The Relationship Between Childhood Trauma Experience and Complicated Grief: The Importance of Psychological Support for Individuals Coping With Pet Loss in Korea

Background@#Loss of companion animals can result in various psychological reactions, including complicated grief, depression, anxiety, and insomnia. However, research on the prevalence of patients requiring clinical intervention is limited. Moreover, research examining the relationship between childhood trauma and psychological symptoms after pet loss is lacking. Therefore, this study aimed to investigate the rates of clinically significant psychological distress after pet loss and the impact of childhood trauma on adults who have experienced pet loss. @*Methods@#An online survey was conducted with non-clinical adult participants who had experienced the loss of a companion animal. Psychiatric characteristics were evaluated using standardized assessments, including the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Insomnia Severity Index (ISI). Childhood trauma was evaluated using the Childhood Trauma Questionnaire (CTQ). @*Results@#In a sample of 137 individuals who had experienced pet loss, the percentages of those who exceeded the cutoff points were 55% for the ICG, 52% for the PHQ-9, 40% for the GAD-7, and 32% for the ISI. The group that reported childhood trauma exhibited significantly higher scores on the ICG (t = 2.16, P = 0.032), PHQ-9 (t = 3.05, P = 0.003), GAD-7 (t = 2.61, P = 0.010), and ISI (t = 2.11, P = 0.037) than in the group without childhood trauma.For participants who experienced pet loss for less than one year, there was no significant difference in the ICG between the trauma and non-trauma groups, as both had extremely high scores. However, the trauma group had a significantly higher PHQ-9 (t = 2.58,P = 0.012) than the non-trauma group. In contrast, for participants who experienced pet loss for more than one year, the trauma group had a significantly higher ICG (t = 2.22, P = 0.03) than the non-trauma group, while there was no significant difference in the PHQ-9. Additionally, the emotional abuse scores on the CTQ were most significantly correlated with the ICG scores even after controlling for depressive symptoms. @*Conclusion@#People who experienced pet loss had significant psychological symptoms, ranging from 32% to 55%. Childhood trauma experiences affect complicated grief, depressive symptoms, anxiety symptoms, insomnia and prolonged grief disorder after pet loss. After pet loss, people with childhood trauma may require more psychological help than those without trauma.

Emotional and Behavioral Correlates of Exposure to Electronic Media in School-Aged Children: A Prospective Study

Background@#Exposure to electronic media is increasing from early childhood. This study aimed to examine the association between screen time and behavioral outcomes in schoolaged children with a prospective birth-cohort. @*Methods@#We examined the association between screen time and behavioral outcomes in school-aged children with a Korean birth-cohort study. Participants were 2,150 children, recruited during their fetal period, assessed annually for developmental outcomes. Media exposure was assessed at T4 (3.2 y/o), T8 (7.3 y/o), and T10 (9.4 y/o). After exclusions for missing data, 1,368 children were categorized into four groups (Low-Low, Low-High, HighLow, and High-High) based on average daily media time in early childhood and during schooldays, respectively. Children's temperament was assessed from T1 (0.5 y/o) to T4.Emotional and behavioral outcomes were assessed using the Child Behavior Checklist (DSMoriented subscales) at T8 and T10. @*Results@#We found that early-years temperament was generally similar between the mediatime groups: they only differed significantly on Activity at T1 and Emotionality at T2 (1.2 y/o).However, compared to the Low-Low group, the Low-High group had significantly higher odds of high-risk scores for Conduct Problems (increased odds ratios [ORs] of 1.82 at T8 and 1.83 at T10) and Anxiety Problems (increased ORs of 1.60 at T8 and 1.82 at T10). Self-rated self-esteem and overall happiness at T10 also significantly differed among the four groups. @*Conclusion@#Our findings suggest the negative impacts of media exposure on the emotional and behavioral development of school-aged children, which substantiates the guidelines that restrict media exposure during childhood.

