Development and evaluation of a post-traumatic growth promotion programme for North Korean refugees.

North Korean refugees exposed to traumatic events often experience a high recurrence of post-traumatic stress disorder symptoms. However, a post-traumatic growth programme has the potential to transform these traumatic events into increasing post-traumatic growth, reduced emotional stress and enhanced well-being. This study investigated the effects of a post-traumatic growth promotion programme on post-traumatic stress disorder recovery among North Korean refugees. Using a non-equivalent control group non-synchronised pretest-posttest design, 60 North Korean refugees who have been in South Korea for 6-8 or 12-13 years were assigned to the experimental (post-traumatic growth promotion programme; n = 30) or control group (post-traumatic growth promotion education brochure; n = 30). The programme comprised group sessions and discussions, each lasting 120 min/session, conducted twice a week for 5 weeks. Mindfulness, anxiety, depression, blood cortisol and post-traumatic growth were assessed at baseline, immediately after intervention and 4 weeks after intervention. The findings showed the programme was effective in significantly increasing post-traumatic growth and decreasing anxiety, depression and cortisol level. The two-way analysis of variance showed a significant interaction between groups and time. Consequently, this post-traumatic growth promotion programme can be utilised as a non-invasive, cost-effective and safe intervention for promoting post-traumatic growth and well-being among North Korean refugees.

Trauma Exposure, Social Networks, and Suicide Risk Among North Korean Refugee Women in South Korea.

Exposure to adverse life events renders North Korean (NK) refugee women vulnerable to mental health problems, suicide risk being one of the most concerning. We examined bonding and bridging social networks as potential moderators of suicide risk among NK refugee women (N = 212). We found that exposure to traumatic events significantly increased suicidal behavior, but its impact was alleviated if they had a stronger bonding social network. The findings suggest that the negative impact of trauma on suicide can be reduced by strengthening bonding between people with similarities (i.e., family, individuals with the same country of origin).

Depression, Alcohol Misuse, and Suicide Attempt Among North Korean Refugee Women Exposed to Gender-Based Violence.

North Korean (NK) refugee women report a disproportionately high rate of suicide compared to the general South Korean (SK) population. NK refugee women's exposure to gender-based violence (GBV) is a risk factor for adverse mental health symptoms. However, the association between GBV exposure and mental health has received less scholarly attention. This study examined NK refugee women's exposure to GBV (i.e., sexual violence, human trafficking, and forced sex work) and explored whether it is associated with an increased risk of depression, alcohol misuse, and suicide attempts. A three-way interaction between depression, alcohol misuse, and suicide attempts among GBV-exposed NK refugee women was examined. Data from a snowball sample of 180NK refugee women were analyzed for this study. Findings show that 47.8% experienced GBV in either NK or intermediary countries. Multivariate analyses revealed that depression (OR = 1.13, p < .05) and alcohol misuse (OR = 3.01, p < .01) was significantly associated with suicide attempts in GBV-exposed groups. Results from the three-way interaction (GBV victimization × Depression × Alcohol misuse) suggest that GBV exposure and higher levels of depression were significantly associated with suicide attempts among NK refugee women with greater severity of alcohol misuse (OR = 1.75, p < .05). The findings indicate that NK refugee women with GBV exposure, depression, and alcohol misuse are at increased risk for suicide attempts. Study limitations included the use of snowball sampling and cross-sectional data. This study discusses implications for future research and targeted, trauma-informed treatments focused on GBV and mental health symptoms among NK refugee women.

Polyvictimization and Psychological Outcomes Among North Korean Refugee Women.

Korean refugee women are at risk of multiple violent victimizations throughout the migration phases. However, migration's association with mental health outcomes has received little scholarly attention. This study examined North Korean refugee women's exposure to polyvictimization-exposure to both gender-based violence (GBV) and intimate partner violence (IPV)-and explored whether polyvictimization is associated with an increased risk of psychological symptoms. Data from a snowball sample of 212 North Korean refugee women were analyzed. Polyvictimization was operationalized as No victimization (0), Only GBV (1), Only IPV (2), and Both GBV and IPV (3). The associations between polyvictimization and depression, suicidal ideation, suicide attempt, and alcohol use disorder were analyzed with multivariate analyses. Results demonstrated that 46.2% experienced GBV in either North Korea or intermediary countries, and 30.9% were victims of IPV from their current intimate partner in South Korea. Approximately 25% were victims of both GBV and IPV. Multivariate analyses revealed that GBV was the most critical factor for mental health outcomes. North Korean refugee women with only GBV or GBV and IPV had significantly higher depressive symptoms and suicidal ideation severity than those without violence victimization. Risk of suicide attempt was also significantly higher among those with only GBV (OR = 16.52, p = .015) or both GBV and IPV (OR = 9.96, p = .048) than those without any violence victimization. Implications for future research and interventions among North Korean refugee women are also discussed.

