Kyungun Jhung

Objective Depression in children and adolescents is a global concern associated with adverse psychological and developmental outcomes. The Center for Epidemiologic Studies Depression Scale for Children (CES-DC) measures depressive symptoms in this population; however, evidence regarding its applicability in Korea remains limited. This study validated the Korean version of the CES-DC and examined its factor structure and associations with other psychological measures.Methods A total of 370 children and adolescents participated; 358 with complete CES-DC data were included, and 301 submitted the CES-DC retest after 2–4 weeks. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and Pearson correlations. Concurrent validity was assessed using parent-reported Child Behavior Checklist for ages 6–18 (CBCL 6–18) and self-reported Youth Self-Report (YSR) and the Revised Children’s Manifest Anxiety Scale (RCMAS). Confirmatory factor analysis (CFA) evaluated model fit; exploratory factor analysis (EFA) explored variations in factor structure.Results The Korean CES-DC demonstrated high internal consistency (Cronbach’s α=0.89) and good test–retest reliability (r=0.70), with subscale-level test–retest correlations (0.55–0.66). Significant correlations with the RCMAS and YSR, and weaker correlations with the CBCL, supported concurrent validity. CFA supported the fit of the original four-factor model.Conclusion The Korean CES-DC is a reliable and valid measure for assessing depressive symptoms in children and adolescents. Further validation in broader age and clinical samples would strengthen generalizability.

Importance: Transcranial direct current stimulation (tDCS) is known to be promising for depression, but heterogeneity across studies highlights the need for strategies to optimize treatment effectiveness. Identifying distinct response patterns based on ecological momentary assessment (EMA) may enhance therapeutic outcomes and support the development of personalized and precision psychiatry. Objective: To identify distinct EMA-derived response profiles to tDCS in patients with depression and examine how the identified subtypes differentially predict treatment responses and symptom return following treatment termination. Design: A secondary analysis of a double-blind, multicenter randomized clinical trial investigating the effects of tDCS on depression. Daily EMA data on mood and sleep duration during the intervention period were processed using time-series feature extraction and clustered via Gaussian Mixture Modeling. Participants: One hundred and ninety-seven participants (original study) and 147 participants (current study) diagnosed with mild-to-moderate depression. Interventions or Exposures: Six-week active tDCS vs 3-week active and 3-week sham tDCS. Main Outcomes and Measures: Beck Depression Inventory-II (BDI-II) and Montgomery–Åsberg Depression Rating Scale (MADRS) measured at baseline (V1), post-treatment (V3), and 6-week follow-up (V4). Results: Clustering analysis identified 3 response types: (1) stable improvement (gradual mood reduction, stable sleep duration, moderate treatment effect with no symptom return), (2) persistent high-symptom (consistently elevated depressive mood, sleep disturbance, low-to-moderate treatment effect without symptom return), and (3) volatile symptom (large day-to-day variability in mood and sleep, marked acute improvement but high symptom return). The linear mixed model identified significant interaction effects between clusters and treatment efficacy (V1, V3)/symptom return (V3, V4) intervals. Conclusions and Relevance: Clustering of daily EMA data identified 3 distinct tDCS response profiles associated with different clinical characteristics and relapse risks. These patterns may reflect underlying subtypes of depression and highlight the value of individualized treatment planning. Future studies can fully characterize the subtypes of response profiles and the unique response patterns of individuals that may facilitate data-driven decision-making and support precision psychiatry by enabling tailored tDCS protocols based on patient-specific response characteristics.

Background: Pregnancy is a vulnerable period for women, with an increased risk of mental health issues such as depression and anxiety. The perinatal period is particularly important, as maternal mental health significantly impacts maternal physical health, pregnancy outcomes, postnatal outcomes, and fetal and infant development. Psychotherapeutic interventions for depression are essential, especially given the limitations of medication use during pregnancy. However, perinatal women experiencing depression often encounter barriers to accessing these interventions. Digital health interventions may offer a promising approach to overcome these barriers. Objective: This study aimed to (1) evaluate the effectiveness of Avecmom, a self-help, mindfulness-based mobile intervention, in reducing depression severity among pregnant women with mild to moderate depression; (2) examine its impact on emotional well-being and maternal-fetal attachment; and (3) explore whether the effect on mental well-being is mediated by increased mindfulness and reduced depression severity. Methods: Participants were recruited both online and offline. Of 158 screened individuals, 90 met the inclusion criteria and were randomly assigned to either the intervention or control group. The intervention group used both the Avecmom and Big 4+ apps, while the control group used only the Big 4+ app. Depressive symptoms, anxiety, and stress were assessed as primary outcomes at baseline and postintervention. Mindfulness, mental well-being, positive and negative emotions, and maternal-fetal attachment were assessed as secondary outcomes. Analysis of covariance (ANCOVA) was conducted with postintervention scores as the dependent variable, adjusting for baseline scores. To estimate the mechanism of change following Avecmom mobile app use, the bootstrapping technique with PROCESS Macro Model 6 was employed, applying the difference score from postintervention to baseline. Results: A total of 86 pregnant women (intervention group: n=42; control group: n=42) completed the study and were included in the final analysis, reflecting an overall dropout rate of 4% (4/90). At postintervention, the intervention group demonstrated lower depression severity scores (F_1,84=5.69; P=.02; partial ƞ²=0.06) and higher scores of mindfulness (F_1,84=11.18; P=.001; partial ƞ²=0.12), maternal-fetal attachment (F_1,84=5.54; P=.02; partial ƞ²=0.06), mental well-being (F_1,84=8.79; P=.004; partial ƞ²=0.10), and positive affect (F_1,84=7.21; P=.009; partial ƞ²=0.08) compared to the control group. Serial mediation analysis revealed that Avecmom app use influenced mental well-being through sequential improvements in mindfulness and decreases in depression severity (standardized β=.33; Boot SE=0.12, 95% CI 0.12-0.58). Conclusions: Mindfulness-based mobile app interventions tailored for pregnant women may be more effective than self-monitoring alone in improving perinatal depression. These findings suggest that mindfulness-based mobile app interventions may help improve mental well-being in pregnant women, potentially by enhancing mindfulness and reducing depression severity.

