Prevalence of Mental Disorders and Associated Factors in Korean Adults: National Mental Health Survey of Korea 2021

Objective@#Mental health is a global concern and needs to be studied more closely. We aimed to estimate the prevalence of mental disorders and their associated factors among the general population in Korea. @*Methods@#The National Mental Health Survey of Korea 2021 was conducted between June 19 and August 31, 2021 and included 13,530 households; 5,511 participants completed the interview (response rate: 40.7%). The lifetime and 12-month diagnosis rates of mental disorders were made using the Korean version of the Composite International Diagnostic Interview 2.1. Factors associated with alcohol use disorder (AUD), nicotine use disorder, depressive disorder, and anxiety disorder were analyzed, and mental health service utilization rates were estimated. @*Results@#The lifetime prevalence of mental disorders was 27.8%. The 12-month prevalence rates of alcohol use, nicotine use, depressive, and anxiety disorders were 2.6%, 2.7%, 1.7%, and 3.1%, respectively. The risk factors associated with 12-month diagnosis rates were as follows: AUD: sex and age; nicotine use disorder: sex; depressive disorder: marital status and job status; anxiety disorder: sex, marital status, and job status. The 12-month treatment and service utilization rates for 12-month AUD, nicotine use disorder, depressive disorder, and anxiety disorder were 2.6%, 1.1%, 28.2%, and 9.1%, respectively. @*Conclusion@#Approximately 25% of adults in the general population were diagnosed with mental disorders during their lifetime. The treatment rates were substantially low. Future studies on this topic and efforts to increase the mental health treatment rate at a national level are needed.

Validation of the Patient Health Questionnaire–9 and Patient Health Questionnaire–2 in the General Korean Population

Objective@#The Patient Health Questionnaire–9 (PHQ-9) and PHQ-2 have not been validated in the general Korean population. This study aimed to validate and identify the optimal cutoff scores of the PHQ-9 and PHQ-2 in screening for major depression in the general Korean population. @*Methods@#We used data from 6,022 participants of the Korean Epidemiological Catchment Area Study for Psychiatric Disorders in 2011. Major depression was diagnosed according to the Korean Composite International Diagnostic Interview. Validity, reliability, and receiver operating characteristic curve analyses were performed using the results of the PHQ-9 and Euro Quality of life-5 dimension (EQ-5d). @*Results@#Of the 6,022 participants, 150 were diagnosed with major depression (2.5%). Both PHQ-9 and PHQ-2 demonstrated relatively high reliability and their scores were highly correlated with the “anxiety/depression” score of the EQ-5d. The optimal cutoff score of the PHQ-9 was 5, with a sensitivity of 89.9%, specificity of 84.1%, positive predictive value (PPV) of 12.6%, negative predictive value (NPV) of 99.7%, positive likelihood ratio (LR+) of 5.6, and negative likelihood ratio (LR-) of 0.12. The optimal cutoff score of the PHQ-2 was 2, with a sensitivity of 85.3%, specificity of 83.2%, PPV of 11.6%, NPV of 99.5%, LR+ of 5.1, and LR- of 0.18. @*Conclusion@#The PHQ-9 and PHQ-2 are valid tools for screening major depression in the general Korean population, with suggested cutoff values of 5 and 2 points, respectively.

Prevalence of Loneliness and Its Association With Suicidality in the General Population: Results From a Nationwide Survey in Korea

Background@#Although it is known that a substantial proportion of the population experience loneliness, the consequence of loneliness remains unclear by countries and ages.Accordingly, this study aimed to assess the association between loneliness and suicidality in the general population of Korea.Method: A total of 5,511 Koreans aged 18–79 completed a tablet-assisted personal interview using the Korean version of the Composite International Diagnostic Interview and responded to questions about loneliness and lifetime suicidal ideation, plans, and attempts. A logistic regression analysis was used to examine the association between loneliness and suicidality. @*Results@#Approximately one-third of the Korean general population reported loneliness.Being older, never married, widowed, separated, or divorced, unemployed, and having a parttime job were all significantly related to loneliness. After adjusting for sociodemographic factors, individuals with loneliness were significantly associated with increased suicidal ideation (adjusted odd ratio [aOR], 4.05; 95% confidence interval [CI], 3.36–4.88), suicidal plans (aOR, 4.91; 95% CI, 3.34–7.21), and suicidal attempts (aOR, 4.82; 95% CI, 3.03–7.66). Even after adjusting for sociodemographic factors and mental disorders, suicidality remained statistically significant. Moreover, frequent, moderate-to-severe, and long-term loneliness were all associated with increased ORs for suicidality, regardless of sociodemographic factors and mental disorders. @*Conclusion@#Loneliness was associated with suicidal ideation, plans, and attempts. This study lays the foundation for public health policymakers to establish early intervention and mental health care support for lonely people.

