Investigation of the Subtypes of Nonsuicidal Self-Injury Based on the Forms of Self-Harm Behavior: Examining Validity and Utility via Latent Class Analysis and Ecological Momentary Assessment

Background@#This study aimed to empirically derive and validate subtypes of nonsuicidal selfinjury (NSSI) based on the forms of self-harm behavior. @*Methods@#Sixty young adults who exhibited repetitive NSSI completed a clinical interview and baseline measures, followed by a two-week ecological momentary assessment (EMA).A latent class analysis was administered to identify NSSI subtypes based on the forms of self-harm behavior. The subtypes were then compared to baseline clinical and EMA variables, including emotions and urges to self-harm. @*Results@#The best-fitting model supported two subtypes: 1) substance abuse and suicide attempt subtype and 2) cutting and scratching subtype. The substance abuse and suicide attempt subtype reported a higher rate of engaging in lifetime suicide plans and suicide attempts and a higher number of lifetime suicide attempts. They also showed significantly higher severity of self-harm behavior, borderline personality traits, anger, posttraumatic symptoms, and difficulties in emotion regulation when compared to the cutting and scratching subtype. However, there was no inter-subtype difference in self-esteem. In the EMA data, anger toward others, feeling of rejection, loneliness, and helplessness were significantly high in the substance abuse and suicide attempt subtype. The variability of anger toward others was also higher in this subtype compared to the cutting and scratching subtype. Finally, in the two-week research period, the substance abuse and suicide attempt group showed a higher rate of reported urges to self-harm with or without suicidal intent. @*Conclusion@#Findings support the validity of the subtypes based on the forms of self-harm behavior, suggesting the clinical utility of addressing heterogeneity within individuals exhibiting self-harm for assessment and treatment.

A Latent Class Analysis of Suicidal Behaviors in Adolescents

Objective@#The purpose of the present study was to identify adolescents’ suicide subgroups using five indicators (depression, anxiety, suicide ideation, and planned and attempted suicide), and explore the distinctive features of each subgroup. @*Methods@#This study included 2,258 teenagers from four schools. Both adolescents and their parents, who voluntarily agreed to participate in the study, completed a series of self-reported questionnaires on depression, anxiety, suicide, self-harm, self-esteem, impulsivity, childhood maltreatment, and deviant behaviors. The data were analyzed using latent class analysis, a person-centered method. @*Results@#Four classes were detected: “high risk for suicide without distress,” “high risk for suicide with distress,” “low risk for suicide with distress,” and “healthy.” The “high risk for suicide with distress” class was the most severe on all evaluated psychosocial risk factors, namely, impulsivity, low self-esteem, self-harming behaviours, deviant behaviour problems, and childhood maltreatment, followed by “high risk for suicide without distress.” @*Conclusion@#This study identified two high risk subgroups for adolescent’ suicidality, “high risk for suicide with or without distress.” Both high risk subgroups for suicide showed higher scores for all psychosocial risk factors than low risk subgroups for suicide. Our findings suggest that special attention needs to be paid to the latent class “high risk for suicide without distress,” as this group’s “cry for help” might be relatively difficult to detect. Specific interventions for each group (e.g., distress safety plans for “suicidal potential with or without emotional distress”) need to be developed and implemented.

Time-Series Trends of Depressive Levels of Korean Adults During the 2020 COVID-19 Pandemic in South Korea

Objective@#This study aimed to observe the changes in people’s depressive levels over 9 months since the coronavirus disease of 2019 (COVID-19) outbreak as well as to identify the predictors of people’s depressive levels including COVID-19 infection fear in the context of South Korea in 2020. @*Methods@#For these purposes, four cross-sectional surveys were periodically implemented from March to December 2020. We randomly recruited 6,142 Korean adults (aged 19 to 70) by using a quota survey. Along with descriptive analysis, which included a one-way analysis of variance and correlations, multiple regression models were built to identify the predictors of people’s depressive levels during the pandemic. Results Overall, people’s depressive levels and fear of COVID-19 infection gradually increased since the COVID-19 outbreak. In addition to demographic variables (i.e., being a female, young age, unemployed, and living alone) and the duration of the pandemic, people’s COVID-19 infection fear was associated with their depressive levels. @*Conclusion@#To ameliorate these rising mental health issues, access to mental health services should be secured and expanded, particularly for individuals who present greater vulnerabilities due to socioeconomic characteristics that may affect their mental health.

