A Research Study on Shift Work Fatigue of Air Operations Control Officer / 항공우주의학회지

Purpose@#Shift work can have physical and mental effects by destroying the physiological rhythm cycle by working at a times that does not match the worker’s physical and daily life rhythm. Due to the nature of its mission, the Korean Air Force performs 24-hour shift work in various fields, and this study attempted to analyze the sleep quality and mental workload of air defense operation control personnel who require shift work. @*Methods@#Three surveys were conducted to analyze fatigue and job difficulty, etc. A general questionnaire asking about mission-related experience and demographic characteristics, the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K), which measures sleep quality, and NASA-TLX (National Aeronautics of Space Administration-task load index), a subjective job difficulty assessment method. @*Results@#Overall, there was no significant difference in the ‘total sleep index’ and ‘job difficulty’ as a result of comparing and analyzing the 5-team 4 shift method and other shift methods, but the ‘total sleep index’ score was analyzed twice as high as the reference score in both comparison groups. @*Conclusion@#In order to prevent shift workers’ sleep-related fatigue and human errors that may arise from this, there is room for improvement in shift work, and as can be seen from the analysis results, it is necessary to manage the schedule by focusing on shift types rather than shift methods.

Fatigue Management Strategy for Shift Workers in the Air Traffic Control / 항공우주의학회지

Recently, shift work, including night shift, has been widely implemented in modern society. These include workplaces that have to work 24 hours a day for production processes, such as petrochemicals, power plants, and steel industries, as well as industries necessary to secure public services such as gas and electricity. In particular, workers in the aviation sector are mostly engaged in shift work due to the nature of their 24 hours of continuous work. Most shift workplaces comply with legal work regulations, but they fail to take into account workers’ fatigue and focus only on compliance with regulatory requirements. Specifically, shift work needs to provide minimum guidelines for workers’ safety and health. Therefore, this study analyzed and reviewed the current status of shift work in the air traffic control field, where shift work is essential, and presented guidelines for the safety and health care of shift workers.First of all, the international shift work guidelines and domestic laws related to shift work were reviewed, and the characteristics of the shift work system in the air traffic control field were reviewed. For the guidelines, we discussed the shift method, shift speed (direction), shift work hours and hours, night work, and other considerations.

A Study on the Risk Assessment Technique of Aviation Sector in the Serious Accidents Punishment Act / 항공우주의학회지

Currently, an important keyword for safety issues in Korean society is the enforcement of the Serious Accidents Punishment (SAP) Act. The purpose of enacting the SAP Act is to prevent accidents and disasters by establishing a system in which society, business, and organizations systematically manage safety and health.The mandatory measures for the enforcement of the SAP Act are to have manpower and budget necessary for accident prevention, and to establish and implement a safety and health management system. Measures concerning the establishment and implementation of the safety and health system begin with the application or risk management procedures to identify hazards, eliminate risk factors, and prepare control measures. In order to increase the validity of the risk management application results, it is important to apply a technique for risk assessment that systematically evaluates risk factors. Therefore, this study intends to examine the recent trends and implications of risk assessment techniques. First, based on the risk assessment guidelines of the MOEL in Korea, major risk assessment techniques were considered and examples were presented. The representative risk assessment techniques consider are 4M, Checklist, HAZOP (HAZards & Operability Studies), What-IF, JSA(Job Safety Analysis), FTA (Fault Tree Analysis), ETA (Event Tree Analysis), and CCA (Cause Consequence Analysis).

A Validation of the Korean Version of Ultra-Short Suicidal Ideation Scale / 신경정신의학

Objectives@#An accurate and easy-to-identify form is needed for the early evaluation of suicidal ideation in high-risk patients. Therefore, this study examined the validity and reliability of a Korean version of the Ultra-Short Suicidal Ideation Scale (K-USSIS). @*Methods@#A total of 161 psychiatric university-affiliated general hospital patients completed the K-USSIS. The data were analyzed using correlation, internal consistency, and confirmatory factor analyses. @*Results@#First, the scale had good internal consistency with a Cronbach’s α of 0.94. Second, the confirmatory factor analysis demonstrated that the single-factor model had a reasonable fit (comparative fit index=0.99, Tucker–Lewis index=0.98, standardized root mean squared residual=0.01, and root mean square error of approximation=0.10). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and hopelessness. @*Conclusion@#The findings suggest that the K-USSIS has good psychometric properties and can serve as a valuable tool for screening for suicidal ideation to ensure early intervention in Korean psychiatric patients.