'I worked until my body was broken': an ethnomedical model of chronic pain among North Korean refugee women.

OBJECTIVES: While increasing numbers of North Korean refugees (NKRs) are migrating to South Korea, different understandings of physical pain between NKR patients and the South Korean healthcare providers may create miscommunication and less satisfaction with their care management. To identify strategies to improve care, this study elicits and presents an ethnomedical model of chronic pain among NKR women. DESIGN: Twenty semi-structured individual interviews were conducted with NKR women with chronic pain living in South Korea. Inductive and deductive thematic analysis was performed on three types of data: interview transcripts, field notes created after each interview, and memos written during the analysis. RESULTS: Participants reported that pain started after a certain period of resettlement and expressed frustration when there was no definite diagnosis for pain. They identified physical factors (e.g. excessive labor, exposure to violence, and poor diet) as the primary causes, while psychological factors (e.g. loneliness, rumination, and financial burden of sending remittances to North Korea) were viewed as collateral or contributing causes. Several participants indicated emotional discomfort when they were referred to psychiatrists for unceasing pain. Physical treatment (injections, medications, or acupuncture) and providers' sincere attitudes were expectations of care considered capable of addressing both physical and emotional distress. CONCLUSIONS: Findings highlight the need to understand NKR women's ethnomedical model of chronic pain, which is distinct from illness model of healthcare providers. These preliminary findings could be used to improve care strategies based on NKRs' care needs.

Weight Gain Predicts Metabolic Syndrome among North Korean Refugees in South Korea.

Previous cross-sectional studies showed that immigrants from low-income to high-income countries have higher risk of cardiovascular disease and type 2 diabetes mellitus. We investigated the association between weight gain during the resettlement in South Korea and risk of metabolic syndrome (MetS) among North Korean refugees (NKRs) in this cross-sectional study. In total, 932 NKRs aged 20-80 years in South Korea voluntarily underwent health examination from 2008 to 2017. We compared the risk of MetS and its components between the weight gain group (gained ≥5 kg) and the non-weight gain group (gained <5 kg, maintained or lost body weight) during resettlement in South Korea after defection from North Korea. Multiple logistic regression analysis predicted odds ratio of MetS on the basis of weight change, adjusting for covariates and current body mass index (BMI). We also evaluated the difference in body composition of NKRs between two groups. The prevalence of MetS in the weight gain group was 26%, compared to 10% in the non-weight gain group (p-value < 0.001). The weight gain group had a two-fold higher risk of MetS than the non-weight gain group after adjusting for current BMI (odds ratio 1.875, p-value = 0.045). The prevalence of central obesity, impaired fasting glucose, elevated blood pressure, and hypertriglyceridemia were higher in the weight gain group than the non-weight gain group (36% vs. 12%, p-value < 0.001; 32% vs. 19%, p-value < 0.001; 34 vs. 25%, p-value = 0.008; 19% vs. 13%, p-value = 0.025, respectively). The analysis of body composition showed that the percentage of body fat in the weight gain group was higher than in the non-weight gain group, indicating increased fat mass rather than muscle mass in the weight gain group as their body weight increased during resettlement (33.4 ± 6.53% vs. 28.88 ± 7.40%, p < 0.005). Excess weight gain after defection from North Korea increased the risk of MetS among NKRs in South Korea. It is necessary to monitor weight change among NKRs and their effect on their metabolic health in the long term.

Reciprocal Prediction between Impulsivity and Problematic Internet Use among North Korean Refugee Youths in South Korea by Gender and Adverse Childhood Experience.