Prevalence of Addictive Behaviors in Medical Students and Their Association With Stress

Objective@#This study aims to investigate the prevalence of the addictive use of the internet, smartphone, and alcohol in medical students, the association of this addictive use with stress, and the mediating roles of resilience and self-esteem in this association. @*Methods@#A total of 866 medical students completed measures of three addictive uses as well as psychological scales for stress, resilience, and self-esteem. Correlation analyses and parallel mediation analysis were carried out. @*Results@#The prevalence of potential-risk and high-risk users was 5.8% and 1.7% for internet use, 5.4% and 2.2% for smartphone use, 22.6% and 5.3% for alcohol use, respectively. All three addictive behaviors tended to increase in terms of prevalence or mean score according to an increase in a students’ grade. Stress was positively correlated with internet use (r=0.324, p<0.001) and smartphone use (r=0.347, p<0.001). Resilience and self-esteem were found to be mediators in the association between stress and internet use or smartphone use. @*Conclusion@#These findings suggest that addictions in medical students are as prevalent as in a general population and that internet use and smartphone use may be better explained by a stress-addiction model with resilience and self-esteem as mediators than alcohol use.

Calculation of Socioeconomic Cost of Depression in Korea in 2019 / 생물치료정신의학

Objectives@#：The high lifetime prevalence of depression in Korea is related to problems such as suicide and decreased productivity, as well as the cost of disease due to increased use of medical services, which can cause great socioeconomic loss. Therefore, in this study, the burden of disease of depression and the importance of managing mental health diseases, which are increasing day by day, are suggested to be helpful in determining priorities in health policy establishment. @*Methods@#：In this study, the socio-economic cost of depression was calculated by dividing it into direct cost and indirect cost. For statistical data, data from the National Health Insurance Service of the public and statistics on diseases of national interest were mainly used. @*Results@#：As a result, the socio-economic cost of depression in 2019 estimated in this study was calculated to be a total of KRW 4.83 trillion, with direct costs 692.9 billion won and indirect costs 4.13 trillion won. Among them, the cost due to decrease in work performance accounted for the largest portion, accounting for 65.5%. @*Conclusions@#：As the socio-economic burden due to depression is expected to increase in the future, it is necessary to establish a systematic funding plan for the treatment and management of depressed patients in daily life.

Autonomic Dysfunction in Patients With Dementia

Autonomic dysfunction commonly occurs in patients with dementia and is typically reported in patients with Alzheimer’s disease and Lewy body dementia. The clinical presentation of autonomic dysfunction includes symptoms related to orthostatic hypotension (manifested as dizziness, falls, and syncope, etc.), constipation, and urinary tract symptoms. Non- pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management includes the administration of midodrine (selective α1-adrenoceptor agonist), droxidopa (norepinephrine prodrug), or atomoxetine (selective noradrenaline reup-take inhibitor). Management of constipation includes the administration of probiotics, osmotic laxatives (e.g. macrogol), and type-2 chloride channel activators (e.g. lubiprostone), and management of urinary tract symptoms includes the administration of mirabegron (selective β 3-adrenergic receptor). Autonomic dysfunction interferes with daily activities and negatively affects patients’ and caregivers’ quality of life. Therefore, early diagnosis of autonomic dysfunction and prompt initiation of optimal treatment are important to improve patients’ quality of life and prognosis.

