The Influence of Life Stress and Sleep Disturbance on White Matter Integrity

Objective@#This study investigated whether sleep and stress mutually interact to induce changes in white matter integrity. @*Methods@#Diffusion tensor imaging (DTI) was conducted on 36 participants (male=22, female=14; mean age=38.33±12.78 years). Participants were divided into three groups depending on their sleep quality and stress levels: poor sleepers with stress, poor sleepers without stress, and good sleepers. Sleep quality and stress level were evaluated using the Pittsburgh Sleep Quality Index and the Life Experiences Survey, respectively. Fractional anisotropy (FA) values were calculated employing DTI tractography. @*Results@#After controlling for age and sex, poor sleepers with stress exhibited a lower FA of the left inferior cerebellar peduncle (ICP) than did poor sleepers without stress (t=2.81, p=0.02). Poor sleepers without stress showed a higher FA of the right middle longitudinal fasciculus (MdLF) than did good sleepers (t=3.35, p=0.006). @*Conclusion@#The current study reports the effects of sleep, stress, and their interaction on the white matter integrities of the ICP and MdLF. ICP change seems to be associated with sleep disturbances related to stress, while MdLF change would be associated with sleep disturbances unrelated to stress.

Sleep Reactivity and Sleep Efforts in Shift Workers

Objective@#The current study aimed to investigate the differences in sleep reactivity and sleep effort differs among late night shift workers (LSWs) and non-late night shift workers (non-LSWs), and non-shift workers (non-SWs). @*Methods@#In total, 6,023 participants (1,613 non-SWs, 3,339 LSWs, and 1,071 non-LSWs) were recruited. Non-SWs was defined as those who works at fixed schedules during standard daylight. LSWs was defined as who work late night hours (10 PM–6 AM), while non-LSWs was SWs who did not work during late night. All completed the Ford Insomnia Response to Stress Test (FIRST), the Glasgow Sleep Effort Scale (GSES), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), and the short-term Center for Epidemiologic Studies-Depression scale (CES-D) through online survey. @*Results@#LSWs and non-LSWs reported higher FIRST, GSES scores than non-SWs. In addition, LSWs reported higher FIRST, GSES scores than non-LSWs. FIRST scores were correlated with CES-D, PSQI, ISI, and ESS for LSWs, non-LSWs, and non-SWs alike. GSES scores were also correlated with CES-D, PSQI, ISI, and ESS for LSWs, non-LSWs, and non-SWs alike. @*Conclusion@#SWs showed higher sleep reactivity and sleep effort than non-SWs. LSWs had higher sleep reactivity and sleep effort than non-LSWs, and these variables are associated with insomnia, daytime sleepiness, and depressive symptoms. Our findings suggests that late night schedule, may increase sleep reactivity and sleep effort, which are associated with sleep and mood disturbances.

Suicide Method, the Recent Stressors, Psychiatric Diagnosis of Suicide Attempters and Suicide Completers / 수면정신생리

Objectives@#Suicide is the major public mental health concerns all over the world. The comparison of suicide attempters and suicide completers could be the fundamental evidence for the suicide prevention. The aim of this study is to explore the differences between suicide attempters and suicide completers in terms of the stressors, suicide methods, and psychiatric diagnosis. @*Methods@#Two types of secondary data were collected for the analyses. Data of the suicide attempters (n = 680) were gathered by intensive reviewing the medical records of Samsung Medical Center, Seoul, Republic of Korea. Data of suicide completers (n = 11,722) were collected by the psychological autopsy data which were gathered by Korean Foundation for Suicide Prevention. Suicidal methods, psychiatric disorders and stressors before suicidal attempt were compared between suicide attempter and completers. @*Results@#Suicide completers were older and male predominant compared to suicidal attempt. Hanging or gas intoxication were more commonly used in the suicide completion, while wrist cutting or drug intoxication were more common in suicide attempters. All types of stressors were found to be high in suicide completers than suicide attempters. However, the proportion of economic and physical stress were greater in suicide completers, while the proportion of family stress were greater in suicide attempters. According to the recorded diagnoses, the rates of depressive disorders, sleep-wake disorders, substance-related disorders were higher in suicide completers, while the rates of anxiety disorders and trauma- and stressor-related disorders, bipolar and related disorders and somatic symptom disorders were higher in suicide attempters. However, after controlling the gender and age, there were no significant differences in diagnosis between suicide attempters and suicide completers. @*Conclusion@#These findings implicate that suicide attempters and completers differed in suicide methods and type of stress. The results suggests that economic stressors, physical illness might raise the risk of suicide completion.

