Reliability and Validity of the Korean Version of the Somatic Symptom Disorder-B Criteria Scale in a Clinical Population

OBJECTIVE

This study aimed to develop and validate the Korean version of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in outpatients at a psychiatric clinic and assess its diagnostic accuracy.

METHODS

A total of 207 patients completed SSD-12. For the diagnostic accuracy of SSD-12, the somatic symptom disorder (SSD) section of the structured clinical interview for DSM-5 disorders-research version (SCID-5-RV) was used. The SSD-12 construct and concurrent validity were assessed by examining the correlations with Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), PHQ-15, 5-level EQ-5D version (EQ-5D-5L), and World Health Organization Quality of Life Brief Version (WHOQOL-BREF).

RESULTS

The SSD-12 had excellent internal consistency (Cronbach α=0.90). Confirmatory factor analysis revealed good fit indices for a general factor model (comparative fit index [CFI]=0.92, Tucker-Lewis index [TLI]=0.88, root mean square error of approximation [RMSEA]=0.10; 95% confidence interval [CI], 0.08-0.11) and a three-factor model (CFI=0.94, TLI=0.91, RMSEA=0.08; 95% CI, 0.07-0.10). The total SSD-12 score was significantly correlated with anxiety (GAD-7: r=0.53, p<0.001), depression (PHQ-9: r=0.52, p<0.001), physical symptom burden (PHQ-15: r=0.36, p<0.001), and quality of life (EQ-5D-5L: r=-0.40, p<0.001; WHOQOL-BREF: r=-0.51, p<0.001). SSD-12 demonstrated good accuracy (area under the curve=0.75, standard error=0.04; 95% CI, 0.68-0.82) with an optimal cut-off of 29.

CONCLUSION

The Korean SSD-12 demonstrates reliability and validity for diagnosing SSD in clinical setting.

The Effect of Time Spent on Online Gaming on Problematic Game Use in Male: Moderating Effects of Loneliness, Living Alone, and Household Size

OBJECTIVE

This study aimed to investigate the association between gaming time and problematic game use (PGU) within a large sample of Korean male gamers and to examine the potential moderating effects of loneliness, living alone, and household size.

METHODS

This study employed data from 743 male gamers from the National Mental Health Survey 2021, a nationally representative survey of mental illness conducted in South Korea. Self-reported data on the average gaming time per day, severity of PGU, loneliness, living alone, and household size were used.

RESULTS

Gaming time was positively associated with PGU and this relationship was significantly moderated by loneliness such that the positive effect of gaming time on PGU was greater when the levels of loneliness were high. The three-way interaction effect of gaming time, loneliness, and living alone was also significant, in that the moderating effect of loneliness on the relationship between gaming time and PGU was significant only in the living alone group. However, household size (i.e., number of housemates) did not moderate the interaction between gaming time and loneliness among gamers living with housemates.

CONCLUSION

These results suggest the importance of considering loneliness and living arrangements of male gamers, in addition to gaming time, in identifying and intervening with individuals at heightened risk of PGU.

Is fear of disease progression associated with antiretroviral therapy adherence in persons with HIV/AIDS?

We examined the mediating role of depression and anxiety on the relationship between fear of disease progression (FoP) and antiretroviral therapy (ART) adherence and the moderating role of social support in the FoP-depression/anxiety-ART adherence relationship in persons with HIV/AIDS (PWHA). 202 PWHA completed self-report measures. Simple mediation and moderated mediation analyses were performed. FoP was directly and negatively associated with ART adherence, and the mediating role of depression in this relationship was significant. Indirect effect of FoP mediated by anxiety on ART adherence was not significant. The moderating effect of social support was significant in the FoP-depression pathway, while the indirect effect of FoP on ART adherence mediated by depression was greatest at a higher level of social support and lower level of FoP. The results suggest the relevance of high FoP and depression-mediated FoP in ART adherence and social support may attenuate the negative impact of FoP.

Prevalence of lifetime psychiatric disorders and suicidality in adults with subthreshold posttraumatic stress disorder: A population-based nationwide study in Korea

BACKGROUND

Subthreshold posttraumatic stress disorder (PTSD) is a chronic condition, and despite its clinical importance, few studies have been conducted. We investigated the relationship of subthreshold PTSD with various psychiatric disorders and suicidality in a South Korean general population.

METHOD

A total of 5,102 respondents, aged at least 18 years, completed face-to-face interviews using the Korean version of the Composite International Diagnostic Interview and questionnaires for lifetime suicidal ideation, plans, and attempts. Subthreshold PTSD was defined as at least one symptom in each of the three symptom clusters (Criteria B, C, and D) and a symptom duration of ≥ 1 month (Criterion E).

RESULTS

The lifetime prevalence of subthreshold PTSD (2.5%) was higher than that of PTSD (1.5%). After adjusting for sociodemographic factors, subthreshold PTSD was significantly associated with nicotine use disorders, major depressive disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder, and specific phobia. Among psychiatric disorders, the odds ratio for OCD was notably high. Subthreshold PTSD was associated with increased suicidal ideation (adjusted OR [AOR] = 2.90, 95% CI [1.98, 4.26]), suicidal plans (AOR = 3.58, [1.86, 6.89]), and suicide attempts (AOR = 3.93, [1.93, 8.01]) after adjusting for sociodemographic factors. When adjusted for sociodemographic factors and psychiatric disorders, suicidal ideation (AOR = 2.04, [1.34, 3.11]) remained statistically significant.

CONCLUSION

This study found that subthreshold PTSD was associated with various psychiatric disorders and suicidality. Increased attention to the mental health of individuals with subthreshold PTSD is necessary. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence of Loneliness and Its Association With Suicidality in the General Population: Results From a Nationwide Survey in Korea

BACKGROUND

Although it is known that a substantial proportion of the population experience loneliness, the consequence of loneliness remains unclear by countries and ages. Accordingly, this study aimed to assess the association between loneliness and suicidality in the general population of Korea.

METHOD

A total of 5,511 Koreans aged 18-79 completed a tablet-assisted personal interview using the Korean version of the Composite International Diagnostic Interview and responded to questions about loneliness and lifetime suicidal ideation, plans, and attempts. A logistic regression analysis was used to examine the association between loneliness and suicidality.

RESULTS

Approximately one-third of the Korean general population reported loneliness. Being older, never married, widowed, separated, or divorced, unemployed, and having a part-time job were all significantly related to loneliness. After adjusting for sociodemographic factors, individuals with loneliness were significantly associated with increased suicidal ideation (adjusted odd ratio [aOR], 4.05; 95% confidence interval [CI], 3.36-4.88), suicidal plans (aOR, 4.91; 95% CI, 3.34-7.21), and suicidal attempts (aOR, 4.82; 95% CI, 3.03-7.66). Even after adjusting for sociodemographic factors and mental disorders, suicidality remained statistically significant. Moreover, frequent, moderate-to-severe, and long-term loneliness were all associated with increased ORs for suicidality, regardless of sociodemographic factors and mental disorders.

CONCLUSION

Loneliness was associated with suicidal ideation, plans, and attempts. This study lays the foundation for public health policymakers to establish early intervention and mental health care support for lonely people.

Validation of the Patient Health Questionnaire-9 and Patient Health Questionnaire-2 in the General Korean Population

OBJECTIVE

The Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 have not been validated in the general Korean population. This study aimed to validate and identify the optimal cutoff scores of the PHQ-9 and PHQ-2 in screening for major depression in the general Korean population.

METHODS

We used data from 6,022 participants of the Korean Epidemiological Catchment Area Study for Psychiatric Disorders in 2011. Major depression was diagnosed according to the Korean Composite International Diagnostic Interview. Validity, reliability, and receiver operating characteristic curve analyses were performed using the results of the PHQ-9 and Euro Quality of life-5 dimension (EQ-5d).

RESULTS

Of the 6,022 participants, 150 were diagnosed with major depression (2.5%). Both PHQ-9 and PHQ-2 demonstrated relatively high reliability and their scores were highly correlated with the "anxiety/depression" score of the EQ-5d. The optimal cutoff score of the PHQ-9 was 5, with a sensitivity of 89.9%, specificity of 84.1%, positive predictive value (PPV) of 12.6%, negative predictive value (NPV) of 99.7%, positive likelihood ratio (LR+) of 5.6, and negative likelihood ratio (LR-) of 0.12. The optimal cutoff score of the PHQ-2 was 2, with a sensitivity of 85.3%, specificity of 83.2%, PPV of 11.6%, NPV of 99.5%, LR+ of 5.1, and LR- of 0.18.