Zolpidem-Induced Complex Sleep-Related Behavior / 생물치료정신의학

Zolpidem is a non-benzodiazepine hypnotic agent as an agonist of the GABA A benzodiazepine receptor. Zolpidem is considered to have lower abuse and dependence potential than benzodiazepines, and is widely used for the shortterm treatment of insomnia. However, the complex sleep-related behaviors caused by zolpidem have recently emerged as a major challenge. The purpose of this study was to review zolpidem-induced complex sleep-related behaviors and one of the most commonly reported behaviors, sleep-related eating disorder. The risk factors for these complex sleep-related behaviors are female sex, advanced age, daily doses of 10 mg or more, alcohol consumption, and comorbid medical illnesses. Strategies for managing zolpidem-induced complex sleep-related behaviors; discontinuing the use of zolpidem, switching to different sedative-hypnotic drugs, treating patients with other classes of medications, and using non-pharmacological treatment strategies for patients with sleep disorder. These strategies should also include examining drug regimens for potential drug interactions that may predispose patients to experiencing complex behaviors, administering zolpidem appropriately, and selecting patients more carefully for treatment in terms of their likelihood of experiencing medication-related adverse reactions. In conclusion, complex sleep-related behaviors related to zolpidem should be considered adverse drug reactions prior to drug prescription, and a patient’s potential risk factors should be evaluated. Physicians should pay attention to the occurrence of abnormal behavioral adverse effects related to zolpidem.

The Association of Childhood Maltreatment with Adulthood Mental Disorders and Suicidality in Korea: a Nationwide Community Study

Background@#Although childhood maltreatment is a known risk factor for adulthood mental health, the impact of different types of childhood maltreatment on mental disorders is not yet clear. This study explored the association of each type of childhood maltreatment with adulthood mental disorders and suicidality in South Korea. @*Methods@#A total of 5,102 individuals from the general populations over the age of 18 responded to the Korean version of the Composite International Diagnostic Interview and questions about childhood maltreatment (emotional neglect, psychological abuse, physical abuse, and sexual abuse). To evaluate the odds ratio for mental disorders and suicidality associated with each type of childhood maltreatment, we used logistic regression analysis. @*Results@#About 17.0% of the respondents reported having experienced a type of maltreatment in childhood. According to the type, 9.4% reported physical abuse, 9.3% reported emotional neglect, 7.9% reported psychological abuse, and 3.8% reported sexual abuse. Exposure to each type of childhood maltreatment was associated with most types of mental disorders after adjusting for sociodemographic factors. Each type of childhood maltreatment victim was associated with suicidality (suicidal ideations, suicide plans, and suicide attempts).Dose-response patterns for suicide attempts were observed in all types of victims. Moreover, the respondents who experienced frequent childhood emotional neglect were 14 times more likely to have attempted suicide. @*Conclusion@#Childhood maltreatment was associated with mental health in adulthood.The findings show the need for early detection and intervention of victims of childhood maltreatment to minimize its negative impact on adult mental health.

Trends in the Prevalence of Major Depressive Disorder by Sociodemographic Factors in Korea:Results from Nationwide General Population Surveys in 2001, 2006, and 2011

Background@#This study investigated trends in the prevalence of major depressive disorder (MDD) by sociodemographic factors in South Korea. @*Methods@#National samples of the general population aged 18 years or older collected from the nationwide Korean Epidemiologic Catchment Area surveys conducted in 2001 (n = 6,206), 2006 (n = 6,466), and 2011 (n = 5,986) were used. For MDD diagnosis, we conducted face-to-face interviews using the Korean version of the Composite International Diagnostic Interview. We performed logistic regression analyses stratified by gender, after adjusting for other sociodemographic variables, to calculate the 2006-to-2001 odds ratio (OR) and 2011-to-2001 OR by subgroups of sociodemographic factors to explore the association of MDD prevalence with sociodemographic factors over time. @*Results@#The prevalence of MDD in the general population of South Korea increased steadily from 2001, to 2006, and to 2011 (1.6%, 2.5%, and 3.1%, respectively). Among the men, the prevalence of MDD continued to increase significantly in 18–29 years of age group (2006: adjusted OR [AOR], 3.32; 2011: AOR, 7.42), at-risk drinking group (2006: AOR, 3.56; 2011: AOR, 4.77), and not living with a partner group (2006: AOR, 3.24; 2011: AOR, 3.25).Meanwhile, among the women, the prevalence of MDD continued to significantly increase in the below-average household income group (2006: AOR, 2.58; 2011: AOR, 2.59), at-risk drinking group (2006: AOR, 2.02; 2011: AOR, 2.47), and unemployed group (2006: AOR, 1.48; 2011: AOR, 2.04). @*Conclusion@#This study may provide significant information for public policymakers to allocate sufficient health resources on MDD to vulnerable groups, particularly, men aged 18–29 years and women living in households with below-average income, and for clinicians to develop appropriate screening and treatment modalities for MDD.