OBJECTIVE: North Korean refugee youths are at higher risk of developing a wide array of psychosocial sequelae, including increased impulsivity and problematic internet use. We aimed to identify reciprocal temporal relationships by performing autoregressive cross-lagged modeling and to examine how these relations differ by gender and adverse childhood experience. METHODS: We used the follow-up data of 108 North Korean refugee youths in South Korea over a 1-year period. The Barratt Impulsivity Scale-Brief and Young's Internet Addiction Test were used to assess impulsivity and problematic internet use, respectively. RESULTS: Autoregressive effects were significant across all groups, indicating that impulsivity and problematic internet use were stable across time; however, prospective prediction of problematic internet use from impulsivity was not significant across all groups. Problematic internet use at baseline positively predicted impulsivity at after 1 year of follow up in only males and individuals with adverse childhood experience. CONCLUSION: Our findings suggest that the negative effect of problematic internet use (i.e., increased impulsivity) among North Korean refugee youths may be more profound in males and those with adverse childhood experience. We present possible explanations for these findings and discuss the implications for targeted interventions.

Factors Affecting Changes in the Mental Health of North Korean Refugee Youths: A Three-Year Follow-Up Study.

This study identified factors affecting changes in depression of 64 North Korean refugee youths (NKRYs) aged 13 to 23 years (40 female) using follow-up data over a three-year period. We collected intrapersonal factors (emotional regulation strategies, resilience, quality of life) and external factors (psychological and practical support, family adaptation, and cohesion) to understand the preventative and risk factors affecting changes in depression. The trend of depression symptoms significantly increased, and the proportion of people classified as depressed (cut-off score = 21) increased steadily from 45.3% to 59.4% in the third year. In addition, we conducted a panel regression analysis, which showed that individual internal factors had a statistically significant effect on changes in depression. Specifically, expressive suppression of emotions was shown to increase depression over time. Resilience and life satisfaction were significant factors reducing depression in this study. On the other hand, external factors were not significantly related to changes over time in depression of NKRYs. Interventions for NKRYs at risk of depression are necessary and should include ways to enhance resilience and life satisfaction, and foster ego strength by recognizing emotions and promoting healthy emotional expression.

Testing the pathway from pre-migration sexual violence to suicide-related risk among North Korean refugee women living in South Korea: do social networks matter?

PURPOSE: To examine the pathways from pre-migration sexual violence to suicide-related risk via the lack of important social networks among North Korean refugee women living in South Korea. METHODS: As part of a larger study, cross-sectional social network data from 273 North Korean refugee women aged 19 or older (M = 41 years; range = 19-69) were collected by self-reported surveys from April to May 2014 in South Korea. Snowball sampling was used for participant recruitment. We analyzed whether lack of network diversity and lack of kin ties mediated the association between pre-migration sexual violence and suicide-related risk in two multivariable mediation analyses. RESULTS: The prevalence of past-year suicide-related risk was 34.4% in our study sample, and 31.1% of the participants reported at least one type of pre-migration sexual violence. Pre-migration sexual violence was associated with increased suicide-related risk. Lack of network diversity (b = 0.03, 95% CI 0.01-0.07) and lack of kin ties (b = 0.03, 95% CI 0.01-0.08) partially mediated this association. CONCLUSION: Assessment of pre-migration sexual violence victimization needs to begin at an early stage of resettlement. Study findings highlight the urgent need to create suicide prevention programs that incorporate social network interventions, especially for North Korean refugee women who have experienced sexual violence during migration.

Corrigendum: The Contribution of Posttraumatic Stress Disorder and Depression to Insomnia in North Korean Refugee Youth.

[This corrects the article DOI: 10.3389/fpsyt.2019.00211.].

The effect of early trauma on North Korean refugee youths' mental health: Moderating effect of emotional regulation strategies.

Research shows that North Korean refugee youths are exposed to early traumatic events and are, therefore, vulnerable to mental health problems. We investigated the relationship between early trauma and emotion regulation strategies with symptoms of depression and attention-deficit hyperactivity disorder (ADHD) among North Korean refugee youths. In 2017-2018, we surveyed youths attending alternative schools for North Korean refugees in Seoul. One hundred and fifty-seven students (54 boys, 103 girls; 18.66 ± 2.82 years) completed questionnaires assessing early trauma experiences, emotion regulation strategies, depressive symptoms, and ADHD symptoms. Descriptive, correlation, and moderation analyses were conducted. Early trauma experience directly and negatively affected both the depressive and ADHD symptoms of North Korean refugee youths. The use of expressive suppression strategy significantly aggravated these effects of early trauma on both depressive and ADHD symptoms, indicating that it might be a risk factor for mental health problems among them. Contrarily, cognitive reappraisal seemed to buffer the effect of the expressive suppression strategy on depressive symptoms. A tailored intervention promoting emotion regulation strategies to prevent depressive and ADHD symptoms among this group is necessary.

