Validation of the Pandemic Grief Risk Factors and Its Relationship With Work-Related Stress and Grief Reaction Among Healthcare Workers Who Witnessed Patient Deaths.

BACKGROUND: The Pandemic Grief Risk Factors (PGRFs) was developed as a self-report tool to compile a comprehensive list of unique risk factors related to grief when experiencing a coronavirus disease 2019 (COVID-19) loss. We explored the reliability and validity of the PGRF among healthcare workers who witnessed their patients' deaths during the COVID-19 pandemic. Further, we examined whether the general severity of PGRF may have been associated with work-related stress and pandemic grief reactions. METHODS: An online survey was conducted among tertiary hospital healthcare workers (doctors and nursing professionals) who had witnessed the deaths of patients they cared for. Pandemic Grief Scale for healthcare workers, the Stress and Anxiety to Viral Epidemics-3 items, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 responses were collected. RESULTS: In total, 267 responses were analyzed. The single-factor structure of the Korean version of the PGRF showed a good fit for the model. The scale demonstrated good internal consistency and convergent validity with other depression and anxiety rating scales. The mediation analysis revealed that work-related stress directly influenced pandemic grief reactions positively, and depression, anxiety, and general severity of grief risk factors partially mediated the association positively. CONCLUSION: Among healthcare workers who witnessed the deaths of their patients due to COVID-19, the Korean version of the PGRF was valid and reliable for measuring the overall severity of PGRF. The PGRF can be used to identify individuals at risk for dysfunctional grief.

Serum lipids as predictive markers for death by suicide.

Serum lipid levels have been associated with an increased risk of suicidal behaviors. This retrospective cohort study aimed to investigate the association between serum lipid levels and death by suicide among suicide attempters according to sex. Suicide attempters visiting emergency departments between 2007 and 2011 were followed up until the date of all-cause death or December 31, 2012. Sex-stratified Cox proportional hazards regression and competing risk models were constructed to obtain the hazard ratios (HR) of serum lipid measures and suicide. For each significant lipid variable in the final models, Kaplan-Meier survival analysis and cumulative incidence function (CIF) were employed to compare the time to suicide between the high- and low-lipid groups based on the best cutoff point from the receiver operating characteristic curve. In 408 female attempters (65.8 %), the HR in the Cox regression model and subdistribution HR in the competing risk model for increased total cholesterol (TC) were 0.968 and 0.970, respectively. In the Kaplan-Meier survival analysis and CIF, increased death by suicide was demonstrated in the low-TC group (< 165 mg/dL). Lower serum TC levels among female suicide attempters may predict suicide. More careful monitoring is warranted in women with lower TC levels who recently attempted suicide.

Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing.

BACKGROUND: This study investigated the relationship between preoccupation with coronavirus disease 2019 (COVID-19), reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, and adherence to physical distancing among frontline nursing professionals working in COVID-19 inpatient wards. Additionally, the study aimed to determine whether the commitment to physical distancing mediates the influence of intolerance of uncertainty on viral anxiety. METHODS: Frontline healthcare professionals working in the COVID-19 inpatient wards at three tertiary-level affiliated hospitals in Korea were surveyed between April 7 and 26, 2022. The survey included scales-such as the Obsession with COVID-19 Scale, Coronavirus Reassurance-Seeking Behaviors Scale, Fear of COVID-19 Scale, and Intolerance of Uncertainty Scale-12 and a questionnaire on adherence to physical distancing. A total of 256 responses were analyzed after excluding inappropriate or incomplete responses. RESULTS: Pearson's correlation analysis found that age was significantly associated with the Obsession with COVID-19 Scale (r = -0.12, P < 0.05) and adherence to physical distancing (r = 0.27, P < 0.01). Linear regression analysis ascertained that age (ß = -0.07, P = 0.002), Coronavirus Reassurance-Seeking Behaviors Scale (ß = 0.35, P < 0.001), and Fear of COVID-19 Scale (ß = 0.24, P < 0.001) were predictors of obsession with COVID-19 (Adjusted R² = 0.60, F = 78.1, P < 0.001). The indirect pathway by mediation analysis showed that reassurance-seeking and viral anxiety mediated the effect of intolerance of uncertainty on the preoccupation with COVID-19. CONCLUSION: During the pandemic, there may be a strong association between reassurance-seeking behavior, viral anxiety, and a heightened preoccupation with COVID-19 among frontline healthcare workers. Thus, from the early stages of infectious disease, a psychological support team for medical staff responding to the disease should be established, and periodic evaluations should be conducted to identify high-risk groups.

