STRESS

Original Articles

Quality of Life and Its Influencing Factors among Older Adults with Diabetes Mellitus in Korea: Mee Young Im; STRESS. 2025;33(4):226-235. Published online December 31, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.4.226

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Abstract PDF: Background
This study aimed to assess the quality of life (QoL) of older adults with diabetes in Korea and to identify the factors influencing their QoL.
Methods
A total of 1,887 individuals aged ≥65 years with diabetes (weighted n=8,305,093) from the 7th–8th (2018–2020) Korea National Health and Nutrition Examination Surveys were analyzed. Considering the complex sampling design, descriptive statistical analyses, independent t-tests, analysis of variance, and multiple regression analyses were performed.
Results
The mean EQ‑5D index score was 0.87 (±0.01). Among the five EQ‑5D dimensions, self-care had the highest proportion of participants reporting “no problems” (86.6%), whereas mobility had the lowest proportion (57.5%). Significant factors associated with QoL included economic activity (B=0.02, p＜.001), chewing difficulty (B=−0.04, p＜.001), activity limitations (B=−0.10, p＜.001), and aerobic physical activity (B=0.04, p＜.001). In particular, all mental health variables—including perceived health status (B=−0.08, p＜.001), perceived stress (B=−0.03, p＜.021), and depression (B=−0.13, p＜.001)—showed significant associations with QoL. The final regression model explained 40.7% of the variance in QoL (Adj. R²=40.7, p＜.001).
Conclusions
The QoL of older adults with diabetes may be influenced not only by physical health, but also by psychological well-being. Therefore, integrated nursing interventions that promote physical activity, maintain oral health, and enhance mental health are essential for improving the QoL in this population.

Effects of Cognitive Load on Attentional Bias under Stress Induction: Won Hee Son, Yun-Kyeung Choi; STRESS. 2025;33(4):216-225. Published online December 31, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.4.216

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Abstract PDF: Background
This study investigated whether visuo-spatial cognitive load modulates threat-related attentional bias during an experimentally induced stress state. Specifically, we examined whether increasing task demand influences threat-related attentional bias, as well as orientation and disengagement components.
Methods
Seventy-two undergraduate participants were randomly assigned to either a stress-induction group or a control group. After viewing a road-traffic-accident video, participants completed a dot-probe task incorporating three levels of visuo-spatial task demand (no load, low load, high load). From this task, a standard Attentional Bias Index (sABI), an Orientation Index (OI), and a Disengagement Index (DI) were calculated.
Results
The main effect of group was significant for both sABI and OI, indicating that across all visuo-spatial load conditions, the stress-induction group demonstrated greater threat-related attentional bias and stronger orientation toward threat than the control group. In contrast, neither the main effect of visuo-spatial task demand nor the Group×Demand interaction reached significance for sABI or OI. For DI, there were no significant group differences, no main effect of visuo-spatial task demand, and no significant interaction, suggesting that disengagement from threat did not differ between groups and was not influenced by cognitive load.
Conclusions
Under stress induction, the stress-induction group consistently showed heightened threat-related attentional bias and increased orientation toward threat compared with the control group, regardless of visuo-spatial load level. These findings carry theoretical and clinical implications, underscoring the importance of distinguishing among attentional-bias components—particularly orientation—when conceptualizing and addressing stress-related attentional processes.

Borderline Personality Traits and Insomnia Severity: A Sequential Mediation Model of Maladaptive Cognitive Emotion Regulation Strategies and Pre-Sleep Arousal: Kyoung Hyun Park, Young Ho Lee; STRESS. 2025;33(4):209-215. Published online December 31, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.4.209

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Abstract PDF: Background
This study examined how borderline personality traits influence insomnia severity.
Methods
Self-report data from 230 adult women were included in the final analysis, to assess borderline personality traits, cognitive emotion regulation, pre-sleep arousal, insomnia severity. Sequential mediation analysis was conducted.
Results
The sequential mediation of maladaptive cognitive emotion regulation and pre-sleep arousal in the relationship between borderline personality traits and insomnia severity was supported.
Conclusions
Individuals with higher borderline personality traits use cognitive emotion regulation strategies that amplify negative emotions during everyday stressful situations, which, in turn, elevate pre-sleep arousal and contribute to greater insomnia severity. From a therapeutic perspective, interventions targeting maladaptive emotion regulation strategies used in response to daily stress, alongside techniques aimed at reducing pre-sleep arousal (e.g., relaxation training), may be particularly beneficial for alleviating insomnia symptoms in this population.

Association between Daily Stress, Sleep Duration, and Attention-Deficit or Hyperactivity Problems among Teenagers: Focusing on the Moderated Mediating Effect of Positive Family Relationships: RaeHyuck Lee; STRESS. 2025;33(4):201-208. Published online December 31, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.4.201

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Abstract PDF: Background
This study investigated the association between daily stress, sleep duration, and attention-deficit or hyperactivity problems (ADH) among teenagers and the moderated mediating effect of positive family relationships.
Methods
The data of a nationally representative sample of teenagers were analyzed using regression analyses.
Results
Daily stress was positively associated with ADH. Sleep duration partially mediated the association between daily stress and ADH. Positive family relationships moderated the mediating effect of sleep duration. Specifically, the mediating effect decreased with increasing levels of positive family relationships.
Conclusions
Based on its results, this study discusses ways to intervene in ADH among teenagers.

The Relationship between Rejection Sensitivity and Loneliness: Double Mediation Effects of Self-Acceptance and Self-Silencing: Ayeong Jeong, Boyoung Kim; STRESS. 2025;33(4):192-200. Published online December 31, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.4.192

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Abstract PDF: Background
This study aimed to provide an integrated explanation of the effects of rejection sensitivity on loneliness. Specifically, this study examined the individual and serial mediating roles of self-acceptance and self-silencing in the relationship between rejection sensitivity and loneliness.
Methods
A cross-sectional online survey was conducted with 310 male and female university students (ages 19-26 years) in South Korea. Participants completed measures assessing rejection sensitivity, self-acceptance, self-silencing, and loneliness. The collected data were analyzed using SPSS 22.0, and the PROCESS macro was used to test for direct and indirect effects.
Results
Rejection sensitivity had a significant direct effect on loneliness; it was negatively correlated with self-acceptance and positively correlated with self-silencing. Both self-acceptance and self-silencing served as partial mediators in the relationship between rejection sensitivity and loneliness. Critically, the serial mediation model was significant: rejection sensitivity predicted lower self-acceptance, which in turn predicted higher self-silencing, ultimately leading to increased loneliness.
Conclusions
The findings suggest that the influence of rejection sensitivity on loneliness is a complex process partially explained by the sequential roles of diminished self-acceptance and subsequent self-silencing. This study highlights the importance of targeting both self-acceptance and self-silencing in clinical and educational settings to develop effective strategies for reducing loneliness among young adults with high rejection sensitivity.

