Standardization of the korean version of the posttraumatic embitterment disorder self-rating scale

Embitterment in Vietnam War Veterans Predicted by Symptoms of Posttraumatic Stress Disorder

OBJECTIVE

Research on the association between posttraumatic embitterment disorder (PTED) and other psychopathologies in veterans and adults aged ≥65 years is lacking. This study aimed to assess embitterment among elderly war veterans and its association with major psychopathological factors.

METHODS

Participants included Vietnam War veterans who visited a psychiatric clinic. Based on the Posttraumatic Embitterment Disorder Self-Rating Scale (PTEDS) score, the participants were divided into the embitterment (PTED(+), mean score of PTEDS items [mPTEDS] ≥1.6) and non-embitterment (PTED(-), mPTEDS <1.6) groups. Demographic characteristics, combat exposure severity, depression, anxiety, sleep, and alcohol use disorder symptom scores of the participants were collected and compared between the PTED(+) and PTED(-) groups. A correlation analysis between symptom measure scores and the mPTEDS was conducted. The influence of psychopathology on embitterment was investigated using stepwise multiple linear regression analysis.

RESULTS

In total, 60 participants (28 in PTED(+) and 32 in PTED(-)) were included. Among those in PTED(+), 21 (35.0%) showed mild embitterment symptoms (1.6≤ mPTEDS <2.5) and 7 (11.7%) reported moderate or severe embitterment symptoms (mPTEDS ≥2.5). The mean scores of posttraumatic stress disorder (PTSD), depression, and anxiety were significantly higher in the PTED(+) than in the PTED(-) group. The mPTEDS were significantly correlated with PTSD, depression, anxiety, and sleep disorder scores. The PTSD symptoms significantly explained the higher mPTEDS score in a regression model.

CONCLUSION

Embitterment symptoms were associated with PTSD, depression, anxiety, and insomnia symptoms in elderly veterans, similar to the results of prior studies involving only the general population.

Investigating the effectiveness of a smart mental health intervention (inMind) for stress reduction during pharmacological treatment for mild to moderate major depressive disorders: Study protocol for a randomized control trial

Background

Although psychological interventions for stress relief, such as cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), have been developed, they have not been widely used in treating depression. The use of mobile devices can increase the possibility of actual use by integrating interventions and reducing the difficulty and cost burden of treatment application. This study aims to determine whether "inMind," an integrated mobile application for stress reduction, developed for the general population, decreases stress for patients with mild to moderate major depressive disorder during the pharmacological treatment period.

Methods

This study is a single-blind, multicenter, randomized, controlled crossover trial. The App, developed in Republic of Korea, provides integrated interventions for stress reduction for the general population through three modules based on mindfulness-based stress reduction, cognitive behavior therapy, and relaxation sounds that are known to be effective in stress reduction ("meditation," "cognitive approach," and "relaxation sounds," respectively). Participants (n = 215) recruited via medical practitioner referral will be randomized to an App first group (fAPP) or a wait list crossover group (dAPP). The study will be conducted over 8 weeks; the fAPP group will use the App for the first 4 weeks and the dAPP group for the next 4 weeks. During all study periods, participants will receive their usual pharmacological treatment. The Depression Anxiety Stress Scale-21 is the primary outcome measure. The analysis will employ repeated measurements using a mixed-model approach.

Discussion

The App can potentially be an important addition to depression treatment because of its applicability and the comprehensive nature of the interventions that covers diverse stress-relieving models.

Clinical trial registration

https://clinicaltrials.gov/ct2/show/NCT05312203, identifier 2021GR0585.

The Relationship Between Posttraumatic Embitterment Disorder and Stress, Depression, Self-Esteem, Impulsiveness, and Suicidal Ideation in Korea Soldiers in the Local Area

BACKGROUND

The purpose of this study was to identify the prevalence of posttraumatic embitterment disorder (PTED) among soldiers, and examine its relation to stress, depression, self-esteem, impulsiveness, and suicidal ideation.

METHODS

The subjects of this study were 200 soldiers and 197 control subjects, a total of 397 persons. Measurement tools used included the PTED self-rating scale, Stress Response Inventory, Beck Depression Inventory, Rosenberg Self-Esteem Inventory, Barratt Impulsiveness Scale, and Beck Scale of Suicide Ideation.

