Effectiveness of Online Interventions for the Universal and Selective Prevention of Mental Health Problems Among Adolescents: a Systematic Review and Meta-Analysis.

With the emergence of the coronavirus disease 2019 pandemic as a threat to mental health, the demand for online interventions that can replace face-to-face approaches for the prevention of mental health problems is increasing. Although several previous reviews on online interventions have targeted adolescents with symptoms of or those diagnosed with mental illness, there is still a lack of evidence on the effectiveness of online preventive interventions for general and at-risk adolescents. Therefore, this review aimed to evaluate the effectiveness of online interventions on the prevention of an increase in the scores of stress, anxiety, and depression in general and at-risk adolescents. A search was performed using PubMed, EMBASE, and Cochrane Library CENTRAL. Altogether, 19 studies were included, and 16 studies were used for the meta-analysis. Our results showed that cognitive behavioral therapy and family-based interventions were most commonly used. Twelve and seven studies conducted universal and selective preventive interventions, respectively. The meta-analysis showed that online interventions significantly prevent an increase in depression score but not in stress and anxiety scores. Evidence regarding the prevention of increases in stress and anxiety scores is limited, suggesting the need for further randomized controlled trials on online interventions for stress and anxiety in adolescents.

Experience of Violence and Factors Influencing Response to Violence Among Emergency Nurses in South Korea: Perspectives on Stress-Coping Theory.

INTRODUCTION: This cross-sectional study aimed to explore the experiences of workplace violence involving emergency nurses and to identify the factors influencing the response to violence on the basis of the stress-coping theory formulated by Lazarus and Folkman. METHODS: Using a cross-sectional design, a structured questionnaire was administered to measure the experience of violence, perceived stress, coping actions after violence, resilience (Connor-Davidson Resilience Scale), and responses to violence. The participants were 131 nurses who were working in the emergency departments in 9 of 11 general hospitals in 2 cities in South Korea. The collected data were analyzed using descriptive statistics, t tests, analyses of variance, Pearson correlations, and hierarchical multiple regression analyses. RESULTS: The most frequent type of violence was verbal violence, and the main offender involved in all types of violence was the patient. The methods for coping with violence were mainly passive, and emotional responses were the most frequently reported response to violence. In the final model (explanatory power = 41.5%), with response to violence as the dependent variable, the effects of the experience of violence disappeared, and only the effects of perceived stress and resilience remained. DISCUSSION: The results of this study suggest that internal factors such as perceived stress and resilience have a more meaningful effect on the response to violence than the experience of violence itself. The findings are expected to serve as assessment data for preparing interventions and policies around prevention of, and effective coping regarding, workplace violence toward emergency nurses.

Mediating effects of family functioning on the relationship between care burden and family quality of life of caregivers of children with intellectual disabilities in Mongolia.

BACKGROUND: Intellectual disabilities are characterized by constant and complex needs for care that place a heavy burden on the families of affected individuals and affect their overall quality of life. We evaluated the mediating effects of family functioning on the relationship between care burden and the family quality of life of caregivers of children with intellectual disabilities in Mongolia. METHODS: Data were collected from a sample of 150 caregivers of children with intellectual disabilities from October 2017 to November 2017. Multiple linear regression analyses were performed to examine the mediating effects of family functioning. RESULTS: Family functioning had a partial mediating effect (ß = .702, p < .001) on the relationship between care burden and family quality of life. CONCLUSION: Family functioning should be considered when developing a social support intervention to improve family quality of life among caregivers of children with intellectual disabilities.

Effects of a Korean version of the metacognitive training program for outpatients with schizophrenia on theory of mind, positive symptoms, and interpersonal relationships.

BACKGROUND: Since the significance of metacognition as the theoretical basis of a psychological intervention for schizophrenia first emerged, there have been ongoing attempts to restore or strengthen patients' metacognitive abilities. AIM: A Korean version of the metacognitive training (MCT) program was developed, and its effects on theory of mind, positive and negative symptoms, and interpersonal relationships were examined in stable outpatients with schizophrenia. METHOD: A pre-test-post-test design with a control group was used. The participants were 59 outpatients (30 in experimental group, 29 in control group) registered at five mental health facilities in a city in South Korea. The developed MCT program was applied for a total of 18 sessions, 60 min per session, over a period of 14 weeks. The hinting task, false belief task, Scale for the Assessment of Positive and Negative Symptoms, and Relationship Change Scale were used to verify the effects of this program. Data were analysed by the chi-square test, t-test, and Mann-Whitney U-test using the SPSS/PASW 18.0 statistics program. RESULTS: The general characteristics, intelligence, and outcome variables of the two groups were homogeneous. After the intervention, the experimental group showed significant improvements in theory of mind, positive and negative symptoms and interpersonal relationships compared with the control group. CONCLUSION: These results suggest that the MCT program can be a complementary psychotherapy that contributes to symptom relief and interpersonal functioning in patients with schizophrenia, and is effective in the Korean culture, beyond the Western context.