The Relationship between Maladaptive Self-Focused Attention and Disordered Eating: The Mediating Effect of Body Dissatisfaction and the Moderating Effect of Mindfulness: Dasom Ki, Sera Lee; STRESS. 2025;33(4):184-191. Published online December 31, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.4.184

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Abstract PDF: Background
Maladaptive self-focused attention is a known psychological risk factor for disordered eating. However, the mechanisms underlying this association, including the mediating role of body dissatisfaction and the moderating role of mindfulness, remain unclear.
Methods
A total of 528 Korean adults aged 19∼39 completed self-report questionnaires assessing maladaptive self-focused attention, body dissatisfaction, disordered eating, and mindfulness. Mediation and moderated mediation analyses were conducted using the PROCESS macro (Models 4 and 14), controlling for gender, age, BMI, marital status, and dieting status.
Results
Maladaptive self-focused attention indirectly influenced disordered eating through body dissatisfaction, whereas its direct effect was not statistically significant. Mindfulness moderated the association between body dissatisfaction and disordered eating, such that the relationship was weaker among individuals with higher mindfulness. Subscale analyses indicated that the “nonjudging” and “acting with awareness” facets attenuated this pathway, whereas the “observing” facet counterintuitively strengthened it.
Conclusions
Body dissatisfaction appears to be a central mechanism linking maladaptive self-focused attention to disordered eating. Mindfulness—particularly the facets of nonjudging and acting with awareness—may buffer this risk. These findings highlight the potential of mindfulness-based interventions to mitigate cognitive–affective pathways underlying disordered eating.

Review Article

Suicide Risk Factors among Military Personnel: A Meta-Analytic Approach: Eunsu Park, Jonghan Sea; STRESS. 2025;33(4):177-183. Published online December 31, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.4.177

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Abstract PDF: Background
Suicide among military personnel is a critical issue that threatens both individual well-being and organizational readiness. Despite a growing body of literature on military suicide in Korea findings remain inconsistent owing to differences in study design, participant characteristics, and measurement tools.
Methods
This meta-analysis examined risk factors for suicide among Korean military personnel. Twenty-nine theses and journal articles published between 2000 and 2025 that reported correlation coefficients (r) and met the inclusion criteria were analyzed. Sixty-two variables reported in at least three studies were extracted and categorized into 11 factors depression, trauma experience, military stress, interpersonal relationships, anxiety, general stress, job stress, impulsivity, drinking problems, age, and rank.
Results
Depression, trauma experience, and military stress showed medium- to- large effect sizes, whereas impulsivity and drinking problems demonstrated small but significant effects. High heterogeneity was observed, likely because of differences in military ranks, research designs, and measurement instruments. Publication bias analysis using the trim-and-fill method revealed no missing studies.
Conclusions
This meta-analysis integrated existing findings on suicide risk factors among Korean soldiers and identified the relative importance of key predictors. The results contribute to a better understanding of the psychological and organizational determinants of military suicide and provide practical implications for prevention strategies and future research.

Original Articles

Reliability and Validity of the Korean Version of the Suicide Rumination Scale (K-SRS): Woongsur Hur, Megan L. Rogers, Eun-Jung Shim; STRESS. 2025;33(3):163-175. Published online September 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.3.163

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Abstract PDF: Background
This study evaluated the psychometric properties of the Korean version of the Suicide Rumination Scale [K-SRS], which assesses fixations on suicidal thoughts, intentions, and plans.
Methods
Between July 2024 and March 2025, 124 adults (aged 18 years and older) with suicidal ideation completed an online self-report survey and a behavioral task.
Results
Factor analysis supported a two-factor structure—Intrusive Rumination about Suicide and Contemplation of Suicide Methods—demonstrating excellent internal consistency (α=.96 and .93, respectively). Convergent validity was supported by significant correlations with brooding, reflective pondering, depressive rumination, and intrusive rumination (rs=.19 to .57). Discriminant validity was indicated by non-significant correlations with deliberate rumination (rs=−.01 to .01). The K-SRS demonstrated concurrent validity via associations with suicidal risk, suicidal ideation intensity, depression, and anxiety (rs=.34 to .65), and incremental validity by predicting suicide risk beyond established factors. Higher K-SRS scores among individuals with clinical levels of depression and anxiety confirmed known-group validity. The K-SRS showed acceptable discriminatory ability for past suicide attempts (AUC=.77), with a cut-off score of 13.5 (sensitivity=0.68, specificity=0.75).
Conclusions
The K-SRS is a reliable and valid measure of suicide-specific rumination and risk assessment.

The Influence of School Maladjustment on Non-Suicidal Self-Injury among Adolescents: Focusing on the Moderated Mediating Effect of Anxiety According to Single-Parent Family Status: RaeHyuck Lee, Jaekyoung Lee; STRESS. 2025;33(3):155-162. Published online September 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.3.155

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Abstract PDF: Background
This study examines the influence of school maladjustment on non-suicidal self-injury among adolescents and the moderated mediating effect of anxiety according to single-parent family status.
Methods
Regression analyses were performed using raw data from a survey of teenagers’ mental health and the PROCESS Macro method.
Results
Adolescents’ school maladjustment had a positive effect on non-suicidal self-injury. In addition, the partial mediating effect of anxiety was confirmed. In other words, adolescents’ level of school maladjustment increased their level of anxiety, which in turn increased the likelihood of non-suicidal self-injurious behavior. Furthermore, the mediating effect of anxiety was moderated by single-parent family status. Specifically, the mediating effect of school maladjustment leading on non-suicidal self-injury through anxiety was more pronounced among adolescents from single-parent families than those from two-parent families.
Conclusions
Intervention plans to deal with school maladjustment and anxiety among adolescents are proposed based on these findings.

