Psychiatric Health Risks in North Korean Refugee Youths Resettled in South Korea

Migrant and refugee populations are increasing globally, and children and adolescents in these populations are particularly susceptible to mental disorders. North Korean refugee (NKR) youths now living in South Korea share a culture, language, and history with South Korean (SK) youths, making these 2 groups suitable for studying the environmental factors in psychiatric health.

To compare the risk of developing mental illness and individual psychiatric disorders among NKR youths and SK youths.

This cohort study obtained data from Korea's National Health Insurance Service claims database from 2005 to 2021. Participants were aged 1 to 18 years between 2007 and 2010 who had no prior psychiatric claims, whether as outpatients or inpatients. Children and adolescents of the SK general population matched 1:10 on sex and age were compared with the NKR youth population. Statistical analyses were performed from August 2024 to March 2025.

Risk, presented as hazard ratio (HR), of developing psychiatric disorders in NKR youths compared with SK youths. This risk was assessed using a Cox proportional hazards regression model and Kaplan-Meier time-to-event probabilities.

In total, 1618 NKR youths (810 males [50.1%]; mean [SD] age, 9.48 [4.62] years) and 308 927 SK youths (194 331 females [62.9%]; mean [SD] age, 11.80 [4.72] years) were included in this study. NKR youths showed a significantly higher risk of developing psychiatric disorders (HR, 1.29; 95% CI, 1.17-1.43) compared with SK youths. Individual psychiatric disorder risks were higher for NKR youths, including posttraumatic stress disorder (HR, 2.33; 95% CI, 1.34-4.06; P = .003), attention-deficit/hyperactivity disorder (HR, 1.67; 95% CI, 1.32-2.11; P < .001), bipolar affective disorders (HR, 1.61; 95% CI, 1.20-2.15; P < .001), major depressive disorder (HR, 1.53; 95% CI, 1.33-1.75; P < .001), and anxiety (HR, 1.25; 95% CI, 1.11-1.42; P < .001).

In this cohort study, compared with SK youths, NKR youths showed a significantly higher risk of developing psychiatric disorders overall and individual psychiatric disorders, such as posttraumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, major depressive disorder, and anxiety. This finding is important for establishing medical and educational service plans and policies for the increasing number of refugee youths in South Korea.