Factors Related to Change in Depression among North Korean Refugee Youths in South Korea.

This study investigated change in depression and revealed factors related to change using one-year follow-up data. A sample of 108 North Korean Refugee Youths (NKRYs) aged 13 to 26 years (66 females) was recruited from two alternative schools for NKRYs in South Korea. Based on the Center for Epidemiologic Studies Depression Scale cut-off score of 16, respondents were grouped based on change in depression score after one year as stable low, alleviated, deteriorated, or prolonged. Multinomial logistic regression assessed the influence of baseline psychological scores (resilience, emotional regulation strategy, and self-esteem), and reported social support (psychological/practical) on the odds of group classification. With the stable low group as the reference category, those with alleviated depression at Time 2 had significantly higher odds of expressive suppression and tended to have lower self-esteem at Time 1. The deteriorated depression group was more likely than the stable low group to have lower resilience and cognitive appraisal scores. Those with prolonged high depression were more likely than the stable low group to have lower resilience, less practical social support, and lower self-esteem. Psychological interventions, particularly those focused on increasing self-esteem and resilience, could be helpful for NKRYs with potential risk of depression. In addition, practical support should be provided on an as-needed basis to prevent chronic depression among NKRYs.

The Contribution of Posttraumatic Stress Disorder and Depression to Insomnia in North Korean Refugee Youth.

Refugees are exposed to multiple traumatic and stressful events and thereby are at higher risk for developing a variety of psychological sequelae including posttraumatic stress disorder (PTSD). However, the relation of PTSD to other mental health conditions has not been fully revealed in refugee populations. The present study investigated relationships among trauma exposure, PTSD, depression, and insomnia in North Korean refugee youth. Seventy-four refugee youth were assessed for exposure to traumatic events, PTSD, depression, and insomnia symptoms. The results showed high rates of multiple trauma exposures among the refugee youth and high incidences of co-occurring symptoms of PTSD and insomnia in those who have multiple trauma. Furthermore, the overall symptoms and four cluster symptoms of PTSD were strongly correlated with insomnia in addition to depression. In the path model to predict insomnia, PTSD affected insomnia only through depression, indicating that the greater the levels of PTSD suffered, the greater the likelihood for developing sleep problems via depression. The present study indicates how sleep problems relate to trauma-related symptoms, i.e., PTSD and depression in refugee populations, and highlights the need for further investigation of the specific relation between sleep problems and trauma-related symptoms for effective evaluation and intervention.

Pre-migration Trauma, Repatriation Experiences, and PTSD Among North Korean Refugees.

Many studies on refugees suggested that refugees' traumatic events associated with post-traumatic stress disorder (PTSD). However, it is unknown whether refugees' PTSD was caused by their negative experience before or after the entry of their destination country. Thus, a separation of refugees' pre-migration from their post-migration experience is particularly important in understanding the causal impact of trauma. Using a sample from North Korean refugees, this study investigates the prevalence of PTSD symptoms, the impact of tortured trauma, repatriation experiences, on PTSD among North Korean refugees (n = 698). We found that North Korean refugees in our sample (a) demonstrated a high rate of current probable PTSD; (b) were demonstrated a higher frequency of repatriation experiences with a greater risk for PTSD symptoms. The findings suggest that particular types of trauma for populations with particular socio-demographic characteristics may be at a greater risk of PTSD.

Correlates of Domestic Violence Victimization Among North Korean Refugee Women in South Korea.

