vulnerable populations and also underscore the importance of paying particular attention to the cultural context of social networks and gender when conducting research on suicidal behavior. They also suggest that suicide intervention and prevention programs for NK refugees can be designed using their significant social networks.