Background: and Purpose The Karolinska Sleepiness Scale (KSS) is widely used for assessing current level of sleepiness, but it has not been validated in South Korea. This study aimed to validate the KSS using the Stanford Sleepiness Scale (SSS), polysomnography (PSG), and electroencephalography (EEG). Methods: The sample consisted of 27 adult participants in this study aged 40.5±7.7 years (mean±standard deviation) and included 22 males. They completed questionnaires and underwent EEG recording and overnight PSG. The KSS was completed from 18:00 to 24:00 every 2 hours and following PSG (at 07:00). KSS scores changed over time and in particular increased with the time since waking, with the score peaking at 24:00. Results: Convergent validity of the KSS was verified by performing a Spearman correlation analysis between the KSS and SSS (r=0.742, p<0.01). Concurrent validity of the KSS was verified by performing a Spearman correlation analysis between the KSS administered before sleep and the sleep onset latency measured using PSG (r=-0.456, p<0.05). Alpha waves were measured 5 minutes before administering the KSS, and the KSS scores were compared with these alpha waves. There were no significant correlations observed between the KSS scores and alpha waves measured in the left occipital area (O1), left frontal area (F3), or left central area (C3). In addition, Spearman correlation analyses of the difference between KSS scores and alpha waves measured at O1, F3, and C3 produced no significant results. Conclusions This study verified the convergent validity and concurrent validity of the KSS, and confirmed the capabilities of this scale in assessing sleepiness changes over time.

Objective: As smartphone use is becoming more common, the age of initial exposure to devices is becoming younger. Young children’s screen use is influenced by various factors; it is more directly dependent on family environment than school-aged children. Our study aimed to examine the effect of mother’s smartphone addition on their child’s smartphone use. Methods: Participants were from the Kids Cohort for Understanding of internet addiction Risk factors in early childhood (K-CURE) study. Adult smartphone addiction self-diagnosis scale was used to evaluate smartphone addiction degree of mother. Child’s smartphone use was assessed by parental questionnaire. Using logistic regression analysis, we examine the association between mother’s smartphone addiction and child’s smartphone use. Results: After adjusting for other factors, mother’s smartphone addiction is related with early smartphone exposure of children. Highrisk group’s children was exposed to smartphone earlier than low risk group (adjusted OR, 0.418; p=0.021). Contrary to expectation, there is no correlation between mother’s smartphone addiction and child’s smartphone use time. Conclusion Our study explain that mother’s smartphone addiction can affect early smartphone exposure on children. Based on our findings, further study might explore the effect of early smartphone exposure on children.

This study explored the psychometric properties of the Arabic version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for assessing people's anxiety in response to the viral epidemic in Lebanon. The 406 participants responded voluntarily to the online survey that included the SAVE-6, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) tools. The single-structure SAVE-6 model showed good internal consistency (Cronbach's α = 0.773). The SAVE-6 scale also showed good convergent validity with the GAD-7 (Spearman's ρ = 0.42, P < 0.001) and PHQ-9 (ρ = 0.38, P < 0.001). Receiver operating characteristic (ROC) analysis revealed an Arabic SAVE-6 cut-off score of 12 points (area under the curve [AUC] = 0.753; sensitivity = 62.74%; specificity = 78.26%) for an at least mild degree of anxiety (GAD-7 score ≥ 5). The Arabic version of the SAVE-6 was a reliable, valid, and solely usable scale for measuring the anxiety response of the general population to the viral epidemic.

Background: This study explored the clinical variables related to public workers' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic. Methods: A total of 938 public workers answered anonymous questionnaires in May 2020.The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields. Results: Married, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic. Conclusion It is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.

Objectives: Nightmare disorder is highly prevalent in clinical settings and is highly comorbid with posttraumatic stress disorder (PTSD). In the current study, we aimed to develop and validate a semi-structured interview based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition for diagnosing nightmare disorder. Methods: We developed a Semi-Structured Clinical Interview for Nightmare Disorder (SCIN) in five steps: we interviewed 100 females (mean age, 24.6±5.88 years) using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5); Structured Clinical Interview for DSM-IV Axis 1 Disorders, Research Version (SCID-I); and self-report questionnaires for nightmares (Disturbing Dream and Nightmare Severity Index, DDNSI), depression, state anxiety, trait anxiety, suicidal ideation, and insomnia. Two independent raters assessed the responses of the interviewees. The interrater reliability for the SCIN was calculated. Pearson’s correlation coefficient was used to assess convergent validity between SCIN and the DDNSI. Chi-square analyses were conducted to compare prevalence of PTSD based on nightmare disorder diagnosis. Results: Among the participants, 42% were diagnosed with nightmare disorder, 15% had subthreshold nightmare disorder, and 43% did not have nightmare disorder. Interrater reliability was moderate (Kappa=0.707, p<0.001). The semi-structured clinical interview showed good convergent validity with the DDNSI (r=0.639, p<0.001). Additionally, individuals who were identified as having nightmare disorder had higher levels of depression, state anxiety, trait anxiety, suicidal ideation, and insomnia (p<0.001). Based on the PTSD diagnosis using CAPS-5, the nightmare group had a higher proportion of PTSD diagnoses than the no-nightmare group (26.2% vs. 8.6%, respectively; χ2=38.41, p<0.001). Conclusions The semi-structured clinical interview for nightmare disorder appears to have good reliability and validity and can be used in clinical settings.