Developing an Attention Assessment Tool for Individuals With Autism Spectrum Disorder Using Timbre, Rhythm, and Pitch

Background@#Music is regarded as a beneficial tool for assessing the clinical symptoms and communication skills in individuals with autism spectrum disorder (ASD) or autism. The present study developed a music-based attention test (MAT) for individuals with autism using music parameters and the algorithm of the comprehensive attention test (CAT). @*Methods@#We recruited 51 autistic individuals and 50 neurotypical individuals to participate in the CAT, MAT, and social intelligence tests. The reliability and validity of the MAT were assessed using exploratory factor analysis, concurrent validity, and criterion-related validity. @*Results@#The MAT had sound internal consistency (high Cronbach’s α = 0.948). In addition, the MAT had suitable concurrent validity in the correlation between CAT and MAT, as well as good criterion validity when attention was measured using the MAT and was compared between autistic individuals and neurotypical individuals. Attention evaluated using the MAT was associated with the social quotient in individuals with autism. @*Conclusions@#The MAT could be a relevant tool for gauging attention in individuals with ASD.Furthermore, attention determined using the MAT may be correlated with social quotient in autistic individuals. Future studies should consider that using music in the field of attention could improve the social quotient of individuals with autism.

Psychological Effects of COVID-19 Patient Management Experience among Paramedics and Emergency Medical Technicians: A Nationwide Survey in Korea

Background@#Throughout the coronavirus disease 2019 (COVID-19) pandemic, not only medical personnel but also paramedics or emergency medical technicians (EMT) have faced multiple physical and psychological challenges while performing their duties. The current study aimed to evaluate the psychological effects of managing patients with COVID-19 on the paramedics and EMT. @*Materials and Methods@#A survey targeting paramedics and EMT in Korea was conducted in December 2020. An official letter requesting participation and with the link to an onlinebased survey was sent to the Public Emergency Medical Services. Only one response was accepted from each participant. @*Results@#A total of 326 paramedics and EMT responded to the survey. Among them, 66.3% (216/326) had experience in managing patients with COVID-19. No differences in the distribution of sex, age, working area, duration of working experience, and underlying comorbidities were observed between those who did (COVID-19 group) and did not (nonCOVID-19 group) experience managing patients with COVID-19. The percentage of participants who showed severe posttraumatic stress disorder (PTSD) symptoms was significantly higher in the COVID group than in the non-COVID group (11.1% vs. 3.6%P = 0.029). The participants in the COVID group had a significantly higher mean Global Assessment of Recent Stress Scale score than those in the non-COVID group (18.7 ± 11.1 vs. 16.1 ± 9.9, P = 0.042). The proportion of paramedics and EMT willing to leave their job if given a chance was higher in the COVID group than the non-COVID group (24.1% vs. 9.1%, P = 0.001). Additionally, paramedics and EMT in the COVID group tended to show concern regarding exposure to COVID-19 infection. @*Conclusion@#The experience of managing patients with COVID-19 resulted in psychological distress among paramedics and EMT in Korea.

The Association Between Temperament and Characteristics, Smartphone App Use Patterns and Academic Performance of University Students

Background@#Smartphone use patterns may predict daily life efficacy and performance improvements in sports. Additionally, personal characteristics may be associated with smartphone overuse. @*Methods@#We investigated the correlation between the temperament and character inventory (TCI) and academic performance using smartphone log data. We hypothesized that the elite and general groups, divided based on academic performance, differed according to the TCI and downloadable smartphone apps (applications). Additionally, we hypothesized a correlation between smartphone app usage patterns and TCI. A total of 151 students provided smartphone log data of the previous four weeks. They also completed the TCI and provided academic records of the previous year. @*Results@#The first and second most frequently used apps by both groups of students were social networking and entertainment, respectively. Elite students scored higher on novelty seeking, reward dependence, persistence, self-directedness, and self-transcendence than general students. In all participants, the usage time of serious apps was correlated with the scores for novelty seeking (r = 0.32, P < 0.007), reward dependence (r = 0.32, P < 0.007), and self-transcendence (r = 0.35, P < 0.006). In the elite group, the usage time of serious apps was correlated with the scores for novelty seeking (r = 0.45, P < 0.001), reward dependence (r = 0.39, P = 0.022), and self-transcendence (r = 0.35, P = 0.031). In the general group, the usage time of serious apps was correlated only with self-transcendence (r = 0.32, P < 0.007). @*Conclusion@#High usage time of serious apps can help sports majors to excel academically. Particularly among sports majors, serious apps are related to activity, the desire for rewards and recognition, and the tendency to transcend themselves.

