Psychological Development during Medical School Clerkship: Relationship to Resilience.

OBJECTIVE: The authors investigated changes in medical students' defenses during clerkship and examined the effects of these changes on students' resilience. METHODS: Between 2012 and 2014, all year-2 preclinical students (N = 249) at Gyeongsang National University Medical School were asked to participate. Those who agreed to participate (N = 237) completed the Korean version of the Defense Style Questionnaire (K-DSQ) and the Connor-Davidson resilience scale-10 (CD-RISC-10). After clerkship, students who proceeded to year 4 in 2 years (n = 187 (93 females), aged 24-38 years (mean, 28.9 ± 2.8 years)) completed the K-DSQ, CD-RISC-10, and the Korean version of the Hospital Anxiety and Depression Scale (K-HADS) in September 2014, 2015, and 2016. RESULTS: The use of adaptive (W = 11,603.5, p < 0.001, r = 0.39) and self-inhibiting (W = 10,901.5, p < 0.001, r = 0.32) styles increased significantly after clerkship. A multiple linear regression analysis showed that changes in adaptive defense styles (B = 1.336, SE = 0.386, ß = 0.218, p = 0.001) during clerkship were significantly related to resilience after adjusting for age, sex, depression, and anxiety. CONCLUSIONS: Both positive personality development and maladaptive changes in defenses were evident. An increase in the adaptive defense style score was related to resilience.

Psychiatric Symptoms and Clinical Diagnosis in High School Students Exposed to the Sewol Ferry Disaster.

BACKGROUND: Two hundred and fifty 11th grade students and teachers from Danwon High School drowned, during a school trip, in the Sewol Ferry Disaster. The goal of this study was to investigate the experiences of the psychiatrists who volunteered and provided psychiatric services to the students at Danwon High School. METHODS: From the second day to the 138th day after the disaster, pro bono psychiatrists provided post-disaster interventions to the 10th and 12th-grade Danwon High School students who did not attend the trip. Officially, 167 psychiatrists conducted outreach in approximately 550 encounters. The study questionnaires were distributed retrospectively to psychiatric volunteers who conducted outreach at Danwon High School. We surveyed the pro bono psychiatrists about their experiences, including the students' chief complaints, psychiatric problems, clinical diagnoses, and psychiatrists' treatment recommendations. RESULTS: We reached 72 (43.1%) of the 167 volunteers, and they reported on 212 (38.6%) of the 550 encounters. The common chief complaints were mental health problems, companion problems, and family problems. The most frequent psychiatric symptoms were anxiety (76.89%), depressive mood (51.42%), and concentration difficulty (50.94%). The most frequent clinical diagnoses of the students were normal reaction (41.04%), acute stress disorder (24.53%), adjustment disorder (17.92%), anxiety disorders (9.43%), and posttraumatic stress disorder (6.60%). More than half of the students needed "additional counseling/therapy" (41.04%) or "referral to psychiatric treatment" (14.15%). CONCLUSION: During the acute aftermath of the Sewol Ferry Disaster, volunteer psychiatrists were able to provide services. These services included psychiatric assessments, crisis counseling, psychological first aid, and referrals for ongoing care. More than half of the students were perceived to have a psychiatric diagnosis, and a substantial proportion of students needed further treatment. Future research should focus on the short- and long-term effects of psychiatric interventions and the characterization of post-disaster mental health needs and service provision patterns.

Allergic diseases, excessive Internet use and suicidal ideation in Korean adolescents.

OBJECTIVE: The aim of this study is to evaluate the relation between suicidal ideation, allergic diseases, and excessive Internet use in Korean youth using a national representative dataset. METHODS: Data from the Korean Youth Risk Behavior Web-Based Survey (KYRBWS), conducted by the Korean Centers for Disease Control and Prevention, were used in this study. Complex sample logistic regression and structural equation modeling were performed to define the relation between suicidal ideation, allergic disease and excessive Internet use. RESULTS: A total of 73,238 students participated in this survey. In Korea, 19.3% of adolescents had suicidal ideation in the previous year. Asthma (OR=1.23, 95% CI=1.15-1.32, p<0.01) and allergic rhinitis (OR=1.17, 95% CI=1.11-1.22, p<0.01) were identified as risk factors for suicidal ideation after adjusting for school and family factors. Structural equation modeling showed that excessive Internet use interacted with the association between allergic diseases and suicidal ideation. CONCLUSION: Allergy problems could positively affect suicidal ideation in Korean adolescents. Excessive Internet use could be a mediating factor between allergic disease and suicidal ideation.

