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Kim S, Jang KI, Lee HS, Shim SH, Kim JS. Differentiation between suicide attempt and suicidal ideation in patients with major depressive disorder using cortical functional network. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110965. [PMID: 38354896 DOI: 10.1016/j.pnpbp.2024.110965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
Studies exploring the neurophysiology of suicide are scarce and the neuropathology of related disorders is poorly understood. This study investigated source-level cortical functional networks using resting-state electroencephalography (EEG) in drug-naïve depressed patients with suicide attempt (SA) and suicidal ideation (SI). EEG was recorded in 55 patients with SA and in 54 patients with SI. Particularly, all patients with SA were evaluated using EEG immediately after their SA (within 7 days). Graph-theory-based source-level weighted functional networks were assessed using strength, clustering coefficient (CC), and path length (PL) in seven frequency bands. Finally, we applied machine learning to differentiate between the two groups using source-level network features. At the global level, patients with SA showed lower strength and CC and higher PL in the high alpha band than those with SI. At the nodal level, compared with patients with SI, patients with SA showed lower high alpha band nodal CCs in most brain regions. The best classification performances for SA and SI showed an accuracy of 73.39%, a sensitivity of 76.36%, and a specificity of 70.37% based on high alpha band network features. Our findings suggest that abnormal high alpha band functional network may reflect the pathophysiological characteristics of suicide and serve as a clinical biomarker for suicide.
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Affiliation(s)
- Sungkean Kim
- Department of Human-Computer Interaction, Hanyang University, Ansan, Republic of Korea
| | - Kuk-In Jang
- Cognitive Science Research Group, Korea Brain Research Institute (KBRI), Daegu, Republic of Korea
| | - Ho Sung Lee
- Department of Pulmonology and Allergy, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
| | - Ji Sun Kim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
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Stephenson M, Edwards AC. Investigating Associations of Substance Use and Dependence With Planned Versus Unplanned Suicide Attempt. J Stud Alcohol Drugs 2024; 85:339-348. [PMID: 38227385 PMCID: PMC11095497 DOI: 10.15288/jsad.23-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE The present analyses investigated substance use and dependence as correlates of past-year suicide attempt and of unplanned versus planned suicide attempt in a nationally representative sample. METHOD Participants were 214,505 adults (52% female; 64% White, 12% Black, <1% Native American, <1% Pacific Islander, 6% Asian, 16% Hispanic, 2% multiracial) from the 2015-2019 National Surveys on Drug Use and Health. Four logistic regression models were constructed. Models 1 and 2 examined substance use and dependence, respectively, as correlates of suicide attempt. Models 3 and 4 evaluated whether substance use and dependence were related to suicide attempt in the absence of a plan. RESULTS In Models 1 and 2, higher cigarette smoking and marijuana use; any use of opioids, sedatives, and hallucinogens; and greater dependence on nicotine, alcohol, marijuana, and any illicit or prescription drug were associated with elevated risk for suicide attempt. Associations with cigarette smoking, sedative use, and dependence on nicotine, alcohol, and any illicit or prescription drug remained statistically significant in sensitivity analyses limited to individuals with suicidal ideation. In Models 3 and 4, substance use and dependence were unrelated to risk for unplanned (vs. planned) suicide attempt. CONCLUSIONS Although substance-related outcomes are consistently associated with suicide attempt, there was little evidence that substance use and dependence are related to risk for unplanned versus planned suicidal behavior.
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Affiliation(s)
- Mallory Stephenson
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
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Gomez SH, Overholser J, McGovern C, Silva C, Stockmeier CA. The role of premeditation in suicide: Identifying factors associated with increased planning among suicide decedents. J Clin Psychol 2023; 79:2768-2780. [PMID: 37539866 PMCID: PMC10838361 DOI: 10.1002/jclp.23577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Suicide premeditation is a critical factor to consider when assessing suicide risk. Understanding which individuals are more or less likely to plan their suicidal behavior can shed light on how suicidal thoughts turn into actions. METHOD The present study used psychological autopsy data to identify factors associated with level of premeditation among 131 adults who died by suicide. RESULTS Logistic regression analyses indicated that suicide decedents with higher premeditation scores had higher odds of being diagnosed with a depressive disorder and choosing a violent suicide method, specifically a firearm. Individuals with lower premeditation scores had higher odds of being diagnosed with a polysubstance use disorder. CONCLUSION Suicide decedents exhibiting greater premeditation before their deaths were different in several ways from suicide decedents exhibiting less premeditation. A better understanding of suicide premeditation can ultimately aid in the development of improved risk assessments and targeted safety interventions for those struggling with suicidal thoughts.
