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.

Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic.

By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions.

A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021.

Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.

This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea.

This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed.

We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (> 18 years) during this period. Among children/adolescent and adult ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74−61.93) and 78.72% (95% CI 78.53−78.91) had at least one psychiatric comorbidity, respectively.

Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.

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

Dental healthcare personnel (DHCP) are at high risk of exposure to coronavirus disease 2019 (COVID-19). We sought to identify how DHCP changed their use of personal protective equipment (PPE) as a result of the COVID-19 pandemic, and to pilot an educational video designed to improve knowledge of proper PPE use.

The study comprised 2 sets of semistructured qualitative interviews.

The study was conducted in 8 dental clinics in a Midwestern metropolitan area.

In total, 70 DHCP participated in the first set of interviews; 63 DHCP participated in the second set of interviews.

In September–November 2020 and March–October 2021, we conducted 2 sets of semistructured interviews: (1) PPE use in the dental community during COVID-19, and (2) feedback on the utility of an educational donning and doffing video.

Overall, 86% of DHCP reported having prior training. DHCP increased the use of PPE during COVID-19, specifically N95 respirators and face shields. DHCP reported real-world challenges to applying infection control methods, often resulting in PPE modification and reuse. DHCP reported double masking and sterilization methods to extend N95 respirator use. Additional challenges to PPE included shortages, comfort or discomfort, and compatibility with specialty dental equipment. DHCP found the educational video helpful and relevant to clinical practice. Fewer than half of DHCP reported exposure to a similar video.

DHCP experienced significant challenges related to PPE access and routine use in dental clinics during the COVID-19 pandemic. An educational video improved awareness and uptake of appropriate PPE use among DHCP.

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.

Hwa-Byung is a cultural-related mental syndrome that reflects the cultural characteristics of Korean in DSM-IV. This syndrome is caused by anger or resentment towards unreasonable social violence and trauma.

The purpose of this study is to revise and validate the ’Hwa-Byung scale’, which can be used to diagnose Hwa-Byung and evaluate the severity of its symptoms.

To begin with, the factors of the Hwa-Byung scale were set based on the previous studies. Additionally, the respective subfactors were generated by the semi-structured interviews with these patients. Based on these factors and previous studies, a 142-item pool was developed and verified by six Oriental Neuropsychiatrists. A pilot study was conducted on 50 patients with Hwa-Byung and the main study for the validation was conducted on 200 Hwa-Byung patients. Item analysis, internal consistency, and exploratory/confirmatory factor analysis were performed. Lastly, this study analyzed the ROC curve to present the diagnostic cut-off score of the scale.

As a result of analyzing the content validity of the item pool, we constructed a preliminary scale. We excluded the inadequate questions from the pilot study results. In the main study, The Hwa-Byung scale showed high internal consistency and its items were suitable for the factor structure. Finally, we suggest an optimal cut-off score of the symptoms sub-scale for screening Hwa-Byung.

Overall, the results of this study indicated the reliability and validity of the Hwa-Byung Scale. Based on these results, we discussed several values and limitations of this study and provided suggestions for further research.

No significant relationships.

Hwa-Byung is a mental syndrome classified as a “cultural-related syndrome” which reflects the cultural characteristics of Korea in DSM-IV. Hwa-Byung is caused by anger, which is characterized by feelings of anger or resent about unreasonable social violence and trauma. Kwon et al (2008) had developed self-report measure to assess severity of Hwa-Byung but it has several limitations to use in current clinical settings. Therefore, we investigated opinions of experts who have professionality in giving treatment of Hwa-Byung patients in the clinical settings.

The present study aimed to reach consent of oriental neuropsychiatrists’ opinions about the direction of revision of the Hwa-Byung scale.

The Delphi method is a survey method that induces people to freely present their opinions without face-to-face processes and reaches consent through continuous feedback of survey results while ensuring anonymity. The Consensus Panel consists of 16 experts who are Oriental neuropsychiatrists and have experience in diagnosing patients with Hwa-Byung. A total of four surveys were conducted as consensus was reached on the fourth round. Each questionnaire was distributed by mail to a panel of experts and was asked to submit a response after receiving the questionnaire.