Identification of Central Symptoms in Depression of Older Adults With the Geriatric Depression Scale Using Network Analysis and Item Response Theory

Objective@#This study aimed to identify the central symptoms of late-life depression using network analysis and the item response theory. @*Methods@#A total of 3,472 older adults were enrolled and the Geriatric Depression Scale-15 (GDS-15) was used to evaluate the depressive symptoms. To identify the central symptoms and the network structures among the individual symptoms, the analyses of symptom network structures and item response theory were performed. @*Results@#Among items on the GDS-15, “Happy,” “Hopeless,” “Empty,” “Bored,” “Worthless,” and “Good spirits” showed significantly higher strength centrality than the other symptoms. Among all the edges, the edge between “Empty” and “Bored” was the strongest; however, these two symptoms were not connected strongly to other symptoms. In the analysis of item response theory, “Empty,” “Bored,” “Hopeless,” “Worthless,” “Happy,” “Helpless,” and “Satisfied” presented a very high value on the discrimination parameter. @*Conclusion@#Our study identified the central symptoms and the network structures among symptoms listed on the GDS-15. Most of central symptoms identified by network analysis and item response theory coincided. Our results suggest that these central symptoms need to be prioritized as highly comorbid symptoms and can contribute to the development of a brief screening tool for the elderly.

Development and Verification of an Internet Game Literacy Scale

Background@#Education on internet games for parents and internet game literacy are needed to prevent problematic internet game playing in Korea. We created an 18-item Internet Game Literacy Scale (IGLS). It is a valuable tool for assessing the positive and negative aspects of internet game play. We aimed to determine the validity of the IGLS and the cut-off for the tendency for internet gameplay. @*Methods@#An online research company gathered data from 300 participants. Factor analysis, including Cronbach's α and consistency coefficient, exploratory factor analysis, and confirmatory factor analysis were conducted to verify the 18 items of the IGLS. Additionally, a K-means cluster analysis was performed to determine the cut-off values for positive and negative IGLS scores. @*Results@#The 18 items of the IGLS were proven to be reliable, as evidenced by a high Cronbach's alpha (α = 0.892). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.903, and Bartlett's test of sphericity was good (χ2 = 1,623.314, P 0.4. In the analysis of the validity of the 18-item IGLS with confirmatory factor analysis (CFA) (maximum likelihood estimation, with an oblique method), the fit indices of the standard three-factor model reached acceptable standards. The cut-off point of the total score between the low positive and average positive groups was 23, and the cut-off point of the total score between the average positive and high positive groups was 30. The cut-off point of the total score between the low negative and the average negative groups was 24. The cut-off point of the total score between the average negative group and the high negative group was 32. @*Conclusion@#The study assessed the reliability and validity of the IGLS and suggested a cut-off for low, average, and high Internet game literacy degree with 300 Korean adults aged 21–49 years. The current results suggest that the IGLS has good internal consistency and a proper cut-off for positive and negative internet game literacy degrees.

Development and Verification of an Internet Game Literacy Scale

Background@#Education on internet games for parents and internet game literacy are needed to prevent problematic internet game playing in Korea. We created an 18-item Internet Game Literacy Scale (IGLS). It is a valuable tool for assessing the positive and negative aspects of internet game play. We aimed to determine the validity of the IGLS and the cut-off for the tendency for internet gameplay. @*Methods@#An online research company gathered data from 300 participants. Factor analysis, including Cronbach's α and consistency coefficient, exploratory factor analysis, and confirmatory factor analysis were conducted to verify the 18 items of the IGLS. Additionally, a K-means cluster analysis was performed to determine the cut-off values for positive and negative IGLS scores. @*Results@#The 18 items of the IGLS were proven to be reliable, as evidenced by a high Cronbach's alpha (α = 0.892). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.903, and Bartlett's test of sphericity was good (χ2 = 1,623.314, P 0.4. In the analysis of the validity of the 18-item IGLS with confirmatory factor analysis (CFA) (maximum likelihood estimation, with an oblique method), the fit indices of the standard three-factor model reached acceptable standards. The cut-off point of the total score between the low positive and average positive groups was 23, and the cut-off point of the total score between the average positive and high positive groups was 30. The cut-off point of the total score between the low negative and the average negative groups was 24. The cut-off point of the total score between the average negative group and the high negative group was 32. @*Conclusion@#The study assessed the reliability and validity of the IGLS and suggested a cut-off for low, average, and high Internet game literacy degree with 300 Korean adults aged 21–49 years. The current results suggest that the IGLS has good internal consistency and a proper cut-off for positive and negative internet game literacy degrees.

