Psychosocial Factors Associated With Thoughts Regarding Life-Sustaining Treatment for Oneself and Family Members

Objective@#This study aims to investigate the thoughts of the general population regarding life-sustaining treatment for both oneself and family members and to assess the factors associated with those thoughts. @*Methods@#A total of 1,500 individuals participated in this study by completing a questionnaire consisting of self-reporting items with some instructions, basic demographic information, thoughts on life-sustaining treatment, and psychosocial scales. The disease status was calculated using the Charlson Comorbidity Index. The psychosocial scales included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index, and Multidimensional Scale of Perceived Social Support. @*Results@#The majority of participants did not want to receive life-sustaining treatment for both themselves and their families. However, more people wanted life-sustaining treatment for their family members (35.9%) than for themselves (21.6%). Among the basic demographic characteristics, there were significant differences in age, sex, marital status, living arrangements, occupational status, religion, and disease status. Regarding the psychosocial scales, there were significant differences in the PHQ-9 and GAD-7 scores between the group that preferred life-sustaining treatment for family members and the group that did not. @*Conclusion@#The findings suggest that life-sustaining treatment decisions for oneself and for one’s family members can be different. We recommend a more clear expression of one’s preferences regarding the last moments of one’s life, including advance directives.

A Pilot Study on the Validity and Reliability of Korean School Readiness Inventory on Children With Autism Spectrum Disorder

Objective@#Successful transition to school is of great importance to children with autism spectrum disorder (ASD). The purpose of this study was to develop a school readiness inventory for Korean children with ASD, and demonstrate its content validity and reliability. @*Methods@#The Korean School Readiness Inventory (K-SRI) was developed to assess current levels of some fundamental skills needed for attending school for children with ASD. The K-SRI was comprised of four subscales and 16 test items: Self-help skills, Social and emotional development, School behavior, and Literacy and numeracy skills. For content validity, six experts rated the validity of the test items. Lawshe’s Content Validity Ratio (CVR) was calculated. For reliability, parents of 22 children with ASD entering school completed the KSRI twice. Cronbach’s alpha coefficient was calculated for internal consistency. The test–retest reliability was assessed using the intraclass correlation coefficient (ICC). @*Results@#All the items except two items in the literacy and numeracy skills did not show a CVR of 1. The two items were deleted resulting in a 14-item inventory. The Cronbach’s alpha coefficient of the K-SRI was 0.93, showing good internal consistency reliability. The test– retest reliability results showed ICC value of 0.93 (p<0.001), which indicates good stability. @*Conclusion@#A parent-rated, 14-item school readiness inventory for Korean children with ASD were developed and preliminary evidence of its content validity and reliability were demonstrated in this study. The present study provides a basis for future studies that would further help evaluate and promote school readiness of the children with ASD.

Computerized Version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS-COMP): Development and Validation of the Korean Clinician-Administered Version

Objective@#The purpose of the present study was to develop and validate the Korean version of the clinician-administered KSADSCOMP, which is the recently updated, web-based computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia for school-age children (KSADS). @*Methods@#A total of 71 participants (mean age=12.04±3.86 years, female=29.57%) participated in the study. A child-adolescent psychiatrist established a diagnosis for the participant after a thorough psychiatric interview with the participant and the parent. Researchers who were blind to the diagnoses administered the clinician-administered KSADS-COMP to the parents and participants. The gold-standard diagnoses made by child-adolescent psychiatrists were compared to the current diagnoses generated by the clinician-administered KSADS-COMP. Percent agreement, Cohen’s Kappa, Gwet’s first-order agreement coefficient (AC1), sensitivity, specificity, positive predictive value, and negative predictive value were calculated. @*Results@#Gwet’s AC1, our preferred measure of agreement, showed excellent range between 0.78 and 1. Sensitivity, specificity, positive predicted value and negative predictive value also showed high scores. @*Conclusion@#The current study demonstrated excellent criterion validity of the Korean version of the clinician-administered KSADSCOMP, though the small sample size could be a limitation. The current study was the first study to examine the criterion validity of the KSADS-COMP. Due to its readily usable format and efficient and accurate diagnostic process, widely-use of KSADS-COMP is expected.