The Association of Childhood Maltreatment with Adulthood Mental Disorders and Suicidality in Korea: a Nationwide Community Study

Background@#Although childhood maltreatment is a known risk factor for adulthood mental health, the impact of different types of childhood maltreatment on mental disorders is not yet clear. This study explored the association of each type of childhood maltreatment with adulthood mental disorders and suicidality in South Korea. @*Methods@#A total of 5,102 individuals from the general populations over the age of 18 responded to the Korean version of the Composite International Diagnostic Interview and questions about childhood maltreatment (emotional neglect, psychological abuse, physical abuse, and sexual abuse). To evaluate the odds ratio for mental disorders and suicidality associated with each type of childhood maltreatment, we used logistic regression analysis. @*Results@#About 17.0% of the respondents reported having experienced a type of maltreatment in childhood. According to the type, 9.4% reported physical abuse, 9.3% reported emotional neglect, 7.9% reported psychological abuse, and 3.8% reported sexual abuse. Exposure to each type of childhood maltreatment was associated with most types of mental disorders after adjusting for sociodemographic factors. Each type of childhood maltreatment victim was associated with suicidality (suicidal ideations, suicide plans, and suicide attempts).Dose-response patterns for suicide attempts were observed in all types of victims. Moreover, the respondents who experienced frequent childhood emotional neglect were 14 times more likely to have attempted suicide. @*Conclusion@#Childhood maltreatment was associated with mental health in adulthood.The findings show the need for early detection and intervention of victims of childhood maltreatment to minimize its negative impact on adult mental health.

Trends in the Prevalence of Major Depressive Disorder by Sociodemographic Factors in Korea:Results from Nationwide General Population Surveys in 2001, 2006, and 2011

Background@#This study investigated trends in the prevalence of major depressive disorder (MDD) by sociodemographic factors in South Korea. @*Methods@#National samples of the general population aged 18 years or older collected from the nationwide Korean Epidemiologic Catchment Area surveys conducted in 2001 (n = 6,206), 2006 (n = 6,466), and 2011 (n = 5,986) were used. For MDD diagnosis, we conducted face-to-face interviews using the Korean version of the Composite International Diagnostic Interview. We performed logistic regression analyses stratified by gender, after adjusting for other sociodemographic variables, to calculate the 2006-to-2001 odds ratio (OR) and 2011-to-2001 OR by subgroups of sociodemographic factors to explore the association of MDD prevalence with sociodemographic factors over time. @*Results@#The prevalence of MDD in the general population of South Korea increased steadily from 2001, to 2006, and to 2011 (1.6%, 2.5%, and 3.1%, respectively). Among the men, the prevalence of MDD continued to increase significantly in 18–29 years of age group (2006: adjusted OR [AOR], 3.32; 2011: AOR, 7.42), at-risk drinking group (2006: AOR, 3.56; 2011: AOR, 4.77), and not living with a partner group (2006: AOR, 3.24; 2011: AOR, 3.25).Meanwhile, among the women, the prevalence of MDD continued to significantly increase in the below-average household income group (2006: AOR, 2.58; 2011: AOR, 2.59), at-risk drinking group (2006: AOR, 2.02; 2011: AOR, 2.47), and unemployed group (2006: AOR, 1.48; 2011: AOR, 2.04). @*Conclusion@#This study may provide significant information for public policymakers to allocate sufficient health resources on MDD to vulnerable groups, particularly, men aged 18–29 years and women living in households with below-average income, and for clinicians to develop appropriate screening and treatment modalities for MDD.

