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The aim of this study was to investigate the risk factors for suicidal ideation in adolescents by gender and age. This study used 2013 nationwide school-based mental health screening test data from 591,303 seventh grade students and 618,271 tenth grade students in Korea. Suicidal ideation, four psychological problems, and three adverse life events were evaluated using the Adolescents Mental Health and Problem Behavior Screening Questionnaire-II. Of all students, 12.9-14.7% of the boys and 17.1-23.2% of the girls had suicidal ideation. Mood had the greatest impact on the risk for suicidal ideation and other factors also significantly increased the risk of suicidal ideation. Distractibility was positively related to suicidal ideation only in seventh grade students and behavioral problems increased suicidal ideation more in girls than in boys. Violence constituted the most powerful factor for suicidal ideation among the events; however, bullying constituted the most important event that increased suicidal ideation in seventh grade girls. All factors except ‘Distractibility’ increased the risk of severe suicidal ideation. The risk factors for suicidal ideation in adolescents differed by gender and age. Interventions should be made according to these characteristics to reduce suicidal ideation in adolescents. [ABSTRACT FROM AUTHOR]

This work investigated whether Tourette syndrome patients exhibit alterations in neural oscillations during spontaneous expression and suppression of tics. Electroencephalograms (EEGs) were recorded from 9 medication-naïve children with Tourette syndrome and 10 age-matched healthy subjects in resting conditions and during tic suppression. Their cortical oscillations were examined using the power spectral method and partial directed coherence. The authors found increased oscillations of broad frequency bands in the frontomotor regions of patients during tic expression, suggesting the involvement of aberrant cortical oscillations in Tourette syndrome. More significantly, prominent increases in theta oscillation in the prefrontal area and directed frontomotor interactions in the theta and beta bands were observed during tic suppression. Furthermore, the directed EEG interaction from the frontal to motor regions was positively correlated with the severity of tic symptoms. These findings suggest that the frontal to motor interaction of cortical oscillations plays a significant role in tic suppression. [ABSTRACT FROM AUTHOR]

Background: Adolescent suicides are more likely to form clusters than those of other age groups. However, the definition of a cluster in the space–time dimension has not been established, neither are the factors contributing to it well known. Therefore, this study aimed to identify space–time clusters in adolescent suicides in Korea and to examine the differences between clustered and non-clustered cases using novel statistical methods. Methods: From 2016 to 2020, the dates and locations, including specific addresses from which the latitude and longitude of all student suicides (aged 9–18 years) in Korea were obtained through student suicide reports. Sociodemographic characteristics of the adolescents who died by suicide were collected, and the individual characteristics of each student who died by suicide were reported by teachers using the Strengths and Difficulties Questionnaire (SDQ). Density-Based Spatial Clustering of Applications with Noise (DBSCAN) analysis was used to assess the clustering of suicides. Results: We identified 23 clusters through the data analysis of 652 adolescent suicides using DBSCAN. By comparing the size of each cluster, we identified 63 (9.7%) spatiotemporally clustered suicides among adolescents, and the temporal range of these clusters was 7–59 days. The suicide cluster group had a lower economic status than the non-clustered group. There were no significant differences in other characteristics between the two groups. Conclusion: This study has defined the space–time cluster of suicides using a novel statistical method. Our findings suggest that when an adolescent suicide occurs, close monitoring and intervention for approximately 2 months are needed to prevent subsequent suicides. Future research using DBSCAN needs to involve a larger sample of adolescents from various countries to further corroborate these findings. [ABSTRACT FROM AUTHOR]

SAs were more likely to involve a physical (32.8% in SAs, 15.3% in SCs, p = 0.009) or mental illness (32.8% in SAs, 17.7% in SCs, p = 0.032) than SCs. SAs involved more self-injurious behaviors (28.1% in SAs, 3.2% in SCs, p <0.001) and prior attempts (33.3% in SAs, 6.8% in SCs, p < 0.001) than SCs. [Extracted from the article]