Validation of the healthcare workers' version of the Pandemic Grief Scale among frontline nursing professionals during the COVID-19 pandemic in Korea.

Introduction: Nurses have been repeatedly exposed to unexpected death and grief during COVID-19 pandemic, and it is necessary to provide grief support for the nurses who have experienced the loss of patients to COVID-19. We aimed to explore the reliability and validity of the Pandemic Grief Scale (PGS) for Healthcare Workers among frontline nursing professionals working in COVID-19 inpatient wards whose patients may have died. Methods: An anonymous online survey was performed among frontline nursing professionals working in COVID-19 wards in three tertiary-level general hospitals in Korea between April 7 and 26, 2021. In total, 229 from participants who confirmed they had witnessed death of patients were employed for the statistical analysis. The survey included demographic characteristics and rating scales, including the Korean version of the PGS for Healthcare Workers, the Fear of COVID-19 scale, the Generalized Anxiety Disorder-7 items, and the Patient Health Questionnaire-9 items. Results: The single-factor structure of the Korean version of the PGS for Healthcare Workers showed good fits for the model. The scale had good internal consistency and convergent validity with other anxiety and depression scales. Conclusion: The Korean version of the PGS of Healthcare Workers was valid and reliable for measuring grief reactions among nursing professionals facing the pandemic. It will be helpful in evaluating the grief reaction of the healthcare workers and providing them with a psychological support system.

Grief Response of Nursing Professionals Is Associated With Their Depression, Loneliness, Insomnia, and Work-Related Stress While Working in COVID-19 Inpatients Wards.

OBJECTIVE: We aimed to explore whether nursing professionals' psychological states affect their grief response for a patient's death in the coronavirus disease-2019 (COVID-19) inpatients' ward. METHODS: Survey was conducted among frontline nursing professionals working in COVID-19 inpatients wards at three tertiary-level affiliated hospitals of the University of Ulsan during April 7-26, 2022. Participants' information such as age, years of employment, or marital status were collected, and their responses to rating scales including Pandemic Grief Scale (PGS) for healthcare workers, Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), Patient Health Questionnaire-9 (PHQ-9), Loneliness and Social Isolation Scale, and Insomnia Severity Scale (ISI) were collected. RESULTS: All 251 responses were analyzed. We observed that 34% reportedly suffered from depression. The linear regression analysis showed that a high PGS score was expected by high SAVE-9 (ß=0.12, p=0.040), high PHQ-9 (ß=0.25, p<0.001), high loneliness (ß=0.17, p=0.006), and high ISI score (ß=0.16, p=0.006, F=20.05, p<0.001). The mediation analysis showed that the depression of nursing professionals directly influenced their pandemic grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. CONCLUSION: We confirm that frontline nursing professionals' depression directly influenced their grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. We hope to establish a psychological and social support system for the mental health of nurses working in the COVID-19 wards.

Acoustic Analysis of Speech for Screening for Suicide Risk: Machine Learning Classifiers for Between- and Within-Person Evaluation of Suicidality.