Zolpidem-Induced Complex Sleep-Related Behavior / 생물치료정신의학

Zolpidem is a non-benzodiazepine hypnotic agent as an agonist of the GABA A benzodiazepine receptor. Zolpidem is considered to have lower abuse and dependence potential than benzodiazepines, and is widely used for the shortterm treatment of insomnia. However, the complex sleep-related behaviors caused by zolpidem have recently emerged as a major challenge. The purpose of this study was to review zolpidem-induced complex sleep-related behaviors and one of the most commonly reported behaviors, sleep-related eating disorder. The risk factors for these complex sleep-related behaviors are female sex, advanced age, daily doses of 10 mg or more, alcohol consumption, and comorbid medical illnesses. Strategies for managing zolpidem-induced complex sleep-related behaviors; discontinuing the use of zolpidem, switching to different sedative-hypnotic drugs, treating patients with other classes of medications, and using non-pharmacological treatment strategies for patients with sleep disorder. These strategies should also include examining drug regimens for potential drug interactions that may predispose patients to experiencing complex behaviors, administering zolpidem appropriately, and selecting patients more carefully for treatment in terms of their likelihood of experiencing medication-related adverse reactions. In conclusion, complex sleep-related behaviors related to zolpidem should be considered adverse drug reactions prior to drug prescription, and a patient’s potential risk factors should be evaluated. Physicians should pay attention to the occurrence of abnormal behavioral adverse effects related to zolpidem.

Impacts of Remaining Single above the Mean Marriage Age on Mental Disorders and Suicidality:a Nationwide Study in Korea

Background@#This study investigated the impact of getting older than the mean marriage age on mental disorders and suicidality among never-married people. @*Methods@#We performed an epidemiological survey, a nationwide study of mental disorders, in 2016. In this study, a multi-stage cluster sampling was adopted. The Korean version of the Composite International Diagnostic Interview was conducted with 5,102 respondents aged 18 years or above. The associations between never-married status, mental disorders, and suicidality were explored according to whether the mean age of first marriage (men = 32.8 years; women = 30.1 years) had passed. @*Results@#Never-married status over the mean marriage age was associated with agoraphobia, obsessive–compulsive disorder, mood disorders, and major depressive disorder after adjusting for sociodemographic factors. Respondents with never-married status above the mean marriage age were associated with suicide attempts (adjusted odds ratio [aOR], 3.21;95% confidence interval [CI], 1.36–7.60) after controlling for sociodemographic factors and lifetime prevalence of mental disorders, while respondents with never-married status under the mean marriage age were not. Moreover, in respondents with never-married status, getting older than the mean marriage age was associated with suicidal ideations (aOR, 1.49;95% CI, 1.04–2.15) and suicide attempts (aOR, 3.38; 95% CI, 1.46–7.84) after controlling for sociodemographic factors and lifetime prevalence of mental disorders. @*Conclusion@#Never-married status above the mean first marriage age was associated with mental disorders and suicidality. These findings suggest the need for a national strategy to develop an environment where people with never-married status do not suffer even if their marriage is delayed.

The Use of Anticholinergic Drugs in the Elderly

Anticholinergic drugs are commonly prescribed for treatment in specific clinical conditions in the elderly. Despite these thera-peutic benefits, the use of anticholinergic drugs is limited due to central or peripheral anticholinergic side effects. Especially in the elderly, since long-term use of anticholinergic drugs is related to mild cognitive impairment and dementia, it is necessary to pre-scribe anticholinergic drugs appropriately. In this review, we try to cover pathophysiology, prevalence of anticholinergic drugs, measuring tools of anticholinergic activity. Also, the negative effects on cognitive function, psychiatric symptoms, delirium, hospi-talization, functionality and mortality, and the benefits and limitations of discontinuing anticholinergic drugs are discussed. Finally, we suggest appropriate prescriptions of anticholinergic drugs for the elderly in various clinical conditions.

e Prevalence of Psychotic Experiences in the Korean General Population and its Association with Psychiatric Disorders / 생물치료정신의학