CONCLUSION

The PHQ-9 and PHQ-2 are valid tools for screening major depression in the general Korean population, with suggested cutoff values of 5 and 2 points, respectively.

Association of driving while intoxicated and suicide ideation and attempts in South Korea: a study in a nationally representative sample

Evidence indicating driving as a means for suicide has been consistently reported. However, there have been few reported studies examining the association between driving while intoxicated (DWI) and suicide. We aimed to investigate the associations between DWI and suicide ideation and suicide attempts taking into account the frequency and amount of alcohol consumption. This cross-sectional study used data from semi-structured, face-to-face interviews conducted with a nationally representative sample of the Korea Community Health Survey in 2009, 2013, and 2017. The study included 267,457 adult participants who drank alcohol at least once and had driven a motor vehicle at least once in the preceding year. The DWI group comprised participants who had driven under the influence of alcohol at least once in the preceding year. The associations between DWI and suicide ideation and suicide attempts were examined using a logistic regression model, adjusting for the frequency and amount of alcohol consumption and history of depressive episodes in the preceding year. The role of DWI as a risk factor for suicide was also examined in an analysis stratified by the frequency and amount of alcohol consumption. The DWI group included 39,062 (14.6%) subjects, who were at higher risk for suicide ideation (adjusted odds ratio [aOR] = 1.91; 95% CI 1.81-2.01) and suicide attempts (aOR = 1.56; 1.27-1.92) than those not involved in DWI. Increased risks of suicide ideation and suicide attempts were observed in most strata in the stratified analysis. People who engage in DWI may have an increased risk of suicide ideation and suicide attempts; this relationship was generally observed regardless of the frequency and amount of alcohol consumption.

A Novel Screening, Brief Intervention, and Referral to Treatment (SBIRT) Based Model for Mental Health in Occupational Health Implemented on Smartphone and Web-Based Platforms: Development Study With Results From an Epidemiologic Survey

BACKGROUND

While the importance of mental health is well-recognized in the field of occupational health, implementation of effective strategies in the workplace has been limited by gaps in infrastructure, program comprehensiveness, coverage, and adherence. The authors developed a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model based occupational mental health intervention, and implemented in a web-based format with a smartphone application.

METHODS

The SBIRT-based intervention was developed by a multidisciplinary team, including occupational health physicians, nurses, psychiatrists, and software developers. The following mental health areas were included, based on outcomes of an epidemiological survey conducted: insomnia, depression, anxiety, problematic alcohol use, and suicidal risk. The viability of the two-step evaluation process utilizing a combination of the brief version and the full-length version of the questionnaire was examined using responses from the survey. The intervention was adjusted according to the survey results and expert opinions.

RESULTS

The epidemiological survey included 346 employees who completed the long-form version of mental health scales. These data were the used to confirm the diagnostic value of using a combination of short-form and long-form version of the scales for screening in the SBIRT model. The model uses a smartphone application for screening, provision of psychoeducation, and for surveillance. The universal methods of the model ensure it can be implemented by all occupational managers, regardless of their specialization in mental health. In addition to the two-step screening procedure to identify employees at-risk for mental health problems, the model includes a stepped care approach, based on risk stratification, to promote mental health education, management, and follow-up for continuous care.

CONCLUSION

The SBIRT model-based intervention provides an easy-to-implement approach for the management of mental health in the workplace. Further studies are required to examine the effectiveness and feasibility of the model.

The Multi-dimensional Assessment of Suicide Risk in Chronic illness-20 (MASC-20): Development and validation

BACKGROUND

We developed and tested the psychometric properties of the Multi-dimensional assessment of suicide risk in chronic illness-20 (MASC-20), which assess suicidal behavior (SB), and its associated distress in chronic physical illness (CPI).

METHODS

Items were developed by incorporating inputs from patient interviews, a review of existing instruments, and expert consultations. Pilot testing with 109 patients and field testing with 367 patients with renal, cardiovascular, and cerebrovascular diseases were conducted. We analyzed Time (T) 1 data to select items and T2 data to examine psychometric properties.

RESULTS

Forty preliminary items were selected through pilot testing; 20 were finalized from field testing. Optimal internal consistency (α = 0.94) and test-retest reliability (Intra class correlation coefficient = 0.92) of the MASC-20 supported reliability. Good fit of the four-factor model (physical distress, psychological distress, social distress, and SB) from exploratory structural equation modeling demonstrated factorial validity. Its correlations with MINI suicidality (r = 0.59) and the Schedule of Attitudes Toward Hastened Death-abbreviated scores (r = 0.62) indicated convergent validity. Higher MASC-20 scores in patients with clinical levels of depression and anxiety and low health status demonstrated known-group validity. The MASC-20 distress score predicted SB beyond known SB risk factors, supporting incremental validity. A cutoff score of 16 was optimal for identifying suicide risk. The area under the curve was within a moderately accurate range. The sum of sensitivity and specificity (1.66) indicated diagnostic utility.

LIMITATIONS

MASC-20's applicability to other patient populations and its sensitivity to change requires testing.

CONCLUSIONS

The MASC-20 appears to be a reliable and valid tool for assessing SB in CPI.

Suicidal behaviors in patients with chronic physical illness: A test on the interpersonal theory of suicide

INTRODUCTION

The unalleviated burden of chronic physical illness (CPI) increases the risk of suicidal behaviors (SB) in affected individuals. This study tested the interpersonal theory of suicide (ITS) in patients with CPI.

METHODS

Patients diagnosed with cardiovascular, cerebrovascular, and renal diseases were recruited from two hospitals in South Korea. Data from 257 participants who completed Time (T) 1 and T2 surveys were analyzed. Hierarchical regression analyses for passive and active suicide ideation (PSI and ASI), and suicide plans and attempts (SP and SA) at both time points were conducted.

RESULTS

Interpersonal theory of suicide hypotheses were partially supported. Even accounting for factors such as depression, anxiety, and lifetime SA, some main and interaction effects of the ITS constructs explained SB in a cross-sectional examination, but to a lesser degree in a longitudinal examination that controlled for T1 SB. PB was a consistent correlate of SB. TB was also relevant, as PB-SA association was significant among participants with high TB both times. ASI was associated with SP and SA at T1, and the ASI-SP association at T1 was stronger at a high CS level.

CONCLUSIONS

Overall, the results suggest the relevance of ITS constructs that warrant attention to prevent SB in patients with CPI.

Prevalence of Mental Disorders and Associated Factors in Korean Adults: National Mental Health Survey of Korea 2021

OBJECTIVE

Mental health is a global concern and needs to be studied more closely. We aimed to estimate the prevalence of mental disorders and their associated factors among the general population in Korea.

METHODS

The National Mental Health Survey of Korea 2021 was conducted between June 19 and August 31, 2021 and included 13,530 households; 5,511 participants completed the interview (response rate: 40.7%). The lifetime and 12-month diagnosis rates of mental disorders were made using the Korean version of the Composite International Diagnostic Interview 2.1. Factors associated with alcohol use disorder (AUD), nicotine use disorder, depressive disorder, and anxiety disorder were analyzed, and mental health service utilization rates were estimated.

RESULTS

The lifetime prevalence of mental disorders was 27.8%. The 12-month prevalence rates of alcohol use, nicotine use, depressive, and anxiety disorders were 2.6%, 2.7%, 1.7%, and 3.1%, respectively. The risk factors associated with 12-month diagnosis rates were as follows: AUD: sex and age; nicotine use disorder: sex; depressive disorder: marital status and job status; anxiety disorder: sex, marital status, and job status. The 12-month treatment and service utilization rates for 12-month AUD, nicotine use disorder, depressive disorder, and anxiety disorder were 2.6%, 1.1%, 28.2%, and 9.1%, respectively.

CONCLUSION

Approximately 25% of adults in the general population were diagnosed with mental disorders during their lifetime. The treatment rates were substantially low. Future studies on this topic and efforts to increase the mental health treatment rate at a national level are needed.

The Effect of Temperament on the Association Between Pre-treatment Anxiety and Chemotherapy-Related Symptoms in Patients With Breast Cancer

OBJECTIVE

Pre-treatment anxiety (PA) before chemotherapy increases complaints of chemotherapy-related symptoms (CRS). The results on the association have been inconsistent, and the effect of temperament remains unclear. We aimed to determine whether PA is a risk factor for CRS and the effect of differing temperaments on CRS.

