The Relationship Between Fast Food Consumption and Daily Lifestyle Changes During School Closures Following the COVID-19 Pandemic: A Cross-Sectional Study Among Adolescents in Korea

Objective@#Increased fast food consumption can have adverse effects on health and well-being among adolescents, posing a significant public health concern. The school closures due to the coronavirus disease-2019 (COVID-19) pandemic have led to changes in eating patterns and disrupted a balance diet among adolescents. This study explored the factors associated with fast food consumption among adolescents during school closures due to the COVID-19 pandemic. @*Methods@#A total of 1,710 middle and high school students in Gwangju, South Korea participated in a cross-sectional survey. The self-administered questionnaire included items assessing dietary intake, physical activity, sleep, media use, and sociodemographic information. The Patient Health Questonnaire-9, Generalized Anxiety Disorder-7, and three item version of the UCLA Loneliness Scale were also administered. Multivariable logistic regression was used to examine the factors associated with increased fast food consumption. @*Results@#Approximately 34.6% of the surveyed adolescents reported increased fast food consumption during school closures, as well as increased sleep duration, increased sedentary behaviors including watching TV and using the internet, and reduced physical activity. Multivariable logistic regression analysis revealed that fast food consumption during school closures was associated with irregular patterns of main meals and sleep, decreased physical activity, increased internet use, and a lack of daytime adult supervision. @*Conclusion@#Our results highlight the need for dietary and lifestyle monitoring and guidelines to promote health among adolescents, especially during school closures. In conclusion, nutrition intervention programs aiming to limit fast food consumption and enhance healthy dietary habits among adolescents during long-term school closures are warranted.

Two Cases of Posttraumatic Stress Disorder Caused by a Motor Vehicle Accident Treated with Virtual Reality Exposure Therapy

Exposure-response prevention is an effective approach to treat anxiety disorders. Virtual reality exposure therapy (VRET) is a promising treatment for patients with posttraumatic stress disorder (PTSD). New research has helped refine and update VRET. In this study, we introduce a form of VRET developed for patients suffering from PTSD after a traffic accident, and present two cases treated using this protocol. After 6 weeks of VRET treatment, the two participants not only improved their PTSD symptoms, but also improved their depressed mood, anxiety, and insomnia symptoms. Future studies of VRET for car accident-related PTSD should utilize a controlled design with randomization in order to account for numerous possible confounds.

Use of Serum Biomarkers to Aid Antidepressant Selection in Depressive Patients

Objective@#This study aimed to identify serum biomarkers prospectively associated with remission at 12 weeks in outpatients with depressive disorders receiving stepwise psychopharmacotherapy, according to the main antidepressant used during the treatment period. @*Methods@#This study included 1,024 depressive outpatients initially treated using antidepressant monotherapy, followed by alternating pharmacological strategies during the acute phase (3−12 weeks; 3-week interval). Fourteen serum biomarkers, sociodemographics, and clinical characteristics were evaluated at baseline. Based on the use frequency and mechanism of action, four main antidepressant types were distinguished: escitalopram, other selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and mirtazapine. A Hamilton Depression Rating Scale score ≤ 7 was take to indicate remission. @*Results@#Lower high-sensitivity C-reactive protein levels were correlated with remission at 12 weeks for all antidepressant types. Lower interleukin (IL)-6 levels and tumor necrosis factor-alpha levels were associated with remission using escitalopram and other SSRIs respectively. Lower IL-1β and leptin levels, predicted remission in association with SSRIs including escitalopram. For SNRIs, remission at 12 weeks was predicted by lower IL-4 and IL-10 levels. For mirtazapine, remission at 12 weeks was associated with lower leptin levels, and higher serotonin and folate levels. @*Conclusion@#Baseline serum status, as estimated by nine serum markers, may help clinicians determine the most appropriate antidepressant to achieve remission in the acute phase of depression.

