Association of loneliness with mental disorders in Korean adults: national mental health survey of Korea 2021.

PURPOSE: Loneliness is a risk factor for mental and physical disorders. Rapid individualization, with increasing associated social burden, is a contributing factor to loneliness among Koreans. This study aimed to investigate the relationship between loneliness and mental disorders, as well as to determine whether long-term loneliness is a factor predicting the occurrence of mental disorders in adults. METHODS: The National Mental Health Survey of Korea 2021, a nationally representative survey on mental disorders, was conducted. Responses from 5511 participants were collected using the Korean version of the Composite International Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition, Structured Clinical Interview for Internet Gaming Disorder, and the World Health Organization Adult Attention-deficit Hyperactivity Disorder (ADHD) self-report scale. Loneliness and its duration were investigated among these participants. RESULTS: Loneliness was reported by approximately 2.9% of the general population. Loneliness was associated with an increased adulthood prevalence of alcohol use disorders, nicotine use disorders, depressive disorders, anxiety disorders, adult ADHD, and internet gaming disorders. Long-term loneliness was significantly associated with an elevated risk of alcohol use disorders, nicotine use disorders, depressive disorders, and anxiety disorders. Internet gaming disorder was associated with loneliness lasting > 1 year. CONCLUSION: Various adult psychiatric disorders were associated with loneliness. The significant dose-effect relationship indicated the importance of early detection of and intervention for loneliness to reduce its negative consequences on mental health.

Trends in the Prevalence of Major Depressive Disorder by Sociodemographic Factors in Korea: Results from Nationwide General Population Surveys in 2001, 2006, and 2011.

BACKGROUND: This study investigated trends in the prevalence of major depressive disorder (MDD) by sociodemographic factors in South Korea. METHODS: National samples of the general population aged 18 years or older collected from the nationwide Korean Epidemiologic Catchment Area surveys conducted in 2001 (n = 6,206), 2006 (n = 6,466), and 2011 (n = 5,986) were used. For MDD diagnosis, we conducted face-to-face interviews using the Korean version of the Composite International Diagnostic Interview. We performed logistic regression analyses stratified by gender, after adjusting for other sociodemographic variables, to calculate the 2006-to-2001 odds ratio (OR) and 2011-to-2001 OR by subgroups of sociodemographic factors to explore the association of MDD prevalence with sociodemographic factors over time. RESULTS: The prevalence of MDD in the general population of South Korea increased steadily from 2001, to 2006, and to 2011 (1.6%, 2.5%, and 3.1%, respectively). Among the men, the prevalence of MDD continued to increase significantly in 18-29 years of age group (2006: adjusted OR [AOR], 3.32; 2011: AOR, 7.42), at-risk drinking group (2006: AOR, 3.56; 2011: AOR, 4.77), and not living with a partner group (2006: AOR, 3.24; 2011: AOR, 3.25). Meanwhile, among the women, the prevalence of MDD continued to significantly increase in the below-average household income group (2006: AOR, 2.58; 2011: AOR, 2.59), at-risk drinking group (2006: AOR, 2.02; 2011: AOR, 2.47), and unemployed group (2006: AOR, 1.48; 2011: AOR, 2.04). CONCLUSION: This study may provide significant information for public policymakers to allocate sufficient health resources on MDD to vulnerable groups, particularly, men aged 18-29 years and women living in households with below-average income, and for clinicians to develop appropriate screening and treatment modalities for MDD.

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.

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.

Impacts of Remaining Single above the Mean Marriage Age on Mental Disorders and Suicidality: a Nationwide Study in Korea.