A Preliminary Study on the Development of a Stigma Scale for Suicide Survivors: Jieun Kwon; STRESS. 2025;33(3):146-154. Published online September 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.3.146

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Abstract PDF: Background
This preliminary study explored the stigma surrounding suicide loss in survivors in South Korea and develops a scale for measuring this stigma.
Methods
An open-ended survey (N=57; 18 men, 39 women) and a structured questionnaire (N=250; 94 males, 156 females) were administered to adults who had experienced bereavement due to the suicide of a close family member or partner (e.g., parent, child, spouse, or significant other). Preliminary items were generated based on open-ended responses. The items were then subjected to content validation and revision by a panel of experts, resulting in 70 preliminary items. The questionnaire was administered based on these items.
Results
The exploratory factor analysis yielded a stigma scale comprising four factors and 15 items. The four factors were labeled as follows: Vulnerable Individual, Responsibility for Suicide, Relational Discomfort, and Relational Distancing. The scale demonstrated acceptable internal consistency.
Conclusions
This study is relevant because it developed a culturally relevant scale to assess the stigma experienced by survivors of suicide loss in Korean society.

Review Articles

The Role Conflict of Nurses: A Concept Analysis: Jin-hui Han, Hee-joo Oh; STRESS. 2025;33(3):136-145. Published online September 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.3.136

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Abstract PDF: Background
This study aimed to understand the attributes and concepts of role conflict among nurses.
Methods
Using Walker & Avant’s (2014) concept analysis framework, a literature search was conducted in the PubMed, cumulative index to nursing and allied health literature (CINAHL), PsycINFO^®, regional information sharing systems (RISS), and DBpia databases using the search terms ‘Nurse’ or ‘Nursing’ and ‘Role conflict’ or ‘Role ambiguity’ or ‘Role strain.’ A total of 55 articles were included in this study.
Results
Role conflict among nurses was defined as conflicts occurring across various dimensions, including individual, interpersonal, role- and system-related. The antecedents of role conflict included excessive workload, job stress, and manpower shortages. The consequences of role conflict included lower quality of nursing care, emotional burnout, and increased turnover.
Conclusions
This concept analysis provides a clear definition of role conflict among nurses, enhances understanding of the concept, and provides foundational data for nursing practice and systems.

Occupational Stress, Coping, and Outcomes among Korean Nurses: An Integrative Review Based on the Transactional Model of Stress and Coping: Myungji Kim, Hyunkyung Choi; STRESS. 2025;33(3):127-135. Published online September 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.3.127

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Abstract PDF: Background
Korean nurses face high levels of occupational stress due to staff shortages and work overload. This stress varies depending on each individual’s cognitive appraisal and coping strategies and affects both the quality of nursing care and the well-being of the nurses themselves. Therefore, this study is intended to conduct a comprehensive investigation into the cognitive appraisal, coping strategies, and occupational stress outcomes of Korean nurses.
Methods
This integrative review study was based on Lazarus and Folkman’s transactional model of stress and coping. Literature published in Korean or English between March 1984 and July 2025 was reviewed using the RISS, KISS, DBpia, PubMed, and CINAHL databases.
Results
Fourteen studies (13 quantitative descriptive and 1 qualitative) were analyzed regarding occupational stress and coping strategies among nurses. Three key attributes were identified: a high level of occupational stress related to various factors, the use of active and passive coping strategies, and outcomes from coping with occupational stress. No study to date has specifically examined occupational stress appraisal.
Conclusions
It is important to develop strategies that help nurses actively cope with occupational stress, allowing for adaptive outcomes, rather than inefficient ones. These findings are expected to serve as foundational data for the development of occupational stress management programs. Future studies on nurses’ occupational stress will also need to include the concept of cognitive appraisal.

Big Data Analysis of Mental Health Trends from the COVID-19 Pandemic into the Endemic Phase: Seo Yeon Lee, Kuem Sun Han, Soo Yeon Lee, Ji Hye Shin, Moon Ju Song; STRESS. 2025;33(3):117-126. Published online September 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.3.117

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Abstract PDF: Background
This study aimed to examine temporal trends in mental health issues in South Korea from the onset of the coronavirus disease (COVID-19) pandemic through to the post-pandemic endemic phase. Using large-scale online data, this study sought to identify key mental health concerns at different stages and offer foundational evidence for future public health policy development.
Methods
A total of 13,797 textual data entries, —comprising 8,664 Naver blog posts and 5,133 news articles, —were collected between January 20, 2020, and April 17, 2024. The data were segmented into five distinct periods based on critical milestones in South Korea’s pandemic response. Text mining and network analysis were employed to extract and examine the following mental health-related keywords: depression, anxiety, and stress.
Results
During the early phase of the pandemic, negative psychological states, such as anxiety, stress, and depression, were highly prevalent, reflecting widespread fear and uncertainty among the public. Although the frequency of these keywords gradually declined, they remained significant even after the transition to the endemic phase. In contrast, the later stages showed an increased frequency of keywords related to recovery and adaptation, such as education, environment, and support, indicating ongoing societal adjustment.
Conclusions
These findings underscore the prolonged psychological effects of COVID-19, with mental health concerns persisting into the endemic phase. Continuous mental health support and adaptive public health strategies are essential to mitigate the enduring impact of global health emergencies.

Original Articles

Effects of Loneliness on Stress in Middle-Aged and Older Adults: Sequential Dual Mediating Roles of Social Interaction Anxiety and Self-Control: Seung Chul Lee, Wonil Choi, SoYeong Yoon, Soo Rim Noh; STRESS. 2025;33(2):93-102. Published online June 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.2.93

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Abstract PDF

Background
The aim of this study is to identify the psychological pathways linking loneliness to stress among middle-aged and older adults, focusing on the mediating roles of social interaction anxiety and self-control.
Methods
A total of 580 adults aged 40∼71 years completed an online self-report questionnaire. Structural equation modeling was used to test a sequential mediation model, and covariates such as age, sex, depression, and extraversion were controlled for.
Results
Loneliness was positively associated with stress and social interaction anxiety, and negatively with self-control. Social interaction anxiety and self-control each mediated the relationship between loneliness and stress. Moreover, a significant sequential mediation pathway was observed: loneliness was associated with higher levels of social interaction anxiety, which in turn was negatively related to self-control, and lower self-control was linked to heightened stress. After controlling for covariates, only the indirect effect via social interaction anxiety remained significant. This suggests that anxiety in social contexts may serve as a robust emotional mechanism underlying the association between loneliness and perceived stress.
Conclusions
This study empirically supports the sequential mediation model in which loneliness increases social interaction anxiety, which in turn reduces self-control, ultimately elevating stress. These findings highlight the importance of considering both interpersonal and intrapersonal factors in mental health interventions for aging populations. Addressing loneliness, reducing social interaction anxiety, and strengthening self-control may be effective targets for psychological intervention and community-based programs tailored to the needs of middle-aged and older adults.