METHODS

This prospective study comprised 176 breast cancer patients awaiting adjuvant chemotherapy post-surgery. We assessed CRS, PA, and temperament using the MD Anderson Symptom Inventory (MDASI), the Hospital Anxiety and Depression Scale, and the short form of the Temperament and Character Inventory-Revised, respectively. The MDASI was re-administered three weeks after the first chemo-cycle.

RESULTS

PA showed weak positive correlation with several CRS after the first cycle; no CRS was significantly associated with PA when pre-treatment depressive symptoms and baseline CRS were adjusted in multiple regression analysis. Moderation model analysis indicated that the PA effect on several CRS, including pain, insomnia, anorexia, dry mouth, and vomiting, was moderated by harm avoidance (HA) but not by other temperament dimensions. In particular, PA was positively associated with CRS in patients with low HA.

CONCLUSION

The results in patients with low HA indicate that more attention to PA in patients with confident and optimistic temperaments is necessary.

Associations of unspecified pain, idiopathic pain and COVID-19 in South Korea: a nationwide cohort study

Background

Few studies have investigated unspecified or idiopathic pain associated with COIVD-19. This study aimed to provide the incidence rates of unspecified pain and idiopathic pain in patients with COVID-19 for 90 days after COVID-19 diagnosis.

Methods

A propensity score matched cohort was used, including all patients with COVID-19 in South Korea, and analyzed their electronic medical records. The control group consisted of those who had not had tests for COVID-19 at all. Unspecified pain diagnoses consisted of diagnoses related to pain included in the ICD-10 Chapter XVIII. Idiopathic pain disorders included fibromyalgia, temporomandibular joint disorders, headaches, chronic prostatitis, complex regional pain syndrome, atypical facial pain, irritable bowel syndrome, and interstitial cystitis.

Results

After matching, the number of participants in each group was 7,911. For most unspecified pain, the incidences were higher in the COVID-19 group (11.7%; 95% confidence interval [CI], 11.0–12.5) than in the control group (6.5%; 95% CI, 6.0–7.1). For idiopathic pain, only the headaches had a significantly higher incidence in the COVID-19 group (6.6%; 95% CI, 6.1–7.2) than in the control group (3.7%; 95% CI, 3.3–4.1). However, using a different control group that included only patients who visited a hospital at least once for any reasons, the incidences of most unspecified and idiopathic pain were higher in the control group than in the COVID-19 group.

Conclusions

Patients with COVID-19 might be at a higher risk of experiencing unspecified pain in the acute phase or after recovery compared with individuals who had not had tests for COVID-19.

The longitudinal effects of chronotype on chemotherapy-induced nausea and vomiting in patients with breast cancer receiving neoadjuvant chemotherapy

OBJECTIVE

The object of this longitudinal cohort study was to investigate whether chronotype affects the incidence of chemotherapy-induced nausea and vomiting (CINV) among patients with breast cancer.

METHODS

The study included a total of 203 breast cancer patients who received neoadjuvant chemotherapy using a regimen of doxorubicin and cyclophosphamide with high emetogenicity. Patients received four cycles of chemotherapy in approximately three months. Patients completed questionnaires including the Munich Chronotype Questionnaire (MCTQ) before the first chemotherapy and the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) after each of the four chemotherapy sessions. To confirm the effect of chronotype on CINV during the four cycles, we performed statistical analyses using a generalized estimating equation (GEE).

RESULTS

CINV occurred in 108 (53.2%), 112 (55.2%), 102 (50.3%), and 62 (30.5%) patients during four cycles of treatment. In the GEE approach, late and early chronotypes (vs. intermediate chronotype) were associated with an increased risk of CINV (late chronotype: odds ratio [OR], 2.06; 95% confidence interval [CI], 1.41-2.99; p < 0.001, early chronotype: OR, 1.84; CI, 1.25-2.73; p = 0.002), which remained significant even after adjusting for age, BMI, antiemetic treatment, history of nausea and vomiting, anxiety, and sleep quality.

CONCLUSION

Chronotype affected CINV across the four cycles of neoadjuvant chemotherapy in patients with breast cancer, suggesting the need to consider chronotype in predicting and managing CINV.

Do posttraumatic stress symptoms predict trajectories of sleep disturbance and fatigue in patients with breast cancer? A parallel-process latent growth model

OBJECTIVE

Using a parallel-process latent growth model (LGM), this study examined whether posttraumatic stress symptoms (PTSS) are associated with the trajectory of sleep disturbance (SD) and fatigue and whether the SD trajectory mediates the PTSS-fatigue relationship.

METHODS

Data were from 215 patients with breast cancer recruited from a tertiary hospital in South Korea. A self-report survey was administered at four time points during the course of adjuvant chemotherapy.

RESULTS

The mean age of the participants was 46.69 (SD = 9.08) and the majority was at stage I and the average months since diagnosis was 1.33 (SD=1.43). Unconditional parallel-process LGM indicated that SD and fatigue were positively associated with each other, both in terms of initial status and growth rate. Then, the conditional parallel-process LGM with baseline PTSS (i.e., avoidance, intrusion, and hyperarousal) as predictors were examined and anxiety, depressive symptoms and chronotype were entered as covariates in the model. Results indicated that a higher initial status and faster growth of SD were associated with a faster increase in fatigue. Greater baseline hyperarousal was directly related to a higher initial status and a slower increase in SD, and higher initial fatigue. Furthermore, a higher hyperarousal was associated with a greater initial SD, which was related to a faster increase in fatigue. Additionally, the late chronotype was related to a faster increase in fatigue through its impact on the initial SD.

CONCLUSIONS

The detrimental impact of hyperarousal on the SD trajectory and fatigue suggests the need to intervene in PTSS and SD early and throughout the course of cancer treatments to prevent fatigue. This article is protected by copyright. All rights reserved.

Morning Chronotype Decreases the Risk of Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer

BACKGROUND

The purpose of this longitudinal prospective cohort study was to investigate the role of chronotype in the incidence of chemotherapy-induced peripheral neuropathy (CIPN) among women with breast cancer.

METHODS

We recruited women with breast cancer awaiting adjuvant chemotherapy, including four cycles of docetaxel. Participants reported peripheral neuropathy symptoms of numbness/tingling at the baseline, and at 4weeks after completion of chemotherapy. Candidate psychiatric factors associated with CIPN were assessed at the baseline, using the Composite Scale of Morningness, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale. To examine the association between chronotype and CIPN, we built logistic regression models, adjusting for demographic, clinical, and other psychiatric variables.

RESULTS

Among 48 participants, 29 participants developed CIPN. The morning chronotype was inversely associated with CIPN (odds ratio, 0.06; confidence interval, 0.01-0.74; P = 0.028) after adjusting for age, BMI, education, type of operation, alcohol use, smoking, sleep quality, depression, and anxiety.

CONCLUSION

Our results suggest that the morning chronotype is a protective factor against the development of CIPN in patients with breast cancer who were treated with docetaxel.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01887925.

Association Between Dementia Development and COVID-19 among Individuals Who Tested Negative for COVID-19 in South Korea: A Nationwide Cohort Study

We aim to assess whether the number of newly diagnosed dementia increases and whether comorbid psychiatric symptoms of patients with dementia worsen, in people who were tested for COVID-19. We used electronic medical records from a nationwide cohort consisting of people who tested positive (positive group), tested negative (negative group), and those who did not receive the test (control group) for COVID-19. For people with neither a history of dementia nor mild cognitive disorder (MCI), the negative group was more likely to develop dementia than the control group, and less likely to develop MCI than the positive group. For people who already had dementia, the negative group was more likely to develop comorbid psychiatric disorders than the control group, but less likely than the positive group. These findings suggest the necessity of managing mental health not only for patients with COVID-19 but also for people who tested negative for COVID-19.

Associations between game use and mental health in early adulthood: A nationwide study in Korea

BACKGROUND

The number of digital game users is increasing, and so is attention to digital gaming's effects on mental health. We aimed to reveal if risky (game addiction) and usual game use (non-risky) are associated with mental health in early adulthood.

METHODS

Using data from the nationwide cross-sectional Korean Epidemic Catchment Area study for psychiatric disorders, 415 participants aged 18-30 years were divided into "non-game," "usual game," and "risky game" user groups based on the previous month's game use and cut-off value of game overuse screening questionnaire. Multiple linear and logistic regressions revealed the association between game use groups, perceived mental health, and lifetime prevalence of clinical mental disorders including suicidal ideation.

