History of the Korean Mental Health Act / 신경정신의학

The aim of this study was to review the history of the Korean Mental Health Act. The Korean Mental Health Act was enacted in 1995 and revised over the next 15 years. We analyzed these changes over time from the viewpoint of the mental health system. Social systems influenced the Mental Health Act through the mental health system. The first Korean Mental Health Act in 1995 was enacted under the industrial age model and as such, supported long-term hospitalization. This was despite the introduction of a preliminary community mental health model. Subsequently, the Korean Mental Health Act has evolved into one which fully supports a community mental health model. Despite the fact that the Korean Mental Health Act plays an important role in Korea, more research is required to improve and thus, ensure a more effective Korean mental health system.

Comparison of Major Procedures of Korean Mental Health Law with Other Developed Countries / 신경정신의학

OBJECTIVES : The Mental Health Act is an initiative aimed at changing and shaping mental health services and protecting human rights of persons with mental disorders. Since the Mental Health Act was legislated in 1995, four amendments have been made according to the issues that arose from public concerns. However, there are still many debates about the human rights protection of the mentally ill. This study aimed to provide information regarding major aspects of the Mental Health Act by comparing them among several developed countries. METHODS : Current Mental Health Acts of the state of Michigan in the United States, Scotland in England, the state of Victoria in Australia, and Japan were reviewed. Issues regarding the Korean Mental Health Act were collected from seminar materials, news media contents, and mental health professionals. RESULTS : The definition of subjects in Korean Mental Health Act was more inclusive than other countries and was derived from a medical classification of mental illness. Family members or guardians were granted important responsibilities for deciding the involuntary admission of mentally ill patients in Korea and Japan. In Western countries, Mental Health Review Tribunals or courts have the primary responsibility for important decisions about mentally ill patients. The regulation of immediate discharge after request by voluntarily admitted patients was not enacted in all countries except Korea. The mandatory procedure for involuntary admission in Western countries includes an individual case review with personal interview by a Mental Health Review Tribunal or court. CONCLUSION : The Korean Mental Health Act appears to meet the basic standards of Guidelines from international organizations. Our traditional culture and inherent health systems seem to influence the legal regulation of mental health service and might be related to the problems of human rights protection of mentally ill patients in Korea.

Implication of the Global Burden of Disease Caused by Psychiatric Disorders in the Viewpoint of Mental Health Professionals / 신경정신의학

OBJECTIVES: The aim of this study was to investigate how mental health professionals in Korea evaluate the burden of disease caused by psychiatric disorders and to propose future directions of the public mental health policies. METHODS: A questionnaire was mailed to 240 mental health professionals, who were composed of psychiatrists from mental hospitals and staffs who are nurses, clinical psychologists and social workers working in the community mental health centers in June, 2004. Two hundred twenty four out of two hundred forty subjects (93.3%), which were composed of 104 psychiatrists and 120 staffs, completed the questionnaire. The questionnaire included 6-item questions about the burden of disease in Korea. RESULTS: Mental health professionals reported that the five diseases with the biggest burden were malignant neoplasms, traffic accidents, schizophrenia, alcohol use disorders and cerebrovascular diseases, consecutively. The burden of alcohol use disorders, cerebrovascular diseases, traffic accidents, unipolar depressive disorder and malignant neoplasms are expected to increase over the next several years. The proportions of psychiatric disorders among all the diseases in terms of burden of disease and medical costs were estimated as 18.4% (+/-12.8) and 12.0% (+/-11.7) respectively. CONCLUSION: This study showed that many of Korean mental health professionals have under-estimated burden of psychiatric disorders, especially, unipolar depressive disorder. It would be necessary to emphasize the importance of unipolar depressive disorder in applying educational and public programs for the mental health professionals, as well as for the general population.

Length of Stay of Psychiatric Patient and Its Correlate in Mental Health-related Facilities / 신경정신의학

OBJECT: This study was aimed to find the contributing factors that influence the length of stay in mental health related facilities and to present future direction for the mental health policy. METHODS: The 1,875 patients who are aged between eighteen and sixty-five are chosen by the stratified random sampling from ten psychiatric hospitals, six psychiatric nursing facilities and five homeless asylums. We investigate about length of stay of all subjects by sociodemographic characteristics, socioeconomic status, functional status, disease related characteristics and analyse contributing factors. RESULTS: From total subjects, average length of stay was 1,906 days, and facilities, where subjects are institutionalized, explains 40% of length of stay. Other related factors are female, old age, single, lack of supportive system before admission and after discharge, medical assistance type I, unavailable of public transportation and utility, long duration of illness, and psychotic disorder. CONCLUSION: For lowering the rate of long-term hospitalization, evaluation of appropriateness is needed for admission to nursing facility and homeless asylum and make up for the medical payment system and the supportive system from family and community.

