Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Network Structure of Depressive Symptoms in General Population

일반 인구 집단의 우울증상 네트워크 구조

  • Seon il, Park (Department of Psychiatry, Dankook University Hospital) ;
  • Kyung Kyu, Lee (Department of Psychiatry, Dankook University Hospital) ;
  • Seok Bum, Lee (Department of Psychiatry, Dankook University Hospital) ;
  • Jung Jae, Lee (Department of Psychiatry, Dankook University Hospital) ;
  • Kyoung Min, Kim (Department of Psychiatry, Dankook University Hospital) ;
  • Hyu Seok, Jeong (Department of Psychiatry, Dankook University Hospital) ;
  • Dohyun, Kim (Department of Psychiatry, Dankook University Hospital)
  • 박선일 (단국대학교병원 정신건강의학과) ;
  • 이경규 (단국대학교병원 정신건강의학과) ;
  • 이석범 (단국대학교병원 정신건강의학과) ;
  • 이정재 (단국대학교병원 정신건강의학과) ;
  • 김경민 (단국대학교병원 정신건강의학과) ;
  • 정효석 (단국대학교병원 정신건강의학과) ;
  • 김도현 (단국대학교병원 정신건강의학과)
  • Received : 2022.08.27
  • Accepted : 2022.10.31
  • Published : 2022.12.31
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Abstract

Objectives : Although subclinical depression symptoms are associated with suicidal idea, most research have focused on clinical depression such as major depressive disorder or dysthymia. The aim of this study is to investigate network structure of depressive symptom and to reveal which symptoms are associated with suicidal ideation. Methods : We used part of data from the seventh Korea National Health and Nutrition Examination Survey. Participants were between 19 and 65 years of age (N=8,741). Network analysis with Isingfit model is used to reveal network structure of depressive symptoms and most central symptom and edges assessed by patient health questionnaire (PHQ-9). Results : The most two central symptoms were psychomotor activity and suicidal ideation. The strongest edge was psychomotor activity-suicidal ideation. Suicidal ideation also has strong association with depressive mood and worthlessness. Conclusions : These results suggest that psychomotor activity and suicidal ideation can serve as treatment target for subclinical depression and psychomotor activity, worthlessness and depressed mood may be important factor for early intervention of suicidal ideation.

연구목적 임상전단계의 우울증상도 삶의 질이나 자살사고와의 연관성이 높고, 자살률이 높은 우리나라의 특성상 자살과 연관성이 높은 증상을 찾기 위해 본 연구에서는 일반인구 대상으로 한 우울증상의 네트워크 구조를 밝히고자 했다. 방 법 제 7기 국민건강 영양조사 데이터를 활용했고, 19세 이상 65세 미만의 우울증 선별도구(PHQ-9) 전문항을 완료한 8,741명을 대상으로 개별 증상에 대한 Ising fit 모델을 활용하여 증상 네트워크를 찾고, 중심강도성이 높은 노드와 가중치가 높은 엣지를 확인하였다. 결 과 정신운동성 변화, 자살사고가 가장 높은 중심강도성을 보였으며 두 증상간의 연결이 가장 높은 엣지 가중치를 보였다. 자살사고는 무가치함이나 우울한 기분과도 높은 연결성을 보였다. 결 론 일반인구 집단에서도 자살사고와 관련된 증상은 우울증상 중 정신운동성 변화, 무가치함, 우울한 기분 등이 높은 연결성을 보였고, 이러한 증상들은 추후 인지행동치료 등 치료 단계에서 주요한 치료 목표가 될 수 있음을 시사한다.