Brain Derived Neurotrophic Factor Methylation and Long-term Outcomes after Stroke Interacting with Suicidal Ideation

Objective@#This study aimed to evaluate the unexplored relationship between BDNF methylation, long-term outcomes, and its interaction with suicidal ideation (SI), which is closely associated with both BDNF expression and stroke outcomes. @*Methods@#A total of 278 stroke patients were assessed for BDNF methylation status and SI using suicide-related item in the Montgomery–Åsberg Depression Rating Scale at 2 weeks post-stroke. We investigated the incidence of composite cerebro-cardiovascular events (CCVEs) during an 8−14-year period after the initial stroke as long-term stroke outcome.We conducted Cox regression models adjusted for covariates to evaluate the association between BDNF methylation status and CCVEs, as well as its interaction with post-stroke SI at 2 weeks. @*Results@#Higher methylation status of CpG 1, 3, and 5, but not the average value, predicted a greater number of composite CCVEs during 8−14 years following the stroke. The associations between a higher methylation status of CpGs 1, 3, 5, and 8, as well as the average BDNF methylation value, and a greater number of composite CCVEs, were prominent in patients who had post-stroke SI at 2 weeks. Notably, a significant interaction between methylation status and SI on composite CCVEs was observed only for CpG 8. @*Conclusion@#The significant association between BDNF methylation and poor long-term stroke outcomes, particularly amplified in individuals who had post-stroke SI at 2 weeks, suggested that evaluating the biological marker status of BDNF methylation along with assessing SI during the acute phase of stroke can help predict long-term outcomes.

Understanding the Fluctuations in Korea’s Suicide Rates: A Change-Point Analysis and Interrupted Time Series Analysis

Background@#Korea has witnessed significant fluctuations in its suicide rates in recent decades, which may be related to modifications in its death registration system. This study aimed to explore the structural shifts in suicide trends, as well as accidental and ill-defined deaths in Korea, and to analyze the patterns of these changes. @*Methods@#We analyzed age-adjusted death rates for suicides, deaths due to transport accidents, falls, drowning, fire-related incidents, poisonings, other external causes, and ill-defined deaths in Korea from 1997 to 2021. We identified change-points using the ‘breakpoints’ function from the ‘strucchange’ package and conducted interrupted time series analyses to assess trends before and after these change-points. @*Results@#Korea’s suicide rates had three change-points in February 2003, September 2008, and June 2012, characterized by stair-step changes, with level jumps at the 2003 and 2008 change-points and a sharp decline at the 2012 change-point. Notably, the 2003 and 2008 spikes roughly coincided with modifications to the death ascertainment process. The trend in suicide rates showed a downward slope within the 2003–2008 and 2008–2012 periods.Furthermore, ill-defined deaths and most accidental deaths decreased rapidly through several change-points in the early and mid-2000s. @*Conclusion@#The marked fluctuations in Korea’s suicide rate during the 2000s may be largely attributed to improvements in suicide classification, with potential implications beyond socio-economic factors. These findings suggest that the actual prevalence of suicides in Korea in the 2000s might have been considerably higher than officially reported.

A Case of Primary Tuberculosis of the Paranasal Sinuses

Tuberculosis of the paranasal sinus is a rare disease caused by infection with Mycobacterium tuberculosis, the causative agent of pulmonary tuberculosis. Although the worldwide incidence of tuberculosis is declining, the diagnosis of primary paranasal tuberculosis remains challenging and cannot be ruled out in patients presenting with refractory chronic rhinosinusitis after adequate surgical and medical treatment. We experienced a case of paranasal tuberculosis with no evidence of previous tuberculosis infection. It was diagnosed after a surgical biopsy revealed granulomatous inflammation and caseous necrosis. The patient responded well to antituberculosis drug therapy and became free of symptoms after 7 months of treatment. We report our findings in this case with a review of the recent literature.

Psychosocial and digital intervention for patients with schizophrenia

Schizophrenia is a severe mental disorder that significantly impairs the daily functioning of patients that causes substantial societal and economic burden. While drug therapy is crucial for schizophrenia treatment, relying solely on antipsychotic drugs does not yield the most favorable therapeutic outcomes.Current Concepts: Integrating psychosocial interventions could result in maximized therapeutic effects for individuals living with schizophrenia. Evidence-based psychosocial interventions for schizophrenia management include cognitive behavioral therapy, family involvement, psychoeducation, supported employment programs, lifestyle adjustments for physical health, and coordinated and comprehensive early intervention services. Incorporating peer support, allowing both service users and care providers to share knowledge and their illnessrelated personal experiences, facilitates mutual assistance along the path to recovery. Moreover, growing interest follows in using digital interventions, such as wearable technology and smartphone applications, as effective therapeutic tools for illness management.Discussion and Conclusion: The above-mentioned psychosocial interventions empower individuals with schizophrenia, helping them improve their functioning, enhance their life quality, and adapt more effectively to society. Combining early medication with comprehensive psychosocial interventions, including digital technology, is crucial for the best outcomes. This approach should begin as soon as schizophrenia is diagnosed, aiming to promote recovery and overall well-being in affected individuals.

