Development of Mental Healthcare Model in Seoul.

OBJECTIVE: To develop an integrated and comprehensive community-based mental healthcare model, opinions were collected on various issues from practitioners in mental health service institutions currently offering mental healthcare services in Seoul through a focus group interview, qualitative research method, and Delphi survey. METHODS: The focus group interview was conducted with six practitioners from mental health welfare centers and six hospital-based psychiatrists. A questionnaire of opinions on the mental healthcare model was filled by these practitioners and psychiatrists. A Delphi survey was additionally conducted with a panel of 20 experts from a community mental health welfare center and hospital-based psychiatrists. RESULTS: The focus group interview results showed the need for integrated community-based mental healthcare service and the need to establish a system for managing mental and physical health in an integrated manner. Based on the survey results, the current status of community-based mental healthcare services was investigated, and the direction of the revised model was established. The Delphi survey was then conducted to refine the revised model. CONCLUSION: The present study presents the Seoul-type community-based mental healthcare model with integrated services between a psychiatric hospital with a mental health welfare center as well as combined mental and physical health services. This is ultimately expected to help people with mental illnesses live healthy lives by meeting their needs as community members.

Influence of Biogenetic Explanations of Mental Disorders on Stigma and Help-Seeking Behavior: A Systematic Review and Meta-Analysis.

BACKGROUND: Biogenetic causal explanations of mental disorders are commonly used for public education and campaigns. However, the influence of biogenetic explanations on the ideas about and attitudes toward mental illness is unclear. We examined the influence of biogenetic explanations on attitudes toward mental disorders using a meta-analytic method accompanied by subgroup analyses. METHODS: The protocol for this meta-analysis was registered in PROSPERO (CRD42020158656) in March 2020. Experimental and correlational studies were analyzed separately. Five outcome measures related to attitudes toward mental disorders were included: 'attitude toward help-seeking,' 'blame,' 'perceived dangerousness,' 'prognostic pessimism,' and 'social distance.' Subgroup analyses were performed for the type of mental disorder, population, and geographic region for which a biogenetic explanation was provided. RESULTS: A total of 44 studies were included, of which 24 were experimental and 20 were correlational. A positive attitude toward help-seeking was associated with having a biogenetic concept (d = 0.43; 95% confidence interval [CI], 0.18 to 0.67; P < 0.001) in general population and in Eastern countries in particular. Although a biogenetic explanation was associated with a decreased level of blame (d = -0.20; 95% CI, -0.38 to -0.02; P = 0.029) in the general population, it was also associated with significantly higher levels of perceived dangerousness (d = 0.13; 95% CI, 0.03 to 0.23; P = 0.008). A tendency toward a higher level of prognostic pessimism and social distance was associated with a biogenetic concept of mental disorders although there was no statistical significance. CONCLUSION: Having a biogenetic concept of the cause of mental disorders was related with a positive attitude toward help-seeking, particularly in the general population and individuals living in Eastern countries. Providing a biogenetic explanation decreased blame toward individuals with mental illness but was associated with increased perceived dangerousness and prognostic pessimism. Therefore, although a biogenetic explanation promotes public use of mental health services, it should be carefully applied to avoid an increase in negative thoughts, such as that mental illness is biologically irreversible and untreatable.

Effectiveness of a Community-Based Intensive Case Management Model on Reducing Hospitalization for People With Severe Mental Illness in Seoul.

