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. 2017 Sep;14(5):550-561.
doi: 10.4306/pi.2017.14.5.550. Epub 2017 Sep 11.

Post-Traumatic Stress Disorder, Depression and Anxiety among North Korean Refugees: A Meta-Analysis

Benjamin Eric Taylor  1 , Eugene Chekaluk  1 , Joanne Bennett  1
Affiliations

Post-Traumatic Stress Disorder, Depression and Anxiety among North Korean Refugees: A Meta-Analysis

Benjamin Eric Taylor et al. Psychiatry Investig. 2017 Sep.

Abstract

Objective: Post-traumatic stress disorder is common among North Korean refugees who have fled their country for economic, financial and humanitarian reasons. Co-morbid depression and anxiety are also common among North Korean refugees, due to the difficulties they have faced within their country and during their escape journey. Depression and anxiety complicate treatment for post-traumatic stress disorder, and lead to poorer outcomes. Thus, the aim of the present study was to provide a meta-analysis of studies investigating post-traumatic stress disorder, depression, and anxiety among North Korean refugees.

Methods: Selected articles were published in English, and included measures of post-traumatic stress, and/or depression and anxiety. 10 studies were included in the depression meta-analysis, and 6 in the anxiety meta-analysis.

Results: A random-effects model revealed strong, significant associations between post-traumatic stress and depression, r=0.63, 95% CI (0.51, 0.72), p<0.001, z=8.33, and anxiety, r=0.51, 95% CI (0.36, 0.63), p<0.001, z=6.07. The relationships between post-traumatic stress, depression and anxiety were higher among adults and those with more than five years outside of North Korea.

Conclusion: Depression appears to be an important treatment focus for North Korean refugees with post-traumatic stress.

Keywords: Anxiety; Depression; North Korean refugees; Post-traumatic stress disorder.

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Figures

Figure 1
Figure 1. Selection process for studies reporting associations between post-traumatic stress disorder, depression, and anxiety among North Korean refugees. PTSD: post-traumatic stress disorder.
Figure 2
Figure 2. Random effects model of studies investigating PTSD and depression among North Korean defectors. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 3
Figure 3. Random effects model of studies investigating PTSD and anxiety among North Korean defectors. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 4
Figure 4. Funnel plot: PTSD and depression. PTSD: post-traumatic stress disorder.
Figure 5
Figure 5. Funnel plot: PTSD and anxiety. PTSD: post-traumatic stress disorder.
Figure 6
Figure 6. Depression and PTSD for North Korean adults. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 7
Figure 7. Depression and PTSD for North Korean youths. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 8
Figure 8. Depression and PTSD: less than five years outside North Korea. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 9
Figure 9. Depression and PTSD: more than five years outside North Korea. *denotes symptom severityPTSD: post-traumatic stress disorder.
Figure 10
Figure 10. Anxiety and PTSD for North Korean adults. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 11
Figure 11. Anxiety and PTSD for North Korean youths. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 12
Figure 12. Anxiety and PTSD: less than five years outside North Korea. *PTSD presentations with multiple major symptoms. PTSD: post-traumatic stress disorder.
Figure 13
Figure 13. Anxiety and PTSD: more than five years outside North Korea. PTSD: post-traumatic stress disorder.
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