PURPOSE: This study was conducted to derive a substantive theory on lived experiences of elderly cancer patients. METHODS: The data were collected from February to March 2018 through in-depth personal interviews with 14 elderly cancer patients. The collected data were analyzed based on Corbin and Strauss's grounded theory. RESULTS: The core category was “the journey to find balance in daily lives as a cancer patient by recovering disturbed ego integrity.” The core phenomenon was “shattered by suffering from cancer,” and the causal conditions were “physical change” and “limitations in daily life.” The contextual conditions were “decreased self-esteem,” “feelings of guilt toward the family,” and the sense of “economic burden.” The participants' action and interaction strategies were “maintaining or avoiding social relations,” “seeking meaning of the illness,” “falling into despair,” and “strengthening the willingness to battle the cancer.” The intervening conditions were “support from health care providers and family,” “dissatisfaction with health care providers,” “spiritual help from religion,” and “the improvement or worsening of health conditions.” The consequences were “having a new insight for life,” “living positively along with cancer illness,” and “the loss of willingness to live.” A summary of the series of processes includes the “crisis stage,” “reorganizing stage,” and the “ego integration stage.” CONCLUSION: This study explored the holistic process of ego integrity impairment and the recovery experience of elderly cancer patients. This study is expected to be used as a basis for the development of nursing interventions that can support patients when coping with all stages of their cancer illness trajectory.
Aged ; Delivery of Health Care ; Ego ; Grounded Theory ; Guilt ; Health Personnel ; Humans ; Nursing ; Qualitative Research

PURPOSE: This qualitative study aimed to describe the common themes of the expectations of childbirth on primigravida whose fetus are diagnosed with congenital heart disease. METHODS: A phenomenological method was used in this study. The data were collected by individual in-depth interviews with six participants during 2016~2017. Colaizzi's phenomenology was adopted for this qualitative study as a research method. RESULTS: Four categories were derived from the data as following: ‘Acknowledge of life and waiting for the baby’, ‘Overcoming guilt and becoming stable’, ‘Strengthening for my baby‘, ‘Trust toward medical staffs’. CONCLUSION: The results of this study can guide nurses and health care workers to understand the expectation of childbirth on primigravida whose fetus are diagnosed with congenital heart disease and to implement individualized nursing interventions suited for them.
Delivery of Health Care ; Fetus ; Guilt ; Heart Defects, Congenital ; Methods ; Nursing ; Parturition ; Qualitative Research

PURPOSE: The purpose of this study was to explore and develop a deeper understanding of the experiences of mothers of premature children receiving rehabilitation therapy. METHODS: The participants were 12 mothers with premature children who had received rehabilitation therapy for over 1 year. Individual in-depth interviews were conducted from July to August 2017. The data were analyzed through the phenomenological research method. RESULTS: The participants' experience was structured into five thematic clusters: ‘Regret and guilt that premature birth led to rehabilitation therapy’, ‘Burden of life in an endless tunnel’, ‘Changes in personal relationships surrounding me and my child’, ‘Meaning of new life through my child’, and ‘Desire to expand the rehabilitation of premature infants’. CONCLUSION: The results of this study will be helpful for developing family-centered care programs for premature infants at high risk of developmental disorders.
Child ; Guilt ; Humans ; Infant, Newborn ; Infant, Premature* ; Methods ; Mothers* ; Premature Birth ; Qualitative Research ; Rehabilitation*

OBJECTIVE: Chronic ‘latent’ infection by Toxoplasma gondii is common and most of the hosts have minimal symptoms or they are even asymptomatic. However, there are possible mechanisms by which T. gondii may affect human behavior and it may also cause humans to attempt suicide. This article aimed to investigate the potential pathophysiological relationship between suicide attempts and T. gondii infection in Korea. METHODS: One hundred fifty-five psychiatric patients with a history of suicide attempt and 135 healthy control individuals were examined with enzyme-linked immunoassays and fluorescent antibody technique for T. gondii seropositivity and antibody titers. The group of suicide attempters was interviewed regarding the history of suicide attempt during lifetime and evaluated using 17-item Korean version of Hamilton Depression Scale (HAMD), Columbia Suicide Severity Rating Scale (C-SSRS), State-Trait Anxiety Inventory (STAI) and Korean-Barratt Impulsiveness Scale (BIS). RESULTS: Immunoglobulin G antibodies were found in 21 of the 155 suicide attempters and in 8 of the 135 controls (p=0.011). The Toxoplasma-seropositive suicide attempters had a higher HAMD score on the depressed mood and feeling of guilt subscales and a higher total score than the seronegative suicide attempters. T. gondii seropositive status was associated with higher C-SSRS in the severity and lethality subscales. T. gondii IgG seropositivity was significantly associated with higher STAI-X1 scores in the suicide attempters group. CONCLUSION: Suicide attempters showed higher seroprevalence of T. gondii than healthy controls. Among the suicide attempters, the T. gondii seropositive and seronegative groups showed several differences in the aspects of suicide. These results suggested a significant association between T. gondii infection and psychiatric problems in suicidality.
Antibodies ; Anxiety ; Depression ; Fluorescent Antibody Technique ; Guilt ; Humans ; Immunoassay ; Immunoglobulin G ; Korea ; Seroepidemiologic Studies ; Suicide ; Toxoplasma ; Toxoplasmosis

