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Background Youth suicide attempts are a major risk factor for future complete suicides. However, the characteristics of suicide attempters based on the emergency department (ED) have rarely been explored, making it challenging to comprehend the characteristics of youth suicide attempters comprehensively. This study aims to investigate the characteristics of youth suicide attempters who visited the ED. Methods We examined the youth (age: 12–25 years) and adult (age: 26–65 years) groups of suicide attempters who visited the ED in Wonju-si, Gangwon-do, Korea. Interviews were conducted with attempters and guardians to identify sociodemographic, clinical, and suicide-related variables. Besides, we performed bivariate logistic regression analysis with statistically adjusted gender, educational age, Socioeconomic Status(SES) level, and medical illness. Results Youth were diagnosed more frequently with Personality disorder compared to adults. Besides, youth tended to report interpersonal or abuse as motivations for suicide, whereas adults tended to report medical illness or economic problems. Furthermore, youth attempted suicide more impulsively and repeatedly; however, medical lethality of each attempt tended to be lower than adults. Limitation We experienced difficulty in collecting complete information because of poor consciousness or cooperation of patients who visited the ED immediately after suicide attempt. Also, the study cohort was only recruited from one hospital in a region. Conclusion Youth suicide attempters are suggested to have relatively serious and persistent problems involving personality or traits than adults. Thus, this study highlights the significance of preventive strategies based on early psychopathological evaluation and treatment.

The purpose of this study was to investigate the effect of continuous case management with a flexible approach on the prevention of suicide by suicide reattempt in a real clinical setting. The subjects in this study were 526 suicide attempters who visited emergency rooms in a teaching hospital in South Korea. Subjects were provided a continuous case management program with a flexible approach according to the severity of their suicide risk and needs. During the entire observation period (from 182 days to 855 days, mean = 572 &plusmn, 254), 18 patients (3.7%) died by suicide reattempt: Eight patients (2.27%) in the case management group and 10 patients (7.35%) in the no-case management group. The Cox regression analysis showed that the case management group had a 75% lower risk of death from suicide attempts than the no-case management group (HR = 0.34, 95% CI = 0.13&ndash, 0.87). This result was shown to be more robust after adjusting for confounding factors such as gender, age, psychiatric treatment, suicide attempts, and family history of suicide (adjusted HR = 0.27, 95% CI = 0.09&ndash, 0.83). This study was conducted in a single teaching hospital and not a randomized controlled one. A flexible and continuous case management program for suicide attempters is effective for preventing death by suicide reattempts.

Background Metabolic syndrome (MetS) is caused by both genetic and environmental factors, such as daily calorie intake, smoking, and alcohol consumption. Lifestyle factors, such as alcohol consumption, are considered to be related to the prevalence of MetS and plays an essential role in the pathogenesis and prognosis of depression. Methods We investigated the bidirectional association between lifestyle factors and MetS among Korean adults with depressive symptoms in third wave of a community-based cohort study. A total of 1,578 individuals, aged 39–72 years, who had MetS at baseline were recruited. Participants were divided into two groups according to depressive symptoms. Logistic regression models were used to estimate the risk of MetS. Results The percentage of heavy drinkers was lower in men with depressive symptoms compared to those who did not (7.0% vs. 7.1%), while the percentage of current smokers were higher in participants who had depressive symptoms (40.2% vs. 30.0%). After adjusting for age, education, monthly income, body mass index (BMI), sleep duration, and volume of drinking and smoking status, logistic regression analysis demonstrated that male heavy drinkers with depressive symptoms were 2.75 times more likely to have MetS than those without depressive symptom. Conversely, depressive women with a high BMI were 3.70 times more likely to have MetS than in those with lower BMI. Limitations The cross-sectional nature of the study, and the study population ethnicity and ages were limitations. Conclusions Lifestyle factors, such as alcohol consumption, may be associated with the risk of MetS in adults with depressive symptoms.