BACKGROUND: Assessing a patient's suicide risk is challenging for health professionals because it depends on voluntary disclosure by the patient and often has limited resources. The application of novel machine learning approaches to determine suicide risk has clinical utility. OBJECTIVE: This study aimed to investigate cross-sectional and longitudinal approaches to assess suicidality based on acoustic voice features of psychiatric patients using artificial intelligence. METHODS: We collected 348 voice recordings during clinical interviews of 104 patients diagnosed with mood disorders at baseline and 2, 4, 8, and 12 months after recruitment. Suicidality was assessed using the Beck Scale for Suicidal Ideation and suicidal behavior using the Columbia Suicide Severity Rating Scale. The acoustic features of the voice, including temporal, formal, and spectral features, were extracted from the recordings. A between-person classification model that examines the vocal characteristics of individuals cross sectionally to detect individuals at high risk for suicide and a within-person classification model that detects considerable worsening of suicidality based on changes in acoustic features within an individual were developed and compared. Internal validation was performed using 10-fold cross validation of audio data from baseline to 2-month and external validation was performed using data from 2 to 4 months. RESULTS: A combined set of 12 acoustic features and 3 demographic variables (age, sex, and past suicide attempts) were included in the single-layer artificial neural network for the between-person classification model. Furthermore, 13 acoustic features were included in the extreme gradient boosting machine learning algorithm for the within-person model. The between-person classifier was able to detect high suicidality with 69% accuracy (sensitivity 74%, specificity 62%, area under the receiver operating characteristic curve 0.62), whereas the within-person model was able to predict worsening suicidality over 2 months with 79% accuracy (sensitivity 68%, specificity 84%, area under receiver operating characteristic curve 0.67). The second model showed 62% accuracy in predicting increased suicidality in external sets. CONCLUSIONS: Within-person analysis using changes in acoustic features within an individual is a promising approach to detect increased suicidality. Automated analysis of voice can be used to support the real-time assessment of suicide risk in primary care or telemedicine.

Borderline Personality Pathology in Major Depressive Disorder, Bipolar I and II Disorder, and Its Relationship With Childhood Trauma.

OBJECTIVE: Mood disorder and borderline personality pathology (BPP) are frequently comorbid and relate to childhood trauma. We investigated the relationship between childhood trauma and BPP features in mood disorder patients versus controls. METHODS: A total of 488 mood disorder patients, particularly major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II), and 734 controls were included. We examined between-group BPP-related differences and correlated between BPP and childhood trauma using the Childhood Trauma Questionnaire-Short Form (CTQ) and the Personality Assessment Inventory-Borderline Features Scale. RESULTS: BD II patients showed significantly higher BPP. Emotional abuse and neglect were prominently associated with BPP, while affective instability and negative relationships exhibited a stronger association with childhood trauma. We also found a positive relationship between childhood trauma and BPP in MDD, BD I, and BD II patients. CONCLUSION: The findings of the present study imply that BPP features are more likely to be found in patients with BD II than BD I or MDD. Mood disorder patients with severe childhood trauma may have higher BPP features. Thus, further study of the relationship between childhood trauma and BPP features could improve the therapeutic approaches and help understand patients with mood disorders.

Effect of Cancer-Related Dysfunctional Beliefs About Sleep on Fear of Cancer Progression in the Coronavirus Pandemic.

BACKGROUND: This study aimed to explore clinical correlates of fear of progression (FoP) among patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic and examine the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS). METHODS: Medical charts of patients with cancer who visited a psycho-oncology clinic between July and November 2021 were reviewed. Baseline socio-demographic and cancer-related variables were collected. Patients' self-report questionnaires, regarding FoP, depression (Patient Health Questionnaire-9 items; PHQ-9), viral anxiety (Stress and Anxiety to Viral Epidemics-6 items; SAVE-6), C-DBS, and other distress, were investigated. Pearson's correlation and linear regression were performed to examine the risk factors of FoP. Mediation effect analysis with the bootstrap method with 2,000 resamples was implemented. RESULTS: A total of 231 patients were included in the analysis. Linear regression revealed that FoP was predicted by age (ß = -0.14, P = 0.003), PHQ-9 (ß = 0.48, P < 0.001), SAVE-6 (ß = 0.34, P < 0.001), and C-DBS (ß = 0.15, P = 0.005). FoP was directly influenced by SAVE-6 and mediated by C-DBS, while it was directly influenced by PHQ-9 with no mediation effect. CONCLUSION: During the COVID-19 pandemic, the FoP of patients with cancer was associated with younger age, depression, viral anxiety, and C-DBS. Depression and viral anxiety directly influenced FoP, while C-DBS mediated the association between viral anxiety and FoP. Therefore, oncology healthcare professionals are recommended to assess C-DBS of their patients when they are highly distressed from FoP.

Applicability and Psychometric Comparison of the General-Population Viral Anxiety Rating Scales among Healthcare Workers in the COVID-19 Pandemic.