The results of the study are as follows. First, common factors for Hwa-Byung include anger, resent/blame, modify memory bias and attention bias for anger events. Second, characteristics of young Hwa-Byung patients include stress caused by social factors and excessive immersion in certain things such as drinking or smoking.

Therefore, when revising the Hwa-Byung scale, it would be necessary to include these factors.

No significant relationships.

Childhood behavioral problems are highly prevalent in school-aged children and are associated with poor long-term outcomes. Yet little is known about their association with patterns of partnering in adulthood.

To (1) describe patterns of partnering from age 18-35 years in a large population-based sample, and (2) examine the association between childhood behavioural problems and adult partnering patterns.

Behavioural ratings were prospectively obtained from teachers when children (n=2960) were aged 10-12 years – for inattention, hyperactivity, aggression-opposition, anxiety and prosociality – and linked to their tax return records from age 18-35 years. We used group-based trajectory modelling to identify distinct trajectories of partnering (married or cohabitating) and multinomial regression models to examine the association between childhood behaviour and trajectory group membership.

Five distinct trajectories of partnering were identified: early-partnered (n=420, 14.4%), mid-partnered (n=620, 21.3%), late-partnered (n=570, 19.2%), early-separated (n=460, 15.5%), and delayed-or-unpartnered (n=890, 30.0%). After adjustment for sex and family background, children rated as being anxious or inattentive were more likely to remain unpartnered from age 18 to 35 years, while those rated as aggressive-oppositional or inattentive were more likely to separate and return to unpartnered status. Prosocial behaviours were consistently associated with earlier and more sustained partnership. Participants in the early-separated and delayed-or-unpartnered trajectories were also more likely to have left high school without a diploma and to have lower earnings.

Childhood behavioural problems were associated with increased likelihood of being unpartnered and of partnership dissolution, which has implications for the psychological health and wellbeing of individuals and their families.

To investigate the association between parity and the risk of incident dementia in women.

We pooled baseline and follow-up data for community-dwelling women aged 60 or older from six population-based, prospective cohort studies from four European and two Asian countries. We investigated the association between parity and incident dementia using Cox proportional hazards regression models adjusted for age, educational level, hypertension, diabetes mellitus and cohort, with additional analysis by dementia subtype (Alzheimer dementia (AD) and non-Alzheimer dementia (NAD)).

Of 9756 women dementia-free at baseline, 7010 completed one or more follow-up assessments. The mean follow-up duration was 5.4 ± 3.1 years and dementia developed in 550 participants. The number of parities was associated with the risk of incident dementia (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02–1.13). Grand multiparity (five or more parities) increased the risk of dementia by 30% compared to 1–4 parities (HR = 1.30, 95% CI = 1.02–1.67). The risk of NAD increased by 12% for every parity (HR = 1.12, 95% CI = 1.02–1.23) and by 60% for grand multiparity (HR = 1.60, 95% CI = 1.00–2.55), but the risk of AD was not significantly associated with parity.

Grand multiparity is a significant risk factor for dementia in women. This may have particularly important implications for women in low and middle-income countries where the fertility rate and prevalence of grand multiparity are high.

To assess the Framingham risk score as a prognostic tool for idiopathic sudden sensorineural hearing loss patients.

Medical records were reviewed for unilateral idiopathic sudden sensorineural hearing loss patients between January 2010 and October 2017. The 10-year risk of developing cardiovascular disease was calculated. Patients were subdivided into groups: group 1 – Framingham risk score of less than 10 per cent (n = 28); group 2 – score of 10 to less than 20 per cent (n = 6); and group 3 – score of 20 per cent or higher (n = 5).

Initial pure tone average and Framingham risk score were not significantly associated (p = 0.32). Thirteen patients in group 1 recovered completely (46.4 per cent), but none in groups 2 and 3 showed complete recovery. Initial pure tone average and Framingham risk score were significantly associated in multivariable linear regression analysis (R2 = 0.36). The regression coefficient was 0.33 (p = 0.003) for initial pure tone average and −0.67 (p = 0.005) for Framingham risk score.

Framingham risk score may be useful in predicting outcomes for idiopathic sudden sensorineural hearing loss patients, as those with a higher score showed poorer hearing recovery.