BACKGROUND: This study investigated the impact of getting older than the mean marriage age on mental disorders and suicidality among never-married people. METHODS: We performed an epidemiological survey, a nationwide study of mental disorders, in 2016. In this study, a multi-stage cluster sampling was adopted. The Korean version of the Composite International Diagnostic Interview was conducted with 5,102 respondents aged 18 years or above. The associations between never-married status, mental disorders, and suicidality were explored according to whether the mean age of first marriage (men = 32.8 years; women = 30.1 years) had passed. RESULTS: Never-married status over the mean marriage age was associated with agoraphobia, obsessive-compulsive disorder, mood disorders, and major depressive disorder after adjusting for sociodemographic factors. Respondents with never-married status above the mean marriage age were associated with suicide attempts (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.36-7.60) after controlling for sociodemographic factors and lifetime prevalence of mental disorders, while respondents with never-married status under the mean marriage age were not. Moreover, in respondents with never-married status, getting older than the mean marriage age was associated with suicidal ideations (aOR, 1.49; 95% CI, 1.04-2.15) and suicide attempts (aOR, 3.38; 95% CI, 1.46-7.84) after controlling for sociodemographic factors and lifetime prevalence of mental disorders. CONCLUSION: Never-married status above the mean first marriage age was associated with mental disorders and suicidality. These findings suggest the need for a national strategy to develop an environment where people with never-married status do not suffer even if their marriage is delayed.

Relationship between subjective memory complaint and executive function in a community sample of South Korean elderly.

AIM: The aim of this study was to investigate the association between subjective memory complaint (SMC) and executive function in a community sample of South Korean elderly. METHOD: Data for 1442 non-cognitive impaired elderly individuals aged 65 and over were selected from a nationwide dementia epidemiological study conducted in South Korea. Global cognitive function was assessed by the Korean version of the Mini-Mental State Examination (MMSE-KC). The registration and recall subscales of the MMSE were used for evaluating memory function. Executive function was measured by using the Initiation/Perseveration (IP) subscale of the Korean dementia rating scale (K-DRS). RESULTS: Of the 1442 participants, 1088 were in the normal control group and 354 were in the SMC group. In the SMC group, compared to the normal control group, the proportion of depression was significantly higher, total MMSE scores, delayed recall score and total IP scores were significantly lower, and the mean scores of complex/simple verbal IP, alternating movements, and graphomotor design were lower. In the unadjusted linear regression model, the SMC significantly associated with a lower score of total MMSE-KC, MMSE delayed recall, K-DRS IP, complex/simple verbal IP, alternating movements and graphomotor design. After adjusting for age, gender, education, marital status, alcohol consumption, smoking behaviour, and depression, the SMC were significantly associated with lower total MMSE score, MMSE delayed recall, K-DRS IP, and K-DRS complex/simple verbal IP. CONCLUSION: In this population-based sample, individuals with SMC had evidence of lower performance on global cognition, memory function, and executive function, especially verbal fluency, after adjusting for demographic variables and depression.

Bidirectional Association between First-Episode Panic Disorder and Major Depressive Disorder in a Nationwide General Population Survey in Korea.

BACKGROUND: Panic disorder (PD) and major depressive disorder (MDD) can occur concurrently, despite different clinical manifestations. Because MDD and PD patients tend to have more complicated conditions, understanding the co-occurrence and pattern of these conditions is important. Here, we investigated the influence of PD and MDD on each other, with respect to time interval. METHODS: Data from three national representative surveys were pooled (total 18,807 respondents), and the age of onset (AOO) of PD and MDD was analyzed. We performed Kaplan-Meier analysis to estimate separate survival functions, using the AOO of MDD and PD as the outcome. To understand the temporal effect of other disorders, we used a Cox proportional hazard model to estimate the hazard ratios for the onset of MDD/PD with other comorbidities as time-dependent covariates. RESULTS: PD elevated the risk of subsequent MDD by 1.5-fold, whereas MDD elevated the risk of subsequent PD by 3.8-fold. The effect of such an elevation risk was significant for up to 2 years. CONCLUSION: The results revealed a bidirectional relationship between MDD and PD. Each disease represents a risk of a subsequent occurrence of the other, which lasts for a considerable duration.

The Association of Childhood Experience of Peer Bullying with DSM-IV Psychiatric Disorders and Suicidality in Adults: Results from a Nationwide Survey in Korea.

BACKGROUND: Few studies have examined the association between childhood bullying and adulthood mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. We investigated the association of childhood peer bullying with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) psychiatric disorders and suicidality in adults. METHODS: A total of 5,102 respondents aged 18 or over completed the Korean version of the Composite International Diagnostic Interview for DSM-IV psychiatric disorders and a questionnaire for suicidal ideas, plans, and attempts. We evaluated peer bullying using an item in the Adverse Childhood Experiences International Questionnaire. Logistic regression analyses were used to identify the association between victimization of peer bullying, adult psychiatric disorders, and suicidality. RESULTS: Around 8.8% of the general population in Korea reported the experience of being bullied when growing up. Bullying experience was associated with an increase in the adulthood prevalence of nicotine use disorders (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.75-3.49), alcohol use disorders (aOR, 1.93; 95% CI, 1.49-2.51), mood disorders (aOR, 4.23; 95% CI, 3.01-5.94), and anxiety disorders (aOR, 2.89; 95% CI, 1.89-4.43) after adjusting for sociodemographic variables. Among anxiety disorders, the OR for post-traumatic stress disorder (aOR, 9.95; 95% CI, 5.62-17.63) was notably high. Frequent victimization (many times) was significantly associated with suicidality even after adjusting for sociodemographic variables and lifetime prevalence of psychiatric disorders, whereas occasional victimization (once or a few times) was not. CONCLUSION: Childhood bullying experience was associated with adult psychiatric disorders and suicidality. The findings indicated the importance of the early detection and management of childhood peer bullying to reduce detrimental adulthood consequences.

Prevalence, correlates, and impact of depressive and anxiety disorder in cancer: Findings from a multicenter study.

ABSTRACTObjective:Our aim was to examine the prevalence, correlates, and association of depressive and anxiety disorders with quality of life (QoL) and such other outcomes as the need for psychosocial services in cancer patients. METHOD: A total of 400 patients participated in a multicenter survey involving five cancer centers located throughout Korea. The Short-Form Health Survey, the MD Anderson Symptom Inventory, the Mini-Mental Adjustment to Cancer (MINI-MAC), and Mini-International Neuropsychiatric Interview were administered. RESULTS: The prevalence rates for depressive and anxiety disorders were 16 and 17.1%, respectively. Younger age and poor Eastern Cooperative Oncology Group performance status, and all physical symptoms, as well as helplessness/hopelessness, anxious preoccupation (AP), and cognitive avoidance (CA) on the MINI-MAC were found to be significantly related to depressive disorder (DD) in a univariate logistic regression analysis. Metastases, the symptoms of disturbed sleep, dry mouth, and numbness or tingling, as well as AP and CA were significantly correlated with anxiety disorder (AD) in the univariate analysis. In the multivariate analyses, only AP was significant for AD (odds ratio = 2.94, p < 0.001), while none reached statistical significance for DD. Psychiatric comorbidity status had a detrimental effect on various dimensions of QoL. Patients with DD or AD reported a significantly higher need for professional psychosocial services. SIGNIFICANCE OF RESULTS: Given the substantial prevalence and pervasive impact of DD and AD on various aspects of QoL, its assessment and care should be integrated as a regular part of oncological care throughout the cancer continuum.

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.

A cross-sectional study about associations between personality characteristics and mental health service utilization in a Korean national community sample of adults with psychiatric disorders.

BACKGROUND: Personality traits are not only associated with psychiatric symptoms, but also with treatment seeking behavior. Our purpose was to examine the relationship between mental health service utilization and personality characteristics in a nationwide community sample of Korean adults. METHOD: Of the 6022 subjects aged 18-74 years who participated in the Korean Epidemiologic Catchment Area study, 1544 (25.6%) with a lifetime diagnosis of any DSM-IV psychiatric disorder were analyzed. Diagnostic assessments were based on the Composite International Diagnostic Interview and personality constructs were measured by Big Five Personality Inventory-10. RESULTS: Of the 1544 participants, 275 (17.8%) had used mental health services. Multivariate analyses revealed positive associations between mental health service utilization and both neuroticism and openness, and an inverse association between mental health service utilization and agreeableness. CONCLUSIONS: These findings suggest that specific personality traits may have a role in treatment-seeking behaviors for mental health problems independent of the psychiatric disorder.

The role of depression in the insomnia of people with subjective memory impairment, mild cognitive impairment, and dementia in a community sample of elderly individuals in South Korea.