RESULTS

Among the 415 participants, 167 were non-game users, 175, usual game users, and 73, risky game users. Risky game users self-reported decreased satisfaction and happiness, and a significantly higher lifetime prevalence of major depressive disorder, alcohol dependence, and suicidal ideation. Usual game users were significantly associated with higher lifetime prevalence of alcohol dependence and suicidal ideation. Self-reported happiness partially mediated between game use and lifetime suicidal ideation in risky, but not usual game users.

LIMITATIONS

This study is a cross-sectional observational study which was not possible to define the temporal relationship.

CONCLUSIONS

Both risky and usual game use are associated with mental health problems in early adulthood, indicating the need for careful mental health screening on not only risky game users but also usual game users.

Screening and Assessment Tools for Measuring Delirium in Patients with Cancer in Hospice and Palliative Care: A Systematic Review

Purpose

This study reviewed screening and assessment tools that are used to measure delirium in patients with cancer in hospice and palliative care settings and examined their psychometric properties.

Methods

Four databases were searched for studies using related search terms (delirium, tools, palliative care, cancer, and others). The inclusion criteria were a) studies that included screening/assessment tools for measuring delirium in cancer patients receiving hospice/palliative care, and b) studies published in English or Korean. The exclusion criteria were a) studies that were conducted in an intensive care setting, and b) case studies, qualitative studies, systematic reviews, or meta-analyses.

Results

Out of the 81 studies identified, only 10 examined the psychometric properties of tools for measuring delirium, and 8 tools were ultimately identified. The psychometric properties of the Memorial Delirium Assessment Scale (MDAS) were the most frequently examined (n=5), and the MDAS showed good reliability, concurrent validity, and diagnostic accuracy. The Delirium Rating Scale had good reliability and diagnostic accuracy. The Delirium Rating Scale-Revised 98 also showed good reliability and structural validity, but its diagnostic performance was not examined in hospice/palliative care settings. The Nursing Delirium Screening Scale showed relatively low diagnostic accuracy.

Conclusion

The MDAS showed evidence of being a valid assessment tool for assessing delirium in patients with cancer in palliative care. Few studies examined the diagnostic performance of delirium tools. Therefore, further studies are needed to examine the diagnostic performance of screening/assessment tools for the optimal detection of delirium in patients with cancer in hospice/palliative care.

Psychiatric symptoms mediate the effect of resilience on health-related quality of life in patients with breast cancer: Longitudinal examination

OBJECTIVE

Patients with breast cancer receiving neoadjuvant chemotherapy are at increased risk of poor health-related quality of life (HRQOL). This study examined clinical caseness on depression and anxiety mediate the relationship between resilience and HRQOL in patients with breast cancer.

METHODS

A total of 193 patients with breast cancer undergoing neoadjuvant chemotherapy completed questionnaires including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-Breast before the first session (T0), before the start of the last session (T1), and 6 months after the end (T2) of chemotherapy. Mediation analyses using a bootstrapping method was performed.

RESULTS

The indirect effect (IE) through T1 depression was significant (IE through depression = 0.043, 95% confidence interval [CI] [0.002-0.090]), while IE through T1 anxiety was not significant (IE through anxiety = 0.037, 95% CI [-0.010-0.097]) in the association between T0 resilience and T2 HRQOL.

CONCLUSIONS

Clinical caseness on HADS depression subscale during chemotherapy was a mediating factor of the relationship between resilience before chemotherapy and HRQOL after chemotherapy in patients with breast cancer receiving neoadjuvant chemotherapy. Depression during chemotherapy in patients with breast cancer may be a target symptom of screening and intervention to maintain the HRQOL after chemotherapy. Also, patients with low resilience are more likely to develop depression during chemotherapy, and clinicians should carefully monitor whether depression occurs in these patients with low resilience.

The Association of Childhood Maltreatment with Adulthood Mental Disorders and Suicidality in Korea: a Nationwide Community Study

BACKGROUND

Although childhood maltreatment is a known risk factor for adulthood mental health, the impact of different types of childhood maltreatment on mental disorders is not yet clear. This study explored the association of each type of childhood maltreatment with adulthood mental disorders and suicidality in South Korea.

METHODS

A total of 5,102 individuals from the general populations over the age of 18 responded to the Korean version of the Composite International Diagnostic Interview and questions about childhood maltreatment (emotional neglect, psychological abuse, physical abuse, and sexual abuse). To evaluate the odds ratio for mental disorders and suicidality associated with each type of childhood maltreatment, we used logistic regression analysis.

RESULTS

About 17.0% of the respondents reported having experienced a type of maltreatment in childhood. According to the type, 9.4% reported physical abuse, 9.3% reported emotional neglect, 7.9% reported psychological abuse, and 3.8% reported sexual abuse. Exposure to each type of childhood maltreatment was associated with most types of mental disorders after adjusting for sociodemographic factors. Each type of childhood maltreatment victim was associated with suicidality (suicidal ideations, suicide plans, and suicide attempts). Dose-response patterns for suicide attempts were observed in all types of victims. Moreover, the respondents who experienced frequent childhood emotional neglect were 14 times more likely to have attempted suicide.

CONCLUSION

Childhood maltreatment was associated with mental health in adulthood. The findings show the need for early detection and intervention of victims of childhood maltreatment to minimize its negative impact on adult mental health.

Network analyses of associations between cancer-related physical and psychological symptoms and quality of life in gastric cancer patients

OBJECTIVE

This study applied network analyses to illustrate patterns of associations between cancer-related physical and psychological symptoms (CPPS) and quality of life (QOL) before and after surgery.

METHODS

Participants consisted of 256 gastric cancer patients admitted for curative section surgery at the surgical department in a teaching hospital in Korea between May 2016 and November 2017. Participants completed the survey, including MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-Gastric Cancer before surgery (T0), 1 week after surgery (T1), and 3-6 months after surgery (T2).

RESULTS

Three networks featured several salient connections with varying magnitudes between CPPS and QOL across all time points. Particularly, anxiety was tightly connected to emotional wellbeing (EWB) across all time points and physical wellbeing (PWB) at T1. On the other hand, depression was connected to functional wellbeing at T0 and T2, gastric cancer concerns (CS) at T1, and PWB at T2. Distress and sadness were the most central symptoms in the three networks. Other central symptoms included shortness of breath at T0, fatigue at T0 and T1, and PWB and CS at T2. Anxiety, depression, and EWB served as bridges connecting CPPS to QOL across all time points with varying degrees of importance, as did PWB at T1 and T2.

CONCLUSIONS

Treating psychological distress and enhancing EWB and PWB can be high impact intervention targets throughout the cancer trajectory.

Prevalence and comorbidities of adult adhd in male military conscripts in korea: Results of an epidemiological survey of mental health in korean military service

We assessed the prevalence/comorbidities of attention deficit hyperactivity disorder (ADHD) in Korean servicemen using the Epidemiological Survey of Mental Health in Military Service in Korea. A total of 3,441 participants were assessed for adult ADHD, depression, social anxiety, generalized anxiety, somatization, insomnia, suicidality, cigarette dependence, and alcohol dependence using a self-report scale. Participants were also asked to rank their perception of their career prospects, health status, and quality of life on a Likert scale. Participants were classified as ADHD according to the WHO A-ADHD self-report scale. Firth multiple logistic regression and Cochran-Armitage trend tests were used to identify the risks of comorbidities and trends of self-perception between the two groups. ADHD (prevalence: 2.8%) was significantly associated with social anxiety (OR, 40.52; 95% CI 25.14-65.74), generalized anxiety (OR, 28.21; 95% CI 17.37-45.69), depression (OR, 16.36; 95% CI 10.50-25.52), somatization (OR, 14.47; 95% CI 9.21-22.76), suicidality (OR, 11.03; 95% CI 6.67-17.86), and insomnia (OR, 5.92; 95% CI 3.68-9.35). Servicemen with ADHD had negative perceptions (p <0.001) of their career prospects, health status, and quality of life compared to servicemen without ADHD. It is essential to revise the enlistment criteria for individuals with ADHD or to develop management programs for servicemen with ADHD.

Phenomenological examinations of delirium in advanced cancer patients: exploratory structural equation modelling and latent profile analysis

Background

This study examined phenomenological manifestations of delirium in advanced cancer patients by examining the factor structure of the Delirium Rating Scale-Revised-98 (DRS-R-98) and profiles of delirium symptoms.

