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Objective@#North Korean defectors (NKDs) have experienced substantial difficulties during the migration and settlement in South Korea. They have a high prevalence of depression, post-traumatic stress disorder, and suicidal behaviors. The high prevalence of mental disorders among NKDs can lead to a high suicide rate. However, there are no suicide prevention programs for NKDs. This study aims to customize a suicide prevention program with content suitable for NKDs’ particular circumstances. @*Methods@#A multidisciplinary research team developed this program based on domestic and international gatekeeper training programs for suicide prevention and articles related to suicide prevention. @*Results@#We developed a multi-part gatekeeper training program, “Suicide CARE for NKDs.” In the “Introduction,” trainees learn about the need for the program and its importance. In “Careful observation,” trainees learn to recognize linguistic, behavioral, and situational signals of suicide risk. In “Active listening,” trainees learn how to ask about suicidal thoughts and to listen empathetically. In “Risk evaluation and expert referral,” trainees learn to evaluate suicide risk and to connect NKDs with institutes or services. @*Conclusion@#We expect this program to become useful for training gatekeepers to prevent suicide among NKD. A future follow-up study is needed to confirm the efficacy of the program.
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Objectives@#This study investigated the relationship between suicidal behavior and the use of methylphenidate (MPH) or atomoxetine (ATX) in patients with attention deficit hyperactivity disorder (ADHD). @*Methods@#The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to conduct a meta-analysis. The Physiotherapy Evidence Database scale was used to score the quality of the studies. @*Results@#Nine studies were included in this quantitative analysis. The analysis included 602864 patients with ADHD (521125 and 81739 patients were taking methylphenidate [MPH group] and atomoxetine [ATX group], respectively) and 19230 healthy controls.The overall estimates were in the order of the control, MPH, and ATX groups; however, no statistically significant between-group difference was observed in the incidence of events (p=0.553 for control vs. MPH; p=1.000 for control vs. ATX; p=1.000 for MPH vs. ATX). @*Conclusion@#The rate of suicidal behavior was higher in the ADHD groups treated with MPH and ATX than in the control group. However, no statistically significant difference was observed between the ADHD groups treated with MPH and ATX, and the control group. Therefore, MPH and ATX did not increase suicidal behavior.
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Background@#This study aims to evaluate suicidal ideation, depression, and insomnia among parent survivors of adolescents who died by suicide and their relevant risk factors using psychological autopsy results from South Korea. @*Methods@#The participants were 42 parent survivors (10 fathers and 32 mothers) of 35 adolescents who died by suicide. We used the Patient Health Questionnaire-9 and the Korean version of the Insomnia Severity Index to evaluate the mental health of the bereaved parents. We used the Korean Psychological Autopsy Checklist for Adolescents, the Korean Beck Depression Inventory, the Korean Version of the Barratt Impulsiveness Scale-II, and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime-Korean versions to evaluate the mental health of deceased adolescents before their deaths. @*Results@#The results showed that many parent survivors of suicide had developed clinically significant suicidal ideation, depression, and insomnia (75.6%, 73.2%, and 42.9%, respectively). Furthermore, the higher the incidence of traumatic events experienced by the deceased adolescents, the higher the severity of depression and insomnia experienced by surviving parents. @*Conclusion@#We should pay attention that parent survivors of suicide can suffer mental disorders after their offspring's death. In future studies, long-term follow-up studies with larger samples need to generalize our findings and clarify the causal relationship.
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Objectives@#Assessing the risks of youth suicide in educational and clinical settings is crucial.Therefore, this study developed a machine learning model to predict suicide attempts using the Korean Youth Risk Behavior Web-based Survey (KYRBWS). @*Methods@#KYRBWS is conducted annually on Korean middle and high school students to assess their health-related behaviors. The KYRBWS data for 2021, which showed 1206 adolescents reporting suicide attempts out of 54848, was split into the training (n=43878) and test (n=10970) datasets. Thirty-nine features were selected from the KYRBWS questionnaire. The balanced accuracy of the model was employed as a metric to select the best model. Independent validations were conducted with the test dataset of 2021 KYRBWS (n=10970) and the external dataset of 2020 KYRBWS (n=54948). The clinical implication of the prediction by the selected model was measured for sensitivity, specificity, true prediction rate (TPR), and false prediction rate (FPR). @*Results@#Balanced bag of histogram gradient boosting model has shown the best performance (balanced accuracy=0.803). This model shows 76.23% sensitivity, 83.08% specificity, 10.03% TPR, and 99.30% FPR for the test dataset as well as 77.25% sensitivity, 84.62% specificity, 9.31% TPR, and 99.45% FPR for the external dataset, respectively. @*Conclusion@#These results suggest that a specific machine learning model can predict suicide attempts among adolescents with high accuracy.
