Development and validation of the trauma-specific emotional counting Stroop paradigm for fMRI study.

BACKGROUND: The emotional-counting Stroop (ecStroop) is a cognitive task to evaluate emotional information processing. This study aimed to develop a trauma-specific ecStroop protocol for firefighters and assess its validity as a functional magnetic resonance imaging (fMRI) activation paradigm. METHODS: To develop the ecStroop protocol, trauma-related words for firefighters were selected from previous studies, and general negative and neutral words were matched corresponding to the number of letters and syllables, parts of speech, and frequency in the Korean language. The negative emotional valence of whole words was investigated in 520 healthy participants. To compare brain activation between three categories, 25 healthy individuals underwent fMRI during the ecStroop task. RESULTS: Eight trauma-related words, eight general negative words, and sixteen neutral words were selected by emotional valence scores. The general negative words were related to increased activation in the right inferior and middle temporal gyrus, right medial frontal gyrus, and left superior frontal gyrus compared to the neutral words. When exposed to the trauma-related words, participants' brain activation was increased in the right inferior temporal gyrus, right medial frontal gyrus, left superior temporal gyrus, and left inferior frontal gyrus as compared to when exposed to the neutral words. LIMITATIONS: The fact that all participants in the phase 2 fMRI study were male could limit generalization to all genders. CONCLUSIONS: These findings suggest that the ecStroop paradigm successfully activated the brain regions for emotional processing. This paradigm could be valuable in assessing the trauma-specific neural changes in firefighters.

Development and verification of the Menopause Emotional Symptom Questionnaire.

OBJECTIVE: A detailed, well-validated scale for measuring emotional symptoms in menopausal women is lacking. We aimed to develop the Menopause Emotional Symptom Questionnaire (MESQ) and to confirm its reliability and validity among Koreans. METHODS: Eighteen primary items based on previous research results were selected using exploratory factor analysis and confirmatory factor analysis (CFA). New data, including answers to the novel MESQ, Menopause Rating Scale, Kupperman Index, Beck Depression Inventory-II, and Beck Anxiety Inventory, were collected from 200 perimenopausal women and 100 young men through a research company. Exploratory factor analysis and CFA were performed again to determine whether the MESQ accurately measures emotional symptoms in perimenopausal women. Receiver operating characteristic curve and k-means cluster analyses were used to identify the most appropriate cutoff value. RESULTS: The MESQ showed high internal consistency (Cronbach α = 0.926), and the CFA revealed that the factor structure comprised two subscales: nine items for mood/anxiety symptoms and four items for sleep symptoms. A high correlation between the total MESQ score and total scores of the existing scales was confirmed, indicating high convergence validity. Comparison of the mean MESQ scores between men and women showed significant sex difference, indicating secure known-group validity. The cutoff point of the total MESQ score between the high-risk and low-risk groups was 26. CONCLUSIONS: The novel MESQ has high validity and reliability, and this study confirmed that the MESQ is a valid tool for screening for and measuring emotional symptoms in menopausal women in Korea.

Correlation Between Attention Deficit Hyperactivity Disorder, Internet Gaming Disorder or Gaming Disorder.

OBJECTIVE: Individuals with internet gaming disorder (IGD) or gaming disorder (GD) had a higher prevalence of ADHD than individuals without IGD or GD. The overpathologizing of excessive gaming behaviors may be associated with the functional impairment due to ADHD in individuals with GD. METHODS: The present study was designed to compare the gaming patterns, accompanying psychopathology, and co-occurring psychiatric disorders, especially ADHD, between clinical and general gamer samples (17-29 years old). RESULTS: Out of the nine IGD criteria, the item "functional impairment" had low diagnostic accuracy in participants with IGD or GD. The IGD (GD) group had a higher prevalence of ADHD compared to the general gamer group. Conversely, there was a higher prevalence of IGD (GD) in the ADHD group compared to the non-ADHD group. DISCUSSION: The possibility of ADHD should be considered when IGD or GD is diagnosed in patients with problematic Internet gaming.