Association analysis of PDE4B polymorphisms with schizophrenia and smooth pursuit eye movement abnormality in a Korean population.

Schizophrenia is a debilitating mental disorder with a high heritability rate. Located on chromosome 1p31.3, the human cAMP-specific 3',5'-cyclic phosphodiesterase 4B (PDE4B) gene has been considered as an important candidate gene for the risk of schizophrenia. Several genetic association studies reported the association between PDE4B polymorphisms and the risk of schizophrenia in Caucasian, African American, Indian, and Japanese populations. The aim of this study is to examine the association of PDE4B variations with schizophrenia and smooth pursuit eye movement (SPEM) abnormality in a Korean population. A case-control association analysis was carried out by comparing the genotype distribution of eight PDE4B polymorphisms between 457 schizophrenia patients and 386 normal healthy subjects. Differences in the frequency distribution of PDE4B single nucleotide polymorphisms (SNPs) and haplotypes were analyzed by logistic regression analyses controlling for age as a covariate. Statistical analyses revealed nominal significant associations of rs1040716, rs472952, rs1321177, and rs2144719 with the risk of schizophrenia (p = 0.02~0.05). The rs11208756 polymorphism showed a nominal significant association with SPEM abnormality (p = 0.05). In a meta-analysis with Japanese and Korean populations, three SNPs (rs472952, rs1040716, and rs2180335) revealed significant associations with schizophrenia (meta-p value = 0.0038~0.019). Our results support previously reported association of PDE4B variations with schizophrenia in other populations. The findings in this study add a new evidence for the involvement of PDE4B gene in schizophrenia etiology.

Usefulness of the combined application of the Mood Disorder Questionnaire and Bipolar Spectrum Diagnostic Scale in screening for bipolar disorder.

OBJECTIVE: This study aimed to examine whether combined application of the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) is more effective than exclusive application of either tool in screening for bipolar disorder (BD). METHOD: The MDQ and BSDS were completed by a total of 113 patients diagnosed with BD and major depressive disorder who were experiencing a current major depressive episode. The initial diagnosis of the subject was confirmed during a 1-year follow-up period. When each MDQ and BSDS optimal cutoff score was calculated, a modified scoring method for the MDQ that considered only one item was used to increase its performance in this population. The following three combinations of the cutoff scores for the two tools were used to screen for BD: (A) The score on either the MDQ or BSDS was greater than or equal to the cutoff score; (B) the scores on both the MDQ and BSDS were greater than or equal to the cutoff score; and (C) Reducing either cutoff score by 1 point resulted in the MDQ and BSDS scores being greater than or equal to the cutoff score. The sensitivity, specificity, positive predictive value, and negative predictive value of the three methods, the MDQ, and the BSDS were compared for screening BD. RESULTS: The sensitivity and specificity of the MDQ were 0.741 and 0.844, respectively, and those for the BSDS were 0.731 and 0.742, respectively. These indicators for the combined application of the MDQ and BSDS were as follows, respectively: method A 0.901 and 0.688, method B 0.580 and 0.875, and method C 0.691 and 0.844. Method A was superior to using one measure alone as well as to methods B and C with regard to sensitivity and negative predictive values. Method A also showed a higher sensitivity for BD subtypes than did the individual tools. Compared with the use of individual instruments, method A showed a similar positive predictive value. CONCLUSION: This study suggests that combined use of the MDQ and BSDS is more effective than the individual use of either of these measures in screening for BD. The data also showed that when both tools were used, the most effective interpretation of the results in terms of screening for BD was achieved when positive scores were defined as those that were equal to or greater than the cutoff for the MDQ or BSDS.