Citations

Citations to this article as recorded by

Loneliness and perceived stress in family caregivers of older adults with disabilities: the mediating role of psychological resilience
Yinghui Song, Ying Luo, Xiwen Zhang, Ying Zhou, Shudi Chen, Caiying Huang
BMC Geriatrics.2026;[Epub] CrossRef

A Validation Study of the Korean Version of the Moral Injury Outcome Scale: Hyeonchan Kim, Yun-Kyeung Choi; STRESS. 2025;33(2):74-92. Published online June 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.2.74

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Abstract PDF: Background
Moral injury (MI) refers to the psychological and functional consequences of potentially morally injurious events (PMIEs), involving perceived violations of deeply held moral beliefs. This study aimed to evaluate the reliability and validity of the Korean version of the Moral Injury Outcome Scale (K-MIOS) and to examine its applicability in Korean populations.
Methods
A total of 546 Korean adults who had experienced at least one PMIE completed an online survey. The sample was randomly split into two groups (n=273 each) for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent and discriminant validity were assessed using correlation analyses with related psychological constructs. Signal detection analysis was performed to identify the optimal cutoff score indicating clinically significant and potentially targetable MI.
Results
EFA and CFA supported a two-factor structure for the K-MIOS, with good internal consistency. The K-MIOS showed significant positive correlations with PMIE exposure, MI, post-traumatic cognitions and emotions, post-traumatic stress symptoms, general psychological distress, and psychosocial dysfunction, supporting its construct validity. Signal detection analysis identified a cutoff score of 27 as optimally efficient for identifying individuals with clinically significant MI.
Conclusions
The K-MIOS showed robust psychometric properties and is suitable for assessing MI in Korean adults. This study provides initial evidence for a screening threshold, that may help identify individuals at clinical risk for MI.

Understanding Nonsuicidal Self-Injury in Adults Based on the Benefits and Barriers Model: Comparing Suicidal Self-Injury and Exploring Functional Differences across Frequency Levels: Hyejin Jeon, Hoon-Jin Lee; STRESS. 2025;33(2):63-73. Published online June 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.2.63

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Abstract PDF: Background
This study aimed to examine differences in nonsuicidal self-injury (NSSI) depending on the presence of suicidal self-injury, such as suicidal ideation or suicide attempts. It also explored patterns of change in self-harm motivation during the initiation and maintenance of NSSI, based on the Benefits and Barriers Model of NSSI.
Methods
A total of 300 adults completed the Self-Injurious Thoughts and Behaviors Interview, Inventory of Statements about Self-Injury, Difficulties in Emotion Regulation Scale, Trait Meta-Mood Scale, Depressive Experiences Questionnaire, Capability for Suicide Questionnaire, and the Interpersonal Needs Questionnaire. Group differences were analyzed.
Results
Individuals in the NSSI with suicide attempt group showed significantly higher motivations related to affect regulation, self-punishment, communication, and interpersonal needs. In contrast, the NSSI-only group exhibited significantly lower levels of emotion dysregulation, interpersonal needs, and self-criticism. Additionally, compared to the middle- and high-frequency NSSI groups, the low-frequency group reported stronger motivations related to peer bonding, interpersonal influence, and the toughness function.
Conclusions
These findings suggest that the Benefits and Barriers Model of NSSI is useful for understanding the relationship between nonsuicidal and suicidal self-injury, as well as the motivational processes involved in the maintenance of NSSI.

The Mediating Effect of Self-Esteem in the Relationship Between Late-Life Volunteering, Depressive Symptoms, and Subjective Well-Being: A Longitudinal Analysis Using a Sequential Process Latent Growth Model: Dapin Cho, DongHee Jeong, Eun-Jung Shim; STRESS. 2025;33(2):53-62. Published online June 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.2.53

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Abstract PDF: Background
This study examined the longitudinal relationship between late-life volunteering, depressive symptoms, and subjective well-being, with a focus on the mediating effect of self-esteem.
Methods
Data were drawn from the 12th to 18th waves (2017∼2023) of the Korean Welfare Panel Study, including 4,954 individuals aged 65 and older at wave 12. A sequential process latent growth model was employed to examine trajectories of self-esteem (waves 13∼15), depressive symptoms, and subjective well-being (both measured at waves 16∼18), as well as their associations over time. The relationship between volunteering, depressive symptoms, and subjective well-being was analyzed while controlling for sex, income and education. Bootstrapping procedure was employed to test the mediating effect of self-esteem.
Results
Self-esteem and depressive symptoms showed a steady decreasing over time, whereas, subjective well-being tended to increase. Compared to non-volunteers, volunteers demonstrated higher initial levels of self-esteem, which were associated with lower subsequent levels and slower declines in depressive symptoms, as well as higher subsequent levels and slower increases in subjective well-being.
Conclusions
This study demonstrates that self-esteem plays a key mediating role between volunteering and mental health outcomes in older adults. Specifically, volunteering was found to enhance self-esteem, which helps reduce depressive symptoms and improve subjective well-being. These findings suggest that interventions aimed at promoting social participation, such as volunteering, and strengthening self-esteem may be effective strategies for enhancing mental health in later life.

Effectiveness of Mental Countermeasures in Psychophysiological Detection of Deception: Kipyoung Kim, Hyeongi Hong, Hyungki Ji, Taeho Kim, Myoung-Ho Hyun; STRESS. 2025;33(2):111-116. Published online June 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.2.111

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Abstract PDF: Background
This study examined the impact of mental countermeasures on the accuracy of the comparison question test (CQT) in psychophysiological detection of deception.
Methods
Forty-five participants were randomly assigned to three groups: innocent, guilty, and guilty with mental countermeasures. A mock crime scenario was used, and the Utah Zone Comparison Test was conducted. Scoring was performed using the Empirical Scoring System–Multinomial.
Results
The CQT accurately identified all guilty participants (100%) and 91.7% of the innocent participants. However, only 25% of the guilty with mental countermeasures participants were correctly classified, indicating a substantial reduction in detection accuracy due to the use of mental countermeasures.
Conclusions
Mental countermeasures can significantly distort physiological responses, undermining the core assumption of the CQT. These findings emphasize the need for advanced detection techniques that integrate neurophysiological measures such as functional near-infrared spectroscopy (fNIRS) and machine learning approaches.