Factors Affecting Stress and Mental Health During the COVID-19 Pandemic

Objective@#This study examined the factors influencing the mental health and stress of individuals during the coronavirus disease-2019 (COVID-19) pandemic. @*Methods@#A total of 600 participants were enrolled in this anonymous questionnaire survey that included questions on their demographic profiles and experiences related to the COVID-19 pandemic. The COVID-19 Stress Scale for Korean People (CSSK), Warwick– Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index, and Multidimensional Scale of Perceived Social Support were used. Data were analyzed using multiple regression to identify the factors affecting the total CSSK scores and the scores of each of the three CSSK subscales. @*Results@#Multiple regression analyses revealed that the severity of insomnia, sex, degree of income decline, occupation, religion, education level, marital status, residential status, level of social support, and degree of depression and anxiety had significant relationships with COVID-19-related stress. @*Conclusion@#We identified factors affecting stress and mental health in the general population during the COVID-19 pandemic. Our findings may be helpful in providing an individualized approach to managing the mental health of the public. We expect that the results of this study will be used to screen high-risk individuals vulnerable to stress and to establish policies related to the public health crisis.

Early Trauma and Relationships among Recent Stress, Depressive Symptoms, Anxiety Symptoms, and Suicidal Ideation in Korean Women

Background@#Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history. @*Methods@#Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET. @*Results@#Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively. @*Conclusion@#Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stressmanagement techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.

Early Trauma and Relationships among Recent Stress, Depressive Symptoms, Anxiety Symptoms, and Suicidal Ideation in Korean Women

Background@#Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history. @*Methods@#Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET. @*Results@#Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively. @*Conclusion@#Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stressmanagement techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.

Childhood Emotional Abuse Is Associated With the Desire to Get Married and Have Children in Korean Young Adults

Objective@#Young adults putting off marriage and having less children have become recent trends in many modern societies. Yet less is known about the psychological factors underlying the drastically low marriage and fertility rates. We hypothesized that childhood maltreatment experience may have a negative association with one’s marriage and childbearing intention. @*Methods@#A total of 1,004 college students (mean age of 20.8±2.3 years, 56.1% female) completed self-questionnaires including sociodemographic information, marriage and childbearing intention, Patient Health Questionnaire 9 (PHQ-9), and Childhood Trauma Questionnaire (CTQ). Multivariable logistic regression analyses were conducted to evaluate the effect of childhood trauma on marriage and childbearing intentions after controlling for sociodemographic variables and depression. @*Results@#29.7% had no intention to get married and 40.4% had no intention to have children in the future. The prevalence of physical, sexual, and emotional abuse was 33.1%, 18.5%, and 22.3%, respectively. Multivariable logistic regression analyses revealed that female (p<0.001), poor health status (p=0.001), and childhood emotional abuse (p=0.01) were independent predictors of no desire to get married. Female (p<0.001), poor health status (p<0.001), and childhood emotional abuse (p=0.038) were also predictors of no desire to have children. @*Conclusion@#Childhood emotional abuse may be the most damaging form among other types of childhood maltreatment because it can occur more pervasively and persist for a longer period, causing extensive damage to a child’s emotional, social and cognitive development. Raising awareness regarding the life-long consequences of childhood emotional abuse and the need to prevent and detect childhood emotional abuse should be emphasized.