Factors Associated With Depression Among Elderly Living Alone and Those Living With a Spouse in an Urban Area / 생물치료정신의학

Objectives@#This study aimed to investigate factors associated with depression among elderly living alone and those living with a spouse in an urban area. @*Methods@#This study was a community-based, cross-sectional study that included 384 elderly aged 60 years or older.The subjects completed a questionnaire that covered sociodemographic characteristics and chronic medical illnesses.The Korean version of the Short Form of the Geriatric Depression Scale, the Korean version of the Quality of Life-Alzheimer’s Disease (KQOL-AD), and the Korean Mini Mental State Examination in the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment packet were also performed. @*Results@#The participants were divided into two groups: 137 elderly individuals living alone and 247 elderly individuals living with a spouse. Heart disease (odds ratio [OR]=13.099, 95% confidence interval [CI]=1.892-90.697, p=0.009) was identified as a risk factor for depression, while the religion (OR=0.137, 95% CI=0.028-0.668, p=0.014) was found to be a protective factor against depression among elderly individuals living alone. Higher scores on the KQOL-AD scale were found to be protective factors against depression for both elderly individuals living alone (OR=0.742, 95% CI= 0.636-0.867, p<0.001) and those living with a spouse (OR=0.664, 95% CI=0.573-0.771, p<0.001). @*Conclusions@#Among elderly living alone in an urban area, heart disease, religion, and the quality of life appear to have an impact on depression. To reduce the risk of depression in the elderly, it is necessary to properly manage heart disease, encourage religious participation, and enhance the quality of life.

Peripheral Markers of Suicidal Behavior: Current Findings and Clinical Implications

Biomarkers of suicidal behavior (SB), particularly peripheral biomarkers, may aid in the development of preventive and intervention strategies. The peripheral biomarkers of SB should be easily accessible, cost-effective, and minimally invasive. To identify peripheral biomarkers of SB, we summarized the current knowledge related to SB biomarkers with a focus on suicidal outcomes (suicidal ideation [SI], suicide risk [SR], suicide attempt [SA], and suicide death [SD]), measured site (center or periphery), and study design (cross-sectional or longitudinal). We also evaluated the central findings to validate the findings of peripheral biomarkers of SB. We found reduced peripheral interleukin (IL)-2 levels in individuals with a recent SA, higher cerebrospinal fluid (CSF) IL-6 levels in patients with a current SR and future SD, higher CSF tumor necrosis factor-α levels for current and future SRs, higher high-sensitivity C-reactive protein levels and lower peripheral total cholesterol levels for recent SAs, lower peripheral 5-HT levels for present SR, and a lower folate level for future SR and SA within 1 year. Previous studies have shown inconsistent associations of low peripheral leptin levels with SR and recent SA; therefore, further study is required. Given the multiple determinants of SB and weak associations with single biological markers, combinations of potential biological markers rather than single markers may improve the screening, diagnosis, and prediction of SB.

Effects of Dietary Habits on General and Abdominal Obesity in Community-dwelling Patients with Schizophrenia

Objective@#To investigate the effects of dietary habits on general and abdominal obesity in community-dwelling patients with schizophrenia spectrum disorder according to sex. @*Methods@#A total of 270 patients with schizophrenia spectrum disorder registered at mental health welfare centers and rehabilitation facilities were recruited. General obesity was defined as a body mass index ≥ 30 kg/m 2 , and abdominal obesity was defined as a waist circumstance ≥ 90 cm in men and ≥ 85 cm in women. Dietary habits were evaluated using dietary guidelines published by the Korean Ministry of Health and Welfare. Demographic and clinical characteristics along with dietary habits and information related to obesity were collected. Factors related to obesity were evaluated separately by sex. @*Results@#Dietary habits differed according to sex, in that scores for healthy eating habits were lower in men than in women. In men, the prevalences of general and abdominal obesity were 17.0% and 37.3%, respectively. In women, the prevalences of general and abdominal obesity were 23.1% and 38.5%, respectively. Regression analysis showed that the scores of regular eating habits were negatively associated with general and abdominal obesity in men, and the scores of healthy eating habits were negatively associated with general and abdominal obesity in women. @*Conclusion@#Among patients with schizophrenia, regular eating habits might reduce the risk of obesity in men, and healthy eating habits might reduce the risk of obesity in women. Nutrition education should be provided to community-dwelling patients with schizophrenia to prevent obesity in this population.

