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1 KISEP Original Article J Korean Neuropsychiatr Assoc Vol 45, No 1 북한이탈주민의외상후스트레스장애에대한 3 년추적연구 홍창형 1 유정자 2 조영아 3 엄진섭 4 구현지 1 서승원 1 안은미 5 민성길 1 전우택 6 A 3-Year Follow-Up Study of Posttraumatic Stress Disorder among North Korean Defectors Chang Hyung Hong, MD 1, Jong-Ja Yoo, MS 2, Young-A Cho, PhD 3, Jinsup Eom, MS 4, HyunJi Ku, MS 1, Seung Won Seo, MD 1, Eun Mi Ahn, MD 5, Sung Kil Min, MD 1 and Woo Taek Jeon, MD 6 1 Department of Psychiatry, College of Medicine, Yonsei University, Seoul, 2 The Institute for Korean Unification Studies, Yonsei University, Seoul, 3 Yonsei Counseling Center, Yonsei University, Seoul, 4 Department of Psychology, College of Social Science, Chungbuk National University, Cheongju, 5 Department of Family Medicine, Seoul National University Hospital, Seoul, 6 Department of Medical Education, College of Medicine, Yonsei University, Seoul, Korea Objective:This study is a follow-up of a first survey of 200 North Korean defectors who entered South Korea in The purpose of this study is to examine changes in the current prevalence of partial PTSD and full PTSD after 3 years and to evaluate related factors. Methods:This study followed up on 151 of the 200 North Korean defectors from our first survey. 20 interviewers conducted face-to-face interviews and assisted defectors in completing a self-report assessment. The traumatic events which participants with chronic PTSD and delayed onset PTSD experienced were then examined. Results:Over the 3 years, the current prevalence rate of partial PTSD was reduced from 31.8% to 5.3%, and the current prevalence rate of full PTSD was reduced from 27.2% to 4.0%. Of particular interest was that 88.8% of those diagnosed with full or partial PTSD in the first survey had recovered after 3 years. Conclusion:The current prevalence rate of partial and full PTSD rapidly decreased during 3 years. (J Korean Neuropsychiatr Assoc 2006;45(1):49-56) KEY WORDS:North Korean defectors Partial PTSD Full PTSD Follow-up study Traumatic event. 서 론 49

2 방법 대상 연구방법 평가도구 - 50

3 Full PTSD와 partial PTSD의진단 북한내및탈북과정중외상경험 통계분석 결과 인구사회학적특성및 partial PTSD 와 full PTSD의유병률변화 51

4 만성 PTSD와지연발병형 PTSD 북한내및탈북과정중경험한외상사건의개수와 partial and full PTSD와의관계 Table 1. Demographic characteristics of 3 diagnotstic groups non-ptsd, partial PTSD, and full PTSD Variable Non-PTSD n=137 p-ptsd n=8 f-ptsd n=6 Total n=151 Sex* Male Female Age years Male Female Total Educational level in High school North Korea* College Graduate School Education in South Korea* Yes No Duration of defection month Duration of residence in South Korea month No. of family members who entered South Korea together No. of family members who is living together in South Korea Living with their spouse* Yes No Marriage in North Korea* Yes No Marriage in South Korea* Yes No Frequency %, MeanSD, period between escape from North Korea and entry into South Korea, p-ptsdpartial PTSD, f-ptsdfull PTSD st survey 151Non PTSD 62 p-ptsd 48 f-ptsd nd survey 151Non PTSD 137 p-ptsd 8 f-ptsd 6 Fig. 1. Change in the number of defectors in each of the 3 diagnostic groups Non PTSD, partial PTSD, full PTSD over 3 Years. p-ptsdpartial PTSD, f-ptsd full PTSD. 52