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Affiliation(s)
- Stephanie H Gomez
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christopher McGovern
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christiana Silva
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Craig A Stockmeier
- Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, Jackson, Mississippi, USA
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Won MR, Choi EJ, Ko E, Um YJ, Choi YJ. The mediating effect of life satisfaction and the moderated mediating effect of social support on the relationship between depression and suicidal behavior among older adults. Int J Geriatr Psychiatry 2021; 36:1732-1738. [PMID: 34216505 DOI: 10.1002/gps.5593] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/28/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to investigate the effect of depression on suicidal behavior among older adults and identify the mediating effect of life satisfaction on the relationship between depression and suicidal behavior. The moderated mediating effects of social support through life satisfaction were also verified in the relationship between depression and suicidal behavior among older adults. METHODS A total of 1375 people aged 65 years or older living in J city, South Korea, were recruited to complete a survey on depression, life satisfaction, suicidal behavior, and social support. Data were analyzed using SPSS24.0 and SPSS PROCESS Macro. RESULTS The results showed that the effect of depression on suicidal behavior was mediated by life satisfaction, and the effect of life satisfaction on suicidal behavior varied according to the level of social support. Moreover, depression negatively affected life satisfaction, increasing the risk of suicidal behavior, and social support decreased suicidal behavior. Finally, the mediating effect of depression leading to suicidal behavior through life satisfaction was moderated by social support. CONCLUSIONS These findings suggest that it is necessary not only to find interventions for older adults to increase their physical, mental, and socioeconomical satisfaction with life, but also to build social networks that increase social support for them.
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Affiliation(s)
- Mi-Ra Won
- Daewon University College, Department of Nursing, Chungbuk, Korea
| | - Eun-Joo Choi
- Chung-Ang University, Graduate School, Department of Nursing, Seoul, Korea
| | - Eunjung Ko
- Chung-Ang University, Graduate School, Department of Nursing, Seoul, Korea
| | - Youn-Joo Um
- Chung-Ang University, Graduate School, Department of Nursing, Seoul, Korea
| | - Yun-Jung Choi
- Chung-Ang University, Red Cross College of Nursing, Seoul, Korea
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Abstract
Mutations in the genes coding for tryptophan-hydrolase-2 and the scaffold protein FKBP5 are associated with an increased risk of suicide. The mutation in both cases enhances the enzymatic activity of glycogen synthase kinase-3 (GSK3). Conversely, anti-suicidal medications, such as lithium, clozapine, and ketamine, indirectly inhibit the activity of GSK3. When GSK3 is active, it promotes the metabolic removal of the transcription factor NRF2 (nuclear factor erythroid 2-related factor-2), which suppresses the transcription of multiple genes that encode anti-oxidative and anti-inflammatory proteins. Notably, several suicide-biomarkers bear witness to an ongoing inflammatory process. Moreover, alterations in serum lipid levels measured in suicidal individuals are mirrored by data obtained in mice with genetic deletion of the NRF2 gene. Inflammation is presumably causally related to both dysphoria and anger, two factors relevant for suicide ideation and attempt. Preventing the catabolism of NRF2 could be a strategy to obtain novel suicide-prophylactic medications. Possible candidates are minocycline and nicotinic-α7 agonists. The antibiotic minocycline indirectly activates NRF2-transcriptional activity, whereas the activation of nicotinic-α7 receptors indirectly inhibits GSK3.
