1.Suicidal Ideation Among Patients With Breast Cancer: A Comparison of Patient Health Questionnaire-9 Item 9and Columbia-Suicide Severity Rating Scale
Hyuntae KIM ; C. Hyung Keun PARK
Journal of Korean Medical Science 2026;41(1):e21-
Background:
The Columbia-Suicide Severity Rating Scale (C-SSRS) is the gold standard for assessing suicidal ideation, behavior, and risk. However, it is unclear whether the Patient Health Questionnaire-9 (PHQ-9) item 9 alone is sufficient for detecting suicidal ideation among patients with breast cancer. This study aimed to assess the validity of PHQ-9 item 9 compared to C-SSRS in female breast cancer patients undergoing psychiatric treatment.
Methods:
In this study, we evaluated the validity of PHQ-9 item 9 compared to C-SSRS for identifying suicidal ideation among 176 female patients with breast cancer receiving psychiatric treatment, using self-reported questionnaires and leveraging demographic, clinical data, and statistical analyses to refine suicide risk assessment methods.
Results:
Among 176 patients, 35.2% showed a positive response to PHQ-9 item 9, 41.0% and 17.0% of them showed a response indicating wish for death and active suicidal ideation based on C-SSRS, respectively. The areas under the ROC curves for wish for death and active suicidal ideation were 0.840 and 0.842, respectively, indicating good discriminatory power with an optimal cut-off of 1/3 for both criteria.
Conclusion
Although PHQ-9 item 9 may have limited utility in detecting active suicidal ideationamong patients with breast cancer, it may serve as a valuable screening tool for identifying those at risk of having thoughts of suicide accompanied by wish for death.
2.Healing Through Loss: Exploring Nurses’ Post-Traumatic Growth After Patient Death
YongHan KIM ; Joon-Ho AHN ; Jangho PARK ; Young Rong BANG ; Jin Yong JUN ; Youjin HONG ; Seockhoon CHUNG ; Junseok AHN ; C. Hyung Keun PARK
Psychiatry Investigation 2025;22(1):40-46
Objective:
This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required.
Methods:
An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed.
Results:
PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator.
Conclusion
PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.
3.Grit and the Relationships among Psychological Distress and Suicidality in Female Patients with Breast Cancer
Ji Seon YOU ; C. Hyung Keun PARK
Cancer Research and Treatment 2025;57(1):159-164
Purpose:
The risk of suicide is approximately two times higher in patients with breast cancer compared to the general population. Suicide risk factors are widely investigated but research on the protective factors is lacking. We investigated whether each subscale of grit, consistency of interest, and perseverance of effort, could serve as a protective factor against suicidality.
Materials and Methods:
Participants were recruited at the Stress Clinic for Cancer Patients, a psycho-oncology clinic at Asan Medical Center from May 2019 to March 2021. A total of 140 female patients with breast cancer completed self-administered questionnaires including Grit scale, Distress thermometer, and Mini International Neuropsychiatric Interview (MINI) suicidality module. We used PROCESS macro for analyzing the mediation model to identify the protective factors for suicidality.
Results:
Our findings showed that perseverance of effort showed statistically non-significant associations with psychological distress (p=0.403) and suicidality (p=0.945), however, consistency of interest decreased suicidality through psychological distress (β=–0.015; 95% confidence interval, –0.035 to –0.002).
Conclusion
The result shows that consistency of interest can be a protective factor against suicidality by reducing psychological distress.
4.Grit and the Relationships among Psychological Distress and Suicidality in Female Patients with Breast Cancer
Ji Seon YOU ; C. Hyung Keun PARK
Cancer Research and Treatment 2025;57(1):159-164
Purpose:
The risk of suicide is approximately two times higher in patients with breast cancer compared to the general population. Suicide risk factors are widely investigated but research on the protective factors is lacking. We investigated whether each subscale of grit, consistency of interest, and perseverance of effort, could serve as a protective factor against suicidality.
Materials and Methods:
Participants were recruited at the Stress Clinic for Cancer Patients, a psycho-oncology clinic at Asan Medical Center from May 2019 to March 2021. A total of 140 female patients with breast cancer completed self-administered questionnaires including Grit scale, Distress thermometer, and Mini International Neuropsychiatric Interview (MINI) suicidality module. We used PROCESS macro for analyzing the mediation model to identify the protective factors for suicidality.
Results:
Our findings showed that perseverance of effort showed statistically non-significant associations with psychological distress (p=0.403) and suicidality (p=0.945), however, consistency of interest decreased suicidality through psychological distress (β=–0.015; 95% confidence interval, –0.035 to –0.002).
Conclusion
The result shows that consistency of interest can be a protective factor against suicidality by reducing psychological distress.
5.Healing Through Loss: Exploring Nurses’ Post-Traumatic Growth After Patient Death
YongHan KIM ; Joon-Ho AHN ; Jangho PARK ; Young Rong BANG ; Jin Yong JUN ; Youjin HONG ; Seockhoon CHUNG ; Junseok AHN ; C. Hyung Keun PARK
Psychiatry Investigation 2025;22(1):40-46
Objective:
This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required.