Keywords

References

  1. Konig H, Konig HH, Konnopka A. The excess costs of depression: a systematic review and meta-analysis. Epidemiology and Psychiatric Sciences 2020;29. 
  2. Gutierrez-Rojas L, Porras-Segovia A, Dunne H, Andrade-Gonzalez N, Cervilla JA. Prevalence and correlates of major depressive disorder: a systematic review. Brazilian Journal of Psychiatry 2020;42:657-672.  https://doi.org/10.1590/1516-4446-2020-0650
  3. Ohayon MM, Hong SC. Prevalence of major depressive disorder in the general population of South Korea. Journal of Psychiatric Research 2006;40:30-36.  https://doi.org/10.1016/j.jpsychires.2005.02.003
  4. OECD. Tackling the mental health impact of the COVID-19 crisis: an integrated, whole-of-society response;2021. 
  5. OECD. Health status OECD Health Statistics;2022. 
  6. Park JH, Kim KW. A review of the epidemiology of depression in Korea. Journal of the Korean Medical Association 2011;54:362-369.  https://doi.org/10.5124/jkma.2011.54.4.362
  7. Association AP. Diagnostic and statistical manual of mental disorders, 2013, Washington, DC: American Psychiatric Association. 
  8. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 2001;16:606-613.  https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  9. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. SLACK Incorporated Thorofare, NJ;2002. p.509-515. 
  10. Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ 2012;184:E191-E196.  https://doi.org/10.1503/cmaj.110829
  11. Choi HS, Choi JH, Park KH, Joo KJ, Ga H, Ko HJ, Kim SR. Standardization of the Korean version of patient health questionnaire-9 as a screening instrument for major depressive disorder. Journal of the Korean Academy of Family Medicine 2007;28:114-119. 
  12. Inoue T, Tanaka T, Nakagawa S, Nakato Y, Kameyama R, Boku S, Toda H, Kurita T, Koyama T. Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care. BMC Psychiatry 2012;12:1-6.  https://doi.org/10.1186/1471-244x-12-1
  13. The Republic of Korea: Ministry of Health and Welfare. 「National Mental Health Survey 2021」; Available from: https://www.korea.kr/news/pressReleaseView.do?newsId=156488517. 
  14. Cuijpers P, Smit F. Subclinical depression: a clinically relevant condition? Tijdschrift Voor Psychiatrie 2008;50:519-528. 
  15. Horwath E, Johnson J, Klerman GL, Weissman MM. What are the public health implications of subclinical depressive symptoms? Psychiatric Quarterly 1994;65:323-337.  https://doi.org/10.1007/BF02354307
  16. van Zoonen K, Kleiboer A, Beekman AT, Smit JH, Boerema AM, Cuijpers P. Reasons and determinants of help-seeking in people with a subclinical depression. Journal of Affective Disorders 2015;173:105-112.  https://doi.org/10.1016/j.jad.2014.10.062
  17. Bertha EA, Balazs J. Subthreshold depression in adolescence: a systematic review. European Child & Adolescent Psychiatry 2013;22:589-603.  https://doi.org/10.1007/s00787-013-0411-0
  18. Balazs J, Miklosi M, Kereszteny A, Hoven CW, Carli V, Wasserman C, Apter A, Bobes J, Brunner R, Cosman D. Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. Journal of Child Psychology and Psychiatry 2013;54:670-677.  https://doi.org/10.1111/jcpp.12016
  19. The Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). 2016-2018, Korea Disease Control and Prevention Agency. 
  20. Mullarkey MC, Marchetti I, Beevers CG. Using network analysis to identify central symptoms of adolescent depression. Journal of Clinical Child & Adolescent Psychology 2019;48:656-668.  https://doi.org/10.1080/15374416.2018.1437735
  21. Olgiati P, Serretti A, Colombo C. Retrospective analysis of psychomotor agitation, hypomanic symptoms, and suicidal ideation in unipolar depression. Depression and Anxiety 2006;23:389-397.  https://doi.org/10.1002/da.20191
  22. Bradvik L. Suicide after suicide attempt in severe depression: a long-term follow-up. Suicide and Life-Threatening Behavior 2003;33:381-388.  https://doi.org/10.1521/suli.33.4.381.25234
  23. Nrugham L, Larsson B, Sund AM. Specific depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence. Journal of Affective Disorders 2008;111:83-93.  https://doi.org/10.1016/j.jad.2008.02.010
  24. McGirr A, Renaud J, Seguin M, Alda M, Benkelfat C, Lesage A, Turecki G. An examination of DSM-IV depressive symptoms and risk for suicide completion in major depressive disorder: a psychological autopsy study. Journal of Affective Disorders 2007;97:203-209.  https://doi.org/10.1016/j.jad.2006.06.016
  25. Kim D, Kwon HJ, Ha M, Lim MH, Kim KM. Network analysis for the symptom of depression with children's depression inventory in a large sample of school-aged children. Journal of Affective Disorders 2021;281:256-263.  https://doi.org/10.1016/j.jad.2020.12.002
  26. Joo J, Hwang S, Gallo JJ. Death ideation and suicidal ideation in a community sample who do not meet criteria for major depression. Crisis: The Journal of Crisis Intervention and Suicide Prevention 2016;37:161. https://doi.org/10.1027/0227-5910/a000365