Objectives@#：The aim of this study was to investigate the lifetime prevalence of psychotic experiences (PEs) and the association of PEs with a range of psychiatric disorders in the Korean general population. @*Methods@#：Multi-stage cluster sampling was adopted in this study. Interviews were conducted face-to-face with 18-year-old and older people living in the community from June to November 2016. Korean version of Composite International Diagnostic Interview (K-CIDI) was applied to assess the prevalence of psychiatric disorders. Psychotic experiences were assessed with 21 items (15 items for hallucinations and 6 items for delusions) in the CIDI psychosis module. @*Results@#：Mean lifetime prevalence (standard error) of ever having a PEs was 3.3% (0.3) with 2.2% (0.2) of hallucinatory experiences and 1.7% (0.2) of delusional experiences. The lifetime prevalence of PEs was higher in young people and in persons with unemployment or part-time-job. PEs were associated with an increase in the lifetime prevalence of anxiety disorders [Adjusted odd ratio (AOR)=6.3 ; p<0.001], mood disorders (AOR=4.9 ; p<0.001), alcohol use disorders (AOR=2.4 ; p<0.001), and nicotine use disorders (AOR=2.4 ; p<0.001) after controlling for sociodemographic variables. @*Conclusion@#：PEs are related to various non-psychotic disorders as well as psychotic disorders. Clinicians should pay more attention to the mental health of individuals with PEs.

Major Depressive Disorder in Family Caregivers of Patients with Dementia / 생물치료정신의학

OBJECTIVES: The family caregivers of patients with dementia experience high caregiver burden. This study aims to investigate the prevalence of depression in family caregivers of dementia patients and to reveal whether or not the depression is affected by caregiver burden.METHODS: Multi-stage cluster sampling was adopted in this study. Interviews were conducted face-to-face with 18-year-old and older people living in the community from June to November 2016. Korean version of Composite International Diagnostic Interview(K-CIDI) was applied to assess the prevalence of one-year MDD of the subjects. It also examined whether caregivers in the survey lived with the dementia patients, whether they were caregiving the dementia patients themselves, and which relationship they had.RESULTS: Cross-analysis was conducted on the relationships in MDD and caregiver burden according to demographic factors, with a total of 5,102 respondents in the study. Prevalence of one-year MDD was 8.2% for sons and daughters and 50% for spouses with dementia. Among the families who had caregiver burden with dementia, prevalence of one-year MDD was 12.9%. Elderly and small numbers of family were also significantly associated with the prevalence of one-year MDD.CONCLUSION: The prevalence of one-year MDD of the family caregivers of patients with dementia was higher than without that of patients according to family relation and caregiver burden. Caregivers who were elderly and had two or fewer family members had more caregiver burden and higher prevalence of one-year MDD.

Gender Differences in the Clinical Manifestation of Depression and Related Neurotransmitters / 생물치료정신의학

Depression is almost twice as prevalent in women than men. Atypical symptoms, somatic complaints, and comorbid anxiety disorders are more common in women, whereas suicide and comorbid substance use disorders are more common in men. Previous studies have also reported gender differences in the efficacy of and tolerability to specific classes of antidepressants. Various psychosocial and biological factors have been proposed to explain the gender differences in clinical characteristics of depression. The predominant theory of depression pathogenesis is the monoamine hypothesis, and consequently, monoamine neurotransmitters have been the primary target of antidepressants. In the first section of this review, study findings of clinical differences in depression by gender are summarized. Then, we provide an overview of the findings from human and rodent studies of gender differences in serotonin, norepinephrine, dopamine, and glutamate neurotransmitter systems. Total level, rate of synthesis, and receptor profiles of neurotransmitters seem to differ by gender in the euthymic state, depressed state, and in responses to stress or antidepressants. Furthermore, these neurotransmitters interact with gonadal hormones and the hypothalamic-pituitary-adrenal axis, systems that innately exhibit gender differences. Although most of the studies conducted so far are limited to animal models and results of the studies are heterogeneous, growing evidence suggests that gender differences exist in neurotransmitter systems, which possibly leads to gender differences in depression. More intensive studies in this field are needed to build gender-specific treatment strategies.