Background: In South Korea, the leading cause of youth death has been suicide for about 20 years. In this study, we conducted a multi-method psychological autopsy to identify the psychiatric diagnosis, developmental history, personality traits, family history, school life, warning signs of suicide, and risk factors related to suicide for the first time in Korea. Methods: This was a postmortem, retrospective, and descriptive study of 36 adolescents who died by suicide between August 2015 and July 2021 in South Korea. We obtained qualitative and quantitative data from the Korean Psychological Autopsy of Adolescent, conducted by the Suicide and School Mental Health Institute, the official student mental health policy-focused research institute of the Korean Ministry of Education. Results: The adolescents comprised equal percentage of girls and boys. Approximately half of the deaths (55.6%) occurred at home and most (72.2%) involved jumping from a height. Most of the adolescents (97.2%) had one major psychiatric disorder before death, with depressive disorder being the most prevalent (75%). They were at a high risk for internet addiction before death. The most common personality trait was avoidance (28.6%), followed by submissiveness (27.3%). Half of the parents reported that the adolescents were satisfied with their school life and the teachers observed that they had no behavioral problems. One year before death, seven (19.4%) adolescents injured themselves and five (13.9%) had attempted suicide. Most of the deceased (80.6%) had expressed suicide warning signs to their families within one year before death. Adolescents had a long experience of family-related adverse events. Conclusions: Most of the adolescents had mental health disorders and expressed suicidal intentions using verbal and nonverbal signs. However, it was challenging for families to recognize the risk signs because of adolescents' personality traits or a good school life. To prevent adolescent suicide, adolescents, parents, and teachers need to be educated to recognize signs of suicide warning signs and equipped to guide adolescents to appropriate care. [ABSTRACT FROM AUTHOR]

A teacher as a suicide prevention gatekeeper has an important role in identifying suicide risks and warning signs in students. After a student's suicide, teachers in Korea have to write a student suicide case report based on their direct and indirect observations. In particular, the section 'characteristic of student suicide' of this report contains valuable information about the suicide; however, it is unstructured, and thus cannot be analyzed using conventional statistical methods. We aimed to identify the characteristics of observed Korean students, who have committed suicide, using text mining techniques as well as to improve our understanding of suicidal behaviors in the school contexts. Therefore, a series of text mining techniques: topic analysis, word correlation, and word frequency analysis, in three problem categories: health, school, and family problems, were used to analyze the characteristics of student suicides. Topic analysis showed that only 30% of the student suicide case reports identified problematic student characteristics related to suicide. Correlations between words showed that words in one problem category were often correlated with words in other problem categories. Frequency word analysis showed that the three problem categories varied across gender and school levels. These results provide interesting insights into the characteristics of suicides among Korean students and important implications for suicide intervention in the education field. [ABSTRACT FROM AUTHOR]

An abstract of the article "Association of School Bullying and Psychotic Experiences in Korean Adolescents" by Jungeun Song and colleagues is presented.

Background: In South Korea, the leading cause of youth death has been suicide for about 20 years. In this study, we conducted a multi-method psychological autopsy to identify the psychiatric diagnosis, developmental history, personality traits, family history, school life, warning signs of suicide, and risk factors related to suicide for the first time in Korea. Methods: This was a postmortem, retrospective, and descriptive study of 36 adolescents who died by suicide between August 2015 and July 2021 in South Korea. We obtained qualitative and quantitative data from the Korean Psychological Autopsy of Adolescent, conducted by the Suicide and School Mental Health Institute, the official student mental health policy-focused research institute of the Korean Ministry of Education. Results: The adolescents comprised equal percentage of girls and boys. Approximately half of the deaths (55.6%) occurred at home and most (72.2%) involved jumping from a height. Most of the adolescents (97.2%) had one major psychiatric disorder before death, with depressive disorder being the most prevalent (75%). They were at a high risk for internet addiction before death. The most common personality trait was avoidance (28.6%), followed by submissiveness (27.3%). Half of the parents reported that the adolescents were satisfied with their school life and the teachers observed that they had no behavioral problems. One year before death, seven (19.4%) adolescents injured themselves and five (13.9%) had attempted suicide. Most of the deceased (80.6%) had expressed suicide warning signs to their families within one year before death. Adolescents had a long experience of family-related adverse events. Conclusions: Most of the adolescents had mental health disorders and expressed suicidal intentions using verbal and nonverbal signs. However, it was challenging for families to recognize the risk signs because of adolescents' personality traits or a good school life. To prevent adolescent suicide, adolescents, parents, and teachers need to be educated to recognize signs of suicide warning signs and equipped to guide adolescents to appropriate care. [ABSTRACT FROM AUTHOR]

In the last few decades, changing socioeconomic and family structures have increasingly left children alone without adult supervision. Carefully prepared and limited periods of unsupervised time are not harmful for children. However, long unsupervised periods have harmful effects, particularly for those children at high risk for inattention and problem behaviors. In this study, we examined the influence of unsupervised time on behavior problems by studying a sample of elementary school children at high risk for inattention and problem behaviors. The study analyzed data from the Children's Mental Health Promotion Project, which was conducted in collaboration with education, government, and mental health professionals. The child behavior checklist (CBCL) was administered to assess problem behaviors among first- and fourth-grade children. Multivariate logistic regression analysis was used to evaluate the influence of unsupervised time on children's behavior. A total of 3,270 elementary school children (1,340 first-graders and 1,930 fourth-graders) were available for this study; 1,876 of the 3,270 children (57.4%) reportedly spent a significant amount of time unsupervised during the day. Unsupervised time that exceeded more than 2h per day increased the risk of delinquency, aggressive behaviors, and somatic complaints, as well as externalizing and internalizing problems. Carefully planned afterschool programming and care should be provided to children at high risk for inattention and problem behaviors. Also, a more comprehensive approach is needed to identify the possible mechanisms by which unsupervised time aggravates behavior problems in children predisposed for these behaviors. [Copyright &y& Elsevier]