Hermann Hesse's personal life (1877–1962) is characterized by traumatization caused by suppressive pietistic discipline of his parents during his youth, and depression in his middle age accompanied by psychoanalysis treatment. At the age of 15, he was admitted to mental institutions due to defiant behavior. With this traumatic experience, his psychosexual development seemed inhibited during his adolescence. At age 39, depression developed precipitated by the death of his father. Hesse had received Jungian psychoanalysis from Dr. Lang and Dr. Jung over a 10-year period. However, psychoanalysis could not prevent the recurrence of depression. His appreciation of psychoanalysis became critical. Meanwhile, Hesse announced that he had been a Protestant Christian. In his 50s, he began to create new novels which, beyond polarity based on Jungian psychoanalysis, described the journey toward a greater harmonious and spiritual oneness. Pietism was at one time the reason of his pain, but became life-long support for Hesse's spiritual maturity. He was diagnosed with type II bipolar disorder. The main dynamic factors are thought to be ambivalence, feelings of guilt regarding his aggression toward his parents, and sexual conflict. His coping mechanisms seemed to include pietistic self-control, avoidance, scholarship and creation of literature. By writing the autobiographical Bildungsromans, Hesse tried not only to master his own personal problems but to enlighten readers. However, it seemed that he could not overcome the feelings of guilt associated with leaving his father.
Adolescent ; Aggression ; Bipolar Disorder ; Depression ; Fathers ; Fellowships and Scholarships ; Guilt ; Hospitals, Psychiatric ; Humans ; Middle Aged ; Parents ; Protestantism ; Psychoanalysis ; Psychosexual Development ; Recurrence ; Self-Control ; Writing

PURPOSE: The aim of this study was to identify the parenting experience of mothers who have teenage girls with conduct disorders and to identify the meaning and structure of their experiences. METHODS: This study was a qualitative research based on Parse's research method. Participants were 9 mothers who had a daughter diagnosed with conduct disorder at a community hospital in the central region of South Korea. RESULTS: The core concept on the parenting experiences of mothers of teenage girls with conduct disorder were survival against a violent environment, a sense of guilt related to the conduct disorder, confusion and frustration concerning mother's role, and hope for the future. The experiences of these mothers can be defined as the process of human becoming with powering and transforming while connecting-separating and enabling-limiting with valuing. CONCLUSION: This research is expected to contribute to understanding of mothers' suffering and struggling and be useful in developing nursing care for clients with conduct disorder and their mothers.
Adolescent ; Conduct Disorder* ; Female* ; Frustration ; Guilt ; Hope ; Hospitals, Community ; Humans ; Korea ; Methods* ; Mothers* ; Nuclear Family ; Nursing Care ; Parenting* ; Parents* ; Qualitative Research

OBJECTIVES: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. RESULTS: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. CONCLUSIONS: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.
Disclosure* ; Education ; Guilt ; Humans ; Intention ; Mass Screening ; Medical Errors ; Patient Safety* ; Punishment