How to Interview Child and Adolescent Patients and Their Families of Diverse Culture by Psychiatrists with Cultural Competency / 신경정신의학

Psychiatry is heavily influenced by culture with varying degrees of tolerance and stigma regarding mental illness. It is important to understand child and adolescent psychiatric patients in terms of cultural competence. Cultural competency is more important for psychiatrists since diagnoses are made and many treatments are delivered strictly based on verbal communication in mental healthcare. Culture provides the analytic frame to understanding patients’ expressions, behaviors, and symptoms based on language, norms, and values of community and family for psychiatric diagnoses. Difficulties in evaluating, diagnosing, and treating patients are escalated when psychiatrists have different cultural backgrounds. Korea faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural.Psychiatrists tend to have trouble stemming from children’s limited language and cognitive abilities for understanding other’s views and limited language fluency among multicultural families. Even with a family has the same cultural background, the increasing generational gap between children and their parents makes it difficult for parents to understand their children’s subcultures. The DSM-5 includes the ‘cultural formulation interview (CFI)’ for psychiatrists to better understand, diagnose, and treat psychiatric patients and families with diverse backgrounds. The author detail how to interview child and adolescent psychiatric patients as well as their families with cultural competency. Psychiatrists can be more culturally competent after practicing how to adapt the semi-structured CFI in a clinical setting in the Korean language.Moreover, it is time to introduce more culturally competent training for medical students and psychiatric trainees.

Perceived Health Status of and Moderating Factorsin Elderly People Caring for Their Grandchildren

Objective@#Situations in which elderly people are the primary caregivers for their grandchildren are becoming more common. Thisstudy aimed to investigate moderating factors of and the association between grandchild care and the grandparents’ perceived health.Financial support in return for grandchild care was also investigated as a moderating factor. @*Methods@#Participants included 357 elderly people over the age of 60 years. The assessment to evaluate the perceived health status andsocial support was performed via a questionnaire. It included questions regarding the care of grandchildren and demographic variables,as well as the Medical Outcome Survey (MOS) 36-item short-form health survey (SF-36), and the MOS Social Support Survey (MOSSSS). @*Results@#The subscale scores of SF-36 and MOS-SSS did not differ significantly for grandchild-care status. However, the subscale scoresof SF-36 were significantly higher in groups that received regular financial support from adult children in return for grandchild carethan in groups that did not. @*Conclusion@#Our data suggest that regular financial support in return for grandchild care may be a moderating factor in the associationbetween grandchild care and the perceived health status of elderly people. These findings have important social implications and warrantfuture study to reveal the psychological mechanism of these associations and enhance the health of elderly individuals.Psychiatry Investig 2020;17(4):275-282

Psychosocial Support during the COVID-19 Outbreak in Korea: Activities of Multidisciplinary Mental Health Professionals

As of April 18, 2020, there have been a total of 10,653 confirmed cases and 232 deaths due to coronavirus disease 2019 (COVID-19) in Korea. The pathogen spread quickly, and the outbreak caused nationwide anxiety and shock. This study presented the anecdotal records that provided a detailed process of the multidisciplinary teamwork in mental health during the COVID-19 outbreak in the country. Psychosocial support is no less important than infection control during an epidemic, and collaboration and networking are at the core of disaster management. Thus, a multidisciplinary team of mental health professionals was immediately established and has collaborated effectively with its internal and external stakeholders for psychosocial support during the COVID-19 outbreak.