COVID-19 Pandemic-Related Job Loss Impacts on Mental Health in South Korea

Objective@#The economic hardship brought by the coronavirus disease-2019 (COVID-2019) pandemic has caused mental health problems among people of different socioeconomic status (SES). As social support helps to buffer these problems, we investigated the association between job loss related to COVID-19 and depression, anxiety, and suicidal thoughts; the differences in the effects according to SES; and the mediating effects of social support. @*Methods@#The effects of COVID-19-related job loss on depression, anxiety, and suicidal thoughts among 1,364 people were investigated through semi-structured and self-administered questionnaires: Patient Health Questionnaire–9, General Anxiety Disorder–7, and the Functional Social Support Questionnaire. Logistic regression and subgroup analyses were performed to assess the association between job loss and mental health status, and the moderating effects of income and educational levels. Moreover, the mediating effects of perceived social support on the association between job loss and depression, anxiety, and suicidal thoughts were analyzed. @*Results@#COVID-19-related job loss increased the risk of depression and suicidal thoughts. Adults with lower income and education level were at higher risk of depression, anxiety, and suicidal thoughts; perceived social support level had significant mediating effects on the association between job loss and depression/anxiety; and income level had significant moderating effects on this mediating pathway. @*Conclusion@#COVID-19-related job loss were likely to be significantly associated with negative mental health outcomes, especially among individuals with low income and education levels. As social support had buffering effects on such outcomes, related government policies in cooperation with the governance of communities and stakeholders must be prepared.

Factors Related to Anxiety and Depression Among Adolescents During COVID-19: A Web-Based CrossSectional Survey

Background@#The coronavirus disease 2019 (COVID-19) outbreak and subsequent disease-containment measures (such as school closures) significantly affected the lives of adolescents. We evaluated the mental-health status and factors associated with anxiety and depression among South Korean adolescents. @*Methods@#A nationwide online survey was conducted to evaluate the mental-health status of South Korean adolescents during the COVID-19 pandemic. In total, 570 adolescents aged 13–18 years were surveyed between May 27 and June 11, 2021. The participants completed the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) to determine anxiety and depression symptoms, respectively. Stepwise logistic regression models were constructed to determine factors related to anxiety and depression. @*Results@#Among the study participants, 11.2% and 14.2% had anxiety and depression, respectively. The results suggested that several factors, such as the experience of COVID-19 infection and quarantine of oneself, a family member or an acquaintance, physical and mental health problems, and fear of one’s local community being discriminated against as a COVID-19 area were related to anxiety and depression. @*Conclusion@#The present study identified COVID-19-related factors associated with anxiety and depression among adolescents, and provides insights regarding potential interventions to improve the mental health of adolescents. To promote the mental health of adolescents during the COVID-19 pandemic, special attention should be paid to individuals with physical or mental-health problems, and efforts should be made to reduce the negative social and emotional impacts of infection-control measures.

COVID-19 and Risk Factors of Anxiety and Depression in South Korea

Objective@#The aims of this study were to explore the prevalence of and identify predictors of anxiety and depression related to coronavirus disease of 2019 (COVID-19) in South Korea. @*Methods@#The analysis is based on a quota survey design and a sampling frame that permitted recruitment of a national sample of 1,014 individuals between March 17–31, 2020. Several standardized measurements were used, including GAD-7, PHQ-9, COVID-19 related fear, restrictions in deaily life, as well as sociodemographic information and physical and psychosocial needs during the pandemic. Multiple logistic regression was conducted to analyze the influence of sociodemographic factors, fear, and physical/psychosocial needs on anxiety and depression. @*Results@#Significant numbers of the respondents were identifiable anxiety (19.0%) and depression group (17.5%), respectively. This indicates that the depression and anxiety prevalence rate after the COVID-19 is substantially high compared to the depression rate of 2.6% in 2020 and 2.8% in 2018 both reported in the Korea Community Health Survey and the anxiety rate of 5.7% reported in 2016 Survey of Mental Disorders in Korea. Multiple logistic regression results showed age, COVID-19 related fear, and the level of restrictions in daily as significant factors in understanding and predicting the anxiety group. Likfewise, the COVID-19 related fear, restrictions in daily life, and need for economic support were important predictors in predicting the depression group. @*Conclusion@#Findings on predictors for greater vulnerability to anxiety and depression has important implications for public mental health in the context of the COVID-19 pandemic.

