Relationship Between Economic Loss and Anxiety During the Coronavirus Disease 2019 Pandemic: Moderating Effects of Knowledge, Gratitude, and Perceived Stress.

Objectives: The prolonged coronavirus disease 2019 (COVID-19) pandemic has caused individuals to suffer economic losses, in particular due to the implementation of intensive quarantine policies. Economic loss can cause anxiety and has a negative psychological impact on individuals, worsening their mental health and satisfaction with life. We examined the protective and risk factors that can influence the relationship between economic loss and anxiety during the COVID-19 pandemic. Methods: Panel data from 911 participants were collected in April and May 2020 and again 6 months later. We analyzed the relationship between economic loss and anxiety and investigated the moderating effects of knowledge about COVID-19, gratitude, and perceived stress. Moreover, we investigated whether there were any changes in moderating effects over time or in different demographic groups. Results: In the early stages of the spread of COVID-19, gratitude (B = -0.0211, F = 4.8130, p < 0.05) and perceived stress (B = 0.0278, F = 9.3139, p < 0.01) had moderating effects on the relationship between economic loss and anxiety. However, after 6 months, only perceived stress had a significant moderating effect (B = 0.0265, F = 7.8734, p < 0.01). Conclusion: In the early stages of COVID-19, lower levels of gratitude and higher perceived stress led to greater anxiety. In later stages of the prolonged pandemic, only perceived stress had a continued moderating effect on the relationship between economic loss and anxiety. This study suggests that psychological interventions to reduce perceived stress are needed to treat the possible adverse effects of the spread of infectious diseases on mental health.

Validation of the Korean Version of the 15-Item Community Assessment of Psychic Experiences in a College Population.

OBJECTIVE: To investigate the reliability and validity of the Korean version of the Community Assessment of Psychic Experiences-15 item positive scale (CAPE-15) in college students. METHODS: This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviews to investigate the instrument's diagnostic validity. The initial screening involved 1,749 college students. The modified Korean version of Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. RESULTS: Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resulted in the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficients of correlation between the CAPE-15 and mKPQ-16 were significant. CONCLUSION: The Korean version of the CAPE-15 is a good instrument for screening for psychosis risk in collegiate settings. The validation of this scale could contribute to the early identification of psychosis in the Korean community.

Clinical Validation of the Psychotic Depression Assessment Scale, Hamilton Depression Rating Scale-6, and Brief Psychiatric Rating Scale-5: Results from the Clinical Research Center for Depression Study.

OBJECTIVE: The aim of this study was to validate the psychotic depression assessment scale (PDAS), which includes the six-item melancholia subscale from the Hamilton depression rating scale (HAMD-6) and the five-item psychosis subscale from the brief psychiatric rating scale (BPRS-5). Data from the Clinical Research Center for Depression (CRESCEND) study, which is a 52-week naturalistic trial, were analyzed. METHODS: Fifty-two patients with psychotic depression from the CRESCEND study met our inclusion criteria. The patients underwent the following psychometric assessments: the PDAS, including HAMD-6 and BPRS-5, the clinical global impression scales, the HAMD, the positive symptom subscale, and the negative symptom subscale. Assessments were performed at the baseline and then at weeks 1, 2, 4, 8, 12, 24, and 52. Spearman correlation analyses were used to assess the clinical validity and responsiveness of the PDAS. RESULTS: The clinical validity and responsiveness of the PDAS, including HAMD-6 and BPRS-5, were acceptable, with the exception of the clinical responsiveness of the PDAS for positive symptoms and the clinical responsiveness of BPRS-5 for negative symptoms. CONCLUSION: The clinical relevance of the PDAS has been confirmed and this clinical validation will enhance its clinical utility and availability.

Potential Relationship between Season of Birth and Clinical Characteristics in Major Depressive Disorder in Koreans: Results from the CRESCEND Study.

We aimed to examine the potential relationship between season of birth (SOB) and clinical characteristics in Korean patients with unipolar non-psychotic major depressive disorder (MDD). Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, 891 MDD patients were divided into two groups, those born in spring/summer (n=457) and those born in autumn/winter (n=434). Measurement tools comprising the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Scale for Suicidal Ideation, Clinical Global Impression of severity, Social and Occupation Functional Assessment Scale, WHO Quality of Life assessment instrument-abbreviated version, Alcohol Use Disorder Identification Test, and Temperament and Character Inventory were used to evaluate depression, anxiety, overall symptoms, suicidal ideation, global severity, social function, quality of life, drinking, and temperament and character, respectively. Using independent t-tests for continuous variables and χ² tests for discrete variables, the clinical characteristics of the two groups were compared. MDD patients born in spring/summer were on average younger at onset of first depressive episode (t=2.084, p=0.038), had greater loss of concentration (χ²=4.589, p=0.032), and were more self-directed (t=2.256, p=0.025) than those born in autumn/winter. Clinically, there was a trend for the MDD patients born in spring/summer to display the contradictory characteristics of more severe clinical course and less illness burden; this may have been partly due to a paradoxical effect of the 5-HT system.

Influence of caregiver personality on the burden of family caregivers of terminally ill cancer patients.

OBJECTIVE: To determine the influence of caregiver personality and other factors on the burden of family caregivers of terminally ill cancer patients. METHOD: We investigated a wide range of factors related to the patient-family caregiver dyad in a palliative care setting using a cross-sectional design. Caregiver burden was assessed using the seven-item short version of the Zarit Burden Interview (ZBI-7). Caregiver personality was assessed using the 10-item short version of the Big Five Inventory (BFI-10), which measures the following five personality dimensions: extroversion, agreeableness, conscientiousness, neuroticism, and openness. Patient- and caregiver-related sociodemographic and psychological factors were included in the analysis because of their potential association with caregiver burden. Clinical patient data were obtained from medical charts or by using other measures. Multivariate linear regression analysis was performed to identify the independent factors associated with caregiver burden. RESULTS: We analyzed 227 patient-family caregiver dyads. The multivariate analysis revealed that caregiver extroversion was protective against caregiver burden, whereas depressive symptoms in caregivers were related to increased burden. Neuroticism was positively correlated with caregiver burden, but this relationship was nonsignificant following adjustment for depressive symptoms. Patient-related factors were not significantly associated with caregiver burden. SIGNIFICANCE OF RESULTS: Evaluating caregiver personality traits could facilitate identification of individuals at greater risk of high burden. Furthermore, depression screening and treatment programs for caregivers in palliative care settings are required to decrease caregiver burden.

Is the BPRS-5 subscale of the psychotic depression assessment scale a reliable screening tool for psychotic depression?: Results from the CRESCEND study.

BACKGROUND: The detection of psychotic depression (PD) among patients with depressive disorders is important for both treatment and monitoring. Therefore, in continuation of our previous work, this study aimed to test the ability of the five-item Brief Psychiatric Rating Scale (BPRS-5) of the Psychotic Depression Assessment Scale (PDAS) in separating patients with psychotic depression from those with non-psychotic depression (non-PD) and to compare this discriminative validity to that of other item sets. METHODS: A receiver operating characteristics curve was used to identify the optimal cut-off score of the BPRS-5 subscale for sensitive and specific distinction between PD and non-PD in a sample of 494 patients with depressive disorders (53 with PD and 441 with non-PD). RESULTS: Using an optimal cut-off score of 1, the sensitivity and the specificity of the BPRS-5 subscale in detecting PD were 71.2% and 87.2%, respectively. The BPRS-5 outperformed other item sets of the PDAS and the positive symptom subscale of the BPRS in identifying patients with PD. LIMITATIONS: The inter-rater reliability of the PDAS and the BPRS-5 subscale was not evaluated in this study. CONCLUSIONS: The BPRS-5 subscale can be regarded as a more sensitive screening method for PD compared to other item sets from the PDAS and the BPRS. Hence, from a screening perspective, a positive score on any of the five symptoms of the BPRS-5 subscale (hallucinatory behavior, unusual thought content, suspiciousness, blunted affect, and emotional withdrawal) is indicative of PD, and should lead to more thorough diagnostic assessment.

Is the Psychotic Depression Assessment Scale a useful diagnostic tool? The CRESCEND study.

