Transcranial direct current stimulation (tDCS) is a promising treatment for major depressive disorder (MDD). This study evaluated its antidepressant and cognitive effects as a safe, effective, home-based therapy for MDD.

This double-blind, sham-controlled, randomized trial divided participants into low-intensity (1 mA, n = 47), high-intensity (2 mA, n = 49), and sham (n = 45) groups, receiving 42 daily tDCS sessions, including weekends and holidays, targeting the dorsolateral prefrontal cortex for 30 minutes. Assessments were conducted at baseline and weeks 2, 4, and 6. The primary outcome was cognitive improvement assessed by changes in total accuracy on the 2-back test from baseline to week 6. Secondary outcomes included changes in depressive symptoms (HAM-D), anxiety (HAM-A), and quality of life (QLES). Adverse events were monitored. This trial was registered with ClinicalTrials.gov (NCT04709952).

In the tDCS study, of 141 participants (102 [72.3%] women; mean age 35.7 years, standard deviation 12.7), 95 completed the trial. Mean changes in the total accuracy scores from baseline to week 6 were compared across the three groups using an F-test. Linear mixed-effects models examined the interaction of group and time. Results showed no significant differences among groups in cognitive or depressive outcomes at week 6. Active groups experienced more mild adverse events compared to sham but had similar rates of severe adverse events and dropout.

Home-based tDCS for MDD demonstrated no evidence of effectiveness but was safe and well-tolerated. Further research is needed to address the technical limitations, evaluate broader cognitive functions, and extend durations to evaluate its therapeutic potential.

People with mental illness often experience a concealable stigmatized identity that may be invisible to others. As a result, they are often faced with the dilemmas of whether to disclosure or conceal their diagnosis and their experience. However, in order to overcome the social stigma and self-stigma that hinder their recovery, they must establish a network and social support through identity disclosure.

This study investigates the effect of clinical characteristics (symptom and social function level), self-stigma and social support on the disclosure of people with mental illness.

The research was conducted with 236 respondents who are currently using community mental health services. (Male: 51.9%, Female: 48.1%; Mean age = 47.97±13.24; SPR: 66.8%, other diagnosis: 33.2%).

Most respondents disclosed their mental illness to health service providers and family, but they are least open about their identity toward neighbors and co-workers. A regression analysis of predictors of disclosure revealed that only social functioning level and social support had significant predictive power. It was discovered that individuals with better level of social function and social support disclosure more about their mental illness.

A program that increases social functions and support network can be recommended to improve disclosure efficacy.

None Declared

Suicide has a complex relationship with several factors, and it is known that identifying high-risk groups of suicide and managing crisis in advance can help prevent suicide. Moreover in a previous study, it showed that people with chronic diseases often suffer from psychological difficulties such as depression and anxiety, which can influence one to commit suicide. Based on many studies about the relationship between diabetes and depression, 10% of diabetic patients experience major depression, and diabetic patients experience twice as much depression as the general population. But, there are few studies examining the relationship between diabetes and suicide risk, and most of them were targeted for type 1 diabetes only.

The objectives of this study were to investigate the suicide risk in diabetic patients, and evaluate the suicide risk varies by the duration of diabetes, using a large population sample in South Korea

Using the 2019 Korea National Health and Nutrition Examination Survey data, 6,296 adults (aged 19 years or older) were included. Suicidal ideation, suicidal plan, and suicidal behavior of diabetic patients were compared with the general population. After classifying the patients into ≤ 1 year, 2 to 9 years, and 10 years ≤ for the duration of diabetes, we evaluated the relationship between the duration of diabetes and the risk of suicide.

Diabetic patients had higher prevalence of suicidal ideation (9.1%, P<0.001) and suicidal plan (3.6%, P<0.001) than general population. After adjusting for potential confounding factors, suicidal plan (aOR = 3.011, 95% CI = 1.392-6.512) was significantly associated with diabetes. In the 2 to 9 year group of diabetes, we found an increase in risk of suicidal ideation (aOR=2.068, 95% CI=1.219-3.510), suicidal plan (aOR=3.640, 95% CI=1.592-8.320), and suicidal behavior (aOR=6.222, 95% CI=1.759-22.008) after adjusting covariates. However, increase in suicide risk was not observed in the ≤1 year and 10 years ≤ groups after diagnosis of diabetes.

In adults, diabetes is associated with increase in suicide risk. Suicide risk in diabetic patients shows an ‘inverted U-shaped’ depending on the duration of diabetes.