Mediating Effect of Acceptance and Moderated Mediation by Emotional Reactivity in the Relationship Between Awareness and Anxiety: Chang Soo Han, Boyoung Kim; STRESS. 2025;33(2):103-110. Published online June 30, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.2.103

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Abstract PDF: Background
This study aimed to examine the mediating effect of acceptance and the moderated mediation effect of emotional reactivity in the relationship between awareness and state anxiety.
Methods
A total of 395 Korean adults participated in this study. Participants completed self-report measures of awareness, state anxiety, acceptance, and emotional reactivity. Data were analyzed using PROCESS macro to test for mediation and moderated mediation effects.
Results
The findings indicated that acceptance significantly mediated the relationship between awareness and state anxiety. Moreover, emotional reactivity significantly moderated the association between awareness and acceptance. A significant moderated mediation effect was also observed, suggesting that the indirect effect of awareness on state anxiety through acceptance differed depending on levels of emotional reactivity.
Conclusions
These results elucidate the mechanisms underlying mindfulness, indicating that its anxiety-reducing effects via acceptance depend on individual differences in emotional reactivity. The study offers suggestions for the clinical application of mindfulness-based interventions, emphasizing the importance of tailoring strategies to clients’ emotional sensitivity.

Double Mediation Effect of Social Interaction Anxiety and Experiential Avoidance between Internalized Shame and Social Media Addiction Tendency: Kiyeon Nam, Myoung-Ho Hyun, Young-Sil Kwon; STRESS. 2025;33(1):45-52. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.45

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Abstract PDF: Background
This study examined the pathway by which internalized shame influences the tendency toward social media addiction through the mediating roles of social interaction anxiety and experiential avoidance.
Methods
Data were collected from 174 Korean adults who completed surveys measuring internalized shame, social interaction anxiety, experiential avoidance, and social media addiction. Linear regression and Process Macro were used for data analysis.
Results
Internalized shame affected social media addiction by mediating experiential avoidance, and the mediation effect of social interaction anxiety was not significant. However, the double mediating effect of social interaction anxiety and experiential avoidance on the relationship between internalized shame and social media addiction was significant.
Conclusions
People who chronically experience negative perceptions and shame about themselves seek stability through others; however, they experience anxiety in face-to-face interactions and use social media to control and avoid these anxieties. To effectively reduce the tendency toward social media addiction, intervention is required to avoid social interaction anxiety, rather than attempting to change maladaptive identity.

Validation of the Sexual Self-Determination Competency Assessment Scale: Yu-jeong Son, Hyeon-gi Hong, Ki-pyoung Kim, Hyung-ki Ji, Hye-hyun Cho, Chae-bin Lee, Myoung-Ho Hyun; STRESS. 2025;33(1):33-44. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.33

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Abstract PDF: Background
This study aims to refine and validate the Sexual Self-Determination Competency Assessment Scale (2020) to enhance its effectiveness.
Methods
The scale comprises self-reported and scenario-based sections. We revised item phrasing; expanded content to better address sexual crimes involving children, adolescents, and individuals with intellectual disabilities; and adjusted the scoring method for better comprehension by individuals with intellectual disabilities. The revised scale was administered to 500 middle and high school students aged 14∼18 to assess reliability and validity. Additionally, we replaced Likert-scale items with open-ended questions to minimize response bias in the scenario-based section. Interviews were conducted with 17 adolescents and individuals with intellectual limitations.
Results
The self-report section demonstrated content validity through an expert review of item appropriateness. Construct and criterion validities were confirmed through statistical analyses. The internal consistency was also high. In the scenario-based section, four open-ended questions were finalized based on interview data, and five scoring criteria were developed to evaluate responses.
Conclusions
This study improved the format and content of the existing scale, thereby enhancing its applicability in investigative and practical contexts. Notably, modifying scenario-based items to an open-ended format enables a qualitative assessment of perception, judgment, and coping abilities in sexual offense scenarios, representing a significant contribution to the field.

Effect of Distress Tolerance Improvement Intervention for Problematic Drinkers: Gwang-Pyo Jang, Hyae Young Yoon; STRESS. 2025;33(1):22-32. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.22

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Abstract PDF: Background
This study examined the effects of an intervention to improving distress tolerance, drinking refusal self-efficacy, and alcohol consumption in problematic drinkers.
Methods
Adults who reported problematic drinking were randomly assigned to either the intervention group (n=11) or comparison group (n=11). The groups were either administered treatment to improve distress tolerance or watch a video in which abstinent women talked about their drinking and abstinence experiences.
Results
The repeated-measures ANOVA showed no significant change in alcohol consumption in the intervention group. However, appraisal, a distress tolerance subscale, and opportunity for drink refusal self-efficacy, a drink refusal self-efficacy subscale, increased.
Conclusions
Short-term interventions to improve distress tolerance may help change distress tolerance and drinking refusal self-efficacy.

The Influence of Attention-Deficit/Hyperactivity on School Adjustment among Adolescents: Focusing on the Moderated Mediation Effect of Depression by Household Economic Status: RaeHyuck Lee; STRESS. 2025;33(1):13-21. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.13

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Abstract PDF: Background
This study examines the influence of attention-deficit/hyperactivity on school adjustment among adolescents and investigates the moderated mediation effect of depression on household economic status.
Methods
The research hypotheses were tested using data from the Korean Teenagers’ Mental Health Study and analyzed utilizing the PROCESS Macro method.
Results
Attention-deficit/hyperactivity had a significant negative impact on students’ school adjustment. Additionally, depression partially mediated the relationship between attention-deficit/hyperactivity and school adjustment. While household economic status did not moderate the influence of attention-deficit/hyperactivity on school adjustment, it did moderate the mediating effect of depression. Specifically, the mediating effect of depression on the relationship between attention-deficit/hyperactivity and school adjustment was more pronounced for adolescents from low-income households than for those from medium- or high- income households.
Conclusions
This study discusses the research implications and considerations.