RESULT

The major findings of the analysis are as follows: first, 11.5% of the soldiers were in the risk group for PTED, and 4% of them had PTED. Second, PTED in the soldiers was significantly associated with a number of variables such as their educational background, stress, depression, self-esteem, impulsiveness, and suicidal ideation, while it was not significantly associated with age. Third, through the hierarchical multiple regression analysis, it was found that academic background, stress, and depression had a statistically significant positive effect on the incidence of PTED in the soldiers.

CONCLUSION

In order to prevent and effectively intervene in PTED in soldiers, there is a need for interventional efforts focused on depression and stress related to negative life events.

Embitterment among the unemployed: A multiple mediation model of belief in a just world

BACKGROUND: The negative consequences of job loss on financial and psychological quality of life have been well documented. OBJECTIVE: This study evaluated the level of unemployed individuals’ embitterment and the mechanism by which negative life experiences increase embitterment by lowering the belief in a just world (BJW). METHODS: A survey was administered to 1,074 unemployed Korean adults who visited a regional Center for Employment and Welfare. Question items included the Korean version of posttraumatic embitterment disorder (PTED) self-rating scale, the BJW (personal and general) scale, negative life events, and sociodemographic characteristics. RESULTS: Only 45.9% of the participants were categorized as being in a ‘normal state,’ indicating that many of the unemployed were emotionally embittered. There was a positive direct effect of an increase in negative life events on embitterment. Negative life events also significantly and indirectly affected embitterment through personal BJW. CONCLUSIONS: Embitterment was prevalent among the unemployed participants and embitterment was a reactive emotion following personal downgrading, not so much related to conditions in the world at large. Thus, we recommend developing a screening program to detect extreme embitterment and an interventional program to help people better cope with emotional stress due to job loss. Efforts should be made to restore their violated expectation and trust that they would be treated in a just and fair way.

The Correlation Function of Communication in an Emotional Domain Observed in the Effect of Media on Embitterment

The media correlation function has mainly been evaluated in cognitive domains from theoretical perspectives, such as agenda-setting, framing, or priming. Here we examined the correlation function in an emotional domain by investigating the association between media use and the degree of embitterment, which is a psychological symptom that originates from the accumulation of negative life experiences. A survey of 1,720 South Koreans revealed that those who had higher frequencies of media use felt a greater degree of embitterment. When different media types were examined, frequent use of print newspapers was associated with a level of embitterment from personal experiences, whereas heavy consumption of the internet and TV news was associated with embitterment from mediated reality. The implications of these findings are addressed in the context of both communication function and social epidemiology.

Second victim phenomenon after patient safety incidents among Korean nursing students: A cross-sectional study

BACKGROUND

Perfectionism in the medical field turns healthcare professionals into second victims of patient safety incidents. They suffer physically and psychologically, which makes them consider changing occupations. Nursing students may also have similar negative experiences during clinical practice.

OBJECTIVE

To describe the second victim phenomenon among nursing students after patient safety incidents during their clinical practice.

DESIGN

A descriptive cross-sectional study using an online questionnaire.

SETTING AND PARTICIPANTS

Fourth-year nursing students (n = 354) who encountered patient safety incidents directly or indirectly during clinical practice. Participants were recruited through convenience and snowball sampling methods using personal contacts, professional networks, and online platforms.

METHODS

The questionnaire addressed the characteristics of patient safety incidents, and physical and psychological responses after the most significant patient safety incident. Descriptive statistics and a chi-square test were performed for data analysis.

RESULTS

Of the participants, 22.6% were directly involved in patient safety incidents and 77.4% had indirectly encountered patient safety incidents, such as witnessing incidents with colleagues or other healthcare professionals. After patient safety incidents, of those, 67.8% experienced shock at the time of the incident, 47.2% feared experiencing a similar incident, and 28.2% were still affected although time had passed. Additionally, 26.3% reported experiencing long-term embitterment; of them, 7.3% were experiencing severe embitterment. Furthermore, 31.9% and 27.1% of the students experienced sleeping and eating difficulties, respectively, and these rates were higher when incidents were encountered directly rather than indirectly.

CONCLUSIONS

Nursing students may become second victims of patient safety incidents during clinical practice. Therefore, nursing education institutions need to develop comprehensive support strategies to help nursing students cope with experiencing the second victim phenomenon.

