Mental illness risk higher for North Korean refugees, immigrants living in South Korea
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Risk for developing mental illness among North Korean refugees and immigrants living in South Korea was significantly higher than for those in the general population, according to a study published in JAMA Network Open.
“The Korean Peninsula currently has the only divided single-ethnicity country in the world,” Rugyeom Lee, PhD, of the department of preventive medicine at Kyung Hee University School of Medicine in Seoul, and colleagues wrote. “Epidemiologic evidence for determining mental illness risk among [North Korean immigrant and refugee (NKIR)] groups has remained underexamined thus far because, to our knowledge, no studies have analyzed these issues in the entire population.”
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Researchers sought to investigate mental illness risk among North Korean immigrants living in South Korea compared with that of the general South Korean population.
Their retrospective, population-based cohort study was based on National Health Insurance claims data from 2007 to 2019 and included 37,209 NKIRs along with 111,627 age-and-sex matched South Korean citizens. The main outcome was incidence and risk for mental illness measured in a Cox proportional risk model and adjusted for sex, age, disability, region, Charlson Comorbidity Index score and insurance premium percentile.
Data were analyzed from March to August 2022.
The final analysis included 112,851 individuals (64.9% female, median age 34), with 90,235 from the South Korean general population and 22,616 from the NKIR group. The propensity score-matching population numbered 24,532 in total, with 12,266 each in the NKIR and GP groups.
Researchers found that NKIR patients had a higher mental illness risk than the GP group (hazard ratio [HR], 2.12; 95% CI, 2.04-2.21). The multivariable adjusted HRs (95% CI) for developing mental disorders were 4.91 (3.59-6.71) for PTSD, 3.1 (2.9-3.3) for major depressive disorder, 2.27 (2.11-2.44) for anxiety and panic disorder, 2.03 (1.58-2.6) for bipolar affective disorder, 1.85 (1.53-2.24) for alcohol use disorder and 1.89 (1.46-2.45) for schizophrenia.
“We observed the increased risk of stress-related psychiatric illness such as major depressive disorder, anxiety and panic disorder, alcohol use disorder and PTSD among NKIR compared with South Korean citizens even after [propensity score matching],” Lee and colleagues wrote.