Association Between Depressed Mood Changes and Physical Activity Among Adolescents Post COVID-19 Pandemic.

Objectives: Following the coronavirus disease 2019 (COVID-19) pandemic, adolescents have experienced decreased physical activity and a decline in mental health. This study analyzed the association between changes in depressed mood after the COVID-19 pandemic and physical activity among adolescents. Methods: The analysis was based on the results of the 17th Youth Health Behavior Online Survey conducted in 2021, which included 54848 middle and high school students in South Korea. Information on physical activity included low-intensity physical activity lasting >60 min/day, high-intensity physical activity, and strength training exercises. A logistic regression analysis was performed to evaluate the association between physical activity and changes in depression after the COVID-19 pandemic. Results: After adjusting for sociodemographic characteristics and previous depression, adolescents who performed strength training exercises more than once per week had a 0.95-fold lower risk (odds ratio [OR]=0.948, 95% confidence interval [CI]=0.905-0.994, p= 0.027) of increasing depression after the COVID-19 pandemic, while the risk of decreasing depression increased by 1.22-fold (OR=1.215, 95% CI=1.131-1.305, p<0.001). The results were not significant for low-intensity physical activity for >60 min/day and high-intensity physical activity. Conclusion: Strength-training exercises are significantly associated with the prevention of depression among adolescents following the COVID-19 pandemic.

Dietary Carotene Intake and Suicidal Ideation in Korean Females: Analysis of Data From the Korea National Health and Nutrition Examination Survey (2012, 2013, and 2015).

OBJECTIVE: The suicide rate in Korea was the highest among countries in the Organisation for Economic Co-operation and Development in 2019. In a previous study, higher intake of vegetables and fruits was associated with a lower risk of suicidal ideation, and carotene-rich fruits and vegetables lowered the risk of depression. This study aimed to examine the direct relationship between carotene intake and suicidal ideation, adjusting for the effect on depression. METHODS: This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2012, 2013, and 2015. Carotene intake was assessed through a food intake frequency survey with a 24-hour recall. Suicidal ideation and depression were assessed using the mental health section of the KNHANES. We applied logistic regression to assess the relationship between carotene intake and suicidal ideation, adjusting for potential confounders. RESULTS: A total of 5,480 females aged 19-64 years were included in this study. Carotene intake was significantly lower in the suicidal ideation group (3,034.5±1,756.4 µg/day) than in the nonsuicidal ideation group (3,225.4±1,795.1 µg/day) (p=0.015). We found a significant inverse association between carotene intake and the risk of suicidal ideation after adjusting for potential confounders (odds ratio=0.934, 95% confidence interval=0.873-0.999). CONCLUSION: These results suggest that carotene intake may be inversely associated with the risk of suicidal ideation. Our findings may inform the development of new nutritional interventions to prevent increases in the risk of suicide worldwide.

Lack of association of the RTN4R genetic variations with risk of schizophrenia and SPEM abnormality in a Korean population.

This study examined the association of the reticulon 4 receptor (RTN4R) gene with schizophrenia and smooth pursuit eye movement (SPEM) abnormality in a Korean population. Although we failed to provide convincing evidence that RTN4R is associated with schizophrenia development and SPEM impairment, our findings may be useful for further genetic studies.

The Type of Daily Life Stressors Associated with Social Media Use in Adolescents with Problematic Internet/Smartphone Use.

OBJECTIVE: This study investigated the types of daily life stressors associated with social media use in adolescents with problematic Internet/smartphone use in a city in Korea. METHODS: Data from 2,997 Internet and smartphone users who participated in a survey about the actual use of smart digital media in Korea were included. The measurement tools included questionnaires on Internet and smartphone usage patterns and types of daily life stressors as well as the Internet Gaming Use-Elicited Symptom Screen and a smartphone addiction scale. The subjects were divided into a problematic Internet/smartphone use group and a control group. We compared the types of daily life stressors associated with social media use for each group. RESULTS: All types of daily life stressors were more prevalent in the problematic Internet use group than in the control group. In the problematic Internet/smartphone use group, the types of daily life stressors that were positively associated with social media use were sibling rivalry and physical health. In the control group, social media use was negatively associated with daily life stressors related to appearance and heterosexual relationships. CONCLUSION: There is a need to provide personalized stress management related to social media use for adolescents with problematic Internet/smartphone use.