Methods

Ninety-three patients with advanced cancer admitted to inpatient palliative care units in South Korea were examined by psychiatrists using the DRS-R-98 and the Confusion Assessment Method (CAM). The factor structure of the DRS-R-98 was examined by exploratory structural equation modelling analysis (ESEM) and profiles of delirium were examined by latent profile analysis (LPA).

Results

CAM-defined delirium was present in 66.6% (n = 62) of patients. Results from the ESEM analysis confirmed applicability of the core and noncore symptom factors of the DRS-R-98 to advanced cancer patients. LPA identified three distinct profiles of delirium characterizing the overall severity of delirium and its core and noncore symptoms. Class 1 (n = 55, 59.1%) showed low levels of all delirium symptoms. Class 2 (n = 17, 18.3%) showed high levels of core symptoms only, whereas Class 3 (n = 21, 22.6%) showed high levels of both core and noncore symptoms except motor retardation.

Conclusions

Clinical care for delirium in advanced cancer patients may benefit from consideration of the core and noncore symptom factor structure and the three distinct phenomenological profiles of delirium observed in the present study.

Age-related differences in the associations among at-risk drinking, alcohol use disorder, and psychological distress across the adult lifespan: a nationwide representative study in South Korea

PURPOSE

To investigate age-related differences in the relationships among at-risk alcohol consumption, alcohol use disorder (AUD), and psychological distress with a special focus on older adults.

METHODS

We used a nationwide cross-sectional study of a representative sample of community-dwelling adults from the Korean Epidemiologic Catchment Area study for psychiatric disorders conducted by door-to-door interviews. The Korean version of the Composite International Diagnostic Interview was applied. Subjects were categorized into four age groups: young-to-middle-aged (20-54 years), near-old (55-64 years), early-old (65-74 years), and late-old (≥ 75 years). The associations among at-risk drinking, alcohol use disorder, and psychological distress were examined according to age groups.

RESULTS

Among a total of 5102 individuals, half of them drank alcohol in the previous year, of whom 20.5% were at-risk drinkers (≥ 100 g/week). Older people were less often diagnosed with AUD than young-to-middle-aged adults with a similar degree of at-risk drinking. They were less likely to meet the DSM-5 AUD criteria in terms of social and vocational role disruption or creation of a physically hazardous situation. However, at-risk drinking showed a stronger association with subjective psychological distress in older adults, particularly in the near-old group (adjusted odds ratio 1.82, 95% confidence interval 1.09-3.03; p = 0.023).

CONCLUSIONS

These findings indicate the importance of screening for mental health problems in older adults, especially near-old adults, who drink more than 100 g of alcohol per week even when they do not satisfy the criteria for a diagnosis of AUD.

Patients' communication preferences for receiving a cancer diagnosis: Differences depending on cancer stage

OBJECTIVE

This study aimed to identify communication preferences for receiving a cancer diagnosis in South Korean patients and explore differences depending on cancer stage-with or without recurrence/metastasis.

METHODS

A total of 312 patients from five cancer centers in South Korea completed the Korean version of the Measure of Patients' Preferences questionnaire, Mini-Mental Adjustment to Cancer scale, Insomnia Severity Index, and Hospital Anxiety and Depression Scale.

RESULTS

Among patients without recurrence/metastasis, four factors were indicated: "additional information," "medical information," "emotional support," and "supportive environment." Among patients with recurrence/metastasis, five factors were indicated: "medical information and explanation," "emotional support," "supportive environment," "additional information," and "informing family." In the group without recurrence/metastasis, a positive attitude was a significant predictor of the preference for all four factors and a lower anxiety level was a predictor of the preference for additional information. Patients who reported a high level of anxious preoccupation preferred supportive environments. In the group with recurrence/metastasis, patients who showed a high level of cognitive avoidance preferred to receive medical and additional information and emotional support.

CONCLUSIONS

Cancer patients' preferences for communication when receiving bad news differ whether recurrence/metastasis or not in South Korea. Especially, patients with recurrence/metastasis preferred a clear explanation of medical information, and physicians informing patients' families about their diagnosis and prognosis. Thus, physicians should take patients' medical and psychological characteristics into consideration when delivering the news regarding their condition.

Gender-based examination of the association between individual symptoms of alcohol use disorder, major depressive disorder, and suicidal behaviors: a network analysis of data from the Korean Epidemiologic Catchment Area Study

BACKGROUND

We aimed to investigate the gender differences in the associations between the individual symptoms of AUD and MDD and SB using a network analysis.

METHODS

Data from the 2011 and 2016 Korean Epidemiologic Catchment Area Study were analyzed. Variables were assessed using the Korean version of Composite International Diagnostic Interview. Of 11,124 total participants, 907 endorsing screening questions for AUD and MDD were included. The undirected and directed network structures of AUD, MDD, and SB were estimated and centrality and bridge centrality indices were examined.

RESULTS

The overall undirected network structure and global strength did not differ between genders. While three AUD symptoms had high strength indices in network structure for both genders, depressed mood for men and worthlessness/guilt for women were the bridge symptoms linking other MDD symptoms and AUD symptoms to SB and had the strongest influence on SB. Directed network indicated that for men, AUD symptoms were related to SB via MDD symptoms with tolerance being a dominant item. For women, none of the AUD symptoms were related to MDD symptoms and SB, and insomnia/hypersomnia was a dominant item. Worthlessness/guilt was the directly linked to SB in the directed network analysis for both genders.

LIMITATIONS

Cross-sectional design and the use of combined dataset with different time points.

CONCLUSIONS

Some differential associations at the level of individual symptoms of AUD and MDD with SB were observed between men and women. Targeting to the central and bridging symptoms may improve the outcomes of SB interventions implemented among patients with AUD or MDD.

Somatic symptoms and sleep quality as indicators of depression and suicide risk among Korean military conscripts

This study examined whether somatic symptoms and sleep quality can be indicators of depression and suicide risk in Korean military conscripts. In October and November of 2016, a total of 1,937 conscripts completed a survey that included the patient health questionnaire (PHQ) 9, PHQ15, the Mini International Neuropsychiatric Interview Plus suicidality module, and the Pittsburgh sleep quality index. Four groups were formed by depression and suicide risk status. Results from analyses of covariance indicated that overall, the severity of somatic symptoms and aspects of sleep quality were higher in conscripts with both depression and suicide risk, and greater associations of depression with somatic symptoms and sleep quality. The results of logistic regression analyses indicated that moderate to high levels of somatic symptoms and poorly perceived health were associated with the risk of depression and suicide, respectively. Poor sleep quality was associated with a higher risk of depression, but it was not significantly related to suicide risk after accounting for depression, which showed a greater association with suicide risk. Monitoring somatic and sleep complaints along with perceived health are needed as potential markers of depression and suicide risk among military conscripts.

The Association between Excessive Internet Gaming Behavior and Immersive Tendency, Mediated by Attention Deficit/Hyperactivity Disorder Symptoms, in Korean Male University Students

OBJECTIVE

Problematic online gaming (POG) and problematic Internet use (PIU) have become a serious public mental health problem, with Internet gaming disorder (IGD) included in "Conditions for further study" section of DSM-5. Although higher immersive tendency is observed in people affected by POG, little is known about the simultaneous effect of immersive tendency and its highly comorbid mental disorder, attention deficit/hyperactivity disorder (ADHD). This study aimed to assess the relationship between immersive tendency, ADHD, and IGD.

METHODS

Cross-sectional interview study was conducted in Seoul, Korea with 51 male undergraduate students; 23 active gamers and 28 controls.

RESULTS

Current ADHD symptoms showed partial mediation effect on the path of immersive tendency on POG and PIU. The mediation model with inattention explained variance in both POG and PIU better than other current ADHD symptom models (R2=69.2 in POG; 69.3 in PIU). Childhood ADHD symptoms models demonstrated mediation effect on both POG and PIU which explained less variance than current ADHD symptom models (R2=53.7 in POG; 52.1 in PIU). Current ADHD symptoms, especially inattention, appear to mediate the effect of immersive tendency on POG/PIU.

CONCLUSION

Immersive tendencies may entail greater susceptibility to IGD, and comorbidity with ADHD may mediate the effect of immersive tendency on IGD.

Effectiveness of a village-based intervention for depression in community-dwelling older adults: a randomised feasibility study

Background

Although a focus on late-life depression may help preventing suicide in older adults, many older people, especially those living in rural areas, have relatively low accessibility to treatment. This study examined the feasibility and effectiveness of a village-based intervention for depression targeting older adults living in rural areas.