OBJECTIVE: To overcome the limited effectiveness of standard case management services, the Seoul Intensive Case Management program (S-ICM) for patients with serious mental illnesses was introduced in 2017. This study aimed to evaluate its effectiveness in reducing the length of hospital stay. METHODS: Monitoring data from April 2019 to March 2020 were retrieved from the Seoul Mental Health Welfare Center. A total of 759 participants with serious mental illnesses were included. The average length of admission per month was compared between the pre-ICM (previous year) and during-ICM periods. For post-ICM observation subgroup, average length of admission per month was compared between pre-ICM, during-ICM, and post-ICM periods. To determine the relative contributions of risk factors for during-ICM and post-ICM admission, multivariate logistic regression analyses were performed. RESULTS: The average admission stay for pre-ICM period was significantly longer than that for during-ICM period (1.47 vs. 0.26 days). Among the predictors for during-ICM admission, pre-ICM psychiatric admission was the most important risk factor, followed by medical aid beneficiary and suicidal behavior. In the subgroup analysis of the post-ICM observation period, the pre-ICM, during-ICM, and post-ICM average admission stays were 1.45, 0.29, and 0.57 days/month, respectively. There was a significant difference in the average length of stay between the pre-ICM and during-ICM periods and between the pre-ICM and post-ICM periods. Post-ICM admission risks included pre-ICM admission, S-ICM duration <3 months, and chronic unstable symptoms. CONCLUSION: The results suggest that the S-ICM effectively reduces psychiatric hospitalization duration, at least over a short-term period.

Effects of short-term exposure to air pollution on hospital admissions for autism spectrum disorder in Korean school-aged children: a nationwide time-series study.

OBJECTIVES: This study explored the effects of short-term exposure to air pollution on hospital admissions for autism spectrum disorder (ASD), a proxy for symptom aggravation, among Korean children aged 5-14 years. DESIGN: Time-series study. SETTING, PARTICIPANTS AND OUTCOME MEASURES: We used data from the National Health Insurance Service (2011-2015). Daily concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3) levels in each region were used as exposures. ASD cases were defined based on a principal admission diagnosis of the claims data. We applied distributed lag non-linear models and a generalised difference-in-differences method to the quasi-Poisson models to estimate the causal effects of air pollution for up to 6 days. We also performed weighted quantile sum regression analyses to assess the combined effects of air pollution mixtures. RESULTS: PM2.5 levels at lag day 1, NO2 levels at lag day 5 and O3 levels at lag day 4 increased the risks of hospital admissions for ASD (relative risk (RR)=1.17, 95% CI 1.10 to 1.25 for PM2.5; RR=1.09, 95% CI 1.01 to 1.18 for NO2 and RR=1.03, 95% CI 1.00 to 1.06 for O3). The mean daily count of hospital admissions for ASD was 8.5, and it would be 7.3, 7.8 and 8.3 when the PM2.5 levels would be decreased by 10.0 µg/m3, NO2 by 10 ppb and O3 by 10 ppb, respectively. The weighted quantile sum index, constructed from PM2.5, NO2 and O3 levels, was associated with a higher risk of hospital admissions for ASD (RR 1.29, 95% CI 1.14 to 1.46), where NO2 was found to contribute to the effects most (the weight of 0.80). CONCLUSIONS: These results emphasise that reduction of air pollution exposure should be considered for ASD symptom management, with important implications for the quality of life and economic costs.

Development of a Seoul-Type Housing Service Model for People With a Mental Illness.

OBJECTIVE: To establish and to promote the qualitative development of a housing service model in South Korea. METHODS: The questionnaire was collected through the housing needs survey and the focus group interview on the mental health professions. We enrolled 365 subjects from 63 places (community conversion facilities, cohabitation, cohabitation families, hospitals, psychiatric nursing homes) to answer the questionnaires. RESULTS: The survey result confirms the needs of people with a mental illness to be self-reliant, but it shows that the economic vulnerability is a hindrance. In addition, the most necessary factor for self-reliant living is to provide services that support daily living. Therefore, the study points out that a system that guarantees self-reliance must be added in order for the housing services to be distributed throughout local communities for the people with mental illness. CONCLUSION: The study proposes the Seoul-type housing services model to replace the housing services that functions in a fragmented manner with the provision of an integrated services through a unified channel by establishing a housing support center (tentative name). This will ultimately help people with a mental illness to live a healthy life that meets their needs as community members.

