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.

Psychological Responses among Humidifier Disinfectant Disaster Victims and Their Families.

To substantiate psychological symptoms following humidifier disinfectant (HD) disasters, counseling records of 26 victims and 92 family members of victims (45 were bereaved) were analyzed retrospectively. Among the victims, 34.6% had Clinical Global Impression-Severity scores of over 4, which meant they were moderately ill. While anxiety/fear and depression with respiratory symptoms were frequently observed in victims and family members, chronic psychological distress such as alcohol/smoking abuse and insomnia was relatively high in bereaved family members. In conclusion, it is important to provide mental health support for victims and their families, focusing on the characteristic symptoms of each group as well as monetary compensation.

Duty-Related Trauma Exposure and Posttraumatic Stress Symptoms in Professional Firefighters.

Firefighters commonly encounter traumatic events during duty hours. The purpose of this study was to investigate the characteristics of duty-related trauma as risk factors for posttraumatic stress disorder in professional firefighters. A sample of 212 firefighters participated in the study and completed self-reported questionnaires. Potentially traumatic events (PTE) were assessed using a list of 17 traumatic event types. The posttraumatic stress symptoms (PTSS) were measured by the Impact of Event Scale-Revised (Lim et al., 2009; Weiss, 2007). A higher score for the composite index, which reflects both multiple PTE and peritraumatic suffering, increased the odds for significant PTSS after adjusting for age, sex, marital status, education, numbers of years worked, childhood trauma, and depressive symptoms (adjusted odds ratio [AOR] = 2.26, p = .001, Cohen's d = 0.20). Furthermore, indirect (AOR = 1.93, p = .009, Cohen's d = .16) and colleague-related PTE (AOR = 1.97, p = .037, Cohen's d = .16) showed significant associations with PTSS. It is noteworthy that the combination of multiple PTE and peritraumatic suffering was more predictive of PTSS than either factor alone. Our findings also suggest that daily work exposure to indirect PTE may contribute to the occurrence of PTSS among professional firefighters.

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.

Causing trouble and being transmissible: COVID-19 survivors' experiences of stigma and discrimination in South Korea.

Background: The stigma associated with coronavirus disease (COVID-19) is relatively neglected in policies for handling the disease. Stigmatization occurs only within specific social contexts in local societies. Objective: This study aims to examine COVID-19 survivors' experiences of social stigma and discrimination in South Korea in the first 2 years of the pandemic. Methods: Semi-structured interviews were conducted. Results: Of 52 participants, 45 reported that they had to cope with stigma and discrimination in their intimate social relationships, workplaces, and children's schools, ranging from subtle actions to job loss. Sexual minorities who were involved in mass disease transmission in the early part of the pandemic experienced a higher level of stigmatization. The stigmatization dealt with in this study was related to two themes: survivors' sense of causing trouble and possibility of transmission. Conclusion: By intertwining this stigma with the experiences of public health measures through the voices of survivors, this study reveals the local context of East Asia in terms of culture-specific aspects of COVID-19-related stigma.

Increase in harm avoidance by genetic loading of schizophrenia.

BACKGROUND: Schizophrenia is highly familial neuropsychiatric disorder with heritability estimated at 60% to 90%. Even unaffected first-degree relatives of schizophrenia manifested some neuropsychologic abnormalities, neurologic soft sign, and morphologic anomalies. Because personality traits are under genetic influence and considerable heritability, we intended to evaluate temperament and character of first-degree relatives of schizophrenia and the influence of schizophrenia genetic loading on their temperament and character. METHODS: Temperament and Character Inventory was completed by 97 first-degree relatives of schizophrenia or schizoaffective disorder, 48 schizophrenic probands (44 patients with schizophrenia and 4 patients with schizoaffective disorder), and 106 control subjects. Within first-degree relatives, parents who have additional probands with schizophrenia spectrum disorder in their ascendant or collateral pedigree and siblings who have offspring with schizophrenia spectrum disorder were defined as presumed carriers (n = 20). Group differences in Temperament and Character Inventory scores were compared using a mixed-model analysis of variance with family as a random effect and age as a covariate. RESULTS: Harm avoidance (HA) scores increased in the order of control subjects, the first-degree relatives, and probands. Among the relatives, presumed carriers, but not presumed noncarriers, had higher HA compared with control subjects. In addition, probands showed significantly low reward dependence, low self-directedness, and low cooperativeness scores compared with the first-degree relatives and control subjects. Probands had also higher self-transcendence scores than the first-degree relatives and had lower persistence scores than control subjects. CONCLUSIONS: Our findings that HA increases in proportion to the genetic loading of schizophrenia suggest that it may be a potential endophenotype of schizophrenia.