We aimed to explore the reliability and validity of viral anxiety rating scales (developed for the general population) among healthcare workers. In addition, we compared the psychometric properties of rating scales in accordance with the Generalized Anxiety Scale-7 items (GAD-7) during this COVID-19 pandemic. The viral anxiety of 330 healthcare workers was measured with Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), SAVE-6, Coronavirus Anxiety Scale (CAS), Fear of COVID-19 Scale (FCV-19S), and COVID-19 Anxiety Scale (CAS-7). Factor analyses, item response theory, and Rasch model analyses were conducted to confirm the construct validities of the scales and compare the psychometric properties of rating scales. The receiver operating curve (ROC) analysis examined the cutoff scores of rating scales in accordance with a mild degree of generalized anxiety. The SAVE-9, SAVE-6, CAS, FCV-19S, and CAS-7 scales showed good reliability of internal consistency among healthcare workers. Their construct validity and convergent validity of each scale were similarly good. Furthermore, in comparing the psychometric properties of rating scales, we observed that the CAS scale was the most discriminating and difficult among the scales. The CAS and FCV-19S provided more information and were more efficient than the SAVE-9, SAVE-6, and CAS-7 scales when they were used to measure healthcare workers' viral anxiety. Viral anxiety rating scales can be applied to healthcare workers with good reliability and validity.

National prescription patterns of antidepressants among patients with amyotrophic lateral sclerosis: An analysis of the Korean National Health Insurance database.

INTRODUCTION/AIMS: The current status of antidepressant use in patients with amyotrophic lateral sclerosis (ALS), such as the prevalence and factors associated with it, has not been systematically investigated. We aimed to analyze the prevalence and patterns of antidepressant prescriptions in patients with ALS and depression, and to identify factors associated with antidepressant prescriptions after the diagnosis of ALS. METHODS: The data of patients with ALS and the prescription of antidepressants were retrieved from the Korean National Health Insurance claims data. A multivariate logistic regression model was used to identify factors associated with antidepressant prescriptions. RESULTS: In total, 533 of 2955 patients had depressive disorders, and 426 were prescribed antidepressants. Selective serotonin reuptake inhibitors and tricyclic antidepressants were the most frequently prescribed drugs. Adjusted odds ratios (ORs) were 1.379 for the prescription of antidepressants in females. For various age groups, compared with those aged 80 years and older, adjusted ORs were 1.889 for those in their 70s, 2.319 for those in their 60s, 2.872 for those in their 50s, 2.854 for those in their 40s, and 3.363 for those under 40 years of age. Adjusted ORs were 1.662 for patients with a history of a psychiatric disorder and 1.861 for those with a history of psychiatric pharmacotherapy (all P < .05). DISCUSSION: Most patients with ALS who had depression received antidepressant prescriptions. In young females with a previous psychiatric disorder or pharmacotherapy, an in-depth evaluation for a depressive disorder should be performed.

Mediating Effect of Viral Anxiety and Perceived Benefits of Physical Distancing on Adherence to Distancing Among High School Students Amid COVID-19.

BACKGROUND: The aim of this study is to explore whether high school students' adherence to physical distancing was associated with health beliefs, social norms, and psychological factors during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Overall, 300 high school students participated in this anonymous online survey conducted from October 18-24, 2021. The survey included rating scales such as attitude toward physical distancing during the pandemic, Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 items, Satisfaction with Life Scale, and Connor Davidson Resilience Scale 2-items. RESULTS: The results revealed that perceived susceptibility or severity (ß = -0.13, P = 0.038), perceived benefit (ß = 0.32, P < 0.001), descriptive social norms (ß = 0.10, P = 0.041), social injunctive norms (ß = 0.19, P < 0.001), and SAVE-6 (ß = 0.24, P < 0.001) predicted students' adherence to physical distancing (adjusted R² = 0.42, F = 19.2, P < 0.001). Social injunctive norms and personal injunctive norms directly influenced adherence to physical distancing. Viral anxiety, measured by SAVE-6, mediated the association between social injunctive norms and adherence to physical distancing, and perceived benefits mediated the relationship between personal injunctive norms and adherence to physical distancing. The influence of perceived susceptibility or severity on adherence to physical distancing was entirely mediated by perceived benefits or viral anxiety. CONCLUSION: Explaining the rationale or benefits of physical distancing may be important in increasing adherence to physical distancing among high school students.

Discrepancy Between Desired Time in Bed and Desired Total Sleep Time, Insomnia, Depression, and Dysfunctional Beliefs About Sleep Among the General Population.