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Background@#Sleep disturbances are common in children and adolescents. However, they are rarely diagnosed and treated because parents, who often report the symptoms, may fail to notice the problems. Factors that can affect parent-child discrepancy include child’s diagnosis, parent’s occupation, and child’s sex. The current study retrospectively analyzed the effect of these factors on parent-child discrepancies of sleep disturbance scores. @*Methods@#Data for sleep-related items in Youth Self-Report (YSR) and Child Behavior Checklist (CBCL) from 2014 to 2020 August in South Korea were collected from psychiatric outpatient clinics at Konkuk University Medical Center and Soonchunhyang University Hospital. @*Results@#A three-way analysis of variance revealed main effect of diagnosis type and interaction between diagnosis type and mother’s occupation. Discrepancies were greater for mood and anxiety disorders compared to conduct-related disorder. Interaction effect revealed greater discrepancies in mood disorders for reports completed by working mothers compared to homemaker mothers. @*Conclusion@#The results of this study emphasize the need to explore with caution the selfreported sleep disturbances in adolescents, especially in those with mood disorders. The results also suggest that mother’s occupation should be taken into account when evaluating sleep reports of parents and adolescents.
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Background@#Hyperactivity, inattention, and impulsivity of children with attention deficit hyperactivity disorder (ADHD) increase parenting stress and familial conflict. Among parentrelated factors, maternal mental health has been studied in-depth, but studies on paternal factors in this context are scarce. This cross-sectional study was conducted of children with ADHD and their parents in South Korea. We investigated the relationships between ADHD symptom severity of children and the mental health of their mothers and fathers. @*Methods@#The study included 70 children with ADHD and their 140 married heterosexual parents (70 fathers and 70 mothers). Children completed the Child Depression Inventory and State-Anxiety Inventory for children, and their parents completed the Korean ADHD rating scale-IV, Adult ADHD self-report scale, State-Anxiety Inventory, Patient Health Questionnaire-9, and Parental Stress Scale. @*Results@#There was a significant positive correlation between children’s ADHD symptoms and maternal anxiety symptom severity, whereby more severe ADHD symptoms were associated with more severe maternal anxiety symptoms. There was also a significant positive correlation between maternal anxiety symptom severity and paternal parenting stress severity, whereby more severe maternal anxiety was associated with more severe paternal parenting stress. A mediation model showed that paternal parenting stress severity was not directly related to children’s ADHD symptoms, but the severity of maternal anxiety mediated this relationship. @*Conclusion@#The present study found the importance of mental health in mothers of children with ADHD and the interrelatedness of mental health within families. Future assessments and treatment of children with ADHD should include both the children and their parents.
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Objective@#This study standardizes the Parental Stress Scale (PSS) for Republic of Korean parents of children with attention-deficit/hyperactivity disorder (ADHD) and verifies its reliability and validity. @*Methods@#Data from 160 parents of children with ADHD who completed the following self-reported questionnaires were analyzed: the Korean ADHD Rating Scales, the Patient Health Questionnaire-9, the State–Trait Anxiety Inventory, the PSS, and the Global Assessment of Recent Stress Scale. All scale items were measured for reliability and validity, and the appropriate factors for measuring stress in Korean parents with ADHD children were extracted. @*Results@#Exploratory and confirmatory factor analyses derived two sub-factors and 11 items. Goodness of fit was confirmed, and the scale was deemed suitable for explaining stress in parents of children with ADHD. @*Conclusion@#In this study, the validity and reliability of the K-PSS-ADHD were investigated. We expect that the K-PSS-ADHD will be used as a basis for future studies on stress in parents of children with ADHD.
