Determinants of Mental Health Service Use Among North Korean Refugee Women in South Korea

BACKGROUND: North Korean (NK) refugee women are at a greater risk for various mental health problems such as depression and suicide because of their cumulative exposure to traumatic and stressful life events (e.g., trauma exposure, acculturation stress, discrimination). However, it has been frequently reported that NK refugee women are hesitant to receive necessary mental health services, and limited studies have explored factors associated with mental health service use (MHSU) among NK refugee women. Thus, this study aimed to examine determinants of MHSU among NK refugee women based on the Andersen model of health behavior.

METHODS: Data were collected in 2020 using a snowball sampling method. Self-administered questionnaires were delivered to a total of 212 adult NK refugee women (19 years or older) in South Korea, and 187 cases with complete data for major variables of the present study were analyzed. We conducted a logistic regression analysis to predict MHSU in the previous 12 months from the Andersen model (i.e., predisposing – enabling – need factors). Predisposing factors consisted of age, education level, and duration of stay in South Korea. Enabling factors consisted of income, employment status, receipt of public assistance including medical care, and household debt. Need factors included levels of depression, suicidal ideation severity, and perceived need for mental health service by significant others. The significance level (alpha) was set at 0.1 due to small sample size and the exploratory nature of this study.

RESULTS: Approximately 27% of NK refugee women in this sample received mental health services in the past 12 months. Results from logistic regression showed that the higher the education level, the greater the odds of MHSU (OR = 1.63, p = .07) amongst the pre-disposing factors. As for enabling factors, receipt of public assistance significantly increased the odds of MHSU (OR = 2.29, p = .08). As for need factors, the odds of MHSU also significantly increased as level of depression (OR = 1.12, p = .001) and suicidal ideation severity (OR = 1.55, p = .001) increased. More importantly, the odds of MHSU were significantly greater among those who were encouraged to receive mental health service by their significant others (OR = 9.82, p < .001).

CONCLUSIONS AND IMPLICATIONS: It is imperative that NK refugee women seek necessary help and receive mental health service in order to prevent mental health disorders. Findings of the present study demonstrated that probabilities of MHSU significantly increased as levels of education and psychological symptoms (e.g., depression and suicidal ideation severity) increased. In addition, recipients of public assistance programs showed a significantly higher chance of receiving mental health services. Considering that public assistance programs also cover medical costs, NK refugee women’s access to mental health services can be facilitated by reducing or covering the cost. Finally, the encouragement by their significant others to receive proper mental health services had a pivotal role in MHSU. Uncertainty about their mental health status may become apparent when their significant others tell them to seek help, which can eventually facilitate their action.