Differential roles of reflection and brooding on the relationship between perceived stress and life satisfaction during the COVID-19 pandemic: A serial mediation study.

Perceived stress is associated with low life satisfaction; however, the underlying mechanism is relatively underexplored. This study investigated whether rumination might mediate this link during the highly stressful COVID-19 pandemic. Building on the distinction between the subtypes of rumination, we predicted that reflection and brooding would sequentially mediate this relationship and that maladaptive brooding would negatively influence life satisfaction. A representative sample of 316 adults was recruited from the greater Daegu area, where the first massive outbreak occurred in South Korea. After informed consent was obtained, they completed a package of questionnaires that included demographics, COVID-19-related experiences, perceived stress, life satisfaction, and rumination. A serial mediation analysis showed that reflection and brooding sequentially mediated the relationship between perceived stress and life satisfaction. As predicted, only brooding was negatively related to life satisfaction. In contrast, reflection per se was positively related to life satisfaction, and it negatively affected life satisfaction only through brooding. Our results extended the negative effect of brooding, as compared to reflection, in the pandemic. Given that reflection may easily turn into brooding under stress, it will be necessary to develop ways to guide people to counteract brooding while maintaining a reflective self-focus to preserve their well-being.

Metabolic alterations in the anterior cingulate cortex and related cognitive deficits in late adolescent methamphetamine users.

The adolescent brain, with ongoing prefrontal maturation, may be more vulnerable to drug use-related neurotoxic changes as compared to the adult brain. We investigated whether the use of methamphetamine (MA), a highly addictive psychostimulant, during adolescence affect metabolic and cognitive functions of the anterior cingulate cortex (ACC). In adolescent MA users (n = 44) and healthy adolescents (n = 53), the levels of N-acetyl aspartate (NAA), a neuronal marker, were examined in the ACC using proton magnetic resonance spectroscopy. The Stroop color-word task was used to assess Stroop interference, which may reflect cognitive functions of behavior monitoring and response selection that are mediated by the ACC. Adolescent MA users had lower NAA levels in the ACC (t = -2.88, P = 0.005) and relatively higher interference scores (t = 2.03, P = 0.045) than healthy adolescents. Moreover, there were significant relationships between lower NAA levels in the ACC and worse interference scores in adolescent MA users (r = -0.61, P < 0.001). Interestingly, early onset of MA use, as compared to late onset, was related to both lower NAA levels in the ACC (t = -2.24, P = 0.03) as well as lower performance on interference measure of the Stroop color-word task (t = 2.25, P = 0.03). The current findings suggest that metabolic dysfunction in the ACC and its related cognitive impairment may play an important role in adolescent-onset addiction, particularly during early adolescence.

Diagnostic utility of worry and rumination: a comparison between generalized anxiety disorder and major depressive disorder.

AIM: Although previous reports have addressed worry and rumination as prominent cognitive processes in generalized anxiety disorder (GAD) and major depressive disorder (MDD) and their distinct correlation with anxious and depressive symptoms, the differential association of worry and rumination with the diagnosis of GAD and MDD remains unclear. The purpose of this study was to investigate the distinct features of worry and rumination in factor structure and their predictive validity for the diagnosis of GAD and MDD. METHODS: Four hundred and sixty-eight patients with GAD (n = 148) and MDD (n = 320) were enrolled and the diagnoses were confirmed with the Structured Clinical Interview for DSM-IV. Participants completed the Penn State Worry Questionnaire and Ruminative Response Scale and the severity of anxiety and depressive symptoms was assessed via clinician ratings. RESULTS: In joint factor analysis using the Penn State Worry Questionnaire and Ruminative Response Scale items, worry and rumination emerged as distinct factors. In logistic regression analyses, worry contributed to a higher probability of the diagnosis of GAD than rumination, as rumination did in MDD than worry. CONCLUSION: This is the first comprehensive study investigating the diagnostic utility of worry and rumination in a well-defined clinical sample of both GAD and MDD. Our results suggest that worry and rumination are distinct cognitive processes and play a differential role in the diagnosis of GAD and MDD, distinguishing them at the cognitive level.

Meaning-making while staying connected matters in psychological adaptation during pandemic: a longitudinal moderated mediation study.