Effectiveness of Switching to Long-acting Injectable Aripiprazole in Patients with Recent-onset and Chronic Schizophrenia

Objective@#This study investigated the effectiveness of switching to once-monthly long-acting injectable (LAI) aripiprazole from other second-generation antipsychotics including LAI paliperidone palmitate in both recent-onset and chronic schizophrenia patients. @*Methods@#This was a 24-week prospective, open-label, flexible dose-switching study in patients with schizophrenia. Scores on the Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance (PSP) scale, Clinical Global Impression (CGI), Subjective Well-being Under Neuroleptics−Short Form (SWN-K), and a computerized emotional recognition test (ERT) were evaluated. Subjects were divided into two groups (recent onset and chronic) based on 5 years’ duration of the illness. @*Results@#Among the 82 patients participating, 67 (81.7%) completed the 24-week study. The discontinuation rate after switching to LAI aripiprazole did not differ according to clinical characteristics including type of previous antipsychotics. Scores on the PANSS, PSP, SWN-K, CGI, and ERT were significantly improved after a switch to LAI aripiprazole without exacerbation of metabolic parameters and bodyweight. The improvements in the PANSS, PSP, and CGI scores were significantly greater in patients with recent-onset than in those with chronic schizophrenia; the improvement in metabolic parameters was significantly greater in the latter group. @*Conclusion@#High rates of successful switching to LAI aripiprazole from other antipsychotics suggest its good tolerability and effectiveness. Improvements in psychopathology and social functioning were more evident in patients with recent-onset schizophrenia, and improvements in metabolic abnormalities were more prominent in patients with chronic schizophrenia.

Possible Link between Serotonin and Interleukin 18 on Suicidality in Patients with Acute Coronary Syndrome

Objective@#We investigated effects of serum serotonin and interleukin 18 levels on suicidal ideation (SI) at acute and chronic phases of acute coronary syndrome (ACS). @*Methods@#Recent-onset 969 ACS patients were evaluated for serum serotonin and interleukin 18 levels; and SI by the“suicidal thoughts” item of the Montgomery–Åsberg Depression Rating Scale. After 1-year, 711 patients were re-evaluated for SI. Logistic regression models were used adjustment for potential covariates. @*Results@#Associations between serum interleukin 18 and SI at both phases were significant only in the lower serotonin group. @*Conclusion@#By evaluating serum serotonin and interleukin 18 levels, the clinical prediction of SI of ACS may be improved.

Psychological and Personality Characteristics Associated With COVID-19 Vaccination Behavior in Korean General Population

Background@#This study characterized coronavirus disease 2019 (COVID-19) vaccination behavior in the Korean general population using cluster analysis and explored related psychological factors. @*Methods@#We categorized 1,500 individuals based on their attitudes toward COVID-19 vaccination using hierarchical clustering and identified their level of vaccine acceptance. We examined the associations between vaccine acceptance and behavioral and psychological characteristics. @*Results@#Clustering revealed three groups according to vaccine acceptance: ‘totally accepting’ (n = 354, 23.6%), ‘somewhat accepting’ (n = 523, 34.9%), and ‘reluctant’ (n = 623, 41.5%). Approximately 60% of all participants who belonged to the ‘totally accepting’ and ‘somewhat accepting’ groups were willing to receive a COVID-19 vaccine despite concerns about its side effects. High vaccine acceptance was associated with older age, regular influenza vaccination, and trust in formal sources of information. Participants with high vaccine acceptance had higher levels of gratitude, extraversion, agreeableness, and conscientiousness, and lower levels of depression, anxiety, and neuroticism. @*Conclusions@#People weighed the benefits of COVID-19 vaccination against the risk of side effects when deciding to receive the COVID-19 vaccine. Our findings also indicate that this vaccination behavior may be affected by coping mechanisms and psychological factors.