Life Lessons: Two Experts on Death and Dying Teach Us about the Mysteries of Life and Living

No abstract available.

Effects of Amisulpride Adjunctive Therapy on Working Memory and Brain Metabolism in the Frontal Cortex of Patients with Schizophrenia: A Preliminary Positron Emission Tomography/Computerized Tomography Investigation

OBJECTIVE: Dopamine plays a significant role in working memory by acting as a key neuromodulator between brain networks. Additionally, treatment of patients with schizophrenia using amisulpride, a pure dopamine class 2/3 receptor antagonist, improves their clinical symptoms with fewer side effects. We hypothesized that patients with schizophrenia treated with amisulpride and aripiprazole show increased working memory and glucose metabolism compared with those treated with cognitive behavioral therapy (CBT) and aripiprazole instead. METHODS: Sixteen patients with schizophrenia (eight in the amisulpride group [aripiprazole+amisulpride] and eight in the CBT group [aripiprazole+CBT]) and 15 age- and sex-matched healthy control subjects were recruited for a 12-week-long prospective trial. An [18F]-fluorodeoxyglucose-positron emission tomography/computerized tomography scanner was used to acquire the images. RESULTS: After 12 weeks of treatment, the amisulpride group showed greater improvement in the Letter-Number Span scores than the CBT group. Additionally, although brain metabolism in the left middle frontal gyrus, left occipital lingual gyrus, and right inferior parietal lobe was increased in all patients with schizophrenia, the amisulpride group exhibited a greater increase in metabolism in both the right superior frontal gyrus and right frontal precentral gyrus than the CBT group. CONCLUSION: This study suggests that a small dose of amisulpride improves the general psychopathology, working memory performance, and brain glucose metabolism of patients with schizophrenia treated with aripiprazole.

A Comparison of Risk and Protective Factors for Excessive Internet Game Play between Koreans in Korea and Immigrant Koreans in the United States

BACKGROUND: Studying immigrants may have the potential to explore how cultural and environmental changes affect the internet game play patterns of individuals in the two countries. We planned to compare risk and preventive factors for Internet Gaming Disorder (IGD) between Korean adolescents in Korea and immigrant Koreans in the US. METHODS: Ninety-four Koreans and 133 immigrant Koreans were recruited. Independent factors consisted of five domains including demographic data, physical activity, academic, art, and music activities, psychological factors, and game and media play. The dependent variable in the current study was the high-risk group of IGD, which was assessed with Young’s Internet Addiction Scale scores. To determine the protective and risk factors for IGD, we performed a multiple logistic regression analysis using the high-risk group as the dependent variable. RESULTS: Five domains affected the risk for IGD in Korean and immigrant Korean groups. Vigorous physical activity was the strongest protective factor for IGD in the Korean group, while media activity was the strongest protective factor for IGD in immigrant Koreans in the US. CONCLUSION: The results indicate that internet gaming problems might be affected by environmental factors and it is recommended that gaming activity is substituted with physical activity, extracurricular classes, books, and music.

Validation Study of a Korean Version of the Abbreviated University of California, Los Angeles, PTSD Reaction Index (Abb-UCLA-PTSD RI) for Adolescents

BACKGROUND: We aimed to verify a Korean version of the Abbreviated University of California, Los Angeles, Post-Traumatic Stress Disorder Reaction Index (Abb-UCLA-PTSD RI-Korean version) among Korean adolescents to assess post-traumatic stress in this population. METHODS: We recruited 1,254 adolescents who completed the Abb-UCLA-PTSD RI-Korean version scale, the Child Report of Post-Traumatic Symptoms (CROPS), the Lifetime Incidence of Traumatic Events (LITE), and the Children's Depression Inventory (CDI). Test-retest reliability was computed for a randomly selected 314 participants. Among all the students, 765 were included in the analysis because 143 students were classified in the normative group (LITE 1) and 622 were in the traumatized group (LITE 4). RESULTS: The internal consistencies of the nine-item and eight-item versions of the Abb-UCLA PTSD RI-Korean version were found to be high (Cronbach's α = 0.843 and 0.842, respectively). The criterion-related validity was based on comparison of the Abb-UCLA PTSD RI total scores between the normative and trauma groups. For the eight-item version, the normative group (4.6 ± 4.6) and the traumatized group (8.8 ± 6.0) demonstrated better criterion-related validity than those in the nine-item version (4.5 ± 4.3 and 8.5 ± 5.0, respectively). The test-retest reliability of the eight-item version was better than the nine-item version (r = 0.85 vs. 0.77). A two-factor model with eight items (two items regarding sleep, and the other six items made up the second factor) showed the best fit. CONCLUSION: Our results indicate that the eight-item Abb-UCLA PTSD RI-Korean version is a useful screening tool for post-traumatic stress in Korean adolescents.

