Korean Clinical Psychology Association

Korean Journal of Clinical Psychology - Vol. 40 , No. 3

[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 40, No. 3, pp.208-220
Abbreviation: KJCP
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 30 Aug 2021
Received 25 Feb 2021 Revised 06 May 2021 Accepted 24 May 2021
DOI: https://doi.org/10.15842/kjcp.2021.40.3.003

사회적 인정이 국가폭력 생존자의 완전정신건강에 미치는 영향
김재웅1 ; 김석웅2 ; 한홍구3 ; 최현정1,
1충북대학교 심리학과

Impact of Social Acknowledgment on Complete Mental Health of State Violence Survivors
Jae-Woong Kim1 ; Seok-Woong Kim2 ; Hong-gu Han3 ; Hyunjung Choi1,
1Department of Psychology, Chungbuk National University, Cheongju, Korea
2Psychologist Group for Mental Health Care, Gwangju, Korea
3Sungkonghoe University, Seoul, Korea
Correspondence to : Hyunjung Choi, Department of Psychology, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Korea; E-mail: hchoi@g.cbnu.ac.kr

© 2021 Korean Clinical Psychology Association
Funding Information ▼


본 연구는 한국에서 국가폭력을 경험한 사람의 정신건강에 영향을 미치는 사회적 인정의 영향력을 완전정신건강 모형에 근거하여 확인하고자 하였다. 이를 위하여 국가 폭력을 직접 경험한 당사자 138명의 참여로 국가폭력 외상 경험에 대한 현재 주관적 고통감, 국가폭력 외상후 사회적 스트레스 경험에 대한 현재 주관적 고통감, 복합외상후스트레스 장애 증상, 정신적 웰빙을 측정하였다. 국가폭력 후 사회적 스트레스 경험에 대한 주관적 고통감은 주축 요인분석을 통해 일곱 개 요인으로 구분되었고 그중에 사회적 인정 부재와 관련하여 사회제도적 비승인, 국가 비승인, 관계적 비승인의 3요인을 확인하였다. 다중 로지스틱 회귀분석 결과 완전 및 양호 정신건강 집단을 근거로 했을 때, 국가 비승인과 관계적 비승인이 쇠약 및 후유증 집단의 위험요인으로 나타났다. 회복에서 후유증 뿐만 아니라 정신적 웰빙 역시 고려해야 한다. 정의 추구, 사과, 배상과 같은 정부의 사회적 인정은 국가 폭력 생존자의 CPTSD 증상과 정신적 웰빙과 관련된 중요한 요인으로, 회복은 이러한 인정의 토대 위에서 구축해야 할 것이다.


This study examined the effect of social acknowledgement on the mental health of individuals who have experienced state violence in Korea based on the complete mental health model. A total of 138 state violence survivors completed surveys measuring perceived distress from state violence trauma and post-state violence social stressors, complex posttraumatic stress disorder (CPTSD) symptoms, and mental well-being. Conducting a principal axis factoring (PAF) of the post-state violence social stressors, we identified seven factors including three factors related to the absence of social acknowledgment, namely, socio-institutional disapproval, disapproval from state, and relational disapproval. A multiple logistic regression analysis showed that disapproval from state and relational disapproval were risk factors for the languishing and syndrome group, in reference to the complete to moderate mental health group. For recovery, mental well-being should be considered, in addition to symptoms. The government’s social acknowledgment, including seeking justice, apologizing, and making reparation, is a crucial factor related to CPTSD symptoms and mental well-being of survivors of state violence, and seeking recovery should be built upon this acknowledgment.

Keywords: state violence, social acknowledgment, complex posttraumatic stress disorder, complete mental health model
키워드: 국가폭력, 사회적 인정, 복합외상후스트레스장애, 완전정신건강 모형


This study was supported by the Ministry of the Interior and Safety.

Author contributions statement

Jae-Woong Kim, M.A., analyzed data, and prepared and developed the manuscript. Seok-Woong Kim, Ph.D. made critical revision of the manuscript. Hong-gu Han, Ph.D., as the principal investigator of the primary research administered data collection. Hyunjung Choi, Ph.D., conceived the research, analyzed data, and revised the manuscript. All authors have none to declare and all approved the final submission.