Discrimination of Mentally Ill Persons in Korean Legislative System / 신경정신의학

OBJECTIVES: The review of Korean legislative system may contribute to minimize the stigma and prejudice related to mental illness. We tried to search and revise the sentences that dicriminate against the mentally ill or are incompatible to contemporary concept of psychiatry in all Korean laws. METHODS: While screening 5,626 laws which were promulgated till August 30th, 2002, we singled out the statutes including the stigma and prejudice related to mental illness in the homepage of the Ministry of Legislation. RESULTS: There were thirty-nine statutes discriminating against mental disorder. The number of statutes related to confering the certificate was 23. Nine laws stipulated to violate the right of psychiatric patients. Seven miscellaneous ones were judged for further evaluation. The most frequent terms used in legislation were 'mental illness' and 'psychosis'. 'Odd persons', 'impairment in mental function', and 'schizophrenia' followed in decreasing orders. Two delphi survey leaded to a tentative conclusion that terminology of 'psychosis' should be replaced by 'psychotic disorder with impaired reality testing'. Most of experts recommended to delete unnecessary clauses of laws to reduce misunderstanding about mentally ill. CONCLUSION: There exists the terms and expressions stipulating discrimination against mentally ill in Korean legislation. It is an urgent issue to revise the laws with experts' opinions in order to reduce prejudice and discrimination against mentally ill.

The Patterns of Antipsychotic Drug Use in Schizophrenic Patients Registered at the Day Rehabilitation Programs of Mental Health Centers / 대한정신약물학회지

OBJECTIVE: This study was to explore the use patterns of antipsychotic drugs in schizophrenic patients who registered at the day rehabilitation programs in mental health centers. METHODS: The sociodemographic and clinical data for individual patients registered at the day rehabilitation programs in 16 mental health centers were gathered from the questionnaires reported by patients and mental health center workers, respectively. Schizophrenic patients were divided into the two groups, the conventional antipsychotics group and the atypical antipsychotics group, in order to identify the selection factors for the prescription of antipsychotic drugs among the sociodemographic characteristics and clinical variables. RESULTS: Three hundred forty seven chronic mentally ill patients had been registered at day rehabilitation programs of 16 mental health centers in year 2002. Among them, 301 patients had the diagnosis of schizophrenia with more male patients than female patients as 58.8% vs 41.2%. The patients aged in twenties and thirties were 78.4% and 52.5% of the patients reported the high school as the educational background. Two hundred forty nine (82.7%) patients were unmarried so that their caretakers were mostly parents and their medical health services were covered by national health insurance in 73.7% of the patients. And 288 schizophrenic patients (95.7%) administered antipsychotic drugs as the drug of treatment. One hundred sixty individuals (53.2%) of the schizophrenic patients administered atypical antipsychotic drugs. The patients in the atypical antipsychotics group were younger in average ages, had the shorter duration of illness, visited secondary or tertiary psychiatric facilities more and used anticholinergics or anxiolytics less than those in conventional antipsychotics group. CONCLUSION: This study suggests that two sociodemographic variables of medical health services and psychiatric facilities might influence the prescription of antipsychotic drugs, conventional or atypical. And medical health services were inter-related with age and duration of illness.

Characteristics of Age Groups in Schizophrenic Patients Registered at Day and Vocational Rehabilitation Programs in Community Mental Health Centers / 신경정신의학

OBJECTIVES: This study was to demonstrate sociodemographic and clinical characteristics, and effectiveness of programs by age groups for schizophrenic patients who were attending day rehabilitation programs in community mental health centers. METHODS: The sociodemographic and clinical data including psychiatric history and various rating scales for individual patients attending day rehabilitation programs in 16 mental health centers were gathered from the questionnaire self-reported by patients and interviewed by mental health center workers. Among 301 schizophrenic patients, the data of 289 patients of 20 to 49 years old were analyzed for the study. RESULTS: The patients in the younger ages tend to be more unmarried, highly educated, covered by medical insurance, to have parents as main care-giver, more family members living with, shorter duration of illness, use atypical antipsychotic drugs, to show lower attendance rate of day programs, higher BPRS and low GAF scores compared to the patients in the older ages. The older patients are likely to be more married and less educated, in medicaid, to have more conventional antipsychotic drugs, relatively lower lower BPRS scores and higher GAF scores. CONCLUSION: This study suggests that the day rehabilitation programs in mental health centers have positive effects on psychosocial rehabilitation of schizophrenic patients across all the age groups. However, many characteristics of schizophrenic patients in mental health centers were different across their age groups, suggesting that there should be age-specific considerations for the programs in the mental health centers.