OBJECTIVE: The aim of this study was to explore the factors that can influence the severity of insomnia in the general population. We also aimed to examine whether sleep effort mediates the association between dysfunctional beliefs about sleep or the discrepancy between desired time in bed and desired total sleep time (DBST) and insomnia severity in individuals. METHODS: A total of 387 participants enrolled in this e-survey study. The symptoms were rated using the insomnia severity index (ISI), Patients Health Questionnaire-9 items, Dysfunctional Beliefs about Sleep-2 items, Glasgow Sleep Effort Scale, and Stress and Anxiety to Viral Epidemics-6 items. In addition, we defined a new sleep index named the DBST index. A linear regression analysis was performed to explore the factors predicting ISI scores, and mediation analysis was implemented to explore whether persistent preoccupation with sleep mediated the influence of dysfunctional beliefs about sleep and DBST on insomnia severity. RESULTS: A linear regression analysis investigated depression (ß=0.17, p<0.001), sleep effort (ß=0.50, p<0.001), dysfunctional beliefs about sleep (ß=0.13, p=0.001), and DBST (ß=0.09, p=0.014) (adjusted R2=0.50, F=65.7, p<0.001). Additionally, we observed that persistent preoccupation with sleep partially mediated the influence of dysfunctional beliefs about sleep and DBST on insomnia severity. CONCLUSION: Depression, preoccupation with sleep, dysfunctional beliefs about sleep, and DBST influenced the insomnia severity of the general population. We also observed that a persistent preoccupation with sleep partially mediated the influence of dysfunctional beliefs about sleep and the DBST index on insomnia severity.

Validation of the Korean Version of the Coronavirus Reassurance-Seeking Behaviors Scale During the COVID-19 Pandemic.

OBJECTIVE: In this study, we aimed to develop a Korean version of the Coronavirus Reassurance-Seeking Behaviors Scale (CRBS) and to explore its reliability and validity among the general population in South Korea. METHODS: Using an online survey conducted during November 9-15, 2021, we collected the demographic data of 400 individuals and their responses to rating scales such as the CRBS, the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), the Generalized Anxiety Disorder-7 items (GAD-7), and the Patient Health Questionnaire-9 items (PHQ-9). We conducted factor analyses and utilized item response theory to confirm the validity and reliability of the Korean version of the CRBS. RESULTS: Factor analyses revealed that the single factor model of the Korean version of the CRBS showed a good fit with the CRBS (χ2=5.475, df=5, p value=0.361, χ2/df=1.095, CFI=0.999, TLI=0.998, RMSEA=0.015). Multigroup CFA results indicated that the CRBS measures reassurance-seeking behaviors consistently across variables of sex, depression, general anxiety, and viral anxiety. The CRBS also exhibited good convergent validity with the SAVE-6 (r=0.431, p<0.001), GAD-7 (r=0.574, p<0.001), and PHQ-9 (r=0.575, p<0.001). CONCLUSION: The CRBS is a reliable and valid rating scale that measures reassurance-seeking behavior in relation to viral epidemics.

The Psychometric Properties of the French-Canadian Stress and Anxiety to Viral Epidemics-6 Scale for Measuring the Viral Anxiety of the General Population During the COVID-19 Pandemic.

Objective: This study examined the psychometric properties of the French-Canadian version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for assessing the anxiety response to the viral epidemic among the general population in Quebec, Canada. Methods: A total of 590 participants responded to a confidential online survey between September 28 and October 18, 2020. Confirmatory Factor Analysis (CFA) was conducted to explore the factor structure of the scale. Psychometric properties were assessed using the Item Response Theory (IRT) approach. To explore the convergent validity, a Pearson correlation analysis between the SAVE-6 scale and the depression (Patient Health Questionnaire-2, PHQ-2) or anxiety subscale (Generalized Anxiety Disorder-2, GAD-2) of the Patient Health Questionnaire-4 items scale was conducted. Findings: The French-Canadian version of the SAVE-6 scale was clustered into a single factor. The CFA of the SAVE-6 scale showed a good model fit (CFI = 0.985, TLI = 0.976, RMSEA = 0.051, RSMR = 0.048), and the multi-group CFA revealed that the SAVE-6 scale can measure anxiety response in the same way across gender or the presence of elevated depressive and anxiety symptoms. It showed good internal consistency (Cronbach's alpha = 0.76, McDonald's Omega = 0.77) and significant correlation with the PHQ-2 score and GAD-2 score. The IRT model suggested the efficiency in discrimination among individuals in this latent trait. Conclusion: The French-Canadian version of the SAVE-6 scale is a valid and reliable rating scale, which can measure the general population's anxiety response to the viral epidemic.