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publication.
2. Barbieri, A., Visco-Comandini, F., Alunni Fegatelli, D., Schepisi, C., Russo, V., Calò, F., . . . Stellacci, A. (2019). Complex trauma, PTSD and complex PTSD in African refugees. European journal of psychotraumatology, 10, 1700621.
3. Ben‐Ezra, M., Karatzias, T., Hyland, P., Brewin, C. R., Cloitre, M., Bisson, J. I., . . . Shevlin, M. (2018). Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD‐11 proposals: A population study in Israel. Depression and anxiety, 35, 264-274.
4. Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., . . . Somasundaram, D. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical psychology review, 58, 1-15.
5. Brodaty, H., Joffe, C., Luscombe, G., & Thompson, C. (2004). Vulnerability to post‐traumatic stress disorder and psychological morbidity in aged holocaust survivors. International Journal of Geriatric Psychiatry, 19, 968-979.
6. Charuvastra, A., & Cloitre, M. (2008). Social bonds and posttraumatic stress disorder. Annual Review of Psychology, 59, 301-328.
7. Choi, H., Kim, N., & Lee, A. (2021). ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among organized violence survivors in modern South Korean history of political oppression. Anxiety, Stress, & Coping, 1-12.
8. Choi, H., & Lee, H. J. (2016). The process of forming a narrative identity of torture survivors in modern Korean history. Korean Journal of Gestalt Counseling, 6, 29-58.
9. Choi, H., Lee, H. J., & Lee, H. Y. (2017). The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors. International journal of psychology, 52, 57-66.
10. Choi, H., Lee, H. Y., & Lee, H. J. (2012). Psychiatric diagnoses of torture survivors. Journal of Korean Neuropsychiatric Association, 51, 127-133.
11. Choi, H., Lee, W., & Hyland, P. (2021). Factor structure and symptom classes of ICD-11 complex posttraumatic stress disorder in a South Korean general population sample with adverse childhood experiences. Child Abuse & Neglect, 114, 104982.
12. Choi, S. C., & Kim, K. B. (2000). The Internal Structure of the Korean Social Face. Korean Journal of Social and Personality Psychology, 14, 185-202.
13. Cloitre, M., Hyland, P., Bisson, J. I., Brewin, C. R., Roberts, N. P., Karatzias, T., & Shevlin, M. (2019). ICD‐11 posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: a population‐based study. Journal of Traumatic Stress, 32, 833-842.
14. Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., . . . Hyland, P. (2018). The International Trauma Questionnaire: Development of a self‐report measure of ICD‐11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138, 536-546.
15. Floyd, F. J., & Widaman, K. F. (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment, 7, 286.
16. Forstmeier, S., Kuwert, P., Spitzer, C., Freyberger, H. J., & Maercker, A. (2009). Posttraumatic growth, social acknowledgment as survivors, and sense of coherence in former German child soldiers of World War II. The American Journal of Geriatric Psychiatry, 17, 1030-1039.
17. Gleeson, C., Frost, R., Sherwood, L., Shevlin, M., Hyland, P., Halpin, R., . . . Silove, D. (2020). Post-migration factors and mental health outcomes in asylum-seeking and refugee populations: A systematic review. European Journal of Psychotraumatology, 11, 1793567.
18. Herman, J. (1997). Trauma and recovery (pp. 155-174). New York: Basic Books.
19. Hyland, P., Ceannt, R., Daccache, F., Abou Daher, R., Sleiman, J., Gilmore, B., . . . Vallières, F. (2018). Are posttraumatic stress disorder (PTSD) and complex-PTSD distinguishable within a treatment-seeking sample of Syrian refugees living in Lebanon? Global Mental Health, 5.
20. Hyland, P., Shevlin, M., Brewin, C. R., Cloitre, M., Downes, A. J., Jumbe, S., . . . Roberts, N. P. (2017). Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta Psychiatrica Scandinvica, 136, 313-322.
21. Jason, L. A., & Aase, D. M. (2016). Community-clinical psychology. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, & M. M. Domenech Rodríguez (Eds.), APA handbook of clinical psychology: Roots and branches (pp. 201-222). Washington, DC, US: American Psychological Association.
22. Jeong, H. J., Oh, S., Lee, Y. H., Park, J. K., Shin, H. K., Kim, S. W., & Jeong, M. I. (2015). A study on psychological trauma of victim and victim’s families due to state violence before and during the Korean War. Journal of Democracy and Human Rights, 15, 385-414.
23. Karatzias, T., Cloitre, M., Maercker, A., Kazlauskas, E., Shevlin, M., Hyland, P., . . . Brewin, C. R. (2017). PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania. European Journal of Psychotraumatology, 8, 1418103.
24. Kazlauskas, E., Gegieckaite, G., Hyland, P., Zelviene, P., & Cloitre, M. (2018). The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services. European journal of Psychotraumatology, 9, 1414559.
25. Kazlauskas, E., Želvienė, P., Eimontas, J., & Gegieckaitė, G. (2017). Association between social acknowledgment and trauma disclosure. Health Sciences in Eastern Europe, 27, 122-127.
26. Keyes, C. L. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207-222.