Relationship Between Hopelessness and Suicidal Ideation Among Psychiatric Patients: The Mediating Effect of Sleep Quality and Interpretation Bias for Ambiguity / 정신신체의학

Objectives@#：This study aimed to examine the mediating effect of sleep quality and interpretation bias for ambiguity in the relationship between hopelessness and suicidal ideation in psychiatric patients. @*Methods@#：A total of 231 psychiatric outpatients and inpatients completed the Beck Hopelessness Scale, Pittsburgh Sleep Quality Index, Ambiguous/Unambiguous Situations Diary-Extended Version, and Ultra-Short Suicidal Ideation Scale. Data analysis was conducted using regression analyses and bootstrap sampling. @*Results@#：The results of this study showed that hopelessness had a direct effect on suicidal ideation, and that sleep quality and interpretation bias for ambiguity mediated the association between hopelessness and suicidal ideation. Moreover, there was a significant double mediating effect of sleep quality and interpretation bias for am-biguity on the relationship between hopelessness and suicidal ideation. @*Conclusions@#：These results suggest that it is important to consider both sleep quality and interpretation bias for ambiguity to prevent hopelessness from leading to suicidal idea. These results suggest that considering both sleep quality and interpretation bias for ambiguity may be important in preventing hopelessness from leading to suicidal ideation.

Diagnostic Utility of Four Brief Korean Versions of the PTSD Checklist for DSM-5 in Adult Psychiatric Outpatient / 우울ㆍ조울병

Background@#The post-traumatic stress disorder (PTSD) Checklist (PCL)-5, originally a 20-item self-questionnaire, has provided abbreviated versions of the checklist. This study aimed to test the diagnostic utility and validity of four brief versions of PCL-5 in a sample of adults seeking treatment at a psychiatric outpatient unit in a South Korean university-affiliated hospital. @*Methods@#The sample comprised 97 adults diagnosed with PTSD and 130 diagnosed with other psychiatric disorders seeking treatment. Each abbreviated scale was examined with the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and positive predictive power. Additionally, internal consistency, correlation with full scale, convergent validity, and concurrent validity were investigated. @*Results@#All four versions demonstrated excellent discriminative power, with AUC values of >0.9. Suggested cut-off scores were 6, 8, 11, and 16 for the short four-item version (S4), PCL4, PCL6, and PCL8, respectively. Internal consistency was adequate or good except for S4. Additionally, brief scales demonstrated good convergent validity with depression and anxiety scales and excellent concurrent validity with other PTSD scales. @*Conclusion@#This study confirms the excellent diagnostic utility and adequate validity of four abbreviated versions of the Korean translation of PCL-5 in the clinical trial.

The Moderating Effect of Reasons for Living on the Relationship Between Depression and Suicidal Ideation Among Psychiatric Patients / 정신신체의학

Objectives@#：This study aimed to examine the moderating effects of reasons for living on the relationship between depression and suicidal ideation among psychiatric patients. @*Methods@#：Patients were recruited from the department of psychiatry of university hospital. A total of 137 participants completed self-report questionnaires assessing depression (Beck Depression Inventory), suicidal ideation (Ultra-Short Suicidal Ideation Scale) and reasons for living (The Reasons for Living Inventory). @*Results@#：Among 4 sub-scales of the reasons for living inventory, survival and coping beliefs, fear of death and social disapproval, and future expectation moderated the relationship between depression and suicidal ideation. @*Conclusions@#：The results suggest that the reasons for living can work as a protective factor on the relationship between depression and suicidal ideation among psychiatric patients.