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Electroencephalography (EEG) measures neural activation due to various cognitive processes. EEG and event-related potentials (ERPs) are widely used in studies investigating psychopathology and neural substrates of psychiatric diseases in children and adolescents. The present study aimed to review recent ERP studies in child and adolescent psychiatry. ERPs are non-invasive methods for studying synaptic functions in the brain. ERP might be a candidate biomarker in child-adolescent psychiatry, considering its ability to reflect cognitive and behavioral functions in humans. For the EEG study of psychiatric diseases in children and adolescents, several ERP components have been used, such as mismatch negativity, P300, error-related negativity (ERN), and reward positivity (RewP). Regarding executive functions and inhibition in patients with attention-deficit/hyperactivity disorder (ADHD), P300 latency, and ERN were significantly different in patients with ADHD compared to those in the healthy population. ERN showed meaningful changes in patients with anxiety disorders, such as generalized anxiety disorder, separation anxiety disorder, and obsessive-compulsive disorder. Patients with depression showed significantly attenuated RewP compared to the healthy population, which was related to the symptoms of anhedonia.
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The purpose of this review is to examine the clinical use of functional near-infrared spectroscopy (fNIRS) in children and adolescents with psychiatric disorders. Many studies have been conducted using objective evaluation tools for psychiatric evaluation, such as predicting psychiatric symptoms and treatment responses. Compared to other tools, fNIRS has the advantage of being a noninvasive, inexpensive, and portable method and can be used with patients in the awake state. This study mainly focused on its use in patients with attention-deficit/hyperactivity disorder and autism spectrum disorder. We hope that research involving fNIRS will be actively conducted in various diseases in the future.
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Objective@#The loudness dependence of the auditory evoked potential (LDAEP) is a reliable indicator that is inversely related to central serotonergic activity, and recent studies have suggested an association between LDAEP and suicidal ideation. This study investigated differences in LDAEP between patients with major depressive disorder and high suicidality and those with major depressive disorder and low suicidality compared to healthy controls. @*Methods@#This study included 67 participants: 23 patients with major depressive disorder with high suicidality (9 males, mean age 29.3 ± 15.7 years, total score of SSI-BECK ≥ 15), 22 patients with major depressive disorder with low suicidality (9 males, mean age 42.2 ± 14.4 years, total score of SSI-BECK ≤ 14), and 22 healthy controls (11 males, mean age 31.6 ± 8.7 years). Participants completed the following assessments: Patient Health Questionnaire-9, Beck Depression Inventory-II, Beck Scale for Suicidal ideation, State Anxiety Scale of the State-Trait Anxiety Inventory, Beck Anxiety Inventory, and LDAEP (measured at electrode Cz). @*Results@#There were no sex-related differences among groups (p = 0.821). The high-suicidality group exhibited significantly higher LDAEP compared to the low-suicidality group (0.82 ± 0.79 vs. 0.26 ± 0.36, p = 0.014). No significant differences were found between the control and high-suicidality (p = 0.281) or the control and low-suicidality groups (p = 0.236). @*Conclusion@#LDAEP was applied to demonstrate the association between serotonergic activity and suicidal ideation and suicide risk in major depression and may be a candidate of biological marker for preventing suicide in this study.
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Electroencephalography (EEG) measures neural activation due to various cognitive processes. EEG and event-related potentials (ERPs) are widely used in studies investigating psychopathology and neural substrates of psychiatric diseases in children and adolescents. The present study aimed to review recent ERP studies in child and adolescent psychiatry. ERPs are non-invasive methods for studying synaptic functions in the brain. ERP might be a candidate biomarker in child-adolescent psychiatry, considering its ability to reflect cognitive and behavioral functions in humans. For the EEG study of psychiatric diseases in children and adolescents, several ERP components have been used, such as mismatch negativity, P300, error-related negativity (ERN), and reward positivity (RewP). Regarding executive functions and inhibition in patients with attention-deficit/hyperactivity disorder (ADHD), P300 latency, and ERN were significantly different in patients with ADHD compared to those in the healthy population. ERN showed meaningful changes in patients with anxiety disorders, such as generalized anxiety disorder, separation anxiety disorder, and obsessive-compulsive disorder. Patients with depression showed significantly attenuated RewP compared to the healthy population, which was related to the symptoms of anhedonia.