Adversity may bring about both negative and positive changes in psychological adaptation. Although there is mounting evidence regarding the psychological distress during the pandemic, the other side of posttraumatic change, posttraumatic growth (PTG) and its predictors are relatively underexamined. Moreover, there is a paucity of longitudinal investigations that examined intra- and interpersonal predictors responsible for both sides of psychological adaptation. Therefore, this study comprehensively examined the longitudinal relationship among cognitive processing, social support, and adaptation during the pandemic using a moderated mediation model. Specifically, it was tested whether two types of event-related rumination mediated the link between perceived stress and ambilateral adaptational outcomes, and whether social support moderated the mediating pathways of ruminations on adaptation. After informed consent, a representative sample of adults was followed up for over a year, and answered a package of online questionnaires. The results showed that intrusive rumination prospectively predicted greater psychological distress and less PTG in response to stress, whereas deliberate rumination led to less psychological distress and more PTG over time. As predicted, the indirect protective effect of deliberate rumination was stronger when perceived social support was higher. This longitudinal study highlighted the core factors responsible for continued suffering and personal growth during the pandemic. These results have both practical and clinical implications for mental healthcare in the post-COVID era, when the heterogeneity of psychological adaptation increases and preparation for the next pandemic is warranted.

Development and Validation of the Mental Health Scale for Maltreated Children.

OBJECTIVE: This study aimed to develop and validate a comprehensive self-report questionnaire to assess emotional and behavioral problems and psychological trauma in maltreated children. METHODS: The Mental Health Scale for Maltreated Children (MHS-MC) was constructed to encompass five major symptoms (depression, anxiety, inattention/hyperactivity/impulsivity, aggression/defiance, and psychological trauma) prevalent in maltreated children. Critical items and ego-resilience subscale were also devised to increase clinical utility. After informed consent, 205 children (maltreated children, n=157, 76.6%) were recruited nationwide, and they answered a package of self-report measures, including the MHS-MC. Reliability, construct validity, concurrent validity, and criterion-related validity were examined to explore the psychometric properties. RESULTS: The reliability was good to excellent. Confirmatory factor analysis yielded a five-factorial solution for the symptom subscales supporting construct validity. In logistic regression, the total scores of the MHS-MC predicted membership in the maltreated group. Criterion-related validity was generally satisfactory in that all subscales of the MHS-MC showed significant correlations with relevant measures in the expected direction. CONCLUSION: This is the first attempt to develop a comprehensive psychological scale based on nationwide data collected from maltreated Korean children. We hope that the continued standardization of this scale will contribute to evidence-based clinical and policy decisionmaking for maltreated children.

A latent profile approach for classifying internet gamers based on motives for online gaming.

Background and aims: Online gaming motives have proven to be useful in differentiating problematic engagement in online gaming. However, the mixture modeling approach for classifying problematic subtypes based on gaming motives remains limited. This study attempted to differentiate heterogeneous online gamers into more homogenous subtypes based on gaming motives using latent profile analysis (LPA). We also compared various psychological and gaming/leisure related variables across the derived profiles. Methods: A total of 674 Korean online game users (mean age = 21.81 years, male = 76%) completed self-report questionnaires, including the Korean version of the Motives for Online Gaming Questionnaire (K-MOGQ). After the LPA, the relationships between latent profile membership and auxiliary variables were explored. Results: Four latent profiles were identified, that were further classified into one problematic (highly motivated-dissatisfied gamer), one highly engaged (highly motivated-satisfied gamer), and two casual (moderately-motivated casual gamer and lowly-motivated casual gamer) gamer profiles. Inter-profile comparisons revealed that highly motivated-dissatisfied gamer had the most pathological profile, characterized by high Internet gaming disorder (IGD) tendency, neuroticism, and impulsivity, but the lowest recreation motive. While highly motivated-satisfied gamer also demonstrated a heightened IGD tendency, they showed positive patterns of psychological and gaming/leisure-related variables, which indicated they could be better considered as high engaged instead of problematic gamers. Discussion and conclusions: These results indicate that the recreation motive, in addition to fantasy or escape motives, is an important factor in differentiating maladaptive online gamers. Classifying online gamers based on gaming motives can contribute to a clearer conceptualization of heterogeneous gamers, paving the way for individualized assessment and treatment planning.

The Effectiveness of Virtual Reality Intervention for COVID-19-Related Psychological Distress: A Systematic Review.