A Study on the Biomathematical Model Approach for Aviation Fatigue Risk Management / 항공우주의학회지

In the aviation sector, it is recommended to adopt an aviation safety management system (SMS) from international organizations (International Civil Aviation Organization, Federal Aviation Administration, etc.) and to apply a related system in each organization. Among them, fatigue management recommends fatigue risk management system (FRMS) operating as part of SMS proactive risk management. Advanced aviation organizations are developing and applying various related risk assessment techniques that consider characteristics in order to apply scientific and systematic FRMS. Among which the biomathematical fatigue model (BFM) are representative. The Bio-mathematical Model is designed to represent the level by converting it into a simple numerical score, taking into account various related factors for the measurement object. The BFM is tool to predict the level of fatigue of the crew based on scientific understanding of the factors that contribute to fatigue. The Biomathematical Model is used as a scientific approach that promotes the transition to a performance-based safety management. In this study, the recent trends and implications for the BFM developed and applied in the aviation field are to be reviewed.First, FRMS was considered within the SMS framework, then the characteristics and application methods of the BFM were examined, and finally, the direction of the development of the BFM was suggested.

A Pilot Feasibility Study on a Single-Session Stabilization Group Psychotherapy for Adults with Acute Stress Symptoms / 우울ㆍ조울병

Background@#Although the field of psychology currently recommends trauma-focused cognitive behavioral therapy for early psychological intervention for acute traumatic stress, additional research is required for safe and efficient psychotherapy that can delivered to a broader population and within a brief period of time. @*Methods@#This pilot study examined the safety and feasibility of a single-session group stabilization intervention for individuals conducted at an average of two weeks after various types of traumatic events. Further development of DSM-5 mental disorders, such as post-traumatic stress disorder (PTSD) and others, was assessed at the six-month follow-up. A total of 38 participants with acute stress symptoms participated in a single-session 90-minute group psychotherapy, which consists of psychoeducation; identification of and coping with triggers; somatosensory grounding; and containment exercise. @*Results@#After six months, follow-up was conducted on 34 (89.5%) patients, who completed the Structured Clinical Interview for DSM-5 Mental Disorders and the PTSD Checklist-5. One (2.9%) participant met the current diagnosis of PTSD, whereas none met any other psychiatric diagnoses. A significant decrease was noted in PTSD scores between baseline and follow-up (t=7.4, df=33, p<0.001, Cohen’s d=1.27) measured using the PTSD Checklist-5. @*Conclusion@#The finding suggests that a single stabilization session can be used in a safe and efficient manner at of the acute stage of trauma.

Optimal PSA Threshold for Androgen-Deprivation Therapy in Patients with Prostate Cancer following Radical Prostatectomy and Adjuvant Radiation Therapy

Purpose@#The benefits of early administration of androgen-deprivation therapy (ADT) in patients with prostate-specific antigen (PSA)-only recurrent prostate cancer (PCa) following radical prostatectomy (RP) are controversial. We investigated the impact of early versus delayed ADT on survival outcomes in patients with non-metastatic, localized or locally advanced PCa who received radiation therapy (RT) following RP and later developed distant metastasis. @*Materials and Methods@#A retrospective analysis was performed on 69 patients with non-metastatic, localized or locally advanced PCa who received RT following RP and later developed distant metastasis between January 2006 and December 2012. Patients were stratified according to the level of PSA at which ADT was administered (<2 ng/mL vs. ≥2 ng/mL). Study endpoints were progression to castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival (CSS). @*Results@#Patients were stratified according to the criteria of 2 ng/mL of PSA at which ADT was administered, based on the Youden sensitivity analysis. Delayed ADT at PSA ≥2 ng/mL was an independent prognosticator of cancer-specific mortality (p=0.047), and a marginally significant prognosticator of progression to CRPC (p=0.051). During the median follow-up of 81.0 (interquartile range 54.2–115.7) months, patients who received early ADT at PSA <2 ng/mL had significantly higher CSS rates compared to patients who received delayed ADT at PSA ≥2 ng/mL (p=0.002). Progression to CRPC-free survival was comparable between the two groups (p=0.331). @*Conclusion@#Early ADT at the PSA level of less than 2 ng/mL confers CSS benefits in patients with localized or locally advanced PCa who were previously treated with RP.

A Study on the Pilot Fatigue Measurement Methods for Fatigue Risk Management / 항공우주의학회지

Pilot fatigue is a great hazard to aviation safety. In recent years, longdistancefights have been increasing and flight hours have been increasing, whichhas made fatigue issues important. International organizations in the aviation sectors(ICAO, FAA, IATA etc.) recommend management of fatigue within the SMS (SafetyManagement System) framework. A scientific and systematic approach to measuringfatigue is required as a prerequisite to preparing safety management measures forpilot’s fatigue. Therefore, in this study, I would like to consider recent trends andimplications for fatigue measurement. First, I aimed to consider recent the accidentcases related to fatigue. Second, I also considered how to measure the pilot’sfatigue. Finally, the direction of the countermeasures against fatigue through fatigue measurement was developed and suggested.