Methods

A community-based randomised pilot trial was performed in two small rural villages in South Korea. Two villages were randomly selected and assigned to the intervention or active control group; all older adults living in the two villages (n = 451) were included in the intervention program or received standard Community Mental Health Service (CMHS) care, and the effectiveness of the program was examined using representative samples from both groups (n = 160). The 12-week intervention included case management according to individual risk level and group-based activities. Healthy residents living in the intervention village who played major roles in monitoring at-risk older individuals were supervised by CMHS staff. The score on the Korean version of the Geriatric Depression Scale-Short Form (SGDS-K) was the primary outcome, while social network, functional status, and global cognitive function were secondary outcomes. Linear mixed models including the factors of intervention group, time, and their interaction were used to examine group differences in changes in primary and secondary outcomes from baseline to follow up.

Results

Overall, there was no significant group × time interaction with respect to the SGDS-K score, but older individuals with more depressive symptoms at baseline (SGDS-K ≥ 6) tended to have a lower likelihood of progressing to severe depression at post-intervention. The social network was strengthened in the intervention group, and there was a significant group × time interaction (F[df1, df2], 5.29 [1, 153], p = 0.023).

Conclusion

This study examined a 12-week village-based intervention for late-life depression in which the CMHS helped village-dwellers deal with late-life depression in their communities. Although the intervention improved social interactions among older adults, it did not reduce depressive symptoms. Further studies including more rural villages and long-term follow up are needed to confirm the effectiveness of this prevention program.

Trial registration

NCT04013165 (date: 9 July 2019, retrospectively registered).

The effect of perceived social support on chemotherapy-related symptoms in patients with breast cancer: A prospective observational study

OBJECTIVE

Few studies have examined the effect of perceived social support (PSS) on chemotherapy-related symptoms (CRS). This study examined the effect of PSS on CRS in 184 patients with breast cancer.

METHODS

Participants were consecutively enrolled from a tertiary general hospital in Seoul, South Korea. CRS were assessed eight times, from before the first neoadjuvant chemotherapy to six months after the end of neoadjuvant chemotherapy, with the MD Anderson Symptom Inventory. PSS was evaluated once, before the first neoadjuvant chemotherapy session, using the Multidimensional Scale of Perceived Social Support (MSPSS). Two groups were formed based on MSPSS scores: the low PSS group (n = 62) and the moderate-to-high PSS group (n = 122). Linear mixed model analyses were used to compare the change in CRS severity between the two groups during chemotherapy.

RESULTS

Results indicated a significant group-by-time (low PSS or moderate-to-high PSS; 8 periods of chemotherapy) interaction for pain (p = .005), nausea (p = .033), insomnia (p < .001), distress (p = .003), dyspnea (p = .014), memory loss (p = .021), vomiting (p = .016), and numbness (p = .008) in which the moderate-to-high PSS group showed significantly lower levels of increase in those symptoms during chemotherapy. Moreover, the effect of PSS on CRS differed depending on the sources of PSS.

CONCLUSION

Patients with moderate-to-high PSS experience less severe CRS compared with patients with low PSS during chemotherapy. The current findings indicate the potential benefits of providing social support in the management of CRS.

A network analysis of the Brief Illness Perception Questionnaire in patients with rheumatic diseases and human immunodeficiency virus infection

Objective: To examine the construct of illness perception (IP) as measured by the Brief Illness Perception Questionnaire (BIPQ) using network analysis in patients with rheumatic diseases (RD) and with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS).Design: Cross-sectional and multicentre survey.Main Outcome Measures: The BIPQ and the Hospital Anxiety and Depression Scale.Results: BIPQ network structures did not differ between patients with RD and HIV/AIDS. Community analysis identified two clusters: one comprised consequences, timeline, identity, concern and emotional response; and the other consisted of personal control, treatment control and comprehensibility. Centrality indices indicate that concern, consequences and emotional response are central dimensions of the BIPQ. Directed acyclic graph analysis revealed that concern was a dominant network item, activating emotional response, consequences, identity and comprehensibility. Emotional response and consequences were bridging items linking IP to anxiety and depression.Conclusion: Perceived impact of illness on life and emotion and illness concern are central dimensions of the BIPQ that link IP to anxiety and depression in patients with RD and HIV/AIDS. Care of patients with RD and HIV/AIDS may benefit from addressing IP, particularly concern, emotional response and consequences to prevent clinical anxiety and depression.

Morning chronotype is a protective factor against chemotherapy-induced hot flashes in premenopausal women with breast cancer

PURPOSE

Adjuvant chemotherapy in patients with breast cancer often causes hot flashes, impairing quality of life. However, the chronobiological or psychiatric factors associated with the development of chemotherapy-induced hot flashes (CIHFs) remain undetermined. The purpose of this study was to investigate whether chronotype was associated with the incidence of CIHFs.

METHODS

A total of 119 premenopausal women with non-metastatic breast cancer awaiting adjuvant chemotherapy after surgery without hot flashes were included. The presence of CIHF was defined as having moderate to severe hot flashes, as measured by the subscale of hot flashes in the Menopause Rating Scale, at 4 weeks after the completion of chemotherapy. Chronotype (Morning/Intermediate/Evening) was assessed with the Composite Scale of Morningness before adjuvant chemotherapy. To examine the association between chronotype and CIHF, we built logistic regression models, adjusting for age, body mass index, sleep quality, and radiation therapy.

RESULTS

CIHF occurred in 50.4% of participants. Morning type was inversely associated with CIHF (reference: Intermediate type, odds ratio [OR], 0.37; 95% confidence interval [CI], 0.16-0.94; p = 0.040) in the univariate model, and the association remained significant (OR, 0.37; CI, 0.13-0.96; p = 0.045) after adjusting for age, body mass index, sleep quality, and radiation therapy.

CONCLUSIONS

Morning chronotype is a protective factor against the development of CIHF in patients with breast cancer. Chronotypes should be assessed and considered in the prediction and management of CIHF.

Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide

PURPOSE

The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS.

METHODS

A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module.

RESULTS

Participants' mean age was 48.6 (SD = 13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk.

CONCLUSIONS

PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.

A longitudinal analysis of the relationships among daytime dysfunction, fatigue, and depression in college students

OBJECTIVE

To examine the longitudinal trajectory of daytime dysfunction (DD) and its relationship with fatigue by depression status in university students.

PARTICIPANTS

243 students completed online surveys from September- December 2016.

METHODS

Surveys were conducted at three time points over a semester period: the beginning of the semester, the end of mid-term and the end of the semester.

RESULTS

Results indicated that the DD significantly increased in all students over the semester. Students with depression showed a higher initial level of DD and faster rate of change compared to those without depression. A faster rate of change of DD predicted a higher level of end-semester fatigue.

CONCLUSIONS

Depression is related to a higher initial level of DD and its faster rate change which in turn, predicted end-semester fatigue, identifying one of the possible pathways through which depression impacts the functioning and health of affected students.

Protocol for the first clinical trial to investigate safety and efficacy of corneal xenotransplantation in patients with corneal opacity, corneal perforation, or impending corneal perforation

BACKGROUND

Xenotransplantation using fresh porcine corneas has been suggested as a feasible alternative to overcome the shortage of human donor corneas. Successful long-term survival of grafts without evidence of xenozoonosis in clinically applicable pig-to-non-human primate corneal transplantation model has brought researchers close to human clinical trials. Accordingly, we aimed to prepare a clinical trial protocol to conduct the first corneal xenotransplantation.

METHODS

We developed the clinical trial protocol based on international consensus statement on conditions for undertaking clinical trials of corneal xenotransplantation developed by the International Xenotransplantation Society. Detailed contents of the protocol have been modified with reference to comments provided by ophthalmologists and multidisciplinary experts, including an infectionist, an organ transplantation specialist, a clinical pharmacologist, a neuropsychiatrist, a laboratory medicine doctor, and a microbiologist.

RESULTS

Two patients with bilateral legal corneal blindness (best-corrected visual acuity ≤20/200 in the better eye and ≤20/1000 in the candidate eye) or with (impending) corneal perforation will be enrolled. During the screening period, participants and their family members will have two separate deep consideration periods before signing informed consent forms. Each patient will undergo corneal xenotransplantation using fresh corneas from Seoul National University miniature pigs. Commercially available immunosuppressants will be administered and systemic infection prophylaxis will be performed according to the program schedule. After transplantation, each patient will be monitored at a specialized clinic to investigate safety up to 2 years and efficacy up to 1 year.