BACKGROUND Pregnancy is a vulnerable period for women, exposing them to various mental health issues such as depression and anxiety. The perinatal period is particularly crucial because the mother's mental health significantly affects the mother’s physical health, pregnancy outcomes, fetal development, postnatal outcomes, and infant development. Psychotherapeutic approaches for depression are vital because medication use is limited during pregnancy. However, perinatal women with depression often face barriers in accessing psychotherapeutic interventions. Digital health may offer a solution for overcoming these barriers. OBJECTIVE In this study, we evaluated the effectiveness of Avecmom, a self-guided mindfulness-based mobile intervention, in reducing depression among pregnant women. We also evaluated the impact of the mobile app on positive/negative emotions, mental well-being, and maternal-fetal attachment. METHODS Participants were recruited online and offline. After screening, 90 out of 158 participants met the study criteria and were randomly assigned to either the intervention or the control group. The intervention group used both apps, whereas the control group used only the Big 4+ app. Depressive symptoms, anxiety, and stress were evaluated as the primary outcomes at baseline and posttest. Mindfulness, mental well-being, positive/negative emotions, and maternal-fetal attachment were also assessed as secondary outcomes. Analysis of covariance (ANCOVA) was performed with post-test scores as the dependent variable, adjusting for baseline scores. The bootstrapping technique from PROCESS Model 6 was applied to estimate the mechanism of change after using the Avecmom mobile app. RESULTS A total of 86 pregnant women were included in the intervention group (n=42; age: mean 34.10, SD 3.04) and the control group (n=44, age: mean 33.80, SD 3.42). The overall dropout rate was 4% (4/90). The intervention group showed lower depression scores, mindfulness, maternal-fetal attachment, mental well-being, and positive affect compared to the control group. Serial mediation analysis indicated that use of the Avecmom app influenced mental well-being through sequential improvements in mindfulness and decreases in depressive symptoms (standardized β=.33, BootSE=0.12, 95% BootCI[0.12; 0.58]). CONCLUSIONS Mindfulness-based mobile interventions designed for pregnant women may be more effective than self-monitoring alone in improving perinatal depression. Enhanced mindfulness through the use of a mobile app seems to lead to a decrease in depressive symptoms and, consequently, improved mental well-being. CLINICALTRIAL KCT0008887.

Heeyeon Kim, Kyungun Jhung, Dukyong Yoon, Jihoon Seo, Hee Young Cho, Jin Young Park. Clin Psychopharmacol Neurosci 2025;23:368-78. https://doi.org/10.9758/cpn.24.1256

Background: Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. Objective: This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. Methods: Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. Results: A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. Conclusions: A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. Trial Registration: Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r

BACKGROUND Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. OBJECTIVE This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. METHODS Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. RESULTS A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. CONCLUSIONS A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. CLINICALTRIAL Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r

Theta phase-gamma amplitude coupling (TGC) plays an important role in several different cognitive processes. Although spontaneous brain activity at the resting state is crucial in preparing for cognitive performance, the functional role of resting-state TGC remains unclear. To investigate the role of resting-state TGC, electroencephalogram recordings were obtained for 56 healthy volunteers while they were in the resting state, with their eyes closed, and then when they were engaged in a retention interval period in the visual memory task. The TGCs of the two different conditions were calculated and compared. The results indicated that the modulation index of TGC during the retention interval of the visual working memory (VWM) task was not higher than that during the resting state; however, the topographical distribution of TGC during the resting state was negatively correlated with TGC during VWM task at the local level. The topographical distribution of TGC during the resting state was negatively correlated with TGC coordinates’ engagement of brain areas in local and large-scale networks and during task performance at the local level. These findings support the view that TGC reflects information-processing and signal interaction across distant brain areas. These results demonstrate that TGC could explain the efficiency of competing brain networks.

Objective This study aimed to examine personality profiles and behavioral problems of children with nail biting (NB) to gain insight into the developmental trajectory of pathological NB. Methods 681 elementary school students were divided into non NB (n=436), occasional NB (n=173) and frequent NB group (n=72) depending on the frequency of NB reported in Child Behavioral Checklist (CBCL). Children's personality was assessed using the Junior Temperament and Character Inventory (JTCI), and behavioral problems were assessed using the CBCL. Latent Profile Analysis (LPA) was performed using JTCI profiles to classify personalities of the children with NB (belonging to frequent and occasional NB group, n=245). Results For subscale scores of CBCL, the total, internalizing, externalizing, anxious/depressed withdrawn/depressed, depression, thought, rule -breaking, and aggressive behavior problems, were most severe in the frequent NB group followed by occasional NB and non NB group. LPA of personality profile in children with NB revealed four classes ("adaptiveness," "high reward dependence," "low self-directedness," and "maldaptiveness"). The four personality classes demonstrated significant group differences in all of the CBCL subscales. Children who showed low self-directedness and cooperativeness and high novelty seeking and harm avoidance personality profiles demonstrated high- est tendency for problematic behavior irrespective of the frequency of NB. Conclusion Children with NB reported significantly more problematic behaviors compared to children without NB. Children with spe- cific personality profile demonstrated higher tendency for problematic behavior irrespective of the frequency of NB. Therefore, accom- panying personality profiles should be considered when assessing behavioral problems in children with NB.