Psychological Responses Among Korean Middle East Respiratory Syndrome Survivors and Bereaved Families.

OBJECTIVE: In 2015, the outbreak of Middle East Respiratory Syndrome (MERS) in South Korea affected 186 patients and led to 38 bereaved families. This study aimed at investigating the nature and related factors of the psychological responses of MERS victims during the acute phase of disaster. METHODS: The MERS Psychological Support Team under the Korean Ministry of Health and Welfare provided counseling services to MERS survivors and bereaved families for 4 weeks, based on crisis intervention. In this study, we reviewed the counseling records of 109 survivors and 80 bereaved family members, and analyzed their epidemiological and MERS-related information along with psychological responses. RESULTS: Somatic symptoms and anxiety related to social stigmatization or disease transmission were common in MERS survivors, whereas grief reactions such as sadness, and anger were frequently observed in bereaved families. Bereaved MERS survivors showed more avoidance/isolation than non-bereaved MERS survivors. Females, those with an underlying physical or psychiatric health condition, and those having experienced longer duration of hospitalization and non-healthcare workers were more at risk of suffering from psychological problems. CONCLUSIONS: Survivors and bereaved families of epidemics can experience various psychological distresses depending on individual characteristics and the inherent features of the epidemic. Therefore, mental health in epidemics should be approached and considered more seriously.

Stress Experience of COVID-19 Patients as Reported by Psychological Supporters in South Korea: A Qualitative Study.

Background: COVID-19 patients experience various stressors during the quarantine period and after release from quarantine. However, stressors experienced during each period remain unclear. Methods: A total of 15 mental health experts from the integrated psychological support group for COVID-19participated in this study. Psychological support was provided for the total 932 confirmed COVID-19 patients and their families. Qualitative data were collected using Focus Group Interview (FGI). The participants were divided into two groups and semi-structured questions were used to allow participants to speak their minds. Results: During the quarantine period, difficulties of being diagnosed with COVID-19, concerns about recovery from COVID-19, stress related to quarantine, issues related to the treatment environment, and limited information about COVID-19 and communication were frequently reported. After release from quarantine, the reported main stressors include reinfection or reactivation, concerns about complications, and financial difficulties. Confusion as vectors and victims, stigma and discrimination, and conflicts within a family were observed during both periods. Conclusions: COVID-19 patients suffered various stressors during the quarantine period and after release from quarantine. Moreover, returning to their daily life required timely psychosocial support, intervention, and treatment for COVID-19 infection.

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.

Development of Korean Disaster Mental Health Support Guidelines: Results of a Scoping Review and a Delphi Survey.

OBJECTIVE: It is necessary to develop new guidelines to delineate the best ways of providing psychosocial care to ensure mental health following a disaster. METHODS: This study applied the scoping review method as a means of establishing evidence-based guidelines for disaster mental health services. A total of 440 literatures were selected through a scoping review of 20,864 documents. Twenty-three recognized experts were invited to participate in the survey and a two-round online Delphi survey was conducted. RESULTS: The concordance rate in the Delphi Round 1 was 95.1%. Six items were excluded and new items were formulated with experts' suggestions. A total of 23 statements were slightly modified to clarify their meaning. In the Delphi Round 2, all items were met with consensus. The three items with the highest consensus among the experts were related to the protection of personal information and privacy. The item with the lowest consensus among experts was related to debriefing. Other items were related to establishing mental health support centers and suicide prevention activities. CONCLUSION: 140 items were developed through scoping reviews based on evidence-based methodology. These items were used to describe the disaster mental health support identified in Delphi. The guideline will provide a foundation for effective preparation and response in disaster situations.

Relationship between ways of coping and posttraumatic stress symptoms in firefighters compared to the general population in South Korea.