Level of Psychological and Somatic Symptoms Predict Perimenopausal Syndrome Severity Better Than Obstetric and Psychiatric History Do Among Korean Women.

OBJECTIVE: Menopause symptoms can vary in type, duration, and severity. The purpose of this study was to investigate the key factors predicting severe symptoms among Korean perimenopausal women with various demographic data, obstetric and psychiatric histories, and menopausal symptoms screening scale scores. METHODS: Data were collected from 1,060 women, and 4 latent classes were identified using latent profile analysis, with 6 major categories of menopausal complaints. Among the 4 classes, we selectively used data from the "all unimpaired" and "all impaired" groups. Menopause rating scale (MRS), sociodemographic, obstetric, and psychiatric factors were assessed, and hierarchical logistic regression analyses were conducted with the "all impaired" group as a dependent variable. RESULTS: Marital status and scores on the psychological and somatic subscales of the MRS were statistically related to being in the "all impaired" group. Otherwise, family history of menopausal symptoms, menarche age, and history of other psychiatric disorders were not statistically significant predictors of being in the "all impaired" group. CONCLUSION: The psychological and somatic subscales of the MRS predict the severity of perimenopausal syndrome better than obstetric and psychiatric history do among Korean perimenopausal women. Psychological and somatic symptoms as well as genitourinary symptoms in menopausal patients should be closely evaluated.

Mental health effects of the Gangwon wildfires.

BACKGROUND: The April 2019 wildfires in Gangwon Province, South Korea forced the evacuation of 1500 individuals and cost more than $100 million in damages, making it the worst wildfire disaster in Korean history. The purpose of this paper was to investigate the mental health effects on survivors following the wildfires. METHODS: Between April and May 2019, outreach psychological support services were delivered to people impacted by the wildfires. Post-disaster psychological responses using a checklist and the Clinical Global Impression Scale-Severity (CGI-S) were evaluated for 206 wildfires survivors. The CGI-S was administered consequently at 1, 3, and 6 months after baseline measurement. RESULTS: Among four response categories, somatic responses (76.2%) were most frequently observed among the wildfire survivors. Specifically, insomnia (59.2%), anxiety (50%), chest tightness (34%), grief (33%), flashbacks (33%), and depression (32.5%) were reported by over 30% of the participants. The mean CGI-S scores were significantly decreased at 1 month (mean score = 1.94; SE = 0.09) compared to baseline (mean score = 2.94; SE = 0.08) and remained at the decreased level until 6 months (mean score = 1.66; SE = 0.11). However, participants with flashbacks showed significantly higher CGI-S scores compared to those without flashback at 6 months. CONCLUSIONS: Wildfire survivors have various post-disaster responses, especially somatic responses. While most participants' mental health improved over time, a few of them may have experienced prolonged psychological distress after 6 months. Flashbacks were particularly associated with continuing distress. These results suggest that the characteristics of responses should be considered in early phase intervention and in follow-up plans for disaster survivors.

Cognitive Developmental Trajectories in Adult ADHD Patients and Controls: A Comparative Study.

OBJECTIVE: There is an updated conceptualization of whole-lifespan attention-deficit hyperactivity disorder (ADHD), promoted by awareness of probable persistence of impairment into adulthood. We investigated cognition trajectories from adolescence to mid-adulthood in ADHD. METHOD: Data of 240 patients with ADHD and 244 healthy controls (HCs) were obtained; clinical symptoms and neuropsychological functions were assessed using the various tests. RESULTS: Compared to HCs, patients with ADHD except 35 to 44 age interval showed lower full scale intelligence quotient. They showed decreased verbal comprehensive scores except in the 35 to 44 age interval and working memory scores in all intervals. In the Comprehensive Attention Test, patients with ADHD showed increased working memory error frequencies except in the 15 to 17 age interval and divided attention omission error in all intervals. CONCLUSION: Adults with ADHD showed deficits not in simple attention but in complex attention, including divided attention and working memory.