OBJECTIVE: The prolonged coronavirus disease-2019 (COVID-19) pandemic is likely to cause psychological distress in people. This systematic review aimed to identify the effectiveness of virtual reality (VR)-based psychological intervention among individuals with psychological distress during the COVID-19 crisis. PubMed, Ovid MEDLINE, Cochrane Library, Web of Science, Embase, and PsycINFO databases were searched for articles published until July 2022. METHODS: The available citations were deduplicated and screened by two authors using the title and abstract information. Eligibility criteria were constructed according to the PICOT guidelines. Empirical studies of all designs and comparator groups were included if they appraised the impact of an immersive VR intervention on any standardized measure indicative of psychological distress (stress, anxiety, depression, and post-traumatic symptoms) or improvements in quality of life in participants, including COVID-19 patients, medical staff working with COVID-19 patients, and people who had experienced strict social distancing during the COVID-19 pandemic. RESULTS: The results were discussed using a narrative synthesis because of the heterogeneity between studies. Seven of the studies met the inclusion criteria. There were two randomized controlled trials and five uncontrolled studies on VR interventions. CONCLUSION: All studies reported significant improvement in a wide range of psychological distress during COVID-19, ranging from stress, anxiety, depression, and post-traumatic symptoms to quality of life, supporting the efficacy of VR-based psychological intervention. Our results suggest that VR intervention has potential to ameliorate COVID-19-related psychological distress with efficacy and safety.

Deep learning-based diagnosis of lung cancer using a nationwide respiratory cytology image set: improving accuracy and inter-observer variability.

Deep learning (DL)-based image analysis has recently seen widespread application in digital pathology. Recent studies utilizing DL in cytopathology have shown promising results, however, the development of DL models for respiratory specimens is limited. In this study, we designed a DL model to improve lung cancer diagnosis accuracy using cytological images from the respiratory tract. This retrospective, multicenter study used digital cytology images of respiratory specimens from a quality-controlled national dataset collected from over 200 institutions. The image processing involves generating extended z-stack images to reduce the phase difference of cell clusters, color normalizing, and cropping image patches to 256 × 256 pixels. The accuracy of diagnosing lung cancer in humans from image patches before and after receiving AI assistance was compared. 30,590 image patches (1,273 whole slide images [WSIs]) were divided into 27,362 (1,146 WSIs) for training, 2,928 (126 WSIs) for validation, and 1,272 (1,272 WSIs) for testing. The Densenet121 model, which showed the best performance among six convolutional neural network models, was used for analysis. The results of sensitivity, specificity, and accuracy were 95.9%, 98.2%, and 96.9% respectively, outperforming the average of three experienced pathologists. The accuracy of pathologists after receiving AI assistance improved from 82.9% to 95.9%, and the inter-rater agreement of Fleiss' Kappa value was improved from 0.553 to 0.908. In conclusion, this study demonstrated that a DL model was effective in diagnosing lung cancer in respiratory cytology. By increasing diagnostic accuracy and reducing inter-observer variability, AI has the potential to enhance the diagnostic capabilities of pathologists.

Effect of atmospheric pressure plasma on inactivation of pathogens inoculated onto bacon using two different gas compositions.

Atmospheric pressure plasma (APP) is an emerging non-thermal pasteurization method for the enhancement of food safety. In this study, the effect of APP on the inactivation of pathogens inoculated onto bacon was observed. Sliced bacon was inoculated with Listeria monocytogenes (KCTC 3596), Escherichia coli (KCTC 1682), and Salmonella Typhimurium (KCTC 1925). The samples were treated with APP at 75, 100, and 125 W of input power for 60 and 90 s. Two gases, helium (10 lpm) or a mixture of helium and oxygen, (10 lpm and 10 sccm, respectively) were used for the plasma generation. Plasma with helium could only reduce the number of inoculated pathogens by about 1-2 Log cycles. On the other hand, the helium/oxygen gas mixture was able to achieve microbial reduction of about 2-3 Log cycles. The number of total aerobic bacteria showed 1.89 and 4.58 decimal reductions after plasma treatment with helium and the helium/oxygen mixture, respectively. Microscopic observation of the bacon after plasma treatment did not find any significant changes, except that the L∗-value of the bacon surface was increased. These results clearly indicate that APP treatment is effective for the inactivation of the three pathogens used in this study, although further investigation is needed for elucidating quality changes after treatment.

Korean validation of the Motives for Online Gaming Questionnaire: Focusing on its factor structure and incremental validity.

