Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms

OBJECTIVE: We investigated the prevalence of insomnia and its clinical characteristics in North Korean refugees. METHODS: North Korean refugees living in South Korea (48 males, 129 females; mean age 38.22±12.24 years) and South Koreans (112 males, 203 females; mean age 39.48±10.32 years) completed the following questionnaires: the Self-reported Questionnaire on Insomnia, Center for Epidemiological Studies-Depression Scale (CES-D), Trauma Exposure Check List for North Korean Refugees, and the Impact of Event Scale-Revised (IES-R). RESULTS: North Korean refugees had insomnia more often than South Koreans did (38.42% vs. 8.89%). Depression combined with insomnia was also more prevalent in North Korean refugees (28.25% vs. 3.17%). Compared with South Koreans with insomnia, North Korean refugees with insomnia showed higher CES-D scores. The North Korean refugees with insomnia had experienced a larger number of traumatic events, and had higher CES-D and IES-R scores compared to North Korean refugees without insomnia. Insomnia in North Korean refugees was also associated with the presence of significant depressive and post-traumatic stress disorder (PTSD) symptoms. CONCLUSION: Insomnia was common in North Korean refugees and was closely associated with depressive and PTSD symptoms. Our study suggests that complaints of insomnia may indicate more severe psychopathology, especially in refugees.