Adherence to Physical Distancing and Health Beliefs About COVID-19 Among Patients With Cancer

Background@#This study aimed to validate questionnaires on adherence to physical distancing and health beliefs about coronavirus disease 2019 (COVID-19) among patients with cancer and explore their interaction with depression or viral anxiety among them. @*Methods@#Through an online survey, data from 154 cancer patients (female: 82.5%, breast cancer: 66.2%, current cancer treatment, presence: 65.6%) were collected from March to June 2022. The survey gathered responses to questionnaires on adherence to physical distancing, health beliefs about COVID-19, perceived social norms, Stress and Anxiety to Viral Epidemics-6 items, and Patient Health Questionnaire-2. Confirmatory factor analysis (CFA) for construct validity and structural equation model (SEM) were performed. @*Results@#The CFA showed a good model fit for adherence to physical distancing (comparative fit index [CFI] = 1.000, Tucker–Lewis index [TLI] = 0.930, root-mean-square-error of approximation [RMSEA] = 0.000, and standardized root-mean-square residual [SRMR] = 0.050) and a satisfactory model fit for health beliefs about COVID-19 (CFI = 0.978, TLI = 0.971, RMSEA = 0.061, and SRMR = 0.089). Through SEM, we found that personal injunctive norms were the main mediators linking health beliefs with physical distancing in patients with cancer. Depression also mediated the effects of viral anxiety and perceived severity on physical distancing (χ2 = 20.073, df = 15, P = 0.169; CFI = 0.984; RMSEA = 0.047). @*Conclusion@#The questionnaires are reliable and valid. Patients with cancer may be able to adhere to physical distancing by addressing perceived severity, viral anxiety, perceived benefits, self-efficacy, perceived barriers, as well as personal injunctive norms.

Mediating Effects of ReassuranceSeeking Behavior or Obsession With COVID-19 on the Association Between Intolerance of Uncertainty and Viral Anxiety Among Healthcare Workers in Korea

Background@#This study explores whether the intolerance of uncertainty among healthcare workers prompts viral anxiety, and whether this association is mediated by their reassuranceseeking behavior and preoccupation with the coronavirus disease 2019 (COVID-19) in Korea. @*Methods@#An online survey was conducted among healthcare workers in Asan Medical Center, on November 29, 2021. Demographic characteristics and responses to items from rating scales were collected, including Stress and Anxiety to Viral Epidemics-9, Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Obsession with COVID-19 Scale (OCS), Patient Health Questionnaire-9, Insomnia Severity Scale, and Intolerance of Uncertainty-12 (IUS-12). @*Results@#Among the 329 participants, viral anxiety of healthcare workers was predicted by being female (β = 0.14, P = 0.002), CRBS (β = 0.30, P < 0.001), OCS (β = 0.32, P < 0.001), and IUS-12 (β = 0.15, P = 0.002) scores (adjusted R2 = 0.43, F = 31.1, P < 0.001). Mediation analysis showed that the intolerance of uncertainty directly influenced viral anxiety, and reassuranceseeking behavior and obsession with COVID-19 partially mediated the association. @*Conclusion@#The intolerance of uncertainty among healthcare workers directly influenced their viral anxiety, and reassurance-seeking behavior and obsession with COVID-19 mediated this association in this era of “living with coronavirus” in Korea.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

Objective@#We aimed to investigate the effect of nursing professionals’ resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. @*Methods@#We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. @*Results@#Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31–1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03–1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85–0.97) were expecting variables for the depression of healthcare workers. @*Conclusion@#Nursing professionals’ level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic

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.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

Objective@#We aimed to investigate the effect of nursing professionals’ resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. @*Methods@#We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. @*Results@#Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31–1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03–1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85–0.97) were expecting variables for the depression of healthcare workers. @*Conclusion@#Nursing professionals’ level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic

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.

How COVID-19 Affected Healthcare Workers in the Hospital Locked Down due to Early COVID-19 Cases in Korea

Background@#The healthcare workers (HCWs) were exposed to never-experienced psychological distress during the early stage of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate how the COVID-19 pandemic affected the mental health of HCWs during the hospital lockdown period due to mass healthcare-associated infection during the early spread of COVID-19. @*Methods@#A real-time online survey was conducted between April 14–18, 2020 among HCWs who worked at the university hospital where COVID-19 was confirmed in a patient, and the hospital was shut down for 3 weeks. Along with demographic variables and work-related information, psychological distress was measured using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Maslach Burnout Inventory-General Survey scale, and the Stress and Anxiety to Viral Epidemics-9. @*Results@#The HCWs working in the cohort ward and those who have experienced social discrimination had significantly higher level of depression (PHQ-9 score; 5.24 ± 4.48 vs. 4.15 ± 4.38; P < 0.01 and 5.89 ± 4.78 vs. 3.25 ± 3.77; P < 0.001, respectively) and anxiety (GAD-7 score; 3.69 ± 3.68 vs. 2.87 ± 3.73;P < 0.05 and 4.20 ± 4.22 vs. 2.17 ± 3.06; P < 0.001, respectively) compared to other HCWs. Worries regarding the peer relationship and the skepticism about job were associated with depression (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.07–1.79; P < 0.05 and OR, 1.69; 95% CI, 1.31–2.17; P < 0.001, respectively) and anxiety (OR, 1.73; 95% CI, 1.21–2.49; P < 0.01 and OR, 1.54; 95% CI, 1.09–2.17; P < 0.05, respectively), while fear of infection or worsening of health was not. Path analysis showed that work-related stress associated with the viral epidemic rather than anxiety about the viral epidemic mainly contributed to depression. @*Conclusion@#The present observational study indicates that mental health problems of HCWs exposed to COVID-19 are associated with distress in work and social relationship. Early intervention programs focusing on these factors are necessary.

