Mental health and psychosocial adjustment in pediatric chronic kidney disease derived from the KNOW-Ped CKD study.

BACKGROUND: Psychosocial development of pediatric chronic kidney disease (CKD) patients is substantially affected due to growth retardation, frequent school absences, and difficulties engaging in normal peer relationship activities. While many studies focus on specific issues such as depression, anxiety, or neurocognitive function, few evaluate prevalence of various types of mental health and psychosocial adjustment problems among children with CKD. This study aimed to investigate these within the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). METHODS: One hundred sixty-six subjects who completed the Korean-Child Behavioral Checklist (K-CBCL) were included. The clinical group comprised subjects with scores indicating psychosocial adjustment or mental health problems using the T scores for the 14 subscales of the K-CBCL. We analyzed associations between mental health or adjustment problems in pediatric CKD and each variable. RESULTS: Mean age was 11.1 (± 3.9) years, number of males was 117 (70.5%), and 20.5% and 22.3% of children had significant mental health problems and psychosocial adjustment problems, respectively. Overall, 33.1% were assigned to the clinical group, and exhibited short stature and higher rates of preterm birth history compared to the non-clinical group. Subjects with adjustment problems had higher comorbidities such as CNS disease, developmental delay, cardiovascular disease, and multi-organ involvement. Logistic regression analysis revealed preterm birth and developmental delay correlated highly with clinical group. CONCLUSIONS: A significant proportion of children and adolescents with CKD experience mental health and adjustment problems. In particular, patients with developmental delay or preterm birth history require screening and targeted follow-up.

A Multicenter Study Investigating Empathy and Burnout Characteristics in Medical Residents with Various Specialties.

We assessed empathy in medical residents, including factors modifying empathy and the relationship between empathy and burnout. Participants (n = 317 residents, response rate = 42%) from 4 university hospitals completed a socio-demographic questionnaire, the Jefferson Scale of Empathy (Health Professional version, Korean edition), and the Maslach Burnout Inventory (MBI). Participants were classified by medical specialty: "people-oriented specialty" (POS group) or "technology-oriented specialty" (TOS group), with more women in the POS than in the TOS group, χ(2) = 14.12, P < 0.001. Being female, married, and having children were factors related to higher empathy (gender, t = -2.129, P = 0.034; marriage, t = -2.078, P = 0.038; children, t = 2.86, P = 0.005). Within specialty group, POS residents showed higher empathy scores in the fourth as compared to the first year, F = 3.166, P = 0.026. Comparing POS and TOS groups by year, fourth year POS residents had significantly higher scores than did fourth year TOS residents, t = 3.349, P = 0.002. There were negative correlations between empathy scores and 2 MBI subscales, emotional exhaustion (EE) and depersonalization (DP). Additionally, first year POS residents had higher DP scores than did first year TOS residents, t = 2.183, P = 0.031. We suggest that factors important for empathy are type of medical specialty, marriage, siblings, and children. Burnout state may be related to decreasing empathy.

Erratum: Analyzing Co-Occurrence of Non-Suicidal Self-Injury With Suicidal Ideation and Related Factors Among Adolescents in Jeju Island.

[This corrects the article on p. 119 in vol. 35, PMID: 38601107.].

Analyzing Co-Occurrence of Non-Suicidal Self-Injury With Suicidal Ideation and Related Factors Among Adolescents in Jeju Island.

Objectives: Non-suicidal self-injury (NSSI) and suicidal behavior, including suicidal ideation (SI) and suicide attempts, are important predictors of suicide in adolescents. This study aimed to investigate the associations between NSSI, SI, NSSI+SI, mental health problems, and family factors in Korean adolescents in Jeju Island, with an emphasis on key findings. Methods: A total of 561 adolescents completed self-report questionnaires regarding demographics, NSSI, SI, suicidal behavior, perceived family functioning, and mental health problems, which were assessed using Center for Epidemiological Studies Depression Scale for Children, Screen for Children Anxiety-Related Disorders (SCARED), and Youth Self-Report (YSR). Data were analyzed using descriptive statistics, one-way analysis of variance, chi-square test, post-hoc analyses, and multivariate logistic regression. Results: In this study, 22.3% of adolescents reported either NSSI or SI, with 5.5% reporting NSSI and 20.7% reporting SI. Combined (NSSI+SI) group showed a significantly higher SCARED score, anxiety/depression, thought problems, attention problem, and rule breaking on YSR than did the SI only group. Higher level of depression and anxiety were significantly associated with NSSI and SI. Female sex and perceived family dissatisfaction were significantly associated factors for SI, but not for NSSI in multivariate logistic regression. Conclusion: This study provides insights into the clinical characteristics and associated factors among adolescents with NSSI, SI, and NSSI+SI in Jeju Island. Identifying these results can inform the development of targeted prevention and intervention strategies to mitigate the negative consequences of these behaviors and contribute to a better understanding of the role of family in this context.

