(see Poster Gallery) The Role of Social Exclusion and Self-Concealment in Depression Among North Korean Refugee Women in South Korea

BACKGROUND AND PURPOSE: Mental health disorders are a central issue in adaptation of North Korean (NK) refugee women in South Korea. Exposure to social exclusion in various life settings is a well-known risk factor, but limited studies have examined mechanisms in which the social exclusion results in adverse mental health outcomes. Although limited, a few previous studies implied that NK refugee women tend to conceal their NK identity believing that it causes discrimination and social exclusion. Not only do they hide their NK identity, but NK refugee women also hesitate to share their negative feelings and difficulties. However, such self-concealment may make NK refugee women vulnerable to depression by isolating them from necessary social support. Thus, this study examined whether social exclusion increases depression and if self-concealment mediates this relationship.

METHODS: Data were collected from 212 adult NK refugee women (19 years or older) in South Korea using a convenience sampling method. A social exclusion scale assessed overall levels of social exclusion in social interaction, political involvement, production/consumption activity, and welfare services. Depression was measured with the Patient Health Questionnaire–9 (PHQ-9), and self-concealment was measured with 15 items of the self-concealment scale (SCS). Higher total scores indicated stronger tendency to hide their identity, negative and distressing feelings, and other personal information. The mediation effect of self-concealment on the relationship between social exclusion and depression was analyzed with the Baron and Kenny’s (1986) three step approach along with bootstrapping. Socio-economic characteristics such as age, education, marital status, employment status, and receipt of public assistance were controlled.

RESULTS: North Korean refugee women in this study were 44.83 years old on average and 28.8% were identified to have a clinical level of depression. Almost 43% of participants experienced all types of social exclusion, and the most frequently reported social exclusion was exclusion from production/consumption activity. Regression analyses testing the mediation model showed that social exclusion significantly increased the level of depression (β = .316, p < .001), and this relationship was partially mediated by self-concealment (β = .300, p < .001). Among the control variables, unemployment significantly increased self-concealment (β = .162, p < .05) and depression (β = .915, p < .01).

CONCLUSION AND IMPLICATIONS: NK refugee women tend not to share their NK identity and other personal experiences with others, but findings of this study highlighted potential risk of such behavior. Considering that implicit exclusion and discrimination still exist in our society, NK refugee women might opt to conceal their information thinking that it could help them blend into the South Korean society. However, we found that the more social exclusion, the higher the levels of self-concealment and depression in this study. Thus, we need to help them find strengths of their NK identity and learn how to positively vent and share their difficulties with others. It is also imperative to reinforce measures to reduce subtle discrimination and stigma against NK refugee women.