None Declared

People experience various negative emotions when they encounter stressful events, and these negative emotions contribute to the onset of illnesses. These emotional responses are not limited to just one; a person can experience multiple emotions at once, and the primary emotional reactions can vary depending on the severity and duration of the illness or life events. This is reason why we created a self-report scale to assess short-term emotional responses, focusing on the current emotional state experienced subjectively by patients.

The purpose of this study was to develop an affective response scale (ARS) and examine its validity and reliability.

We established clusters of affective via a literature review and developed preliminary items based on the structure. We conducted expert content validation to converge on the final items, followed by construct validity and reliability analyses.

The research findings indicate that the Affective Response Scale was composed of three main dimensions: anxiety, anger, and depression. Content validity results confirmed the validity of most items. The scale developed in this study was found to be valid in both exploratory and confirmatory factor analyses, and it was identified to be stable and consistent through the analysis of the internal reliability.

These results indicate that the ARS is highly reliable and valid, and that it can be utilized as an effective measure of the patient’s emotion and its severity.

None Declared

It has been several years since the World Health Organization (WHO) advocated for shared decision-making(SDM) models when developing treatment plans for individuals with mental illnesses. It is emphasizing the importance of actively involving patients in expressing their opinions and sharing treatment-related information. However, few clinicians accept patients’ subjective views in clinical practice. Given that patients’ subjective beliefs about their symptoms significantly impact treatment satisfaction, prognosis, and adherence, it is essential to assess these perceptions. However, few studies have been conducted to assess patients’ subjective beliefs, their mental representation, of their disease. Therefore, this study aims to develop Interview that enable the utilization of patients’ cognitive representations of their mental illnesses in clinical practice.

The primary objective of this study is to develop a semi-structured interview and a self-report scale to evaluate patients’ mental representations of their illnesses. Subsequently, validate the reliability and validity of these tools as psychological assessments.

An initial structure for both the semi-structured interview and self-report scale was established through a literature review of existing disease representation measurements. Subsequently, expert panel discussions and further literature reviews were conducted to refine the structure and content of both tools. Content validity for both the interview and self-report scale was assessed by a panel of nine experts and a group of ten students. Following this, the developed interview tool was subjected to a validity analysis with clinical patients using Missick’s six validity criteria(Content, Substantive, Structural, Generalizability, External, Consequential).

Content validity index (CVI) values for the overall structure indicated that all subdomains scored above 0.8, demonstrating the appropriateness of the interview tool’s five subdomains: symptoms, causes, temporal aspects, impact, and treatment and control. Content validity assessment for individual items revealed that some items within the “causes of the disease” subdomain, specifically stress-related factors, scored below 0.6, prompting necessary item modifications. All other factors achieved CVI scores of 0.6 or higher. Facial validity assessment yielded favorable results for all items in the self-report scale. All validity was demonstrated to be satisfactory.

This study has provided evidence that the developed tools are reliable and valid instruments for measuring patients’ perceptions of their illnesses, offering a trustworthy means to assess these vital cognitive representations in clinical practice.

None Declared

While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.

Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.

A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3–2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83–7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2–10.5%; RR: 1.56, 95% CI: 1.38–1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2–11.3%; RR: 1.60, 95% CI: 1.42–1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.

Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.

During the COVID-19 pandemic, care for the elderly in the community was greatly limited. Accordingly, the demand for alternative community care have increased to cope with changing situations.

In this study, we tried to find out whether the companion robot improved mood state and related problem in depressive or isolated community dwelling elderly

For 186 community dwelling elderly who have received social welfare service due to depression or social isolation, we provided companion robot that could support their daily living. The robot was equipped with special program that could recognize and respond to the participant’s own emotion. It was part of behavioral activation techniques which is one of powerful treatment for depression. The self-report questionnaires were used to measure changes in cognitive function, depression, suicidality, loneliness, resilience and satisfaction of life. Outcomes were measured before using companion robot and after 3 months, and we compared them.

The elderly using companion robot for 3 months showed improved cognitive function (45.7% to 30.1%), depression (p<0.001), suicidality(p<0.001), and loneliness (p=0.033) in the self-report questionnaire. Resilience(p=0.749) and satisfaction of life (p=0.246) were also improved but not reached significance.

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These findings showed that the use of companion robot with emotional recognition coaching program could help improve depression, cognitive function, loneliness and suicidal ideation. In particular, this effect was also useful for those who were diagnosed with depression. Also if we can put more techniques of behavioral activation programs into robot, it could be useful in community care for depressive and isolated elderly.