Childhood Trauma and Pharmacotherapy Retention among Outpatients with Panic Disorder / 정신신체의학

Objectives@#：This study investigated lifetime experiences of trauma, treatment retention, and psychiatric symptoms among outpatients with panic disorder after initiation of pharmacotherapy. Our research hypothesis was that panic patients with childhood trauma would display more severe symptoms and less treatment retention compared to those without such history. @*Methods@#：A total of 135 first-visit outpatients with DSM-IV panic disorder were approached during the period from March 2012 to August 2016. Fifty-three patients (39%) either refused or returned incomplete questionnaires, leading to a final sample size of 82. Participants completed the Trauma History Screen, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Abbreviated PTSD checklist. @*Results@#：The number of lifetime trauma was significantly correlated with treatment retention (rho=-0.269, p=0.015). Among subtypes of trauma, only childhood physical abuse was significantly correlated with treatment retention (rho=-0.298, p=0.007). @*Conclusions@#：Our results indicated that psychological trauma, particularly of an interpersonal nature from childhood, can affect pharmacotherapy treatment retention in panic disorder. This may be mediated by poor patient- doctor relationships originating from trust issues among childhood trauma survivors or lack of perceived improvement due to the more severe symptoms and unfavorable course experienced by those with childhood trauma. Further studies are needed to explore the reasons for poor treatment adherence in this population.

Psychological Characteristics of Psychiatric outpatients with High Suicide Risk : Using MMPI-2-RF / 정신신체의학

Objectives@#：The purpose of this study was to examine whether the MMPI-2-RF serves as a useful tool to differentiate between the subtypes of high risk of suicide among psychiatric outpatients. @*Methods@#：Patients were recruited from the department of psychiatry of university hospital. Participants were diagnosed using DSM-5 criteria by board certified psychiatrists. Their medical records were reviewed retrospectively. And participants were put into 4 groups (Suicide ideation, Suicide attempt, Non-suicidal self-injury, and general psychiatric diagnosis as a control group). For statistical comparison, the MANCOVA with gender as a covariate was used. @*Results@#：The results indicated that as previous research with non-clinical sample suggested, psychiatric outpatients with high suicide risk also have significantly higher Emotional/Internalizing Dysfunction, Helplessness/ Hopelessness, Suicidal/Death Ideation, Demoralization, Cognitive complaints, Cynicism, Dysfunctional negative thoughts than general psychiatric patients group. But group differences within the high suicide risk patients have not been observed. However, suicide attempt group and NSSI group has higher Behavioral/Externalizing Dysfunction, RC4, AGG than general psychiatric patients group. But there was no difference between suicidal idea group and general psychiatric patients group. @*Conclusions@#：There was no group difference observed between all three subtypes, which mean the MMPI- 2-RF may not be the useful diagnostic tool to navigate high suicide risk subtypes. Even though there was no difference observed in the suicide ideation group, suicide attempt group and NSSI group have higher aggression and externalization. So those indexes could serve as a useful marker to investigate riskiness of suicide related symptoms.

Change of Temperament and Personality in Post-traumatic Stress Disorders / 정신신체의학

Objectives@#：This study investigate to identify the stability of temperament and personality characteristics of patients including Posttraumatic Stress Disorder (PTSD) patients. @*Methods@#：The number of subjects was 102, of which 33 were PTSD patients and 69 were non-PTSD patients. To demonstrate the change in individual temperament and personality characteristics, Temperament and Character Inventory (TCI) were administered repeatedly on the subjects. Repeated measures ANOVA and simple main effects analysis were conducted. @*Results@#：When analysed by dividing the subjects into PTSD groups and non-PTSD groups, the differences between the primary and secondary tests did not appear in the non-PTSD groups, but the differences between the primary and secondary tests were significant in Harm Avoidance (HA), Reward Dependence (RD), Self-Directedness (SD), Cooperativeness (C). In addition, it was noted that the time and group interaction effects of HA, RD, SD and C were significant, and that the main effects of time of HA, RD, SD and C were significant. @*Conclusions@#：This study is meaningful in that in the course of experience and recovery of traumatic events,we have clinically confirmed that changes in the temperament, known as stable variables, are possible.