Importance of connectedness for the management of embitterment and loneliness in the era of COVID-19

Background: Coronavirus disease 2019 (COVID-19) has made ‘untact’ life a new standard (next normal) way of life, minimizing physical contacts among people. Emotional exchanges between people are rapidly being replaced by contact through the Internet, social networks, and over-the-top services.Current Concepts: People are expressing more stress and anxiety that are caused by fear of infection, and also embitterment due to perceived distrust and injustice is increasing. In the era of COVID-19, it is necessary and important to manage burnout, depression, and anxiety symptoms of medical staff and quarantine personnel. The pandemic and the resulting social changes intensifies loneliness, leading to deterioration in mental and physical health. The World Health Organization has warned that loneliness and social isolation are leading to the exacerbation of physical illness and increased mortality due to suicide and other mental health problems.Discussion and Conclusion: It is needed to establish a next standard of mental health service such as untact diagnosis and follow-up support system. Government and society should establish a sustainable system even after the COVID-19 crisis, rather than stopgap measures made with people’s sacrifice as collateral.

Reliability and validity of the Chinese version of the post-traumatic embitterment disorder self-rating scale (PTED-21) among inpatients in general hospital

Embitterment and in some cases also post-traumatic embitterment disorder (PTED) are relevant problem in the general population and even more so in psychiatric patients. PTED screening should be an essential component of routine mental health management, which can be done by the 21-item Post-traumatic Embitterment Disorder Self-Rating Scale (C-PTED-21), which measures the intensity of reactive stimulus bound embitterment. The PTED-21 German version was translated into Chinese, and 200 nonpsychiatric inpatients, reporting major negative life events, were recruited through convenience sampling to evaluate test performance. Ninety patients were selected for retest 2 weeks later to examine scale reliability. Factor analysis was used to assess construct validity and receiving operating characteristic curve analysis based on the "PTED standardized diagnostic interview" to assess diagnostic utility. Correlations with depression, somatic symptom, and anxiety scales were examined to assess aggregate validity. The C-PTED-21 demonstrated high internal consistency (Cronbach's α = 0.944) and good test-retest reliability (total score r = 0.783, individual item r value range, 0.635-0.889). Factor analysis revealed three common factors consistent with PTED core features. Total C-PTED-21 score was strongly correlated with the score on the nine-item Patient Health Questionnaire depression scale (PHQ-9, r = 0.735). Mean PTED-21 score ≥1.6 points distinguished clinical PTED as defined by diagnostic interview with 97.6% sensitivity and 90.5% specificity (AUC = 0.988, 95%CI: 0.976-0.999). The results show that the C-PTED-21 can assess the severity of PTED with good reliability and validity.

Modeling embitterment dynamics: The influence of negative life events and social support mediated by belief in a just world

BACKGROUND

Embitterment is an emotional state as a reaction to negative life events and is characterized as a nagging and burning feeling of being let down, insulted, or being a loser, and of being revengeful but helpless. There have been few studies concerning embitterment dynamics. This study aims to test a structural equation model for embitterment dynamics by examining likely factors that could have contributed to feelings of embitterment.

METHODS

A total of 2024 South Koreans completed Post-Traumatic Embitterment Disorder Self-Rating Scale and Bern Embitterment Inventory, as well as the scales of belief in a just world (BJW), negative life events, and social support.

RESULTS

Experiencing more negative life events was connected to a higher level of embitterment, whereas having more social supports decreased embitterment. As an indirect effect, BJW showed the most powerful influence on embitterment and BJW itself was reduced or increased either by negative life events or social support, respectively.

LIMITATIONS

Although some significant influences on embitterment were examined, other aspects that include individual characteristics (self-efficacy, trust, political orientation, and media use) await examination.

CONCLUSIONS

The level of embitterment was affected by BJW, social support, and negative life events, which suggests points of possible intervention.

Embitterment: The Nature of the Construct and Critical Issues in the Light of COVID-19

Embitterment is a construct that is vast and complex and may be seen in a variety of conditions and circumstances. The following paper reviews the construct of embitterment and tries to explain the concept from a psychological perspective. It also looks at the role of embitterment in the genesis of psychiatric disorders like depression, anxiety, and PTSD, while focusing on the nature and factors needed to make a diagnosis of Posttraumatic Embitterment Disorder. Situations due to the current pandemic where embitterment may develop are discussed and this is coupled with a need to manage embitterment when it develops, as it may progress to a chronic condition where its effects may be both physical and psychological. Embitterment and its management from a psychotherapy standpoint is also discussed and the same is done from a workplace perspective.

Posttraumatic Symptoms and Change of Complicated Grief among Bereaved Families of the Sewol Ferry Disaster: One Year Follow-up Study

BACKGROUND

The objective of this study was to determine whether severity and severity change of coexisting psychiatric symptoms might affect change of complicated grief (CG) regarding the Sewol ferry disaster.