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The purpose of this review is to examine the clinical use of functional near-infrared spectroscopy (fNIRS) in children and adolescents with psychiatric disorders. Many studies have been conducted using objective evaluation tools for psychiatric evaluation, such as predicting psychiatric symptoms and treatment responses. Compared to other tools, fNIRS has the advantage of being a noninvasive, inexpensive, and portable method and can be used with patients in the awake state. This study mainly focused on its use in patients with attention-deficit/hyperactivity disorder and autism spectrum disorder. We hope that research involving fNIRS will be actively conducted in various diseases in the future.
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Objective@#The loudness dependence of the auditory evoked potential (LDAEP) is a reliable indicator that is inversely related to central serotonergic activity, and recent studies have suggested an association between LDAEP and suicidal ideation. This study investigated differences in LDAEP between patients with major depressive disorder and high suicidality and those with major depressive disorder and low suicidality compared to healthy controls. @*Methods@#This study included 67 participants: 23 patients with major depressive disorder with high suicidality (9 males, mean age 29.3 ± 15.7 years, total score of SSI-BECK ≥ 15), 22 patients with major depressive disorder with low suicidality (9 males, mean age 42.2 ± 14.4 years, total score of SSI-BECK ≤ 14), and 22 healthy controls (11 males, mean age 31.6 ± 8.7 years). Participants completed the following assessments: Patient Health Questionnaire-9, Beck Depression Inventory-II, Beck Scale for Suicidal ideation, State Anxiety Scale of the State-Trait Anxiety Inventory, Beck Anxiety Inventory, and LDAEP (measured at electrode Cz). @*Results@#There were no sex-related differences among groups (p = 0.821). The high-suicidality group exhibited significantly higher LDAEP compared to the low-suicidality group (0.82 ± 0.79 vs. 0.26 ± 0.36, p = 0.014). No significant differences were found between the control and high-suicidality (p = 0.281) or the control and low-suicidality groups (p = 0.236). @*Conclusion@#LDAEP was applied to demonstrate the association between serotonergic activity and suicidal ideation and suicide risk in major depression and may be a candidate of biological marker for preventing suicide in this study.
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Objectives@#Although aggressive behavior in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) has previously shown correlations with hyperactivity/impulsivity, few studies have examined its association with inattention or the effect of working memory on aggressive behavior. This study aimed to assess the relationship between inattention and aggressive behavior and the effect of working memory on the relationship between inattention and aggressive behavior in children and adolescents with ADHD. @*Methods@#Thirty-one children and 26 adolescents with ADHD were retrospectively investigated. The subjects completed the Korean Wechsler Intelligence Scale for Children-Fourth Edition (K-WISC-IV), the Korean Child Behavior Checklist (K-CBCL), and the Korean Children’s Depression Inventory (CDI). @*Results@#Inattention was positively correlated with aggressive behavior in children and adolescents with ADHD and working memory showed an insignificant correlation. However, working memory had a significant moderating effect on aggressive behavior by interacting with inattention. The moderating effect of working memory manifested when the working memory index score on the K-WISC-IV was 73.5 points or higher, and it had a significant effect on aggressive behavior. @*Conclusion@#This study shows that the severity of inattention and hyperactivity/impulsivity should be addressed to provide appropriate treatment to children and adolescents with ADHD who exhibit aggressive behavior.