Association Between Suicide and Drinking Habits in Adolescents.

OBJECTIVES: Adolescent suicide is a serious social problem. Adolescent alcohol use is one of the most important risk factors for adolescent suicide. This study aimed to identify the relationship between drinking habits and suicide among Korean adolescents. METHODS: Data from the 14th and 15th Korean Youth Risk Behavior Web-based Survey, conducted in 2018 and 2019, were used for analysis. Multiple logistic regression analysis was used to identify the relationship between drinking habits-including the age of drinking initiation, frequency of drinking, average drinking amount, frequency of drunkenness-and suicidal ideation, plans, and attempts. RESULTS: Even after adjusting for age, sex, school grade, academic achievement, socioeconomic status, depression, stress, and drinking habits, the frequencies of drinking and drunkenness increased the risk of suicide attempts. Suicide attempts were associated with the frequency of drinking in girls and middle school students, and with the frequency of drunkenness in boys and high school students. CONCLUSION: This study identified associations between drinking habits (the age of drinking initiation, frequency of drinking, average amount of drinking, frequency of drunkenness) and suicidal behavior in adolescents. Our findings suggest that to prevent adolescent suicide, it might be necessary to investigate drinking habits, including the frequencies of drinking and drunkenness. Moreover, considering the differences in sex and school grade, it is important to include the individual group characteristics when evaluating drinking habits.

Screening for Adult Attention-Deficit Hyperactivity Disorder in the Korean Community Sample: Prevalence and Association with Mood and Sleep Symptoms.

Objective: Attention-deficit hyperactivity disorder (ADHD) symptoms start in early childhood and continue into adulthood, and are frequently associated with comorbid symptoms of depression, bipolar, insomnia, and daytime sleepiness. The aim of this study was to screen adult ADHD symptoms in a community sample and investigate the association of adult ADHD symptoms with mood and sleep symptoms. Methods: Respondents (n = 1500) from the general adult population, aged between 19 and 49 years, were recruited. The sample consisted of a population in Busan, Korea that was representative in terms of sex, age, and residential area. ADHD symptoms and mood/sleep symptoms were assessed using validated questionnaires with cut-off threshold. Results: The screening for adult ADHD documented ADHD symptoms in 3% (45 out of 1500) of the participants. The ADHD screen-positive group was more likely to have depression symptoms (OR = 14.97, 95% CI: 7.94-28.25, P < .001) and daytime sleepiness symptoms (OR = 3.18, 95% CI: 1.55-6.52, P < .001). Conclusion: Present result indicates high prevalence of adult ADHD symptoms in a community sample in Korea. The findings of this study also suggest significant association between adult ADHD symptoms and depression symptoms and daytime sleepiness. Optimal management of adult ADHD requires the consideration of not only ADHD symptoms but also the assessment and treatment of symptoms associated with comorbid conditions.

Early menarche as a risk factor for suicidal ideation in girls: The Korea youth risk behavior web-based survey.

Puberty, at which point girls experience menarche, is a biologically and psychologically unstable period. This study investigated the association between early menarche and suicidal ideation in girls. This study analyzed data from approximately 35,000 girls from the Korea Youth Risk Behavior Web-Based Survey every year from 2011 to 2015. The odds ratios of suicidal ideation were compared between the early and average menarche groups. Generally, the odds ratios of suicidal ideation in girls with early menarche were significantly higher than those with average menarche.

The Mediating Effect of Impulsivity on Resilience and Depressive Symptoms In Korean Conscripts.