Methods:
An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed.
Results:
PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator.
Conclusion
PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.
6.Grit and the Relationships among Psychological Distress and Suicidality in Female Patients with Breast Cancer
Ji Seon YOU ; C. Hyung Keun PARK
Cancer Research and Treatment 2025;57(1):159-164
Purpose:
The risk of suicide is approximately two times higher in patients with breast cancer compared to the general population. Suicide risk factors are widely investigated but research on the protective factors is lacking. We investigated whether each subscale of grit, consistency of interest, and perseverance of effort, could serve as a protective factor against suicidality.
Materials and Methods:
Participants were recruited at the Stress Clinic for Cancer Patients, a psycho-oncology clinic at Asan Medical Center from May 2019 to March 2021. A total of 140 female patients with breast cancer completed self-administered questionnaires including Grit scale, Distress thermometer, and Mini International Neuropsychiatric Interview (MINI) suicidality module. We used PROCESS macro for analyzing the mediation model to identify the protective factors for suicidality.
Results:
Our findings showed that perseverance of effort showed statistically non-significant associations with psychological distress (p=0.403) and suicidality (p=0.945), however, consistency of interest decreased suicidality through psychological distress (β=–0.015; 95% confidence interval, –0.035 to –0.002).
Conclusion
The result shows that consistency of interest can be a protective factor against suicidality by reducing psychological distress.
7.Healing Through Loss: Exploring Nurses’ Post-Traumatic Growth After Patient Death
YongHan KIM ; Joon-Ho AHN ; Jangho PARK ; Young Rong BANG ; Jin Yong JUN ; Youjin HONG ; Seockhoon CHUNG ; Junseok AHN ; C. Hyung Keun PARK
Psychiatry Investigation 2025;22(1):40-46
Objective:
This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required.
Methods:
An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed.
Results:
PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator.
Conclusion
PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.
8.Healing Through Loss: Exploring Nurses’ Post-Traumatic Growth After Patient Death
YongHan KIM ; Joon-Ho AHN ; Jangho PARK ; Young Rong BANG ; Jin Yong JUN ; Youjin HONG ; Seockhoon CHUNG ; Junseok AHN ; C. Hyung Keun PARK
Psychiatry Investigation 2025;22(1):40-46
Objective:
This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required.
Methods:
An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed.
Results:
PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator.
Conclusion
PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.
9.Healing Through Loss: Exploring Nurses’ Post-Traumatic Growth After Patient Death
YongHan KIM ; Joon-Ho AHN ; Jangho PARK ; Young Rong BANG ; Jin Yong JUN ; Youjin HONG ; Seockhoon CHUNG ; Junseok AHN ; C. Hyung Keun PARK
Psychiatry Investigation 2025;22(1):40-46
Objective:
This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required.
Methods:
An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed.
Results:
PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator.
Conclusion
PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.
10.Interpersonal Needs and Dysfunctional Self-Focus Mediate the Effect of Dysfunctional Pandemic Grief on Suicidality Among Nursing Professionals Who Witnessed Patients’ Deaths
C. Hyung Keun PARK ; Hussein MAKHOUR ; Junseok AHN ; Jin Yong JUN ; Jangho PARK ; Seockhoon CHUNG
Journal of Korean Medical Science 2025;40(46):e332-
Background:
We aimed to explore whether the dysfunctional pandemic grief of nursing professionals who experienced a patient’s death may be related with their suicidal ideation and examine whether their interpersonal problems and dysfunctional self-focus mediate this association.
Methods:
An anonymous online survey was conducted on November 16–18, 2023 among nurses in a tertiary hospital who witnessed people’s death. Their psychological states were assessed using the Pandemic Grief Scale (PGS) for healthcare workers, Dysfunctional Selffocus Attributes Scale (DSAS), Interpersonal Needs Questionnaire (INQ), and Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). Linear regression analysis was conducted to explore the expecting variables for the DSI-SS. Mediation analysis was performed to examine the mediating effects of self-focus and interpersonal problems between grief reaction and suicidal ideation.
Results:
The PGS (β = 0.18, P = 0.005), INQ-Perceived Burdensomeness (INQ-PB; β = 0.51, P < 0.001), and DSAS-Negatively Biased Focus (DSAS-NBF; β = 0.17, P = 0.021) were significantly associated with the DSI-SS. Mediation analysis using these variables showed that the PGS directly influenced the DSI-SS, and the INQ-PB and DSAS-NBF partially mediated the influence of the PGS on DSI-SS.
Conclusion
Dysfunctional grief experienced by nurses following the loss of patients during the pandemic exacerbated suicidal ideation by fostering a greater focus on negative outcomes and heightened feelings of being a burden. These findings underscore the need for targeted interventions to address these specific cognitive and emotional vulnerabilities to mitigate the risk of suicidal ideation.

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