Review Article

An Integrative Review on Risk and Relapse Factors for Narcotics Addiction: Based on an Ecological Model: Youjin Shin, Hwal Lan Bang, Soo-Hyun Nam; STRESS. 2025;33(1):1-12. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.1

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Abstract PDF: Background
The study aim was to explore and integrate the experiences of individuals with substance addiction in South Korea using a ecological model to identify risk factors and relapse triggers across multiple dimensions.
Methods
This integrative review was conducted using Whittemore and Knafl’s five-step integrative review method. A comprehensive literature search was conducted using five Korean electronic databases from June 13 to July 25, 2023. Keywords included “narcotic,” “drug,” “addict,” and “recovery.”
Results
A total of 22 studies met the inclusion criteria. Risk and relapse factors in narcotics addiction were categorized into intrapersonal (emotional, cognitive, behavioral, physical, physiological), interpersonal (family, relationships, occupation), community (social, structural), and public policy (legal, institutional) aspects. These factors interacted to form a complex structure that heightened addiction risk and overlapped as both risk and relapse factors.
Conclusions
Narcotics addiction remains a serious public health issue that is exacerbated by various intrapersonal, interpersonal, community, and public policy-related factors. The study findings underscore the multifaceted nature of addiction and relapse and provide a broad perspective on the complexities of prevention and recovery strategies.

Original Articles

A Reliability and Validity of the Korean Version of Behavioral Activation for Depression Scale-Short Form: A Community Sample of Adults: Yeongeun Kim, Jini Tae, Yoonhyoung Lee, Kiho Park, Wonhye Lee; STRESS. 2024;32(4):214-220. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.214

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Abstract PDF

Background
The behavioral activation method is a short-term, evidence-based approach that promotes functional activation by reinforcing adaptive behaviors and eliminating avoidance behaviors. This study aims to validate the Korean version of the Behavior Activation for Depression Scale-Short Form (K-BADS-SF) among Korean community adults, providing an objective measure of behavioral activation.
Methods
A total of 471 participants, ranging in age from 18 to 69 years, completed an online survey. They filled out the K-BADS-SF and its long-form version, the K-BADS, as well as the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). The K-BADS-SF was subject to a thorough psychometric evaluation, which included analyzing internal consistency, test-retest reliability, exploratory and confirmatory factor analyses, and both convergent and discriminant validity analyses.
Results
Exploratory and confirmatory factor analyses show that the model fit of the K-BADS-SF improves when certain items from the original scale are moved from the activation factor to the avoidance factor.
Conclusions
The K-BADS-SF exhibits sufficient reliability and validity in the Korean community sample, confirming its effectiveness as a valuable tool for assessing behavioral activation.

Citations

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The relationship between behavioral activation and burnout in a community setting: the mediating role of acceptance-based action, automatic negative thought, and self-efficacy
Hyewon Yeo, Jini Tae, Yoonhyoung Lee, Youngeun Kim, Wonhye Lee
Frontiers in Psychology.2025;[Epub] CrossRef

The Effectiveness of an Imagery-Based Behavioral Activation Intervention for Depressive Symptoms: Sujeong Yun, Eun-Jung Shim; STRESS. 2024;32(4):204-213. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.204

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Abstract PDF: Background
Behavioral activation treatment (BAT) is an evidence-based treatment for depression. However, depressive symptoms can make it difficult to engage in activities crucial for the success of behavioral activation. Mental imagery may assist with activity engagement. This study examined the effectiveness of imagery-based BAT (BAT-I) compared to standard BAT in reducing depressive symptoms and improving behavioral activation, activity anticipation, activity motivation, and activity completion rates.
Methods
Thirty adults with moderate to severe depressive symptoms were randomly assigned to either the BAT-I or BAT groups. The participants received eight sessions of twice-weekly BAT intervention, with an additional four-eight mental imagery sessions provided for the BAT-I group.
Results
Repeated measures analysis of variance indicated that participants in both groups showed reductions in depressive symptoms and improvements in behavioral activation, activity anticipation, and activity motivation. However, the BAT-I group demonstrated significantly higher activity motivation (6.1＞ 5.1) and activity completion rates (93.17%＞66.18%) than the BAT group.
Conclusions
While use of imagery appears to support activity engagement, further research is needed to explore how imagery can be utilized to enhance the BAT effectiveness.

Internalized Shame Mediates the Relationship between Borderline Personality Traits and Suicidal Ideation: Nanyoung Bae, Hyejeen Lee; STRESS. 2024;32(4):196-203. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.196

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Abstract PDF: Background
Internalized shame, defined as the enduring incorporation of shame as a trait due to repeated experiences of shame, is considered a core emotion in individuals with borderline personality traits. It is closely related to self-destructive behaviors, such as self-harm and suicidal ideation. This study aimed to investigate whether internalized shame mediates the relationship between borderline personality traits and suicidal ideation.
Methods
Self-report questionnaires were administered to 303 undergraduate and graduate students to assess borderline personality traits, suicidal ideation, internalized shame, depression, impulsivity, and history of suicide attempts.
Results
Internalized shame mediated the relationship between borderline personality traits and suicidal ideation, even after controlling for known predictors of suicidal ideation, including depression, impulsivity, history of suicide attempts, sex, and age. Specifically, higher borderline personality traits were associated with stronger feelings of shame, which in turn increased suicidal ideation.
Conclusions
These findings suggest that addressing internalized shame could be a key target for interventions aimed at reducing suicide risk in individuals with borderline personality traits.

Moderated Mediating Effect of Anxiety by Household Type on the Relationship between Daily Life Stress and Non-Suicidal Self-Injury among Adolescents: RaeHyuck Lee; STRESS. 2024;32(4):188-195. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.188

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Abstract PDF

Background
This study examined the impact of adolescents’ daily life stress on non-suicidal self-injury among adolescents, focusing on the mediating role of anxiety and the moderated mediating effect of anxiety by household type (two-parent vs. single-parent households).
Methods
This study utilized data from the Korean Teenagers’ Mental Health Study, conducted by the National Youth Policy Institute and applied the PROCESS macro method for analysis.
Results
First, daily life stress significantly increased the likelihood of non-suicidal self-injury among adolescents. Second, anxiety played a full mediating role. Third, no significant difference was observed in the direct impact of daily life stress on non-suicidal self-injury between adolescents from two-parent and single-parent households. Fourth, the mediating effect of anxiety on the relationship between daily life stress and non-suicidal self-injury was more pronounced among adolescents in single-parent households than those in two-parent households.
Conclusions
The findings highlight the need for tailored interventions to deal with non-suicidal self-injuries among adolescents, particularly in the context of household type.