Background Exposure to pesticides is associated with mental disorders, including depression, especially among occupationally exposed populations, such as farmers. The results of experimental studies ascribed the negative effects of pesticides on mental health to their neurotoxic and endocrine-disrupting activities. Purpose This study aimed to investigate the association between the risk of depression and high- or low-level exposure to pesticides in a rural population. Methods This longitudinal study was performed in 2005–2008 (baseline) and 2008–2012 (follow-up) to evaluate the risk of depression among 2151 Korean adults. A standardized questionnaire was used to obtain information on depression upon self-reported exposure to pesticide based on the Center for Epidemiologic Studies Depression Scale. Logistic regression analysis was performed to evaluate the association between pesticide exposure and depression. We adjusted the data for age, cigarette smoking status, current alcohol use, monthly income, educational level, marriage status, and religion. Results Among the individuals who reported depression, the number of participants who used pesticides was significantly higher than that who did not (N = 61 [7.2%] vs. N = 54 [4.2%], P = 0.003). A positive association was noted between >20-year period of pesticide use and depression (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.41–3.88). Individuals who reported depression showed greater odds of being exposed to higher pesticide concentrations (OR, 2.33; 95% CI, 1.40–3.88) and experiencing pesticide poisoning (OR, 5.83; 95% CI, 1.80–18.86) than those who did not. Conclusion Exposure to pesticides at a high concentration was found to be associated with depressive symptoms among Korean adults.

The aim of this study was to evaluate the association between content type of smartphone use and psychological characteristics and addiction propensity, including the average time of smartphone use and problematic smartphone use. Data were obtained from the 2017 Korea Youth Risk Behavior Web-Based Survey, a nationally representative survey of middle- and high-school students (n = 62,276). The content type of smartphone use was divided into four categories: (1) Study, (2) Social-Networking Services (SNS), (3) Game, and (4) Entertainment. The association of depressive mood and suicidal ideation with content type of smartphone use was analyzed, using multiple and binary logistic regression analyses, respectively. The relationship between content type of smartphone use and time spent on smartphone use and problematic smartphone use was analyzed by using multiple logistic regression, adjusted for related covariables. The results of this study revealed that depressive mood and suicidal ideation were significantly associated with the SNS smartphone use group, compared with the other groups. Our results also indicate that the SNS group showed higher addiction propensity, such as overuse and experiencing adverse consequences of smartphone use.

Background Many suicide attempters brought to our emergency department (ED) have been found to have alcohol problems, and this should be taken serious consideration because alcohol use disorder is a risk factor for suicide reattempt. In this study, we aimed to estimate the effectiveness of alcohol-related biochemical markers and Alcohol Use Disorder Identification Test Consumption (AUDIT-C) in suicide attempters who visited our ED based on the gold standard for clinical diagnosis used by psychiatrists for alcohol use disorder. Moreover, we aimed to search for a significant standard when clinicians make correct predictions about alcohol use disorder using these markers. Methods Among the subjects who visited ED following a suicide attempt, a total of 203 subjects were selected. Following a psychiatric interview, the subjects who met the criteria for alcohol abuse or alcohol dependence according to DSM-IV-TR in the past year were defined as the “alcohol use disorder” group. Although some subjects did not meet these criteria, men with a weekly alcohol intake of ≥14 drinks and women with a weekly alcohol intake of ≥7 drinks were classified as the “risky drinking” group. AUDIT-C was used as a self-report; further, aspartate aminotransferase, gamma-glutamyltransferase (GGT), and carbohydrate-deficient transferrin (CDT) were assayed using standard methods, and GGT–CDT was calculated using this formula: 0.8 × ln(GGT) + 1.3 × ln(%CDT). Results In total, 88 subjects met the criteria for alcohol use disorder and 115 were included in the reference group. In the screening for alcohol use disorder, the AUC of AUDIT-C was 0.89 for men and 0.87 for women. In the screening for risky drinking, the AUC of AUDIT-C was 0.99 for men and 0.93 for women. Compared with other biochemical markers, AUDIT-C showed the highest AUC value for screening for both alcohol use disorder and risky drinking, with the trend being more prominent in men. Conclusions Among the biochemical markers, AUDIT-C yielded the highest sensitivity, specificity, and accuracy in diagnosing alcohol use disorder among suicide attempters in ED. Comparison of results revealed that the use of AUDIT-C with biochemical markers or its use alone can help screen for alcohol use disorder or risky drinking in clinical settings.