Introduction of digital therapeutics.

BACKGROUND AND OBJECTIVES: Digital therapeutics are an emerging type of medical therapy and are defined as evidence-based therapeutic interventions for patients by means of qualified software programs to prevent, manage, or treat medical conditions. Today, digital therapeutics products are on the market or under development for a wide range of medical conditions such as diabetes, oncology treatment management, and neuropsychiatric disorders including anxiety disorder, depression, and substance use disorder. Digital therapeutics can be more flexible than other treatment methods to address patients' individual needs. METHODS AND RESULTS: The advantages of digital therapeutics fall in line with market demand; thus, the digital therapeutics market is expanding globally, focusing on advanced medical markets. There are many digital therapeutics products such as Sleepio for insomnia, Daylight for anxiety, Livongo and Omada products for diabetes, pre-diabetes, hypertension, etc. None of these are cleared by the Food and Drug Administration (FDA), but all are commercially available through health insurance or employers. The EU, including Germany, and a number of Asian countries, including Korea, Japan, and China, are also introducing policies for the regulation of new fields and digital therapeutics. CONCLUSIONS: The adoption of digital therapeutics is intricate and often involves various interests in numerous fields, decision-making processes, and individual or organizational value judgments. For digital therapeutics to be thoroughly introduced into real life, technical aspects must be supported, and an approach that considers users must be further investigated.

Online Mental Health Assessments of COVID-19 Patients in South Korea.

Experiences of infectious diseases cause stressful and traumatic life events, hence, coronavirus disease 2019 (COVID-19) patients could suffer from various mental health problems requiring psychological support services. This study investigates the severity of mental health problems among confirmed COVID-19 patients. From March to November 2020, we collected the data from 118 COVID-19 patients who voluntarily participated in the National Center for Disaster Trauma's online mental health assessment consisting of self-report scales like Primary Care of Posttraumatic Stress Disorder screen (PC-PTSD), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Health Questionnaire-15 (PHQ-15), and P4 Suicidality Screener. For control, 116 other disaster-experienced and 386 non-COVID-19-experienced participants were recruited. The COVID-19 patients showed more severe symptoms including post-traumatic symptoms, depression, anxiety, and somatic symptoms than control groups across all four screening scales (p < 0.001). Regarding high-risk, COVID-19 patients had an increased association with high-risk compared to the comparison groups (PC-PTSD: OR = 24.16, 95% CI = 13.52-43.16 p < 0.001; PHQ-9: OR = 14.45, 95% CI = 8.29-25.19, p < 0.001; GAD-7: OR=20.71, 95% CI = 10.74-39.96, p < 0.001; PHQ-15: OR = 5.65, 95% CI = 3.44-9.25, p < 0.001; P4: OR = 14.67, 95% CI = 8.95-25.07, p < 0.001). This study's results imply that there is a high-risk of overall mental health problems, especially stronger associations of post-traumatic stress symptoms, in COVID-19 patients. These findings help inform practitioners about the psychological responses to COVID-19 experiences and to prepare appropriate interventions and services for the incremental number of confirmed cases.

Correlations Between Cognitive Functions and Clinical Symptoms in Adolescents With Complex Post-traumatic Stress Disorder.

Introduction: Complex post-traumatic stress disorder (C-PTSD) is characterized by the typical symptoms of PTSD, in addition to affective dysregulation, negative self-concept, and disturbances in interpersonal relationships. Children and adolescents with C-PTSD have been reported to have deficits in emotional and cognitive functions. We hypothesized that the following are associated with the severity of C-PTSD symptoms: (1) adolescents with C-PTSD who show deficits in emotional perception and cognitive functions, including executive function and attention; and (2) deficits in neurocognitive functions. Methods: Information on 69 adolescents with PTSD, aged 10-19 years, was gathered from seven shelters. All participants were assessed using complete clinical scales, including the C-PTSD Interview and Depression, Anxiety, and Stress Scales, and neurocognitive function tests, including the emotional perception, mental rotation, and modified Tower of London tests. Results: Adolescents with C-PTSD were more likely to have a history of sexual assault, dissociation, and self-harm than those with PTSD. The total and subscale scores of the C-PTSD Interview Scale in adolescents with C-PTSD were higher than that in adolescents with PTSD. In addition, neurocognitive functions, including emotional perception, attention, and working memory, were correlated with the severity of C-PTSD symptoms. Discussion: Adolescents with C-PTSD experienced more serious clinical symptoms and showed more deficits in neurocognitive functions than adolescents with PTSD. Clinicians should pay careful attention toward the emotional and neurocognitive functions when assessing and treating patients with C-PTSD.