5 Table 2. Comparison of the cumulative number of types of traumatic events among the 3 diagnostic groups in the first survey Frequency Non- PTSD n=62 p-ptsd n=48 f-ptsd n=41 F Tukey post hoc test Total No. of traumas by type in North Korea* 25 items p-ptsdnon PTSD During defection* 19 items p-ptsdnon PTSD Total* 44 items p-ptsdnon PTSD MeanSD, p0.05, p0.01, p-ptsdpartial PTSD, f-ptsdfull PTSD Table 3. Comparison of the cumulative number of types of traumatic events among the 3 diagnostic groups in the second survey Frequency Non-PTSD n=137 p-ptsd n=8 f-ptsd n=6 Total No. of traumas by typein North Korea* items During defection* items Total* 44 items MeanSD, p-ptsdpartial PTSD, f-ptsdfull PTSD p p p F 고찰 53

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7 결론 55

8 중심단어 감사의글 REFERENCES 1) Jeon WT, Hong CH, Lee CH, Kim DK, Han MY, Min SK. Correlation between traumatic events and posttraumatic stress disorder among North Korean defectors in South Korea. J Trauma Stress 2005; 18; ) Jeon WT. Issues and problems of adaptation of North Korean defectors to South Korean society: An in-depth interview study with 32 defectors. Yonsei Med J 2000;4: ) 한오수, 안준호, 송선희, 조맹제, 김장규, 배재남등한국어판구조화임상면담도구개발 : 신뢰도연구. 신경정신의학 2000;39: ) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder. 4th ed. Washington DC, American Psychiatric Press; ) Blank AA. The longitudinal course of posttraumatic stress disorder. In JRT Davidson & EB Foa. Editors. Posttraumatic Stress Disorder: DSM-IV and Beyond. Washington DC, American Psychiatric Press; p ) Carlier IV, Gersions BP. Partial Posttraumatic Stress Disorder PT- SD: The issue of psychological scars1 and the occurrence of PTSD Symptoms. J Nerv Ment Dis 1995;183: ) Parson ER. Post traumatic demoralization syndrome. J Contemp Psychother 1990;20: ) Blanchard EB, Hickling EJ, Taylor AE, Loos WR, Gerardi RJ. Psychological morbidity associated with motor vehicle accidents. Behav Res Ther 1994;32: ) Schnurr PP, Lunney CA, Sengupta A, Waelde LC. A descriptive analysis of PTSD chronicity in Vietnam veterans. J Trauma Stress 2003; 16: ) Kang SR. Development of trauma scale for North Korean refugee. Unpublished doctoral dissertation. Seoul: Yonsei University; ) Breslau N, Davis GC. Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. Am J Psychiatry 1992;149: ) Freedman SA, Brandes D, Peri T, Shalev A. Predictors of chronic post-traumatic stress disorder. A prospective study. Br J Psychiatry 1999;174: ) Mayou R, Tyndel S, Bryant B. Long-term outcome of motor vehicle accident injury. Psychosom Med 1998;60: ) McFarlane AC, Papay P. Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. J Nerv Ment Dis 1992; 180: ) Yehuda R, Kahana B, Schmeidler J, Southwick SM, Wilson S, Giller EL. Impact of cumulative lifetime trauma and recent stress on current posttraumatic stress disorder symptoms in holocaust survivors. Am J Psychiatry 1995;152: ) Port CL, Engdahl B, Frazier PA. Longitudinal and retrospective study of PTSD among older prisoners of war. Am J Psychiatry 2001;158: ) Malt U. The long-term psychiatric consequences of accidental injury: A longitudinal study of 107 adults. Br J Psychiatry 1988;153: ) McLeer SV, Deblinger E, Henry D, Orvaschel H. Sexually abused children at high risk for post-traumatic stress disorder. J Am Acad Child Aol Psychiatry 1992;31: ) Weiss DS, Marmar CR, Schlenger WE, Fairbank JA, Jordan BK, Kulka RA, et al. The prevalence of lifetime and partial post-traumatic stress disorder in Vietnam theater veterans. J Trauma Stress 1992;a5: ) Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52:

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon