Ki Young Lim

Childhood Predictors of Deliberate Self-Harm Behavior and Suicide Ideation in Korean Adolescents: A Prospective Population-Based Follow-Up Study

The aim of this study was to investigate predictors of adolescence suicidality in a longitudinal study. Additionally, the prevalence of deliberate self-harm behavior and suicide ideation at age 7 and during middle school were examined. Initial assessment data was obtained from 1998 to 2000, and a follow-up assessment was performed in 2006 when the original subjects became middle school students. The addresses and names of 1,857 subjects were located from the original data; they were 910 boys and 947 girls. The subjects were evaluated with the Korean version of the Child Behavior Checklist (K-CBCL), which was administered by the parents of the children, and by various demographic and psychosocial factors. They were reassessed using self reports on the Korea Youth Self Report (K-YSR); in particular, replies to items related to self-harm behavior and suicide ideation were recorded. A logistic regression analysis showed that the factors of gender, economic status, the overall amount of behavior problems, the tendency to internalizing and externalizing problems, somatic problems, thought problems, delinquent behavior, and aggressive behavior were independent predictors of adolescent suicide ideation and self-harm behavior. The importance of total behavior problems suggested that adolescent difficulty is a consequence of an accumulation of various risk factors. Accordingly, clinicians must consider a range of internalizing and externalizing issues, especially overall adaptation, for suicide intervention.

Participation in Physical, Social, and Religious Activity and Risk of Depression in the Elderly: A Community-Based Three-Year Longitudinal Study in Korea

Background We examined the longitudinal association between participation in individual or combinations of physical, social, and religious activity and risk of depression in the elderly. Methods Elderly subjects aged ≥60 years who completed the Living Profiles of Older People Survey in Korea (n = 6,647) were included. The baseline assessment, Wave 1, was conducted in 2008, and a follow-up assessment, Wave 2, was conducted in 2011. We defined participation in frequent physical activity as ≥3 times weekly (at least 30 minutes per activity). Frequent participation in social and religious activity was defined as ≥1 activity weekly. The primary outcome was depression at 3-year follow up. Results Multivariable logistic regression analysis showed that subjects who participated in frequent physical, social, and religious activity had an adjusted odds ratio of 0.81 (95% confidence interval [CI], 0.69–0.96), 0.87 (95% CI, 0.75–1.00), and 0.78 (95% CI, 0.67–0.90), respectively, compared with participants who did not participate in each activity. Participants who participated in only one type of activity frequently and participants who participated in two or three types of activities frequently had an adjusted odds ratio of 0.86 (95% CI, 0.75–0.98) and 0.64 (95% CI, 0.52–0.79), respectively, compared with participants who did not participate in any type of physical, social, and religious activity frequently. Conclusion Participation in physical, social, and religious activity was associated with decreased risk of depression in the elderly. In addition, risk of depression was much lower in the elderly people who participated in two or three of the above-mentioned types of activity than that in the elderly who did not.

Characteristics of Patients Who Visit the Emergency Department with Self-Inflicted Injury

During visits to emergency medical facilities, the primary care of and risk identification for individuals who have attempted suicide is considered an important element in suicide prevention. With the ultimate goal of helping to prevent suicide, the aim of the present study was to determine the characteristics of patients with self-inflicted injuries who presented in the emergency department. Patients with self-inflicted injuries who visited 1 of 3 sentinel emergency medical centers from 2007 through 2009 were included in the study. The characteristics, methods, and reasons for suicide attempts were evaluated. Moreover, predictors of severe outcomes were evaluated. A total of 2,996 patients with self-inflicted injuries visited the three centers during a period of 3 yr. The male-to-female suicide ratio was 1:1.38 (P < 0.001). The mean age was 41 yr. Poisoning was the most common method of self-inflicted injury (68.7%) among all age groups. Medication was the primary means of injury in the < 50 age group, and the use of agricultural chemicals was the primary means in the ≥ 50 age group. The reasons for attempting suicide varied among the age groups. The predictors of severe outcome are male gender, older age, and not having consumed alcohol.

