Migration-Related Stressors and Suicidality of North Korean Refugee Women: Moderating Effects of Social Networks

Background and Purpose: Rates of completed suicide among North Korean refugees (NKRs) are 3 times higher than those among their host-country counterparts in South Korea. NKR women endure traumatic experiences in North Korea, such as chronic famine, oppression, and violence. In intermediary countries, NKR women experience human trafficking and sexual exploitation. Following resettlement in South Korea, they continue facing hardships, such as discrimination and social exclusion, which negatively affect mental health. However, no study to date has examined the associations among pre- and post-migration stressors and suicidal ideation among NKR women. Using the stress-buffering hypothesis, this study tested the moderating effects of social networks on the relationships among pre-migration trauma, post-migration discrimination, and suicidal ideation for NKR women living in South Korea. Social capital theory posits that an individual’s network diversity is associated with positive mental health outcomes. Research has shown that NKRs consider relationships with people they meet in churches to be significant sources of emotional support. Hence, in this study, social networks were defined as network diversity and church-based ties.

 

Methods: 273 NKR women in South Korea were recruited (April-May 2014). Past-year suicidal ideation was assessed by a 5-item suicidal ideation scale and was dichotomized. Pre-migration trauma was assessed using an 18-item trauma checklist developed for NKRs. Post-migration discrimination was measured by the 9-item Everyday Discrimination Scale. Social network variables (network diversity, church-based ties) were measured by egocentric network data. Network diversity was assessed by the number of different types (e.g., family, coworker, friend, neighbor, church acquaintance, etc.) of social ties. Church-based ties was assessed by the number of church acquaintances. Multivariable logistic regression analyses examined the moderating effect of network diversity on suicidal ideation and the moderating effect of church-based ties on suicidal ideation.

Results: 34.4% of participants reported past-year suicidal ideation. Controlling for religious affiliation, self-rated health, self-esteem, mean length of relationships, pre-migration trauma (OR=1.10, 95% CI=1.03-1.17) and post-migration discrimination (OR= 1.10, 95% CI=1.04-1.16) increased the odds of suicidal ideation. Network diversity moderated (OR=0.93, 95% CI=0.86-0.98) the association between post-migration discrimination and suicidal ideation, while social networks with church-based ties moderated (OR=0.94, 95% CI=0.89-0.98) the association between pre-migration trauma and suicidal ideation.

Conclusions and Implications: This study found that pre-migration trauma and post-migration discrimination independently affected suicidal ideation among NKR women. Study findings provide empirical evidence that supports the stress-buffering hypothesis and have implications for practitioners serving vulnerable populations, such as refugees. Suicide prevention and intervention programs for NKR women can emphasize the importance of participating in diverse types of social settings and building relationships with diverse people, which might mitigate the stress appraisal response of discriminatory treatment. In addition, suicide intervention programs can be designed using refugees’ social networks with church-based ties to reduce the negative impact of pre-migration trauma on suicidality. Community organizations that serve NKR women could partner with churches where many NKRs attend and provide services with church members to these refugees so that they can better cope with their trauma.