Effects of a Brief Empowerment Program for Families of Persons with Mental Illness in South Korea: A Pilot Study.

Families of persons with mental illness (PMIs) are considered important resources for PMIs rather than as contributors to their mental illness. However, these families experience not only the burden of caregiving but also social stigma and discrimination in various aspects of their lives, and their psychosocial needs tend to be overlooked. This was a pilot study to explore the effects of a brief empowerment program on the empowerment and quality of life of families of PMIs in South Korea. A repeated-measures design with a control group and pre/post-follow-up testing was used. We enrolled 18 participants (experimental group = 9, control group = 9). The experimental group participated in an empowerment program consisting of four sessions over 4 weeks. Data were collected before and after the program, and again 4 weeks later. The χ2-test, Fisher's exact probability test, t-test, and repeated-measures analysis of covariance were used, as appropriate, to analyze data. The program significantly increased empowerment (F = 4.66, p = .020) and quality of life (F = 5.83, p = .009) among participants in the experimental group over time. Its therapeutic features, such as sharing their experiences, discussion, and presentations, can be applied to create effective psychosocial interventions for families of PMIs.

Experience of migrant care and needs for cultural competence training among public health workers in Korea.

OBJECTIVE: This study explored the experiences of public health workers (PHWs) providing health care for migrants living in Korea and clarified needs for cultural competence training. DESIGN AND SAMPLE: Twenty-six PHWs from five public health centers in Gwangju city, South Korea, participated in this exploratory qualitative study. METHODS: Five semi-structured focus group interviews of PHWs were conducted from September to December 2016. A directed content analysis approach was conducted using four categories: perceived characteristics of migrants, interaction between PHWs and migrants, interaction between PHWs and organizations/systems, and cultural competence training needs. RESULTS: PHWs perceived that migrants lacked autonomy in health decisions and awareness of health behaviors. PHWs experienced difficulties in communicating and in establishing trusting relationships. They found clients hard to reach and easy to miss, a lack of continuity in health care programs, and inadequate human and material resources. They preferred passive teaching methods to activity-based simulation. PHWs believed essential training should be provided through e-learning to all PHWs, including management. CONCLUSION: PHWs reported experiencing multiple challenges from a lack of preparedness for culturally competent care and their clients' vulnerability. Development of cultural competence training is suggested through e-learning that reflects the PHWs' experiences and provides systematic support.

Experiences of Family Stigma among Mothers of Adult Children with Mental Illness in South Korea.

People with mental illness suffer from stigma in addition to the illness itself; their families also suffer from the stigma of having a family member with a mental illness. The aim of the present study was to explore the lived experiences of the family stigma among mothers of mentally ill children in South Korea. The work was qualitative in nature; we used the phenomenological method of Colaizzi. Mothers with an adult child enrolled as mentally ill patients in the Mental Health Centre of K Province in South Korea were eligible for inclusion. FINDINGS: Six themes emerged; these were being ashamed, feeling of being ignored, isolating oneself from social relationships, becoming a mentally sick person, living like a guilty person, and becoming a part of the socially weak. The study contributes to our understanding of stigma experienced by family members in a socio-cultural context and will aid in the development of culturally appropriate strategies for the destigmatization of families of mentally ill persons.

A Summary of Selective Experimental Research on Psychosocial Interventions for Sexually Abused Children.

This study was conducted to explore current trends in psychosocial interventions for sexually abused children through a review of recent research. Our comprehensive review is limited to published (quasi) experimental studies in the English language over a period of 2000-2013. It provides a detailed analysis of the final 18 articles that met our inclusion criteria, from the 670 potentially relevant articles that were identified. Reviewers analyzed candidate articles to determine whether they met inclusion or exclusion criteria. The retrieved studies reported positive results with respect to improvements in the negative psychosocial sequelae of child sexual abuse following the use of a diverse set of treatment strategies. Of the various interventions, cognitive behavioral therapy was shown to be the most promising type of intervention for sexually abused children. In this review, we discuss some of the implications of psychosocial interventions for victims of child sexual abuse, citing both the methodological and ethical issues that should be considered.