None Declared

Self-compassion (SC) describes an emotionally positive attitude extended toward ourselves when we suffer, consisting of three main components; self-kindness, common humanity, and mindfulness (Germer & Neff, 2013). SC entails being warm and understanding towards ourselves when encountering pain or personal shortcomings, rather than ignoring them or flagellating ourselves with self-criticism. SC also involves recognizing that suffering and failure are part of the shared human experience rather than isolating. In addition, SC requires taking a mindful approach to one’s feelings and thoughts, without judgment of them.

Self-compassion (SC) involves taking an emotionally positive attitude towards oneself when suffering. Although SC has positive effects on mental well-being as well as a protective role in preventing depression and anxiety in healthy individuals, few studies on white matter (WM) microstructures in neuroimaging studies of SC has been studied.

Magnetic resonance imaging data were acquired from 71 healthy participants with measured levels of SC and its six subscales. Mirroring network as WM regions of interest were analyzed using tract-based spatial statistics (TBSS). After the WM regions associated with SC were extracted, exploratory correlation analysis with the self-forgiveness scale, the coping scale, and the world health organization quality of life scale abbreviated version was performed.

We found that self-compassion scale (SCS) total scores were negatively correlated with the fractional anisotropy (FA) values of the superior longitudinal fasciculus (SLF) in healthy individuals. The self-kindness and mindfulness subscale scores of SCS were also negatively correlated with FA values of the same regions. The FA values of SLF related to SC were found to be negatively correlated with the total scores of self-forgiveness scale, and self-control coping strategy and confrontation coping strategy.

Our findings suggest that levels of SC and its self-kindness and mindfulness components may be negatively associated with DMN-related WM microstructures in healthy individuals. These less WM microstructures may be associated with positive personal attitudes, such as self-forgiveness, self-control and active confrontational strategies.

None Declared

With the increase of older adult population, late life depression is emerging as a major problem in many countries as it significantly deteriorates function and quality of life in older adults. Late life depression is a multidimensional disease that requires intervention in biopsychosocial perspective. Recent reduction in family size and rapid simplification of generations are making this decrease more dramatic. Thus, single older households are becoming general type of household in late life, emphasizing the importance of social engagement in late life depression

the purpose of this study is to assess the correlation between the frequency of face-to-face and non-face-to-face contact with non-cohabitating adult children and late life depression after the COVID-19 pandemic. Additionally, we hypothesized 10 possible moderators and evaluated the moderation effect of each moderator on the correlation. By identifying groups of older adults that are more affected by contact with their children, the understanding of the relationship between late life depression and family contact in older adults might provide insights to set intervention targets in the community.

Older adults who completed the Living Profiles of Older People Survey in Korea were included. In total, 7,573 participants were analyzed by measuring their contact frequency and depression symptoms. Regression analysis was done adjusting covariates. Process macro was used to verify the moderating effects of variables.

Multivariable logistic regression analysis showed that both infrequent face-to-face (OR=1.87, 95% CI=1.56-2.23) and non-face-to-face contact (OR=1.22, 95% CI=1.03-1.44) with non-cohabitating adult children group was associated with higher risk of late life depression compared to a frequent contact group. Further linear regression analysis, which viewed depressive symptoms as SGDS-K score, indicated consistent results in face-to-face and non-face-to-face contact (estimate=0.468, standard error [SE]=0.091, p<0.001 and estimate=0.262, standard error [SE]=0.079, p<0.001, respectively). Finally, using moderation analysis, association with late life depression and frequency of face-to-face contact was moderated by age, quartiles of household income, number of chronic diseases, frequency of physical activity, existence of spouse, and nutritional status (NSI) whether effect of frequency of non-face-to-face contact on late life depression was increased by participation in social activity, frequent physical activity, and good cognitive function (MMSE-DS score)(p for interaction<0.05).

Frequent contact of non-cohabitating children lowers the risk of later life depression. Several variables were found significant in moderating contact frequency-depression symptoms.

None Declared

Nurses are at an increased risk for work-related stress resulting in post-traumatic stress disorder (PTSD). They are susceptible due to frequent exposure to traumatic situations providing care for patients.

The purpose of this systematic review is to comprehensively review the content and characteristics of intervention programs for reducing the post-traumatic stress of nurses or nursing students, providing a basis for developing a standardized protocol for programs to promote the integrated health of nurses and protect them from stress events in clinical environments.