Change of Temperament and Personality in Post-traumatic Stress Disorders / 정신신체의학

Objectives@#：This study investigate to identify the stability of temperament and personality characteristics of patients including Posttraumatic Stress Disorder (PTSD) patients. @*Methods@#：The number of subjects was 102, of which 33 were PTSD patients and 69 were non-PTSD patients. To demonstrate the change in individual temperament and personality characteristics, Temperament and Character Inventory (TCI) were administered repeatedly on the subjects. Repeated measures ANOVA and simple main effects analysis were conducted. @*Results@#：When analysed by dividing the subjects into PTSD groups and non-PTSD groups, the differences between the primary and secondary tests did not appear in the non-PTSD groups, but the differences between the primary and secondary tests were significant in Harm Avoidance (HA), Reward Dependence (RD), Self-Directedness (SD), Cooperativeness (C). In addition, it was noted that the time and group interaction effects of HA, RD, SD and C were significant, and that the main effects of time of HA, RD, SD and C were significant. @*Conclusions@#：This study is meaningful in that in the course of experience and recovery of traumatic events,we have clinically confirmed that changes in the temperament, known as stable variables, are possible.

Factorial Validity of the Korean Version of the Illness Intrusive Rating Scale among Psychiatric Outpatients Mainly Diagnosed with Anxiety or Depressive Disorders / 정신신체의학

OBJECTIVES@#The Illness Intrusiveness Rating Scale (IIRS) is a well-validated self-report instrument for assessing negative impact of chronic illness and/or adverse effects of its treatment on everyday life domains. Although extensive literature probed its psychometric properties in medical illness, little attention was paid for its validity for psychiatric population. This study aimed to test factorial structure of the Korean Version of the IIRS (IIRS-K) in a consecutive sample of psychiatric outpatients.@*METHODS@#Data set of 307 first-visit patients of psychiatric clinic at Guri Hanyang univ. Hospital were used. Exploratory and confirmatory factor analysis, internal consistency were tested in IIRS-K. We also checked Spearman's correlation analysis between IIRS-K, Zung's self-report anxiety scale and Zung's self-report depression scale.@*RESULTS@#76.9% of the patients were with anxiety disorder and depressive disorder. The principal component factor analysis of the IIRS-K extracted three-factor structure accounted for 63.2% of total variance that was contextually similar to the original English version. This three-factor solution showed the best fit when tested confirmatory factor analysis compared to the original IIRS, two-factor model of IIRS-K suggested from medical outpatients, and one-factor solution. The IIRS-K also showed good internal consistency (Cronbach's α=0.90) and good convergent validity with anxiety and depression scales.@*CONCLUSIONS@#The IIRS-K showed the three-factor structure that was similar but not identical to original version. Overall, this study proved factorial validity of the IIRS-K and it can be used for Korean clinical population.

Wrist Rehabilitation after Scapholunate Interosseous Ligament Reconstruction for a Collegiate Basketball Player / 대한스포츠의학회지

For a basketball player who had scapholunate interosseous ligament injury related to sport, it is crucial to secure the active range of motion (ROM) and regain proprioception of the wrist. The player was involved in a 21-week rehabilitation procedure based on controlling pain with inactive treatments, restoring the wrist ROM with active treatments. We measured the visual analog scale (VAS) for pain, upper extremity functional outcome measurement (Disabilities of Arm, Shoulder, and Hand [DASH]) for the functionality, and active ROMs of the wrist. The VAS was decreased (after surgical treatment, 8.7; 1 week, 2.5; 12 week, 3–5; 21 week, 0). The DASH score was decreased when he returned to play (after surgical treatment, 78; end of the rehabilitation, 23). Wrist flexion and extension ROM were increased to 55° and 67°, respectively. To restore the function of the wrist for basketball performance, improvement of active ROM and proprioception is the primary goal to return to play.