Transcultural adaptation and validity of the nurse professional competence scale Korean version for graduating nursing students: An explanatory factor analysis.

AIM: The study aimed to assess the validity and reliability of the short-form Nurse Professional Competence Scale-Korean version (NPC-K) among Korean nursing students at the point of graduation. DESIGN: This was a cross-sectional survey. METHODS: The Nurse Professional Competence scale was translated into Korean using the World Health Organization (WHO) translation method. A total of 195 graduating nursing students participated. Exploratory factor analysis for validity and Cronbach's alpha coefficients for reliability were examined. RESULTS: Factor analysis showed that five NPC-K factors accounted for 68.38% of the total variance. Cronbach's alpha for the total scale was 0.97. The NPC-K has high internal reliability and acceptable construct validity. The content of the scale reflected nursing students' confidence in formal competence requirements based on Korean cultural and educational backgrounds. An accurate assessment of nurse professional competence using the NPC-K may help nursing academics enhance the quality of education and training.

Effects of a Walking Exercise-Focused Health Promotion Program for Middle-Aged Women in the Korean Community.

We assessed the effectiveness of a walking exercise-focused health promotion program based on an information-motivation-behavioral skills model. This intervention study employed a non-equivalent control group pre-test/post-test design. We recruited 44 middle-aged women (22 per group) who visited two health check-up centers in G city of South Korea. The intervention included information (health education), personal motivation (pedometer monitoring, setting goals, and keeping an exercise log), social motivation (group discussion and support, telephone counseling), and behavioral skills (walking exercise) components. Ten sessions of this program involved three face-to-face and seven online interactions via mobile instant messaging. As primary outcomes (health behavior), physical activity level and health-promoting lifestyle were measured by standardized scales. As secondary outcomes (health status), physiological indicators by body measurements and perceived stress by a scale were produced. We used the chi-squared test, independent t-test, and Mann-Whitney U test for the analysis. After the intervention, in the experimental group, the level of physical activity (Z = -2.065, p = 0.039) and health-promoting lifestyle improved (t = 3.344, p = 0.002), and both waist circumference (t = -4.328, p < 0.001) and perceived stress (t =-3.578, p < 0.001) decreased. In conclusion, our theory-based intervention has advantages in terms of high standardization potential, high availability, and improvement of health behavior and health status. In future, this approach will be useful for devising interventions that meet the health needs of people who are concerned about quality of life in the second half of life.

[Experience of Peer Support Work among People with Mental Illness in the Community: A Grounded Theory Approach].

PURPOSE: This study discovered a substantive theory of the experience and process of peer support work among people with mental illness. METHODS: The participants were members of community-based mental health facilities and had been working as peer supporters for more than six months. The data were collected through in-depth interviews with twelve participants and analyzed using Corbin and Strauss's grounded theory approach. RESULTS: The core category was "becoming a healer going with patients in the journey of recovery," and the core phenomenon was "identity confusion as a peer supporter." The causal conditions were "starting peer support work without certainty" and "standing at the boundary between the therapist and patient." The intervening conditions were "willingness to become a successful peer supporter," "feeling a sense of homogeneity with the patient," "accepting the mental illness," and "support from people around." The action and interaction strategies were "letting go of greed," "being open about oneself," "developing professional skills," "maintaining wellness in the body and mind," and "being with the patient." The consequences were "becoming a useful person," "changing attitude toward life," "expansion of the sense of self-existence," "recovering from mental illness," and "discovering a role as peer supporter." Finally, the substantive theory of "becoming a healer going with patients in the journey of recovery" was derived. CONCLUSION: This study provides a holistic understanding of peer support work and the implications of interventions to help people with mental illness in a person-centered recovery process.

Gender Differences in Lifestyle and Mental Health among Senior High School Students in South Korea.

Gender differences in health outcomes have long been a concern worldwide. We investigated the gender differences in the lifestyle and mental health status of senior students in general high schools who were preparing for college entrance exams. This secondary analysis was based on data from the 14th Korea Youth Risk Behavior Web-Based Survey (2018). The data of 8476 students in the third year (12th grade) of general high school, among a total of 60,040 middle and high school students nationwide, were analyzed. Mean and standard error (SE) and weighted percentage data were obtained, and the Rao-Scott χ2 test was performed. Boys reported more risky behaviors related to drinking and smoking, while girls had more negative perceptions of their bodies and overall health. In addition, girls showed unhealthier lifestyle-related behaviors (breakfast, physical activity, weight control) and greater vulnerability to poor mental health, including lower sleep satisfaction, stress, depression, and suicidal thoughts. Our results suggest that education and health institutions should consider the needs of each gender separately. A gender-specific approach to maintaining healthy lifestyles and good health status among senior high school students is highly recommended.