CT and MR Imaging Findings of Structural Heart Diseases Associated with Sudden Cardiac Death

Sudden cardiac death is an unexpected death originating from the heart that occurs within an hour of the onset of symptoms. The main cause of sudden cardiac death is arrhythmia; however, diagnosing underlying structural heart disease significantly contributes to predicting the long-term risk. Cardiovascular CT and MR provide important information for diagnosing and evaluating structural heart disease, enabling the prediction and preparation of the risk of sudden cardiac death. Therefore, we would like to focus on the various structural heart diseases that increase the risk of clinically-important sudden cardiac death and the importance of imaging findings.

CT and MR Imaging Findings of Structural Heart Diseases Associated with Sudden Cardiac Death

Sudden cardiac death is an unexpected death originating from the heart that occurs within an hour of the onset of symptoms. The main cause of sudden cardiac death is arrhythmia; however, diagnosing underlying structural heart disease significantly contributes to predicting the long-term risk. Cardiovascular CT and MR provide important information for diagnosing and evaluating structural heart disease, enabling the prediction and preparation of the risk of sudden cardiac death. Therefore, we would like to focus on the various structural heart diseases that increase the risk of clinically-important sudden cardiac death and the importance of imaging findings.

COVID-19 and Risk Factors of Anxiety and Depression in South Korea

Objective@#The aims of this study were to explore the prevalence of and identify predictors of anxiety and depression related to coronavirus disease of 2019 (COVID-19) in South Korea. @*Methods@#The analysis is based on a quota survey design and a sampling frame that permitted recruitment of a national sample of 1,014 individuals between March 17–31, 2020. Several standardized measurements were used, including GAD-7, PHQ-9, COVID-19 related fear, restrictions in deaily life, as well as sociodemographic information and physical and psychosocial needs during the pandemic. Multiple logistic regression was conducted to analyze the influence of sociodemographic factors, fear, and physical/psychosocial needs on anxiety and depression. @*Results@#Significant numbers of the respondents were identifiable anxiety (19.0%) and depression group (17.5%), respectively. This indicates that the depression and anxiety prevalence rate after the COVID-19 is substantially high compared to the depression rate of 2.6% in 2020 and 2.8% in 2018 both reported in the Korea Community Health Survey and the anxiety rate of 5.7% reported in 2016 Survey of Mental Disorders in Korea. Multiple logistic regression results showed age, COVID-19 related fear, and the level of restrictions in daily as significant factors in understanding and predicting the anxiety group. Likfewise, the COVID-19 related fear, restrictions in daily life, and need for economic support were important predictors in predicting the depression group. @*Conclusion@#Findings on predictors for greater vulnerability to anxiety and depression has important implications for public mental health in the context of the COVID-19 pandemic.

Risk Factors for Suicidal Ideation and Attempts in Adolescents

OBJECTIVE: Although suicide is a serious public health concern for adolescents, there is a lack of studies that explore its risk factors in the Republic of Korea. The present study aims to investigate risk factors associated with suicidal behaviors in Korean adolescents. METHODS: Participants consisted of 2258 middle and high school students who completed a series of questionnaires regarding suicide ideation or attempts, non-suicidal self-injuries, depression, impulsivity, drinking behaviors, and negative life events, including peer bullying. RESULTS: Among the participants, 8.3% of students reported suicide ideation, while 3.2% reported a history of a suicide attempt in the past 12 months. Depression, peer-victimization, internet-related delinquency, and positive attitudes toward suicide were associated with suicidal ideations and attempts. Adverse life events were also associated with suicide ideation, but not attempts, while not living with both parents and poor family relationships were associated with suicide attempts, but not ideations. Non-suicidal self-injuries were associated with both suicide ideations and attempts. Students with suicidal ideations and attempts can be differentiated depending on the presence of self-injury. CONCLUSION: In addition to depression or behavioral problems, non-suicidal self-injuries and lack of support from family may also play significant roles in suicide attempts in adolescents. To facilitate the prevention of suicide in adolescents, longitudinal studies should be followed to confirm the risk factors identified in this study.

Altered Function of Ventrolateral Prefrontal Cortex in Adolescents with Peer Verbal Abuse History

OBJECTIVE: Previous studies showing the association of exposure to peer (PeVA) and parental verbal abuse in childhood with structural alterations in the young adult brain suggest functional changes in adolescence. In this functional MRI study, we investigated the effects of exposure to PeVA, during elementary and middle school periods, on brain response to emotional words, in high school students. METHODS: An emotional Stroop task consisting of swear, negative, positive, and neutral words was performed during functional MRI scan for 23 subjects who were divided into low- and high exposure groups to PeVA. RESULTS: High-PeVA group had a higher depression score, greater left ventrolateral prefrontal cortex (VLPFC) activity, and higher left VLPFC-left hippocampus connectivity in swear word conditions. The VLPFC activity and left VLPFC-left hippocampus connectivity was negatively related to the severity of anxiety and depressive symptoms, respectively. CONCLUSION: These preliminary findings support the hypothesis that exposure to PeVA, during childhood, is an aversive stimulus associated with meaningful functional change in emotional regulation network, showing hypersensitivity to swear words, at middle adolescence.