The Effect of Suicide Prevention Education on Attitudes Toward Suicide in Police Officers

Objective@#This study investigated the effect of suicide prevention education on attitudes toward suicide among police officers. @*Methods@#We used an anonymous questionnaire for 518 officers and surveyed the demographic profiles and examined attitudes toward suicide utilizing the Attitudes Towards Suicide Scale (ATTS) (1=totally agree, 5=totally disagree). Our study divided participants into two groups, based on whether or not they had received suicide prevention education, and examined the differences in attitudes toward suicide between the groups. @*Results@#Of the total population, 247 (47.7%) officers had received suicide prevention education. The education group thought suicide as a predictable matter, disagreeing significantly more with the ATTS factor ‘suicide is unpredictable’ (3.36 vs. 3.35; p=0.001) compared with the no education group. Also, the education group more perceived suicide as a cry for help and at the same time disagreed more with the notion ‘suicidal thoughts will never disappear’ (2.08 vs. 2.26; p=0.025, 3.2 vs. 3.05; p=0.035, respectively). @*Conclusion@#Officers with experience in suicide prevention education showed more positive attitude toward suicide and suicide prevention. These findings suggest a need to organize more opportunities of suicide prevention educations, such as making the training mandatory for police officers.

Smartphone Addiction Proneness Is Associated With Subjective-Objective Sleep Discrepancy in Patients With Insomnia Disorder

Objective@#Subjective reports of patients with insomnia often show a discrepancy with their objective assessments of sleep. We aimed to assess subjective-objective sleep discrepancy in subjects with insomnia disorder as well as the psychological factors associated with the discrepancy. @*Methods@#This study is a secondary analysis of the baseline data of a randomized controlled study on 110 adults aged 18 years to 59 years with insomnia disorder. Subjective reports on sleep and the objective measures acquired by an overnight polysomnography were used to measure the sleep discrepancy. Smartphone Addiction Proneness Scale (SAPS), Center for Epidemiologic Studies Depression Scale (CES-D), beck anxiety inventory (BAI), and Global Assessment of Recent Stress (GARS) were used to evaluate the psychological factors associated with the sleep discrepancy. @*Results@#Mean total sleep time (TST) discrepancy of the participants was -81.65±97.41 minutes. Multivariable logistic regression analyses revealed that age (adjusted OR=1.07, 95% CI=1.01–1.13, p=0.027), years of education (adjusted OR=0.69, 95% CI=0.48–0.91, p=0.017), and smartphone addiction proneness (adjusted OR=1.14, 95% CI=1.04–1.27, p=0.008) were independent predictors of TST misperception. Mean sleep onset latency (SOL) discrepancy of the participants was 41.28±45.01 minutes. Only anxiety was an independent predictor of SOL misperception (adjusted OR=1.16, 95% CI=1.05–1.31, p=0.006). @*Conclusion@#The present study provides empirical evidence to increase our understanding of the various factors that are associated with subjective-objective sleep discrepancy. Screening insomnia patients with smartphone addiction proneness may help predict the potential discrepancy between the patients’ subjective reports and objective measures of sleep duration.

Knowledge and Perception of Attention-Deficit/Hyperactivity Disorder among Elementary-School Teachers / 신경정신의학

Objectives@#The aim of this study was to investigate elementary school teachers' knowledge and perception of attention-deficit/hyperactivity disorder (ADHD). Variables associated with the teacher's tendency to recommend treatment to parents of the ADHD children were also evaluated. @*Methods@#A total of 73 elementary-school teachers completed a self-questionnaire regarding their demographic characteristics, previous experience, and perception of ADHD children. Knowledge of the Attention Deficit Disorders Scale (KADDS) was used to examine the participants' level of knowledge of ADHD. Multivariable logistic regression analysis was performed to identify the variables associated with the participants' tendency to recommend treatment to parents of ADHD students. @*Results@#The average correct rate was 64.4% on the KADDS. 64 (87.7%) participants had a positive perception of medical treatments of ADHD, but only 41 (56.2%) participants reported that they would recommend treatment to parents of ADHD children. Teachers that were older and married were more likely to recommend treatment. The teacher's sense of efficacy was found to have a positive association with the tendency to recommend treatment to parents. @*Conclusion@#Educational programs and specific guidelines that can improve the knowledge of ADHD and self-efficacy as a teacher are needed for elementary school teachers. Teachers should understand that they have significant roles in the management of ADHD children.