Effects of Group Comprehensive Behavioral Intervention for Tics in Children With Tourette's Disorder and Chronic Tic Disorder.

Objectives: Comprehensive behavioral intervention for tics (CBIT) is effective in children with chronic tic disorders. This study aimed to assess the effect of group-based CBIT (group-CBIT) on tic severity and comorbid symptoms. We compared the efficacy of group CBIT with that of a control. Methods: Thirty children with chronic tic disorder or Tourette's disorder were enrolled in this study. Eighteen were assigned to the group-CBIT for eight sessions, and 12 were assigned to the control group. Tics and comorbid symptoms were assessed pre- and post-intervention using the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale, attention-deficit hyperactivity disorder Rating Scale-IV, Children's Yale-Brown Obsessive-Compulsive Scale, and the Korean-Children Behavioral Checklist. We compared the pre- and post-intervention results of each group and determined the difference in the pre- and post-intervention results between intervention and the control group. Results: The YGTSS motor and vocal tic interference, global impairment, and global severity scores decreased in the intervention group only. Group CBIT was superior in reducing the motor tic interference, impairment score, and global severity score to the control group. Conclusion: The group-CBIT showed an improvement in tic symptoms, especially in reducing the level of interference and impairment of tics.

The intergenerational transmission of maternal adverse childhood experiences on offspring's psychiatric disorder and the mediating role of maternal depression: Results from a cross sectional study.

Maternal adverse childhood experiences (ACEs) may negatively affect the mental health and development of their offspring. The purpose of this study was to investigate the association of maternal ACE and offspring's psychiatric disorder and the mediating effect of maternal depression. The subjects included 463 mothers (42.78 ± 5.68 years) and their offspring aged 6-18 years (13.26 ± 3.90 years). Mothers reported their ACE before age 18 and completed the Beck Depression Inventory-II and Diagnostic Predictive Scales (DPS), a screening tool for offspring's psychiatric disorder. 35.42% of subjects had at least one ACE, and 11.0% reported three or more ACEs. Higher maternal ACE scores were associated with a significantly higher prevalence of offspring's psychiatric disorders (p < 0.001). Household dysfunction of maternal ACE (OR = 2.263, p < 0.001) is significantly associated with offspring's psychiatric disorder. In the mediation model in which the household dysfunction affects the number of offspring's psychiatric disorders, the partial mediation model through maternal depression was significant. The mother's experience of household dysfunction before the age of 18 has a significant impact on her offspring's psychiatric disorder and supported significant mediation through maternal depression. Further research is needed to determine the mechanisms of intergenerational transmission of ACE and offspring's psychopathology.

The Impact of Maternal Adverse Childhood Experiences on Offspring's Internalizing and Externalizing Problems.

OBJECTIVE: Adverse childhood experiences (ACEs) are associated with negative physical and mental health outcomes across the lifespan, but research on intergenerational transmission of maternal ACEs and its impact on the offspring's mental health problems are limited. The study examines the effects of maternal ACEs on the risk of internalizing or externalizing problems among offspring. METHODS: There were 450 mother-child dyads. Mothers completed the Adverse Childhood Experiences Questionnaire. The child outcomes included internalizing and externalizing problems assessed by the Korean Child Behavior Checklist (K-CBCL) and Korean Youth Self-Report (K-YSR), depression assessed by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) and anxiety assessed by the Screen for Child Anxiety Related Emotional Disorders (SCARED). RESULTS: 36.1% of mothers experienced at least one ACE, and 11.1% experienced three or more ACEs. Cumulative maternal ACEs were associated with internalizing problems, externalizing problems, depression and anxiety in the offspring. Household dysfunction from maternal ACEs was significantly associated with delinquent behavior, anxiety/depression, and somatic complaints in the offspring. CONCLUSION: The findings support the hypothesis that maternal ACEs are related to mental health problems in the offspring. Further research is needed to determine the factors mediating intergenerational transmission as well as intervention strategies to prevent ACEs and mental health problems in the offspring.

An Update on Mental Health Problems and Cognitive Behavioral Therapy in Pediatric Obesity.

