Abstract
The psychological impact of indirect trauma is unknown among North Korean (NK) refugees. We aimed to investigate the effects of direct and indirect trauma on the mental health of NK refugees in South Korea and evaluate the potential moderating effect of acculturative stress in this association. Using respondent-driven sampling, we recruited 323 NK refugees for this retrospective study. We measured exposure to direct and indirect trauma as independent variables, and posttraumatic stress symptoms (PTSS) and symptoms of depression and anxiety as dependent variables. After implementing multivariate imputation using chained equations, the associations between trauma type and psychological outcomes were assessed using ordinary least squares regression analyses, controlling for demographic covariates; the potential effect modification of acculturative stress was studied by adding an interaction term to the analyses. PTSS and symptoms of depression and anxiety were significantly associated with exposure to both direct, Bs = 0.24, 0.16, 0.19, respectively, p < .001s, and indirect trauma, Bs = 0.13, 0.08, 0.07, respectively, ps < .001. Although we did not observe significant effect modification, the magnitude of association between indirect trauma and PTSS significantly differed between the high, B = 0.18, p < .001, and low acculturative stress groups, B = 0.08, p = .024. These findings suggest that indirect trauma is associated with a more severe mental health consequence among NK refugees who experience high acculturative stress. Efforts to mitigate acculturative stress may reduce the mental health consequences of indirect trauma exposure.