Knowledge and Perception of Attention-Deficit/Hyperactivity Disorder among Elementary-School Teachers / 신경정신의학

Objectives@#The aim of this study was to investigate elementary school teachers' knowledge and perception of attention-deficit/hyperactivity disorder (ADHD). Variables associated with the teacher's tendency to recommend treatment to parents of the ADHD children were also evaluated. @*Methods@#A total of 73 elementary-school teachers completed a self-questionnaire regarding their demographic characteristics, previous experience, and perception of ADHD children. Knowledge of the Attention Deficit Disorders Scale (KADDS) was used to examine the participants' level of knowledge of ADHD. Multivariable logistic regression analysis was performed to identify the variables associated with the participants' tendency to recommend treatment to parents of ADHD students. @*Results@#The average correct rate was 64.4% on the KADDS. 64 (87.7%) participants had a positive perception of medical treatments of ADHD, but only 41 (56.2%) participants reported that they would recommend treatment to parents of ADHD children. Teachers that were older and married were more likely to recommend treatment. The teacher's sense of efficacy was found to have a positive association with the tendency to recommend treatment to parents. @*Conclusion@#Educational programs and specific guidelines that can improve the knowledge of ADHD and self-efficacy as a teacher are needed for elementary school teachers. Teachers should understand that they have significant roles in the management of ADHD children.

Effect of Omega-3 and Korean Red Ginseng on Children with Attention Deficit Hyperactivity Disorder: An Open-Label Pilot Study

Objective@#The purpose of the present study was to evaluate the efficacy of omega-3 and Korean red ginseng on improving attention deficit hyperactivity disorder (ADHD) symptoms and cognitive function in children with ADHD. @*Methods@#A total of 40 children aged 6 to 12 years diagnosed with ADHD participated in this open-label trial. Participants received daily supplements containing 500 mg of omega-3 (eicosapentaenoic acid, 294 mg; docosahexaenoic acid, 206 mg) and 3 mg of Korean red ginseng extract (combination of ginsenoside Rg1, Rb1, and Rg3) for 12 weeks. No psychotropic drug was allowed during the study period. ADHD symptoms were assessed using the ADHD Rating Scale (ADHD-RS) and Clinical Global Impression-Severity (CGI-S) scale. Neuropsychological tests on sustained attention, short-term memory, and executive function were also assessed. @*Results@#After 12 weeks, participants showed significant improvements on ADHD-RS (31.12 ± 8.82 at baseline, 24.15 ± 11.45 at endpoint; p ＜ 0.001) and CGI-S (3.38 ± 1.18 at baseline, 2.94 ± 1.00 at endpoint; p ＜ 0.001). On the Continuous Performance Test, commission errors significantly decreased, while reaction time significantly increased. Immediate recall and delayed recall on both Auditory Verbal Learning Test and Complex Figure Test showed significant improvements. Scores of Color−Word Task from Stroop Color−Word Test also showed significant improvements after the treatment. The supplement was well tolerated. @*Conclusion@#The results of this pilot study suggest that the combination of omega-3 and Korean red ginseng may improve ADHD symptoms and cognitive function including attention, memory, and executive function in children with ADHD. Future randomized placebo-controlled trials with a larger sample is warranted.

Assessment of Functional Impairments in Male Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder / 신경정신의학

OBJECTIVES@#Many studies have demonstrated comorbidities and overlapping symptoms in attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). The purpose of this study was to examine the functional impairment in subjects with ADHD, ODD, and in those with both ADHD and ODD.@*METHODS@#172 male subjects, aged 6 to 15 years old, were enrolled in this study. Based on diagnoses made by applying the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (K-SADS-PL), the subjects were categorized into four groups: ADHD group (n=64), ODD group (n=17), ADHD+ODD group (n=28), and control group (n=63). The Child and Adolescent Functioning Impairment Scale (CAFIS) was used to measure the functional impairment of the subjects. CAFIS consists of four subscales : Family relationship, Teacher relationship, Peer relationship, and Academic achievement scales. A high CAFIS score implies high functional impairment. Analysis of covariance was conducted to compare the scores between the four groups.@*RESULTS@#Both the ODD and the ADHD+ODD groups had significantly high scores for Parent relationship compared to that of the ADHD group. Compared to the control group, both the ADHD and the ADHD+ODD group had significantly higher scores for Peer relationship and Academic achievement, whereas, the ODD group showed no significant difference from the control group on those two subscales.@*CONCLUSION@#The present study showed that subjects with ADHD and ODD have different functional impairment characteristics. The subjects' relationships with their parents were worsened by the presence of ODD. Peer relationships and Academic achievements were significantly affected by the presence of ADHD.