Citations

Citations to this article as recorded by

The Influence of Attention-Deficit/Hyperactivity on School Adjustment among Adolescents: Focusing on the Moderated Mediation Effect of Depression by Household Economic Status
RaeHyuck Lee
STRESS.2025; 33(1): 13. CrossRef
The Influence of School Maladjustment on Non-Suicidal Self-Injury among Adolescents: Focusing on the Moderated Mediating Effect of Anxiety According to Single-Parent Family Status
RaeHyuck Lee, Jaekyoung Lee
STRESS.2025; 33(3): 155. CrossRef

Social Representation Study on Disabled Persons: A Longitudinal Study of Mentally Ill Patients and Verification of Differences by Type: Yeun-Joo Hur, KyuMan Han, MinKyu Rhee; STRESS. 2024;32(4):178-187. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.178

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Abstract PDF: Background
This study aimed to examine changes in the social representation of mental illness over the past 50 years and to compare these changes with the social representation of physical disability.
Methods
To measure the causes, symptoms, treatment, and attitudes toward patients and hospitals for the general public, opinion surveys on mental illness were based on questionnaires, and in the case of physically disabled people, the scale of mental illness was revised and supplemented.
Results
As a result of this study, it was confirmed that the social representation of the general public about mental illness has changed significantly over the past 50 years, but certain parts have deteriorated in some negative directions. Furthermore, when comparing the physically disabled and the mentally ill, it was confirmed that the social representation of the mentally ill was more negatively formed than that of the physically disabled.
Conclusions
Based on these research results, the implications and limitations of this study were discussed.

The Effects of Internalized Shame and Social Exclusion on Approach-Avoidance Behavior: Jae-Yun Sim, Myoung-Ho Hyun; STRESS. 2024;32(4):171-177. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.171

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1 Citations

Abstract PDF

Background
This study examined the effects of internalized shame and social exclusion on approach-avoidance behavior.
Methods
A survey was conducted offline and online with 618 adult participants to assess their level of internalized shame. Among them, 59 were selected and assigned to either the high- or low-internalized shame group. These participants were then randomly assigned to either the social exclusion or inclusion condition. After experimental manipulation, explicit and implicit approach-avoidance behaviors were measured.
Results
In terms of explicit behavioral choices, the high-internalized shame group exhibited approach behavior in the social inclusion condition and avoidance behavior in the exclusion condition. In terms of explicit behavioral preferences, the high-internalized shame group and social exclusion condition exhibited avoidance responses. In terms of implicit behavior, the low-internalized shame group exhibited approach responses in the social exclusion condition, whereas the high-internalized shame group exhibited avoidance responses.
Conclusions
This study investigated the impact of internalized shame and social exclusion on social functioning and confirmed that individuals with high levels of internalized shame are more vulnerable to social exclusion. Finally, the implications, significance, and limitations of this study are discussed.

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The Impact of Social Exclusion Experience on Impulsive Buying: The Mediating Effect of Materialism and the Moderating Effect of Mindful Consumption
Namuundari Battulga, Jin-Hwa Lee
Journal of the Korean Society of Costume.2025; 75(2): 29. CrossRef

Efficacy of Ecological Momentary Intervention Tailored to Drinking Motives for Reducing Problematic Drinking in Young Adults: Hee-Eun Kim, Eun-Jung Shim; STRESS. 2024;32(3):161-169. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.161

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Abstract PDF: Background
Brief interventions can inform young problematic drinkers about the risks associated with alcohol use. Ecological Momentary Interventions (EMIs), which provide feedback closer to the point of drinking, may help to translate the internal changes made from these brief interventions into actual behavior.
Methods
Thirty-six problematic drinkers aged 19∼34 years were randomly assigned to one of three groups: Ecological Momentary Assessment (EMA), Standard EMI, or Tailored EMI. Participants in all groups completed two daily EMAs for four weeks following a single-session intervention. They reported their drinking intentions and motives for the current day, and their alcohol consumption and drinking motives from the previous day. The Standard EMI group received feedback on the general negative consequences of drinking, while the Tailored EMI group received feedback specifically tailored to their drinking motives based on their EMA responses.
Results
Problematic drinking, along with related variables (e.g., drinking behavior, alcohol consumption, negative consequences, alcohol expectancies, and drinking motives) was reduced across all groups.
Conclusions
Further research is needed on the potential of monitoring drinking behavior to reduce problematic drinking and how to improve tailored EMI.

Emotional Dissonance and Coping Strategies According to the Emotional Processing Type of Call Center Counselors: SoonJin Choi, HaeYoun Choi; STRESS. 2024;32(3):153-160. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.153

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Abstract PDF: Background
This study explored the emotional processing types of call center counselors and examined the differences in emotional dissonance and related adaptation indicates of coping strategies, emotional exhaustion and work performance orientation according to the types.
Methods
A total of 271 call center agents (204 females, 67 males; mean age 36.5) participated in the study. Latent class analysis of emotional awareness, emotional expression, ambivalence over emotional expression were conducted. Analysis of variance(ANOVA) was used to examine differences in adaptation indicators according to emotion processing type.
Results
Emotional processing types were categorized into Clear(CG), Passive(PG) Repressive(RG) groups. The CG showed low emotional dissonance, good adaptation indicates and functional coping strategies whereas results for the RG type revealed the opposite.
Conclusions
By distinguishing between emotional processing types, this study found that emotional processing type is more closely correlated with burnout and work performance orientation than emotional dissonance itself.

Does Stress Affect Adolescent Anxiety by Mediating Sleep Time?: Si On Jang; STRESS. 2024;32(3):142-152. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.142

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2 Citations

Abstract PDF

Background
Health is essential for the sustainable well-being, yet high stress, anxiety, and lack of sleep among Korean adolescents have become significant social concerns.
Methods
This study examined the impact of stress on anxiety and investigated whether sleep time mediates this relationship in 46,870 male and female adolescents, ranging from first-year of middle school students to third-year high school students. Data were obtained from the "18th Korea Youth Risk Behavior Survey" conducted by the Korea Disease Control and Prevention Agency.
Results
The analysis showed that increased stress was associated with reduced sleep time and higher anxiety levels, stress was found to heighten anxiety, partly by reducing sleep time.
Conclusions
Based on these findings, the study recommends: ① developing mental health indicators to quickly identify adolescents at risk for mental health issues, ② encouraging cooperation between schools, government agencies, healthcare providers to enhance access to mental health programs for adolescents, and ③ implementing policies that promote healthy behaviors, ensure adequate sleep, and improve overall well-being.