Previous psychiatric disorders in the multistep hypothesis of amyotrophic lateral sclerosis: a South Korean population study.

Objective: There is accumulating evidence about an association between amyotrophic lateral sclerosis (ALS) and psychiatric disorders. We aimed to investigate the prevalence of previous psychiatric disorders before ALS onset and evaluate the contribution of psychiatric disorders to the number of steps toward developing ALS.Methods: We analyzed the National Health Insurance claims data from 2011 to 2017 and calculated the incidence of ALS. We created a multistep model using the linear least squares method with regression of the log incidence against the log age.Results: The mean annual incidence of ALS was 0.95/100,000 and frequency of familial ALS (fALS) was 5.89%. The proportions of patients who had psychiatric disorders before ALS diagnosis were 36.8% and 47.0% in fALS and sporadic ALS (sALS), respectively (p = 0.009). In both fALS and sALS, depressive disorders and anxiety and stress disorders were relatively frequent, whereas psychotic disorders and bipolar disorders were rare. Further, the slope estimates for regression analyses were 3.50 (R2 = 0.94) and 3.56 (R2 = 0.99) for fALS and sALS, respectively, suggesting a 4-5-step process to ALS onset. However, slope estimates did not differ between sALS patients with pre-symptomatic psychiatric disorders and those without.Conclusions: The incidence of ALS is relatively low in Korea and fewer steps are required to develop ALS compared to Western populations (all 6 steps). Although the prevalence of previous depression or anxiety is seemingly high, the multistep model provides no evidence that these conditions modify the risk of developing ALS in our cohort.

Application of Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) to Public Workers for Measuring Their Anxiety Response During the COVID-19 Pandemic.

Objective: This study aimed to compare the adaptability of the adapted version of Stress and Anxiety to Viral Epidemics-9 (SAVE-9) for public workers and the SAVE-6 scale and to validate them among public workers who are on the frontline of the coronavirus disease 2019 pandemic. Methods: A total of 300 public workers responded to the anonymous online survey during April 1-12, 2021. Principal component analysis was conducted with varimax rotation to explore the factor structure of this scale. Confirmatory factor analysis was also used to explore construct validity. Spearman correlation analysis of the scale with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) was performed to explore the convergent validity. The cut-off score in accordance with the mild degree of generalized anxiety symptoms (GAD-7 score of 5) was defined using the receiver operating characteristic (ROC) analysis. Findings: The single-structure model of each scale (the adapted version of SAVE-9 and SAVE-6) was adopted based on the results of the parallel analysis. Because SAVE-6 showed good construct validity, but the adapted version of SAVE-9 did not, we adopted to apply the SAVE-6 scale to assess the anxiety response of public workers in response to the viral epidemic. SAVE-6 showed good internal consistency (Cronbach's alpha = 0.817; McDonald's Omega = 0.818) and good convergent validity with GAD-7 (rho = 0.417, p < 0.001) and PHQ-9 (rho = 0.317, p < 0.001) scale scores. The appropriate cut-off score for SAVE-6 was determined to be ≥ 16. Conclusion: The SAVE-6 scale, as compared to the public workers' version of SAVE-9, is a reliable and valid rating scale to assess the work-related stress and anxiety of public workers due to the viral epidemic.

Characteristics of Patients Presenting to a Psycho-Oncology Outpatient Clinic.

OBJECTIVE: We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site. METHODS: The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site. RESULTS: Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups. CONCLUSION: There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.

The influence of poverty attribution on attitudes toward suicide and suicidal thought: A cross-national comparison between South Korean, Japanese, and American populations.