Background The purpose of this study was to identify the demographic and clinical characteristics of suicide attempts in adolescents who visit the emergency department compared to those of adults. Methods This study included 149 children under the age of 18, and 1427 people in the age of 19–65 who came to the emergency department with suicide attempt from 2009 to 2015. We compare sociodemographic, clinical, and suicide attempt-related characteristics through Chi-square test and logistic regression analysis to evaluate the difference between two groups. Results In adolescents, suicide attempters had more number of previous suicide attempt history than adults. Adolescents used more non-lethal method such as poisoning of over the counter drugs and had about 5 times higher odds ratio in suicide attempts with analgesics. The motivation of suicide attempt among adolescents was more related with interpersonal problems but less with financial or illness-related problems. The intention of suicide attempt in adolescents was less serious and lethal compared to adults. Conclusion Suicide attempts among adolescents had showed different from adults in method, motivation and intention. Considering the characteristics of suicide attempt among adolescent, it is necessary to keep close attention to adolescent’s suicide attempters and develop the customized intervention program to prevent the suicide attempt in this groups.

Objective We investigated the association between suicide and pesticide exposure in a community-based cohort study. Methods We performed a longitudinal analysis of 6333 who participated in the initial survey of the Korean Genome and Epidemiology Study. Data were collected using a questionnaire to assess the prevalence of suicide. We calculated the hazard ratios (HRs) for suicide by pesticide exposure using the Cox proportional hazard model. Results After adjusting for variables, participants exposed to pesticides had a 1.88-fold increased risk of suicide (HR, 1.88; 95% confidence interval [CI], 1.11 to 3.16) than those who were not exposed. Study populations with greater pesticide use (HR, 2.42; 95% CI, 1.27 to 4.60) and pesticide addiction had the highest suicide rates (HR, 1.91; 95% CI, 1.03 to 3.56). Conclusions Pesticide exposure for suicide should be considered during the development and implementation of suicide prevention in rural area.

(1) Background: The health implications associated with the metabolically healthy obese (MHO) phenotype, in particular related to symptoms of depression, are still not clear. the purpose of this study is to check whether depression and metabolic status are relevant by classifying them into four groups in accordance with the MHO diagnostic standard. Other impressions seen were the differences between sexes and the effects of the MHO on the occurrence of depression. (2) Methods: A sample of 3,586,492 adult individuals from the National Health Insurance Database of Korea was classified into four categories by their metabolic status and body mass index: (1) metabolically healthy non-obese (MHN), (2) metabolically healthy obese (MHO), (3) metabolically unhealthy non-obese (MUN), and (4) metabolically unhealthy obese (MUO). Participants were followed for six to eight years for new incidences of depression. The statistical significance of the general characteristics of the four groups, as well as the mean differences in metabolic syndrome risk factors, was assessed with the use of a one-way analysis of variance (ANOVA). (3) Results: The MHN ratio in women was higher than in men (men 39.3%, women 55.2%). In both men and women, depression incidence was the highest among MUO participants (odds ratio (OR) = 1.01 in men, OR = 1.09 in women). It was concluded as well that, among the risk factors of metabolic syndrome, waist circumference was the most related to depression. Among the four groups, the MUO phenotype was the most related to depression. Furthermore, in women participants, MHO is also related to a higher risk of depressive symptoms. These findings indicate that MHO is not a totally benign condition in relation to depression in women. (4) Conclusion: Therefore, reducing metabolic syndrome and obesity patients in Korea will likely reduce the incidence of depression.