METHODS

Data from a cross-sectional survey were obtained 18 months (Time 1) and 30 months (Time 2) after the disaster. We ascertained sociodemographic variables and variables obtained from self-reporting questionnaires (i.e., CG, depression, anxiety, post-traumatic stress disorder [PTSD], insomnia, embitterment, and suicidal risk) among 56 bereaved family members.

RESULTS

Severity of other psychiatric symptoms at Time 1 had no effect on change of CG at Time 2. However, changes in severity of PTSD over a year affected change of CG.

CONCLUSION

It is important to evaluate changes in severity of PTSD and its treatment during management of CG, especially when it involves bereaved families experiencing a traumatic accident.

Posttraumatic Embitterment Disorder in Patients with Chronic Kidney Disease

Objective

Posttraumatic embitterment disorder (PTED), a subgroup of an adjustment disorder, is a feeling with anger and helplessness. Hemodialysis may be a trigger event leading to PTED. We investigated the prevalence of PTED in patients with each categorized stages of chronic kidney disease (CKD) and the association between PTED and depression and functional impairment.

Methods

Patients were categorized into three groups according to the stages of CKD (stage I–II, III–IV, and V). CKD (I–II) group was defined as estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m², CKD (III–IV) group as eGFR <60 ml/min/1.73 m², and CKD (V) group as CKD stage V including patients ongoing hemodialysis. Patients were assessed for the prevalence of PTED, depression, and decreased quality of life by using the scale of PTED, Patient Health Questionnaire-9 (PHQ-9), and EuroQol Five Dimensional Questionnaires, Visual Analogue Scale (EQ-5D-VAS), respectively.

Results

A total of 445 patients were analyzed. The number of patients in CKD (I–II) was 166, CKD (III–IV) was 172, and CKD (V) was 107. Multivariate analysis by binomial logistic regression demonstrated that CKD (V) was significantly associated with the prevalence of PTED (odds ratio, 4.13; 95% confidence interval, 1.56–15.6; p=0.006) after adjustment for age, gender, and diabetes mellitus. Also, a significant correlation existed between PTED and EQ-5D-VAS in all stages, but the correlation was nonsignificant between PTED and PHQ-9 score in group CKD (V).

Conclusion

The findings suggest that PTED is underdiagnosed in CKD patients. Acknowledgment and diagnosis of PTED in CKD patients may lead to a better quality of life.

Social support moderates association between posttraumatic growth and trauma-related psychopathologies among victims of the Sewol Ferry Disaster

Disasters have numerous harmful effects on the mental health status of trauma-exposed people. We investigated the differences in the association between trauma-related psychopathologies and posttraumatic growth according to the perceived social support level among victims of the Sewol Ferry disaster on April 16, 2014, in South Korea. Data from 241 bereaved family members, survivors, and family members of survivors were used. The Duke-UNC Functional Social Support Questionnaire, Posttraumatic Growth Inventory, PTSD Checklist-5, Posttraumatic Embitterment Disorder Self-Rating Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 were used to evaluate perceived social support, posttraumatic growth, and trauma-related psychopathologies. We found that the severity of depression and anxiety showed inverse correlations with posttraumatic growth only in the low-social support group, while they did not demonstrate significant correlations in the high-social support group. The social support level had correlations with posttraumatic growth and the severity of posttraumatic stress disorder and posttraumatic embitterment disorder only in female respondents. Furthermore, there was a mediation pathway from social support level to posttraumatic growth through depressive symptoms. This study explored the complex relationship between social support, posttraumatic growth, trauma-related psychopathologies, and gender among trauma-exposed individuals in the aftermath of the Sewol Ferry disaster.

Exposure to Negative Life Events and Post-Traumatic Embitterment Symptoms in Young Adults in Korea: Cumulative and Differential Effects

BACKGROUND

Post-traumatic embitterment disorder (PTED) has recently been introduced as a subgroup of adjustment disorders related to stressful life events. Embitterment is defined as persistent feelings of inadequacy or hoping for revenge after being insulted but feeling helpless after experiencing a life stressor. This study aims to investigate the cumulative and differential effects of negative life events on the risk of developing embitterment among young adults in South Korea.

METHODS

Data for the present study were collected from a web-based survey of 1,000 young adults aged 18-35 years. All participants completed a list of negative life events, the PTED Self-Rating Scale. Logistic regression analysis was conducted to evaluate the relationships between the number of negative life events and reactive embitterment. Analyses of the relationships between each negative life event and reactive embitterment were performed using covariates, including childhood trauma, depression, and anxiety symptoms.