The aim of this study was to evaluate theprevalence of night eating syndrome (NES) and its correlates in schizophrenicoutpatients.

The 14 items of self-reported night eatingquestionnaire (NEQ) was administered to 201 schizophrenic patients in psychiatricoutpatient clinic. We examined demographic and clinical characteristics, bodymass index (BMI), subjective measures of mood, sleep, binge eating, andweight-related quality of life using Beck's Depression Inventory (BDI),Pittsburgh Sleep Quality Index (PSQI), Binge Eating Scale (BES) and Koreanversion of Obesity-Related Quality of Life Scale (KOQoL), respectively.

The prevalence of night eaters in schizophrenicoutpatients was 10.4% (21 of 201). Comparisons between NES group and non-NES grouprevealed no significant differences in sociodemographic characteristics, clinical status and BMI. Compared to non-NES, patients with NES reportedsignificantly greater depressed mood and sleep disturbance, more binge eatingpattern, and decreased weight-related quality of life. While 'morning anorexia'and 'delayed morning meal' (2 of 5 NES core components in NEQ) were notdiffered between groups, 'nocturnal ingestions', 'evening hyperphagia', and'mood/sleep' were more impaired in NES group.

These findings are the first to describe theprevalence and its correlates of night eaters in schizophrenic outpatients. These results suggest that NES has negative mental health implications, although it was not associated with obesity. Further study to generalize theseresults is required.

Thisstudy was to assess the prevalence and its correlates of restless legs syndrome(RLS) in outpatients with bipolar disorder.

A total of 100clinical stabilized bipolar outpatients were examined. The presence of RLS andits severity were assessed using the International Restless Legs Sydrome StudyGroup (IRLSSG) diagnostic criteria. Beck's Depression Inventory (BDI), Spielberg's StateAnxiety Inventory (STAI-X-1), Pittsburgh Sleep Quality Index (PSQI), Koreanversion Drug Attitude Inventory (KDAI-10), Subjective Well-Beings under NeurolepticTreatment Scale-Short Form(SWN-K) and Barnes Akathisia Rating Scale (BARS) wereused to evaluate the depressive symptomatology, level of anxiety, subjectivequality of sleep, subjective feeling of well-being, drug attitude, presence ofakathisia, respectively.

Of the 100 bipolar outpatients,7 (7%) were met to full criteria of IRLSSG and 36 (36%) have at least one ofthe 4 IRLSSG criterion. Because of relatively small sample size, non-parametricanalysis were done to compare the characteristics among 3 groups (full-RLS, 1≥positiveRLS-symptom and Non-RLS). There were no significant differences in sex, age, and other sociodemographic and clinical data among 3 groups. BDI, STAI-X-1 andPSQI are tended to be impaired in RLS and 1≥positive RLS-symptomgroups.

This is the first preliminarystudy for studying the prevalence and its correlates of RLS in bipolardisorder. The results shows that RLS was relatively smaller presentin bipolar disorder than schizophrenia. Sametendencies shown in schizophrenic patients were found that bipolar patientswith RLS had more depressive symptoms, state anxiety and poor subjective sleepquality.

Life events and accompanying psychological and behavioral reactions frequently have an impact upon people's daily lives and are believed to predispose them to disease. Psychological stressors impact many physiological and pathological disease outcomes, including mental illness. Positive social interactions have in turn been shown to exert powerful beneficial effects on health outcomes and longevity.

The Objective of this study was to analyze the relationships of Psychological Distress, Social Support, and Mental Fitness among patients of mental health services.

This article aims to discuss the evidence supporting the mediating effect of social support between psychological stress and mental health.

This study was performed on patients who visited the mental health services in Daejeon from October to December 2011. In total, 395 patients were evaluated with Mental Fitness Scale, Kessler Psychological Distress Scale(KPDS), and Multidimensional Scale of Perceived Social Support(MSPSS).

Correlations among variables of psychological distress and social support on subordinate variable of mental fitness of patients were significant. The result of the regression analysis, psychological distress and social support have a positively significant influence on mental fitness of patients. social support showed mediating effects between psychological distress and mental fitness.

These results suggest that health care providers ought to seek social support for patients, in order to provide positive mental fitness of patients.