Suicide is a leading cause of death among adolescents and a major public health concern. Here we developed a risk stratification model for adolescent suicide attempts using sociodemographic characteristics, risk behaviours and psychological variables. Participants were 247,222 subjects in the Korea Youth Risk Behavior Web-based Survey (KYRBS). We developed a suicide index based on the suicide risk estimated in the generalized linear model and proposed the risk stratification model using the R language to measure the probability of suicide attempt among adolescents. Among the study population, the annual rate of suicide attempt was approximately 4%. The model provided good prediction for suicide attempt (AUC = 0.85). The important univariate risk factors for the outcome were dimensional measures of age, sex, breakfast consumption, experience of violence, sleep duration, perceived stress, feeling of sadness, current cigarette smoking, current alcohol drinking, perceived general health, perceived academic record, household economic status and living with biological or adoptive parents. Our suicide index model allowed the identification of adolescents who are at a high risk for suicide. This tool may promote the prevention of adolescent suicide and can be particularly useful in everyday settings where it is difficult to contact mental health professionals immediately.

Objectives The purpose of this study was to identify distinctive characteristics of old-old suicide attempters (75 years and older) from young-old (60-74 years old) and middle-aged suicide attempters (45-59 years old). Methods We included consecutive series of 920 patients aged 45 years and older who had visited the emergency room from 2009 to 2015 because of suicide attempts. They were divided into 3 groups according to age. Information about the suicide attempt and sociodemographic status was gathered through interviews with attempters or caregivers. Chi-square test and logistic regression analysis were performed to evaluate the differences among the 3 groups. Results We found that old-old suicide attempters had high intent to die and high medical lethality as a result of the attempt, and illness-related problems exerted a strong motivational effect on this group. Psychiatric drugs, pesticides, and herbicides were frequently used to attempt suicide. These attempts were less likely to be associated with alcohol consumption compared to other age groups. Conclusion Old-old suicide attempters have different characteristics, compared with young-old and middle-aged counterparts. It is necessary to assess suicide risk and depression when examining patients with physical illness or when prescribing psychotropic drugs. High-risk groups should be given immediate intervention including psychiatric treatment before they act on high suicide intent.

Background Somatization refers to the tendency to emphasize somatic symptoms when experiencing a psychiatric disturbance. This tendency has been widely reported in patients from East Asian cultural contexts suffering from depression. Recent research in two Chinese samples have demonstrated that the local cultural script for depression, involving two aspects—the experience and expression of distress (EED) and conceptualization and communication of distress (CCD)—can be evoked to help explain somatization. Given the beliefs and practices broadly shared across Chinese and South Korean cultural contexts, the current study seeks to replicate this explanatory model in South Koreans. Methods Our sample included 209 psychiatric outpatients from Seoul and Wonju, South Korea. Self-report questionnaires were used to assess somatization tendency, adherence to traditional values, and psychological and somatic symptoms of depression. Results Results from SEM showed that the EED and CCD factors of somatization tendency were differently associated with cultural values and somatic symptoms, replicating our previous findings in Chinese outpatients. Limitations The reliance on a brief self-report measure of somatization tendency, not originally designed to assess separate EED and CCD factors, highlights the need for measurement tools for the assessment of cultural scripts in cross-cultural depression research. Conclusions The replication of the Chinese structural model of somatization in South Korea lends empirical support to the view that somatization can be understood as the consequence of specific cultural scripts. These scripts involve the experience and expression of distress as well as culturally meaningful ways in which this distress is conceptualized and communicated to others.

