Jee Hoon Sohn

Prevalence of DSM-IV major mental disorders among Korean adults: A 2006 National Epidemiologic Survey (KECA-R)

OBJECTIVES The aim of this study was to estimate the prevalence of the DSM-IV major mental disorders in the Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). METHODS The Korean Epidemiologic Catchment Area study Replication (KECA-R) was conducted between August 2006 and April 2007. The sampling of the subjects was carried out across 12 catchment areas using a multistage, cluster sampling design. The target population included all eligible community dwelling residents aged 18-64 years. Face-to-face interviews were conducted using the K-CIDI based on the DSM-IV. RESULTS A total of 6510 participants completed the interview (response rate=81.7%). The lifetime and 12-month prevalence rates for DSM-IV major mental disorders were 29.0% and 16.9%, respectively. Those of specific disorders were as follows: (1) alcohol use disorder, 16.2% and 5.6%; (2) nicotine use disorder, 9.0% and 6.0%; (3) specific phobia, 3.8% and 3.4%; (4) major depressive disorder, 5.6% and 2.5%; and (5) generalized anxiety disorder, 1.6% and 0.8%. Additionally, data related to nicotine and alcohol use disorder revealed a very high male to female ratio. Further, mood and anxiety disorders were more prevalent in females than in males. CONCLUSION The prevalence of major mental disorders was high. In comparison with the studies performed in other countries, notable differences were observed with respect to the distribution of mental disorders in Korea.

Prevalence and Correlates of DSM-IV Mental Disorders in South Korean Adults: The Korean Epidemiologic Catchment Area Study 2011

Objective The aim of this study was to estimate the prevalence and correlates of mental disorders in Korean adults. Methods Door to door household surveys were conducted with community residents aged 18-74 years from July 19, 2011, to November 16, 2011 (n=6,022, response rate 78.7%). The sample was drawn from 12 catchment areas using a multistage cluster method. Each subject was assessed using the Korean version of the World Health Organization Composite International Diagnostic Interview (CIDI) based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Results Lifetime and 12-month prevalence estimates were as follows: alcohol use disorders, 13.4% and 4.4%, respectively; nicotine use disorders, 7.2% and 4.0%, respectively; anxiety disorders, 8.7% and 6.8%, respectively; and mood disorders, 7.5% and 3.6%, respectively. The prevalence rates of all types of DSM-IV mental disorders were 27.6% and 16.0%, respectively. Being female; young; divorced, separated, or widowed; and in a low-income group were associated with mood and anxiety disorders after adjustment for various demographic variables, whereas being male and young were associated with alcohol use disorders. Higher income was not correlated with alcohol use disorder as it had been in the 2001 survey. Conclusion The rate of depressive disorders has increased since 2001 (the first national survey), whereas that of anxiety disorders has been relatively stable. The prevalence of nicotine and alcohol use disorders has decreased, and the male-to-female ratio of those with this diagnosis has also decreased.

Childhood parental death and lifetime suicide attempt of the opposite-gender offspring in a nationwide community sample of Korea.

Although previous studies have shown that childhood parental death influences suicide attempts of their offspring, few studies have examined influence of gender and age at exposure. Koreans show the third highest suicide rate in the world, and many children and adolescents lost their parents during and after the Korean War. A total of 12,532 adults, randomly selected through a one-person-per-household method, completed the Korean version of the Composite International Diagnostic Interview and questionnaire for suicidal ideation, plan, and attempt (response rate 80.2%). A total of 2,332 subjects experienced biological parental death in childhood (18.6%). Male suicide attempts were associated with age of exposure to maternal death from 0 to 4 years (adjusted OR = 4.48, 95% CI 1.32-15.18) and from 5 to 9 years (adjusted OR = 5.52, 95% CI 1.97-16.46), but not with paternal death, after adjusting for age, education years, marital status, monthly income, and psychiatric comorbidities. Female suicide attempts were associated with paternal death from 5 to 9 years (adjusted OR = 2.20, 95% CI 1.13-4.27), but not with maternal death. Childhood parental death is significantly associated with lifetime suicide attempt in the opposite-gender offspring, especially when exposure occurs before age 10.

The 12-Item General Health Questionnaire as an Effective Mental Health Screening Tool for General Korean Adult Population

Objective The 12-item General Health Questionnaire (GHQ-12) has been used extensively in various settings across different cultures. This study was conducted to determine the thresholds associated with optimum sensitivity and specificity for the GHQ-12 in Korean adults. Methods Data was acquired from a sample of 6,510 Korean adults, ages 18 to 64 years old, who were selected from the 2005 Census (2,581 men and 3,929 women). Participants completed the GHQ-12 and the Korean Composite International Diagnostic Interview (K-CIDI). Receiver Operating Characteristic (ROC) curve analysis was conducted. Results The mean GHQ-12 score for the total sample was 1.63 (SD 1.98). The internal consistency of the GHQ-12 was good (Cronbachs α=0.72). Results from the ROC curve indicated that the GHQ-12 yielded greater accuracy when identifying mood and anxiety disorders than when identifying all mental disorders as a whole. The optimal threshold of the GHQ-12 was either 1/2 or 2/3 point depending on the disorder, but was mainly 2/3. Conclusion The Korean version of the GHQ-12 could be used to screen for individuals at high risk of mental disorders, namely mood and anxiety disorders.

