Factors on the Pathway from Trauma to Suicidal Ideation in Adolescents

OBJECTIVES: Suicide is the most frequent cause of death among Korean adolescents, and adolescents who have experienced trauma have an increased risk of post-traumatic stress disorder (PTSD) symptoms, depression, and suicide attempts. However, resilience and self-esteem are protective factors. We examined the effects of resilience and self-esteem on the relationship among traumatic experiences, PTSD symptoms, depression, and suicidal ideation. METHODS: Middle-school students (n=403) completed questionnaires assessing traumatic experiences, PTSD symptoms, depression, suicidal ideation, resilience, and self-esteem. Path analysis was performed to investigate the mediating effects of PTSD symptoms, resilience, self-esteem, and depression on the relationship between trauma exposure and suicidal ideation. RESULTS: Traumatic experience was positively correlated with PTSD symptoms, depression, and suicidal ideation. PTSD symptoms and depression were positively correlated with suicidal ideation. The relationship between traumatic experiences and suicidal ideation was mediated by PTSD symptoms, which had both direct and indirect effects on suicidal ideation; the indirect effect was mediated by resilience, self-esteem, and depression. CONCLUSION: Korean adolescents who had experienced trauma were more likely to develop PTSD symptoms, increasing their risk of depression and suicidal ideation. However, self-esteem and resilience may help protect against depression and suicidal ideation. Our findings could inform suicide prevention initiatives.

Antenatal Depressive Symptoms and Associated Risk Factors among Pregnant Women / 신경정신의학

OBJECTIVES@#Maternal depression has a detrimental effect on baby growth. Recent reports suggest that depressive symptoms are more likely to occur during pregnancy than in the postpartum period. In Korea, there are relatively few studies of depression during pregnancy compared to those related to postpartum depression. The purpose of this study is to identify factors associated with antenatal depression.@*METHODS@#The study included 143 pregnant women who had completed the Korean version of the Edinburgh Postnatal Depression Scale (K-EPDS), the Korea-Marital Satisfaction Inventory's global distress scale, the Rosenberg Self-Esteem Scale, and the Connor-Davidson Resilience Scale-2. Based on the K-EPDS scores, we divided the participants into two groups. Logistic regression was performed to identify factors associated with antenatal depression.@*RESULTS@#Thirty (21%) of the subjects were evaluated as being depressed, pregnant women. Pregnant women with high self-esteem and marital satisfaction were less likely to have depression. Similarly, those who are younger and those with an abortion history were more likely to have depression. Past psychiatric history and family history were not significantly different between the two groups.@*CONCLUSION@#Dissatisfaction with marriage, low self-esteem, younger age, and abortion history were closely related to the presence of antenatal depression. The results of this study can be used as baseline data for the development of family-based education programs and early antenatal depression policies.

Validation of the Center for Epidemiological Studies Depression Scale among Korean Adolescents

OBJECTIVE: The Center for Epidemiological Studies Depression Scale (CES-D) is designed to measure the current level of depressive symptomatology in the general population. However, no review has examined whether the scale is reliable and valid among children and adolescents in Korea. The purpose of this study was to test whether the Korean form of the CES-D is valid in adolescents. METHODS: Data were obtained from 1,884 adolescents attending grades 1–3 in Korean middle schools. Reliability was evaluated by internal consistency (Cronbach’s alpha). Concurrent validity was evaluated by a correlation analysis between the CES-D and other scales. Construct validity was evaluated by exploratory factor and confirmatory factor analyses. RESULTS: The internal consistency coefficient for the entire group was 0.88. The CES-D was positively correlated with scales that measure negative psychological constructs, such as the State Anxiety Inventory for Children, the Korean Social Anxiety Scale for Children and Adolescents, and the Reynold Suicidal Ideation Questionnaire, but it was negatively correlated with scales that measure positive psychological constructs, such as the Korean version of the Rosenberg Self-Esteem Scale and the Connor-Davidson Resilience Scale-2. The CES-D was examined by three-dimensional exploratory factor analysis, and the three-factor structure of the scale explained 53.165% of the total variance. The variance explained by factor I was 24.836%, that explained by factor II was 15.988%, and that explained by factor III was 12.341%. The construct validity of the CES-D was tested by confirmatory factor analysis, and we applied the entire group’s data using a three-factor hierarchical model. The fit index showed a level similar to those of other countries’ adolescent samples. CONCLUSION: The CES-D has high internal consistency and addresses psychological constructs similar to those addressed by other scales. The CES-D showed a three-factor structure in an exploratory factor analysis. The present findings suggest that the CES-D is a useful and reliable tool for measuring depression in Korean adolescents.

The Effects of Social Anxiety, Self-Esteem, and Depression on Suicidal Ideation in Korean Adolescents / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the manner by which social anxiety symptoms, self-esteem, and depression influence suicidal ideation in adolescents. METHODS: This study involved 1320 middle school students. All participants completed several self-assessment questionnaires. Correlations among variables were assessed, and multiple regression analysis was performed to evaluate the relationships between variables and suicidal ideation. Finally, a structural equation model was used to determine the pathways by which the tested variables can influence suicidal ideation. RESULTS: Symptoms of social anxiety were positively correlated with depression and suicidal ideation, but were negatively correlated with self-esteem. Additionally, multiple regression analysis revealed that social anxiety symptoms, depression, and self-esteem were significantly related to suicidal ideation. The influence of social anxiety symptoms on suicidal ideation was associated with an increase in depression, whereas self-esteem acted as an intermediary between social anxiety symptoms and depression. CONCLUSION: The results of the present study demonstrate that social anxiety symptoms can directly increase depression and lower self-esteem, which in turn can increase the risk of suicidal ideation. Thus, it may be possible to prevent depression and ultimately lower the risk of suicide in adolescents by pursuing programs designed for the early detection of social anxiety symptoms and by using intervention programs that improve self-esteem.