Purpose: Adolescent self-harm is a public health problem. Research suggests a link between adverse childhood experiences (ACEs) and self-destructive behaviors. Few studies, however, have examined the effects of ACEs on self-harm among Asian adolescents. This study explored the association between lifetime ACEs and a history of self-harm among Korean children and adolescents in elementary, middle, and high schools. Methods: A cross-sectional, retrospective medical record review was conducted on a dataset of a national psychiatrist advisory service for school counselors who participated in the Wee Doctor Service from January 1 to December 31, 2020. The data were analyzed using multiple logistic regression to predict self-harm. Results: Student cases (n=171) were referred to psychiatrists by school counselors for remote consultation. Multiple logistic regression analyses revealed that the odds of self-harm were higher among high school students (adjusted odds ratio [aOR]=4.97; 95% confidence interval [CI]=1.94-12.76), those with two or more ACEs (aOR=3.27; 95% CI=1.43-7.47), and those with depression (aOR=3.06; 95% CI=1.32-7.10). Conclusion The study's findings provide compelling evidence that exposure to ACEs can increase vulnerability to self-harm among Korean students. Students with a history of ACEs and depression, as well as high school students, require increased attention during counseling. School counselors can benefit from incorporating screening assessment tools that include questions related to ACEs and depression. Establishing a systematic referral system to connect students with experts can enhance the likelihood of identifying self-harm tendencies and offering the essential support to prevent self-harm.

Objectives: The purpose of this study is to analyze the prevalence and factors of depression among the elderly population, a significant issue in Korea’s aging society. We aim to provide basic indicators for improving mental health and quality of life. Methods: From February to December 2021, a study was conducted on a population of 19,158 elderly individuals aged 65 and above residing in Gyeongsangbuk-do province. The severity of depression was evaluated using the Korean version of the Patient Health Questionnaire (PHQ)-9. In addition, demographic information was collected to analyze factors that may influence depression. Results: In the PHQ-9 screening, the average score was 3.65. The results showed that 13,705 individuals (71.5%) were in the normal group with scores ranging from 0 to 4, 3,683 individuals (19.2%) were in the mild group with scores ranging from 5 to 9, 1,575 individuals (8.2%) were in the moderate group with scores ranging from 10 to 19, and 195 individuals (1.0%) were in the severe group with scores of 20 or higher. It was found that place of residence, education level, type of housing, top two difficulties in daily life, subjective economic status, desired services, subjective mental health, past and current history of mental health treatment, and medication for physical illness had statistically significant effects on depression. Conclusions Various factors were found to have a significant impact on depression among the elderly population in Gyeongsangbuk-do. Proactive prevention and treatment tailored to the population characteristics of the region may be necessary.

Objectives: This study identifies the socioeconomic characteristics and attitudes toward suicide (ATTS) of gatekeepers participating in a suicide prevention project in Gyeongsangbuk-do. Through this study we hope to increase the understanding required to prevent suicide in the community. Methods: We conducted a survey from October 11 to November 4, 2022, with 1,284 individuals from private organizations who participated in the suicide prevention project between September 23 and November 30, 2022. The survey established demographic characteristics, experience in participating in suicide prevention projects, awareness and need for suicide prevention and mental health services, and ATTS. The study conducted cross-analysis and chi-square tests to identify differences in responses according to demographics. An independent sample t-test, one-way analysis of variance, and Scheffe’s post hoc test were performed to analyze the comparisons between each measurement factor. SPSS 21.0 was used to process data and the level of statistical significance was set to p<0.05. Results: The gatekeepers’ ATTS were moderate, with an average of 3.11 out of 5. Specifically, preventability obtained the highest score (4.07), followed by preparedness to prevent (3.96), incomprehensibility (3.74), and noncommunication (3.34). Conversely, resignation obtained the lowest score (2.05), followed by tabooing (2.32) and relation-caused (2.51). The scores for preventability and preparedness to prevent increased with sustained participation in the suicide prevention program, while those for suicidal process decreased. Conclusions Gatekeepers’ ATTS may improve as a result of participation in the suicide prevention project, with better results with continued participation. Thus, actively recruiting more gatekeepers and keeping them engaged in the program may help prevent suicide.