Transgenerational Transmission of Trauma: Psychiatric Evaluation of Offspring of Former “Comfort Women,” Survivors of the Japanese Military Sexual Slavery during World War II

“Comfort women” are survivors of sexual slavery by the Imperial Japanese Army during World War II, who endured extensive trauma including massive rape and physical torture. While previous studies have been focused on the trauma of the survivors themselves, the effects of the trauma on the offspring has never been evaluated before. In this article, we reviewed the first study on the offspring of former “comfort women” and aimed to detect the evidence of transgenerational transmission of trauma. In-depth psychiatric interviews and the Structured Clinical Interview for DSM-5 Axis I Disorders were conducted with six offspring of former “comfort women.” Among the six participants, five suffered from at least one psychiatric disorder including major depressive disorder, panic disorder, posttraumatic stress disorder, adjustment disorder, insomnia disorder, somatic symptom disorder, and alcohol use disorder. Participants showed similar shame and hyperarousal symptoms as their mothers regarding stimuli related to the “comfort woman” issue. Increased irritability, problems with aggression control, negative worldview, and low self-esteem were evident in the children of mothers with posttraumatic stress disorder. Finding evidence of transgenerational transmission of trauma in offspring of “comfort women” is important. Future studies should include more samples and adopt a more objective method.

The Author Reply: Major Difficulties in Pursuing Research on Offspring of Former “Comfort Women” in Korea

No abstract available.

Suicidal Ideation of the Elderly According to Their Involvement in Grandchild Care

The purpose of the present study was to examine the severity of suicidal ideation of the older adults according to the amount of involvement in grandchild care. Data for this research were drawn from a cross-sectional study conducted on community-dwelling adults aged 65 years or older. The 922 participants were divided into three groups according to their involvement in grandchild care: 18.5% had provided daily care, 12.4% had provided occasional care, and 69.1% had never cared for their grandchildren. ANCOVA analysis showed that the scores for depression was significantly lower in the group which took care of their grandchildren occasionally compared to the other two groups. The scores for suicidal ideation was significantly higher in the group which had never taken care of their grandchildren compared to the other two groups. Current study suggests that grandparenting may have a positive effect on suicidal ideation of the older adults.

A Study on Variables Influencing Acceptability and Perception Towards Suicide among the Elderly in the City of Bucheon / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the variables influencing acceptability and perception towards suicide among the elderly in Bucheon city, South Korea. METHODS: A total of 1099 elderly over 65 years old participated in this study. The subjects completed a self-questionnaire including their demographic characteristics, psychiatric characteristics, factor 1 and 4 of the Attitudes Towards Suicide-20, and Geriatric Depression Scale Short Form Korea Version. One-way analysis of variance was performed to identify the variables associated with the acceptability and perception towards suicide. RESULTS: As result of this study, the demographic characteristics (older age, lower education level, lower economic state, bereavement, divorce or separated marital status, and life without spouse) and psychiatric characteristics (psychiatric past history, treatment history, and suicidal attempt history) were found to be associated with a more acceptable attitude toward suicide. In addition, a lower education level, no psychiatric history, and no psychiatric treatment history influenced the lack of perception to suicide. CONCLUSION: For public services to prevent suicide of the elderly population who lack spontaneity and accessibility to suicidal evaluations, it would be important to focus on the variables identified in this study for enhancing the effectiveness of the services.