BACKGROUND: The Psychotic Depression Assessment Scale (PDAS) has been validated as a method of assessing the severity and treatment outcomes of psychotic depression (PD). We aimed to compare the results of the PDAS in PD and non-psychotic depression (non-PD) patients and validate the PDAS as a diagnostic tool for PD. METHODS: We included 53 patients with PD and 441 with non-PD who participated in the Clinical Research Center for Depression study in South Korea. In addition to the PDAS, psychometric tools including the HAMD17, HAMA, BPRS, CGI-S, SOFAS, SSI-Beck, WHOQOL-BREF, AUDIT, and FTND were used to assess, respectively, depression, anxiety, overall symptoms, global severity, social functioning, suicidal ideation, quality of life, alcohol use, and nicotine use. RESULTS: After adjusting for age and total HAMD17 score, PD patients had higher scores for depressive mood, hallucinations, unusual thought content, suspiciousness, blunted affect, and emotional withdrawal on the PDAS and higher total scores on the SSI-Beck than non-PD patients. Binary logistic regression identified hallucinatory behavior and emotional withdrawal as predictors of PD. Receiver operating characteristic analysis showed that emotional withdrawal could be used to differentiate psychotic from non-psychotic depression. LIMITATIONS: The inter-rater reliability for psychometric assessments was not evaluated. CONCLUSIONS: In addition to assessing the severity and treatment outcomes of PD, PDAS can help in the diagnosis of PD.

Comparative validity of depression assessment scales for screening poststroke depression.

INTRODUCTION: This study aimed to compare screening properties of four assessment scales for poststroke depression (PSD) at 2 weeks and 1 year after index stroke, and investigated factors contributing to misclassification. METHODS: A total of 423 patients were evaluated 2 weeks after stroke and 288 (68%) were followed 1 year later, and were diagnosed as having major and minor PSD applying DSM-IV criteria gold standards. The Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale-depression subscale (HADS-D), Hamilton Rating Scale for Depression (HAMD), and Montgomery-Asberg Depression Rating Scale (MADRS) were administered. The balance of sensitivity and specificity was assessed using receiver operating characteristics (ROC) analysis. RESULTS: Discriminating abilities of all the scales for major and all PSD were good (area under ROC values 0.88-0.93 and 0.88-0.92 at 2 weeks; and 0.93-0.96 and 0.89-0.91 at 1 year, respectively). Misclassification was influenced by demographic characteristics and stroke severity particularly for the BDI and HAMD, was more marked for all PSD than for major PSD, and was more prominent at 2 weeks than at 1 year after stroke. LIMITATIONS: Patients with only mild to moderate stroke severity were included. CONCLUSIONS: Although there were no marked differences in the screening abilities for PSD between the scales, differences were found in factors influencing misclassification. Assessment scales with less somatic items may be recommended for the screening of PSD, particularly at the acute phase of stroke.

Predictive value of folate, vitamin B12 and homocysteine levels in late-life depression.

BACKGROUND: The role of folate, vitamin B(12) and homocysteine levels in depression is not clear. AIMS: To investigate cross-sectional and prospective associations between folate, B(12) and homocysteine levels and late-life depression. METHOD: A total of 732 Korean people aged 65 years or over were evaluated at baseline. Of the 631 persons who were not depressed, 521 (83%) were followed over a period of 2-3 years and incident depression was ascertained with the Geriatric Mental State schedule. Serum folate, serum vitamin B(12) and plasma homocysteine levels were assayed at both baseline and follow-up. RESULTS: Lower levels of folate and vitamin B(12) and higher homocysteine levels at baseline were associated with a higher risk of incident depression at follow-up. Incident depression was associated with a decline in vitamin B(12) and an increase in homocysteine levels over the follow-up period. CONCLUSIONS: Lower folate, lower vitamin B(12) and raised homocysteine levels may be risk factors for late-life depression.

Correlates of caregiver burden for Korean elders according to cognitive and functional status.

BACKGROUND: Caregiver strain was investigated in a community sample of Korean elders with cohabiting caregivers, and factors associated with this were compared between groups classified by cognitive and functional impairment. METHODS: The study sample consisted of 484 elders and their cohabiting caregivers resident in Kwangju, South Korea. Caregiver burden was measured by the Zarit Burden Interview. Data on the elders' socio-demographics (age, gender, education, and religion) and clinical characteristics (cognitive function (MMSE), activities of daily living (IADL), depressive symptoms, alcoholism, and physical illness), and caregivers' socio-demographic characteristics (age, gender, education, relation to elders, and current employment) and caregiving environments (living area, alternative caregiver, number of rooms, monthly income, and social network) were gathered. Participants were classified into those with (n=61) or without cognitive impairment. The second group was classified into those with (n=68) or without (n=355) functional impairment. RESULTS: Caregiver strain was significantly associated with cognitive impairment. In the group without cognitive impairment, caregiver strain was significantly associated with participant characteristics (IADL impairment, and symptoms of depression and alcoholism). In those with cognitive impairment, caregiver strain was associated with both participant status (depressive symptoms and IADL impairment) and caregiver characteristics (a child caregiver, lower social support, and urban environment). CONCLUSIONS: Individual mental and physical health characteristics predict caregiver strain regardless of cognitive impairment. Caregiver characteristics are most important in the presence of cognitive impairment.

