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Objective The relationship among chronic fatigue, depressive symptoms, and post-traumatic stress symptoms (PTSSs) among Middle East respiratory syndrome (MERS) survivors is poorly understood. Methods Of 148 survivors who consented to be registered and underwent assessments at 12 months (T1) and 18 months (T2) after the MERS outbreak, 72 (48.65%) were evaluated for chronic fatigue, depressive symptoms, and PTSSs based on the Impact of Event ScaleRevised (IES-R), the Patient Health Questionnaire-9 (PHQ-9), and the Fatigue Severity Scale (FSS). Data from 52 subjects, who completed both assessments, were analyzed using a regression-based serial multiple mediation model (PROCESS Model 6). Results Bootstrap analyses indicated no direct effects of T1 FSS on T2 IES-R but significant positive indirect effects of T1 FSS on T2 IESR through T1 PHQ-9 and T2 PHQ-9 (B=2.1601, SE=1.3268, 95% confidence interval=0.4250-6.1307). In other words, both T1 PHQ-9 and T2 PHQ-9 fully mediated the relationship between T1 FSS and T2 IES. Conclusion Chronic fatigue 12 months after MERS had indirect effects on prolonged PTSSs 18 months after MERS via persisting depression in MERS survivors. This finding supports the need to promote interventional programs for emerging infectious disease survivors with chronic fatigue to reduce depression and prevent prolonged PTSSs.

Objective The aim of this study was to examine the reliability and validity of the Korean version of the Impaired Control Scale (K-ICS), a scale to screen patients with alcohol use disorder. Methods Participants were 173 inpatients with alcohol use disorder (AUD), and 174 normal controls (NC). Both AUD and NC groups completed the K-ICS as well as the Alcohol Dependence Scale (ADS), the Alcohol Abstinence Self-Efficacy Scale (AASES), the Brief Self-Control Scale (BSCS), and the Hospital Anxiety and Depression Scale (HAD). Results The internal consistencies of K-ICS were good in both AUD and NC. A good convergent validity was clearly shown by significant correlations with the ADS and the AASES, respectively. But the K-ICS had no or weak correlations with the BSCS and the HAD. The ROC curve analyses indicated that the optimal cut-off points of failed control (FC) and predicted control (PC) were estimated as >15 and >13, respectively. Hierarchical multiple regression analysis suggested that FC is a robust predictor of the severity of AUD. Conclusion The K-ICS, especially FC subscale of it appears to be a valid and reliable measure of impaired control among both clinical and non-clinical sample.

The aim of this study was to examine whether both self-control and alcohol abstinence self-efficacy mediate the relationship between purpose in life and alcohol self-regulation failure among male inpatients with alcohol use disorder (AUD). A total of 140 male patients with AUD were recruited from alcohol centers of four psychiatric hospitals in South Korea. All participants completed psychological assessments, including the Purpose in Life, the Alcohol Abstinence Self-Efficacy Scale, the Brief Self-Control Scale, and the Alcohol Self-Regulation Failure Scale. As hypothesized, the indirect effect analysis found that both self-control and abstinence self-efficacy may fully mediate the effects of purpose in life on alcohol self-regulation because the total effect was significant, but the direct effect was not significant. Moreover, bootstrap analysis found that the indirect effects were statistically significant. In conclusion, the effects of self-control and alcohol abstinence self-efficacy might not have different mediation effects on the relationship between purpose in life and alcohol self-regulation failure. These results suggest that both to enhance self-efficacy and self-control ability and to find purpose in life are important for AUD treatment.

Alcohol use disorder (AUD) has been conceptualized as a chronic self-regulation failure.The aim of this study was to examine the most probable pathways related to self-regulation among patients with AUD. In this study, a hypothetical model was proposed that focused on the relationship between risk factors (extrinsic life goals, emotion dysregulation) and protective factors (intrinsic life goals, self-control, and abstinence self-efficacy).Male patients with AUD (N = 188) were recruited from alcohol centers of four psychiatric hospitals between March 2015 and September 2015. All participants completed psychological assessments, including the Future Oriented Goals Scale (FOGS), the Alcohol Abstinence Self-Efficacy Scale (AASE), the Brief Self-Control Scale (BSCS), and the Difficulties in Emotion Regulation Scale (DERS) as well as sociodemographic characteristics.The final model was found to be a good fit to data. In testing indirect effects, it was shown that intrinsic life goals via emotion dysregulation, self-control, and alcohol abstinence self-efficacy decreased alcohol self-regulation failure. On the other hand, extrinsic life goals via these factors increased alcohol self-regulation failure. Conclusions/Importance: These results suggest that intrinsic goals might indirectly be the important and protective factors for AUD. Moreover, the findings implicate that self-regulation through goal setting may be necessary to alleviate symptoms and improve function among patients with AUD.