Development of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Work-related Stress and Anxiety in Healthcare Workers in Response to Viral Epidemics

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.

Trends in Suicide Methods and Rates among Older Adults in South Korea: A Comparison with Japan

OBJECTIVE: Lethality of the chosen method during a suicide attempt is a strong risk factor for completion of suicide. We examined whether annual changes in the pattern of suicide methods is related to annual changes in suicide rates among older adults in South Korea and Japan. METHODS: We analyzed annual the World Health Organization data on rates and methods of suicide from 2000 to 2011 in South Korea and Japan. RESULTS: For Korean older adults, there was a significant positive correlation between suicide rate and the rate of hanging or the rate of jumping, and a significant negative correlation between suicide rate and the rate of poisoning. Among older adults in Japan, annual changes in the suicide rate and the pattern of suicide methods were less conspicuous, and no correlation was found between them. CONCLUSION: The results of the present study suggest that the increasing use of lethal suicide methods has contributed to the rise in suicide rates among older adults in South Korea. Targeted efforts to reduce the social acceptability and accessibility of lethal suicide methods might lead to lower suicide rate among older adults in South Korea.

Association between Media Reporting and a Lower Suicide Rate in 2012 / 신경정신의학

OBJECTIVES: A recent study conducted by the Korea National Statistical Office (KNSO) reported that the suicide rate in Korea decreased in 2012. The aim of this study was to investigate the association between the decrease in suicide rate and media reporting of suicide events. METHODS: Data on suicide rates were obtained from the KNSO. Correlation between suicide rate and celebrity suicide events, number of media reports on suicide, and suicide searches was compared. Data were analyzed using Pearson's correlation coefficient. RESULTS: The number of celebrity suicide events and recognition of celebrity decreased in 2012. Pearson's correlation test showed a significant positive correlation between the monthly number of media reports on suicide and the suicide rate (daily newspaper r=0.619, p<0.001 ; broadcast r=0.393, p<0.001). The number of suicide searches showed association with celebrity suicide events. CONCLUSION: The suicide rate may be influenced by the number of media reports on suicide events. Establishing guidelines for media reporting on these events could help to decrease the suicide rates.

Development of North Korean Version of the Composite International Diagnostic Interview / 신경정신의학

OBJECTIVES: The aim of the study was to develop a North Korean version of the Composite International Diagnostic Interview (NK-CIDI) and to evaluate the reliability and validity of NK-CIDI. METHODS: Subjects were 100 North Korean defectors, aged 18 to 65, who were recruited in a center for defectors in the National Medical Center or who were on an education curriculum in the defector settlement support center. NK-CIDI was developed based on the Korean version of CIDI considering the sociocultural background of North Korea. Inter-rater reliability, test/retest reliability, and validity of NK-CIDI were evaluated and kappa value was calculated. RESULTS: Different vocabularies and awkward expressions were adjusted, and additional explanations were supplemented for difficult phases. The target for development of NK-CIDI was early defectors who entered South Korea less than 3 months ago. Inter-rater reliability (n=30, kappa value 0.35-1.00), test/retest reliability (n=30, kappa value 0-0.86), and diagnostic validity (n=100, kappa value -0.02-0.42) were evaluated. CONCLUSION: Compared to the general population, defectors experience more psychiatric issues, and a standardized tool for diagnosis is needed. In this study, NK-CIDI was developed and the results suggest that reliability is acceptable but validity needs further verification. NK-CIDI could be utilized in future epidemiologic studies.

A Study on Reliability and Validity of the Impact of Event Scale-Revised-North Korea (IES-R-NK) / 신경정신의학

OBJECTIVES: This study was conducted to translate the Impact of Event Scale-Revised (IES-R) into North Korean language and confirm its reliability and validity. METHODS: A total of 207 North Korean defectors recruited from the Call Center for North Korean Defectors participated in this study. Psychiatrists and psychiatric residents interviewed the participants individually and made psychiatric diagnosis. Subsequently, they completed the Brief Psychological State Inventory for North Korean Refugees (BPSI-NKR), the Center for Epidemiologic Studies Depression Scale-North Korea (CES-D-NK), and the Alcohol Use Disorders Identification Test-North Korea (AUDIT-NK) as well as the Impact of Event Scale-Revised-North Korea (IES-R-NK). Of the original participants, 143 subjects participated in test-retest reliability study after one week. RESULTS: The internal consistency using Cronbach's alpha was superior in both male and female from North Korea. In addition, the temporal stability was also satisfactory. A good convergent validity was clearly shown by significant correlations with BPSI-PTSD and CES-D-NK, respectively. On the other hand, IES-R-NK had no or weak correlations with AUDIT-NK and BPSI-NKR-alcohol, demonstrating its satisfactory discriminant validity. CONCLUSION: IES-R-NK might be considered as a short and valid screening tool for identification of PTSD symptoms in North Korean defectors.

Overview of Suicide by Charcoal Burning and Prevention Strategies / 신경정신의학

Suicide by charcoal burning is common in Asian countries such as Hong Kong and Taiwan. Suicide by charcoal burning has recently shown a rapid increase in Korea, following a celebrity suicide, which was extensively reported by the media. Not only is suicide by charcoal burning fatal, but it also causes delayed neuropsychiatric symptoms through carbon monoxide poisoning. Risk factors associated with charcoal-burning suicide include middle age, male, divorced or unmarried, and economically active but with financial difficulties. To prevent suicide by charcoal burning, limited access to charcoal, responsible media reporting as recommended by international guidelines, and detoxification of charcoal by modifying the raw material should all be considered. In addition, suicide prevention programs should increasingly focus on suicide by charcoal burning. Relevant measures to prevent suicide by charcoal burning will be essential in order to lower the overall suicide rate in Korea.