Perceived sleep quality is associated with depression in a Korean elderly population

Our study aimed to examine the relationship between perceived sleep quality and depression using Pittsburgh Sleep Quality Index (PSQI) and Coles model to materialize the concept of perceived sleep quality in the non-cognitively impaired elderly. Older adults aged 60+ were recruited from the baseline study of Suwon Project (SP) between 2009 and 2011 (n=2040). Perceived sleep quality was measured using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K), and depression was accessed using the Korean version of the Geriatric Depression Scale-Short Form (SGDS-K). We excluded the cognitively impaired elderly using the Korean version-Mini Mental Status Examination (K-MMSE) score less than or equal to 17. In multivariable adjusted logistic regression related to PSQI-K components, poor perceived sleep quality, including poor subjective sleep quality (Odds ratio (OR)=1.27, 95% confidence interval (CI)=1.01-1.61), longer sleep latency (OR=1.32, 95% CI=1.13-1.55) and the frequent use of sleeping medication (OR=1.30, 95% CI=1.10-1.53) were significantly associated with depression after adjusting for age, sex, education, living status, current smoking and current alcohol drinking, the number of comorbidity and Beck Anxiety Inventory (BAI). PSQI-K global score also had greater odds of reporting depression (OR=1.12, 95% CI=1.07-1.16). These results suggested that poor perceived sleep quality was associated with a greater level of depression in the elderly.

Suicide among the elderly and associated factors in South Korea

With the population of the elderly increasing, suicides among elderly people present a serious problem for global societies. However, there are few studies on suicide among elderly subjects, especially in Asia. The study aimed to determine the relationship between physical health, mental health, social environmental condition, and the suicide behavior among elderly subjects in the city of Suwon, located southeast of Seoul. We analyzed 1548 Korean aged over 60 years from baseline data of a larger prospective study called the Suwon Project. The study protocol included sociodemographic variables, mental health factors, and physical health factors. In the interview, the subjects were asked about suicide ideation and history of suicide attempt. Of the total subjects, 7.42% reported suicide ideation and 1.42% reported a history of suicide attempt. A logistic regression analysis showed that physical illness, five stroke warning signs, anxiety and depression associated with suicide ideation, and depression strongly corresponded to the suicide ideation. Anxiety, depression, and stroke warning signs were associated with history of suicide attempt among the elderly. Additionally, stroke warning signs and depression are independently associated with history of suicide attempt. This study revealed that stroke warning signs have a high correlation with history of suicide attempt in the elderly, independent from the depression factors. This study suggests that there is an independent relationship between physical health status and suicide behavior in the case of elders.

Predictors of Self-Reported Depression in Korean Children 9 to 12 Years of Age.

Purpose The aim of this study was to evaluate the relationships among various psychosocial factors, behavior problems, and depressive symptoms reported by parents, and to investigate self-reported depression in Korean children using a community sample. Materials and Methods The sample consisted of 1279 children between 9 and 12 years of age. The children were evaluated using the Korean version of the Child Behavior Checklist (K-CBCL) and the Child Depression Inventory (CDI). Results The average self-reported depression score as measured by the CDI was 12.34 (SD: 6.79), and a cut-off point of 19 identified approximately 14% of the children as depressed. The group difference was identified by the age at which younger children were found to have higher CDI scores. Univariate logistic regression analysis showed that the high-CDI group and the low-CDI group differed in all behavioral domains identified in the parent-reported subscales of the K-CBCL. Age and fathers education level were also independently associated with the risk for childhood depression. In addition, results from the logistic regression analyses indicated that parental reporting of problem internalization, total behavior problems, and social competence were independent predictors of child depression not identified by the anxious/depressed subscale. Conclusion It is believed that extensive behavioral problems reported by parents and several sociodemographic factors are related to childhood depression. However, parents tend to under-report depressive symptoms relative to what their own children report. Thus, clinicians must consider the self-reports of children related to depression in their diagnosis and intervention, because reports of depressive symptoms from children are more valid measures than those from parents.