Diagnostic validity of assessment scales for depression in patients with schizophrenia.

The aim of this study was to examine the diagnostic validity of four commonly used assessment scales for depression in schizophrenia. The study population consisted of 84 inpatients meeting the DSM-IV criteria for schizophrenia. Depression in the study subjects was defined by the DSM-IV criteria for major depressive episode. The Positive and Negative Syndrome Scale (PANSS) and the Simpson-Angus Rating Scale (SARS) were used to differentiate depression from the negative and extrapyramidal symptom-related depressive phenomena in schizophrenia. The following four depression scales were assessed for their diagnostic validity as measures of depressive disorder in schizophrenia: the Calgary Depression Scale for Schizophrenia (CDSS), the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HAM-D), and the depression subscale of the PANSS (PANSS-D). Of 84 patients with schizophrenia, 32 were diagnosed as having comorbid depressive disorder. The areas under the Receiver Operating Characteristic (ROC) curves of the CDSS, HAM-D, PANSS-D, and BDI were 0.94, 0.89, 0.90, and 0.81, respectively. The area under the ROC curve of the CDSS was significantly greater than that of the BDI and tended to be more favorable than those for the HAM-D and the PANSS-D. Our study suggests that the CDSS may provide the best assessment for depression in patients with schizophrenia.

Assessment of association between mitochondrial aldehyde dehydrogenase polymorphism and Alzheimer's disease in an older Korean population.

BACKGROUND: The mutant allele of mitochondrial aldehyde dehydrogenase (ALDH2(*)2) was found to be associated with Alzheimer's disease (AD) in a Japanese sample, interacting with the apolipoprotein E epsilon 4 allele (Apo E4). OBJECTIVE: In a community Korean population we sought to investigate associations between ALDH2 genotypes and the following outcomes: cognitive impairment, previous cognitive decline, dementia and AD. METHODS: Six hundred ninety community residents aged 65 or over were assessed for demographic characteristics, drinking behaviour, cognitive function, clinical diagnoses of dementia and AD, physical health status, and genotype (ALDH2 and Apo E). RESULTS: There were no significant associations between the ALDH2(*)2 and any cognitive outcome, before or after adjustment for alcohol-related characteristics. These findings were consistent both in the non-drinkers and drinkers. Interaction between ALDH2 and Apo E was only found for one outcome (previous cognitive decline) at borderline levels of significance (P=0.058). CONCLUSIONS: Overall, these findings in a community population did not support a substantial role for ALDH2 genotype in the aetiology of dementia.

Predictors of institutionalization in patients with dementia in Korea.

BACKGROUND: Many studies have sought to determine the predictors of institutionalization of patients with dementia. Such studies, performed in developed western societies, have come to various conclusions which may not be supported in an East Asian culture such as that found in Korea. OBJECTIVES: This study aimed to determine the factors that predict institutionalization of patients in Korea diagnosed with dementia. METHODS: Seventy-nine cases (37 institutionalized, 42 community-dwelling) in the Kwangju area were evaluated for patient characteristics, severity of dementia symptoms, caregiver characteristics, burden and distress. Logistic regression was performed to determine predictors of actual institutionalization. RESULTS: Six predictors of institutionalization were identified. Of these, three were patient-related factors: higher score on the Clinical Dementia Rating, higher score on the Brief Psychiatric Rating Scale, and shorter duration of dementia. The other three were caregiver-related factors: younger age, higher education (formal schooling), and higher cost of home care. CONCLUSIONS: As seen in previous western studies, institutionalization of dementia sufferers was influenced by both patient and caregiver factors. But, the specific predictors and their relative influences might be explained best by the particular social, cultural and economic situation in Korea. This study was the first of its kind in Korea and, as such, could serve as a reference for future intra-cultural and cross-cultural comparisons.