Although many North Korean (NK) refugee women are victims of domestic violence (DV) in North Korea, face sexual exploitation during migration, and remain at risk of DV while adapting to life in South Korea, there is no empirical evidence about risk factors for DV in this population. To fill this gap, this study examined whether gender role beliefs, child abuse history, and sociocultural adaptation were associated with past-year physical, emotional, sexual, and economic abuse, and whether they were associated with multiple forms of abuse. We also explored whether these associations were similar or different across different types of DV among NK refugee women. A sample of 180 ever-married NK refugee women in South Korea from the 2010 National Survey on Family Violence was used for analysis. Physical abuse was associated with more traditional gender role beliefs; emotional abuse and multiple forms of abuse were associated with lower levels of sociocultural adaptation; and sexual and economic abuse were associated with an increased likelihood of childhood abuse and poor sociocultural adaptation. Our study findings underscore the importance of assisting NK refugee women to be better adapted to the new culture in a practical way, because better sociocultural adaptation might protect them from experiencing various types of abuse. At the same time, findings of this study highlight the need for empowering NK refugee women who report physical abuse by educating their rights and altering their traditional beliefs of gender roles, and screening of childhood abuse and providing culturally sensitive psychotherapy to those who report sexual or economic abuse. Moreover, we suggest future studies to examine correlates of different forms of abuse separately because they can inform culturally tailored interventions for abused NK refugee women. To prevent further victimization, educational programs should be provided to NK refugee women at an early stage of resettlement in South Korea.

Mental health status of North Korean refugees in South Korea and risk and protective factors: a 10-year review of the literature.

Background: North Korean refugees (NKRs) are often exposed to traumatic events in North Korea and during their defection. Furthermore, they face sociocultural barriers in adapting to the new society to which they have defected. Objective: To integrate previous findings on this mentally vulnerable population, we systematically reviewed articles on the mental health of NKRs in South Korea. Method: We searched for empirical studies conducted in the last 10 years in six online databases (international journals: Embase, PubMed, Scopus, Web of Science; Korean journals: DBPIA, KMbase) through June 2017. Only quantitative studies using new empirical data on the mental health of NKRs were included. We summarized the 56 studies ultimately selected in terms of NKRs' mental health status and three domains of associated factors: pre- and post-settlement factors and personal factors. Results: NKRs had a high prevalence and severity of psychiatric symptoms, particularly post-traumatic stress disorder and depression. We identified nine risk factors consistently found in previous studies, including traumatic experience, longer stay periods in third country, forced repatriation, acculturative stress, low income, older age, poor physical health, and female and male sex, as well as four protective factors, including educational level in North Korea, social support, family relationship quality, and resilience. Conclusions: We suggest that future studies focus on the causal interactions between different risk and protective factors and mental health outcomes among NKRs from a longitudinal perspective. Furthermore, comprehensive policies for NKRs' psychological adaptation are needed, particularly the development of evidence-based mental health interventions.

Planteamiento: Los refugiados de Corea del Norte (RCN) suelen estar expuestos a eventos traumáticos en Corea del Norte y durante su deserción. Además, se enfrentan a barreras socioculturales a la hora de adaptarse a la nueva sociedad a la que han desertado. Objetivo: Para integrar los hallazgos previos sobre esta población mentalmente vulnerable, revisamos sistemáticamente artículos sobre la salud mental de los RCN en Corea del Sur. Método: Buscamos estudios empíricos realizados en los últimos 10 años en seis bases de datos en internet (revistas internacionales: Embase, PubMed, Scopus, Web of Science, revistas coreanas: DBPIA y KMbase) hasta junio de 2017. Solo se incluyeron estudios cuantitativos que usaban nuevos datos empíricos sobre la salud mental de los RCN. Se resumieron los 56 estudios seleccionados en última instancia en términos de estado de salud mental de los RCN y tres dominios de factores asociados: factores pre y post-establecimiento y factores personales. Resultados: Los RCN presentaron una alta prevalencia y gravedad de síntomas psiquiátricos, particularmente trastorno de estrés postraumático y depresión. Se identificaron nueve factores de riesgo encontrados consistentemente en estudios previos, los cuales incluyen experiencias traumáticas, períodos de permanencia más prolongados en el tercer país, repatriación forzada, estrés por aculturación, bajos ingresos, edad avanzada, mala salud física, y sexo femenino y masculino, así como cuatro factores de protección, que incluyen nivel educativo en Corea del Norte, apoyo social, calidad de la relación en la familia y la capacidad de recuperación o resiliencia. Conclusiones: Sugerimos que en el futuro, los estudios se centren en las interacciones causales entre los diferentes factores de riesgo y de protección y los resultados de salud mental entre los RCN desde una perspectiva longitudinal. Además, se necesitan políticas globales para la adaptación psicológica de los RCN, en particular el desarrollo de intervenciones de salud mental basadas en la evidencia.

Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms.