This is a systematic review. Participants (P) targeted nurses or nursing students; Intervention (I) included intervention programs for reducing post-traumatic stress; Comparison (C) was control groups provided with usual or no interventions ; and Outcomes (O) referred to changes in physical or emotional reactions toward post-traumatic stress. Two researchers searched four databases including PubMed, CINAHL, PsycINFO, and EMBASE with keywords such as “nurse,” “post-trumatic stress disorder,” “program,” and “intervention”. A total of 7,523 studies were searched and 10 studies were included for final analysis (Image 1). The Risk of Bias2 (Image 2) and the Risk of Bias for Non-randomized Study I (Image 3) were used to evaluate the quality the included studies.

The number of studies is increasing, with four studies published before 2020, and six studies published since, of which three in 2022. Definitions of trauma situations to which nurses are exposed included diverse elements such as patient death, workplace violence, the COVID-19 pandemic, and complex trauma experiences due to working environments. Most studies have provided multiple intervention sessions, which is appropriate considering the characteristics of PTSD. Most studies examined the secondary effects on mental health such as anxiety, depression, and burnout caused by stress rather than evaluating stress itself. The quality of the study was generally highly biased. The risk of bias increased for the two randomized controlled trials in terms of measurement outcomes and outcome description. The other eight non-randomized studies all included a self-reporting questionnaire of participants, leading to a risk of bias in terms of measurement outcomes.

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Studies have been conducted to confirm the effectiveness of interventions given heightened concerns about PTSD in nurses. However, the concept of the trauma experienced by nurses was not integrally defined, and information on interventions was often limited. Efforts are required to improve the quality of research in terms of experimental study design.

None Declared

Bladder cancer, which is primarily a non-muscle invasive bladder cancer (NMIBC), is prevalent worldwide and its incidence is increasing. NMIBC shows a high recurrence rate of 50-70%, and in 25% of cases, progresses to muscle-invasive disease (Saginala K et al. Med Sci 2020; 15) (Fernandez-Gomez, J et al. J Urol 2009; 182(5) 2195-2203). Frequent recurrence and consecutive medical interventions in patients with NMIBC lead to psychological problems such as anxiety, fear of recurrence, depression, and stress, resulting in reduced quality of life (Chung et al. Support Care Cancer 2019; 27(10), 3877-3885). It is expected that the increased accessibility and convenience of mobile health (mHealth) will be effective in providing a mobile-based psychological intervention program to promote the mental health of patients with NMIBC.

This study aims to develop a mobile-based mental health improvement program for NMIBC patients, design a protocol for evaluating feasibility, and provide preliminary evidence of the efficacy of the developed program.

The program content was developed based on the results of a needs assessment conducted among patients with NMIBC through a cross-sectional study. The draft program was prepared by referring to the guidelines of the National Comprehensive Cancer Network and publications of the International Continence Society. Based on the developed draft, two professors of nursing, a professor of counseling psychology, a registered nurse, and a counseling practitioner verified the validity of the content before finalizing the program. The final version of the developed program consisted of one session on NMIBC knowledge and symptom management and five sessions on mental health improvement. Researchers sent an online link to the YouTube video comprising lecture materials and voice recordings of health professionals weekly using a mobile messenger (Kakao Talk) (Image 1). The topics of each session were as follows: Session 1 (Understanding of bladder cancer and treatment), Session 2 (Understanding and respecting myself), Session 3 (Maintaining reasonable thoughts and positive emotions), Session 4 (Benefits of positive emotions and healthy communication), Session 5 (Living in a healthy way through stress management), and Session 6 (Finding happiness and meanings in daily life).

The protocol for evaluating the feasibility of the developed program is outlined in Image 2.

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The feasibility of the mental health improvement program for patients with NMIBC based on mobile messenger (KakaoTalk) will be evaluated through the developed protocol. Moreover, by introducing a program that reflects the feasibility of test results into practice, the results of this study can contribute to improving the quality of life of patients with NMIBC.

None Declared

Panic disorders (PD) are associated with suicidality. The link between PD and suicide has been suggested to be depression; however, this remains controversial. Comprehensive research on the history of suicide attempts (SAs) in patients with PD is scarce.

This study investigated the characteristics and pharmacological short- and long-term treatment responses of patients with PD, with or without SAs. Moreover, a network analysis was conducted to investigate the central symptoms and their connection to suicidality among SA-related variables with and without SAs.

We investigated the characteristics of SAs in patients with PD using PD-related scales, magnetic resonance imaging, and network approaches. A total of 1151 subjects were enrolled, including 755 patients with PD (97 with SA and 658 without SA) and 396 healthy controls. Suicide and PD-related scales were also administered.