Psychiatric Sequelae of Former “Comfort Women,” Survivors of the Japanese Military Sexual Slavery during World War II

“Comfort women” refers to young women and girls who were forced into sexual slavery by the Imperial Japanese military during World War II. They were abducted from their homes in countries under Imperial Japanese rule, mostly from Korea, and the rest from China, Philippines, Malaysia, Taiwan, Indonesia, the Netherlands, etc. “Comfort women” endured extreme trauma involving rape, sexual torture, physical abuse, starvation, threats of death, and witnessed many others being tortured and killed. This article reviews all the studies that have investigated the psychiatric or psychosocial sequelae of the survivors of the Japanese military sexual slavery. Most importantly, a recent study which conducted a psychiatric evaluation on the former “comfort women” currently alive in South Korea is introduced. The participants’ unmarried rate was relatively high and their total fertility rate was relatively low. Majority of the participants reported having no education and being the low economic status. They showed high current and lifetime prevalence of posttraumatic disorder, major depressive disorder, somatic symptom disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Participants showed high suicidality and majority of the participants still reported being ashamed of being former “comfort women” after all these years. This article high-lights the fact that the trauma has affected the mental health and social functioning of former “comfort women” throughout their lives, and even to the present day.

Factors Associated with Willingness to Visit Psychiatric Clinic among General Adult Population in Bucheon City / 신경정신의학

OBJECTIVES: The aim of this study was to investigate various factors associated with the willingness to visit psychiatric clinics among the general adult population in Bucheon city, South Korea. METHODS: One thousand seventy-five adults completed a self-questionnaire assessing their willingness to visit psychiatric clinics, family history of mental illnesses, frequency of contact with the mentally ill, stigma and discrimination toward the mentally ill, and the Community Attitude toward the Mentally Ill (CAMI). Logistic regression analyses were performed to identify variables associated with the willingness to visit psychiatric clinics. RESULTS: Study results showed that being single was associated with reduced willingness to visit psychiatric clinics. Subjects who had more frequent contact with mentally ill patients were more willing to visit psychiatric clinics. Concerning the CAMI scale, higher scores in authoritarianism and lower scores in benevolence subscales were associated with greater willingness to visit psychiatric clinic. Subjects who strongly admitted the existence of the stigma, and discrimination, toward mentally ill patients were more willing to visit psychiatric clinics. CONCLUSION: Enhanced understanding of the factors associated with the willingness to visit psychiatric clinics would be helpful in reducing barriers to mental health services utilization in the community.

DNA immunization of Mycobacterium tuberculosis resuscitation-promoting factor B elicits polyfunctional CD8+ T cell responses

PURPOSE: T cell-mediated immune responses, and particularly activation of polyfunctional T cells that simultaneously produce multiple cytokines, are necessary for the control of Mycobacterium tuberculosis. In the present study, we examined if DNA immunization of Mycobacterium tuberculosis resuscitation-promoting factor B (RpfB) elicits polyfunctional T cell responses in mice. MATERIALS AND METHODS: C57BL/6 mice were immunized intramuscularly three times, at 3-week intervals, with RpfB-expressing plasmid DNA. For comparison, protein immunization was performed with recombinant RpfB in control mice. After immunization, RpfB-specific T cell responses were assessed by interferon-gamma (IFN-gamma) enzyme-linked immunosorbent spot assay and intracellular cytokine staining (ICS), and T cell polyfunctionality was assessed from the ICS data. RESULTS: RpfB DNA immunization induced not only humoral immune responses, but also CD8+ and CD4+ T cell responses. Immunodominant T-cell epitopes were identified within RpfB by assays with overlapping peptides. RpfB DNA immunization elicited a polyfunctional CD8+ T cell response that was dominated by a functional phenotype of IFN-gamma+/TNF-alpha+/IL-2-/CD107a+. CONCLUSION: RpfB DNA immunization elicits polyfunctional CD8+ T cell responses, suggesting that RpfB DNA immunization might induce protective immunity against tuberculosis.