Professional firefighters frequently encounter stressful events in the line of duty, which may lead to the development of posttraumatic stress symptoms (PTSS). However, it remains unclear how PTSS relates to ways of coping in this population. We evaluated the differences in ways of coping between firefighters and the general population, and we determined the relationship between ways of coping and PTSS in both groups. Professional firefighters (N = 212) and adults from the general population (N = 500) completed measures of potentially traumatic events (PTEs), the Ways of Coping Checklist, the Beck Depression Inventory, the Childhood Trauma Questionnaire. Participants who reported experiencing at least one PTE also completed the Impact of Events Scale-Revised to assess PTSS severity. Firefighters showed greater use of problem-focused coping, seeking social support, and wishful thinking than did the general population. In the firefighters group only, there were negative correlations between PTSS and problem-focused coping and seeking social support; however, the opposite was found in the general population. This study identified the unique relationship between ways of coping and PTSS in professional firefighters. Our findings highlighted that active coping, including problem-focused and seeking social support, might play a key role in alleviating firefighters' post-traumatic stress reactions.

Cerebellar gray matter volume correlates with duration of cocaine use in cocaine-dependent subjects.

This study was conducted to explore differences in gray and white matter volume between cocaine-dependent and healthy comparison subjects using optimized voxel-based morphometry (VBM). Brain magnetic resonance imaging (MRI) and neuropsychological function tests were performed for 40 cocaine-dependent subjects (41.4+/-6.9 years, 27 men) and 41 healthy age- and sex-matched comparison subjects (38.7+/-8.8 years, 26 men). Optimally normalized whole brain MR images were segmented, modulated, smoothed, and compared between groups with statistical parametric mapping. The cocaine-dependent group had lower gray matter volumes in bilateral premotor cortex (Brodmann area (BA) 6, 8; 16.6%), right orbitofrontal cortex (BA 10, 15.1%), bilateral temporal cortex (BA 20, 38; 15.9%), left thalamus (12.6%), and bilateral cerebellum (13.4%) as well as lower right cerebellar white matter volume (10.0%) relative to the comparison group at a corrected p<0.05 for multiple comparisons. Duration of cocaine use negatively correlated with right and left cerebellar gray matter volumes (r=-0.37, r=-0.39, respectively). In cocaine-dependent subjects, lower cerebellar hemispheric gray and white matter volumes were correlated with deficits in executive function and decreased motor performance. This study reports that cocaine-dependent subjects have lower gray matter volumes in cerebellar hemispheres as well as in frontal, temporal cortex, and thalamus. These findings are the first to suggest that the cerebellum may be vulnerable to cocaine-associated brain volume changes, and that cerebellar deficits may contribute to neuropsychological deficits and motor dysfunction frequently observed in cocaine-dependent subjects.

Depression and Internet addiction in adolescents.

BACKGROUND: The aim of the study was to evaluate the relationship between depression and Internet addiction among adolescents. SAMPLING AND METHOD: A total of 452 Korean adolescents were studied. First, they were evaluated for their severity of Internet addiction with consideration of their behavioral characteristics and their primary purpose for computer use. Second, we investigated correlations between Internet addiction and depression, alcohol dependence and obsessive-compulsive symptoms. Third, the relationship between Internet addiction and biogenetic temperament as assessed by the Temperament and Character Inventory was evaluated. RESULTS: Internet addiction was significantly associated with depressive symptoms and obsessive-compulsive symptoms. Regarding biogenetic temperament and character patterns, high harm avoidance, low self-directedness, low cooperativeness and high self-transcendence were correlated with Internet addiction. In multivariate analysis, among clinical symptoms depression was most closely related to Internet addiction, even after controlling for differences in biogenetic temperament. CONCLUSIONS: This study reveals a significant association between Internet addiction and depressive symptoms in adolescents. This association is supported by temperament profiles of the Internet addiction group. The data suggest the necessity of the evaluation of the potential underlying depression in the treatment of Internet-addicted adolescents.

Decreased blood flow of temporal regions of the brain in subjects with panic disorder.

OBJECT: The purpose of the current study was to investigate alterations of regional cerebral blood flow (rCBF) in subjects with panic disorder. METHODS: Twenty-two subjects with panic disorder who were under psychotropic medications and 25 age and gender-matched healthy comparison subjects were assessed regarding the rCBF of using Tc-99m-hexamethyl propylenamino oxime single photon emission tomography (SPECT). Using statistical parametric mapping, the rCBF was compared between panic disorder and healthy comparison groups. RESULTS: Decreased rCBF flow in right superior temporal lobe was observed in subjects with panic disorder (p<0.05 after correction for multiple comparisons). The rCBF in right superior temporal gyrus negatively correlated with the duration of illness, scores of panic disorder severity scale (PDSS), Hamilton anxiety rating scale (HARS) and Zung self-rating anxiety scale (Z-SAS). CONCLUSION: We report that there is a decreased cerebral blood flow of temporal regions of the brain in panic disorder and that this decrease may, in part, reflect the clinical severity of panic disorder.