BACKGROUND AND AIMS: Research has suggested that considering gaming motives can be useful in differentiating between heterogenous online game users. This study validated the Korean version of the Motives for Online Gaming Questionnaire (K-MOGQ) and attempted to reconcile the mixed findings on its factor structure. We also examined the incremental validity of the K-MOGQ beyond the personality variables implicated in Internet gaming disorder (IGD). METHODS: After informed consent, six hundred and forty-one Korean online game users (mean age = 21.49 years) completed a survey package including the K-MOGQ. After exploratory factor analysis (EFA) was conducted, all existing models were compared using confirmatory factor analysis (CFA). A hierarchical regression analysis was conducted to demonstrate the incremental variance explained by gaming motives. RESULTS: The K-MOGQ demonstrated a satisfactory reliability. The EFA and CFA revealed a six-factor (fantasy, escape, skill development, competition, recreation, and social motives) solution in which the coping factor disappeared from the original seven-factor structure. In addition, the escape and fantasy motives significantly predicted increased IGD symptoms even when introversion, neuroticism, and impulsivity were controlled for. DISCUSSION AND CONCLUSIONS: Our results indicate that the K-MOGQ possesses good psychometric properties for measuring the motivational basis of online gaming in Korean-speaking populations. Furthermore, escape and fantasy factors emerged as the most salient motives for IGD symptoms. More research is required to clarify whether a Western-Eastern distinction applies to the factor structure of the MOGQ.

The Role of Event-Related Rumination and Perceived Social Support on Psychological Distress during the COVID-19 Pandemic: Results from Greater Daegu Region in South Korea.

OBJECTIVE: Research on psychological distress from the coronavirus disease 2019 (COVID-19) crisis has increased significantly, but the factors that can exacerbate or mitigate such distress have remained underexplored. To address the research gap, this study examined whether two types of rumination and perceived social support predict psychological distress during the pandemic. METHODS: Participants were recruited from communities of the greater Daegu area (n=316) where the first massive outbreak in South Korea occurred and most residents underwent substantial disruption of daily life. They completed self-report questionnaires that included measures of psychological distress, event-related rumination, and social support. RESULTS: The hierarchical regression analysis showed that maladaptive intrusive rumination and perceived social support predicted increases and decreases in psychological distress, respectively, even when subjective severity of COVID-19-related experiences was controlled. Putatively adaptive type of rumination (i.e., deliberate rumination) was not a significant predictor concurrently. CONCLUSION: This is among the early endeavors to comprehensively understand risk and protective factors associated with an effective coping strategy against the COVID-19 crisis. Our results indicate that intrusive rumination aggravates but social support mitigates psychological distress during the pandemic, indicating that we can better adapt by differently attending to recent experiences and maintaining perceived social support.

Behavioral activation system (BAS) dysregulation and bipolar spectrum psychopathology in daily life: An online-diary study.

Dysregulation of the behavioral activation system (BAS) has been theorized to be a core factor underlying mood swings in bipolar disorder (BD). However, few studies have directly addressed BAS dysregulation and more research is needed to understand its dynamic expression in daily life. The aim of this study was to directly assess BAS dysregulation, and to examine its moderating effect on the relationship between life events and bipolar spectrum symptoms via multilevel modeling. Korean young adults (n = 100) were screened using the Hypomanic Personality Scale (HPS) from a large sample (N = 1,591). They completed online diaries for 7 consecutive days including the Daily Events Record as well as bipolar spectrum symptoms. BAS-activating and/or -deactivating scores were allocated to each reported life event by an expert consensus rating. Cross-level interaction analysis showed that the occurrence of BA life events contributed to a steeper increase in bipolar spectrum symptoms, particularly for individuals with high BAS dysregulation. The present study suggests that BAS dysregulation is a unique construct that deserves further exploration in BD.

Psychometric Properties of the Nine-Item Korean Internet Gaming Disorder Scale: Short Form.

The main objective of this study was to examine the psychometric properties of the Korean version of the Internet Gaming Disorder Scale-Short Form (K-IGDS9-SF), a brief self-report instrument developed to assess Internet gaming disorder (IGD) in accordance with the Diagnostic and Statistical Manual of Mental Disorders-5th edition criteria. A total of 594 Korean game users (average age = 23.5 years, 70.37 percent male) participated and completed questionnaires containing the K-IGDS9-SF and other measures for its validation. The K-IGDS9-SF showed good reliability (Cronbach's α = 0.86, composite reliability coefficient = 0.87). Consistent with previous studies, the K-IGDS9-SF demonstrated a single-factor structure in a confirmatory factor analysis. Moreover, the K-IGDS9-SF had significant associations with related variables (IGD, game playing variables, self-esteem, impulsivity, and loneliness) in the expected direction, supporting its concurrent, criterion, and convergent validity. Taken together, these results indicated that the K-IGDS9-SF has satisfactory psychometric properties, suggesting its utility as a unified robust instrument for studying IGD worldwide.