Objectives: ：The purpose of this study was to identify suicide risk factors among elderly residents in Gyeongsangbuk-do and to reveal the relationships between them. In addition, the differences in suicide risk factors were analyzed between the cognitively impaired group and the cognitively normal group. Methods: ：We investigated 20,127 elderly over 65 years of age, from January 2019 to December 2019. Participants were asked to complete a questionnaire survey. Cognitive function, depression, anxiety, sleep disturbance, and suicidal ideation data were assessed using a Korean version of the Mini-Mental Status Examination for Dementia Screening (MMSE-DS), Short Geriatric Depression Scale for Korean version (S-GDS), Geriatric Anxiety Inventory (GAI), Athens Insomnia Scale (AIS), and Scale for Suicidal Ideation (SSI). Data were analyzed using the chi-squared test and logistic regression analysis to examine suicide risk factors and the relationships between them. Furthermore, differences in suicide risk factors according to cognitive function were examined. Results: ：Age, cognitive function, depression, anxiety, and sleep disturbance were identified as suicide risk factors among elderly residents in Gyeongsangbuk-do. Depression was the factor that increased risk of suicide the most, followed by anxiety, impaired cognitive function, sleep disturbance, and 65-74 years of age. In addition, depression increased risk of suicide by 1.86 times in the cognitively impaired group. Conclusions ：Among elderly residents in Gyeongsangbuk-do, depression was the factor that contributed the highest risk for suicide. More active prevention and treatment measures for depressive symptoms should be implemented in the cognitively impaired group.

Objectives: ：The purpose of this study is to investigate the characteristics of the perception of the somatic symptoms and the cognitive emotion regulation strategies in patients with posttraumatic stress disorder (PTSD). Methods: ：A total of 48 patients meeting DSM-5 criteria for PTSD and 48 normal controls were recruited for participation in this study. We evaluated subjects using Clinician-Administered PTSD Scale (CAPS), Somato-Sensory Amplification Scale (SSAS), Hamilton Anxiety Scale (HAM-A) and Cognitive Emotion Regulation Questionnaire (CERQ). We analyzed data using an independent t-test and Pearson’s correlation analysis. Results: ：In terms of SSAS, PTSD patients presented higher average SSAS scores than normal controls but the result is not statistically significant. In PTSD patients, the severity of PTSD is significantly correlated with CERQrumination and CERQ-catastrophizing. The SSAS scores of PTSD patients show the significant positive correla-tion with PTSD hyperarousal symptoms, CERQ-catastrophizing and CERQ-blaming others. Conclusions ：These results reveal that patients with PTSD have maladaptive cognitive emotion regulation strategies such as rumination and catastrophizing. Somato-sensory amplification seems to be related with PTSD hyperarousal, CERQ-catastrophizing and CERQ-blaming others. Therefore, reducing somato-sensory amplifica-tion, rumination and catastrophizing can be helpful to reduce PTSD symptoms and somatic symptoms in PTSD patients.

OBJECTIVES: This study aimed to investigate the risk factors affecting suicidal ideation in community dwelling elderly individuals and to predict suicidal ideation through assessment tools.METHODS: We investigated 2,343 elderly individuals, aged 65 years or older, from February 2018 to December 2018. The participants were asked to complete sociodemographic questionnaires, including the Mini-Mental Status Examination for Dementia Screening(MMSE-DS), Short Geriatric Depression Scale(SGDS-K), Geriatric Anxiety Inventory(GAI), Athens Insomnia Scale(AIS), and Scales for Suicidal Ideation(SSI). We performed the Chi-squared test and logistic regression analysis for these data, to examine the relationship between suicidal ideation and the participants' risk factors. Moreover, we performed Receiver Operating Characteristics(ROC) curve analysis, to predict suicidal ideation through the assessment tools.RESULTS: The prevalence of suicidal ideation was 6.0%. Binary logistic regression revealed that cognitive impairment (OR=1.729, CI : 1.029–2.904), depression(OR=3.479, CI : 2.177–5.560), anxiety(OR=3.822, CI : 2.454–5.951), and sleeping disorders(OR=1.661, CI : 1.132–2.438) were independently associated with suicidal ideation. The cutoffs to predict suicidal ideation, obtained using ROC analysis were ≤21[area under the curve(AUC) : 0.582] for the MMSE-DS, >6(AUC : 0.822) for SGDS, >3(AUC : 0.817) for GAI, and >8(AUC : 0.718) for AIS.CONCLUSION: The incidence of suicidal ideation in the community dwelling elderly was quite high and was particularly related with depression and anxiety. These results could contribute to prevention and management of suicide among community dwelling elderly individuals.
Aged ; Anxiety ; Cognition Disorders ; Dementia ; Depression ; Humans ; Incidence ; Independent Living ; Logistic Models ; Prevalence ; Risk Assessment ; Risk Factors ; ROC Curve ; Sleep Initiation and Maintenance Disorders ; Suicidal Ideation ; Suicide ; Weights and Measures