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Serdenes R, Graham J. Evaluating the Psychiatric Benefits of Formulating Acetaminophen With N-Acetylcysteine. Front Psychiatry 2020; 11:564268. [PMID: 33192684 PMCID: PMC7649790 DOI: 10.3389/fpsyt.2020.564268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan Serdenes
- PGY2 Psychiatry Resident, Temple University Health System, Philadelphia, PA, United States
| | - James Graham
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
- Medical Director-Crisis Response Center, Temple University Health System, Philadelphia, PA, United States
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Bornheimer LA, Zhang A, Li J, Hiller M, Tarrier N. Effectiveness of Suicide-Focused Psychosocial Interventions in Psychosis: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:829-838. [PMID: 32340594 DOI: 10.1176/appi.ps.201900487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suicide ideation, plan, attempt, and death are significant and prevalent concerns among individuals with psychosis. Previous studies have focused on risk factors, but few have systematically evaluated the effect of psychosocial interventions on these experiences among individuals with psychosis. This study evaluated the effectiveness of psychosocial interventions in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. METHODS Eight electronic databases were systematically searched from inception until June 30, 2019. Identified studies included both randomized controlled trials and controlled trials without randomization that examined psychosocial interventions for suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. A random-effects model was used to pool the effect sizes for synthesis. RESULTS Eleven studies with 14 effect sizes (N=4,829 participants) were analyzed. The average age of participants ranged from 21 to 51, and most participants identified as male and non-Hispanic Caucasian or Chinese and were in an early or first-episode stage of illness. On average, participants who received psychosocial interventions were less likely than their counterparts in the control group to report suicide ideation, plan, and attempt and die by suicide (odds ratio [OR]=0.57, 95% confidence interval [CI]=0.41-0.78). Subgroup analyses further revealed significant reductions in suicide ideation (OR=0.73, 95% CI=0.55-0.97) and suicide death (OR=0.45, 95% CI=0.30-0.68) among intervention participants. CONCLUSIONS Preliminary evidence indicated that psychosocial interventions are effective in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. Intervention characteristics, however, varied across studies, which suggests a lack of consensus on best clinical practices.
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Affiliation(s)
- Lindsay A Bornheimer
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Juliann Li
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Matthew Hiller
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Nicholas Tarrier
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
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9
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Predicting Planned Suicide Attempts With the Columbia-Suicide Severity Rating Scale: A Subanalysis of the 2013 Korea National Suicide Survey on Emergency Department Visitors. J Nerv Ment Dis 2019; 207:59-68. [PMID: 30672875 DOI: 10.1097/nmd.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Identifying predictors of planned suicide attempts (PSA) is critical because these are associated with grave consequences. Using data of suicide attempters visiting emergency departments, we investigated whether the Columbia-Suicide Severity Rating Scale (C-SSRS) subscales, by retrospectively evaluating ideation before an attempt, could predict the occurrence of PSA versus unplanned suicide attempts using logistic regression analyses. The severity subscale was used as a continuous (model A) and a categorical (model B) variable. In model A, higher scores on each subscale were associated with increased risk of PSA. In model B, the highest score on the severity subscale and a higher intensity subscale score predicted PSA. The severity and intensity subscales had areas under receiver operating curves of 0.712 and 0.688 with optimum cutoff points of 4/5 and 15/16, respectively. In addition, being aged 30 to 49 and 50 to 69 years, being male, interpersonal stress, and depressive and adjustment disorders increased PSA risk. The C-SSRS subscales, along with sociodemographic and clinical risk factors, can predict PSA.
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Lee H, Seol KH, Kim JW. Age and sex-related differences in risk factors for elderly suicide: Differentiating between suicide ideation and attempts. Int J Geriatr Psychiatry 2018; 33:e300-e306. [PMID: 28967671 DOI: 10.1002/gps.4794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/10/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the age and sex-related differences in socio-demographic factors that influence suicide ideation and attempts in the elderly. METHODS The total number of subjects was 93 151, of whom 8441 belonged to the high suicide-risk group (2064 male; 6377 female). Following this identification, we investigated their socio-demographic information, health status, and depressive symptoms, which might have influenced their suicide ideation and attempts. RESULTS Residence in an urban area was identified as a risk factor for both male and female elderly in their 60s and 70s and female elderly in their 80s. Marital status showed a different influence on suicide ideation depending on age and sex. A negative perception of one's own health status was a significant risk factor that increased the likelihood of suicide ideation in all ages, except the female elderly in their 60s. No factor was identified that significantly influenced suicide attempts in the male elderly. However, in the female elderly, residence in an urban area and a negative perception of one's own health status were identified as significant risk factors. CONCLUSIONS This study revealed that factors known to influence suicide ideation in the elderly from previous studies, such as residence area, separation from a spouse, education level, religion, and drinking, show changed influence as the elderly reach their 70s and 80s. However, a negative perception of one's own health status was a risk factor that encompassed most ages and sexes.