Effect of the Genotypes of ALDH II and the Ways of Coping with Stress on the Alcohol Use in Freshmen of a University / 신경정신의학

OBJECTIVES: The authors investigated the genotypes of ALDH II and the ways of coping with stress affecting the alcohol use of university freshmen to see the differences associated with the alcohol use according to genotype. METHODS: Five hundred fifty one Chungbuk National University freshmen were investigated on the amount of alcohol consumption per episode, the frequency of alcohol use, and the ways of coping with stress by using a self-questionnaires. Their blood samples were also analysed for their ALDH II genotypes by PCR-RFLP method. The degree of alcohol use was calculated by integrating the amount and the frequency of alcohol use, was assessed according to ALDH II genotype, sex, the ways of coping with stress associated. Collected data was analysed by stepwise multiple linear regression analysis according to genotype and sex. RESULTS: There was a significant difference of the amount of alcohol use per episode according to ALDH II genotype. But there was no difference of the frequency of alcohol use according to ALDH II genotype. Subjects with ND and DD genotype showed significantly lower degree of alcohol use than NN genotype. Women showed significantly lower amount, frequency and degree of alcohol use than men. Active coping, emotional expression, religious seeking, and support seeking for problem solving were associated with the degree of alcohol use in the group with D allele. Religious coping and fatalism were associated with the degree of alcohol use in women. CONCLUSION: There are significant differences of the degree of alcohol use and the ways of coping to stress according to sex and ALDH II genotype.

Factors Influencing on Length of Stay in a Psychiatric Open Ward of a General Hospital / 신경정신의학

OBJECTIVES: The cost of psychiatric service is increasing every year in Korea. The length of inpatient stay (LOS) is an important factor determining in-patient service cost. This study was aimed to find the factors that influence LOS in a psychiatric open ward of a general hospital. METHODS: The study includes 134 inpatients who were consecutively admitted to a psychiatric open ward in a general hospital from January 1st to June 30th in 2001. Demographic data, clinical characteristics on admission and discharge, global functioning, social support levels and life stressors were collected. RESULTS: The mean LOS for the 134 patients was 15.5 days (S.D 9.2). The occupation of housekeeper and those secred high in phobic anxiety subscale on SCL-90-R were statistically significant predictor for longer LOS in the univariate analysis. No significant differences in LOS were found by diagnostic groups and social support. In multiple regression analysis, the scores of phobic anxiety subscale, occupation and presence of physical illness were statistically significant predictor for LOS. CONCLUSION: This study failed to find the significant variables to account for substantial proportion of variance for LOS.

Influencing Factors on Length of Stay of Psychiatric Patients in Mental Health-related Facilities / 신경정신의학

OBJECTIVES: The objective of this study was to explore the explanatory factors on the length of stay of psychiatric patients in various mental health-related facilities. METHODS: Subjects in this study were consisted of 1,028 psychiatric patients staying in 22 mental health-related facilities randomly sampled after proportional stratification by regions. The subjects in 22 mental health-related facilities including psychiatric hospitals/clinics, psychiatric welfare facilities, welfare facilities for homeless, and illegal institutions were interviewed by psychiatrists and social workers with clinical experience. Demographic characteristics, socioeconomic support, diagnosis/history of illness, clinical symptom/functional disability and type of facilities were investigated and included in the multiple regression models to examine their influence on the length of stay. RESULTS: Two thirds of total variance of length of stay were explained by the independent variables in this study, and the type of facilities had the most explanatory power. In addition to type of facilities, sex, age, economic status, type of medical security, familial support, living condition before admission, diagnosis, dual diagnosis, age of onset of illness and number of admissions were significant explanatory factors. CONCLUSION: This study provides bases for specific strategies to develop efficient mental health facilities and community mental health system by disclosing the important explanatory factors for length of stay.

Needs Assessment of the Chronic Mentally Ill with Low Income Living in the Community / 신경정신의학

