Reliable and valid diagnostic screening tools in the primary care setting enable accurate estimation of depression in individuals at risk or in need of treatment, and provide patients with an opportunity to receive optimal treatments. Although there have been extensive studies on screening tools for depression used in domestic mental health settings, there is little consideration and lack of a thorough review of the diagnostic validity of screening tools. In the current review, we selected 13 representative screening tools for depression which were evaluated in a total of 19 validation studies conducted in Korea. We summarized DSM-5 target domains, diagnostic indices, sensitivity, specificity, cut-off scores, and diagnostic validity information for each tool. Finally, the depression measurement expert group was constituted to evaluate the current status of screening tools for depression, and their recommendations for a new screening tool were summarized. This study was conducted as part of the Mental Health Technology Development project to develop the Korean screening tool for depression (K-DEP).

Non-suicidal self-injury (NSSI) has been noted as a significant risk factor for possible suicide attempts. According to the Interpersonal Psychological Theory of Suicide, individuals can attempt suicide after they have acquired the capability to commit it. The acquired capability for suicide can be defined as one's habituated level to the pain and fear associated with suicidal behaviors. This is obtained through constant exposure to painful and provocative events, NSSIs being a prime example. This article reviews prior related studies to determine the extent to which the acquired capability for suicide can be utilized as a predictive factor for fatal suicide attempts following NSSIs. Our review finds a total of 11 studies that directly or indirectly support the claim that the acquired capability for suicide should be considered as a relevant factor linking NSSIs and suicide attempts. Given that NSSIs are most frequently observed in clinical settings, our findings suggest that the acquired capability for suicide will be a useful indicator for clinicians to predict the risk of future suicide attempts by patients.

우울증은 높은 유병률을 가지며 심각하고 만성화 될 수 있는 질병이다. 환자가 증상 없이 기능적 회복이 되어 일상을 영위하기 위해 임상가는 단독요법 이상의 치료 전략이 필요하다. 본 연구에서 SSRI와 aripiprazole 또는 bupropion 부가 요법은 우울증의 증상 호전을 보였다. SSRI와 aripiprazole 부가 요법은 우울증의 전반적 점수의 호전뿐 아니라 세부척도의 핵심 증상에서 bupropion 병합 요법에 비해 더 의미 있는 변화를 보였다. 또한 두 약제 모두 핵심 우울증상이라 할 수 있는 개별증상(우울한 기분, 일과 활동, 정신적 불안)에서 가장 큰 변화를 보였다

Objective : A variety of approaches are needed to solve high suicide rates in Korean society. Although suicide prevention education has been provided for the public and suicide risk groups in Korea, a systematic discussion of simple, effective suicide prevention guidelines for the general public has yet to be made. Self-help guidelines for suicide prevention, which can help prevent suicide in at risk individuals, will be developed through expert questionnaires. Methods : In order to develop the draft guidelines, suicide prevention self-help phrases were gathered and compiled from homepages and publicity materials of domestic and international suicide prevention and related organizations. A panel of 16 suicide prevention experts conducted primary and secondary surveys using the Delphi method, which derives results from consensus among expert groups. The validity and appropriateness of the guidelines was analyzed using content validity ratios (CVR). Results : Of 33 candidate phrases selected for the suicide prevention guidelines, 9 showed high CVR after the secondary Delphi round. The highest level of support with total agreement was given to 'Do not be alone, stay with someone'. However, more than half of the panelists evaluated 14/27 of the primary Delphi round and 12/26 of the secondary Delphi round phrases as invalid. The researchers completed 10 self-help guidelines for suicide prevention, after eliminating 1 redundant phrase and including 2 additional phrases that showed relatively high CVR. Conclusion : We have developed 10 self-help guidelines for suicide prevention through the consensus of experts. Further studies on the effects of the guidleines relative to suicide rates are needed after widespread dissemination.

Objective : This study evaluated the factor structure of a Korean version of the Penn State Worry Questionnaire (K-PSWQ) with exploratory factor analysis in healthy adult subjects, and confirmatory factor analysis of subjects who have received psychiatric treatment. Methods : Exploratory principal component analysis was conducted with data from 318 non-psychiatric subjects, and 118 psychiatric patients were subjected to confirmatory factor analysis (maximum likelihood estimation). Participants were voluntary visitors at the booth who agreed to undergo screening for anxiety disorder at 2013 & 2014 Korea Mental Health Exhibitions. Results : Exploratory analysis revealed a two factor structure of the scale with total variance of 56.3%. Factor 1 was considered 'Worry engagement', and factor 2 was considered 'Absence of worry'. However, the results of the confirmatory factor analysis supported that both one factor model with method factor and two factor model are fit to structure of the scale considering fit indices. Internal consistency of total questions was good (Cronbach's ${\alpha}=0.899$). Conclusion : Our results supported the previously suggested factor structure of the PSWQ, and proved factorial validity of the K-PSWQ in both populations.

