Association of Traumatic Events, Post Traumatic Stress Disorder and Sexual Autonomy among Female University Students of North Korean Defectors

Young Jin Lee; Hae Won Kim

doi:10.4069/kjwhn.2019.25.1.46

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Lee and Kim: Association of Traumatic Events, Post Traumatic Stress Disorder and Sexual Autonomy among Female University Students of North Korean Defectors

Original Article

Korean Journal of Women Health Nursing 2019; 25(1): 46-59.

Published online: 25 February 2019

DOI: https://doi.org/10.4069/kjwhn.2019.25.1.46

Association of Traumatic Events, Post Traumatic Stress Disorder and Sexual Autonomy among Female University Students of North Korean Defectors

Young Jin Lee¹

, Hae Won Kim^2,³

¹Graduate Student, College of Nursing, Seoul National University, Seoul, Korea.

²Professor, College of Nursing, Seoul National University, Seoul, Korea.

³Researcher, The Research Institute of Nursing Science, Seoul National University, Seoul, Korea.

Corresponding author: Young Jin Lee. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8465, Fax: +82-2-740-8465, hygiene2@snu.ac.kr

Received 19 November 2018 Revised 27 December 2018 Accepted 31 December 2018

Korean Society of Women Health Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine associations of traumatic events and post-traumatic stress disorder (PTSD) with sexual autonomy and identify factors influencing sexual autonomy among female university students of North Korean defectors.

Methods

A cross-sectional, descriptive study was performed with a total of 103 female students who completed a structured online self-report survey from January 7 to March 31, 2018. This study was conducted using questionnaires on interpersonal trauma scale, the Traumatic Scale for North Korean Refugees (TSNKR), and sexual autonomy measurement for college students. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficients, and multiple linear regression with SPSS WIN 23.0 program.

Results

Traumatic events, PTSD, and sexual autonomy scores were 3.96±3.07, 31.47±10.75, and 52.66±6.89, respectively. PTSD was positively correlated with traumatic events (r=.22, p=.030). Sexual autonomy was inversely correlated with PTSD (r=−.25, p=.010). Contraceptive use, PTSD, and voluntary sexual debut explained 26% of sexual autonomy of participants.

Conclusion

To improve sexual autonomy of young women from North Korea, reproductive intervention programs including contraception, sexual assertiveness training, and psychoeducation to reduce PTSD need to be developed and implemented.

Keywords: Personal autonomy, Post-traumatic stress disorders, Refugees, Sexual health

Figures and Tables

Table 1

General and Sex-related Characteristics of Subjects (N=103)

Characteristics		Categories	n(%)	M±SD	Range
General characteristics
	Age (year)	≤25	54 (52.4)	25.89±2.98	20–36
	Age (year)	≥26	49 (47.6)	25.89±2.98	20–36
	Grade	Freshman	34 (33.0)
		Sophomore	20 (19.4)
		Junior	15 (14.6)
		Senior	26 (25.2)
		Leave of absence	8 (7.8)
	Major	Health-related	33 (32.0)
	Major	Health-unrelated	70 (68.2)
	Religion	Yes	86 (83.5)
	Religion	No	17 (16.5)
	Living with	Alone	42 (40.8)
		With family	44 (42.7)
		With friends/others	17 (16.5)
	Length of stay in South Korea (month)	≤60	62 (60.2)	60.95±45.29	2–240
	Length of stay in South Korea (month)	≥61	41 (39.8)	60.95±45.29	2–240
	Length of stay in China or other nation (month)	≤24	78 (75.7)	24.94±40.24	0–264
	Length of stay in China or other nation (month)	≥25	25 (24.3)	24.94±40.24	0–264
Sex-related characteristics
	Sex education	Yes	80 (77.7)
	Sex education	No	23 (22.3)
	Experience of sexual intercourse	Yes	70 (68.0)
	Experience of sexual intercourse	No	33 (32.0)
	Age of sexual debut^† (year)	≤21	39 (55.7)	21.23±2.56	15–30
	Age of sexual debut^† (year)	≥22	31 (44.3)	21.23±2.56	15–30
	Voluntary sexual debut^†	Yes	50 (71.4)
	Voluntary sexual debut^†	No	20 (28.6)
	Contraceptive use^†	Never	13 (18.6)
		Sometimes	12 (17.1)
		Always	45 (64.3)
	Experience of pregnancy^†	Yes	15 (21.4)
	Experience of pregnancy^†	No	55 (78.6)
	Experience of birth^†	Yes	9 (12.9)
	Experience of birth^†	No	61 (87.1)
	Experience of abortion^†	Yes	10 (14.3)
	Experience of abortion^†	No	60 (85.7)

M±SD=mean±standard deviation.

^†Participants with experience of sexual intercourse (n=70).

Table 2

The Degree of Traumatic Events, PTSD and Sexual Autonomy (N=103)

Characteristics	Categories	n(%)	M±SD	Range
Traumatic events^†	Total		3.96±3.07	0–10
	Separation from family^†	84 (81.6)
	Witness death of family or close person^†	54 (52.4)
	Witness death^† (except family or close person)	43 (41.7)
	Family violence^†	31 (30.1)
	Physical assault^† (except family violence)	24 (23.3)
	Sexual assault^†	28 (27.2)
	Verbal violence^†	56 (54.4)
	Interrogation and torture^†	26 (25.2)
	Forced confinement^†	27 (26.2)
	Identity threat^†	36 (35.0)
PTSD	Total score		31.47±10.75	16–62
PTSD	Item score		1.97±0.67	1–4
Sexual	Total score		52.66±6.89	36–65
Autonomy	Item score		4.05±0.53	1–5

M±SD=mean±standard deviation; PTSD=post-traumatic stress disorder.