Tourette syndrome (TS) is a neuropsychiatric disorder with involvement of genetic and environmental factors. We investigated genetic loci previously implicated in Tourette syndrome and associated disorders in interaction with pre- and perinatal adversity in relation to tic severity using a case-only (N = 518) design. We assessed 98 single-nucleotide polymorphisms (SNPs) selected from (I) top SNPs from genome-wide association studies (GWASs) of TS; (II) top SNPs from GWASs of obsessive–compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD); (III) SNPs previously implicated in candidate-gene studies of TS; (IV) SNPs previously implicated in OCD or ASD; and (V) tagging SNPs in neurotransmitter-related candidate genes. Linear regression models were used to examine the main effects of the SNPs on tic severity, and the interaction effect of these SNPs with a cumulative pre- and perinatal adversity score. Replication was sought for SNPs that met the threshold of significance (after correcting for multiple testing) in a replication sample (N = 678). One SNP (rs7123010), previously implicated in a TS meta-analysis, was significantly related to higher tic severity. We found a gene–environment interaction for rs6539267, another top TS GWAS SNP. These findings were not independently replicated. Our study highlights the future potential of TS GWAS top hits in gene–environment studies. [ABSTRACT FROM AUTHOR]

Objective: This study intended to classify subtypes of Korean adolescents with suicidal ideation based on mental health problems and to explore the relationship between such subtypes and individual-, school- and community-level factors. Method: Data from high school freshmen who participated in the 2013 school-based mental health screening test and data about school and community variables obtained from public sources were combined and analyzed. A multilevel latent profile analysis using mental health issues as class indicators that included several predictors was conducted. Results: Three latent profiles were identified: Group 1 (6.5%) had high scores for both the internalizing and externalizing problems; Group 2 (40.2%) had high scores for internalizing problems, such as depression and mood related symptoms; and Group 3 (53.3%) had lower scores for all mental health problems compared to Groups 1 and 2. Gender, peer conflict, family conflict and academic problems were significant predictors at the individual level; school dropout rate was a significant school-level variable; and percent of youth in the total population, availability of mental health services, number of social welfare facilities and percentage of the total budget devoted to education/welfare were significant community-level variables. Conclusion: The present findings suggest that adolescents with suicidal ideation can be classified into several distinct subtypes based on mental health problems. These profiles and their associated covariates will aid in the establishment of youth suicide prevention policies. [ABSTRACT FROM AUTHOR]

Genetic studies in Tourette syndrome (TS) are characterized by scattered and poorly replicated findings. We aimed to replicate findings from candidate gene and genome-wide association studies (GWAS). Our cohort included 465 probands with chronic tic disorder (93% TS) and both parents from 412 families (some probands were siblings). We assessed 75 single nucleotide polymorphisms (SNPs) in 465 parent-child trios; 117 additional SNPs in 211 trios; and 4 additional SNPs in 254 trios. We performed SNP and gene-based transmission disequilibrium tests and compared nominally significant SNP results with those from a large independent case-control cohort. After quality control 71 SNPs were available in 371 trios; 112 SNPs in 179 trios; and 3 SNPs in 192 trios. 17 were candidate SNPs implicated in TS and 2 were implicated in obsessive-compulsive disorder (OCD) or autism spectrum disorder (ASD); 142 were tagging SNPs from eight monoamine neurotransmitter-related genes (including dopamine and serotonin); 10 were top SNPs from TS GWAS; and 13 top SNPs from attention-deficit/hyperactivity disorder, OCD, or ASD GWAS. None of the SNPs or genes reached significance after adjustment for multiple testing. We observed nominal significance for the candidate SNPs rs3744161 (TBCD) and rs4565946 (TPH2) and for five tagging SNPs; none of these showed significance in the independent cohort. Also, SLC1A1 in our gene-based analysis and two TS GWAS SNPs showed nominal significance, rs11603305 (intergenic) and rs621942 (PICALM). We found no convincing support for previously implicated genetic polymorphisms. Targeted re-sequencing should fully appreciate the relevance of candidate genes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Pre- and perinatal complications have been implicated in the onset and clinical expression of Tourette syndrome albeit with considerable inconsistencies across studies. Also, little is known about their role in co-occurring obsessive-compulsive disorder (OCD) and attention–deficit/hyperactivity disorder (ADHD) in individuals with a tic disorder. Therefore, we aimed to investigate the role of pre- and perinatal complications in relation to the presence and symptom severity of chronic tic disorder and co-occurring OCD and ADHD using data of 1113 participants from the Tourette International Collaborative Genetics study. This study included 586 participants with a chronic tic disorder and 527 unaffected family controls. We controlled for age and sex differences by creating propensity score matched subsamples for both case-control and within-case analyses. We found that premature birth (OR = 1.72) and morning sickness requiring medical attention (OR = 2.57) were associated with the presence of a chronic tic disorder. Also, the total number of pre- and perinatal complications was higher in those with a tic disorder (OR = 1.07). Furthermore, neonatal complications were related to the presence (OR = 1.46) and severity ( b = 2.27) of co-occurring OCD and also to ADHD severity ( b = 1.09). Delivery complications were only related to co-occurring OCD (OR = 1.49). We conclude that early exposure to adverse situations during pregnancy is related to the presence of chronic tic disorders. Exposure at a later stage, at birth or during the first weeks of life, appears to be associated with co-occurring OCD and ADHD. [ABSTRACT FROM AUTHOR]