Five Months Follow-up Study of School-based Crisis Intervention for Korean High School Students Who Experienced a Peer Suicide

BACKGROUND: The purpose of this study was to examine post-traumatic stress, depression, anxiety, and complicated grief in Korean high school students who experienced a peer suicide. METHODS: A total of 956 students were included in the statistical analysis. One week after a peer suicide, a school-based crisis intervention program was conducted. The cohort was followed-up at one week and five months after a peer suicide. The program consists of screening tests, educational sessions, and further interview with psychiatric specialists for the selected group. Screening tests were conducted for all students to measure the Child Report of Post-traumatic Symptoms (CROPS), the post-traumatic stress symptoms (The University of California at Los Angeles post-traumatic stress disorder [PTSD] reaction index; UCLA-PTSD-RI), the anxiety symptoms (The Korean-Beck Anxiety Inventory; K-BAI), the depressive symptoms (The Korean-Beck Depression Inventory-II; K-BDI-II), and the complicated grief reaction (The Inventory of Complicated Grief; ICG). For statistical analysis, the SPSS Statistics 21.0 program was used. RESULTS: At baseline and five months follow-ups, 8.6% and 2.9% of the students showed post-traumatic stress symptoms. At five months follow-up, there was a statistically significant decline in the post-traumatic stress symptoms, anxiety, depression, and complicated grief among the ‘trauma group.’ A higher proportion of the female students showed post-traumatic stress symptoms after the incident of peer suicide than the male students. CONCLUSION: School-based crisis intervention helps improvement of trauma-related symptoms. It might be an effective way to prevent suicide spreading among students by alleviating trauma-related symptoms.

Comparison of Electroencephalography (EEG) Coherence between Major Depressive Disorder (MDD) without Comorbidity and MDD Comorbid with Internet Gaming Disorder

Internet gaming disorder (IGD) has many comorbid psychiatric problems including major depressive disorder (MDD). In the present study, we compared the neurobiological differences between MDD without comorbidity (MDD-only) and MDD comorbid with IGD (MDD+IGD) by analyzing the quantitative electroencephalogram (QEEG) findings. We recruited 14 male MDD+IGD (mean age, 20.0 ± 5.9 years) and 15 male MDD-only (mean age, 20.3 ± 5.5 years) patients. The electroencephalography (EEG) coherences were measured using a 21-channel digital EEG system and computed to assess synchrony in the frequency ranges of alpha (7.5–12.5 Hz) and beta (12.5–35.0 Hz) between the following 12 electrode site pairs: inter-hemispheric (Fp1–Fp2, F7–F8, T3–T4, and P3–P4) and intra-hemispheric (F7–T3, F8–T4, C3–P3, C4–P4, T5–O1, T6–O2, P3–O1, and P4–O2) pairs. Differences in inter- and intra-hemispheric coherence values for the frequency bands between groups were analyzed using the independent t-test. Inter-hemispheric coherence value for the alpha band between Fp1–Fp2 electrodes was significantly lower in MDD+IGD than MDD-only patients. Intra-hemispheric coherence value for the alpha band between P3–O1 electrodes was higher in MDD+IGD than MDD-only patients. Intra-hemispheric coherence values for the beta band between F8–T4, T6–O2, and P4–O2 electrodes were higher in MDD+IGD than MDD-only patients. There appears to be an association between decreased inter-hemispheric connectivity in the frontal region and vulnerability to attention problems in the MDD+IGD group. Increased intra-hemisphere connectivity in the fronto-temporo-parieto-occipital areas may result from excessive online gaming.