Suicide and Non-Suicidal Self-Injury From Internet Addiction Among Korean Adolescents

Objectives@#This study examined the associations between Internet addiction and suicide and non-suicidal self-injury (NSSI) among South Korean adolescents. @*Methods@#We conducted a cross-sectional study of 1694 Korean adolescents. The suicidal Ideation Questionnaire and Deliberate SelfHarm Inventories were used to identify high-risk suicide and NSSI groups, respectively. Internet addiction was assessed using the Internet Addiction Scale. Other questionnaires included sociodemographic data, perceived academic stress, and daily life-related factors. We also performed a logistic regression analysis using the high suicide risk and NSSI groups as dependent variables. @*Results@#The high suicide risk and NSSI prevalence rates among participants were 11.8% and 28.3%, respectively. A multivariable logistic regression analysis revealed that Internet addiction is associated with higher suicide risk and NSSI. Additionally, being female and academic stress were significant suicide risk factors, while male participants had a higher NSSI prevalence. @*Conclusion@#Our results suggest that monitoring adolescents’ Internet use and providing education to prevent Internet addiction would lower high suicide and NSSI risk. Moreover, suicide and NSSI risk screening in adolescents with Internet addiction and providing suitable interventions will be essential for the preventing suicide and NSSI.

Development of a Machine Learning Model for Diagnosing Schizophrenia and Bipolar Disorder Based on Diffusion Tensor Imaging: A Preliminary Study / 생물치료정신의학

Objectives@#This study aimed to develop a machine learning model for diagnosing schizophrenia (SZ) and bipolar disorder (BD) based on diffusion tensor imaging (DTI) data. @*Methods@#We used 3T-magnetic resonance imaging to examine SZ, BD, healthy control (HC) subjects (aged 20-50 years, n=65 in each group). Applying Support Vector Machine (SVM) to fractional anisotropy (FA) values, we built classification models of SZ and HC, BD and HC, and SZ and BD. Features of white matter (WM) tracts were selected through recursive feature elimination, and 5-fold cross validation was performed. @*Results@#The SVM models classified SZ and BD from HC with a mean accuracy of 83.5% and 75.4%, respectively. The SZ-BD classification model archived 75.0% accuracy. These classification models used FA values in 15-18 WM tracts as features, including the retrolenticular part of the internal capsule, superior corona radiata, cingulum, and superior fronto-occipital fasciculus. @*Conclusions@#This study presented a preliminary machine learning model to diagnose SZ and BD based on DTI data. Our findings also suggest that there might be a specific pattern of abnormalities in WM integrity that can differentiate the two psychotic disorders.

Effect Modification of Cortisol on the Associations Between Obsessive-Compulsive Symptoms on Suicidality in Patients With Acute Coronary Syndrome

Objective@#Obsessive-compulsive symptoms (OCS) and suicidal ideation (SI) are common in patients with acute coronary syndrome (ACS). This study investigated the associations of OCS and serum cortisol levels with SI, and further evaluated the possible modifying effects of cortisol on the associations between OCS and SI in acute and chronic phases of ACS. @*Methods@#In total, 969 ACS patients were recruited from a tertiary university hospital in Korea within 2 weeks of disease onset and evaluated in terms of OCS (using the OCS dimension of the Symptom Checklist-90–Revised), serum cortisol levels, and SI (using the “suicidal thoughts” item of the Montgomery–Åsberg Depression Rating Scale). Covariates included sociodemographics, depression, vascular risk factors, and disease severity. After 1 year, 711 patients were re-evaluated in terms of SI. Logistic regression analysis was performed with adjustment for covariates. @*Results@#Higher OCS was significantly associated with SI both at baseline and follow-up. Serum cortisol showed no such association, but modified the association between OCS and SI. That was the associations were significant only in the higher but not in the lower serum cortisol levels, with significant interaction terms after adjusted for relevant covariates. @*Conclusion@#Evaluating OCS and serum cortisol levels at the acute phase could improve the accuracy of clinical predictions of SI both in the acute and chronic phases of ACS.

The Effect of Fear of COVID-19 Infection and Anxiety on Loneliness: Moderated Mediation Effects of Gratitude

Objective@#This study was conducted to identify factors related to loneliness during the coronavirus disease-2019 (COVID-19) pandemic and focused on how the fear of COVID-19 infection affects loneliness and the conditional effect of gratitude as a moderator in the relationship among the fear of COVID-19, anxiety, and loneliness. @*Methods@#For the analysis of this study, a survey was conducted among 1,500 individuals aged 19 to 69 years living in three metropolitan areas in South Korea. Questionnaires included sociodemographic data, psychological experience and stress associated with COVID-19, Generalized Anxiety Disorder Scale–7, UCLA Loneliness Scale–3, and Gratitude Questionnaire–6. An analysis was conducted by applying SPSS PROCESS macro models 4 and 7. @*Results@#First, anxiety mediated the relationship between the fear of COVID-19 infection and loneliness. Second, the effect of the fear of COVID-19 infection on loneliness through anxiety was moderated by gratitude. The higher the gratitude, the more the fear of COVID-19 infection is buffered in the path to anxiety, and the lower the indirect effect on loneliness. @*Conclusion@#This suggests that in the context of the COVID-19 pandemic, interventions for psychological problems such as anxiety and loneliness can be carried out through gratitude, a significant protective variable.

