Sense of coherence is associated with ICD-11 complex PTSD among North Korean defectors

Background: North Korean defectors (NKDs) are exposed to multiple traumatic events and post-resettlement stressors, placing them at elevated risk for stress-related mental health problems. Sense of coherence (SOC) reflects the extent to which individuals perceive life as comprehensible, manageable, and meaningful. Higher SOC has been consistently linked to better mental health and psychological adaptation across diverse populations. However, its association with ICD-11 defined post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) remains underexplored.Objective: This study examined SOC levels and their associations with ICD-11 defined PTSD and CPTSD in NKDs residing in South Korea.Methods: In this cross-sectional study, 202 NKDs completed the Korean version of SOC-13, a checklist of lifetime exposure to traumatic events and ICD-11-aligned self-report measures of depression, anxiety, PTSD, and CPTSD. Pearson correlations and t-tests examined associations between SOC and mental health symptoms. Binary logistic regression assessed whether SOC was independently associated with probable PTSD or CPTSD after controlling for trauma exposure, probable depression, and probable anxiety.Results: Mean SOC was 56.77 ± 11.26. SOC showed significant negative correlations with severity of depression (r = −.394), CPTSD (r = −.378), anxiety (r = −.374), and PTSD (r = −.289; all p < .001). Participants with probable depression, anxiety, and CPTSD had significantly lower SOC scores, whereas SOC did not differ by PTSD status. In logistic regression analyses, higher SOC was significantly associated with lower odds of probable CPTSD (aOR = 0.935, 95% CI [0.878, 0.996]) after controlling for covariates. For probable PTSD, SOC was not associated (aOR = 0.994, 95% CI [0.956, 1.034]).Conclusions: Lower SOC was significantly associated with probable CPTSD among NKDs. These findings suggest that SOC may represent a potentially relevant target for future intervention research among NKDs experiencing CPTSD-related difficulties. Longitudinal studies are needed to clarify the temporal direction of these associations.