OBJECTIVE: This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. METHODS: Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). RESULTS: Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. CONCLUSION: The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.
Alprazolam ; Anti-Anxiety Agents ; Antidepressive Agents* ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Clonazepam* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Incidence ; Lorazepam

We aimed to examine the potential relationship between season of birth (SOB) and clinical characteristics in Korean patients with unipolar non-psychotic major depressive disorder (MDD). Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, 891 MDD patients were divided into two groups, those born in spring/summer (n=457) and those born in autumn/winter (n=434). Measurement tools comprising the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Scale for Suicidal Ideation, Clinical Global Impression of severity, Social and Occupation Functional Assessment Scale, WHO Quality of Life assessment instrument-abbreviated version, Alcohol Use Disorder Identification Test, and Temperament and Character Inventory were used to evaluate depression, anxiety, overall symptoms, suicidal ideation, global severity, social function, quality of life, drinking, and temperament and character, respectively. Using independent t-tests for continuous variables and χ2 tests for discrete variables, the clinical characteristics of the two groups were compared. MDD patients born in spring/summer were on average younger at onset of first depressive episode (t=2.084, p=0.038), had greater loss of concentration (χ2=4.589, p=0.032), and were more self-directed (t=2.256, p=0.025) than those born in autumn/winter. Clinically, there was a trend for the MDD patients born in spring/summer to display the contradictory characteristics of more severe clinical course and less illness burden; this may have been partly due to a paradoxical effect of the 5-HT system.
Adult ; Age of Onset ; Aged ; Alcohol Drinking ; Bipolar Disorder/*diagnosis/*ethnology/psychology ; Character ; Cost of Illness ; Depression ; Depressive Disorder, Major/*diagnosis/*ethnology/psychology ; Female ; Humans ; Male ; Middle Aged ; Personality Inventory/statistics & numerical data ; *Quality of Life ; Republic of Korea/epidemiology ; *Seasons ; Temperament

OBJECTIVES: The aim of this study is to develop guideline for evaluation of depression. METHODS: Development of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. RESULTS: Careful evaluations on the characteristics of depression, including subtype, severity, suicidality, and psychiatric and physical comorbidities were recommended because these factors can have an influence on course and prognosis in treatment of depression. CONCLUSION: The results of this study may contribute to the systematic evaluation of depression, based on clinical importance. However, this guideline did not include systematic reviews regarding useful scales for evaluation of depression. In the future, amendment of this guideline might be needed in order to supplement limitations.
Comorbidity ; Depression* ; Depressive Disorder ; Diagnosis* ; Methods ; Peer Review ; Prognosis ; Weights and Measures

OBJECTIVES: The aim of this study is to develop guideline for use in diagnosis of depression. METHODS: Development of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. RESULTS: There has been no evidence on strategies to improve the accuracy and rate of diagnosis of depression. The screening tools for depression were useful in diagnosis of depression in clinical practice. CONCLUSION: The results of this study may suggest the necessity of strategies to improve the validity and reliability of diagnosis of depression. In contrast, scales for screening depression can be useful in diagnosis of depression. This guideline did not include systematic reviews regarding useful scales for diagnosis of depression. In the future, amendment of this guideline might be needed in order to supplement limitations.
Depression* ; Depressive Disorder ; Diagnosis* ; Mass Screening ; Methods ; Peer Review ; Reproducibility of Results ; Weights and Measures