Ghrelin Modifies the Impact of Life Stress on Suicidality in Patients With Acute Coronary Syndrome

Objective@#This study investigated associations of life stressors and serum ghrelin levels with suicidal ideation (SI), and evaluated the potential mediating effect of ghrelin on associations between life stressors and SI in patients with acute coronary syndrome (ACS). @*Methods@#In total, 969 ACS patients recruited from a tertiary university hospital in Korea within 2 weeks of disease onset were evaluated in terms of life stressors (using the List of Threatening Events Questionnaire), serum ghrelin levels, and SI (using the “suicidal thoughts” item of the Montgomery–Asberg Depression Rating Scale). Covariates included sociodemographics, depression, vascular risk factors, and disease severity. After 1 year, 711 patients were re-evaluated in terms of SI; logistic regression was performed with adjustment for covariates. @*Results@#Life stressors were significantly associated with SI at baseline and follow-up. Serum ghrelin showed no such associations, but high levels thereof mediated associations of life stressors with SI; significant interaction terms were also observed after adjustment for covariates. @*Conclusion@#By evaluating life stressors and serum ghrelin levels, clinical prediction of SI in the acute and chronic phases of ACS could be improved.

Factors Associated With Depression and Anxiety in Korean Adolescents During the COVID-19 Pandemic

Objective@#This study was performed to identify factors associated with depression and anxiety among Korean adolescents during the coronavirus disease (COVID-19) pandemic. @*Methods@#We conducted a cross-sectional study of 1,898 Korean adolescents (55.2% male, 44.8% female) ranging in age from 12 to 17 years (mean±standard deviaion age, 15.4±2.6 years). Depression and anxiety were defined as a Patient Health Questionnaire-9 score ≥10 and Generalized Anxiety Disorder-7 score ≥10, respectively. Other questionnaires included sociodemographic data, psychosocial stresses, and experiences in association with COVID-19. Psychiatric scales included Gratitude Questionnaire-6, Perceived Stress Scale-10, and UCLA Loneliness Scale-3. @*Results@#The prevalence rates of depressive and anxiety symptoms among participants were 13.8% and 21.0%, respectively. Multivariable logistic regression analysis revealed that female sex, fear of COVID-19 infection, low gratitude were risk factors for depression. Fear of COVID-19 infection, increased TV watching time, and academic-related stress were risk factors for anxiety. @*Conclusion@#Depression and anxiety were prevalent during the pandemic in Korean adolescents, and were associated with fear of COVID-19 infection. Providing appropriate information on COVID-19, helping adolescents manage academic-related stress and maintain daily life patterns, and implementing interventions to foster gratitude are important for preventing depression and anxiety in Korean adolescents.

Structural Model Analysis of Discriminatory Behavior Toward People With Severe Mental Illness

Objective@#This study aimed to determine how prejudice and attitude toward people with severe mental illness, formed through exposure to the mass media, affect discriminatory behavior toward them. @*Methods@#Between September and November 2019, demographic data were collected using an online survey of 622 adults residing in South Korea. The scales used in this study were taken from the 2008 survey by the National Human Rights Commission of Korea. Structural equation modeling was performed for a comparative analysis of the direct and indirect effects. @*Results@#Virtual experience through mass media exposure had a statistically significant effect on prejudice against people with severe mental illness. Direct experience had a positive influence on reducing prejudice and discriminatory behavior. The direct effects of prejudice on discriminatory behavior were significant. In terms of indirect effects, the full mediating effect of prejudice was significant for the virtual experience through the mass media-prejudice-discriminatory behavior path, and the partial mediating effect of prejudice was significant on the direct experience-prejudice-discrimination behavior path. @*Conclusion@#This study recommends more careful reporting of mental illness in the media, promoting anti-stigmatization programs that provide opportunities for direct contact between the public and people with severe mental illness.