Perceived barriers to psychiatric help-seeking in South Korea by age groups: text mining analyses of social media big data.

BACKGROUND: The psychiatric treatment gap is substantial in Korea, implying barriers in seeking help. OBJECTIVES: This study aims to explore barriers of seeing psychiatrists, expressed on the internet by age groups. METHODS: A corpus of data was garnered extensively from internet communities, blogs and social network services from 1 January 2016 to 31 July 2019. Among the texts collected, texts containing words linked to psychiatry were selected. Then the corpus was dismantled into words by using natural language processing. Words linked to barriers to seeking help were identified and classified. Then the words from web communities that we were able to identify the age groups were additionally organized by age groups. RESULTS: 97,730,360 articles were identified and 6,097,369 were included in the analysis. Words implying the barriers were selected and classified into four groups of structural discrimination, public prejudice, low accessibility, and adverse drug effects. Structural discrimination was the greatest barrier occupying 34%, followed by public prejudice (27.8%), adverse drug effects (18.6%), and cost/low accessibility (16.1%). In the analysis by age groups, structural discrimination caused teenagers (51%), job seekers (64%) and mothers with children (43%) the most concern. In contrast, the public prejudice (49%) was the greatest barriers in the senior group. CONCLUSIONS: Although structural discrimination may most contribute to barriers to visiting psychiatrists in Korea, variation by generations may exist. Along with the general attempt to tackle the discrimination, customized approach might be needed.

Different Influence of Negative and Positive Spillover between Work and Life on Depression in a Longitudinal Study.

BACKGROUND: This study investigated the longitudinal associations between the degrees of positive and negative spillover in work-life balance (WLB) at baseline and reports of depressive mood at a 2-year follow-up in Korean women employees. METHODS: We used a panel study design data of 1386 women employees who participated in the Korean Longitudinal Survey of Women and Families in both 2014 and 2016. Depressive mood was measured using the "10-item Center for Epidemiologic Studies Depression Scale." Associations between the positive and negative spillover in WLB at baseline and reports of new incidence of depressive mood at 2-year follow-up were explored using a multivariate logistic regression model. RESULTS: Negative spillover in WLB at baseline showed a significant linear association with reports of depressive mood at 2-yearfollow-up after adjusting for age, education level, marital status, number of children, and positive spillover (P = 0.014). The highest scoring group in negative spillover (fourth quartile) showed a significant higher odds ratio of 1.95 compared with the lowest scoring group (first quartile; P = 0.036). CONCLUSION: Positive spillover in WLB showed a U-shaped association with depression. The degrees of positive and negative spillover in WLB among Korean women employees at baseline were associated with new incidence of depressive mood within 2 years. To prevent depression of female workers, more discrete and differentiated policies on how to maintain healthy WLB are required.

Burnout as a Mediator in the Relationship between Work-Life Balance and Empathy in Healthcare Professionals.

OBJECTIVE: This cross-sectional study aimed to 1) explore the relationships among work-life balance (WLB), burnout, and empathy and 2) investigate the roles of the subtypes of burnout relating to WLB and empathy. METHODS: A total of 105 health care professionals from a general hospital in Seoul were assessed using the Maslach Burnout Inventory, Jefferson Scale of Physician Empathy, and a one-sentence-question on subjective WLB. Multiple questions on psychiatric problems, including sleep problems, anxiety, depressive symptom, and alcohol problems, were also included. RESULTS: In the mediation analyses, personal achievement was considered as a potential mediating variable between WLB and empathy. The direct effect (ß=3.93, 95% CI: 1.21-6.64) and the indirect effect (ß=1.95, 95% CI: 0.52-3.76) of WLB on empathy were also significant. CONCLUSION: Interventions encouraging personal achievement may help mitigate burnout of health professionals.