Polymorphism in the Promoter Region of SEMA5A Is Associated with Sociality Traits in Korean Subjects with Autism Spectrum Disorders

In this study, we evaluated the association between autism spectrum disorders (ASDs) and 10 single-nucleotide polymorphisms (SNPs) in the 5' region of the semaphorin 5A gene (SEMA5A) for 250 Korean trios including children with ASDs. Family-based association testing and haplotype analysis revealed a statistically significant association between rs194085 and multiple sociality traits with Korean ASDs in the dominant model (p < 0.001, corrected p=0.035). This indicates that genetic variations in the 5' region of SEMA5A play a role in the genetic predisposition to sociality traits in Korean ASDs.

Factors that Affect the Adherence to ADHD Medications during a Treatment Continuation Period in Children and Adolescents: A Nationwide Retrospective Cohort Study Using Korean Health Insurance Data from 2007 to 2011

OBJECTIVE: Several factors, such as male gender, older age, type of insurance, comorbid conditions, and medication type, have been associated with attention-deficit/hyperactivity disorder (ADHD) medication adherence rates, but the results have been inconsistent. We analyzed data to answer several questions: 1) How old were patients who first refilled their treatment medications used primarily for ADHD, regardless of the medication type? 2) What socio-demographic factors are associated with medication adherence? 3) What medical conditions, such as medication type and comorbid diagnosis, influence adherence? METHODS: We analyzed National Health Insurance data, which comprised continuously enrolled Korean National Medical Insurance children (6–18 years) with at least 2 ADHD prescription claims (January 2008–December 2011). The persistence of use regarding the days of continuous therapy without a 30-day gap were measured continuously and dichotomously. Adherence, using a medication possession ratio (MPR), was measured dichotomously (80% cut-off). RESULTS: The cumulative incidence of index cases that initiated medication refills for ADHD treatment during the 4 year period was 0.85%. The patients who exhibited a MPR greater than 80 comprised approximately 66%. The medication type, high school age groups, physician speciality, treatment at a private clinic, and comorbid conditions were associated with medication adherence during continuous treatment using a multivariate analysis. CONCLUSION: A better understanding of ADHD treatment patterns may lead to initiatives targeted at the improvement of treatment adherence and persistence. Other factors, including the severity, family history, costs, type of comorbidities, and switching patterns, will be analyzed in future studies.

Korean Version of Inventory of Complicated Grief Scale: Psychometric Properties in Korean Adolescents

We aimed to validate the Inventory of Complicated Grief (ICG)-Korean version among 1,138 Korean adolescents, representing a response rate of 57% of 1,997 students. Participants completed a set of questionnaires including demographic variables (age, sex, years of education, experience of grief), the ICG, the Children's Depression Inventory (CDI) and the Lifetime Incidence of Traumatic Events-Child (LITE-C). Exploratory factor analysis was performed to determine whether the ICG items indicated complicated grief in Korean adolescents. The internal consistency of the ICG-Korean version was Cronbach's alpha=0.87. The test-retest reliability for a randomly selected sample of 314 participants in 2 weeks was r=0.75 (P<0.001). Concurrent validity was assessed using a correlation between the ICG total scores and the CDI total scores (r=0.75, P<0.001). The criterion-related validity based on the comparison of ICG total scores between adolescents without complicated grief (1.2±3.7) and adolescent with complicated grief (3.2±6.6) groups was relatively high (t=5.71, P<0.001). The data acquired from the 1,138 students was acceptable for a factor analysis (Kaiser-Meyer-Olkin Measure of Sampling Adequacy=0.911; Bartlett's Test of Sphericity, chi2=13,144.7, P<0.001). After omission of 3 items, the value of Cronbach's alpha increased from 0.87 for the 19-item ICG-Korean version to 0.93 for the 16-item ICG-Korean version. These results suggest that the ICG is a useful tool in assessing for complicated grief in Korean adolescents. However, the 16-item version of the ICG appeared to be more valid compared to the 19-item version of the ICG. We suggest that the 16-item version of the ICG be used to screen for complicated grief in Korean adolescents.