Physical Comorbidity According to Diagnoses and Sex among Psychiatric Inpatients in South Korea.

People with mental disorders are susceptible to physical comorbidities. Mind-body interventions are important for improving health outcomes. We examined the prevalence of physical comorbidities and their differences by diagnoses and sex among psychiatric inpatients. The dataset, from National Health Insurance claims data, included 48,902 adult inpatients admitted to psychiatric wards for at least 2 days in 2016 treated for schizophrenia, schizotypal and delusional disorders, or mood disorders. We identified 26 physical comorbidities using the Elixhauser comorbidity measure. Among schizophrenia-related disorders, other neurological disorders were most common, then liver disease and chronic pulmonary disease. Among mood disorders, liver disease was most common, then uncomplicated hypertension and chronic pulmonary disease. Most comorbid physical diseases (except other neurological disorders) were more prevalent in mood disorders than schizophrenia-related disorders. Male and female patients with schizophrenia-related disorders showed similar comorbidity prevalence patterns by sex. Among patients with mood disorders, liver disease was most prevalent in males and third-most in females. In both diagnostic groups, liver disease and uncomplicated diabetes mellitus were more prevalent in males, and hypothyroidism in females. Mental health professionals should refer to a specialist to manage physical diseases via early assessments and optimal interventions for physical comorbidities in psychiatric patients.

Leisure Factors Predicting the Happiness of Self-Employed Workers in South Korea.

South Korea's employment status is characterized by a high rate of self-employment and many small-scale self-employed businesses with no employees. This study explored leisure factors relating to self-employed individuals' subjective happiness based on data from the 2019 National Leisure Activity Survey. The extracted data (N = 2343) were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, Kendall's τb coefficient, Eta correlation coefficient, phi coefficient, and Cramer's V. And a three-step hierarchical regression analysis was performed to identify multidimensional variables that predict happiness more effectively. In Model 3, which additionally inserted positive and intrinsic factors into Model 2, the explanatory power was significantly increased. The predictors of subjective happiness among self-employed people identified in the final regression model were high economic status (ß = 0.05), perceived health status (ß = 0.32), financial constraints (ß = -0.09), leisure recognition (ß = 0.20), and work-life balance (leisure-oriented ß = 0.09; work-oriented ß = -0.13). This study's findings will contribute to the establishment of basic data, to prepare empirical measures to improve self-employed individuals' quality of life.

Effects of Self-Esteem, Problem-Solving Ability, and Professional Nursing Values on the Career Identity of Nursing College Students in South Korea: A Cross-Sectional Study.

In Korea, the number of admissions to nursing colleges has greatly increased over the past 20 years to address the shortage of nurses. However, many nursing students have unclear career identities during college and stop working in healthcare after graduation. This study aimed to examine the effects of self-esteem, problem-solving ability, and professional nursing values on career identity. The participants were 140 third- and fourth-year nursing students recruited from a university in South Korea. Data were collected between September and October 2019 using a self-administered questionnaire. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation, and multiple linear regression. The results showed significant correlations between satisfaction with college life and major subject, subjective academic achievement, self-esteem, problem-solving ability, professional nursing values, and career identity. The factors that significantly affected career identity were self-esteem and professional nursing values. Nursing educators can support the career development of nursing students by enhancing their self-esteem and professionalism, along with efforts to improve satisfaction with their college life and major.

Gender Differences in Sexual Behaviors and Their Relevance to Mental Health among High School Students with Sexual Experience in South Korea.

We explored gender differences in sexual behavior, and their relevance to mental health among high school students in South Korea. This study was based on data from the 14th Korea Youth Risk Behavior Web-Based Survey (2018). The subjects were 2460 high school students who reported sexual experiences. Student's t-test, ANOVA, and Rao-Scott chi-squared test were performed to identify the significance of the differences. Boys had earlier sexual debuts (Rao-Scott χ2 = 53.55, p < 0.001), a lower frequency of using contraceptives (Rao-Scott χ2 = 26.57, p < 0.001), and lower rates of sex education in school (Rao-Scott χ2 = 11.20, p = 0.004). With respect to mental health factors, there was a difference in suicidality according to sexual risk behaviors, with a stronger association found in boys. In girls, there was an association between pregnancy experiences and suicidal ideation (Rao-Scott χ2 = 9.90, p = 0.003), plans (Rao-Scott χ2 = 17.25, p < 0.001), and attempts (Rao-Scott χ2 = 23.11, p < 0.001). Our findings suggest differences by gender and age group in the association between sexual behavior and mental health. It is necessary to devise a sex education strategy for adolescents considering gender and early versus late adolescent development period.