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Objective@#Event-related potential (ERP) changes with brain development in healthy children and adolescents. However, few studies have focused on age-related changes in the N200 and P300 components among individuals with attention-deficit/hyperactivity disorder (ADHD). Therefore, this study aimed to assess age-related differences in the auditory nogo-N200 components in individuals with ADHD. @*Methods@#We enrolled 46 participants with auditory nogo-N200 and nogo-P300 components. We assessed ADHD symptoms using the Advanced Test of Attention (ATA) and Korean ADHD Rating Scale-IV (K-ARS-IV). Moreover, we assessed emotional and behavioral problems using the Korean Child Behavior Checklist (K-CBCL). Further, we measured auditory ERPs. @*Results@#There were no differences with respect to sex or ATA, K-ARS-IV, and K-CBCL scores between the groups. With a 1-year increase in age, the nogo-N200 latency at Fz and Cz decreased by 6.08 ms and 4.88 ms, respectively; this result was statistically significant in multivariable linear regression adjusted by sex and dominant hand. @*Conclusion@#Our findings revealed age-related changes in nogo-N200 latency at the Fz and Cz electrodes in individuals with ADHD. Future studies should perform comparisons with healthy controls to determine whether auditory nogo-N200 can be used to evaluate the developmental level in individuals with ADHD.
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Objective@#The mismatch negativity (MMN) event-related potential is an index of the pre-attentive stage of neural auditory information processing and an electrophysiological signal indicative of the integrity of auditory information processing with regard to the attention deficit symptom of attention deficit hyperactivity disorder (ADHD). We investigated the association between the MMN amplitude and latency in frontal brain regions and symptom severity in children with ADHD and subclinical ADHD symptoms. @*Methods@#This study included 29 children: 16 (10 boys; mean age, 13.06 ± 3.67 years) with ADHD (ADHD group) and 13 (eight boys; mean age, 13.40 ± 3.31 years) with sub-clinical ADHD symptoms (subclinical ADHD group). We performed the following assessments: Korean ADHD rating scale-IV (K-ARS-IV), children depression inventory, state/trait anxiety inventory for children, and MMN (measured at Fz, FCz, Cz, and CPz). @*Results@#There were no sex or mean age differences between the groups (2 = −0.01, p = 0.958; Z = −1.88, p = 0.060, respectively). The ADHD group had a significantly higher mean K-ARS-IV score (26.13 ± 9.56 vs. 17.15 ± 11.73, Z = −2.11, p = 0.035). Significant differences were found according to symptom severity in the MMN amplitude at FCz (Z = −2.11, p = 0.035) and MMN latency at Fz and FCz (Z = −2.48, p = 0.013; Z = −2.57, p = 0.010). The K-ARS-IV, K-ARS inattention subscale, and K-ARS hyperactivity-impulsivity subscale scores in the ADHD group correlated significantly with the MMN amplitude at Cz and CPz. @*Conclusion@#This study found differences in the MMN amplitude and latency according to the severity of ADHD symptoms and identified MMN as a potential adjunct to the diagnosis of ADHD.
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Objectives@#ZZThe aim was to find effective vectorization and classification models to predict a psychiatric diagnosis from text-basedmedical records. @*Methods@#ZZElectronic medical records (n = 494) of present illness were collected retrospectively in inpatient admission notes withthree diagnoses of major depressive disorder, type 1 bipolar disorder, and schizophrenia. Data were split into 400 training data and 94 independentvalidation data. Data were vectorized by two different models such as term frequency-inverse document frequency (TF-IDF)and Doc2vec. Machine learning models for classification including stochastic gradient descent, logistic regression, support vectorclassification, and deep learning (DL) were applied to predict three psychiatric diagnoses. Five-fold cross-validation was used to find aneffective model. Metrics such as accuracy, precision, recall, and F1-score were measured for comparison between the models. @*Results@#ZZFive-fold cross-validation in training data showed DL model with Doc2vec was the most effective model to predict the diagnosis(accuracy = 0.87, F1-score = 0.87). However, these metrics have been reduced in independent test data set with final workingDL models (accuracy = 0.79, F1-score = 0.79), while the model of logistic regression and support vector machine with Doc2vec showedslightly better performance (accuracy = 0.80, F1-score = 0.80) than the DL models with Doc2vec and others with TF-IDF. @*Conclusions@#ZZThe current results suggest that the vectorization may have more impact on the performance of classification thanthe machine learning model. However, data set had a number of limitations including small sample size, imbalance among the category,and its generalizability. With this regard, the need for research with multi-sites and large samples is suggested to improve the machinelearning models.