An abstract of the article "Latent Aggression Subgroups Associated With Psychopathologic Behavior and Bullying/Victimization Experience in Elementary and Middle School Students" by Kyungun Jhung and colleagues is presented.

Objective: This study had two main goals: to examine the structure of co-occurring peer bullying experiences among adolescents in South Korea from the perspective of victims and to determine the effects of bullying on suicidal behavior, including suicidal ideation and suicide attempts, among adolescents. Method: This study used data gathered from 4,410 treatment-seeking adolescents at their initial visits to 31 local mental health centers in Gyeonggi Province, South Korea. The structure of peer bullying was examined using latent class analysis (LCA) to classify participants’ relevant experiences. Then, a binomial logistic regression adjusted by propensity scores was conducted to identify relationships between experiences of being bullied and suicidal behaviors. Results: The LCA of experiences with bullying revealed two distinct classes of bullying: physical and non-physical. Adolescents who experienced physical bullying were 3.05 times more likely to attempt suicide than those who were not bullied. Victims of (non-physical) cyber bullying were 2.94 times more likely to attempt suicide than were those who were not bullied. Conclusions: Both physical and non-physical bullying were associated with suicide attempts, with similar effect sizes. Schools and mental health professionals should be more attentive than they currently are to non-physical bullying. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the relationship between the five common polymorphisms (rs2242446, rs5568, rs5569, rs998424, and rs1616905) in the norepinephrine transporter (NET) gene and the OROS-methylphenidate response in a medication-naïve Korean attention-deficit hyperactivity disorder (ADHD) sample. One hundred thirty-seven patients with ADHD were recruited from the child and adolescent psychiatric outpatient units. The trial was an eight-week, open-label study of OROS-methylphenidate monotherapy, and treatment outcomes were measured using the Korean version of the ADHD Rating Scales-IV (K-ARS) for the parents, the Clinician Global Impression Severity Scale (CGI-S) and the Clinician Global Impression Improvement Scale (CGI-I). Associations between the five NET polymorphisms and the drug response were analyzed using genotype and allele frequencies at each locus. There was no significant difference in genotype and allele distribution for each NET polymorphism between responders and non-responders (P >0.05). There were no significant differences in change of the K-ARS score, change of CGI-S scores or CGI-I scores at 8weeks among each genotype and allele of five NET polymorphisms (P >0.05). Although there were no significant positive results, our findings may have several implications and offer direction for future studies. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]

Background: We investigated the characteristics of adolescents who committed suicide in South Korea, and how these characteristics differed by gender. Method: Data from middle and high school students who committed suicide between 2014 and 2016 were analyzed. We evaluated differences in suicide method and place, personal characteristics, and school life characteristics by gender using the Chi square test and t test. Results: Jumping from a high place was the most common suicide method for both male and female students. A significantly greater proportion of female adolescents had experienced depressive symptoms, previous self-injury, previous suicide attempts, and had problems with school attendance and peers. Additionally, they were more likely to be classified as high risk according to a school-based mental health screening test and to utilize professional mental health treatment services. Conclusion: Our results demonstrate that adolescents who committed suicide exhibited gender differences in personal characteristics and school life. These characteristics might aid in the development of adolescent suicide policies and intervention programs. [ABSTRACT FROM AUTHOR]

An abstract of the article "Behavior Assessment System for Children-2, Parent Rating Scale-Chidren As a Potential Screener for Autism Spectrum Disorder in Korean Children" by Jungeun Song and colleagues is presented.