OBJECTIVES: Current study was conducted between September 2014 and January 2015 in Gaziantep proviency Şehitkamil town Şirinevler district. Purpose of the study is to measure changes experienced, point of view on menopause, and life style of women who are older than 40, living in said district, and within post-menopause and how these factors effected their feelings of guilt and shame. METHODS: Out of universe consisting of 800 women, 500 participants have joined the study. Data collected by personal information form, Guilt-Shame scales, and World Health Organization quality of life (WHOQOL-BREF) scales. SPSS 18 was used to conduct statistical analysis. RESULTS: Analysis indicated that 78.6% of the participants was not literate, 37.8% of the participants were was subjected to domestic violence. Fifty-five percent of the participants were found to see menopause as a predicament, 45.4% as a disease, and 56% as infertility. Results of scales are as follows; guilt factor 48.95 ± 0.37, shame factor 44.89 ± 0.27, body 10.64 ± 0.42, mental 10.96 ± 0.39, social 11.12 ± 0.49, environment 10.84 ± 0.37. CONCLUSIONS: No significant correlation found between Guilt: body, mental, social, and environmental area (P < 0.05). It was found that there is a significant correlation between the thought that menopause is not a bad thing and the perceived guilt (P < 0.001). Results of analyses indicate that information about menopause significantly correlates between perceived guilt (P < 0.05). Current study found that as perceived shame and guild increases, the life quality of the sample decreases and the average life quality of the sample is below average.
Domestic Violence ; Female ; Guilt* ; Humans ; Infertility ; Life Style ; Menopause* ; Postmenopause ; Quality of Life* ; Shame* ; Weights and Measures ; Women's Health ; World Health Organization

OBJECTIVE: The pathophysiology of major depressive disorder (MDD) is still not well understood. Conflicting results for surrogate biomarkers in MDD have been reported, which might be a consequence of the heterogeneity of MDD patients. Therefore, we aim to investigate how the severity of depression and various symptom domains are related to the levels of dehydroepiandrosterone sulfate (DHEA-s) in MDD patients. METHODS: We recruited 117 subjects from a general practice. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Depressive symptoms were divided into three subdomains according to BDI items; somatic symptoms, guilt and failure, and mood and inhibition. RESULTS: In subjects with very-mild-to-moderate depression, the DHEA-s level increased as BDI score did. However, the DHEA-s levels in the subjects with severe depression were significantly lower than in subjects with moderate depression (p=0.003). DHEA-s level was correlated with the BDI subscore for guilt and failure in very-mild-to-moderate depression (r=0.365, p=0.006). CONCLUSION: The DHEA-s level appears to be indicative of MDD severity with respect to depressive symptoms, especially regarding guilt and failure. Our findings suggest that the upregulation of DHEA-s may be a part of a compensatory process in very-mild-to-moderate depression, and the failure of this compensation mechanism may underlie the development of severe depression.
Biomarkers ; Compensation and Redress ; Dehydroepiandrosterone Sulfate* ; Dehydroepiandrosterone* ; Depression ; Depressive Disorder, Major* ; Diagnosis, Differential ; General Practice ; Guilt ; Humans ; Neuroendocrinology ; Population Characteristics ; Up-Regulation

BACKGROUND: This study aimed to develop a simple tool for identifying alcohol use disorders in female Korean drinkers from previous questionnaires. METHODS: This research was conducted on 400 women who consumed at least one alcoholic drink during the past month and visited the health promotion center at Chungnam National University Hospital between June 2013 to May 2014. Drinking habits and alcohol use disorders were assessed by structured interviews using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria. The subjects were also asked to answer the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-Consumption, CAGE (Cut down, Annoyed, Guilty, Eye-opener), TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), TACE (Tolerance, Annoyed, Cut down, Eye-opener), and NET (Normal drinker, Eye-opener, Tolerance) questionnaires. The area under receiver operating characteristic (AUROC) of each question of the questionnaires on alcohol use disorders was assessed. After combining two questions with the largest AUROC, it was compared to other previous questionnaires. RESULTS: Among the 400 subjects, 58 (14.5%) were identified as having an alcohol use disorder. Two questions with the largest AUROC were question no. 7 in AUDIT, "How often during the last year have you had a feeling of guilt or remorse after drinking?" and question no. 5 in AUDIT, "How often during the past year have you failed to do what was normally expected from you because of drinking?" with an AUROC (95% confidence interval [CI]) of 0.886 (0.850-0.915) and 0.862 (0.824-0.894), respectively. The AUROC (95% CI) of the combination of the two questions was 0.958 (0.934-0.976) with no significant difference as compared to the existing AUDIT with the largest AUROC. CONCLUSION: The above results suggest that the simple tool consisting of questions no. 5 and no. 7 in AUDIT is useful in identifying alcohol use disorders in Korean female drinkers.
Alcohol Drinking ; Alcoholics ; Amnesia ; Chungcheongnam-do ; Diagnostic and Statistical Manual of Mental Disorders ; Drinking ; Female* ; Guilt ; Health Promotion ; Humans ; ROC Curve