Resting-State Functional Connectivity Changes Associated With Post-Traumatic Stress and Anxiety Symptoms in North Korean Refugees

OBJECTIVE: North Korean refugees (NKRs) face substantial mental health challenges related to trauma during escape and resettlement, yet neurobiological research in this population is scarce. We examined resting-state functional connectivity (RSFC) differences between NKRs and South Korean healthy controls (SKCs) and explored associations between psychiatric symptoms and functional connectivity (FC). METHODS: Twenty-eight NKRs and 28 matched SKCs underwent functional magnetic resonance imaging and were assessed for posttraumatic stress disorder (PTSD), depression, and anxiety. Seed-to-voxel FC analysis was performed using the CONN toolbox with previously reported depression- and anxiety-related brain regions as seeds. RESULTS: Among the 28 NKRs, 22 had psychiatric diagnoses, including major depressive disorder and PTSD, and 18 had trauma exposure. NKRs showed significant RSFC alterations, such as lower FC between the right amygdala and visual cortex and between the left dorsolateral prefrontal cortex and postcentral gyrus, and higher FC between the left ventromedial prefrontal cortex and the bilateral putamen and between the right dorsal anterior cingulate cortex and insula. The FC between the right amygdala and visual cortex was negatively correlated with PTSD symptom severity (r=-0.427, p=0.030), and the FC between the right ventral striatum and left cerebellum was negatively correlated with trait anxiety scores (r=-0.416, p=0.035) among the NKRs. CONCLUSION: Our study revealed distinct RSFC changes in NKRs compared with SKCs. These may implicate disturbances in emotional processing, cognitive control over somatosensory processing, reward processing, and heightened anxiety-related attention and adaptive stress responses among NKRs.