OBJECTIVE: Resilience and impulsivity have opposite effects on depression in stressful situations. This study aimed to investigate the association among resilience, impulsivity, and depression in young males. METHODS: The participants consisted of 429 conscripts who underwent military training over 5 weeks. The surveys included the Connors- Davidson Resilience Scale-Korean version, the Barratt Impulsiveness Scale-11-Revised, and the Center for Epidemiological Studies- Depression Scale. The surveys were administered both before and after training. RESULTS: When simultaneously considering impulsivity and resilience, resilience was not associated with depression. Impulsivity had a complete negative mediating effect on resilience and depressive symptoms. Impulsivity is a significant negative mediating factor for the protective effect of resilience on depression. CONCLUSION: This study recommends considering impulsivity when evaluating the protective role of resilience against depression.

Mental Health Interventions Provided by Volunteer Psychiatrists after the Sewol Ferry Disaster: April 16-November 30, 2014.

OBJECTIVE: The aim of this study was to examine the experience of volunteer psychiatrists who provided mental health interventions to adolescents and teachers of Danwon High School from April 16, 2014, to November 30, 2014. METHODS: Data for this study were collected from 72 volunteer psychiatrists about their intervention experiences for 212 adolescents and 32 teachers during the eight months following the disaster. Developmental survey themes were identified, and coding was used to analyze the data. In addition, qualitative data analysis was performed using ATLAS.ti (version 8.2, 2018, ATLAS.ti GmbH). RESULTS: A volunteer prepared with appropriate mental health interventions may facilitate the emergency response to a disaster. Intervention services included psychological first aid, psychoeducation, screening, anxiety reduction techniques, and group therapy. CONCLUSION: In the acute aftermath of the Sewol Ferry disaster of April 16, 2014, volunteer psychiatrists were able to provide mental health interventions in a disaster response setting. The outcomes from this study have important policy and mental health system implications for volunteer psychiatrists. The results of this study constitute the basis of a better understanding of the essential mechanisms of crisis interventions after a disaster.

Effects of Emotional Stability on Insomnia through Anxiety in Patients with Cataracts.

This study investigated the effect of emotional stability (ES) on insomnia through anxiety in preoperative patients with cataracts. Fifty-four subjects completed a self-questionnaire that included the Insomnia Severity Index (ISI), the International Personality Item Pool (IPIP) for ES, and the Hospital Anxiety and Depression scale (HADS). Pathway analysis was performed to analyze the mediating effects of ES, the anxiety subscale scores of the HADS, and the ISI scores. The low-ES group exhibited an insomnia severity that was significantly higher than that of the high-ES group (p=0.048). According to the pathway analysis, the significant indirect effect of ES on the ISI scores was mediated by the scores on the anxiety subscale of the HADS. Cataract patients with low ES waiting to undergo surgery have a high risk of experiencing insomnia due to anxiety. Before surgery, it is essential to identify patients' personality characteristics and provide appropriate intervention.

Development of post-disaster psychosocial evaluation and intervention for children: Results of a South Korean delphi panel survey.

OBJECTIVE: This study aimed to administer a Delphi panel survey and provide evidence for the development of a psychological intervention protocol for use after disasters in South Korea. METHOD: A three-round Delphi survey was conducted. In all rounds, respondents answered open- or closed-ended questions regarding their views on i) the concept of disaster, ii) evaluation, iii) intervention, and iv) considerations in a disaster. Data from Round 1 were subjected to content analysis. In Round 2, items with content validity ratios (CVRs) greater than 0.49 were included, and in Round 3, items with a CVR≥0.38 were accepted. RESULTS: The response rates for the Delphi survey were high: 83% (n = 15, Round 1), 80% (n = 16, Round 2), and 86% (n = 24, Round 3). The data collected during this survey showed a need for a support system for children; for preventive strategies, including disaster readiness plans; for the protection of children's safety; and for the development of post-disaster psychosocial care. CONCLUSIONS: The panel experts reached a consensus regarding the steps they considered critical in post-disaster evaluation and intervention. The findings suggest a unified model for advancing the development of the Korean version of an intervention protocol for children and adolescents exposed to traumatic events.

LRRK2 kinase regulates α-synuclein propagation via RAB35 phosphorylation.