27. Keyes, C. L. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539.
28. Keyes, C. L., Wissing, M., Potgieter, J. P., Temane, M., Kruger, A., & Van Rooy, S. (2008). Evaluation of the mental health continuum–short form (MHC–SF) in setswana‐speaking South Africans. Clinical Psychology & Psychotherapy, 15, 181-192.
29. Kim, J. (2013). The reconstruction of “Historical Taruma” concept. A Journal of Philosophical Thought in Korea, 24, 37-64.
30. Kim, S. W. (2019). The impact of impunity on psychological state of state violence families. Journal of Democracy and Human Rights, 19, 37-73.
31. Lim, Y. J., Ko, Y. G., Shin, H. C., & Cho, Y. R. (2012). Psychometric evaluation of the mental health continuum-short form (MHC-SF) in South Koreans. Korean Journal of Psychology: General, 31, 369-386.
32. Lis-Turlejska, M., Szumiał, S., & Drapała, I. (2018). Posttraumatic stress symptoms among Polish World War II survivors: The role of social acknowledgement. European Journal of Psychotraumatology, 9, 1423831.
33. Maercker, A., & Hecker, T. (2016). Broadening perspectives on trauma and recovery: A socio-interpersonal view of PTSD. European Journal of Psychotraumatology, 7, 29303.
34. Maercker, A., & Müller, J. (2004). Social acknowledgment as a victim or survivor: A scale to measure a recovery factor of PTSD. Journal of Traumatic Stress, 17, 345-351.
35. Mueller, J., Moergeli, H., & Maercker, A. (2008). Disclosure and social acknowledgement as predictors of recovery from posttraumatic stress: A longitudinal study in crime victims. The Canadian Journal of Psychiatry, 53, 160-168.
36. Murphy, S., Elklit, A., Dokkedahl, S., & Shevlin, M. (2018). Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11. European Journal of Psychotraumatology, 9, 1457393.
37. Noh, S. S., & Cho, Y. R. (2015). The relationship of mental health to suicidal behavior in the elderly based on the complete mental health model. Korean Journal of Clinical Psychology, 34, 1059-1078.
38. Oh, S. (1991, May). Psychological shock of Gwangju May Peoples’ Movement. Gwangju May Peoples’ Movement 10th Anniversary Nationwide Academic Conference, Gwangju.
39. Oh, S. (2013). National violence and Trauma. Journal of Democracy and Human Rights, 13, 5-12.
40. Oh, S., & Shin, H. K. (2008). The relationship between stress, coping, perceived social support, posttraumatic stress, and mental health of 5.18 victims. Korean Journal of Psychology, 27, 595-611.
41. O’Hare, T., Sherrer, M. V., & Shen, C. (2006). Subjective distress from stressful events and high‐risk behaviors as predictors of PTSD symptom severity in clients with severe mental illness. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 19, 375-386.
42. Osterman, L. L., & Brown, R. P. (2011). Culture of honor and violence against the self. Personality and Social Psychology Bulletin, 37, 1611-1623.
43. Park, K. S. (2012). National violent offence and victim. Democracy Law Riview, 32, 317-338.
44. Rauchfuss, K., & Schmolze, B. (2008). Justice heals: The impact of impunity and the fight against it on the recovery of severe human rights violations’ survivors. Torture, 18, 38-50.
45. Rizkalla, N., & Segal, S. P. (2018). Well‐being and posttraumatic growth among syrian refugees in Jordan. Journal of Traumatic Stress, 31, 213-222.
46. Shacknove, A. E. (1985). Who is a Refugee? Ethics, 95, 274-284.
47. Sleijpen, M., Haagen, J., Mooren, T., & Kleber, R. J. (2016). Growing from experience: An exploratory study of posttraumatic growth in adolescent refugees. European Journal of Psychotraumatology, 7, 28698.
48. Sonis, J., Gibson, J. L., De Jong, J. T., Field, N. P., Hean, S., & Komproe, I. (2009). Probable posttraumatic stress disorder and disability in Cambodia: Associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials. JAMA, 302, 527-536.
49. Tozer, M., Khawaja, N. G., & Schweitzer, R. (2018). Protective factors contributing to wellbeing among refugee youth in Australia. Journal of Psychologists and Counsellors in Schools, 28, 66-83.
50. Ullman, S. E., & Peter‐Hagene, L. (2014). Social reactions to sexual assault disclosure, coping, perceived control, and PTSD symptoms in sexual assault victims. Journal of Community Psychology, 42, 495-508.
51. Ullman, S. E., Townsend, S. M., Filipas, H. H., & Starzynski, L. L. (2007). Structural models of the relations of assault severity, social support, avoidance coping, self-blame, and PTSD among sexual assault survivors. Psychology of Women Quarterly, 31, 23-37.
52. Van der Boor, C. F., Amos, R., Nevitt, S., Dowrick, C., & White, R. G. (2020). Systematic review of factors associated with quality of life of asylum seekers and refugees in high-income countries. Conflict and Health, 14, 1-25.
53. Woodhouse, S., Brown, R., & Ayers, S. (2018). A social model of posttraumatic stress disorder: Interpersonal trauma, attachment, group identification, disclosure, social acknowledgement, and negative cognitions. Journal of Theoretical Social Psychology, 2, 35-48.
54. World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Geneva: WHO; 2018. Retrieved from https://icd.who.int/browse11/l-m/en