BACKGROUND: This study investigates the relationship between insomnia and cognitive dysfunctions including, subjective memory impairment (SMI), mild cognitive impairment (MCI), and dementia, by considering depression in a community sample of elderly individuals. METHODS: Data for 1,740 elderly individuals aged 65 years and over were obtained from a nationwide dementia epidemiological study conducted in South Korea. Cognitive functional status was assessed by the Mini-Mental State Examination and the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet Clinical Assessment Battery. Insomnia was defined as the presence of at least one of the four sleep complaints (difficulty in initiating sleep, difficulty in maintaining sleep, early morning awakening, and non-restorative sleep), accompanied by moderate to severe daytime consequences. Depression was evaluated using the Geriatric Depression Scale. RESULTS: The prevalence of insomnia in the patients with SMI, MCI, and dementia was found to be 23.2%, 19.6%, and 31.0%, respectively. The patients with SMI, MCI, and dementia were significantly more likely to have insomnia and the four sleep complaints than the normal comparison patients. After adjusting for sociodemographic factors, the significant relationships between cognitive dysfunctional status and insomnia remained. However, after adjusting for sociodemographic factors and depression, no significant relationships with any of the sleep complaints or insomnia remained. CONCLUSION: Insomnia is a very common complaint in the elderly with SMI, MCI, and dementia. Depression might play an important factor in the relationship between insomnia and cognitive dysfunctional status in the elderly.

Association of Overweight with the Prevalence of Lifetime Psychiatric Disorders and Suicidality: General Population-based Study in Korea.

Many epidemiological studies suggest that overweight is associated with an elevated risk of psychiatric disorders and suicidal tendency. However, findings vary across studies, and some have contradictory results. We investigated the relationship of overweight with a range of psychiatric disorders and suicidality in the Korean general population. A multistage cluster sampling design was adopted. A total of 6,022 participants aged 18-74 years completed face-to-face interviews (response rate: 78.7%) including assessment of psychiatric disorders, suicidality, and height and weight. Overweight (defined as body mass index of ≥ 25) was associated with an increase in the lifetime prevalence of depressive disorders (adjusted odds ratio [AOR] 1.38; 95% confidence interval [CI], 1.07-1.77), suicidal ideation (AOR, 1.42; 95% CI, 1.20-1.68), and suicidal plans (AOR, 1.44; 95% CI, 1.02-2.03), controlling for sociodemographic variables. Subgroup analysis found that the association between overweight and depressive disorders exists only in women aged 18-44 years (AOR, 1.75; 95% CI, 1.07-2.89) while the association of overweight with suicidal ideation (AOR, 2.08; 95% CI, 1.53-2.82) and suicide plans (AOR, 2.59; 95% CI, 1.25-5.37) existed only in men aged 18-44 years. Overweight was associated with increased odds of nicotine use disorders in women aged 18-44 years (AOR, 2.35; 95% CI, 1.02-5.43), but the association was in the opposite direction in men aged 45-74 years (AOR, 0.64; 95% CI, 0.43-0.94). In conclusion, overweight is related to various psychiatric disorders and suicidality in Korea. Policy makers and clinicians should pay more attention to the mental health of overweight individuals.

Gender Differences in Depressive Symptom Profile: Results from Nationwide General Population Surveys in Korea.

This study investigated gender differences in symptom profiles of major depressive disorder (MDD) in the Korean general population. Data were pooled from the series of nationwide Korean Epidemiologic Catchment Area surveys conducted in 2001, 2006 and 2011, respectively. Of the 18,807 participants, 507 (397 women and 110 men) were diagnosed with MDD within the prior 12 months. In agreement with previous studies, women with MDD appeared to be more vulnerable to experiencing atypical depressive episodes defined as depression with two or more symptoms of fatigue, increased appetite and hypersomnia (P < 0.001). In terms of individual symptoms, female gender was significantly related with higher prevalence of fatigue (P = 0.008), hypersomnia (P = 0.001), noticeable psychomotor retardation (P = 0.029) and suicidal attempts (P = 0.016) with adjustment for birth cohort effect, partner status, and employment status. In the same analysis, men with MDD appeared more vulnerable to decreased libido than women (P = 0.009). This is the first report to demonstrate gender differences in symptomatology of MDD in the general Korean population, and the results are comparable to previous investigations from western societies. Assumingly, the intercultural similarity in female preponderance to atypical depression might reflect the common biological construct underlying the gender difference in mechanism of MDD. In clinical settings, gender differences of MDD should be carefully considered, because these features could be related with treatment response and drug side effects.

