Psychosocial pathways linking PTSD and DSO symptoms to somatic symptoms among female North Korean defectors

Background: North Korean defectors (NKDs), approximately 72% of whom are female, are a trauma-exposed population in which somatic symptoms are common and culturally patterned. Previous research identified loneliness, perceived discrimination, and post-traumatic stress disorder (PTSD) and disturbances in self-organization (DSO) symptoms as correlates of somatic symptoms. However, whether loneliness and perceived discrimination account for these relationships remains unclear.Objective: To examine whether loneliness and perceived discrimination mediate the relationship between PTSD/DSO symptoms and somatic symptoms among female NKDs.Methods: This secondary analysis used cross-sectional survey data from 372 female NKDs in South Korea. PTSD and DSO symptom severity were assessed using the International Trauma Questionnaire. Loneliness was measured using the UCLA Loneliness Scale, perceived discrimination was assessed using the Everyday Discrimination Scale, and somatic symptoms were measured using the somatic subscale of the Depression and Somatic Symptoms Scale. Separate parallel mediation models were tested using 10,000 bootstrap resamples, adjusting for sociodemographic covariates and cumulative trauma exposure.Results: Loneliness mediated the relationship between PTSD symptoms and somatic symptoms (B = 0.102, 95% bootstrap CI [0.059, 0.151]) and the relationship between DSO symptoms and somatic symptoms (B = 0.111, 95% bootstrap CI [0.052, 0.176]), whereas perceived discrimination mediated the relationship between PTSD symptoms and somatic symptoms (B = 0.063, 95% bootstrap CI [0.026, 0.104]) but not the relationship between DSO symptoms and somatic symptoms (B = 0.044, 95% bootstrap CI [−0.027, 0.112]). Direct effects remained significant in both models, indicating partial mediation.Conclusions: Loneliness emerged as a common psychosocial pathway linking both PTSD and DSO symptoms to somatic symptoms, whereas perceived discrimination was relevant only to the relationship between PTSD symptoms and somatic symptoms. These findings suggest that interventions targeting loneliness may help reduce somatic symptoms among female NKDs with PTSD or DSO symptoms.