The influence of patient-centeredness on patient safety perception among inpatients.

PURPOSE: This study investigated the influence of patient-centeredness on patient safety perception among inpatients, with particular focus on the relationships between subfactors of patient-centeredness and patient safety perception. METHODS: Data were collected from 122 inpatients in a university hospital from September 24 to October 8, 2019. Patient-centeredness was evaluated using the Patient-Centeredness Assessment Scale; patient safety perception was evaluated using the Korean version of the Patient Safety Perception Scale. Multiple linear regression analysis was conducted using SPSS for Windows 24.0. RESULTS: Average patient-centeredness score among inpatients was 77.14 ± 12.64 (range 0-100), and average patient safety perception score was 99.24 ± 15.90 (range 24-120). Patient-centeredness influenced patient safety perception (R2 = 70%, F = 27.75, p < .001). With respect to subfactors of patient safety perception, the medical team's activities to ensure safety was affected by the general treatment process and overall evaluation of patient-centeredness (R2 = 54%, F = 13.14, p < .001); patient safety practice was influenced only by the general treatment process (R2 = 39%, F = 7.02, p < .001); and trust in the medical system was affected by nurses' service, the general treatment process, and the hospital environment (R2 = 44%, F = 8.49, p < .001). CONCLUSIONS: To enhance patient safety perception, strategies should seek to strengthen patient-centeredness and its related subfactors, particularly the general treatment process, the hospital environment, and nurses' service.

[Job Retention Process among Working People with Mental Illness: A Grounded Theory Approach].

PURPOSE: The study was conducted to explore the experiences of job retention among working people with mental illness. METHODS: The participants were members with mental illness at the S Community Mental Health Center in Gyeonggi Province and who had been working for more than six months. The data were collected through in-depth interviews with 11 participants between June 27 and August 20, 2018. The data were analyzed through Corbin and Strauss's grounded theory method. RESULTS: The core category was struggling to take root in the community as a productive member. The core phenomenon was the desire to be a productive person, and the causal condition was the willingness to change for a purposeful life. The action and interaction strategies included maintaining regular living patterns, maintaining medication, developing one's tips for self-management, and self-approval. The intervening conditions were difficulties in forming social relationships, presence of symptoms, social resources, and acceptance of one's mental illness. The consequences were restoration of family relationships, healthy pleasure through work, social inclusion, development of self-worth, and transition to an independent person. CONCLUSION: Working people with mental illness are struggling to take root in the community as a productive member. This study suggests that a holistic understanding of the job retention experience among people with mental illness is required. The findings will provide the basis for developing interventions that can improve job retention among working people with mental illness.

Moderating Effect of Mindfulness on the Influence of Stress on Depression According to the Level of Stress among University Students in South Korea.

Stress and depression are representative of the mental health problems of university students worldwide. This cross-sectional study explored the moderating effect of mindfulness on the influence of stress on depression according to the degree of life stress. The participants were 738 university students in years 2-4 in five 4-year universities in South Korea. Depression was positively correlated with stress and negatively with mindfulness at a statistically significant level. In multiple regression analysis, stress was found to have an effect by increasing depression, and mindfulness by relieving depression. In the moderated multiple regression analysis, mindfulness had a moderating effect on the impact of stress on depression only in low-stress groups, showing that the interaction of stress with mindfulness was significantly negative (ß = -0.11, t = -2.52, p = 0.012) and the inclusion of this interaction significantly increased the explanatory power for depression variation (F change 6.36, p = 0.012) in the full model. In conclusion, we suggest considering stress levels in the development of mindfulness-based intervention strategies to effectively manage the depression of university students.

Effects of an empowerment program for community-dwelling people with mental illness in South Korea.

PURPOSE: This study aimed to examine the effects of an empowerment program on empowerment, quality of life, and recognition of human rights of people with mental illness residing in a community in South Korea. DESIGN AND METHODS: A repeated-measures design (before, immediately after, and 4 weeks after the intervention) with a control group was used. The experimental group received an eight-session empowerment program over 8 weeks. FINDINGS: The empowerment program significantly increased empowerment and quality of life, but not recognition of human rights. PRACTICE IMPLICATIONS: Nursing interventions should be developed to enhance the recognition of human rights for people with mental illness.