This study investigated associations between specific defense mechanisms and life satisfaction among North Korean refugees in South Korea. The results showed that greater use of denial predicted higher overall and economic life satisfaction among North Korean refugees in South Korea, even after controlling for depression, anxiety, and number of traumatic events experienced. Low resignation also predicted higher overall and economic life satisfaction, although this association was affected by depression and anxiety.
As suggested by our primary hypothesis, specific defense mechanisms affected specific domains of life satisfaction. Denial affected life satisfaction independently of psychiatric symptoms such as depression and anxiety. The positive relationship between denial and life satisfaction may indicate that denial leads individuals to rate their subjective life satisfaction as high [33, 34]. Denial is often described as a defense mechanism that protects one’s subjective perception of traumatizing and stressful aspects of given situations [35, 36]. Because individuals who uses denial refuse to recognize the reality of painful conditions, denial could be regarded as a maladaptive defense mechanism. However, some have suggested that denial is not always maladaptive. Rather, it may serve to temporarily distance the individual from stressful events, allowing the person to feel safe and satisfied. One study reported that denial was grouped with other adaptive defense mechanisms including humor, omnipotence, and sublimation in a factor analysis of the DSQ [31]. Especially in unusually tragic situations, several studies have shown that denial served as an adaptive coping strategy [35, 37].
Resignation entails passively accepting a situation by simply not coping with negative events that feel uncontrollable. In a previous study of patients diagnosed with lung cancer, those who showed resignation in the course of accepting the disease reported low quality of life and a negative mood [38]. The present study showed that North Korean refugees who used resignation to cope with stressors had lower overall and economic life satisfaction. However, the effects of resignation on life satisfaction seemed to be influenced by depression or anxiety. Giving up on dealing with situations and holding negative expectations for the future may cause a negative mood that then leads to low life satisfaction.
Among the domains of life satisfaction considered in these North Korea refugees, the overall and economic domains were most strongly related to defense mechanisms; educational, medical, and occupational satisfaction showed less association with defense mechanisms. Generally, the acceptability of education and medical care in a new society depends on the social systems of that community rather than on one’s personal characteristics. In South Korea, the government offers basic educational and medical opportunities equally to all people, including North Korean refugees, so it makes sense that satisfaction with education and medical care was less affected by refugees’ defense mechanisms. On the other hand, as economic status can differ among individuals in a capitalist society such as South Korea, satisfaction with one’s economic status is more strongly associated with individual characteristics. The average period spent in South Korea was less than 3 years. During this period, most refugees participated in a training course or educational program at a government agency before they officially took a job. For this reason, occupational satisfaction would not be likely to be associated with individuals’ defense mechanisms.
If refugees express high life satisfaction even under painful circumstances, it is important to keep in mind that they may be using denial as a defense mechanism. For refugees who use denial and claim a high level of life satisfaction, determining which aspects of denial are helpful to them may provide some insight for mental health practitioners working with refugees. When a refugee expresses dissatisfaction with the situation, it would be helpful to check for depression and anxiety related to feelings of resignation. For refugees who frequently use resignation as a defense, highlighting its negative aspects, such as avoidance of reality, may help to improve the patient's psychiatric symptoms and life satisfaction.
The current study has several limitations. First, this study was conducted using a cross-sectional design. Hence, sufficient evidence for causal relationships between defense mechanisms and life satisfaction is lacking. Furthermore, we did not obtain information about psychiatric symptoms such as depression and anxiety before the traumatic events considered here. Therefore, the effects of such symptoms on life satisfaction in South Korea could not be investigated in this study. Second, over 80% of North Korean refugees in South Korea are female, so it is not surprising that the current study had more female than male participants. Thus, this study may not have sufficiently considered the experiences of male North Korean refugees. Third, even though life satisfaction is subjective, it can be affected by objective economic variables such as employment and income. Refugees’ objective economic status might indicate how well they have adapted to the new social system. In the present study, interpretation of the relationships between objective status, defense mechanisms, and life satisfaction is limited.