ABSTRACT
BACKGROUND: In South Korea, the leading cause of youth death has been suicide for about 20 years. In this study, we conducted a multi-method psychological autopsy to identify the psychiatric diagnosis, developmental history, personality traits, family history, school life, warning signs of suicide, and risk factors related to suicide for the first time in Korea. METHODS: This was a postmortem, retrospective, and descriptive study of 36 adolescents who died by suicide between August 2015 and July 2021 in South Korea. We obtained qualitative and quantitative data from the Korean Psychological Autopsy of Adolescent, conducted by the Suicide and School Mental Health Institute, the official student mental health policy-focused research institute of the Korean Ministry of Education. RESULTS: The adolescents comprised equal percentage of girls and boys. Approximately half of the deaths (55.6%) occurred at home and most (72.2%) involved jumping from a height. Most of the adolescents (97.2%) had one major psychiatric disorder before death, with depressive disorder being the most prevalent (75%). They were at a high risk for internet addiction before death. The most common personality trait was avoidance (28.6%), followed by submissiveness (27.3%). Half of the parents reported that the adolescents were satisfied with their school life and the teachers observed that they had no behavioral problems. One year before death, seven (19.4%) adolescents injured themselves and five (13.9%) had attempted suicide. Most of the deceased (80.6%) had expressed suicide warning signs to their families within one year before death. Adolescents had a long experience of family-related adverse events. CONCLUSIONS: Most of the adolescents had mental health disorders and expressed suicidal intentions using verbal and nonverbal signs. However, it was challenging for families to recognize the risk signs because of adolescents' personality traits or a good school life. To prevent adolescent suicide, adolescents, parents, and teachers need to be educated to recognize signs of suicide warning signs and equipped to guide adolescents to appropriate care.
ABSTRACT
The purpose of this study was to investigate the neural correlates of cognitive-behavioral therapy (CBT) for externalizing behavior problems in perpetrators of school bullying using assessments of brain activity and behavior. Twenty-five adolescent bullies participated in an 8-session intervention. Prior to and after participation, 24 adolescents were evaluated using the Child Behavior Checklist (CBCL) and 23 completed resting-state functional magnetic resonance imaging. Changes in the fractional amplitude of low-frequency fluctuations (fALFF) and scores on the CBCL were analyzed. We also compared the identified changes into 2 groups (low and high delinquency) differentiated by a cutoff of 65 points on the delinquency subscale of the CBCL. Following the intervention, participants exhibited improvement in the subscores of the CBCL and decreases in the fALFF of the inferior parietal lobule, lingual, interior frontal and middle occipital gyrus. A positive correlation was observed between changes in the CBCL externalizing behavior scores and fALFF of the inferior frontal gyrus. The high delinquency group showed a greater decrease in delinquency and externalizing CBCL subscores across time than did the low delinquency group. The high delinquency group had more areas that showed change in fALFF post-intervention than did the low delinquency group. A positive correlation was observed between changes in the CBCL delinquency scores and fALFF of the precentral gyrus in the high delinquency group. The results indicate that this CBT for externalizing behavior problems in bullies had more positive effects on delinquent behavior in adolescents with high levels of delinquency, and these changes were associated with functional changes in brain activity. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02670876.