Propagation of α-synuclein aggregates has been suggested as a contributing factor in Parkinson's disease (PD) progression. However, the molecular mechanisms underlying α-synuclein aggregation are not fully understood. Here, we demonstrate in cell culture, nematode, and rodent models of PD that leucine-rich repeat kinase 2 (LRRK2), a PD-linked kinase, modulates α-synuclein propagation in a kinase activity-dependent manner. The PD-linked G2019S mutation in LRRK2, which increases kinase activity, enhances propagation efficiency. Furthermore, we show that the role of LRRK2 in α-synuclein propagation is mediated by RAB35 phosphorylation. Constitutive activation of RAB35 overrides the reduced α-synuclein propagation phenotype in lrk-1 mutant C. elegans. Finally, in a mouse model of synucleinopathy, administration of an LRRK2 kinase inhibitor reduced α-synuclein aggregation via enhanced interaction of α-synuclein with the lysosomal degradation pathway. These results suggest that LRRK2-mediated RAB35 phosphorylation is a potential therapeutic target for modifying disease progression.

Relationship between School Violence and Depressive Symptoms among Multicultural Families' Offspring in South Korea.

The aim of the study was to evaluate the effect of school violence on depressive symptoms among the offspring of multicultural families in South Korea. Data from the National Survey of Multicultural Families 2012, conducted by the Korean Women's Development Institute and Statistics Korea, were used in this study. Complex samples logistic regression was performed to determine the effect of school violence on depressive mood. The survey participants were 3999 students between the ages of 9 and 24. Of the participants, 22.1% reported experiencing depressive symptoms and 9.1% reported experiencing school violence within the last year. School violence was a strong risk factor (OR=5.142, 95% CI=4.067-6.500) for depressive symptoms after adjusting for personal, familial and school factors. School violence is a serious contributor to depressive mood among the offspring of multicultural families. There is a significant need to monitor school violence among this vulnerable group.

More Resilience in Males with Probable Bipolar Depression than Probable Unipolar Depression among Korean Conscripts.

OBJECTIVE: This study investigated whether the resilience of males with probable bipolar depression (PBD) can be strengthened and compared it to that of males with probable unipolar depression (PUD). METHODS: Prospective data for 198 participants (PBD: 66, PUD: 66, normal control: 66) were analyzed. The participants' resilience, bipolarity and severity of depressive symptoms were evaluated at baseline and after 5 weeks. Analysis of variance (ANOVA) and repeated measure ANOVA was performed for comparing resilience between three groups through a basic military training. RESULTS: The PBD group demonstrated more resilience than the PUD group at baseline. Participants with PBD became significantly more resilient than participants with PUD after 5 weeks (p<0.01, F=6.967, η2p=0.052). CONCLUSION: The study indicates that interventions that strengthen resilience need to be developed for males with PBD and that such interventions are more effective for males with PBD than PUD.

Effects of resilience on quality of life in patients with bipolar disorder.

BACKGROUND: Few studies have examined the effects of resilience on quality of life (QOL) in patients with bipolar disorder (BD). Therefore, this study investigated the association between resilience and QOL in patients with BD and compared it to the relationship between resilience and QOL in healthy individuals. METHODS: Participants were 68 euthymic patients with BD and 68 age-, sex-, and length of education-matched controls. Sociodemographic characteristics and clinical variables of the two groups were obtained using face-to-face interviews, and all participants completed the Connor-Davidson Resilience Scale, the World Health Organization QOL-Brief Form. RESULTS: The QOL of the BD group was significantly impaired compared with that of the controls. Degree of resilience, number of depressive episodes, Clinical Global Impression scores, degree of impulsivity, and length of education were significantly correlated with QOL in the BD group. Resilience was significantly associated with overall QOL, physical subdomains of QOL, psychological subdomains of QOL, social subdomains of QOL, and environmental subdomains of QOL in the BD group, even after controlling for confounders. In the control group, resilience was significantly associated with overall QOL, the physical subdomains of QOL, psychological subdomains of QOL, and social subdomains of QOL. LIMITATIONS: The number of participants in each group was 68, which is a relatively small sample size. CONCLUSIONS: Resilience in patients with BD was independently and positively correlated with various areas of QOL. Various strategies to reinforce resilience in patients with BD are needed to improve the low QOL in this population.