Our results revealed that the scores of all symptom severities were significantly higher in the PD+SA group than in the PD-SA group. Multiple linear regression analysis revealed that short- and long-term pharmacological treatment responses were significantly poor in the PD+SA group. Network analysis showed that fear of cognitive dyscontrol (FCD) was the strongest central symptom among strength, expected influence (1 and 2 step), randomized shortest path betweenness, and eigenvector centrality measures in PD+SA, whereas depression was the central symptom in PD-SA.Table 1.Results of multiple regression analysis to predict treatment response for patients with panic disorder.

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Our results suggest that SA history could be associated with high symptom severity and poor pharmacological treatment response in patients with PD and that FCD is the central symptom in the PD+SA network.

None Declared

Olanzapine (OLA) is a common first-prescribed antipsychotic and has shown favorable efficacy in acutely exacerbated patients with schizophrenia. The mixed receptor activity of OLA and its greater affinity for serotonin 5-HT2A rather than dopamine D2 receptors are similar to those of clozapine. Pharmacokinetically, OLA is metabolized mainly by hepatic cytochrome enzyme P450 1A2 (CYP1A2). Because risks of antipsychotic polypharmacy include increased drug-drug interactions, pharmacokinetic considerations are important for selection of antipsychotics to be combined. Due to its pharmacological characteristics, amisulpride (AMI), another atypical antipsychotic with proven efficacy, is a promising adjuvant agent of special interest. AMI is unlikely to interact with other drugs due to the low plasma protein binding and metabolism and does not affect the activity of the CYP system. Furthermore, AMI is highly selective for dopamine D2/D3 receptors; has minimal or no affinity for D1, D4, or D5 receptors. Despite the potential benefits of the combination of OLA and AMI, only a few open-label studies have been conducted, and no randomized clinical trial has been performed to date to examine the efficacy and tolerability of the combination. Hence, the goals of this study were to test the hypothesis that AMI augmentation would improve psychotic symptoms and be well tolerated in schizophrenic patients who showed poor response to OLA monotherapy.

The purpose of this study was to compare the efficacy and tolerability of continued olanzapine (OLA) versus amisulpride (AMI) augmentation in schizophrenic patients with poor response to OLA monotherapy.

The present 4-week, randomized, rater-blinded study included 25 patients with schizophrenia who were partially or completely unresponsive to treatment with OLA monotherapy. Eligible subjects were randomly assigned at a 1:1 ratio to continuation of OLA monotherapy (OLA group) or OLA with AMI augmentation (AMI group). Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at 1, 2, and 4 weeks.

The changes in PANSS total score and PANSS-positive subscale score were significantly different (p < 0.05) between the OLA and AMI groups. The differences between the two groups in PANSS-negative subscale, PANSS-general subscale, Brief Psychiatric Rating Scale, and Clinical Global Impression-Severity (CGI-S) scale scores were not statistically significant.

AMI augmentation could be an effective strategy for patients with schizophrenia who show inadequate early response to OLA monotherapy.

W.-M. Bahk Grant / Research support from: Handok Pharmaceuticals, Seoul, Korea, Y. S. Woo: None Declared, S.-Y. Park: None Declared, B.-H. Yoon: None Declared, S.-M. Wang: None Declared, M.-D. Kim: None Declared

Obsessive-compulsive disorder (OCD) and schizophrenia are often reported as co-morbid conditions. However, the evidence of an association between OCD and the risk of schizophrenia is limited. This study investigated the risk of schizophrenia in patients newly diagnosed with OCD using a nationally representative sample cohort in South Korea.

Data were obtained from the 2002–2013 Korean National Health Insurance Service-National Sample Cohort of the National Health Insurance Service. Using propensity score matching, 2509 patients with OCD and a control group of 7527 patients were included in the analysis. Chi-squared tests were used to investigate and compare the general characteristics of the study population. The risk of schizophrenia was analysed using the Cox proportional hazard model.

The incidence rate was 45.79/10 000 person-year for patients with OCD and 4.19/10 000 person-year for patients without OCD. Patients with OCD had a higher risk of schizophrenia compared to the control group after adjusting for covariates (hazard ratio = 10.46, 95% confidence interval = 6.07–18.00).

This study identified an association between the diagnosis of OCD and the risk of schizophrenia in a South Korean national representative cohort. Further research using a prospective design to clarify the causality of OCD in schizophrenia in a controlled environment should be conducted to validate these findings.