Increased Plasma Levels of Heat Shock Protein 70 Associated with Subsequent Clinical Conversion to Mild Cognitive Impairment in Cognitively Healthy Elderly

Background and Aims Heat shock proteins (HSPs) have been regarded as cytoprotectants that protect brain cells during the progression of neurodegenerative diseases and from damage resulting from cerebral ischemia. In this study, we assessed the association between plasma HSP 70/27 levels and cognitive decline. Methods Among participants in the community-based cohort study of dementia called the Gwangju Dementia and Mild Cognitive Impairment Study, subjects without cognitive impairment at baseline, who then either remained without impairment (non-conversion group), or suffered mild cognitive impairment (MCI) (conversion group) (non-conversion group, N = 36; conversion group, N = 30) were analyzed. Results After a five to six year follow-up period, comparison of the plasma HSP 70 and HSP 27 levels of the two groups revealed that only the plasma HSP 70 level was associated with a conversion to MCI after adjustments for age, gender, years of education, follow-up duration, APOE e4, hypertension, and diabetes (repeated measure analysis of variance: F = 7.59, p = 0.008). Furthermore, an increase in plasma HSP 70 level was associated with cognitive decline in language and executive function (linear mixed model: Korean Boston Naming Test, -0.426 [-0.781, -0.071], p = 0.019; Controlled Oral Word Association Test, -0.176 [-0.328, -0.023], p = 0.024; Stroop Test, -0.304 [-0.458, -0.150], p<0.001). Conclusions These findings suggest that the plasma HSP 70 level may be related to cognitive decline in the elderly.

Frequency of contact with non-cohabitating adult children and risk of depression in elderly: A community-based three-year longitudinal study in Korea

PURPOSE Our study aimed to assess the longitudinal association of frequency of contact with non-cohabitating adult children and risk of depression in the elderly. METHODS Elderly aged ≥60 years were included from Living Profiles of Older People Survey (LPOPS) in Korea. The baseline assessment, Wave 1, was conducted in 2008, and follow-up assessment, Wave 2, was conducted in 2011. We included participants who completed both waves and excluded those who met the following criteria: no adult children, living with adult children, cognitive impairment at either waves, and depression at baseline (n=4398). We defined infrequent contact as <1 time per month face-to-face contact or <1 time per week phone contact and classified participants into four groups based on contact method and frequency. Depression was measured using the 15-item geriatric depression scales (SGDS-K). RESULTS In multivariable logistic regression analysis, infrequent face-to-face and phone contact group had adjusted odds ratio (OR) of 1.86 (95% CI, 1.44-2.42) when compared with frequent face-to-face and phone contact group. Frequent face-to-face contact with infrequent phone contact group and infrequent face-to-face contact with frequent phone contact group had adjusted OR of 1.49 (95% CI, 1.12-1.98) and 1.44 (95% CI, 1.15-1.80), respectively, when compared with frequent face-to-face and phone contact group. CONCLUSION These results propose that the risk of subsequent depression in elderly is associated with frequency of contact with non-cohabitating adult children. Moreover, the efficacy of face-to-face contact and that of phone contact were similar, while the group lacking both types of contact demonstrated the highest risk of depression.

Effect of Psychotropic Drugs on Development of Diabetes Mellitus in Patients With Alzheimer's Disease