CONCLUSIONS

A detailed clinical trial protocol for the first corneal xenotransplantation reflecting the global guidelines is provided.

Incidence and risk factors of subsyndromal delirium after curative resection of gastric cancer

Background

Subsyndromal delirium, a condition in which patients exhibit some, but not all, of the symptoms of delirium, can negatively affect the outcomes of patients with cancer. However, the incidence of subsyndromal delirium in patients with gastric cancer is unknown. Here, we investigated the incidence and risk factors of subsyndromal delirium after curative resection of gastric cancer.

Methods

We recruited consecutive patients with gastric cancer who were scheduled for curative resection at a tertiary hospital. Patients’ subsyndromal delirium symptoms were serially assessed preoperatively and 1, 2, 3, and 7 days postoperatively using the Delirium Rating Scale-Revised-98 (DRS-R-98). A DRS-R-98 score of 8–14 at any postoperative assessment was considered to indicate subsyndromal delirium. Sociodemographic and pre−/intra-operative clinical data were also assessed. Logistic regression analyses were used to determine the associated risk factors.

Results

Data were analysed from 163 out of 217 eligible patients. Postoperative delirium occurred in one patient (0.6%) and subsyndromal delirium occurred in 19 patients (11.7%). Age ≥ 70 years (odds ratio, [OR] 3.85; 95% confidence interval [CI], 1.36–10.92; p = 0.011) and education level ≤ 9 years (OR, 3.98; 95% CI, 1.39–11.41; p = 0.010) were independent risk factors of subsyndromal delirium after adjusting for preoperative cognitive function. Other pre−/intra-operative variables including anxiety/depression, poor sleep quality, and anaesthesia duration were not associated with subsyndromal delirium.

Conclusions

In contrast to the low incidence of delirium among patients undergoing curative resection of gastric cancer, a substantial proportion of such patients experienced subsyndromal delirium. Considering the prognostic implications, more careful detection and management of subsyndromal delirium may be warranted in patients with gastric cancer.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4681-2) contains supplementary material, which is available to authorized users.

Psychometric properties of the Korean version of the medical outcomes study HIV health survey: results from a multicenter survey in Korea

Background

Precise assessment of health-related quality of life (HRQOL) with a reliable and valid measure is a prerequisite to the enhancement of HRQOL. This study examined the psychometric properties of the Korean version of the Medical Outcomes Study HIV Health Survey (K-MOS-HIV).

Methods

The reliability and validity of the K-MOS-HIV were examined in a multicenter survey involving 201 outpatients with human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) from four teaching hospitals throughout Korea.

Results

Ceiling effects were observed in six subscales scores, particularly, for the role functioning (71.1%), social functioning (63.2%), and pain (48.8%) scores. The Cronbach’s α for the physical health summary and mental health summary were 0.90 and 0.94, respectively, and it ranged from 0.78 to 0.95 for the subscales. The results of the exploratory structural equation modeling supported the two-factor structure of the K-MOS-HIV (physical health summary and mental health summary). An examination of the mean square statistics values from the Rasch analysis showed that the information-weighted fit and outlier-sensitive fit statistics were within the acceptable ranges of 0.6–1.4 except for two items in the mental health summary. The convergent validity of the K-MOS-HIV was supported by its significant positive correlations with the World Health Organization Quality of Life-HIV-BREF subscale scores. Its known-group validity was proven with its ability to detect significant differences in several K-MOS-HIV subscale scores among participants with different sociodemographic and clinical characteristics.

Conclusions

The K-MOS-HIV health survey appears to be a reliable and valid measure of HRQOL.

Pre-treatment anxiety is associated with persistent chemotherapy-induced peripheral neuropathy in women treated with neoadjuvant chemotherapy for breast cancer

OBJECTIVE

Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent adverse reaction caused by chemotherapeutic agents, especially the taxanes. CIPN can persist from months to years after completion of chemotherapy, decreasing quality of life for cancer survivors. The aim of this study was to explore the incidence and risk factors of persistent CIPN among women with breast cancer receiving neoadjuvant chemotherapy.

METHODS

In this prospective study, we recruited women with breast cancer receiving neoadjuvant chemotherapy, including four cycles of docetaxel. Participants reported neuropathic symptoms of tingling/numbness at baseline, at the end of chemotherapy treatment, and at 8 months after completion of chemotherapy. Candidate factors associated with CIPN were assessed before chemotherapy.

RESULTS

Among 111 participants, 50 (45.0%) experienced CIPN during chemotherapy, and 21 (18.9%) reported persistent CIPN after chemotherapy. Univariate logistic regression analysis revealed that development of CIPN was significantly associated with pre-treatment numbness (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.09-7.40; p = .033), and persistent CIPN was significantly associated with pre-treatment numbness (OR, 3.60; 95% CI, 1.12-11.61; p = .032) and pre-treatment anxiety (OR, 5.02; 95% CI, 1.84-13.70; p = .002). Multivariate analysis indicated that pre-treatment anxiety remained significantly associated with persistent CIPN (OR, 4.01; 95% CI, 1.25-12.87; p = .020).

CONCLUSION

Our results suggested that pre-treatment anxiety might be related to a patient's risk for persistent CIPN in women with breast cancer undergoing neoadjuvant chemotherapy. Further research is required to investigate if interventions targeting pre-treatment anxiety could provide prevention and management for persistent CIPN.

Cross-Cultural Validation of the Korean Version of the Chalder Fatigue Scale

PURPOSE

University students are vulnerable to fatigue. If not adequately dealt with, fatigue might develop into various health problems and negatively affect quality of life (QOL). The present study examined psychometric properties of the Korean version of the Chalder Fatigue Scale (K-CFQ) in university students.

METHOD

Data were obtained from two samples of undergraduate students in Korea. The first dataset (N = 557) was collected in a cross-sectional survey in 2015 and the second dataset (N = 338) from a longitudinal survey with three time points over a semester period in 2016. Participants completed measures of fatigue, QOL, depression, anxiety, and sleep quality.

RESULTS

Three-factor model (physical fatigue, low energy, and mental fatigue) rather than the original two-factor model (physical and mental fatigue) provided a better goodness of fit indices to the data. Internal consistency of the K-CFQ was satisfactory, with Cronbach's α value of 0.88 for the total scale and those of subscales ranging from 0.73 to 0.87. Its convergent validity was supported by its significant association with anxiety, depression, sleep quality, and QOL. Significant association between T1 K-CFQ with physical QOL at T2 and T3 supported its predictive validity. Its known-group validity was proven with higher K-CFQ scores observed in the participants with depression and those with poor sleep quality.

CONCLUSIONS

Current results suggest that K-CFQ is a valid and reliable measure of fatigue, and a better model fit of the three-factor structure of the K-CFQ implies potential cross-cultural differences in the dimensionality of fatigue.

Relationship between physicians' perceived stigma toward depression and physician referral to psycho-oncology services on an oncology/hematology ward

OBJECTIVE

This study was performed to identify relationships between physicians' perceived stigma toward depression and psycho-oncology service utilization on an oncology/hematology ward.

METHODS

The study participants were 235 patients in an oncology/hematology ward and 14 physicians undergoing an internal medicine residency training program in Inha University Hospital (Incheon, South Korea). Patients completed the Patient Health Questionnaire-9 (PHQ-9), and residents completed the Perceived Devaluation-Discrimination scale that evaluates perceived stigma toward depression. A total PHQ-9 score of ≥5 was defined as clinically significant depression. Physicians decided on referral on the basis of their opinions and those of their patients. The correlates of physicians' recommendation for referral to psycho-oncology services and real referrals psycho-oncology services were examined.

RESULTS

Of the 235 patients, 143 had PHQ-9 determined depression, and of these 143 patients, 61 received psycho-oncology services. Physicians recommended that 87 patients consult psycho-oncology services. Multivariate analyses showed that lower physicians' perceived stigma regarding depression was significantly associated with physicians' recommendation for referral, and that real referral to psycho-oncology services was significantly associated with presence of a hematologic malignancy and lower physicians' perceived stigma toward depression.

CONCLUSION

Physicians' perceived stigma toward depression was found to be associated with real referral to psycho-oncology services and with physician recommendation for referral to psycho-oncology services. Further investigations will be needed to examine how to reduce physicians' perceived stigma toward depression.