OBJECTIVE: We investigated the prevalence of insomnia and its clinical characteristics in North Korean refugees. METHODS: North Korean refugees living in South Korea (48 males, 129 females; mean age 38.22±12.24 years) and South Koreans (112 males, 203 females; mean age 39.48±10.32 years) completed the following questionnaires: the Self-reported Questionnaire on Insomnia, Center for Epidemiological Studies-Depression Scale (CES-D), Trauma Exposure Check List for North Korean Refugees, and the Impact of Event Scale-Revised (IES-R). RESULTS: North Korean refugees had insomnia more often than South Koreans did (38.42% vs. 8.89%). Depression combined with insomnia was also more prevalent in North Korean refugees (28.25% vs. 3.17%). Compared with South Koreans with insomnia, North Korean refugees with insomnia showed higher CES-D scores. The North Korean refugees with insomnia had experienced a larger number of traumatic events, and had higher CES-D and IES-R scores compared to North Korean refugees without insomnia. Insomnia in North Korean refugees was also associated with the presence of significant depressive and post-traumatic stress disorder (PTSD) symptoms. CONCLUSION: Insomnia was common in North Korean refugees and was closely associated with depressive and PTSD symptoms. Our study suggests that complaints of insomnia may indicate more severe psychopathology, especially in refugees.

Posttraumatic Stress Disorder as a Mediator Between Trauma Exposure and Comorbid Mental Health Conditions in North Korean Refugee Youth Resettled in South Korea.

A structural equation model was used to investigate the relationship between trauma exposure and comorbid mental health problems and the mediation effect of posttraumatic stress disorder (PTSD) between trauma and mental health variables. The research model is based on the stress-vulnerability conceptual framework in which PTSD as a comorbid disorder mediates the relationship between trauma exposure and mental health problems. A self-administered survey was administered to 144 North Korean refugee youth residing in South Korea. Trauma exposure, both interpersonal and noninterpersonal, had no direct relationship with comorbid mental health problems. However, interpersonal trauma contributed to comorbid mental health problems through PTSD, demonstrating the mediation effect of PTSD and supporting the stress-vulnerability hypothesis of the current research model. Clinical implications of the study and future direction for research are discussed.

Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms

OBJECTIVE: We investigated the prevalence of insomnia and its clinical characteristics in North Korean refugees. METHODS: North Korean refugees living in South Korea (48 males, 129 females; mean age 38.22+/-12.24 years) and South Koreans (112 males, 203 females; mean age 39.48+/-10.32 years) completed the following questionnaires: the Self-reported Questionnaire on Insomnia, Center for Epidemiological Studies-Depression Scale (CES-D), Trauma Exposure Check List for North Korean Refugees, and the Impact of Event Scale-Revised (IES-R). RESULTS: North Korean refugees had insomnia more often than South Koreans did (38.42% vs. 8.89%). Depression combined with insomnia was also more prevalent in North Korean refugees (28.25% vs. 3.17%). Compared with South Koreans with insomnia, North Korean refugees with insomnia showed higher CES-D scores. The North Korean refugees with insomnia had experienced a larger number of traumatic events, and had higher CES-D and IES-R scores compared to North Korean refugees without insomnia. Insomnia in North Korean refugees was also associated with the presence of significant depressive and post-traumatic stress disorder (PTSD) symptoms. CONCLUSION: Insomnia was common in North Korean refugees and was closely associated with depressive and PTSD symptoms. Our study suggests that complaints of insomnia may indicate more severe psychopathology, especially in refugees.

The Early Childhood Caring Experience of North Korean Refugee Mothers

PURPOSE: This study was done to develop a theory on the early childhood caring experience of North Korean refugee mothers and how such caring affects how they deal with the socio-psychological problems they face as North Korean refugees. METHODS: Data were gathered by in-depth interviews, participant observation, and medical records, and were analyzed using the Grounded Theory methods of Strauss and Corbin (1998). RESULTS: From open coding 62 concepts, 23 subcategories and 11 categories were derived, and the North Korean refugee mothers' caring experience was revealed to be 'hopeful upbringing'. A central theme common to the participants was 'coexistence of expectations and worries'. CONCLUSION: The results of this study provide theoretical grounds to understand North Korean refugee mothers' child care experiences and offer personalized nursing and a deeper understanding of their needs by looking at their experience. Findings may also be useful to help nurses who care for North Korean refugee mother-child dyads in the community and in clinical settings to gain insight on this special needs group, and facilitate the development of interventions based on better understanding of the mothers' experiences.