Prevalence of pediatric obesity has increased worldwide in the last 20 years. Obese children suffer not only physical complications but also mental health problems such as depression, attention deficit hyperactivity disorder (ADHD), and eating disorders, as well as psychosocial impairments, such as school adjustment problems, bullying, and low self-esteem. Recently, there have been some studies on the association of mental health problems and pediatric obesity. In the treatment of pediatric obesity, many previous studies suggest multidisciplinary treatment. However, cognitive behavioral therapy (CBT) has attracted attention because obese children are accompanied by body image distortion, emotion dysregulation, and difficulties in stimulus control. This review is a narrative summary of the recent studies on mental health problems and CBT in pediatric obesity. The relationship between depression/anxiety and pediatric obesity is still inconsistent but recent studies have revealed a bidirectional relation between depression and obesity. Additionally, some studies suggest that obese children may have eating disorder symptoms, like loss of control eating, and require therapeutic intervention for pediatric obesity treatment. Furthermore, impulsivity and inattention of ADHD symptom is thought to increase the risk of obesity. It has also been suggested that CBT can be very effective for mental health problems such as depression, impulsivity, and body image distortion, that may coexist with pediatric obesity, and use of multimedia and application can be useful in CBT.

The Concept and Historical Background of Custody Evaluation.

This article reviews a wide range of literature on the standards and process of child custody evaluation in the US, and proposes custody evaluation standards appropriate to Korea. Custody evaluation refers to the process of making psychiatric and psychological evaluations of each parent and the child during a custody dispute and presenting to the family court a report of custody evaluation with the aim of safeguarding the best interests of the child. In the past, it was thought that children arethe fathers' possessions or that younger children should be raised by the mother; however, currently, custody rights are evaluated in accordance with the principle of the best interests of the child. The principle is all-encompassing and vague and hence, the court makes increasingly more requests to mental health professionals for custody evaluation. Since the Seoul Family Court introduced the expert consultation system in 2017, the involvement of mental health professionals in child custody decisions has increased in Korea. Custody evaluators should try to be neutral and find the objective facts, keeping in mind that their role is to aid the court in making a custody decision.

Custody Evaluation Process and Report Writing.

As in western countries, divorce rates in South Korea have recently been rising, and family disruption has become one of serious social problems. Parents are able to express their opinions and wishes confidently, but the thoughts and wishes of children, especially infants and young children, tend to be ignored. Children can also experience several emotional and behavioral problems during the process of and after their parents' divorce. When South Korean family courts determine custody arrangements, they typically do not have a systematic strategy and process based on custody evaluation to help children and their parents overcome conflicts and build healthy parent-child relationships after divorce. Furthermore, under the current court system, it is difficult for mental health specialists and child psychiatrists to intervene in familial conflicts as mediators or therapists during the course of divorce proceedings. Acknowledging these limitations, the South Korean family court system implemented a formal program for custody evaluations by child psychiatrists and psychologists in 2017. However, they have faced challenges such as a shortage of experienced specialist and lack of a training system or instruments for evaluation. In this paper, the authors aim to share professional knowledge of and experiences with aspects of the custody evaluation process, such as indications, procedures, methods, psychological tests, resources, and final report writing, to better serve children and their parents undergoing a painful divorce process.

Custody Evaluation in High-conflict Situations Focused on Domestic Violence and Parental Alienation Syndrome.

In a divorced family, child-centered custody evaluation is essential to ensure the child's best interests and healthy adaptation. A mental health professional's role and involvement are required in gaining an in-depth understanding of various environments and dynamics surrounding the child and family. Domestic violence, including child abuse and intimate partner violence (IPV) or parental alienation syndrome (PAS), is often observed in cases of custody evaluation in high-conflict divorced families, sometimes accompanied by allegations. Such cases warrant an extremely careful approach by the evaluator, who needs to be competent in interpreting the familial dynamics based on a reasonable context understanding. Genuine professionalism is a must for a custody evaluator to best help the child and carry out a high-quality custody evaluation process, and evaluators need to be ready for this task through adequate preparation and empowerment. This article is devoted to examining custody evaluation in divorced families in cases of IPV, child abuse, and PAS.