Comparing Effectiveness Between a Mobile App Program and Traditional Cognitive Behavior Therapy in Obsessive-Compulsive Disorder: Evaluation Study.

BACKGROUND: This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention-inspired serious game to treat patients with obsessive-compulsive disorder (OCD). OBJECTIVE: We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract. METHODS: The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed. RESULTS: There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT. CONCLUSIONS: OCfree, an OCD treatment app program, was effective in the treatment of drug-naïve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD.

Comparison of Psychological Status and Investment Style Between Bitcoin Investors and Share Investors.

Bitcoin has unique characteristics that have inspired people to invest in it as well as distinct drawbacks. With a rapid increase in Bitcoin prices in the short term, more investors enthusiastically began investing in it, raising concerns about a speculative bubble. This study investigated the multiple factors involved in the Bitcoin craze despite concerns about its shortcomings. In what concerns to personality traits and psychological states, online use patterns, and investment patterns, we first hypothesized that Bitcoin investors would show differences in multiple factors when compared to share investors. Based on our assumptions about these differences, we secondly hypothesized that investors' personality, psychological states, and investment patterns could predict whether they would invest in Bitcoin or shares. In total, 307 respondents completed the research protocol and were sorted into Bitcoin investors (n = 101), share investors (n = 102), and non-investors (n = 104). A self-report questionnaire on demographic data, online use patterns, investment patterns as well as the Fear of Missing Out (FoMO) scale, Temperament and Character Inventory-Revised-Short (TCI-RS), Mood Disorder Questionnaire (MDQ), trait anxiety part of the State-Trait Anxiety Inventory (STAI-T), and the Korean version of the Canadian Problem Gambling Index (K-CPGI) were administered. The results of this study indicated that Bitcoin investments can be attributed to the interaction of multiple factors, among which personality, psychological states, and investment patterns are particularly important. Specifically, the investment pattern is the strongest predictive factor for Bitcoin investment. Bitcoin investors were distinct with regard to higher novelty seeking, higher gambling tendencies, and unique investment patterns. Thus, personality, psychological states, and investment patterns could explain the substantial investments in Bitcoin.

Effects of Repetitive Transcranial Magnetic Stimulation on Improvement of Mental Health and Clinical Parameters in Depressed Hemodialysis Patients: a Pilot Study.

BACKGROUND: This study aimed to evaluate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) as a nonpharmacologic treatment in depressed hemodialysis patients. METHODS: Patients who scored ≥ 5 on the Patient Health Questionnaire-9 were randomized to either the rTMS (n = 7) or sham group (n = 7). The rTMS group was stimulated with a 110% motor threshold and 10 Hz on the left dorsolateral prefrontal cortex for 20 minutes, three times a week, for 4 weeks. In the sham group, the "1-wing 90-degree method" was used. We analyzed clinical indices before and after the intervention, as well as data from quantitative electroencephalography (frontal alpha asymmetry [FAA]), and various psychiatric questionnaires (Beck Depression Inventory-II, Beck Anxiety Inventory [BAI], Symptom Checklist-90-Revised Somatization Subscale [SCL-90R-SOM]), and Perceived Stress Scale. RESULTS: One month after rTMS, the changes in hemoglobin A1c levels in the rTMS group were significantly greater than those in the sham group (F = 6.687, P = 0.032). The changes in BAI scores in the rTMS group were significantly greater than those in the sham group (F = 6.700, P = 0.025), and the changes in SCL-90R-SOM scores in the rTMS group were greater than those in the sham group (F = 4.943, P = 0.048). In addition, the changes in the FAA value at the F7 and F8 electrodes in the rTMS group were greater than those in the sham group (F = 6.468, P = 0.027). CONCLUSION: In depressed hemodialysis patients, rTMS may improve anxiety and somatization symptoms, which may lead to improvements in clinical measures. Trial Registration Clinical Research Information Service Identifier: KCT0004082.

