Narei Hong

Psychological and neuroendocrinological characteristics associated with depressive symptoms in breast cancer patients at the initial cancer diagnosis

OBJECTIVE Breast cancer patients can have biopsychosocial changes induced by distress related to the cancer diagnosis. This study investigated psychological characteristics and hypothalamic-pituitary-adrenal (HPA) axis function associated with depressive symptoms in breast cancer patients at the initial diagnosis. METHOD Seventy-eight breast cancer patients were enrolled, and 61 patients were included in the final analysis. Patients were evaluated concerning psychological adjustment to cancer diagnosis, self-concept and depressive symptoms and given a dexamethasone suppression test before the main surgical treatment. RESULTS Self-concept scale scores and fighting spirit factor scores of the Korean version of the Mental Adjustment to Cancer (KMAC) scale showed inverse correlations. Anxious preoccupation (AP) factor scores of the KMAC scale positively correlated with depressive symptom scores. Depressive symptom scores were significantly correlated with postdexamethasone serum cortisol levels. In multiple regression analysis, postdexamethasone serum cortisol and the KMAC-AP factor score had significant partial effects in the final model. CONCLUSION Hypothalamic-pituitary-adrenal axis dysfunction and anxious coping to cancer diagnosis may be associated with depressive symptoms in breast cancer patients before treatment. Based on this analysis, we recommend psychotherapeutic interventions to increase adaptive mental coping strategy and to ameliorate psychological distress. Screening for HPA axis dysfunction and provision of depression treatment may prevent breast cancer patients from developing depressive symptoms.

Depression, aggression, and suicidal ideation in first graders: a school-based cross-sectional study

OBJECTIVE This study explored the clinical characteristics and risk factors of suicidal ideation in a sample of first graders from South Korea. Childrens depression and aggression and maternal depression were examined as possible risk factors. METHODS This study is a school-based, cross-sectional study of 5 elementary schools in Gunpo City, South Korea. Participants were 707 first graders (mean age, 6.54 years) and their mothers. We assessed childrens depressive and aggressive symptoms using the Behavior Assessment System for Children-2 (BASC-2) and maternal depression using the Beck Depression Inventory (BDI). Two items from BASC-2 and 1 item from BDI identified childrens and maternal suicidal ideation. RESULTS Twenty-seven (3.8%) children evidenced suicidal ideation. Children with suicidal ideation had higher mean scores of depression domain (10.11 ± 5.34 vs 4.57 ± 3.44, P < .0001) and aggression domain (7.78 ± 3.84 vs 3.80 ± 2.85, P < .0001) on BASC-2 and maternal depression (9.78 ± 6.45 vs 7.28 ± 5.38, P = .02) on BDI. In regression analysis, childrens depression (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.07-1.32; P = .001) and aggression (OR, 1.24; 95% CI, 1.08-1.41; P = .002) contributed significantly to childrens suicidal ideation, whereas maternal depression was not significantly related to childrens suicidal ideation (OR, 0.99; 95% CI, 0.92-1.06; P = .75). CONCLUSIONS This study demonstrated that even first graders had a considerable prevalence of suicidal ideation and that depression and aggression were associated with suicidal ideation in young children.

Mental Health and Extracurricular Education in Korean First Graders: A School-Based Cross-Sectional Study

OBJECTIVE This study explores the results of mental health screening in Korean first graders in association with the amount of time the children spent in extracurricular education. METHOD The study included a community sample of 761 boys and girls, with a mean age of 6.6 years, collected from 5 elementary schools in Gunpo-si, South Korea, in July 2007. Primary caregivers completed a questionnaire that included information on demographic characteristics, the amount of time the children spent in extracurricular education and other activities, and an adapted form of the Behavior Assessment System for Children, Second Edition (BASC-2) to screen for mental health problems. RESULTS These first graders spent a mean of a little over 2 hours each day in extracurricular education. Extracurricular education demonstrated positive correlations with 4 BASC-2 domains, including hyperactivity (r = 0.092, P < .05), aggression (r = 0.073, P < .05), conduct problems (r = 0.073, P < .05) and depression (r = 0.137, P < .01). A positive linear relationship between depression and extracurricular education was also evident in regression analyses (F = 2.25, R(2) = 0.022, P = .001). The relationship held true even when controlling for time spent with parents, time spent with friends, and time spent asleep. Post hoc analyses revealed that children receiving more than 4 hours of extracurricular education per day showed a sharp increase in depressive symptoms as well as a decrease in the amount of time spent with caregivers. CONCLUSIONS Results of this study demonstrate that excessive amounts of time spent in extracurricular education (greater than 4 hours per day) may be associated with depression in school-aged children. These findings have relevance for mental health screening and educational policy.

Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression

Abstract Objectives: As South Korea has the highest incidence of completed suicides, the present study aimed to investigate the predictive power of the variables that have been associated with suicide attempts in Korean patients diagnosed with depression. Methods: Hundred participants were divided into two groups: suicide attempters (31%) and suicide non-attempters (69%). Participants with a history of more than one suicidal attempt were assigned to the suicide attempter group. A hierarchical logistic regression analysis was performed to determine the predictive strengths of the variables that were likely to be associated with suicide attempts. Results: After controlling for the effects of such variables as the severity of depressive symptoms, life stress events and impulsivity, the severity of past suicidal ideation was the most important predictive factor for discriminating suicide attempters from suicide non-attempters. The odds ratio for attempting suicide relative to not attempting suicide increased by a factor of 4.408 for each unit of increase in suicidal ideation. Conclusions: The present study suggests that the most severe suicidal ideation throughout one’s entire life should not be overlooked and may be a major predictor of the risk of suicide.

Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents

We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt and non-suicide attempt groups and we examined significant predictors of suicide attempts. Gender differences in suicidal ideation and suicidal behavior were also analyzed. Among 106 depressed participants, 50 (47.2%) adolescents were classified in the suicide attempt group. Generally, the suicide attempt and non-suicide attempt group shared similar clinical characteristics. The suicide attempt group had more females, more major depressive disorder diagnoses, more depressive episodes, and higher suicidal ideation than the non-suicide attempt group. Suicidal ideation was the only significant predictor of suicidal attempt, regardless of gender. Higher suicidal ideation frequency scores and more non-suicidal self-injurious behaviors were shown in the female suicide attempt group than the male suicide attempt group. It is recommended that suicidal ideation be assessed regularly and managed rigorously to decrease suicide risks in depressive adolescents.

The protective role of resilience in attenuating emotional distress and aggression associated with early-life stress in young enlisted military service candidates

Early life stress (ELS) may induce long-lasting psychological complications in adulthood. The protective role of resilience against the development of psychopathology is also important. The purpose of this study was to investigate the relationships among ELS, resilience, depression, anxiety, and aggression in young adults. Four hundred sixty-one army inductees gave written informed consent and participated in this study. We assessed psychopathology using the Korea Military Personality Test, ELS using the Childhood Abuse Experience Scale, and resilience with the resilience scale. Analyses of variance, correlation analyses, and hierarchical multiple linear regression analyses were conducted for statistical analyses. The regression model explained 35.8%, 41.0%, and 23.3% of the total variance in the depression, anxiety, and aggression indices, respectively. We can find that even though ELS experience is positively associated with depression, anxiety, and aggression, resilience may have significant attenuating effect against the ELS effect on severity of these psychopathologies. Emotion regulation showed the most beneficial effect among resilience factors on reducing severity of psychopathologies. To improve mental health for young adults, ELS assessment and resilience enhancement program should be considered.

Opioid Analgesics and Depressive Symptoms in Burn Patients: What Is the Real Relationship?

Objective Major burn injuries are strongly associated with both psychological trauma and severe pain, and opioids are the mainstay analgesics for the treatment of severe burn pain. The objectives of this study are to find the complex relationship between opioid dose, depression, and post-traumatic stress disorder (PTSD) symptoms during the acute management of pain in burn patients. Methods The symptoms of depression and PTSD were assessed in 43 burn patients immediately following wound stabilization and 2 weeks after the initial evaluation. Results Total opioid doses and Hamilton Depression Scale (HAMD) scores obtained during the second evaluation were positively but weakly correlated after controlling for age and total burn surface area (R=0.33, p=0.03). Moreover, pain management with opioids was significantly more common in burn patients with low Clinician Administered PTSD Scale scores (evaluation 1) and high HAMD scores (evaluation 2) (F=6.66, p=0.001). Conclusion High opioid dose following acute burn trauma might have correlation with depressive symptoms. Monitoring of depressive symptoms may be important following acute burn trauma and consequent opioids pain management, particularly when PTSD symptoms appear minimal during the early stabilization of patients.

Effects of repetitive transcranial magnetic stimulation on late-onset hallucinations: a case report.