Abstract We aimed to examine risk of diabetes mellitus (DM) among older adults with Alzheimers disease receiving 3 types of psychotropic drugs, that is, antipsychotics, antidepressants, and sedative anxiolytics. We retrospectively analyzed data from a hospital-based Clinical Research Center for Dementia of South Korea (CREDOS) study conducted between January 1, 2008 and December 31, 2012. Participants (n = 3042) with Alzheimers disease were aged 65 or older and had no preexisting history of DM. Development of DM was identified using claims for initiating at least 1 prescription of antidiabetic medications or a diagnosis of DM during the follow-up period. Cox proportional hazards regression was used to demonstrate the Hazard ratio of DM in use of each psychotropic drug. Among the 3042 participants, 426 patients (14.0%) developed DM, representing an incidence rate of 5.2/100 person-years during an average 2.9 years of follow-up period. Among the 3 types of psychotropic drugs, antipsychotic users had a significantly higher risk of DM (hazard ratio = 1.74, 95% confidence interval = 1.10, 2.76) than nonusers, after adjusting covariates. Antidepressants and sedative anxiolytics did not achieve statistical significance. These results suggested that the diabetes risk was elevated in Alzheimer patients on antipsychotic treatment. Therefore, patients with Alzheimers disease receiving antipsychotic treatment should be carefully monitored for the development of DM.

Gender-specific early risk factors for delinquent behavior of Korean youth: a 6- to 8-year longitudinal study

In this study, we used data from a longitudinal sample, followed from childhood (age 7) to adolescence (age 13–15), to identify the early childhood risk factors correlated with adolescent delinquency according to gender, since such studies are rare [1–3]. At baseline, 3,808 first grade pupils participated in an epidemiological study on child psychiatric disorders in Osan, a small city southwest of Seoul, Korea. The researchers conducted the first assessment, with teachers’ and parents’ approval, from 1998 to 2000. At 6to 8-year follow-ups, the researcher requested 5,670 middle school students living in Osan to complete a questionnaire, with parental consent. Among them, 1,821 students had participated in the first assessment. The retention rate was 47.8 %, and the mean age of the children at the first assessment was 6.85 years (SD 0.41); at the second assessment, the mean age was 13.75 years (SD 1.0). The dropout analyses showed no significant differences relating to socioeconomic status, family structure, or parental education level. At baseline, the children’s parents completed the Korean version of the Child Behavior Checklist (K-CBCL) [4] regarding their own children. K-CBCL was sent home with each child, completed by the parents, and collected after 3–5 days. In addition to the K-CBCL, the parents also completed a general questionnaire covering family structure, parental education and economic status, and the age and gender of their children (Table 1). At the 6to 8-year follow-up, the now-adolescent participants completed the Korean version of the Youth Self Report (K-YSR) forming a delinquent-tendency group (DTG) and a normal group. We defined the DTG as those participants having a high score on the K-YSR ‘‘delinquent behavior’’ syndrome scale, i.e., scores higher than the 80th percentile cut-off, based on the gender-specific distribution of scores in this sample. We used the Chi-square test to examine differences between the DTG and NDTG in environmental characteristics, including family structure, gender, parental income and educational levels. In addition, we carried out Chisquare tests to make gender comparisons on frequency of items from the K-YSR’s ‘‘delinquent behavior’’ scale. First, we analyzed prospective associations between adolescent delinquency and environmental factors, childhood emotional problems, and childhood behavior problems. Our analyses’ univariate logistic regressions showed the associations between adolescent delinquency and K-CBCL syndrome scales’ scores at baseline. To quantify these associations, we calculated odds ratios (ORs) and 95 % confidence intervals (CIs), defining p values\0.05 as statistically significant. Next, we calculated ORs and CIs separately for each gender, using univariate logistic regression. We entered the variables associated with each outcome variable in the final multivariate analysis. Due to the hierarchical relationship of the total problem scale and the eight CBCL syndrome scales, we did not include the total problems scale in a multivariate logistic regression analysis. Of the 1,821 children, 390 (21.4 %) fell into the DTG when they were between ages 13 and 15. Comparisons revealed that socio-demographic variables, i.e., gender (v = 2.70, df = 1, p [ 0.05), family structure (v = 3.00, df = 1, p [ 0.05), the father’s education level (v = 1.42, K. M. Shin Y. M. Shin K. Y. Lim Y. K. Chung S.-M. Cho (&) Department of Psychiatry and Behavioral Science, Ajou University School of Medicine, San-5, Wonchon-dong, Yeongtong-gu, Suwon 443-721, Korea e-mail: smcho@ajou.ac.kr