Evaluation of atmospheric pressure plasma to improve the safety of sliced cheese and ham inoculated by 3-strain cocktail Listeria monocytogenes.

The objective of this study was to evaluate the efficacy of atmospheric pressure plasma (APP), which is capable of operating at atmospheric pressure in air, in sliced cheese and ham inoculated by 3-strain cocktail of Listeria monocytogenes (ATCC 19114, 19115, and 19111, LMC). The process parameters considered were input power (75, 100, 125, and 150 W) and plasma exposure time (60, 90, and 120 s). Microbial log reduction increased with increases of input power and plasma exposure time. After 120 s APP treatments at 75, 100, and 125 W, the viable cells of LMC were reduced by 1.70, 2.78, and 5.82 log in sliced cheese, respectively. More than 8 log reductions can be achieved in 120 s at 150 W. In contrast, reductions after 120 s ranged from 0.25 to 1.73 log CFU/g in sliced ham. Calculated D values, the exposure time required to inactivate 90% of a population, from the survival curves of 75, 100, 125, and 150 W of APP treatments were 71.43, 62.50, 19.65, and 17.27 s for LMC in sliced cheese, respectively, and those in sliced ham were 476.19, 87.72, 70.92, and 63.69 s. No viable cells were detected at 125 and 150 W of APP treatment in sliced cheese, irrespective of plasma exposure time, after 1 week at a detection limit of 10(1) CFU/g. These results indicate that the inactivation effects of APP on L. monocytogenes are strongly dependent on the type of food.

Korean Validation of the Internet Gaming Disorder-20 Test.

Since "Internet gaming disorder (IGD)" was included as a tentative disorder in Section III of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5), more efforts have been undertaken to provide standardized assessment tools. Among the recently proposed measures of IGD, the IGD-20 (IGD-20) Test was designed to encompass the nine IGD criteria of the DSM-5, and it was subsequently validated into other languages. The present study aimed to validate the Korean version of the IGD-20 Test. In total, 1,403 Korean online game users were recruited for a self-report survey comprising the Korean IGD-20 (K-IGD-20) Test and other measures, including demographics and playing variables. The K-IGD-20 Test had good reliability, and a confirmatory factor analysis revealed six factors, consistent with the original scale. Moreover, the K-IGD-20 Test demonstrated appropriate concurrent and convergent validity with other measures of Internet (game) addiction and psychological problems. Overall, the present results indicate that the K-IGD-20 Test could be used as a reliable and valid tool in IGD research on Korean-speaking populations. Furthermore, this adds empirical evidence to continue the cross-cultural validation of the IGD-20 Test, which could contribute to a more unified, integrative approach in IGD research worldwide.

Comparing the screening property of the shortened versions of the Hypomania Checklist-32 (HCL-32): Cross-validation in Korean patients with bipolar disorder and major depressive disorder.

BACKGROUND: To date, shortened versions of the Hypomania Checklist-32 (HCL-32) were proposed to overcome the limitation of a lengthy format; however, a cross-validation study is currently needed to identify which shorter version may function optimally in a clinical sample. METHODS: In a Korean patient sample with bipolar disorder (BD) and major depressive disorder (MDD) (BD-I n = 84, BD = II n = 145, MDD n = 285), we examined the reliability and screening property of three shorter versions of the HCL (HCL-20, -16, -8) in comparison with the full HCL-32. Diagnosis was confirmed by the structured clinical interview (SCID-I). RESULTS: All three shortened HCLs demonstrated a fair screening ability (Area Under the Curve = .72~.74) to discriminate BD patients from MDD patients, which was comparable to that of the HCL-32. When sensitivity and specificity were considered, the HCL-20 showed relatively superior performance among the shortened versions. LIMITATIONS: The shorter versions were not administered in a 'stand-alone' manner. CONCLUSIONS: This is the first cross-validation study in a large clinical sample with an increased statistical power to compare the screening property of the shortened HCLs. Our results suggest that briefer versions of the HCL could be reliably and economically utilized in clinical and research settings to enhance detection of BD.

Initial Psychometric Properties of the Korean Altman Self-Rating Mania Scale: Preliminary Validation Study in a Non-Clinical Sample.