BACKGROUND: Previous studies report that income inequality is an important risk factor for depression and suicide, and an increasing income gap appears inevitable. However, little study to date has investigated associations between the attribution of poverty and suicide. Though we previously reported associations between socio-cultural factors, including income, and suicide, we tried to explore more focused associations between income, attribution of poverty (individualistic, societal), permissive attitude toward suicide, and suicidal thought using a structural equation model. METHODS: A total of 2213 participants from each of three nations (South Korea, Japan, and the United States) completed an online survey. Participants without a history of psychological disorders or suicide attempts completed scales measuring attributions of poverty, attitudes toward suicide, and severity of suicidal thoughts. RESULTS: We established a structural equation model, which exhibited a good fit for all nations, and compared significant path coefficients by country. South Korea had the highest severity of suicidal thought and societal attribution of poverty, followed by Japan and America. In all nations, a permissive attitude was positively related to the severity of suicidal thought and individualistic attribution of poverty was positively related to a permissive attitude toward suicide. Societal attribution of poverty was positively associated with a permissive attitude in Japan and the United States. Income was negatively associated with the severity of suicide in South Korea and the United States. CONCLUSION: Through an established structural equation model, we found the influence of poverty on suicide and identify the common and distinctive factors associated with suicide in each country.

The association between serum microbial DNA composition and symptoms of depression and anxiety in mood disorders.

There is increasing evidence supporting the association between gut microbiome composition and mood disorders; however, studies on the circulating microbiome are scarce. This study aimed to analyze the association of the serum microbial DNA composition with depressive and anxiety symptoms in patients with mood disorders. The sera of 69 patients with mood disorders, aged from 19 to 60, were analyzed. Bacterial DNA was isolated from extracellular membrane vesicles and, subsequently, amplified and quantified with specific primers for the V3-V4 hypervariable region of the 16S rDNA gene. Sequence reads were clustered into Operational Taxonomic Units and classified using the SILVA database. There were no significant associations between alpha diversity measures and the total Hamilton depression rating scale (HAM-D) or Beck anxiety inventory (BAI) scores. Only the weighted UniFrac distance was associated with the total HAM-D score (F = 1.57, p = 0.045). The Bacteroidaceae family and Bacteroides genus were negatively associated with the total HAM-D score (ß = - 0.016, p < 0.001, q = 0.08 and ß = - 0.016, p < 0.001, q = 0.15, respectively). The Desulfovibrionaceae family and Clostridiales Family XIII were positively associated with the total BAI score (ß = 1.8 × 10-3, p < 0.001, q = 0.04 and ß = 1.3 × 10-3, p < 0.001, q = 0.24, respectively). Further studies with larger sample sizes and longitudinal designs are warranted.

Correlates of Psychological Distress in Patients With Cancer at a Psycho-oncology Clinic.

BACKGROUND: Patients with cancer experience significant psychological distress. Most studies investigated individual risk factors for distress in their respective treatment setting, which limit generalizability of results or comparison of relative importance. OBJECTIVE: To investigate the relation between psychological distress in patients referred to a psycho-oncology clinic and its correlates in a comprehensive manner. METHOD: Medical charts of patients who visited the psycho-oncology clinic at a tertiary hospital from May 2019 to May 2020 were reviewed. Demographic, cancer-related, and psychiatric factors; health-related quality of life; and somatic pain were investigated. The Hospital Anxiety and Depression Scale, item 9 on the Patient Health Questionnaire-9, Functional Assessment of Cancer Therapy-General, Present Pain Intensity, and Distress Thermometer were measured at the index visit. Simple and multiple linear regression analyses were performed with the Distress Thermometer score as a dependent variable. RESULTS: A total of 454 patients were included. The univariate analyses showed age and physical, emotional, and functional well-being scores on the Functional Assessment of Cancer Therapy-General were negatively associated with the Distress Thermometer scores, while female genital cancer, advanced disease, recent radiotherapy, the Hospital Anxiety and Depression Scale score, and the Present Pain Intensity score showed a positive relation. After adjusting for all other variables, female genital cancer (P = 0.027), anxiety subscale of the Hospital Anxiety and Depression Scale (P < 0.001), the Present Pain Intensity (P = 0.002), and physical (P < 0.001) and functional (P = 0.019) well-being subscales of the Functional Assessment of Cancer Therapy-General remained significant. CONCLUSIONS: Patients with cancer who visited a psycho-oncology clinic experienced more distress if they had female genital cancer, low health-related quality of life score, severe anxiety, or somatic pain.