Post-Resettlement Social Stigma and Post-Traumatic Stress Disorder Symptoms Among North Korean Refugees in South Korea: A Cross-Sectional Study

BACKGROUND: North Korean refugees (NKRs) are exposed to severe cumulative trauma before and during migration, yet their post-traumatic stress disorder (PTSD) symptoms may also be related to the social environment they encounter after resettlement. AIMS: To examine whether post-resettlement social stigma and self-concealment are associated with PTSD symptoms among NKRs after adjustment for pre-migration trauma exposure and post-resettlement socioeconomic conditions, and to explore whether the stigma-PTSD association differs by self-concealment, gender, age, or household income. METHODS: This cross-sectional study analyzed data from 410 NKRs who participated in the 2023 Survey on the Family and Social Life of North Korean Refugees in South Korea, designed and conducted directly by the principal investigator and the research team. Hierarchical regression analyses used a refined nine-item stigma score and heteroskedasticity-consistent standard errors. RESULTS: Social stigma was associated with PTSD symptoms (B = 0.257, β = .31, p < .001) after adjustment for gender, age, length of residence, and pre-migration trauma exposure, and the association remained after additional adjustment for household income, education, marital status, and social support. Self-concealment was independently associated with symptoms (B = 0.111, p = .003). The stigma × self-concealment interaction was not significant with the refined score (p = .074) and is reported as an exploratory, measurement-sensitive finding. There was no evidence that the stigma-PTSD association differed by gender or age, but it was tentatively stronger in the lowest income group. CONCLUSIONS: Post-resettlement social stigma was associated with PTSD symptoms after adjustment for pre-migration trauma exposure and socioeconomic conditions. Although the cross-sectional design precludes establishing the direction of these associations, the findings provide a rationale for longitudinal and intervention research on stigma in refugee mental health.