OBJECTIVE: We aimed to examine the reliability and validity of the Korean Altman Self-Rating Mania Scale (K-ASRM) in a large sample of Korean non-clinical undergraduates. METHODS: Participants (n=1,091) filled out the K-ASRM with other self-report questionnaires assessing bipolarity, mood symptoms and affect. Reliability test, exploratory factor analysis and correlation analyses were conducted to examine its psychometric properties. RESULTS: The reliability of the K-ASRM was adequate (Cronbach's α=0.73, item-to-total correlation 0.53-0.78) and the exploratory factor analysis yielded one factor of mania. The K-ASRM demonstrated significant associations with measures of hypomanic personality (r=0.33), lifetime history of hypomanic symptoms (r=0.23). Also, the K-ASRM was significantly correlated with positive affect (r=0.53), negative affect (r=-0.17) and depressive symptoms (r=-0.35). CONCLUSION: These results suggest preliminary possibility that the K-ASRM can be utilized as self-rating tool for mania in Korea as well as future directions for further validation.

The link between hypomania risk and creativity: The role of heightened behavioral activation system (BAS) sensitivity.

BACKGROUND: The relationship between bipolar disorder (BD) and creativity is well-known; however, relatively little is known about its potential mechanism. We investigated whether heightened behavioral activation system (BAS) sensitivity may mediate such relationship. METHODS: Korean young adults (N=543) completed self-report questionnaires that included the Hypomanic Personality Scale (HPS), the Behavioral Activation System(BAS) Scale, the Everyday Creativity Scale (ECS), the Positive Affect and Negative Affect Schedule (PANAS), and the Altman Self-Rating Mania Scale (ASRM). Correlational, hierarchical regression and mediation analyses using bootstrap confidence intervals were conducted. RESULTS: As predicted, BAS sensitivity was associated with self-reported creativity as well as hypomania risk and symptoms. Even when positive affect was controlled, BAS sensitivity predicted incrementally significant variance in explaining creativity. In mediation analysis, BAS sensitivity partially mediated the relation between hypomania risk and creativity. LIMITATIONS: Reliance on self-report measures in assessing creativity and usage of non-clinical sample. CONCLUSIONS: BAS sensitivity was related not only to mood pathology but also to creativity. As a basic affective temperament, BAS sensitivity may help explain incompatible sides of adaptation associated with BD.

An International Comparative Study on Driving Regulations on People with Dementia.

Over 40% of people with dementia drive, with a two to five times greater accident risk than controls. This has fueled public concerns about the risk of traffic accidents by drivers with dementia (DWD). We compared driving regulations on seniors and DWD between ten European and Asia-Pacific countries to identify key implications for national strategies. Moderate to severe dementia was a reason for driver's license revocation in all countries. However, regulations on mild dementia varied considerably, with most basing their decisions on severity, rather than simply the presence of dementia. Most used validated assessments, but responsibility for triggering the administrative process fell on drivers in some countries and on physicians in others. Administrations should consider the following when developing driving policies: 1) ideal regulations on DWD should ensure that restrictions are implemented only when needed; 2) fitness to drive should be assessed using validated instruments; 3) the use of processes that automatically initiate driving competency examinations following a diagnosis of dementia should be explored; and 4) restrictions should be delicately tailored to a range of driving competence levels, and assistive incentives compensating for lost driving privileges should be provided.

Comparisons of Subthreshold Versus Full Posttraumatic Stress Disorder Distinguished by Subjective Functional Impairment Among Train Drivers: A Population-Based Nationwide Study in South Korea.

OBJECTIVE: Subthreshold posttraumatic stress disorder (SPTSD), a condition that meets the full symptomatic criteria of posttraumatic stress disorder (PTSD) without subjective functional impairment, has yet to be fully investigated. In this study, we aimed to determine the prevalence and characteristics of SPTSD. METHODS: The web-based survey including psychiatric diagnosis and experience of human error was conducted in actively working train drivers in South Korea. RESULTS: Of the 4,634 subjects, 103 (2.23%) were categorized as full PTSD and 322 (6.96%) were categorized as having SPTSD. Individuals with full PTSD showed higher impulsivity and anxiety compared to those with SPTSD and those without PTSD, while those with SPTSD had more frequent clinically meaningful depression, posttraumatic stress, and alcohol and nicotine dependence and significant human error. CONCLUSION: Despite not qualifying as a subjective functional disability, SPTSD still had significant psychiatric symptoms. More clinical attentions need to be given to the diagnosis and treatment of SPTSD.