OBJECTIVES: The purposes of the study were to assess the unmet needs of the chronic mental ill in low income class living in community and to provide basic data for developing services and programs in community mental health. METHODS: Face to face interviews were done for the subjects (n=320) who were diagnosed as schizophrenia, major depressive disorder, and bipolar I disorder. The Korean version of Camberwell Assessment of Need Short Appraisal Scale (CANSAS) was used as the assessment tool of the needs. Frequencies and rates of met needs and unmet needs of each 22 items of CANSAS were estimated. We classified 22 items into six need areas by operational definition, and then estimated mean percentages of unmet needs and met needs for each 6 need areas. We also classified subjects into 2 groups by the presence of psychiatric care needs, and then estimated mean percentage of unmet needs for other 5 need areas according to psychiatric care needs. RESULTS: Among the respondents, 77.7% of them had no spouses, and 66.4% had the education of six years and over. Of the respondents, 53.8% were males, 46.2% females. And 74.3% used medical aid in social security. Most respondents did not have present occupations and persons who were living with their parents were 48.3% and persons living alone reached 8%. The diagnosis of schizophrenia was 60.9%, major depressive disorder 15.2%, respectively. Most respondents (73.6%) had been admitted to the hospitals, but they hardly used rehabilitation services or programs during the daytimes. In estimating the unmet needs for each 22 items of CANAS, the need of company of others was the highest and that of welfare benefit and daytime activity were next. Information for treatment, intimate relationship, psychological distress, money, and psychotic symptoms follow the order. The mean percentages of unmet needs for each 6 needs area were 29.5% for income needs, 26.9% for social relation needs, 17.0% for physical care needs, 14.2% for psychiatric care needs, 11.6% for daily living skill needs, and 9.6% for residency needs. We classified subjects into 2 groups by the presence of psychiatric care needs: 49% of the subjects had no psychiatric care needs and 51% had psychiatric care needs. The group that had psychiatric care needs also had higher mean percentage of unmet need in 5 other needs areas than group that had no psychiatric care needs. And these results showed statistically significant except residency needs area. CONCLUSION: When preparing services or programs in community mental health, occupational rehabilitation and social support should be included as basic services. Other services such as physical treatment, psychiatric treatment, social skill training, and residency could be considered as optional.

Comorbid Mental Disorders Among the Patients with Alcohol Abuse and Dependence in Korea

This study investigated the patterns of alcohol disorder comorbidity with other psychiatric disorders, using Korean nationwide epidemiological data. By two-stage cluster sampling, 5,176 adult household residents of Korea were interviewed using the Korean version of the Diagnostic Interview Schedule. Psychiatric disorders strongly associated with alcohol disorders were, other drug abuse or dependence, major depression, simple phobia, antisocial personality disorder, tobacco dependence, and pathological gambling. Male alcoholics had a tendency to begin with tobacco dependence, and some male pathological gamblers first had alcohol disorders. The presence of comorbid psychiatric disorders was associated with a more severe form and the later onset of alcohol disorders, and associated with help-seeking for alcohol abuse/dependence.

Correlates and Risk Factors of Probable Alcohol Dependence Group among Korean Adult Drinkers: Nationwide Probability Sample Survey / 신경정신의학

OBJECTIVES: The aims of this study were 1) to estimate prevalence rates of drinkers, two subtypes of drinkers-drinkers without dependence and drinkers with probable alcohol dependence(AD) using CAGE, and 2) to find out the correlates of sociodemographic variables and drinking patterns of the drinkers with probable AD by comparing those of the drinkers without dependence, 3) to analyse risk factors for the drinkers with probable AD. METHODS: Using data from face-to-face interviews conducted during 1995, we investigated the prevalence and characteristics of two subtypes of drinkers in a national probability sample of 1,695 drinkers 20 years of age and older. We defined drinkers with CAGE scores 2 and over as drinkers with probable AD, and scores less than 1 as drinkers without dependence. The comparisons of sociodemographic characteristics and drinking patterns between two subtypes of drinkers were examined through chi-square test using weighted data. Statistical analysis including multiple logistic regression analysis were done for each sex, respectively. Because of the large number of coefficients estimated, Bonferroni's method was used to compute p values. RESULTS: The results were as follows: 1) Prevalence of the drinkers was 33.7% in the total sample. Prevalence rate of male and female drinker were 26.3% and 7.40%, respectively. Prevalence of the drinkers with probable AD was 10.9%. For males the prevalence of the drinkers with probable AD was 9.99% and for females 0.94%. 2) According to sociodemographic variables between drinkers without dependence and drinkers with probable AD, males drinkers with probable AD were older, less educated, more depressive, married marital status and were more likely to have occupations of service section than male drinkers without dependence. Female drinkers with probable AD were less educated, more depressive and had less monthly income than drinkers without dependence. 3) As for the drinking patterns, male drinkers with probable AD drank more frequently, had more drinks, had more trying to quit drinking and preferred Soju. Female drinkers with probable AD drank more frequently, had more drinks, were more trying to quit drinking, too. 4) Multiple logistic regression analysis showed that the risk factors for male drinkers with probable AD were lower education(< or =6 years) and depressive symptoms. For females, depressive symptoms and lower education(< or =6 years) were strongly indicative of risk factors though not reaching the statistical significance. CONCLUSIONS: Prevalence of the drinkers with probable AD was 10.9%, and male to female ratio was 10.6:1, which was lower than previous results. Depressive symptoms and lower education proved to be strong predictors for alcohol dependence. This suggest that early detection and treatment of depression and public education for the lower education group should be important.