Effects of Organic Light-Emitting Diodes on Circadian Rhythm and Sleep

Objective@#Organic light-emitting diodes (OLEDs) emit less blue light than traditional light-emitting diodes (LEDs), and we previously found that early-night OLED light exposure (LE) delays the melatonin phase by less than LED at a color temperature of 4,000 K. As a follow-up study, we investigated the effects of OLED and LED at a different color temperature (3,000 K) on melatonin profile, sleep, and vigilance. @*Methods@#24 healthy subjects (27.5±5.1 years) were exposed to three light conditions [OLED, LED, and dim light (DL)] from 17:30 to 24:00, in a random order and with a 1-week interval. Saliva samples for melatonin were taken every hour from 18:00 to 24:00. Polysomnography (PSG) and a psychomotor vigilance test (PVT) were performed. @*Results@#Melatonin onset time was significantly delayed under OLED and LED compared with DL, with no significant difference between OLED and LED. The mean melatonin level at 24:00 under LED was lower than that under DL, but there was no significant difference between OLED LE and DL. The percentage of slow wave sleep (N3) in LED was significantly lower than in OLED. @*Conclusion@#Exposure to light in the evening can suppress melatonin secretion late at night and disturb deep sleep, and those effects are slightly worse under LED than OLED.

Effects of Organic Light-Emitting Diodes on Circadian Rhythm and Sleep

Objective@#Organic light-emitting diodes (OLEDs) emit less blue light than traditional light-emitting diodes (LEDs), and we previously found that early-night OLED light exposure (LE) delays the melatonin phase by less than LED at a color temperature of 4,000 K. As a follow-up study, we investigated the effects of OLED and LED at a different color temperature (3,000 K) on melatonin profile, sleep, and vigilance. @*Methods@#24 healthy subjects (27.5±5.1 years) were exposed to three light conditions [OLED, LED, and dim light (DL)] from 17:30 to 24:00, in a random order and with a 1-week interval. Saliva samples for melatonin were taken every hour from 18:00 to 24:00. Polysomnography (PSG) and a psychomotor vigilance test (PVT) were performed. @*Results@#Melatonin onset time was significantly delayed under OLED and LED compared with DL, with no significant difference between OLED and LED. The mean melatonin level at 24:00 under LED was lower than that under DL, but there was no significant difference between OLED LE and DL. The percentage of slow wave sleep (N3) in LED was significantly lower than in OLED. @*Conclusion@#Exposure to light in the evening can suppress melatonin secretion late at night and disturb deep sleep, and those effects are slightly worse under LED than OLED.

The Moderating Effect of Sleep Disturbance on the Association of Stress with Impulsivity and Depressed Mood

Objective@#This study was performed to investigate the associations of life event stress with impulsivity, anxiety, and depressed mood as a function of the presence of a sleep disturbance. @*Methods@#In total, 214 participants (age 38.96±10.53 years; 111 females) completed self-report questionnaires, including the Life Experience Survey (LES), Pittsburgh Sleep Quality Index (PSQI), Barratt’s Impulsivity Scale (BIS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). The presence of a sleep disturbance was defined as a PSQI score >5. @*Results@#In total, 127 participants presented with a sleep disturbance (age 39.33±10.92 years; 64 females), whereas the remaining 87 did not (age 38.43±9.97 years; 47 females). Negative LES scores were significantly correlated with BIS (r=0.22, p=0.001), BAI (r=0.46, p< 0.001), and BDI (r=0.51, p<0.001) scores, and PSQI scores were significantly correlated with BAI (r=0.49, p<0.001) and BDI (r=0.60, p< 0.001) scores. Moderation analysis revealed statistically significant interactions between negative LES scores and the presence of a sleep disturbance on BIS (p=0.044) and BDI (p=0.014) but not on BAI (p=0.194) scores. @*Conclusion@#The findings of the present study suggest that life event stress has varying degrees of influence on mental health, especially impulsivity and depressed mood, depending on the presence or absence of a sleep disturbance.

The Effectiveness of Cognitive Behavioral Therapy on Depressive Symptoms in North Korean Refugees

Objective@#Despite the growing need for psychological programs for North Korean refugees, most psychological interventions for these people lack a verification study that tests their effectiveness. This study aims to evaluate the effectiveness of cognitive behavioral therapy (CBT) in North Korean refugees. @*Methods@#Participants included 38 North Korean refugees, of whom 23 participated in simple relaxation and 15 participated in CBT. The Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D), State-Trait Anxiety Inventory-State (STAI-S), and Impact of Event Scale-Revised were used to evaluate symptoms pre- and post-intervention. @*Results@#Participants had a significant decrease in CES-D scores after treatment (p=0.037). The decrease in CES-D was larger in those who participated in the CBT compared to those in simple relaxation (p=0.023). The superior effects that CBT had on depressive symptoms over simple relaxation were particularly more prominent in those with severe depression (p=0.035). Participants with high levels of anxiety also showed significant decreases in STAI-S scores after treatment, regardless of which type of program they participated in (p=0.023). @*Conclusion@#This preliminary findings suggests that CBT is an effective psychiatric approach in treating depressive symptoms in North Korean refugees, especially for those with a higher degree of depressive symptom.

