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

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.