OBJECTIVE The aim of this study was to examine the efficacy of the life goal-focused brief intervention, or the so-called the goal-focused self-regulation program (GFSRP), for patients with alcohol use disorder (AUD). METHODS The GFSRP was developed as an 8-week group-program, which is based on a wide range of self-regulation theories, such as goal setting and implementation intentions. Patients with AUD (n=50) took part in the GFSRP and were compared to the control group (n=48). This study examined the changes in outcome measures from baseline to follow-up (12-week) in a mixed design. RESULTS The GFSRP group had higher scores for the abstinence self-efficacy in negative affect situations than the control group at the post-test. In addition, it showed greater scores of optimisms compared to the control group. Furthermore, in the GFSRP group, there was no difference in intrinsic life goals from baseline to the 12-week follow-up, whereas the control group showed a significant decrease. CONCLUSION The GFSRP could increase the abstinence self-efficacy and optimism among patients with AUD. Moreover, it might prevent loss of life-goals as core factors in self-regulation among patients with AUD.

Purpose Our research was designed to test and explore the relationships among embitterment, social support, and perceptions of meaning in life in the Danwon High School survivors of the Sewol ferry disaster. Materials and methods Seventy-five Sewol ferry disaster survivors were eligible for participation, and were invited to participate in the study 28 months after the disaster. Forty-eight (64%) survivors (24 males, 24 females) completed questionnaires; the Posttraumatic Embitterment Disorder (PTED) scale, the Functional Social Support Questionnaire (FSSQ), and the Meaning in Life Questionnaire (MLQ). Results PTED scores were negatively correlated with scores on the FSSQ and the Presence of Meaning (MLQ-P) (r=-0.43 and -0.40, respectively). The hierarchical regression analysis showed that FSSQ scores may fully mediate the effects of PTED scores on MLQ-P scores, given that the indirect effect was significant whereas the direct effect was not (95% confidence interval=-0.5912 to -0.0365). Conclusion These findings imply that therapies targeting embitterment may play a vital role in increasing positive cognitions, such as those related to perceived social support and the meaningfulness of life.

Changwoo Han,1 Hwallip Bae,2 Sung-Doo Won,3 Jaeyoung Lim,3 Dai-Jin Kim41Department of Psychiatry, Ansan Hospital, College of Medicine, Korea University, Ansan, 2Department of Psychiatry, Myongji Hospital, College of Medicine, Seonam University, Goyang, 3Department of Clinical Psychology, Keyo Hospital, Keyo Medical Foundation, Uiwang, 4Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaAbstract: Alcohol dependence is a disorder ascribable to multiple factors and leads to cognitive impairment. Given that insulin dysregulation can cause cognitive impairment, patients with alcohol dependence are likely to develop insulin dysregulation such as that in diabetes. The purposes of this study are to identify an association between cognitive functioning and insulin and to investigate insulin as the biomarker of cognitive functioning in alcohol-dependent patients. Serum insulin levels were measured and cognitive functions were assessed in 45patients with chronic alcoholism. The Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K), a battery of cognitive function tests, was used to assess cognitive functioning. Serum insulin levels were not significantly correlated with most CERAD-K scores, but there was a significant negative correlation with scores on the Trail Making Test B, which is designed to measure executive functioning. Lower serum insulin levels were associated with slower executive functioning responses on the Trail Making Test B, suggesting that executive functioning may be in proportion to serum insulin levels. Thus, in patients with alcohol dependence, insulin level is associated with cognitive functioning. In addition, the present findings suggest that insulin level is a potential biomarker for determining cognitive functioning.Keywords: insulin, alcohol dependence, executive function, trail making test

Brain-derived neurotrophic factor (BDNF), the most abundant neurotrophin in the brain, has a known association with the pathophysiology of anxiety and depression. However, the role of BDNF in suicide has not been well investigated to date. This study examined plasma BDNF levels in 32 major depressive disorder (MDD) patients who had recently attempted suicide, 32 non-suicidal MDD patients, and 30 normal controls. The lethality of the suicide attempt was measured using the Risk-Rescue Rating (RRR) and Lethality Suicide Attempt Rating Scale (LSARS). The severity of depression was measured with the Hamilton Depression Rating Scale (HDRS). Plasma BDNF levels were measured by enzyme linked immunosorbent assay. BDNF levels were significantly lower in suicidal MDD patients (430.5+/-397.0 pg/ml) than non-suicidal MDD patients (875.80+/-663.02 pg/ml) or normal controls (889.4+/-611.3 pg/ml) (F=6.682, p=0.002). The most suitable cut-off point of BDNF level between suicidal depression and non-suicidal depression groups was 444.58 pg/ml. At this cut-off point, the sensitivity=68.7%, specificity=78.1%, positive predictive value=75.9%, and negative predictive value=71.4%. However, there was no significant difference in BDNF levels between the depressive control and normal control groups (p=0.996). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal patients. In addition, BDNF levels were not different between fatal and non-fatal suicide attempts. These results suggest that reduction of plasma BDNF level is related to suicidal behavior in major depression and that BDNF level may be a biological marker of suicidal depression.