Eunkyung Kim

Objective Historical theological frameworks, particularly those rooted in Christianity, have conceptualized guilt as a defining component of melancholy. This study compared the network structures of depressive symptoms in guilt-rich and guilt-free presentations of depression using a large-scale cross-national Asian dataset.Methods We analyzed data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 (REAP-AD3), which included patients with depressive disorders from 11 Asian countries. Network analysis was used to estimate symptom interactions and identify the central symptoms in each group. Participants were dichotomized according to the presence or absence of prominent guilt symptoms, as determined by the “feeling bad about yourself” item of the Patient Health Questionnaire-9 (PHQ-9).Results The network structures of the two groups differed substantially. In the guilt-rich group, depressed mood was the central node that was closely linked to self-blame. By contrast, the guilt-free group exhibited centralized networks with a loss of energy.Conclusion Variations in symptom network structures can be partly explained as broadly consonant with early ideas of Richard Baxter and Robert Burton on melancholia. Clinically, symptoms related to moral judgment and self-criticism may indicate potentially different specific therapeutic attention from individuals with significant guilt. Conversely, for those without pronounced guilt, interventions targeting physical and motivational symptoms such as fatigue might inform hypothesis-driven treatment strategies.

Lee E, et al. J Korean Med Sci. 2026 May;41:e139. https://doi.org/10.3346/jkms.2026.41.e139

Kim D, et al. Yonsei Med J. 2026 ;67:e18. https://doi.org/10.3349/ymj.2025.0167

Kim D, et al. J Korean Med Sci. 2026 Mar;41:e98. https://doi.org/10.3346/jkms.2026.41.e98

Objective The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.Methods We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.Results Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).Conclusion This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.

Extensive research has established that interpersonal trauma is related to depression and dissociation severity. Extending prior research, this study found that childhood and adulthood interpersonal traumas are related to depressive symptoms and examined the role of dissociative process as a mediator. Two hundred eighty-nine adult participants retrospectively reported on traumatic experiences and current symptoms of dissociation and depression, indicating that both childhood and adulthood interpersonal traumas are related to the severity of depression. However, childhood interpersonal trauma was associated with a higher level of dissociative symptoms. Moreover, it was suggested that dissociation serves as a pathway through which childhood interpersonal trauma influences depression, although this relationship was not observed for adulthood interpersonal trauma. In conclusion, this study highlights the potential role of dissociation in the development and maintenance of depression, particularly among individuals who have experienced childhood interpersonal trauma. These findings suggest that interventions targeting dissociation show potential for mitigating retrospective depression, especially for survivors of childhood interpersonal trauma.

Objective This study aimed to investigate the validity and reliability of the Korean version of the Brief Irritability Test (BITe) and adapt it for Korean patients with psychiatric disorders.Methods A total of 296 patients at the Department of Psychiatry of Hanyang University Guri Hospital completed the BITe, Korean Beck Depression Inventory-II, Korean Beck Anxiety Inventory, the Korean version of the State-Trait Anger Expression Inventory, and Barratt Impulsiveness Scale-11. Construct validity was confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability testing included assessments of internal consistency (Cronbach’s α) and item-total correlations. Convergent validity was examined through correlational analyses with variables such as anxiety, depression, anger, and impulsivity.Results First, the scale had good internal consistency with a Cronbach’s α of 0.88. Second, EFA indicated a single dimensionality of the BITe, and CFA demonstrated a reasonable fit for the single-factor model (comparative fit index=0.97, Tucker-Lewis Index=0.95, normed fit index=0.97, goodness-of-fit index=0.96, root mean square error of approximation=0.12, standardized root mean residual=0.03). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and anger, except for anger control, which is a sub-variable of anger.Conclusion The results showed that the Korean version of the BITe had good psychometric properties, and might serve as a valuable tool for assessing irritability in Korean patients with psychiatric disorders.

김주영, et al. J Korean Neuropsychiatr Assoc. 2024 Aug;63(3):190-197. https://doi.org/10.4306/jknpa.2024.63.3.190