Personality and Psychological Factors of Problematic Internet Gamers Seeking Hospital Treatment.

Introduction: Previous studies on internet gaming disorder (IGD) have reported an association between personality traits and impulsive or problematic use of the internet or internet games, but the results obtained were inconsistent. Our study's hypothesis was that personality traits are associated with the individual's choice to play internet games, and psychological status of the individual is associated with seeking treatment for addictive behavior at a hospital. Method: In the current study, individuals who reported excessive internet gaming and visited the hospital for treatment were enrolled and defined as the problematic internet gaming group; through advertisement, additional 138 individuals who were frequent gamers and 139 who were infrequent gamers were recruited. In a multiple logistic regression analysis of all participants' data, a discrete set of hierarchical variables, with gaming preference (frequent gamers + problematic gamers) or problematic internet gaming as the dependent variable, was added to the demographic factors for model 1, personality traits for model 2, and psychological state for model 3. Results: Temperament was a potential factor associated with internet gaming preference. Additionally, model 2, which comprised both demographic factors and personality traits, was a significant factor to enhance the predictability of internet gaming preference with maximum accuracy of 96.7%. Of the three models in the current study, model 2 and model 3 with combined model 2 and patient's psychological status were associated with problematic internet gaming. Discussion: The current study indicated that personality traits were potential factors associated with the individual's preference for gaming. In addition, abnormal psychological status, especially, depressive mood and attention deficit, may lead individuals with problematic internet gaming to seek treatment at the hospital.

A Comparison of Risk and Protective Factors for Excessive Internet Game Play between Koreans in Korea and Immigrant Koreans in the United States.

BACKGROUND: Studying immigrants may have the potential to explore how cultural and environmental changes affect the internet game play patterns of individuals in the two countries. We planned to compare risk and preventive factors for Internet Gaming Disorder (IGD) between Korean adolescents in Korea and immigrant Koreans in the US. METHODS: Ninety-four Koreans and 133 immigrant Koreans were recruited. Independent factors consisted of five domains including demographic data, physical activity, academic, art, and music activities, psychological factors, and game and media play. The dependent variable in the current study was the high-risk group of IGD, which was assessed with Young's Internet Addiction Scale scores. To determine the protective and risk factors for IGD, we performed a multiple logistic regression analysis using the high-risk group as the dependent variable. RESULTS: Five domains affected the risk for IGD in Korean and immigrant Korean groups. Vigorous physical activity was the strongest protective factor for IGD in the Korean group, while media activity was the strongest protective factor for IGD in immigrant Koreans in the US. CONCLUSION: The results indicate that internet gaming problems might be affected by environmental factors and it is recommended that gaming activity is substituted with physical activity, extracurricular classes, books, and music.

Brain Functional Connectivity in Patients With Somatic Symptom Disorder.

