Profiles of Refugee-Related Trauma Exposure and Depression Among North Korean Refugees in South Korea: A Latent Class Analysis

Background and Purpose: Most North Koreans have faced severe trauma while residing in North Korea and during migration in intermediary countries such as China. Previous studies have found that multiple trauma exposure was associated with depression among North Korean refugees (NKRs). Although recent research has shown that distinct patterns of trauma exposure are differentially associated with mental health outcomes, prior research has predominantly summed the number of traumatic events to calculate trauma exposure. Latent class analysis (LCA) allows for the examination of population heterogeneity by identifying trauma exposure patterns and how these distinct patterns are associated with mental health. However, to date, no study has employed LCA to identify distinct classes of refugee-related trauma exposure and their relationship with depression among NKRs. Thus, we used LCA to identify whether there are distinct classes of NKRs who experienced similar patterns of trauma and investigate whether class membership is associated with depression.

Methods: A sample of 405 NKRs (aged 19—69) living in South Korea were recruited by snowball sampling (April—May 2014) and completed self-administered surveys. Pre-migration trauma exposure was measured by a 39-item traumatic events checklist developed for NKRs. Depression was assessed by the 20-item Center for Epidemiologic Studies Depression Scale. LCA was conducted to classify participants with similar patterns of pre-migration trauma exposure into subgroups (i.e., latent classes). Multivariate linear regression analysis was performed to examine the association between trauma exposure classes and depression while controlling for covariates.

Results: Most participants were women (67.4%) and married (72.8%). The best-fitting LCA model described three classes: deprivation trauma and witnessing death (59.3%), complex and pervasive trauma (23.7%), and low exposure (17.0%). Membership in the deprivation trauma and witnessing death class or low exposure class was mostly characterized by experiencing nonviolent trauma or witnessing violent trauma. Members in the complex and pervasive trauma class were characterized by experiencing multiple direct and violent forms of trauma and nonviolent trauma, and reported the highest depression score (M=21.7, SD=11.8) among all latent classes. Regression analyses showed that when compared with the low exposure class, membership in the deprivation trauma and witnessing death class (β=.130, p<.05) and complex and pervasive trauma class (β=.318, p<.001) was positively associated with depression.

Conclusions and Implications: To our knowledge, the current study is the first to identify patterns of refugee-related trauma exposure among NKRs in South Korea. Using LCA, we demonstrated that NKRs could be grouped into qualitatively different classes of trauma exposure. Our study findings show that membership in the complex and pervasive trauma class had the strongest association with elevated levels of depression. This finding suggests that NKR members in the complex and pervasive trauma class may benefit from a wide range of specialized interventions that are different from those for NKRs in the other classes. Additionally, our study findings highlight the need for early identification of refugee-related trauma exposure that occurred before arriving in South Korea so that its negative consequences do not persist for a prolonged period as NKRs navigate their new resettlement society.