Feelings of worthlessness, traumatic experience, and their comorbidity in relation to lifetime suicide attempt in community adults with major depressive disorder

BACKGROUND Major depressive disorder (MDD) and traumatic experience are independent risk factors for lifetime suicide attempt (LSA). However, the relationships between trauma history and depressive symptomatology as they relate to LSA are not fully understood. METHODS A total of 12,532 adults, randomly selected through one-person-per-household method, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) and a questionnaire for LSA (response rate 80.2%). RESULTS Among 825 subjects with MDD, 141 subjects reported an LSA (17.1%). LSAs were significantly greater in those who had experienced any trauma than in those who had not (χ(2)=34.66, p<0.0001). Multivariate logistic regression showed that only feelings of worthlessness were significantly associated with LSA among 20 depression symptoms in individuals with MDD (AOR=3.08, 95% CI 1.70-5.60). Feelings of worthlessness was associated with LSA in those who had experienced serious trauma (AOR=5.02, 95% CI 3.35-7.52), but not in those who had not. Serious traumas associated with LSA included military combat, witnessing a violent crime, rape or sexual assault, a bad beating, being threatened by others, and learning about traumas to others. Serious trauma showed no significant association with LSA in those who did not have feelings of worthlessness. PTSD was a comorbidity that showed the highest odds ratio with LSA in individuals with MDD. CONCLUSIONS Feelings of worthlessness are more strongly associated with LSA than other depression symptoms in individuals with MDD, and it is significantly associated with LSA in those who experienced serious trauma but not in those who did not.

Prevalence, correlates, and comorbidities of four DSM-IV specific phobia subtypes: Results from the Korean Epidemiological Catchment Area study

Although several studies have detected differences in clinical features among specific phobias, there is a shortage of detailed national data on the on the DSM-IV SP subtypes, particularly in the Asian population. To examine the prevalence, demographic and other correlates, and co-morbidities of DSM-IV SP subtypes in a nationwide sample of Korean adults. We recruited 6510 participants aged 18-64 years for this study. Lay interviewers used the Composite International Diagnostic Interview to assess participants. We analyzed socio-demographics, health-related correlates and frequencies of comorbid mental disorders among participants with SP and each subtypes compared to unaffected adults. The prevalence of lifetime DSM-IV SP was 3.8%, and animal phobias were the most prevalent type of SP. Blood-injection-injury phobia was negatively associated with education, whereas situational phobia was positively associated with education. The strongest mental disorder comorbidity was associated with situational phobia; there is a higher probability of comorbid mood (OR=5.73, 95% CI=2.09-15.73), anxiety (OR=7.54, 95% CI=2.34-24.28), and somatoform disorders (OR=7.61, 95% CI=1.64-35.22) with this subtype. Blood-injection-injury phobia was highly associated with alcohol dependence (OR=9.02, 95% CI=3.54-23.02). Specific phobias are heterogeneous with respect to socio-demographic characteristics and comorbidity pattern. Implications of the usefulness of current subtype categories should continue to be investigated.

Prevalence, work-loss days and quality of life of community dwelling subjects with depressive symptoms.

The nationwide prevalence of major depressive disorder in Korea is lower than most countries, despite the high suicide rate. To explain this unexpectedly low prevalence, we examined the functional disability and quality of life in community-dwelling subjects with significant depressive symptoms not diagnosable as depressive disorder. A total of 1,029 subjects, randomly chosen from catchment areas, were interviewed with the Center for Epidemiologic Studies Depression scale, Mini International Neuropsychiatric Interview, WHO Quality of Life scale, and the WHO Disability Assessment Schedule. Those with scores over 21 on the depression scale were interviewed by a psychiatrist for diagnostic confirmation. Among community-dwelling subjects, the 1-month prevalence of major depressive disorder was 2.2%, but the 1-month prevalence of depressive symptoms not diagnosable as depressive disorder was 14.1%. Depressive disorders were the cause of 24.7% of work loss days, while depressive symptoms not diagnosable as depressive disorder were the cause of 17.2% of work loss days. These findings support the dimensional or spectrum approach to depressive disorder in the community and might be the missing link between the apparent low prevalence of depressive disorder and high suicide rate in Korea.