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Affiliation(s)
- Hyuk Lee
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea.,Medical Unit of the 7th Division, Korea Army, Hwacheon, Republic of Korea
| | - Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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Kim E, Jeong KY, Lee JS, Choi HS. Predictive Value of Psychological Scales for Hospitalization of Elderly Suicide Attempters. Ann Geriatr Med Res 2017. [DOI: 10.4235/agmr.2017.21.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Eundo Kim
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Korea
- Department of Emergency Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Korea
- Department of Emergency Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Han Sung Choi
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Korea
- Department of Emergency Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Banchini A, Schirripa ML, Anzillotti L, Cecchi R. Planned and unplanned complex suicides: Casuistry of the Institute of Legal Medicine of Parma (Italy). Leg Med (Tokyo) 2017; 29:62-67. [DOI: 10.1016/j.legalmed.2017.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/01/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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13
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Atescelik M, Yilmaz M, Korkmaz S, Goktekin MC, Gurger M, Ilhan N. The Relationship between Ghrelin and Copeptin Levels, and Anxiety and Depression Levels in Suicide Attempts. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:256-260. [PMID: 28783935 PMCID: PMC5565089 DOI: 10.9758/cpn.2017.15.3.256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/13/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022]
Abstract
Objective It was aimed to detect acylated ghrelin (AG), unacylated ghrelin (UG) and copeptin levels in patients with suicide attempts and to determine if these biomarkers are risk factors for suicide attempts. Methods Serum copeptin, AG and GU levels were screened in 128 patients who were admitted to emergency department with suicide attempts and 59 healthy controls. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were applied simultaneously, and the data were compared statistically. Results AG, UG and copeptin levels were higher in the patient group compared with the healthy control group. BAI scores of patients were found to be positively correlated with BDI scores. While there was a significant difference (p=0.0064) between psychiatric and non-psychiatric patients with suicide attempts in terms of BAI scores, there were no differences in BDI scores and levels of biomarkers. We found significantly increased BDI and BAI scores and increased levels of AG, UG and copeptin in psychiatric and non-psychiatric patients compared with healthy individuals. The specificities yielded by receiver operating characteristic curve analysis in patients with suicide attempts were as follows: 91.53% for AG, 72.88% for UG and 94.92% for copeptin. Conclusion Serum levels of AG, UG and copeptin increase with increasing anxiety and depression in patients with suicide attempts. Increased levels of AG, UG and copeptin could be considered a risk factor for suicide attempts.
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Affiliation(s)
- Metin Atescelik
- Department of Emergency Medicine, Firat University School of Medicine, Elazig, Turkey
| | - Mustafa Yilmaz
- Department of Emergency Medicine, Firat University School of Medicine, Elazig, Turkey
| | - Sevda Korkmaz
- Department of Psychiatry, Firat University School of Medicine, Elazig, Turkey
| | - Mehmet Cagri Goktekin
- Department of Emergency Medicine, Firat University School of Medicine, Elazig, Turkey
| | - Mehtap Gurger
- Department of Emergency Medicine, Firat University School of Medicine, Elazig, Turkey
| | - Nevin Ilhan
- Department of Biochemistry, Firat University School of Medicine, Elazig, Turkey
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Kwon A, Song J, Yook KH, Jon DI, Jung MH, Hong N, Hong HJ. Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:383-387. [PMID: 27776392 PMCID: PMC5083937 DOI: 10.9758/cpn.2016.14.4.383] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/06/2016] [Accepted: 08/11/2016] [Indexed: 12/01/2022]
Abstract
We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt and non-suicide attempt groups and we examined significant predictors of suicide attempts. Gender differences in suicidal ideation and suicidal behavior were also analyzed. Among 106 depressed participants, 50 (47.2%) adolescents were classified in the suicide attempt group. Generally, the suicide attempt and non-suicide attempt group shared similar clinical characteristics. The suicide attempt group had more females, more major depressive disorder diagnoses, more depressive episodes, and higher suicidal ideation than the non-suicide attempt group. Suicidal ideation was the only significant predictor of suicidal attempt, regardless of gender. Higher suicidal ideation frequency scores and more non-suicidal self-injurious behaviors were shown in the female suicide attempt group than the male suicide attempt group. It is recommended that suicidal ideation be assessed regularly and managed rigorously to decrease suicide risks in depressive adolescents.
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Affiliation(s)
- Ahye Kwon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jungeun Song
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ki-Hwan Yook
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Myung Hun Jung
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Narei Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyun Ju Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.,Suicide and School Mental Health Institute, Hallym University, Anyang, Korea
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