^†Multiple responses.

Table 3

Differences in Sexual Autonomy by General and Sex-related Characteristics (N=103)

Characteristics		Categories	Sexual autonomy
Characteristics		Categories	M±SD	t or F	p
General characteristics
	Age	≤25	52.85±7.75	0.30	.769
	Age	≥26	52.45±5.88	0.30	.769
	Grade	Freshman	50.74±5.69	1.10	.362
		Sophomore	53.55±6.51
		Junior	54.53±7.03
		Senior	53.38±7.98
		Leave of absence	52.75±8.31
	Major	Health-related	53.76±7.32	1.11	.269
	Major	Health-unrelated	52.14±6.68	1.11	.269
	Religion	Yes	52.44±6.95	0.72	.472
	Religion	No	53.76±6.69	0.72	.472
	Living with	Alone	53.26±7.01	0.60	.550
		With family	51.80±6.73
		With friends/others	53.41±7.19
	Length of stay in South Korea (month)	≤60	51.23±6.15	2.67	.009
	Length of stay in South Korea (month)	≥61	54.83±7.45	2.67	.009
	Length of stay in China or other nation (month)	≤24	53.01±6.62	0.73	.470
	Length of stay in China or other nation (month)	≥25	51.97±7.45	0.73	.470
Sex-related characteristics
	Sex education	Yes	53.01±6.95	0.97	.336
	Sex education	No	51.43±6.69	0.97	.336
	Experience of sexual intercourse	Yes	53.07±6.34	0.88	.381
	Experience of sexual intercourse	No	51.79±7.99	0.88	.381
	Age of sexual debut^† (year)	≤21	52.36±6.70	1.06	.295
	Age of sexual debut^† (year)	≥22	53.97±5.83	1.06	.295
	Voluntary sexual debut^†	Yes	54.50±6.09	3.17	.002
	Voluntary sexual debut^†	No	49.50±5.61	3.17	.002
	Contraceptive use^†,‡	Never^a	50.23±4.69	6.39	.003
		Sometimes^b	49.17±3.64
		Always^c	54.93±6.60
	Experience of pregnancy^†	Yes	50.20±5.94	2.02	.047
	Experience of pregnancy^†	No	53.85±6.26	2.02	.047
	Experience of birth^†	Yes	49.00±6.89	2.12	.038
	Experience of birth^†	No	53.67±6.08	2.12	.038
	Experience of abortion^†	Yes	49.30±4.00	2.90	.009
	Experience of abortion^†	No	53.70±6.46	2.90	.009

M±SD=mean±standard deviation.

^†Participants with experience of sexual intercourse (n=70); ^‡Scheffé post hoc test (a,b<c).

Table 4

Correlations of Traumatic Events, PTSD and Sexual Autonomy (N=103)

Variables	Traumatic events	PTSD
Variables	r (p)	r (p)
PTSD	.22 (.030)	-
Sexual autonomy	−.02 (.855)	−.25 (.010)

PTSD=post-traumatic stress disorder.

Table 5

Influencing Factors on Sexual Autonomy (N=70)

Variables	B	SE	β	t	p
(Constant)	52.74	2.91	-	18.12	<.001
Contraceptive use^† (1=always)	4.06	1.40	.31	2.90	.005
PTSD	−0.15	0.07	−.24	−2.15	.035
Voluntary sexual debut^† (1=yes)	3.27	1.52	.24	2.15	.035
	Adj. R²=.26, F=9.03, p<.001

SE=standard error; PTSD=post-traumatic stress disorder; Adj. R²=adjusted coefficient of determination R².

^†Dummy variable: contraceptive use (1=always,0=never,0=sometimes), voluntary sexual debut (1=yes,0=no).

Notes

^{Conflicts of Interest} The authors declared no conflict of interest.

^{Author Contributions}

Conceptualization: Kim HW, Lee YJ.
Data curation: Lee YJ.
Formal analysis: Lee YJ.
Investigation: Lee YJ.
Methodology: Kim HW, Lee YJ.
Supervision: Kim HW.
Validation: Kim HW.
Visualization: Lee YJ.
Writing - original draft: Lee YJ.
Writing - review & editing: Kim HW, Lee YJ.

Summary Statement

• What is already known about this topic?

Most female North Korean defectors are known to have post-traumatic stress disorder (PTSD) which is positively correlated with traumatic experience. Previous studies have shown that women with PTSD have negative sex-related behaviors.
• What this paper adds?

This is the first study to investigate sexual autonomy and PTSD among young female North Korean defectors. Results showed that the greater the severity of PTSD, the lower the sexual autonomy. In addition, this study revealed that PTSD was an influential factor of sexual autonomy. Our findings confirmed that the use of contraception, PTSD, and voluntary sexual debut were influential factors of sexual autonomy.
• Implications for practice, education, and/or policy

When providing reproductive health education for female North Korean defectors, it is necessary to develop educational programs that include discussion of contraception, sexual assertiveness training, and psychological intervention therapies.

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ORCID iDs

Young Jin Lee
https://orcid.org/0000-0003-2471-0325

Hae Won Kim
https://orcid.org/0000-0002-6730-1575

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