Objective : This study aimed to evaluate the association of exhaustion, ADHD, self-esteem, impulsivity, suicidal tendencies and quality of life as well as depression and anxiety in fire officers in Korea. Methods : This study was undertaken for the first time in Korea, from September 2016 to December 2016. A set of questionnaires was provided to a total of 113 fire officers and 284 other participants as a comparison group. All subjects were evaluated using the Beck's Depression Inventory, Beck's Anxiety Inventory, Malach Burnout Inventory, Korean Adult Attention Deficit Hyperactivity Disorder Scales, Rosenberg's Self-esteem Inventory, Baratt's Impulsivity Scale, Beck's Scale of Suicide Ideation, and Quality of Life Scale. Furthermore, the odds ratio of depression, anxiety, exhaustion, ADHD, self-esteem, impulsivity, suicidal tendency and quality of life were evaluated the fire officer group and control group were compared through logistic regression analysis. Result : The results of this study indicated that the fire officers were more likely to show depression, anxiety, exhaustion, ADHD, low self-esteem and higher impulsivity. Also, the association between the fire officer group and depression, ADHD and impulsivity was confirmed through logistic regression analysis. Conclusion : Timely and effective evaluation and treatment of impulsivity, as well as depression is required for fire officers.

Objective : The purpose of this study was to investigate strategies used to cope with stress and the cognitive characteristics of somatic symptom perception in patients with generalized anxiety disorder(GAD). Methods : A total of 55 patients meeting DSM-5 criteria for GAD and 55 normal controls were recruited for participation in this study. We evaluated subjects using The Way of Stress Coping Questionnaire (SCQ), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and the Generalized Anxiety Disorder for 7 Item (GAD-7). We analyzed data using an independent t-test and Pearson's correlation analysis. Results : In terms of SCQ, GAD patients presented significantly lower scores on seeking social support and higher scores on wishful thinking than normal controls. GAD patients had significantly greater amplification of physical sensation in SSAS and higher scores in physical, psychological interpretation subsets of SIQ than normal controls. GAD-7 scores were positively correlated with physical interpretation scores on SIQ. Conclusion : Results reveal that patients with GAD have insufficient coping strategies for stress, greater amplification of body sensations, and tendency towards a physical, psychological interpretation of somatic symptoms.

Objective : A pilot project entitled '50s mental health screening project' was conducted in Seoul. As a part of this project, we conducted surveys to obtain the opinions of psychiatrists regarding mental health screenings. Methods : A questionnaire was mailed to members registered with the Korean Neuropsychiatric Association, which enquired about the '50s mental health screening project'. Results: A majority (90.9%) of the subjects agreed on the purpose and implementation of the project. However, there were fewer individuals that actually showed the intent to participate (65.8%). The mean age of the group with the intention to participate was higher compared to the group with no intention to participate. The factors that negatively affected the intent to participate included prejudice and discrimination against psychiatry (3.795), low health insurance reimbursement (3.784), and inconvenience of reporting to public health centers (3.664). The most appropriate method that scored the highest for screening mental health was face-to-face consultation with a psychiatrist (3.889). Most of the participants agreed on the method of a self-reported survey along with an interview of psychiatrist (84.9%). Conclusion : Subjects were concerned about prejudice and discrimination against psychiatry, low health insurance reimbursement, and inconvenience of reporting to public health centers. These problems need to be supplemented. Face-to-face consultation with a psychiatrist may be considered an appropriate method for future mental health screening.

Objective : The experiences in close relationships questionnaire-revised (ECR-R) (Fraley, Waller & Brennan, 2000) is a valuable tool for measuring adult attachment, and its Korean version, the ECRR-K (Kim, 2004), is widely used in Korea. However, given its substantial length, this study was aimed to develop and validate a short version of the ECRR-K called the ECRR-K14. Methods : Two hundred and ninety-four medical students participated in this study in 2016. They completed the ECRR-K, the Perceived Stress Scale (PSS), the Rosenberg Self-Esteem Scale (RSES), and the UCLA Loneliness Scale (UCLA-LS). The study authors applied the Rasch rating scale to check each item's model fit and then performed confirmatory factor analyses (CFAs) to test the new scale's validity. Results : The authors selected seven items each for the anxiety and avoidance subscales, and the ECRR-K14 showed fair to good internal consistency (Cronbach's ${\alpha}=0.93$ and 0.92 for anxiety and avoidance, respectively). The anxiety subscale showed concurrent validity with the PSS and the RSES while the avoidance subscale showed concurrent validity with the UCLA-LS. The CFAs also demonstrated the validity of the model with a goodness-of-fit index of 0.916. Conclusion : The ECRR-K14 showed excellent reliability and validity and appears to be a promising instrument for measuring the two attachment dimensions in adults.