Advances in magnetic resonance imaging methods for the evaluation of bipolar disorder.

This article reviews the current state of magnetic resonance imaging techniques as applied to bipolar disorder. Addressed are conventional methods of structural neuroimaging and recently developed techniques. This latter group comprises volumetric analysis, voxel-based morphometry, the assessment of T2 white matter hyperintensities, shape analysis, cortical surface-based analysis, and diffusion tensor imaging. Structural analysis methods used in magnetic resonance imaging develop exponentially, and now present opportunities to identify disease-specific neuroanatomic alterations. Greater acuity and complementarity in measuring these alterations has led to the generation of further hypotheses regarding the pathophysiology of bipolar disorder. Included in the summary of findings is consideration of a resulting neuroanatomic model. Integrative issues and future directions in this relatively young field, including multi-modal approaches enabling us to produce more comprehensive results, are discussed.

Disrupted white matter tract integrity of anterior cingulate in trauma survivors.

The objective of this study was to examine the integrity of whole-brain white matter in posttraumatic stress disorder patients. Twenty posttraumatic stress disorder patients who survived the Taegu subway fire incident and 20 healthy volunteers participated in this study. Statistical parametric mapping was used to evaluate the global differences in fractional anisotropy values between the two groups. The results show that posttraumatic stress disorder patients had significantly lower fractional anisotropy values in the left anterior cingulate regions. Posttraumatic stress disorder symptom severity negatively correlated to the level of decrease in anterior cingulate fractional anisotropy values. The outcome of the current study suggests that the disruption of the left anterior cingulate white matter tract integrity may play an important role in the pathophysiology of posttraumatic stress disorder.

Multivariate Analysis of Relationship between Childhood Trauma and Psychotic Symptoms in Patients with Schizophrenia.

The aim of this study was to examine the relationship between childhood trauma and psychotic symptoms in schizophrenic patients after controlling for the possible confounding factors, such as depression and dissociative symptoms. Ninety-eight schizophrenic inpatients participated. Childhood trauma was examined using the Childhood Trauma Questionnaires (CTQ), which consists of physical abuse (PA), sexual abuse (SA), emotional abuse (EA), physical neglect (PN), and emotional neglect (EN). Positive and Negative Syndrome Scale (PANSS), Dissociative Experience Scale (DES), and Beck's Depression Inventory (BDI) were also administered. Data were analyzed by partial correlation and general linear model. The total score of CTQ was positively correlated with positive, general, and total scores of PANSS. All five types of childhood trauma were associated with dissociative symptoms. EA and EN were positively correlated with depressive symptoms. Only SA significantly predicted positive symptoms of schizophrenia after controlling for age, sex, BDI, and DES scores, with a dose-response relationship between SA and positive symptoms.

Decreased N-acetyl-aspartate levels in anterior cingulate and hippocampus in subjects with post-traumatic stress disorder: a proton magnetic resonance spectroscopy study.

The purpose of this study was to investigate the concentration of N-acetyl-aspartate (NAA) in the brain and its relationship with clinical characteristics in patients with post-traumatic stress disorder (PTSD). Proton magnetic resonance spectroscopy was performed in order to measure NAA concentrations in the anterior cingulate cortex (ACC) and bilateral hippocampus in 26 subjects with fire-related PTSD, who were survivors of a subway fire in South Korea, and 25 age- and sex-matched healthy comparison subjects. There were decreased NAA levels in the ACC (t = -3.88, d.f. = 49, P < 0.001) and bilateral hippocampus (right, t = -3.88, d.f. = 49, P < 0.001; left, t = -3.62, d.f. = 49, P < 0.001) in the PTSD group relative to the healthy comparison group. Also, NAA levels of the ACC (r = -0.43, n = 26, P = 0.027) and bilateral hippocampus (right, r = -0.48, n = 26, P = 0.013; left, r = -0.40, n = 26, P = 0.04) were negatively correlated with re-experience symptom scores in subjects with PTSD. In conclusion, our findings suggest that subjects with PTSD had decreased neuronal viabilities in the ACC and bilateral hippocampus, and that these deficits may play an important role in the pathophysiology of PTSD, especially regarding the re-experiencing of traumatic events.