OBJECTIVE: The aim of the study was to evaluate whether individuals with somatic symptom disorder (SSD) display increased resting-state functional connectivity (FC) within and between the sensorimotor network (SMN), default mode network (DMN), salience network, and dorsal attention network (DAN). METHODS: Eighteen patients with SSD and 20 age- and sex-matched healthy control participants underwent resting-state functional magnetic resonance imaging. We used a seed-based correlation approach for the four brain networks. RESULTS: Patients with SSD had higher scores on the Somato-Sensory Amplification Scale (z = 5.22, p < .001) and Symptom Checklist-90-Revised-Somatization (z = 4.94, p < .001) and greater FC within the SMN, DMN, and salience network than healthy control participants. Patients with SSD also had increased FC between the SMN and DMN, SMN and salience network, SMN and DAN, and salience network and DAN (t = 5.10-7.47, all false discovery rate q < .05). The Somato-Sensory Amplification Scale scores correlated with FC between the SMN and salience network and between the SMN and DAN (r = .61-.82, all p < .003). CONCLUSIONS: Based on the results of the FC analysis between the SMN and salience network, we suggest that SSD may be associated with alterations of sensory-discriminative processing of pain and other somatic symptoms, which is influenced by affective processing. Based on the results of the FC analysis of the SMN and DAN, we suggest that patients with SSD have a deficit in attention, leading to misperception of external stimuli and failure to regulate bodily functions aimed at interactions with external stimuli.

Imperforate Hymen: A Comprehensive Systematic Review.

Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. In this study, a literature search of PubMed, Scopus and Medline databases was performed for sources published up to 3 July 2018 for English-language studies with the term "imperforate hymen". The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus. In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection.

The Effects of a Serious Game on Depressive Symptoms and Anxiety in Breast Cancer Patients with Depression: A Pilot Study Using Functional Magnetic Resonance Imaging.

Objective: Depression is common in cancer patients. We investigated the effects of playing a serious game in breast cancer patients with mild to moderate depression using functional neuroimaging. Materials and Methods: Thirty-five participants were randomly assigned to the Game group and the Nongame group, and fifteen participants in each group completed the study protocol. Participants in the Game group were asked to play a serious game, "Hit the Cancer" (RAW HAND, Seoul, Korea), for at least 30 minutes/day, 5 days/week, for 3 weeks. Participants in the Nongame group received usual care. At baseline and follow-up, all participants were assessed with the Beck Depression Inventory (BDI), Beck Anxiety Inventory, Stress Response Inventory (SRI), and 3-Tesla resting-state functional magnetic resonance imaging. Changes in functional connectivity (FC) between the brain regions in the default mode network (DMN) and salience network (SN) were analyzed. Results: After the intervention, BDI and SRI scores in the Game group greatly decreased compared with those in the Nongame group. In addition, compared with the Nongame group, the Game group showed decreased postintervention FC between the right posterior cingulate cortex (PCC) of the DMN and right insula of the SN. The improvement in BDI and SRI scores correlated with the decrease in FC between the right PCC and right insula. Conclusion: Selective attention training and repetitive stimulation of the insula by serious game play might cause normalization of the FC between the SN and DMN, thus improving depressive mood.

Character strengths as protective factors against depression and suicidality among male and female employees.

BACKGROUND: So far, studies on workplace mental health have only focused on work-related environmental risk factors, disregarding both protective and individual factors of employees. Therefore, we aimed to identify character strengths that act as protective factors against depressive moods and suicidality in Korean employees. METHODS: In total, 84 male and 151 female employees (aged 19-50 years) reported their sociodemographic characteristics; depressive symptoms, as measured by the Beck Depression Inventory-II; suicidality, as measured by the Korean version of the MINI International Neuropsychiatric Interview suicidality module; and character strengths, as measured by the 24 Character Strength Alphas on the Values in Action Survey-72. We conducted a hierarchical logistic regression, in which depressive mood and suicidality served as the categorical outcome variables. RESULTS: In females, scores on the "curiosity" (B = 1.107, Wald = 10.207, odds ratio = 3.026, p = .001) and "love" (B = .862, Wald = 5.767, odds ratio = 2.367, p = .016) sub scales of the 24 Character Strength Alphas on the Values in Action Survey-72 were statistically significant predictors of having depressive mood. Additionally, females' scores on "judgment" (B = - 1.405, Wald = 5.663, odds ratio = .245, p = .017) and "kindness" (B = - 1.456, Wald = 6.486, odds ratio = .233, p = .011) were protective factors against suicidality. In males, the "love" (B = 1.746, Wald = 4.279, odds ratio = 5.729, p = .039) score was a predictor of having depressive mood, while "teamwork" (B = - 2.204, Wald = 4.666, odds ratio = .110, p = .031) and "creativity" (B = - 1.384, Wald = 4.202, odds ratio = .251, p = .040) scores were protective factors against having depressive mood and suicidality, respectively. CONCLUSIONS: We suggest that focusing on "judgement" and "kindness" in female employees, and "teamwork" and "creativity" in male employees, and engaging in activities that use these strengths at the workplace can be protective factors against depression and suicidality. Future research should focus on developing interventions to promote these character strengths among employees at the workplace.