Background: The coronavirus disease 2019, or COVID-19, has had a major psychological impact on healthcare workers. However, very few scales are available to specifically assess work-related stress and anxiety in healthcare workers responding to a viral epidemic. This study developed a new assessment tool, the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) and aimed to validate it among healthcare workers directly affected by COVID-19 in Korea. Methods: A total of 1,019 healthcare workers responded through anonymous questionnaires during April 20–30, 2020. Exploratory factor analysis (EFA) was conducted to explore the construct validity, and the reliability was assessed using internal consistency measures of Cronbach's alpha coefficients. Receiver operating characteristic analysis was conducted to define the most appropriate cut-off point of SAVE-9 using the Generalized Anxiety Disorder-7 scale (GAD-7; ≥ 5). Second, Spearman's rank correlation coefficient was used to establish convergent validity for the SAVE-9 questionnaire with GAD-7 and the Patient Health Questionnaire-9. Results: The nine-item scale had satisfactory internal consistency (Cronbach's α = 0.795). It adopted a two-factor structure: 1) anxiety regarding viral epidemics and 2) work-related stress associated with viral epidemics. A cut-off score of 22 for the SAVE-9 ascertained levels of stress and anxiety in response to a viral epidemic in healthcare workers that warranted clinical attention. Correlations between the SAVE-9 and the other scales were statistically significant (P < 0.05). Conclusion The results suggest that the SAVE-9 is a useful, reliable, and valid tool to evaluate stress and anxiety responses in healthcare workers during viral epidemics.

Objectives: Bedtime procrastination (BP) is defined as the behavior of voluntarily postponing bedtime without having external reasons for doing so. According to previous studies, people with reduced use of active emotion regulation strategies may use BP to cope with negative emotions. However, research about the relationship among active emotional regulation strategies, BP, and insomnia is lacking. This study aimed to investigate the mediating effect of BP between active emotional regulation strategies and insomnia severity. Methods: In total, 597 adults (female, 81.9%; mean age, 23.18±2.80 years) completed the Emotional Regulation Strategies Checklist, Insomnia Severity Index, and Bedtime Procrastination Scale. Results: There was a significant association between active emotional regulation strategies and BP (r=-0.152, p<0.01), between BP and insomnia severity (r=0.259, p<0.01), and between active emotional regulation strategies and insomnia severity (r=-0.128, p<0.01). BP significantly mediated the relationship between active emotional regulation strategies and insomnia severity (B=-0.024; 95% confidence interval [CI], -0.04 to -0.01). Conclusions BP may be considered in the relationship between active emotional regulation strategies and insomnia severity. Understanding the mediating role of BP may help prevent insomnia.

This study explored the psychometric properties of the Arabic version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for assessing people's anxiety in response to the viral epidemic in Lebanon. The 406 participants responded voluntarily to the online survey that included the SAVE-6, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) tools. The single-structure SAVE-6 model showed good internal consistency (Cronbach's α = 0.773). The SAVE-6 scale also showed good convergent validity with the GAD-7 (Spearman's ρ = 0.42, P < 0.001) and PHQ-9 (ρ = 0.38, P < 0.001). Receiver operating characteristic (ROC) analysis revealed an Arabic SAVE-6 cut-off score of 12 points (area under the curve [AUC] = 0.753; sensitivity = 62.74%; specificity = 78.26%) for an at least mild degree of anxiety (GAD-7 score ≥ 5). The Arabic version of the SAVE-6 was a reliable, valid, and solely usable scale for measuring the anxiety response of the general population to the viral epidemic.

Background: This study explored the clinical variables related to public workers' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic. Methods: A total of 938 public workers answered anonymous questionnaires in May 2020.The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields. Results: Married, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic. Conclusion It is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.

Objectives: Nightmare disorder is highly prevalent in clinical settings and is highly comorbid with posttraumatic stress disorder (PTSD). In the current study, we aimed to develop and validate a semi-structured interview based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition for diagnosing nightmare disorder. Methods: We developed a Semi-Structured Clinical Interview for Nightmare Disorder (SCIN) in five steps: we interviewed 100 females (mean age, 24.6±5.88 years) using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5); Structured Clinical Interview for DSM-IV Axis 1 Disorders, Research Version (SCID-I); and self-report questionnaires for nightmares (Disturbing Dream and Nightmare Severity Index, DDNSI), depression, state anxiety, trait anxiety, suicidal ideation, and insomnia. Two independent raters assessed the responses of the interviewees. The interrater reliability for the SCIN was calculated. Pearson’s correlation coefficient was used to assess convergent validity between SCIN and the DDNSI. Chi-square analyses were conducted to compare prevalence of PTSD based on nightmare disorder diagnosis. Results: Among the participants, 42% were diagnosed with nightmare disorder, 15% had subthreshold nightmare disorder, and 43% did not have nightmare disorder. Interrater reliability was moderate (Kappa=0.707, p<0.001). The semi-structured clinical interview showed good convergent validity with the DDNSI (r=0.639, p<0.001). Additionally, individuals who were identified as having nightmare disorder had higher levels of depression, state anxiety, trait anxiety, suicidal ideation, and insomnia (p<0.001). Based on the PTSD diagnosis using CAPS-5, the nightmare group had a higher proportion of PTSD diagnoses than the no-nightmare group (26.2% vs. 8.6%, respectively; χ2=38.41, p<0.001). Conclusions The semi-structured clinical interview for nightmare disorder appears to have good reliability and validity and can be used in clinical settings.