Sleep duration and associated factors in a community sample of elderly individuals in Korea.

BACKGROUND: This study estimates the duration of sleep and its relationships with clinical correlates in a community sample of elderly individuals in Korea. METHODS: A total of 1924 individuals aged 65 and over were interviewed in Korea. Sleep durations were classified into five categories: 5.00 h or less, 6.00 h per day, 7.00 h per day, 8.00 h per day, and 9.00 h or more per day. Sleep disturbance was classified into four sleep complaints: difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep. The Mini-Mental Status Examination, the Geriatric Depression Scale, and questionnaires about the presence of cardiovascular disease were employed. RESULTS: The most frequent self-reported sleep duration was 7.00 h. The mean sleep duration was 6.46 h. Female subjects, subjects between the ages of 75 and 79, and subjects with current depression were associated with sleeping for 6.00 h or less or 9.00 h or more. Subjects who lived alone and those with cardiovascular disease were associated with sleeping for 5.00 h or less. Subjects aged 80 and over, formally educated subjects, current smokers, and subjects with cognitive dysfunction were associated with sleeping for 9.00 h or more. Sleep disturbances according to sleep duration has a U-shaped distribution. We found that all sleep disturbances were significantly related to sleep durations of 6.00 h or less compared to sleep durations of 7.00 h. We also found that non-restorative sleep was significantly related to sleep durations of 8.00 h or more compared to sleep durations of 7.00 h. CONCLUSION: A relatively high prevalence of short or long sleep duration was identified. Various sociodemographic variables influenced sleep duration. Depression, cognitive dysfunction, and cardiovascular disease were associated with short or long sleep duration. Careful attention should be paid to the health of elderly individuals who are short or long sleepers.

Pattern of pharmacotherapy by episode types for patients with bipolar disorders and its concordance with treatment guidelines.

This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%-48.7%) compared with that for depressive inpatients (18.6%-46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses.

Impact of illiteracy on depression symptomatology in community-dwelling older adults.

BACKGROUND: In many countries, illiteracy rates among aged people are quite high. However, only few studies have specifically investigated the impact of illiteracy on depression. METHODS: Data for 1,890 elderly individuals (aged ≥65 years) were obtained from a nationwide dementia epidemiological study conducted in South Korea. Based on their reading ability, the participants were divided into three groups: totally illiterate, partially illiterate, and literate. The Korean version of the Geriatric Depression Scale - Short Form (SGDS-K) was used to detect depression (cut-off score = 8). Multivariate logistic regression analyses were used to assess the association between illiteracy and depression. To explore clinical features of depression in illiterate people, we performed logistic regression to calculate odds ratios of positive responses (or negative responses to reverse-coded items) for each SGDS-K item using literate individuals as the reference group. RESULTS: Totally illiterate participants had 2.41 times the odds and partially illiterate individuals had 1.59 times the odds of being depressed compared with literate participants after controlling for other variables. Compared with literate individuals, illiterate elderly persons were at increased odds for responding negatively to the majority of SGDS-K items, including "having memory problems," "others are better off than me," and "feeling worthless" even after controlling for various demographic and clinical factors. CONCLUSIONS: Illiteracy in elderly individuals was associated with a higher rate and increased severity of depression. Illiteracy negatively affected depression symptomatology, especially factors associated with self-esteem. Therefore, clinicians should carefully monitor for the presence of depression in illiterate elderly adults.

Prevalence of insomnia and associated factors in a community sample of elderly individuals in South Korea.