Investigation of a Mobile "Serious Game" in the Treatment of Obsessive-Compulsive Disorder: A Pilot Study.

OBJECTIVE: Exposure and response prevention (ERP) therapy is considered a first-line treatment for obsessive-compulsive disorder (OCD). Dysregulation in the cortico-striato-thalamo-cortical (CSTC) circuit has been implicated in the pathophysiology of OCD, as have decreased functional connectivity (FC) between the dorsal anterior cingulate cortex (dACC) and the prefrontal cortex and increased FC between the dACC and the basal ganglia. We hypothesized that a new ERP-inspired mobile "serious game" would improve clinical symptoms in OCD and that symptom improvement would be associated with altered FC within CSTC. MATERIALS AND METHODS: Fifteen OCD subjects and 15 healthy controls were recruited. All subjects completed questionnaires covering demographic data, the Yale-Brown Obsessive-Compulsive Scale, the Beck Depressive Inventory, and the Beck Anxiety Inventory. In addition, all subjects were scanned at baseline to assess brain FC using resting-state functional magnetic resonance imaging. RESULTS: After 3 weeks of gameplay, FC from the left dACC seed to the right frontal precentral gyrus and from the right dACC seed to the left inferior frontal gyrus and the right middle frontal gyrus, increased in the OCD group. Responders showed increased brain connectivity from the left dACC seed to the right superior frontal gyrus compared with nonresponders. CONCLUSION: Our results suggest that serious games may improve symptoms in OCD and that this improvement may be related to increased brain connectivity between the dACC and the prefrontal cortex. Further exploration is needed to assess the potential role of serious games in OCD treatment.

Influence of Major Coping Strategies on Treatment Non-adherence and Severity of Comorbid Conditions in Hemodialysis Patients.

BACKGROUND: Non-adherence and comorbidities are prevalent among hemodialysis patients and are associated with increased mortality and financial burden. We aimed to investigate the influence of major coping strategies (CSs) on non-adherence and comorbidities in hemodialysis patients. METHODS: A total of 49 patients were enrolled. We collected participant data including CS measured by a Korean version of the ways of coping questionnaire (K-WCQ), comorbidities measured by age-adjusted Charlson comorbidity index (CCI), and adherence measured by the 8-item Morisky medication adherence scale (MMAS-8). RESULTS: Regarding major CS, 61.2% of participants reported use of support-seeking CS (SUP group), 14.3% reported use of problem-focused CS (PRO group), and 24.5% reported use of hopeful-thinking CS (HOP group). The mean MMAS-8 score was higher in the PRO group than in the HOP group (P = 0.024). The mean CCI score was lower in the PRO group than in the HOP group (P = 0.017). In the HOP group, the severity of somatic symptoms was positively correlated with the scores for the emotion-focused CS subscale (r = 0.39, P = 0.029) and the hopeful-thinking CS subscale (r = 0.38, P = 0.036) of the K-WCQ. The level of life satisfaction positively correlated with the score for the problem-focused CS subscale in the HOP group (r = 0.40, P = 0.027). CONCLUSION: We should pay more attention to the CSs of hemodialysis patients and provide interventions that promote problem-focused CSs, especially for nonadherent patients with high comorbidity rates who mainly use a hopeful-thinking CS.