Recent Advances in Diagnosis and Treatment of Sleep Disorders / 신경정신의학

No abstract available.

Recent Advances in Diagnosis and Treatment of Insomnia Disorder / 신경정신의학

The diagnostic concepts of insomnia are controversial. New diagnostic criteria of insomnia disorder have been published in the International Classification of Sleep Disorders (ICSD-3) and the Diagnostic and Statistical Manual of Mental Disorder (DSM-5). Both the ICSD-3 and DSM-5 did not accept the concept of secondary and primary insomnia. According to the ICSD-3 and DSM-5, insomnia disorder can be diagnosed, even with a comorbid mental or sleep disorder. The medical, psychiatric, and sleep history are essential for the diagnosis of insomnia disorder. Polysomnography can be helpful for differential diagnoses or the clinical subtyping of insomnia disorder. Recently, the European and American Sleep Society published clinical guidelines for the treatment of insomnia. Both guidelines strongly recommended non-pharmacological treatment (e.g., cognitive behavioral disorder for insomnia) as a treatment of choice for insomnia. Pharmacological treatments for insomnia are weakly recommended only for a short time. New non-pharmacological and pharmacological treatments for insomnia disorder are being developed and studied.

Assessment and Understanding of Chronotype / 수면정신생리

Chronotype (CT) is defined as an inter-individual difference in sleep-wake cycles and daily activities. Previous studies have suggested that this individual difference can influence our biological and psychological functioning. Literature regarding the psychometric properties and validity of CT measures are reviewed. We provide an overview of biological indicators (sleep-wake cycle, body temperature, cortisol, and melatonin) that are used for distinguishing two chronotypes: morningness (MT) and eveningness (ET). We also review the differences between CT in relation to personality traits and the occurrence of psychopathology. In addition, the methodological limitations of studies on CT are discussed. Finally, future research directions in terms of CT are proposed.

Insufficient Sleep and Visuospatial Memory Decline during Adolescence / 수면정신생리

OBJECTIVES: The objective of this study was to investigate the correlation between insufficient sleep and visuospatial memory in adolescents using a computerized neurocognitive function test. METHODS: A total of 103 high school students (26 males and 77 females; mean age 17.11 ± 8.50 years) without a serious psychiatric problem was recruited. All subjects were requested to complete a self-report questionnaire about weekday total sleep time and weekend total sleep time. The epworth sleepiness scale (ESS) and the beck depression inventory (BDI) were administered to measure daytime sleepiness and symptoms of depression. Seven subsets of the Cambridge Neuropsychological test automated battery were examined to assess visuospatial memory. RESULTS: After controlling for age, sex, ESS, and BDI, longer weekend total sleep time was correlated with poor performance on delayed matching to sample (r = −0.312, p = 0.002) and immediate recall on pattern recognition memory (r = −0.225, p = 0.025). Increased weekend catch-up sleep time was correlated with poor performance of delayed matching to sample (r = −0.236, p = 0.018), immediate recall on pattern recognition memory (r = −0.220, p = 0.029), and delayed recall on pattern recognition memory (r = −0.211, p = 0.036) after controlling for age, sex, ESS, and BDI. CONCLUSION: This study showed that increased weekend catch-up sleep time reflecting insufficient weekday sleep were associated with poor performance in delayed recall tasks of visual memory. This finding suggests that insufficient sleep during adolescence might produce a decline of visuospatial memory.

Sleep and Anger / 수면정신생리

Anger is a multi-dimensional concept ranging from feeling irritable to violent aggression. A growing body of literature suggests the relevance of sleep in regard to anger. The current study aims to review previous studies on the association between anger and diverse aspects of sleep including sleep disruption, chronotype, sleep disorders and sleep deprivation. An association between sleep and anger has been observed starting in the early stage of life, with sleep of infants or toddlers affecting emotional and behavioral aspects of anger. However, the association between anger and sleep is not clear in adolescents and might be due to the effects of psychosocial factors on both sleep and anger during adolescence. Subjective but not objective sleep disturbances of adults have been also associated with anger. Evening types showed more anger, which might be mediated by psychological characteristics or social jet lag of evening people. Increased anger has also been found in those with insomnia, sleep apnea, or experimental sleep-deprivation. Previous studies have reported that diverse sleep disturbances are related to anger. Future study assessing the various sleep or circadian indices and considering the multidimensional aspects of anger are needed.

