Intimate Partner Violence, Alcohol Misuse, and Acculturation Among North Korean Refugee Women

BACKGROUND AND PURPOSE: North Korean (NK) refugee women in South Korea are disproportionately affected by intimate partner violence (IPV). Past studies suggest that IPV victims may use alcohol to cope with psychological pain caused by violence, which may result in more serious mental health problems. However, only a limited number of studies have explored culturally relevant moderating factors that may impact the association between IPV and alcohol misuse in this population. Acculturation has been found to significantly mitigate many adverse outcomes associated with exposure to IPV. Thus, this study examined NK refugee women’s exposure to IPV and alcohol misuse and explored whether acculturation attenuates the effects of IPV exposure on alcohol misuse.

METHODS: Data from a snowball sample of 212 North Korean refugee women were analyzed in this study. IPV was assessed using eight items on past-year victimization experiences including physical, psychological, and sexual violence, and controlling behavior. Alcohol misuse was assessed using 10 items from the Korean version of the Alcohol Use Disorders Identification Test (K-AUDIT). Acculturation was measured using 10 items indicating the level of adaptation to South Korean culture. Four moderating analyses using interaction terms were conducted to explore whether IPV types (i.e. physical, psychological, and sexual violence, controlling behavior), acculturation, and their interaction are associated with alcohol misuse while controlling for age, educational attainment, stay duration in South Korea, public assistance receipt status, marital status, and trauma exposure during migration.

RESULTS: The results demonstrated that 30.9% of NK refugee women in this sample were exposed to IPV in the past year. Approximately 21.4% were considered hazardous or dependent drinkers. Results from the multivariate analyses revealed that physical IPV (B = 3.54, p = .03) and sexual IPV (B = 4.97, p = .03) significantly increased the risk of alcohol misuse. Acculturation moderated the relationship between IPV and alcohol misuse for physical IPV (B = -0.22, p = .03 and sexual IPV (B = -0.21, p = .04). That is, the impact of IPV on alcohol misuse is alleviated for NK refugee women with greater acculturation levels. No significant moderation effects were found for psychological IPV and controlling behavior.

CONCLUSIONS AND IMPLICATIONS: The findings of this study show that the associations between physical and sexual victimization and alcohol misuse were attenuated among IPV-exposed North Korean (NK) refugee women with higher levels of acculturation. NK refugee women with lower levels of acculturation may have limited ability to seek help and may rely on more avoidant or emotional coping mechanisms, such as drinking. Conversely, highly acculturated NK refugee women may have access to greater social support and resources to cope with IPV and thus may demonstrate a greater likelihood of help-seeking behavior. Therefore, clinicians should consider ways to facilitate the acculturation process when assessing and treating alcohol misuse among IPV-exposed NK refugee women. Intervention approaches are needed that focus on developing problem-solving coping strategies and should also enhance acculturation and increase access to resources to respond to IPV.