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Objectives@#ZZThe aim was to find effective vectorization and classification models to predict a psychiatric diagnosis from text-basedmedical records. @*Methods@#ZZElectronic medical records (n = 494) of present illness were collected retrospectively in inpatient admission notes withthree diagnoses of major depressive disorder, type 1 bipolar disorder, and schizophrenia. Data were split into 400 training data and 94 independentvalidation data. Data were vectorized by two different models such as term frequency-inverse document frequency (TF-IDF)and Doc2vec. Machine learning models for classification including stochastic gradient descent, logistic regression, support vectorclassification, and deep learning (DL) were applied to predict three psychiatric diagnoses. Five-fold cross-validation was used to find aneffective model. Metrics such as accuracy, precision, recall, and F1-score were measured for comparison between the models. @*Results@#ZZFive-fold cross-validation in training data showed DL model with Doc2vec was the most effective model to predict the diagnosis(accuracy = 0.87, F1-score = 0.87). However, these metrics have been reduced in independent test data set with final workingDL models (accuracy = 0.79, F1-score = 0.79), while the model of logistic regression and support vector machine with Doc2vec showedslightly better performance (accuracy = 0.80, F1-score = 0.80) than the DL models with Doc2vec and others with TF-IDF. @*Conclusions@#ZZThe current results suggest that the vectorization may have more impact on the performance of classification thanthe machine learning model. However, data set had a number of limitations including small sample size, imbalance among the category,and its generalizability. With this regard, the need for research with multi-sites and large samples is suggested to improve the machinelearning models.
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OBJECTIVES@#Cognitive dysfunction, including inattention, is often observed in patients with depression. Inattentive symptoms in patients with depression is similar to those among attention deficit/hyperactivity disorder (ADHD) patients. It is important to diagnose the two diseases accurately, because the treatment varies depending on the cause of inattention. This study aimed to investigate the coexistence rate of ADHD and the correlation between ADHD symptoms and depression in patients with depression.@*METHODS@#Participants in this study were 158 outpatients presenting with depression, who visited the psychiatric department from March 2015 to July 2018. Participants divided into a depression and a non-depression group according to the Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) score and were administered the following : a sociodemographic variables form (age, sex, academic background, occupation), the self-reporting test for adult ADHD (Adult Attention Deficit/Hyperactivity Disorder self-report scale-V 1.1; ASRS V1.1), and the Korean version of the Connors adult ADHD rating scale (K-CAARS). Descriptive statistical analysis, crossover analysis, t-tests, and Pearson's correlation coefficient were conducted on the data.@*RESULTS@#The coexistence rate of adult ADHD symptom was as high as 36.7% in patients with depression (p<0.001). In K-CAARS, the depression group (Inattention=1.80, Hyperactivity=1.92, Impulsivity=1.56, Self-concept=2.06) showed higher average scores on ADHD symptoms than the non-depressive group (Inattention=1.28, Hyperactivity=1.25, Impulsivity=1.09, Self-concept=1.42, p<0.001).@*CONCLUSIONS@#This study confirmed that ADHD symptoms coexist in the depression group. When evaluating the symptoms of patients who complain of depression, it is suggested that they should be accurately diagnosed and appropriately treated with interest to the coexistence of ADHD symptoms and the possibility for ADHD diagnosis.
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OBJECTIVE: Post-traumatic stress symptoms (PTSS) in out-of-school youths (OSYs) may be influenced by alcohol use, but there is a lack of evidence explaining how PTSS affect alcohol use problems in OSYs. The present study aimed to investigate the relationships among PTSS, quality of life, and alcohol use in OSYs. METHODS: In total, 125 OSYs (46.4% male) in South Korea completed the Korean Version of the Child Report of Post-Traumatic Symptoms (CROPS), the KIDSCREEN-27 Quality of Life Measure for Children and Adolescents, and the Alcohol Use Disorders Identification Test-Consumption. RESULTS: Mean CROPS score was 18.7 (SD=11.6); 37.6% were problem drinkers. Quality of life in the domain of parent relations and autonomy significantly mediated the relationship between PTSS and alcohol use problems. OSYs with high parental satisfaction and autonomy were less likely to have alcohol use problems even with PTSS. CONCLUSION: Family assessments and therapeutic approaches are needed for OSYs with both PTSS and alcohol use problems.