Development of Korean Social Affective Visual Stimuli / 수면정신생리

OBJECTIVES: The current study aims to develop Korean Social Affective Visual Stimuli (K-SAVS) to arouse social affect. METHODS: K-SAVS is composed of pictures of social situations among East Asians. Each picture contains a negative, positive, or neutral affect. Positive and negative stimuli were presented to one group of subjects. Negative and neutral stimuli were presented to another group of subjects. All subjects were required to fill out Affective Valence and Arousal Manikin. RESULTS: In the initial test, 18 positive affective stimuli pictures (1 set) and 36 negative affective stimuli pictures (2 sets) were chosen from 95 stimuli pictures. Positive affective stimuli pictures showed higher valence (p < 0.001) and lower arousal (p < 0.001) than negative affective stimuli pictures. In the confirmatory test, 18 neutral stimuli pictures (1 set) were additionally selected out of the total of 79 pictures of neutral stimuli pictures and the pictures used in the former experiment. Neutral stimuli pictures showed higher valence (p < 0.001) and lower arousal (p < 0.001) than negative affective stimuli pictures. CONCLUSION: K-SAVS can be a valid and useful tool for inducing specific social affects of Koreans.

Association of Anxiety, Depression, and Somatization with Menstrual Problems among North Korean Women Defectors in South Korea

OBJECTIVE: North Korean women defectors have suffered from anxiety, depression, and somatization after defection. Also they have had many menstrual problems like amenorrhea. This study was done to identify the correlations of anxiety, depression, and somatization to menstrual problems among North Korean woman defectors in South Korea. METHODS: The participants in this study were 126 women from 5 government resettlement centers throughout South Korea. Questionnaires which included State-Trait Anxiety Inventory (STAI), Center for Epidemiological studies-Depression Scale (CED-S), and Symptom Checklist-90-Revised (SCL-90-R) were used to identify anxiety and somatization. Data were collected between June and September, 2012. RESULTS: The women reported the following problems; amenorrhea (9.5%), hypomenorrhea (13.6%), menorrhagia (19.8%), polymenorrhea (13.5%), oligomenorrhea (4.8%), changes in amount of menstrual discharge (4.0%), and changes in amount of blood clot (9.5%). Anxiety (r=0.20, p=0.002), depression (r=0.25, p=0.005), and Somatization (r=0.35, p<0.001) were correlated with number of menstrual problems. CONCLUSION: The results of this study indicate that mental health services need to be taken into account in interventions for North Korean woman defectors to improve their reproductive health including addressing menstrual problems.

Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms

OBJECTIVE: We investigated the prevalence of insomnia and its clinical characteristics in North Korean refugees. METHODS: North Korean refugees living in South Korea (48 males, 129 females; mean age 38.22+/-12.24 years) and South Koreans (112 males, 203 females; mean age 39.48+/-10.32 years) completed the following questionnaires: the Self-reported Questionnaire on Insomnia, Center for Epidemiological Studies-Depression Scale (CES-D), Trauma Exposure Check List for North Korean Refugees, and the Impact of Event Scale-Revised (IES-R). RESULTS: North Korean refugees had insomnia more often than South Koreans did (38.42% vs. 8.89%). Depression combined with insomnia was also more prevalent in North Korean refugees (28.25% vs. 3.17%). Compared with South Koreans with insomnia, North Korean refugees with insomnia showed higher CES-D scores. The North Korean refugees with insomnia had experienced a larger number of traumatic events, and had higher CES-D and IES-R scores compared to North Korean refugees without insomnia. Insomnia in North Korean refugees was also associated with the presence of significant depressive and post-traumatic stress disorder (PTSD) symptoms. CONCLUSION: Insomnia was common in North Korean refugees and was closely associated with depressive and PTSD symptoms. Our study suggests that complaints of insomnia may indicate more severe psychopathology, especially in refugees.