Psycho-oncology in Korea: past, present and future

Background

Psycho-oncology in Korea was introduced among the circle of consultation-liaison psychiatrists, in the 1990s. For almost 25 years, the field has been developing at a steady pace as the psychosocial needs of patients with cancer continue to increase. In this study, we review the history of psycho-oncology in Korea, in a chronological order, within the domains of clinical practice, research activity, training, and public policy.

Main body

Before the 1990s, patients with cancer with psychiatric comorbidities were usually taken care of by consultation-liaison psychiatrists in general hospitals. In 1993, psycho-oncology was first introduced by psychiatrists. Psychologists, nurses, and social workers have also been increasingly involved in providing psychosocial care for patients with cancer. Professionals from various disciplines began to communicate, and agreed to found the Korean Psycho-Oncology Study Group (KPOSG) in 2006, the first academic society in this field. In 2009, National Cancer Center published the “Recommendations for Distress Management in Patients with Cancer”, which are consensus-based guidelines for Korean patients. In 2014, the KPOSG was dissolved and absorbed into a new organization, the Korean Psycho-Oncology Society (KPOS). It functions as a center of development of psycho-oncology, publishing official journals, and hosting annual conferences. There are many challenges, including, low awareness of psycho-oncology, presence of undertreated psychiatric disorders in patients with cancer, shortage of well-trained psycho-oncologists, stigma, and suicide risk. It is important to improve the cancer care system to the extent that psycho-oncology is integrated with mainstream oncology. Considering the socio-cultural characteristics of Korean cancer care, a Korean model of distress management is being prepared by the KPOS.

Conclusion

This article provides an overview of the development, current issues, and future challenges of psycho-oncology in Korea. Through its long journey to overcome the many barriers and stigmas of cancer and mental illnesses, psycho-oncology is now acknowledged as an essential part of integrated supportive care in cancer. Active research and international cooperation can gradually shape the Korean model of distress management.

Late chronotypes are associated with neoadjuvant chemotherapy-induced nausea and vomiting in women with breast cancer

Neoadjuvant chemotherapy, that is, the administration of chemotherapy before surgery, has been commonly used for locally advanced breast cancer to improve the surgical outcomes and increase the opportunity for breast-conserving therapy. Women with breast cancer often receive an anthracycline-based regimen as the neoadjuvant chemotherapy, which is associated with a high risk of emesis. Despite the development of novel antiemetics, chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as a major adverse effect, affecting the quality of life of the patients. However, the factors predicting CINV in women with breast cancer undergoing neoadjuvant chemotherapy remain unclear. In this single-institution, prospective, observational study conducted at an outpatient cancer centre in the Republic of Korea from November 2013 to March 2016, we analysed women with breast cancer who planned to be treated with neoadjuvant chemotherapy before surgery. Candidate factors associated with CINV were assessed before neoadjuvant chemotherapy using the Munich Chronotype Questionnaire, Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. CINV was assessed after chemotherapy by using the Multinational Association of Supportive Care in Cancer Antiemesis Tool. Of a total of 143 participants, 7 patients were lost to follow-up and 2 patients were excluded due to changes in their treatment plan; thus, 134 patients were finally included in the analyses. Overall, 48.5% of the participants experienced CINV, with delayed CINV prevalence (42.5%) being more common than acute (39.6%). In the univariate analyses, overall CINV was significantly associated with late chronotypes (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.37-8.87; p = 0.009), a history of nausea/vomiting (OR, 2.19; 95% CI, 1.10-4.37; p = 0.026) and anxiety (OR, 2.25; 95% CI, 1.05-4.81; p = 0.036). In the multivariate analyses, late chronotypes (OR, 3.53; 95% CI, 1.27-9.79; p = 0.015) and a history of nausea/vomiting (OR, 2.83; 95% CI, 1.31-6.13; p = 0.008) remained significantly associated with CINV. In conclusion, in women with breast cancer undergoing neoadjuvant chemotherapy before surgery, late chronotypes were found to have an increased risk of CINV; these data suggest that clinicians need to assess and consider the chronotype in the management of CINV.

Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression

PURPOSE

To examine factors in the fear-avoidance model, such as pain, pain catastrophizing, fear-avoidance beliefs, physical disability, and depression and their relationships with physical and psychological quality of life in patients with rheumatic diseases.

MATERIALS AND METHODS

The data were obtained from 360 patients with rheumatic diseases who completed self-report measures assessing study variables. Structural equation modeling was used to examine the hypothesized relationships among factors specified in the fear-avoidance model predicting physical and psychological quality of life.

RESULTS

Final models fit the data well, explaining 96% and 82% of the variance in physical and psychological quality of life, respectively. Higher pain catastrophizing was related to stronger fear-avoidance beliefs that had a direct negative association with physical disability and depression, which, in turn, negatively affected physical quality of life. Pain severity was also directly related to physical disability. Physical disability also affected physical quality of life indirectly through depression. The hypothesized relationships specified in the model were also confirmed for psychological quality of life. However, physical disability had an indirect association with psychological quality of life via depression.

CONCLUSION

The current results underscore the significant role of cognitive, affective, and behavioral factors in perceived physical disability and their mediated detrimental effect on physical and psychological quality of life in patients with rheumatic diseases. Implications for rehabilitation The fear-avoidance model is applicable to the prediction of quality of life in patients with rheumatic diseases. As pain-catastrophizing and fear-avoidance beliefs are important factors linked to physical disability and depression, intervening these cognitive factors is necessary to improve physical function and depression in patients with rheumatic diseases. Considering the strong association between depression and physical and psychological quality of life, the assessment and treatment of the former should be included in the rehabilitation of patients with rheumatic diseases. Interventions targeting physical function and depression are likely to be effective in terms of improving physical and psychological quality of life in patients with rheumatic diseases.

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students

BACKGROUND

Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI).

METHODS

The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI) and questions regarding quality of life (QOL) and self-rated physical health (SPH) were administered.

RESULTS

Exploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach's α = .78). Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI's ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH.

CONCLUSIONS

The K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

Evaluation of a Functional Model of Acquired Capability for Suicide in a Nationwide Sample of Korean Adults

OBJECTIVE

We examined a functional model of acquired capability for suicide, which was elaborated from the "Interpersonal-Psychological Theory of Suicide".

METHODS

A total of 6,027 Korean community subjects were recruited from The Korean Epidemiologic Catchment Area study conducted in 2011. The subjects were assessed systematically using the Korean version of the Composite International Diagnostic Interview version 2.1, the Korean version of the Barratt Impulsiveness Scale, and the Korean version of the Mood Disorder Questionnaire. We used structural equation modeling to identify potential factors contributing to a suicide attempt.

RESULTS

Most aspects of the model were supported by the data and "the short-term enhancer for the acquired capability for suicide" had direct effects on suicide attempts. However, the suicidal planning effects of "the short-term enhancer for the acquired capability for suicide" were eliminated by the rule of parsimony.

CONCLUSION

The main finding was that "the short-term enhancer for the acquired capability for suicide" is relevant to suicide attempts when it's direct, indirect, and reciprocal effects are tested within a more complete system of relationships than found in existing studies. The implications of these findings are discussed with regard to future conceptual work and empirical research.

Tailoring communications to the evolving needs of patients throughout the cancer care trajectory: a qualitative exploration with breast cancer patients

Background

Doctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum.

Methods

In-depth interviews with seven breast cancer patients were carried out.

Results

Themes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as ‘a disease of the mind’, which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important.

Conclusion

Current findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12905-016-0347-x) contains supplementary material, which is available to authorized users.

Development and validation of the National Cancer Center Psychological Symptom Inventory

OBJECTIVE

To report the development and validation of the National Cancer Center Psychological Symptom Inventory (NCC-PSI).

METHODS

Psychometric properties of the NCC-PSI were examined by using multicenter surveys involving 400 patients with cancer in 5 cancer-treatment hospitals throughout Korea. Related measures including the Mini-International Neuropsychiatric Interview were administered.

RESULTS

Convergent validity was supported by NCC-PSI's significant associations with related measures. Known-group validity was proven with higher scores of helplessness/hopelessness and anxious preoccupation on the Mini-Mental Adjustment to Cancer in the depression and anxiety diagnosis group, defined by the NCC-PSI. Cutoff scores for insomnia, anxiety, and depression were identified. Overall, the screening performance of the NCC-PSI was comparable to that of the distress thermometer and Patient Health Questionnare-2.

CONCLUSIONS

The NCC-PSI represents a meaningful effort to develop a distress screening tool that addresses specific psychological symptoms common in cancer, which are tailored to the local oncology care system with varying degrees of psychosocial care resources.