Temperament and Character Profiles Associated with Internalizing and Externalizing Problems in Children with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: This study aimed to identify temperament and character profiles associated with internalizing and externalizing problems in children with attention deficit hyperactivity disorder (ADHD). METHODS: Children with ADHD (n=114, 8.51±1.87 years) were selected from the Department of Child and Adolescent Psychiatry at Jeju National University Hospital. They were diagnosed by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version and evaluated using the Advanced Test of Attention and Korean Wechsler Intelligence Scale for Children-Fourth Edition. Their parents completed the ADHD Rating Scale, Korean-Child Behavioral Checklist, and Junior Temperament and Character Inventory. RESULTS: The participants with both internalizing and externalizing problem had more severe ADHD symptoms and significantly higher novelty seeking, harm avoidance, and self-transcendence, as well as lower self-directedness and cooperativeness than those who had not comorbid problems. Harm avoidance was correlated with their level of internalizing problems regardless of severity of ADHD symptoms. In addition, novelty seeking and sex (male) were being associated with the level of externalizing problems. CONCLUSION: Differences were observed in the temperament and character profiles of children with ADHD according to their comorbid psychopathology. Results suggested that temperament and character profiles may affect the comorbid psychopathology in children with ADHD regardless of ADHD symptom severity.

Differences in Parenting Stress, Parenting Attitudes, and Parents' Mental Health According to Parental Adult Attachment Style.

OBJECTIVES: We aimed to compare the differences in parenting stress, parenting attitudes, and parents' mental health between different adult attachment styles. METHODS: Forty-four parents who completed a parental education program were enrolled in our study. They completed the Korean version of the Experience of Close Relationship Revised, Korean-Parenting Stress Index-Short Form, Maternal Behavior Research Instrument, and Symptom Checklist-90-Revised. RESULTS: The avoidant attachment score positively correlated with parenting stress. The anxious attachment score showed a positive relationship with parenting stress, hostile parenting attitude, and psychopathology, but a negative association with an affectionate parenting attitude. The secure attachment group exhibited a more autonomous, affectionate parenting style and a less hostile parenting attitude and less parenting stress than the insecure attachment group. Dismissing-avoidant attachment parents reported significantly higher parenting stress scores than secure attachment parents. Preoccupied and fearful-avoidant attachment parents displayed a more hostile parenting style than secure attachment parents. Dismissing-avoidant and preoccupied parents reported a less affectionate parenting attitude than secure attachment parents. CONCLUSION: There were differences in parenting stress, parenting attitudes, and parents' mental health depending on the adult attachment style. More specific education and interventions based on parental attachment type are necessary for parents.

The Effect of Community-Based Parent Education Program on Parenting Stress According to Adult Attachment Styles.

OBJECTIVES: The aim of this study was to measure the effect of a group-based parent education program on parenting stress and attitude and comparing the same according to adult attachment styles. METHODS: Twenty-two mothers who enrolled in the parent education program participated in our study. The participants filled in the Korean version of the Experience in Close Relationship Revised (ECR-R), Korean-Parenting Stress Index-Short Form (K-PSI-SF), Maternal Behavior Research Instrument (MBRI), and Symptom Checklist-90-Revised (SCL-90-R) before and after the program. We compared the pre-and post-scores of the groups and compared the differences in effect according to adult attachment styles. RESULTS: For all study participants, the Parent Distress (p=0.023) and Total Parenting Stress (p=0.018) significantly declined after the parent education program. There were no differences in other variables. Within the secure attachment group, the Total Parenting Stress (p= 0.008), Parent Distress (p=0.015), and Difficult Child (p=0.011) scores in the K-PSI-SF significantly decreased after participating in the program. The Difficult Child scores (p=0.040) significantly dropped in the K-PSI-SF post program within the secure attachment group, compared to the insecure attachment group. CONCLUSION: The group-based parent education program impacted parenting stress. Depending on the adult attachment styles, the effect of the program varied.

Temperament and character profiles for children with ADHD with and without tic disorders.

There is no research about whether ADHD with tic disorder that temperamental features that differ from the ADHD. This research aimed to identify temperament and character profiles for children with ADHD according to tic disorder by comparing them with a healthy control group. A discriminant analysis was conducted to identify whether temperament and character profiles can discriminate comorbidity. The sample consisted of three groups (N = 40 per group): ADHD alone, ADHD with tic disorder and age- and sex- matched healthy control. The parents of 120 children (mean age 8.57 ±â€¯1.71 years) completed the Junior Temperament and Character Inventory (JTCI). The two ADHD groups showed higher novelty seeking and low persistence, self-directedness and cooperativeness than the control group. The ADHD alone group had lower scores for persistence and self-directedness than the other two groups. Temperament and character profiles were useful for discriminating ADHD from the control group. However, their discriminating power was relatively low for all three groups. Results indicated that differences in temperament and character in ADHD children were present according to comorbid tic disorders. JTCI's discriminating power for ADHD alone and ADHD with tic disorder was relatively lower than that of the combined ADHD group and the control group.