Annual Prevalence and Incidence of Schizophrenia and Similar Psychotic Disorders in the Republic of Korea: A National Health Insurance Data-Based Study.

OBJECTIVE: We conducted this study to address the incidence and prevalence of schizophrenia and similar psychosis in South Korea with Health Insurance Review and Assessment (HIRA) database. METHODS: We used HIRA database, which includes diagnostic information of nearly all Korean nationals to collect number of cases with diagnosis of schizophrenia and schizophrenia-similar disorders (SSP), including schizophreniform, acute/transient psychotic disorders, schizoaffective disorders, and other/unspecific nonorganic psychosis (ICD-10 codes F20/23/25/28/29) between 2010 and 2015. The annual prevalence and incidence were calculated using the population data from the Korean Statistical Office. RESULTS: The 12-month prevalence of SSP of Korea between 2010 and 2015 were 0.48-0.66%. The 12-month prevalence of schizophrenia were 0.40-0.52%; The annual incidence rates (IR) of SSP between 2010 and 2015 were 118.8-148.7 per 100,000 person-year (PY). For schizophrenia, IR per 100,000 PY were 77.6-88.5 between 2010 and 2015. CONCLUSION: The 12-month prevalence found in the present study was higher than that reported in community-based epidemiologic studies in South Korea but similar to those from other countries. The annual incidence of SSP and schizophrenia was found to steadily increase and was higher than that of other countries. The high incidence rate observed in the current study needs to be studied further.

Poor Work-Life Balance May Lead to Impaired Cognitive Function in Bus Drivers.

OBJECTIVE: This study aimed to investigate how work-life balance (WLB) corresponds to cognitive functions and which mental health conditions play a mediating role in this association among Korean bus drivers. METHODS: The cognitive failures questionnaire (CFQ) was administered to 347 bus drivers in Seoul, Korea. The differences in the CFQ and WLB scores were examined by analysis of covariance, and a structural equation model (SEM) was constructed for investigating the mediating role of mental health indices between WLB and CFQ scores. RESULTS: Compared with the highest subjective work-life balance group, the lowest group had significantly higher CFQ scores. In the SEM, anxiety was a mediating variable between subjective work-life balance and CFQ scores. CONCLUSIONS: Work-life balance is associated with cognitive failures among Korean bus drivers, and anxiety was a key mediating mental health indicator.

Prevalence of Possible Depression and Post-traumatic Stress Disorder among Community Dwelling Adult Refugees and Refugee Applicants in South Korea.

BACKGROUND: Because there has been a recent increase in refugee applications in Korea, the mental health of these refugees merits greater study. METHODS: We surveyed 129 refugees (including those in process of refugee application) and 121 migrant workers living in urban communities, using: the Patient Health Questionnaire-9 for depressive symptoms, the Impact Event Scale-Revised for post-traumatic stress disorder (PTSD) symptoms, and the health questionnaires used in 2016 Korean National Health and Nutrition Examination Survey (KNHANES). The majority of refugee subjects were from sub-Saharan Africa and Middle East. We compared the prevalence of possible depression and possible PTSD between refugees and migrant workers and refugees and age-gender matched samples from the KNHANES 2016. RESULTS: Frequency of suicidal planning during the last year was higher in the refugee group than Korean nationals, but frequency of suicidal attempt was not. High risk drinking was found in 0.8% of refugees, 6.6% of migrant workers and 27.2% of Korean nationals. Possible depression was present in 42.9% of refugee subjects, 33.3% of migrant workers, and 4.2% of Korean controls. Possible PTSD was present in 38.9% of refugees compared to 12.5% of migrant workers. Only major risk factor for depression among refugees was a traumatic event before entering Korea. CONCLUSION: Possible depression and PTSD are significantly more prevalent in refugees, compared to both migrant workers and Korean nationals. Prevalence rates are commensurate with refugee studies worldwide. Appropriate early screening and intervention schemes need to be developed for refugees entering Korea.