The Psychometric Properties of the Korean Version of the Verbal Abuse Questionnaire in University Students

OBJECTIVE: The aim of the present study was to examine the psychometric properties of the Korean Verbal Abuse Questionnaire (K-VAQ) that consists of 15 items related with life-time verbal aggression exposure. METHODS: A total of 5814 university students who agreed to take part in the study completed the K-VAQ, the Korean version of the Life Event CheckList (LEC-K) and Impact of Event Scale-Revised (K-IES-R). Internal consistency was checked by using item-total item correlation and Cronbach's alpha coefficient. Exploratory and confirmatory factor analyses were performed, and convergent and concurrent validity levels were examined. Finally, a cluster analysis was conducted to verify the validity of the cutoff point of the K-VAQ. RESULTS: The Cronbach's alpha correlation coefficient was 0.9. The K-VAQ showed a single factor structure which explained 55.34% of the total variance. The K-VAQ was significantly associated with the LEC-K (r=0.24) and K-IES-R (r=0.28), indicating good convergent validity and concurrent validity. The cluster analysis provided four clusters of trauma experiences: high, moderate, low, and minimal, with K-VAQ ranges of 43-81, 20-42, 7-19, and 0-6, respectively. In a further investigation, a K-VAQ score of 40 was found to be the appropriate cutoff point to delineate the highly verbally abused group, as used in the previous studies. A sum of 36.5% of the highly verbally abused group reported to show substantial symptoms of PTSD (K-IES-R score >22). CONCLUSION: The present findings suggest that the K-VAQ has good psychometric properties for assessing verbal aggression among the Korean population.

Basal Cell Carcinoma on the Pubic Area: Report of a Case and Review of 19 Korean Cases of BCC from Non-sun-exposed Areas

Basal cell carcinoma (BCC) is one of the most commonly diagnosed malignant skin tumors and develops characteristically on sun-exposed areas, such as the head and neck. Ultraviolet light exposure is an important etiologic factor in BCCs, and BCCs arising from non-sun- exposed areas are, therefore, very rare. In particular, the axilla, nipple, the genital and perianal areas are not likely to be exposed to ultraviolet light; thus, if BCC develops in these areas, other predisposing factors should be considered. Herein, we report a case of BCC arising on the pubic area in a 70-year-old man. We also performed a survey of the literature and discussed the 19 cases of BCC from non-sun-exposed areas reported to date in Korea.

Tinea Incognito with Changes in Clinical Feature Related to Antifungal Treatment / 대한의진균학회지

Clinical features of the dermatophyte infections of the glabrous skin can be altered by inappropriate treatment such as topical steroid treatment. We describe a case of dermatophyte infection with changes in clinical feature related to antifungal treatment. A 23-year-old woman presented with reddish annular scaly lesions on her right forearm. On the basis of the detection of hyphae on KOH examination, oral terbinafine 250 mg/day in combination with topical isoconazole was used for 3 weeks, but scattered papulopustules on erythematous bases occurred. Histopathologic examination revealed the presence of hyphae within the follicular infundibulum. Oral itraconazole 100 mg/day was administered for 2 weeks in combination with topical flutrimazole and produced a good clinical response. At her visit about 7 weeks after stopping itraconazole, agminated papulopustules on erythematous bases were seen on her right forearm. Trichophyton mentagrophytes was isolated on the culture of skin scraping from the surface of agminated lesions. She was successfully treated with oral fluconazole 150 mg weekly for 6 weeks and topical flutrimazole and isoconazole.

Foreign Body Granuloma Following Dried Honey Bee Venom (Apitoxin Inj) Injection / 대한피부과학회지

Bee sting therapy is sometimes used for the treatment of chronic recalcitrant neuralgia and arthralgia in traditional Korean herbal medicine, but retained sting materials at the treatment site may induce granulomatous inflammation. Recently, dried honey bee venom (Apitoxin Inj, Guju Pharma. Co., Seoul, Korea) has been approved by the Korea Food and Drug Administration (KFDA) as an anti-inflammatory drug. The adverse events associated with dried honey bee venom injection include itching, edema, pain, headache, fever and myalgia, but foreign body granuloma caused by drug injection has not been previously reported. We herein report two interesting cases of foreign body granuloma induced by dried honey bee venom injection.