RESULTS

The total number of participants with reactive embitterment (cut-off scores > 2.5) was 452 (45.2%). Greater exposure to negative life events increased the risk of reactive embitterment compared to no negative events. Negative life events, including financial problems, family problems, and being excluded by friends, had significant associations with the risk of reactive embitterment.

CONCLUSIONS

The present study revealed a substantial number of young adults with a high level of embitterment. Furthermore, cumulative and differential effects of negative events increased the risk for reactive embitterment. Our findings underlined the crucial role of adverse life events in the development of reactive embitterment.

Bereaved families are still embittered after the Sewol ferry accident in Korea: A follow-up study 18 and 30months after the disaster

INTRODUCTION

The Sewol ferry accident that occurred in April 2014 was one of the most tragic human-made disasters in Korean history. Due to the deaths of hundreds of children, bereaved families likely feel embittered; however, there is little extant research documenting embitterment among those who experienced the disaster. Consequently, we investigated bereaved family members' embitterment and other psychiatric symptoms 18months and 30months after the disaster.

METHODS

Data from a cross-sectional survey were obtained 18months (Time 1) and 30months (Time 2) after the disaster. We ascertained socio-demographic variables and variables obtained from a self-reporting questionnaire (i.e., depression, anxiety, posttraumatic stress disorder, complicated grief, and embitterment) among 56 bereaved family members.

RESULTS

Bereaved families showed substantial embitterment at Time 1 (64.3%), which increased at Time 2 (76.8%, t=1.761, p=0.084). The participants who displayed increased embitterment at Time 2 also increased in anxiety, post-traumatic stress symptoms, and complicated grief (but not depression). Furthermore, participants who displayed decreased embitterment at Time 2 also decreased in all other psychiatric symptoms. (time×group interaction in depression (F 0.644, p=0.426), anxiety (F 4.970, p=0.030), PTSD (F 10.699, p=0.002), and complicated grief (F 8.389, p=0.005)).

CONCLUSIONS

Embitterment of bereaved families had not ceased after 18months and even increased 1year later. Additionally, as embitterment increased, many other psychiatric symptoms also increased, and vice versa. Our results suggest that embitterment is associated or can even influence other psychiatric symptoms; therefore, embitterment should be examined after disasters.

Embitterment in War Veterans with Posttraumatic Stress Disorder

AIM

The aim of this study was to analyze frequency of embitterment in war veterans with Posttraumatic stress disorder (PTSD).

PATIENTS AND METHODS

It was analyzed 174 subjects (from Health Center Zivinice/ Mental Health Center) through a survey conducted in the period from March 2015 to June 2016, of witch 87 war veterans with PTSD and control subjects 87 war veterans without PTSD. The primary outcome measure was the Post-Traumatic Embitterment Disorder Self-Rating Scale (PTED Scale) who contains 19 items designed to assess features of embitterment reactions to negative life events. Secondary efficacy measures included the Clinician-Administered PTSD Scale - V (CAPS), the PTSD CheckList (PCL), the Combat Exposure Scale (CES), the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A) and the World Health Organization Quality of Life Scale (WHOQOL-Bref). All subjects were male. The average age of patients in the group war veterans with PTSD was 52·78 ± 5·99. In the control group average age was 51·42 ± 5·98. Statistical data were analyzed in SPSS statistical program.

RESULTS

Comparing the results, t tests revealed significant difference between group veterans with PTSD and control group (t=-21·216, p<0·0001). War veterans group with PTSD (X= 51·41 SD= 8·91), war veterans without PTSD (X=14·39, SD=13·61).

CONCLUSION

Embitterment is frequent in war veterans with PTSD.

Suicidal and Aggressive Ideation Associated with Feelings of Embitterment

BACKGROUND

Mental disorders can be associated with suicidal or aggressive ideation and behavior, especially in the context of embitterment. The aim of this study is to investigate the types, prevalence, and dangerousness of aggressive and suicidal ideations associated with embitterment.

METHODS

When therapists from the department of behavioral medicine detected signs of embitterment, aggression, or suicidal thoughts in their patients, they routinely filled out a questionnaire on aggressive ideation, assessed the embitterment, and contacted a senior psychiatrist. Additionally, patients answered an embitterment scale.