Childhood Trauma and Treatment Implications in Major Depressive Disorder in South Korea: Comparison with Medical Outpatients and Two-Year Follow-Up / 우울ㆍ조울병

BACKGROUND: Little is known about the specific types of childhood trauma and their relationship to treatment-related issues in major depressive disorder (MDD). This study examined trauma experiences and treatment-related variables in outpatients with MDD at a psychiatric department of a university hospital in Korea.METHODS: First, 75 outpatients with MDD were compared to medical outpatients without MDD matched by age, sex, income, and educational qualifications. Both groups completed the Life Stressor Checklist-Revised, which assesses comprehensive life events. Second, treatment-related variables and medication compliance measured by the Compliance Rating Scale were investigated for the two-year period after the initial assessment.RESULTS: The MDD group had experienced a significantly higher number of lifetime traumas than the control group (p=0.003), including more frequent witnessing of family violence (p<0.001), adulthood physical assault by a family member (p<0.001), and childhood emotional abuse (CEA) (p<0.001). CEA was associated with early onset of the first depressive episode and premature termination of pharmacotherapy; childhood physical neglect was associated with premature termination and less time in therapy.CONCLUSION: Our findings support the important influence of childhood emotional trauma and its relationship to treatment retention.

Reliability and Validity of the Korean Version of Clinician-Administered Posttraumatic Stress Disorder Scale for DSM-5

BACKGROUND: For diagnosis of post-traumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale (CAPS) is one of the most widely used structured diagnostic interviews. METHODS: In this study, we aimed to develop and validate the Korean version of CAPS for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition ([DSM-5] K-CAPS-5). Seventy-one subjects with PTSD, 74 with mood disorder or anxiety disorder, and 99 as healthy controls were enrolled. The Korean version of the structured clinical interview for DSM-5-research version was used to assess the convergent validity of K-CAPS-5. BDI-II, BAI, IES-R, and STAI was used to evaluate the concurrent validity. RESULTS: All subjects completed various psychometric assessments including K-CAPS-5. K-CAPS-5 presented good internal consistency (Cronbach's α = 0.92) and test-retest reliability (r = 0.91). K-CAPS-5 showed strong correlations with the structured clinical interview for DSM-5 PTSD (k = 0.893). Among the three subject groups listed above there were significant differences in the K-CAPS-5 total score. The data were best explained by a six-factor model. CONCLUSION: These results demonstrated the good reliability and validity of K-CAPS-5 and its suitability for use as a simple but structured instrument for PTSD assessment.

Validation of the Korean Version of the Trauma Symptom Checklist-40 among Psychiatric Outpatients / 정신신체의학

OBJECTIVES: Effects of multiple trauma are complex and extend beyond core PTSD symptoms. However, few psychological instruments for trauma assessment address this issue of symptom complexity. The Trauma Symptom Checklist-40 (TSC-40) is a self-report scale that assesses wide range of symptoms associated with childhood or adult traumatic experience. The purpose of the present study was to evaluate the validity of the Korean Version of the TSC-40 in a sample of psychiatric outpatients. METHODS: Data of 367 treatment-seeking patients with DSM-IV diagnoses were obtained from an outpatient department of psychiatric unit at a university hospital. The diagnoses were anxiety disorder, posttraumatic stress disorder, depressive disorder, adjustment disorder and others. Included in the psychometric data were the TSC-40, the Life events checklist, the Impact of Event Scale-Revised, the Zung's Self-report Depression Scale, and the Zung's Self-report Anxiety Scale. Cronbach's α for internal consistency were calculated. Convergent and concurrent validity was approached with correlation between the TSC-40 and other scales (PTSD, anxiety and depression). RESULTS: Exploratory factor analysis of the Korean Version of TSC-40 extracted seven-factor structure accounted for 59.55% of total variance that was contextually similar to a six-factor structure and five-factor structure of the original English version. The Korean Version of TSC-40 demonstrated a high level of internal consistency. (Cronbach's α=0.94) and good concurrent and convergent validity with another PTSD scale and anxiety and depression scales. CONCLUSIONS: Excellent construct validity of The Korean Version of TSC-40 was proved in this study. And subtle difference in the factor structure may reflect the cultural issues and the sample characteristics such as heterogeneous clinical population (including non-trauma related disorders) and outpatient status. Overall, this study TSCdemonstrated that the Korean version of TSC-40 is psychometrically sound and can be used for Korean clinical population.