Objective : The PTSD Checklist (PCL) is a self-report screen for posttraumatic stress disorder (PTSD) that can be scored for both diagnostic assessment and symptom severity measurement. The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains a number of changes to the definition of PTSD, and the aim of this study was to assess the psychometric properties of the Korean version of the PCL for the DSM-5 (PCL-5-K). Methods : The participants were 204 Korean veterans of the Vietnam War who completed the PCL-5-K, the Mini Mental Status Examination (MMSE), PTSD module of Structured Clinical Interview for DSM-5, Research Version (SCID5-RV PTSD module), Korean version of Impact of Event Scale-Revised (IES-R-K) and Combat Exposure Scale (CES-K). Results : The PCL-5-K demonstrated good internal consistency (${\alpha}=0.972$) and test-retest reliability (r=0.96); the suggested cut-off score for PTSD diagnosis was ${\geq}37$ with 0.88 sensitivity and 0.96 specificity. The PCL-5-K scale correlated highly with the IES-R-K and CES-K. Factor analysis identified only one factor. Conclusion : Among elderly Korean veterans of the Vietnam War, the PCL-5-K demonstrated similar psychometric qualities to those of both the original PCL and subsequent versions. It is expected that the PCL-5-K will be a useful PTSD screening tool.

Objective : The Working Alliance Inventory-Short Revised (WAI-SR) has been reported as a reliable, valid and widely used tool for measuring therapeutic alliance. The aim of this study was to assess the reliability and validity of the Korean version of WAI-SR (WAI-SR-K). Methods : A sample of 196 outpatients completed the WAI-SR-K and the data were analyzed for internal consistency and factor structure. Additionally 51 outpatients re-filled WAI-SR-K after two weeks for the test-retest reliability. To test for the validity, questionnaires of treatment satisfaction, and scales including the Korean version of Drug attitude inventory-10 (K-DAI-10) and Hospital anxiety and depression scale (KHADS) were administered. Results : Internal consistency of WAI-SR-K was good (Cronbach's alpha=0.928) and an exploratory factor analysis revealed a two-factor structure. The WAI-SR-K showed a reasonable test-retest reliability (r= 0.810, p<0.01). The total score of WAI-SR-K was positively correlated with K-DAI-10 (r=0.276, p<0.01), and negatively correlated with scores of K-HADS-D (r=-0.217, p<0.01) and K-HADS-A (r=-0.159, p<0.05). Conclusion : The Korean version of Working Alliance Inventory-Short Revised proved to be a reliable and valid instrument for measuring therapeutic alliance in Korean patients with depressive symptoms.

Objective : This study aimed to evaluate the relationship between comorbid obsessive compulsive disorder (OCD) and quality of life in stable patients with schizophrenia. Methods : We interviewed 162 symptom-stable inpatients who have been on a constant dose of antipsychotics for at least 3 months prior and diagnosed as chronic schizophrenia. Subsequently, patients were classified according to the existence of OCD as evaluated using the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Further, all clinical and demographic data were collected and evaluated. To investigate potential interrelationships, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Korea-Positive and Negative Symptom Scale (K-PANSS), Korean Modification of the Scale to Measure Subjective Well-Being under Neuroleptic Treatment (KmSWN) and Korean Version Quality of Life Scale (K-QOLS) were performed. Independent t-test and Chi-square test were used to compare groups and regression analysis was done to assess the relationship between the Y-BOCS and quality of life. Results : Schizophrenia patients with OCD showed significantly earlier onset of schizophrenia, more severe psychiatric symptoms and lower quality of life, compared to those without comorbid OCD. OCD might be associated with lower quality of life in schizophrenia. Conclusion : Schizophrenia patients with OCD showed lower quality of life than those without OCD. In the treatment for schizophrenia, evaluation of OCD might be needed to improve their quality of life and social function.

Objective : We have explored the relationship between suicidal ideation and some very specific characteristics of the symptoms of depression and anxiety in Korean employees. Methods : During the period 2013 through 2014, 100,793 employees who visited the Health Screening Center were asked to complete questionnaires, including the Center for Epidemiologic Study-Depression scale (CSE-D), the Beck Anxiety Inventory (BAI) and the presence of suicidal ideation. We attempted to determine which specific subscale, of each the CES-D and BAI would be more closely related to suicidal ideation by different gender and age by logistic regression. Results : Depression has been found to be a more prevalent and predominant factor in suicidal ideation, when compared to the presence of the condition of anxiety. Of four subscales of CES-D, issues arising from interpersonal relationships were most often associated with suicidal ideation, regardless of the chronologic age or gender of the subject. In BAI, cognitive anxiety showed a more significant association with suicidal ideation than did somatic anxiety in our study participants, showing same pattern in different gender and age groups. Conclusions : Among subscales of CES-D and BAI, the interpersonal relationship in CES-D and cognitive anxiety in BAI showed a higher and more significant association with suicidal ideation in Korean employees.