Comparison of treated and untreated alcohol dependence in a nationwide sample of Korean adults

We examined factors associated with lifetime treatment of alcohol dependence in a nationwide sample of Korean adults. Of the 6510 respondents, aged 18–64, who participated in the Korean Epidemiologic Catchment Area study, we analyzed 458 who had a lifetime diagnosis of alcohol dependence. Lay interviewers administered a diagnostic assessment, based on the Korean version of the Composite International Diagnostic Interview, to each of the respondents. Of the 458 respondents with a lifetime diagnosis of alcohol dependence, 55 (12.0%) had been treated for psychiatric problems. Treated alcohol-dependent respondents were less likely to have a stable, dyadic relationship or a full-time job. In addition, they were more likely to have experienced alcohol withdrawal symptoms, given up important activities because of alcohol use, and continued alcohol use despite knowing they had an alcohol-associated physical or psychological problem and were less likely to have spent a great deal of time obtaining or drinking alcohol or recovering from its effects. Treated individuals were also more likely to have comorbid mood disorders, especially major depressive disorder, or comorbid anxiety disorders, especially post-traumatic stress disorder, social phobia, or obsessive–compulsive disorder. Alcohol-dependent persons significantly underuse mental health services. Patterns of alcohol use and comorbid psychiatric disorders, as well as socio-demographic factors, affected treatment-seeking by alcohol-dependent individuals in Korea.

Corrigendum to “Prevalence of DSM-IV major mental disorders among Korean adults: A 2006 National Epidemiologic Survey (KECA-R)” [Asian Journal of Psychiatry 3 (2010) 26–30]

Maeng Je Cho *, Sung Man Chang , Young Moon Lee , Ahn Bae , Joon Ho Ahn , Jungwoo Son , Jin Pyo Hong , Jae Nam Bae , Dong-Woo Lee , Seong-Jin Cho , Jong-Ik Park , Jun-Young Lee , Jin Yeong Kim, Hong Jin Jeon , Jee Hoon Sohn , Byung-Soo Kim a Department of Psychiatry and Behavioral Science, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, South Korea Department of Psychiatry, School of Medicine, Kyungpook National University, 200 Dongduk-ro, Jung-gu, Daegu 700-721, South Korea Medical Humanities and Social Medicines, School of Medicine, Ajou University, Woncheon-dong, Yeongtong-gu, Suwon-si, Gyeonggi-do 443-749, South Korea Department of Psychiatry, Naju National Hospital, 500 Sanje-ri, Sanpo-myeon, Naju-si, Jeollanam-do 520-833, South Korea Department of Psychiatry, College of Medicine, University of Ulsan, 102 Daehak-ro, Nam-gu, Ulsan 680-749, South Korea Department of Psychiatry, College of Medicine, Chungbuk National University, Gaesin-dong, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do 361-763, South Korea Department of Psychiatry, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea Department of Psychiatry, College of Medicine, Inha University, Sinheung-dong 3-ga, Jung-gu, Incheon 400-711, South Korea Department of Psychiatry, Sanggye Baek Hospital, College of Medicine, Inje University, Sanggye 7-dong, Nowon-gu, Seoul 139-707, South Korea Department of Psychiatry, Gachon Medical School, Gachon University of Medicine and Science, Guwol 1-dong, Namdong-gu, Incheon 405-760, South Korea Department of Psychiatry, College of Medicine, Kangwon National University, Hyoja 3-dong, Chuncheon-si, Gangwon-do 200-722, South Korea Department of Psychiatry, Boramae Hospital, College of Medicine, Seoul National University, Sindaebang 2-dong, Dongjak-gu, Seoul 156-707, South Korea Department of Neuropsychiatry, Dongguk University International Hospital, College of Medicine, Dongguk University, Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773, South Korea Department of Psychiatry, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea

Evaluation of a Functional Model of Acquired Capability for Suicide in a Nationwide Sample of Korean Adults

Objective We examined a functional model of acquired capability for suicide, which was elaborated from the “Interpersonal-Psychological Theory of Suicide”. Methods A total of 6,027 Korean community subjects were recruited from The Korean Epidemiologic Catchment Area study conducted in 2011. The subjects were assessed systematically using the Korean version of the Composite International Diagnostic Interview version 2.1, the Korean version of the Barratt Impulsiveness Scale, and the Korean version of the Mood Disorder Questionnaire. We used structural equation modeling to identify potential factors contributing to a suicide attempt. Results Most aspects of the model were supported by the data and “the short-term enhancer for the acquired capability for suicide” had direct effects on suicide attempts. However, the suicidal planning effects of “the short-term enhancer for the acquired capability for suicide” were eliminated by the rule of parsimony. Conclusion The main finding was that “the short-term enhancer for the acquired capability for suicide” is relevant to suicide attempts when its direct, indirect, and reciprocal effects are tested within a more complete system of relationships than found in existing studies. The implications of these findings are discussed with regard to future conceptual work and empirical research.