Effects of Psychiatric Symptoms on Attention in North Korean Refugees

OBJECTIVE: We investigated the performance of North Korean refugees on attention tasks, and the relationship between that performance and psychiatric symptoms. METHODS: Sustained and divided attention was assessed using the computerized Comprehensive Attention Test in North Korean refugees and in South Koreans. All participants also completed the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale-Revised and the Dissociative Experiences Scale-II (DES-II). RESULTS: The North Korean refugees showed slower reaction times (RTs) on the visual sustained attention task compared to the South Koreans after controlling for age and sex. North Korean refugees had a greater number of omission errors (OEs) on the divided attention task and a higher standard deviation (SD) of RT. Total DES-II scores of the North Korean refugees were associated with the number of OEs and the SD of RT on the sustained attention task, and with the number of OEs on the divided attention task. CONCLUSION: North Korean refugees showed poorer performance on computerized attention tasks. In addition, attention deficit among North Korean refugees was associated with their dissociative experiences. Our results suggest that refugees may have attention deficits, which may be related to their psychiatric symptoms, particularly dissociation.

Relationship between Perceived Stigma for Psychological Helps and Depression in North Korean Defectors / 신경정신의학

OBJECTIVES: This study was implemented for North Korean defectors to understand the relationship between perceived stigma for psychological helps and depression. METHODS: Two hundred defectors from North Korea were subjects in this study, including 28 males and 172 females. Both self-questionnaires and interviews were conducted. Patient Health Questionnaires-9 (PHQ-9) was used to measure depression scores. Stigma Scale for Receiving Psychological Help (SSRPH) for stigma and Multidimensional Scale of Perceived Social Support (MSPSS) were used to determine social supportive levels that they recognize. RESULTS: In the initial analysis, SSRPH was associated with PHQ-9. Multiple regression analysis to identify the relationship of stigma for subjects' psychological helps on depression showed that staying longer than five years in the third country, working, high MSPSS score, and low SSRPH were negatively associated with the PHQ-9. CONCLUSION: The stigma among North Korean defectors for psychological help is positively associated with depression. Perceived stigma may act as a barrier to the initiation and maintenance of psychiatric treatment who subjects in need of psychological help. Understanding the relationship between perceived stigma for psychological help and depression is important.

Difference of Traumatic Experience according to Menstrual Regularity among North Korean Woman Refugees in South Korea

PURPOSE: This study aimed to investigate the differences of traumatic experience according to menstrual regularity among North Korean woman refugees in South Korea. METHODS: This study used a sample of convenience consisting of 131 women in 5 government resettlement centers throughout South Korea. The traumatic experiences scale for North Korean defectors was used for identifying traumatic experience. Data were collected between June 2012 and December 2012. Data was analyzed using mean, percentage, and t-test. RESULTS: The rate of irregular menstruation was 35.1%. Irregular menstruation group had more traumatic experiences than regular one (t=-1.78, p=.038). CONCLUSION: This study demonstrates that their reproductive health promotion was necessary regarding menstrual problem. Also, their severe traumatic experiences were considered into healthcare program.

The Impact of Celebrity Suicide on Subsequent Suicide Rates in the General Population of Korea from 1990 to 2010

The association between celebrity suicide and subsequent increase in suicide rates among the general population has been suggested. Previous studies primarily focused on celebrity suicides in the 2000s. To better understand the association, this study examined the impacts of celebrity suicides on subsequent suicide rates using the data of Korean celebrity suicides between 1990 and 2010. Nine celebrity suicides were selected by an investigation of media reports of suicide deaths published in three major newspapers in Korea between 1990 and 2010. Suicide mortality data were obtained from the National Statistical Office of Korea. Seasonal autoregressive integrated moving average models with intervention analysis were used to test the impacts of celebrity suicides, controlling for seasonality. Six of the 9 celebrity suicides had significant impacts on suicide rates both in the total population and in the same gender- or the same age-subgroups. The incident that occurred in the 1990s had no significant impact on the overall suicide rates, whereas the majority of the incidents in the 2000s had significant influences for 30 or 60 days following each incident. The influence of celebrity suicide was shown to reach its peak following the suicide death of a renowned actress in 2008. The findings may suggest a link between media coverage and the impact of celebrity suicide. Future studies should focus more on the underlying processes and confounding factors that may contribute to the impact of celebrity suicide on subsequent suicide rates.

Mental Health of Disaster Workers / 신경정신의학

We sought to gain insights on the prevalence of psychiatric disorders, the risk and protective factors and the prevention and intervention programs of mental health problems among disaster workers. The prevalence of Posttraumatic Stress Disorder (PTSD) among disaster workers was higher than that of the general population and lower than that of disaster survivors. They might suffer from various mental health problems and comorbid disorders. Those mental problems could affect not only their physical health but also self-medication, life satisfaction, and job functioning. Heterogeneous and various factors were positively and negatively associated with psychiatric problems. Prevention and intervention programs were summarized for PTSD among disaster workers. Self-help technique 'RESCUE' and cognitive behavior therapy, developed especially for disaster workers was introduced. Future research and directions were suggested.