RESULTS

There were 127 patients (3.84% of all patients) with suicidal and/or aggressive ideation. They had an increased score of 2.93 (SD 0.74) on the embitterment scale, associated with personal vilification (62.7%), breach of trust (30.2%), public humiliation (25.4%), death/loss (5.6%), or attacks by another person (14.3%). We found that 83.5% of the patients harbored aggressive ideations; in 94.1% of this group, these were directed against the person who had caused the problem, 88.3% wanted to inflict severe damage, 38.8% to harm another person, 31.5% showed suicidal ideation, and 3.2% had fantasies of murder-suicide. Only 34.3% of the patients reported spontaneously about their current aggressive ideation. The limitations of the study are that the data come from an inpatient sample and patients were identified according to clinical judgement.

CONCLUSION

Aggressive ideation is regularly associated with embitterment. This deserves the attention of therapists for the prevention of aggressive acts.

Social Support as a Mediator of Posttraumatic Embitterment and Perceptions of Meaning in Life among Danwon Survivors of the Sewol Ferry Disaster

PURPOSE

Our research was designed to test and explore the relationships among embitterment, social support, and perceptions of meaning in life in the Danwon High School survivors of the Sewol ferry disaster.

MATERIALS AND METHODS

Seventy-five Sewol ferry disaster survivors were eligible for participation, and were invited to participate in the study 28 months after the disaster. Forty-eight (64%) survivors (24 males, 24 females) completed questionnaires; the Posttraumatic Embitterment Disorder (PTED) scale, the Functional Social Support Questionnaire (FSSQ), and the Meaning in Life Questionnaire (MLQ).

RESULTS

PTED scores were negatively correlated with scores on the FSSQ and the Presence of Meaning (MLQ-P) (r=-0.43 and -0.40, respectively). The hierarchical regression analysis showed that FSSQ scores may fully mediate the effects of PTED scores on MLQ-P scores, given that the indirect effect was significant whereas the direct effect was not (95% confidence interval=-0.5912 to -0.0365).

CONCLUSION

These findings imply that therapies targeting embitterment may play a vital role in increasing positive cognitions, such as those related to perceived social support and the meaningfulness of life.

Post-Traumatic Stress Disorder, Depression and Anxiety among North Korean Refugees: A Meta-Analysis

OBJECTIVE

Post-traumatic stress disorder is common among North Korean refugees who have fled their country for economic, financial and humanitarian reasons. Co-morbid depression and anxiety are also common among North Korean refugees, due to the difficulties they have faced within their country and during their escape journey. Depression and anxiety complicate treatment for post-traumatic stress disorder, and lead to poorer outcomes. Thus, the aim of the present study was to provide a meta-analysis of studies investigating post-traumatic stress disorder, depression, and anxiety among North Korean refugees.

METHODS

Selected articles were published in English, and included measures of post-traumatic stress, and/or depression and anxiety. 10 studies were included in the depression meta-analysis, and 6 in the anxiety meta-analysis.

RESULTS

A random-effects model revealed strong, significant associations between post-traumatic stress and depression, r=0.63, 95% CI (0.51, 0.72), p<0.001, z=8.33, and anxiety, r=0.51, 95% CI (0.36, 0.63), p<0.001, z=6.07. The relationships between post-traumatic stress, depression and anxiety were higher among adults and those with more than five years outside of North Korea.

CONCLUSION

Depression appears to be an important treatment focus for North Korean refugees with post-traumatic stress.

Unresolved Bereavement and Other Mental Health Problems in Parents of the Sewol Ferry Accident after 18 Months

OBJECTIVE

This study examined the overall mental health consequences of the bereaved parents after the Sewol ferry accident.

METHODS

Eighty-four bereaved parents participated in the study. Self-report scales assessing the severity of psychiatric symptoms and other related psychosomatic problems were used at 18 months following the accident. Univariate descriptive statistics and regression analyses were performed to report the prevalence, severity, and correlates of psychiatric symptoms.

RESULTS

94% of the participants appeared to suffer from complicated grief based on scores on the Inventory of Complicated Grief (ICG). Half of the participants were categorized as having severe depression and 70.2% reported clinically significant post-traumatic symptoms according to scores on the Patient Health Questionnaire-9 (PHQ-9) and PTSD Check List-5 (PCL-5). No significant differences by gender were observed in the severity of psychiatric symptoms. A higher educational level was associated with more severe psychiatric symptoms in fathers.

CONCLUSION

The loss of a child due to a disaster caused by human error may continue to have a substantial impact on parental mental health at 18 months after the event. A longitudinal study following parents' mental health state would be necessary to investigate the long-term effects of the traumatic experience in the future.