Effects of a Class-Based School Violence Prevention Program for Elementary School Students.

OBJECTIVES: This study was conducted to investigate the effectiveness of a class-based school violence prevention program for elementary school student. METHODS: 29 students were assigned to the school violence prevention program of 8 sessions, 28 students have been assigned to the control group. We assessed participants at baseline and post-intervention, through their self-report questionnaires such as Children's Depression Inventory (CDI), Strengths and Difficulties Questionnaire and school violence experience, awareness about school violence, and coping ability to school violence. We compared the baseline and post-intervention result of each group and compared the posttest scores between the intervention group and the control group. RESULTS: Comparing the intervention group and the control group, the post-intervention CDI total score and the awareness about school violence showed significant improvement in the intervention group. When compared according to gender, male students' perception of school violence was improved, and female students showed significant differences in CDI scores. CONCLUSION: The CDI total scores and the perception of school violence were improved in the intervention group compared to the control group. And there are differential pattern of intervention effects according to gender. These findings have important implications to develop effective violence prevention programs.

Factors that Affect the Adherence to ADHD Medications during a Treatment Continuation Period in Children and Adolescents: A Nationwide Retrospective Cohort Study Using Korean Health Insurance Data from 2007 to 2011.

OBJECTIVE: Several factors, such as male gender, older age, type of insurance, comorbid conditions, and medication type, have been associated with attention-deficit/hyperactivity disorder (ADHD) medication adherence rates, but the results have been inconsistent. We analyzed data to answer several questions: 1) How old were patients who first refilled their treatment medications used primarily for ADHD, regardless of the medication type? 2) What socio-demographic factors are associated with medication adherence? 3) What medical conditions, such as medication type and comorbid diagnosis, influence adherence? METHODS: We analyzed National Health Insurance data, which comprised continuously enrolled Korean National Medical Insurance children (6-18 years) with at least 2 ADHD prescription claims (January 2008-December 2011). The persistence of use regarding the days of continuous therapy without a 30-day gap were measured continuously and dichotomously. Adherence, using a medication possession ratio (MPR), was measured dichotomously (80% cut-off). RESULTS: The cumulative incidence of index cases that initiated medication refills for ADHD treatment during the 4 year period was 0.85%. The patients who exhibited a MPR greater than 80 comprised approximately 66%. The medication type, high school age groups, physician speciality, treatment at a private clinic, and comorbid conditions were associated with medication adherence during continuous treatment using a multivariate analysis. CONCLUSION: A better understanding of ADHD treatment patterns may lead to initiatives targeted at the improvement of treatment adherence and persistence. Other factors, including the severity, family history, costs, type of comorbidities, and switching patterns, will be analyzed in future studies.

Nationwide rate of attention-deficit hyperactivity disorder diagnosis and pharmacotherapy in Korea in 2008-2011.

INTRODUCTION: Using the National Health Insurance database in Korea, we examined the diagnostic and treatment incidence and comorbidity of attention-deficit hyperactivity disorder (ADHD). METHODS: During 2007-2011, we chose subjects aged 6-18 years, who had at least one medical claim containing an International Classification of Diseases, 10th Revision code for diagnosis of ADHD (F90.0) with no medication use in the previous 360 days. Then, we analyzed the data for 2008-2011 to determine the mean annual incidence and prevalence of newly diagnosed and medicated patients, as well as comorbidity. RESULTS: The average annual diagnostic incidence of ADHD was 0.357% (29,310.5/8,218,252), and the incidence of medication use for ADHD was 0.248% (20,340.3/8,218,252) during 2008-2011 with no significant annual difference. The transition rate from diagnosis to medication among newly diagnosed ADHD patients was 69%. The overall prevalence rate of ADHD diagnosis and medication during 2008-2011 was 0.799% (65,702/8,218,252) and 0.610% (50,127/8,218,252), respectively. Among newly diagnosed patients with ADHD, osmotic-controlled release oral delivery system methylphenidate was the most commonly used first medication, and depression was the most common comorbid psychiatric diagnosis. DISCUSSION: This is the first report of the nationwide data on the current diagnosis and pharmacotherapy of ADHD in the whole population aged 6-18 years. We need further investigation to find the factors of low diagnostic and treatment incidence compared with high prevalence of ADHD.