BACKGROUND: Insomnia is a common psychiatric complaint among elderly individuals. This study investigates the prevalence and sociodemographic correlates of insomnia by considering a community sample of elderly individuals in South Korea. METHODS: A face-to-face household survey was conducted in five regions of South Korea from June 2008 to August 2008. Among a total of 3,074 individuals aged 65 years and over, 2,002 participants were interviewed. The presence of insomnia was defined as having at least one of four sleep complaints that included difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and non-restorative sleep (NRS) more than three times per week in the last month. The Restless Legs Syndrome (RLS) Questionnaire, a short form of the Geriatric Depression scale (GDS), and a medical review of systems were implemented. RESULTS: Insomnia was found in 29.2% of the participants. DIS, DMS, EMA, and NRS accounted for 19.4%, 21.7%, 19.6%, and 8.0% of the participants respectively. Insomnia accompanied by daytime consequences accounted for 17.1% of the participants. The participants who were females, had no education, lived alone, showed symptoms of RLS or depression, and had a lifetime history of physical illness were significantly more likely to report insomnia. The prevalence of DIS, DMS, EMA, or insomnia increased slightly with age, whereas that of NRS decreased slightly. The lifetime history of head trauma, hyperlipidemia, heart disease, anemia, or depression was significantly related to insomnia. CONCLUSION: Sleep problems are common among elderly individuals and are closely related to their lifetime history of physical illness.

Major depressive disorder, panic disorder, and post-traumatic stress disorder in Korean subway drivers.

PURPOSE: The purposes of this study are to investigate the prevalence of major depressive disorder, panic disorder, and post-traumatic stress disorder (PTSD) in Korean subway drivers, and find the association between these disorders and the drivers' person-under-train (PUT) experiences. METHODS: A total of 826 subway drivers who participated in a cross-sectional work and health survey were included for this study. The Korean version of the Composite International Diagnostic Interview 2.1 was applied to assess major depressive disorder, panic disorder, and PTSD. The date of PUT, whether victim died, and how many PUTs the drivers experienced were asked using a structured questionnaire. RESULTS: The standardized prevalence ratios (SPRs) for lifetime prevalence of panic disorder and PTSD in subway drivers were 13.3 (95 % confidence interval [CI] 6.6-22.4) and 2.1 (95 % CI 1.1-3.4), respectively. In lifetime prevalence, after adjusting for age, education, income, and working career, the drivers who experienced PUT had significantly higher risks for panic disorder (odds ratio [OR] = 4.2, 95 % CI 1.2-16.6) and PTSD (OR = 4.4, 95 % CI 1.3-16.4). In 1-year prevalence, the drivers who experienced PUT had a significantly higher risk for PTSD (OR = 11.7, 95 % CI 1.9-225.8). There was no significant value of SPR and OR in major depressive disorder. CONCLUSIONS: This study suggests that Korean subway drivers are at higher risk for panic disorder and PTSD compared to the general population, and PUT experience is associated with panic disorder and PTSD. Drivers who have experienced PUT should be treated quickly, sympathetically, and sensitively by a psychological professional and their colleagues, so they can return to work soon.

Temporal priority of lifetime alcohol use disorders and comorbid psychiatric disorders in adults: Results from a population-based nationwide survey in Korea.

BACKGROUND: Despite the high prevalence of alcohol use disorders (AUDs) in Korea, few studies have been conducted on the temporal priority with comorbid mental disorders. We investigated the temporal priority of lifetime AUDs and comorbid mood and anxiety disorders among the general population of Korea. METHODS: Data of 18,807 respondents aged 18 years or older, collected from three national epidemiological surveys comprising face-to-face interviews using the Korean version of the Composite International Diagnostic Interview for DSM-IV mental disorders. For each mood or anxiety disorder, the extent to which one mental disorder precedes another was investigated by calculating the proportion of primary AUDs by that of primary mood or anxiety disorder. RESULTS: Regarding alcohol dependence, dysthymic disorder is 5.6 times more likely to occur before alcohol dependence. Moreover, generalized anxiety disorder, social phobia, and specific phobia are 3.6 times, 4.5 times, and 6.3 times more likely to occur before, respectively. Regarding alcohol abuse, specific phobia is 6.3 times more likely to occur before, whereas major depressive disorder is two times more likely to occur after. Moreover, the lag times between primary alcohol abuse and subsequent mood or anxiety disorders were longer than those between primary alcohol dependence and the latter. LIMITATIONS: The age of onset might be subject to recall bias. The presence of non-respondents could have influenced the results. CONCLUSION: We need to recognize that one of the mental disorders could lead to another and consider it in the management of people with AUDs or mood and anxiety disorders.