American Journal of Preventive Medicine
Volume 55, Issue 2, 2018, Pages 271-279

Human Rights as Political Determinants of Health: A Retrospective Study of North Korean Refugees (Article)

Cha J.* , Surkan P.J. , Kim J. , Yoon I.A. , Robinson C. , Cardozo B.L. , Lee H.
  • a Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • b Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • c Dankook Center for Dispute Resolution, Dankook University, Yongin, Gyeonggi, South Korea
  • d Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California, United States
  • e Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • f Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
  • g Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, Department of Social Development, Korea International Cooperation Agency, Seongnam, Gyeonggi, South Korea

Abstract

Introduction: The gravity, scale, and nature of human rights violations are severe in North Korea. Little is known about the mental health consequences of the lifelong exposures to these violations. Methods: In 2014–2015, a retrospective study was conducted among 383 North Korean refugees in South Korea using respondent-driven sampling to access this hidden population. This study collected information on the full range of political and economic rights violations and measured post-traumatic stress disorder, anxiety and depression symptoms, and social functioning by standard instruments. Multivariate regression analysis was performed with the adjustment of political, economic, and demographic variables in 2016–2017. Results: The results indicate elevated symptoms of anxiety (60.1%, 95% CI=54.3%, 65.7%), depression (56.3%, 95% CI=50.8%, 61.9%), and post-traumatic stress disorder (22.8%, 95% CI=18.6%, 27.4%), which are significantly associated with exposures to political rights violations (ten to 19 items versus non-exposure: anxiety AOR=16.78, p<0.001, depression AOR=12.52, p<0.001, post-traumatic stress disorder AOR=16.71, p<0.05), and economic rights violations (seven to 13 items versus non-exposure: anxiety AOR=5.68, p<0.001, depression AOR=4.23, p<0.01, post-traumatic stress disorder AOR=5.85, p<0.05). The mean score of social functioning was also lower in those who were exposed to political (adjusted difference= –13.29, p<0.001) and economic rights violations (adjusted difference= –11.20, p<0.001). Conclusions: This study highlights mental health consequences of lifelong human rights violations in North Korea. Beyond the conventional approach, it suggests the need for a collaborative preventive response from global health and human rights activists to address human rights in regard to mental health determinants of the 20 million people in North Korea. © 2018 American Journal of Preventive Medicine

Author Keywords

[No Keywords available]

Index Keywords

South Korea depression educational status Republic of Korea refugee North Korean political violence mental health human Refugees middle aged violence Stress, Psychological social determinants of health mental stress health status controlled study social interaction human rights abuse human rights Surveys and Questionnaires Freedom Young Adult social status family civil rights psychology Humans political rights male economic rights female socioeconomics questionnaire Article Retrospective Studies adult posttraumatic stress disorder global health Stress Disorders, Post-Traumatic exposure to violence retrospective study social discrimination Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85048824641&doi=10.1016%2fj.amepre.2018.04.006&partnerID=40&md5=28eef07964ef0791b0ee96f5f1a6708d
DOI: 10.1016/j.amepre.2018.04.006
ISSN: 07493797
Cited by: 2
Original Language: English