Objective:

To quantify mental health and behavioral disparities between North Korean refugee youths (NKRY) and their South Korean peers, and to evaluate the limits of conventional social determinants of health (SDH) frameworks.

Approach:

• Study Design: Cross-sectional analysis using data from the Korea Youth Risk Behavior Survey (KYRBS) from 2011 to 2024.
• Population: Included 876,693 adolescents, categorized into South Korean-origin youth (SKY), NKRY, and international-origin youth (IOY).
• Data Collection: Utilized anonymous, self-administered questionnaires with a multistage, stratified cluster sampling design.
• Outcome Measures: Mental health outcomes included perceived stress, self-rated health, sleep problems, depressive symptoms, and suicidality. Health risk behaviors included smoking, alcohol use, and drug use.
• Analysis: Conducted survey-weighted logistic regression and Fairlie decomposition analysis to assess the explanatory power of conventional SDH variables.

Key Findings:

• Significant mental health disparities exist between NKRY and SKY, even after adjusting for conventional socioeconomic factors.
• Observable demographic, family, and school factors do not fully account for the disparities in mental health outcomes.
• NKRY experience unique structural determinants that contribute to their health inequities.

Interpretation:

The study highlights the inadequacy of conventional SDH frameworks in explaining the mental health disparities faced by NKRY.

Limitations:

• The study relies on self-reported data, which may be subject to bias.
• The cross-sectional design limits causal inferences.
• Potential unmeasured confounding factors may still influence outcomes.

Conclusion:

Substantial inequalities in mental health among NKRY persist beyond conventional socioeconomic explanations.