Introduction We aimed to investigate the association of non-daily smoking with depressive symptoms and suicidal behaviours among adolescents by analysing data from the 2016 Korean Youth Risk Behavior Web-based Survey (KYRBWS), a national school-based survey. Methods We analysed data from a nationally representative sample of Korean adolescents aged 12–18 years (n = 65,528). We investigated the risks of depressive symptoms, suicide ideation, plan and attempt in adolescent non-daily smokers using multiple logistic regression analyses after adjusting for confounding factors. Taking into account the trajectory of smoking patterns in adolescents, we assessed all analyses with stratification by early (aged 12–15) and late (aged 16–18) adolescents. Results Among early adolescents, non-daily smokers were more likely to have depressive symptoms, suicide ideation and plan compared with never smokers and even more likely to have depressive symptoms compared with daily smokers. Among late adolescents, non-daily smokers had higher risks of depressive symptoms, suicide ideation, plan and attempt than never smokers, whereas the risk for suicide attempts was lower than daily smokers. Conclusions Our findings suggest that non-daily smoking in adolescents was associated with risks for depressive symptoms and suicidal behaviours, and the association was more prominent in early adolescents. Careful attention on the mental health of adolescent non-daily smokers is needed because this is an increasing and easily overlooked group.

This study aims to evaluate the association between smartphone use and suicide attempts, independent of possible confounders, including conflicts with family/friends and poor academic performance due to smartphone use. Data were obtained from the 2017 Korea Youth Risk Behavior Web-based Survey, a nationally representative survey of middle- and high-school students (N = 62,276). Time spent using a smartphone was divided into four categories: less than 1 h, 1-2 h, 3-4 h, and 5 h or more a day. The association of conflicts with family due to smartphone use, conflicts with friends due to smartphone use, and poor academic performance due to smartphone use with suicide attempts and time spent using a smartphone were analyzed using multiple and binary logistic regression analyses, respectively. The relationship between time spent on a smartphone and suicide attempts was analyzed using a multiple logistic regression analysis. All analyses were also stratified according to the main purpose of smartphone use (process purposes/social purposes). Conflicts with family/friends due to smartphone use was significantly associated with suicide attempts (P

Delirium is an acute disturbance in attention and awareness in response to one or more physiological stressors that is closely related to poor clinical outcomes. The aim of this study is to investigate whether delirium patients with psychotic symptoms (PS) would have unique clinical characteristics and outcomes. A retrospective chart review was performed on the patients with delirium due to general medical conditions to assess clinical characteristics and outcomes. All patients were assessed by Delirium Rating Scale-revised-98 and classified as having PS when scored two or more on at least one of the psychotic symptom items (perceptual disturbances, delusions, and thought process abnormalities). Of 233 patients with delirium, 116 (49.8%) manifested PS. Patients with PS were younger, more likely to use antipsychotics to manage delirium, and had more hyperactive motor subtype than patients without PS. Logistic regression analysis showed that odds ratio of psychotic symptoms for having in-hospital mortality was 0.27 (95% CI = 0.08-0.94) after controlling age, sex, disease severity, comorbidity, number of medications, etiologies, motor subtypes, delirium severity and use of antipsychotics. The present study demonstrated that PS of delirium was associated with unique clinical characteristics and may affect the clinical course in a psychiatry-referral sample.

To determine the effects of excessive drinking and alcohol dependency on mortality and chronic health problems in a rural community in South Korea, this study represents a nested case-control study. In 1998, we conducted the Alcohol Dependence Survey (ADS), a population survey of a village in Korea. To measure the effects of alcohol on chronic health conditions and mortality over time, in 2004, we identified 290 adults from the ADS sample (N=1,058) for follow-up. Of those selected, 145 were adults who had alcohol problems, either alcohol dependence as assessed in the ADS by the Severity of Alcohol Dependence Questionnaire (N=59), or excessive drinking without dependency (N=86). Further 145 nondrinkers were identified, matching those with alcohol problems in age and sex. We revisited the village in 2004 and completed personal interviews with them. In multivariate logistic regressions, the rates of mortality and morbidity of chronic health conditions were three times greater for alcohol dependents compared with the rate for nondrinkers. Importantly, however, excessive drinking without dependency was not associated with the rates of either mortality or morbidity. Future investigations would benefit by attending more specifically to measures for alcohol dependence as well as measures for alcohol consumption.