Sutureless Burow's Graft Using Adhesive Skin Tape (Steri-strip(R)) / 대한피부과학회지

Immobilization of skin grafts on the recipient bed is essential for graft survival. There are several methods of securing skin grafts to the recipient wound bed. Classically, nylon basting sutures and a tie-over bolster dressing are commonly used. This method is currently recognized to ensure that the full thickness skin grafts "take"; however, this method is complicated and time-consuming. Moreover, suturing in this manner may also pull the edges of the skin with too much tension, cause elevation and crater-like deformity and suture marks. We experienced two cases of sutureless Burow's graft using skin tapes to reconstruct a skin defect after Moh's micrographic surgery. Instead of the conventional method, the Steri-strip(R) was used to fix the graft and a light compressive dressing with dry gauze and Tegaderm(R) was applied over the graft. This method has the advantage of being convenient to apply and remove, time-saving and inexpensive. Therefore, we recommend the use of the sutureless method using skin tape as an alternative to suturing small skin grafts, and particularly for the relatively immobile areas on the face.

Clinicohistopathological Study of Recurrent Basal Cell Carcinomas after Surgical Excision / 대한피부과학회지

BACKGROUND: Basal cell carcinoma in Korea is the most common skin cancer and its incidence is increasing at a steady rate. It is not unusual for dermatologists to experience the recurrence of tumor after surgery but there is no data on recurrent basal cell carcinoma in Korea. OBJECTIVE: The aim of this retrospective survey was to determine the clinical and histopathological characteristics of recurrent basal cell carcinoma after surgical excision in Korean patients. METHODS: We analyzed clinical findings and histopathologic subtypes of 21 cases of recurrent basal cell carcinoma after surgical excision among 480 cases diagnosed between January of 1980 and December of 2006 at the Department of Dermatology, Chonbuk National University Hospital. RESULTS: Overall recurrence rate was 4.38%. The average interval between the surgical excision of the primary tumor and recurrence was 40.8 months. The mean age of the patients was 65.1 years old and the ratio of men to women was 1 : 2. The most frequent location of the tumor recurrence was the nose and the mean size was 1.2 cm. There were no immunocompromised patients with underlying disorders, but two patients had taken corticosteroid for an extended period of time. The most common histological subtype of the primary and the recurrent basal cell carcinoma was nodular type. Six cases of primary basal cell carcinomas of nodular type transformed to aggressive subtype when they recurred. Perineural involvement of the primary basal cell carcinoma was found in 5 cases. CONCLUSION: This study demonstrates the clinicopathological features of recurrent basal cell carcinoma in the Korean population and we hope this data would be of help to dermatologists when treating Korean patients with basal cell carcinoma.

Two Cases of Tinea Capitis Caused by Microsporum canis in Elderly Women / 대한의진균학회지

Tinea capitis is the most common in children, but can be seen in adults. In the adult population, tinea capitis is more frequent in elderly women than other adults. We report two cases of tinea capitis occurring in an 85-year-old female and an 80-year-old female. The vertex of the former showed an erythematous scaly patch with slight hair loss and the scalp of the latter showed a painful erythematous plaque with severe hair loss. From two patients, Microsporum canis was isolated.

Two Cases of Pityriasis Amiantacea / 대한피부과학회지

Pityriasis amiantacea is a distinct scalp disease characterized by asbestos-like, thick, adherent scales that engulf and bind down tufts of hair. Herein, we report two cases of pityriasis amiantacea. One case was a 75-year-old female who showed simultaneous keratotic follicular papules and psoriasiform dermatitis on her body. The other case was a 14 year old female showing seborrheic dermatitis on her face. Previously, only one case of pityriasis amiantacea had been reported in Korea.

A Case of Sebaceous Trichofolliculoma / 대한피부과학회지

Sebaceous trichofolliculoma is a rare benign tumor and represents a variant of trichofolliculoma. It presents as a centrally depressed solitary tumor and occurs in areas rich in sebaceous lobules. Microscopically, it shows keratin-filled cystic cavities and sebaceous lobules. The lobules are connected to the cystic wall. Herein we report a case of sebaceous trichofolliculoma on the right cheek in a 64-year-old man.