Several lines of evidence have established that low-frequency repetitive transcranial magnetic stimulation (rTMS) over the left temporoparietal cortex in schizophrenic patients with auditory hallucinations leads to the amelioration of symptoms for several weeks following treatment cessation (Hoffman et al., 2003; Aleman et al., 2007). Although Liang et al. (2010) hypothesized that rTMS is a possible novel therapeutic approach to dementia with Lewy bodies characterized clinically by visual hallucinations, few rTMS studies have examined elderly patients with psychotic symptoms, especially patients with hallucinations. Patients with late-onset psychotic symptoms are relatively rare compared with adults with psychotic disorders, and they manifest different characteristics and pathologies (Yeon & Hong, 2007). In addition, the physiological characteristics of elderly patients have to be approachedmore carefully during treatment than do those in adult patients. rTMS is safe, noninvasive and subconvulsive therapy that may be effective and tolerable for treating elderly patients, and it may result in less concern about side effects than other treatment modalities. We report a case with late-onset hallucinations that we treated with rTMS. A 79-year-old female was admitted to hospital with a 3-year history of auditory hallucinations. Before the hallucinations started, she had a persistent depressive mood and insomnia for several years. She had no history of psychotic symptoms before 3 years ago. She had been medicated for asthma for 4 years. She had a 1-month history of delirium 2 years ago, when she underwent surgery for a right femoral neck fracture; since then, she had taken psychiatric medications for delirium and hallucinations. She complained of persistent dizziness for 1 year. This was her fourth psychiatric admission. Her psychotic symptoms were aggravated by an episode of delirium; subsequently, the symptoms had fluctuated continuously at an intolerable level, and the auditory hallucinations had persisted. She had had mild hearing difficulty before the symptoms started, but she had not had any problems in everyday life. After the hallucinations, her hearing weakened when the auditory hallucinations worsened and it improved when the symptoms decreased. She had been treated with olanzapine 12.5 mg per day; this had a partial effect on the auditory hallucinations, but she suffered from excessive sedation. When we changed this to paliperidone 3 mg per day, she developed extrapyramidal side effects shortly after changing medication, and her psychotic symptoms worsened. We changed her medication back to olanzapine 10 mg per day and treated her with 1 Hz rTMS five times a week for 3 weeks. Before starting rTMS, her score on the auditory hallucination subscale of the Psychotic Symptom Rating Scales (PSYRATS) (Haddock et al., 1999) was 40, and scores on the positive and negative subscales of the

Does Emotional Intelligence Fluctuate within Clinical Depressive Condition

Objective Emotional intelligence (EI) is regarded an important factor related to psychiatric disorder. Most of previous studies of EI and depression only dealt with EI in present of depressive symptoms. Our study investigated EI both before and after remission of depression and to identify which component of EI is changeable by depression condition. Methods EI was evaluated for 23 depression patients and 44 normal control participants. Adult Emotional Quotient Test (AEQT) was used as subjective EI measure and Emotional Literacy Test (ELT) was used as objective EI measure to both groups. Results During the initial evaluation of the subjective EI, patient group reported significantly lower scores than control group on all AEQT sub-domains except ‘empathy’. However, group difference on ‘utilization’ disappeared after the remission evaluation. There was no significant difference within the objective EI measure. Conclusion According to the result of the study, EI could be sub-divided into trait-dependent EI and state-dependent EI. Further implication, strength and limitation were discussed.

Incidence and course of depression in patients with Alzheimer’s disease

Objective Depressive symptoms are common in Alzheimers disease (AD) and they might influence the course and prognosis of AD. Depression could appear anytime in the course of the disease, and could either last considerably long or disappear easily. This study is intended to investigate the occurrence of depression in the course of AD and the risk factors of incidence. Methods This study targeted 1,272 AD patients without depressive symptoms at the start of this study in Korea. A total of 775 subjects completed the study, and the occurrence of depression was assessed after 12 months. Demographic information of subjects was collected and cognitive functions, overall functions, and depression severity were assessed at the start of this study and after 12 months. Results Among the 775 subjects, 103 subjects (13.29%) developed depression 12 months later. The MMSE-KC scores showed significant changes in both groups that developed depression and did not. In the univariate analysis, significant differences in the incidence of depression were found in terms of gender, the administration of the antidepressant at the baseline, the SGDS-K score, and the GDS score. The multiple logistic regression analysis showed that the increase in the incidence of depression was associated with a female, in the increase in SGDS-K score and the GDS score. Conclusion The incidence of depression in the subjects who completed the 12-month follow-up observation was 13.29%. Moreover, in the multivariate analysis, a female gender and the severity of dementia, including the overall functions, seemed associated with the occurrence of depression.