The Association of Childhood Experience of Peer Bullying with DSM-IV Psychiatric Disorders and Suicidality in Adults: Results from a Nationwide Survey in Korea

BACKGROUND: Few studies have examined the association between childhood bullying and adulthood mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. We investigated the association of childhood peer bullying with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) psychiatric disorders and suicidality in adults. METHODS: A total of 5,102 respondents aged 18 or over completed the Korean version of the Composite International Diagnostic Interview for DSM-IV psychiatric disorders and a questionnaire for suicidal ideas, plans, and attempts. We evaluated peer bullying using an item in the Adverse Childhood Experiences International Questionnaire. Logistic regression analyses were used to identify the association between victimization of peer bullying, adult psychiatric disorders, and suicidality. RESULTS: Around 8.8% of the general population in Korea reported the experience of being bullied when growing up. Bullying experience was associated with an increase in the adulthood prevalence of nicotine use disorders (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.75–3.49), alcohol use disorders (aOR, 1.93; 95% CI, 1.49–2.51), mood disorders (aOR, 4.23; 95% CI, 3.01–5.94), and anxiety disorders (aOR, 2.89; 95% CI, 1.89–4.43) after adjusting for sociodemographic variables. Among anxiety disorders, the OR for post-traumatic stress disorder (aOR, 9.95; 95% CI, 5.62–17.63) was notably high. Frequent victimization (many times) was significantly associated with suicidality even after adjusting for sociodemographic variables and lifetime prevalence of psychiatric disorders, whereas occasional victimization (once or a few times) was not. CONCLUSION: Childhood bullying experience was associated with adult psychiatric disorders and suicidality. The findings indicated the importance of the early detection and management of childhood peer bullying to reduce detrimental adulthood consequences.

Bidirectional Association between First-Episode Panic Disorder and Major Depressive Disorder in a Nationwide General Population Survey in Korea

BACKGROUND: Panic disorder (PD) and major depressive disorder (MDD) can occur concurrently, despite different clinical manifestations. Because MDD and PD patients tend to have more complicated conditions, understanding the co-occurrence and pattern of these conditions is important. Here, we investigated the influence of PD and MDD on each other, with respect to time interval. METHODS: Data from three national representative surveys were pooled (total 18,807 respondents), and the age of onset (AOO) of PD and MDD was analyzed. We performed Kaplan-Meier analysis to estimate separate survival functions, using the AOO of MDD and PD as the outcome. To understand the temporal effect of other disorders, we used a Cox proportional hazard model to estimate the hazard ratios for the onset of MDD/PD with other comorbidities as time-dependent covariates. RESULTS: PD elevated the risk of subsequent MDD by 1.5-fold, whereas MDD elevated the risk of subsequent PD by 3.8-fold. The effect of such an elevation risk was significant for up to 2 years. CONCLUSION: The results revealed a bidirectional relationship between MDD and PD. Each disease represents a risk of a subsequent occurrence of the other, which lasts for a considerable duration.

Mediating Effect of Resilience on the Association between Emotional Neglect and Depressive Symptoms

OBJECTIVE: Previous studies have reported that childhood maltreatment experiences could induce biological and psychological vulnerability in depressive disorders. However, it is still unclear that type-specific effects of childhood maltreatment on psychological resilience, depressive symptoms and interactions among childhood maltreatment experiences, resilience, and depressive symptoms. METHODS: A total of 438 medical students were included in the study. The Childhood Trauma Questionnaire-Short Form, the Conner-Davidson Resilience Scale, and the Beck Depression Inventory were used for measuring childhood maltreatment experiences, psychological resilience, and depressive symptoms, respectively. We investigated the effects of childhood maltreatment experiences on resilience and depressive symptoms using correlation analysis. In addition, we analyzed the mediating effect of resilience on the association between childhood maltreatment and symptoms of depression. RESULTS: Among childhood maltreatment, emotional neglect was a significant predictor of the scores of low resilience and high depressive symptoms in both gender groups (all ps < 0.05). Furthermore, resilience was found to be a mediator connecting emotional neglect experiences with depressive symptoms. CONCLUSION: Our results suggest that emotional neglect has detrimental effects on mood and resilience, and clinicians need to focus on the recovery of resilience when they deal with depressive symptoms in victims of childhood maltreatment.