Citations

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Association between Daily Stress, Sleep Duration, and Attention-Deficit or Hyperactivity Problems among Teenagers: Focusing on the Moderated Mediating Effect of Positive Family Relationships
RaeHyuck Lee
STRESS.2025; 33(4): 201. CrossRef
Comparative effects of music therapy and aromatherapy on stress, quality of life, and happiness among shift nurses in Korea: a randomized controlled trial
So-heun Lee, Won-jong Kim, Eun-Hi Choi, Myung-Haeng Hur
Journal of Korean Biological Nursing Science.2024; 26(4): 337. CrossRef

Review Articles

An Integrative Review of Interventions for Preventing Internet and Smartphone Addiction in Elementary School Students: Based on the IMB Model: Hyemin Park, Bohye Kim, Jaehee Jeong, Hwa Jeong Kim, Yebin Kim; STRESS. 2024;32(3):133-141. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.133

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Abstract PDF

Background
This study analyzes and evaluates the effectiveness of various interventions designed to prevent internet and smartphone addiction among elementary school students based on the Information-Motivation-Behavioral Skills (IMB) model.
Methods
An integrative literature review examined studies published in the last ten years that focus on preventive interventions for internet and smartphone addiction among elementary school students. The selected studies were analyzed using the IMB model, which includes information, motivation, and behavioral skills as key components.
Results
The analysis identified several critical components of effective prevention programs: providing relevant information, enhancing interpersonal relationships, emotional management, self-control, and impulse control skills. Effective programs often included group interventions, visual aids, play activities, and parental involvement.
Conclusions
The findings suggest that balanced integration of information, motivation, and behavioral skills is essential for developing effective prevention programs for internet and smartphone addiction among elementary school students. The study provides a foundation for future research and the development of comprehensive prevention programs tailored to the unique characteristics of this age group.

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A Study on Feminine Cleansing Product Purchasing Behavior Applying the IMB Model
Min-Jung Kim, Min-Shin Kim
Journal of the Korean Society of Cosmetology.2025; 31(4): 876. CrossRef

An Integrative Review of Psychosocial Intervention Programs for Children and Adolescents who Experienced Traumatic Events: Eun-Mi Seol, Soo-Hyun Nam; STRESS. 2024;32(3):121-132. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.121

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Abstract PDF: Background
This integrative review study aims to analyze the core components, intervention strategies, and effects of psychosocial intervention programs conducted for children and adolescents in Korea who have experienced traumatic events.
Methods
The integrative review involved a search of major domestic databases using key terms such as 'children’, 'adolescents’, 'trauma’, 'post-traumatic stress’, 'intervention’, and 'education’. A total of 10 studies were selected for analysis based on predefined criteria.
Results
The 10 selected studies were categorized into three types of interventions based on the environment and structure of the intervention delivery: individual-based interventions targeting only children and adolescents, family-based interventions involving family members, and school-based interventions conducted within schools. These interventions were found to be effective in addressing mental health issues caused by trauma in children and adolescents.
Conclusions
Despite the serious nature of traumatic experiences among children and adolescents, this integrative review found that domestic research on psychosocial interventions for this population lacks rigorous study design and is limited in the selection of participants and trauma events. Therefore, the study suggests the need for the development and dissemination of more proactive psychosocial interventions for children and adolescents. The findings of this study are expected to serve as foundational data for the development of trauma managing programs for this population.

Psychological Interventions for Chronic Pain: An Umbrella Review of Systematic Reviews and Meta-Analyses of Randomized Controlled Trials: Eun-Mi Koh; STRESS. 2024;32(3):111-120. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.111

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Abstract PDF: Background
There is a continuous increase in the number of studies showing that psychological interventions help reduce chronic pain. Systematic review studies that analyze the effect are also increasing. The aim of this umbrella review was to synthesise the best available research evidence for the effectiveness of standardised psychological interventon for adults with chronic pain.
Methods
Using MEDLINE (PubMed) and Cochrane CENTRAL search engines, four systematic reviews met the study criteria, including 60 randomized control trials and 7,025 patients with chronic pain.
Results
Compared to waiting control and treatment as usual, psychological interventions displayed medium effect sizes for pain intensity (SMD −0.35, CI −0.42 to −0.29, 4 reviews, N=4,061), pain disability (SMD −0.44, CI −0.51 to −0.36, 3 reviews, N=2,609), and physical functioning (SMD 0.38, CI 0.29 to 0.48, 2 reviews, N=1,699). Additionally, psychological interventions exhibited a medium effect size in reducing pain intensity (SMD −0.34, CI −0.42 to −0.26, 2 reviews, N=2,508) and pain disability (SMD −0.43, CI −0.51 to −0.35, 2 reviews, N=2,563) in chronic low back pain.
Conclusions
The results reaffirm that psychological interventions, along with drug or conventional treatments, can be helpful in managing chronic pain.

Original Articles

Trauma-Informed Care for Children: A Scoping Review: Kyung-Sook Bang, Ji-Hye Choe, Sinyoung Choi, Yeseul Jeong, Sungjae Kim; STRESS. 2024;32(2):94-103. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.94

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Abstract PDF

Background
Trauma-informed care involves providing services to traumatized patients with an understanding of and sensitivity to their experiences. This scoping review examines the literature concerning trauma-informed care for children.
Methods
We conducted a comprehensive literature search across domestic (RISS, NDSL, KISS, and DBpia) and international (PubMed, Embase, CINAHL, and PsycINFO) databases. The search terms were “trauma,” “PTSD,” “trauma-informed,” “trauma-focused,” “trauma-sensitive,” “newborn,” “neonate,” “premature infant,” “infant,” “child,” “adolescent,” “teen,” “juvenile,” “adolescence,” “pediatric,” and “nursing”. The final selection comprised 18 documents that were analyzed for general characteristics (publication year, study country, academic sector, research design, and data collection method), population demographics, variables, and measurement tools.
Results
Literature on this topic considerably increased since 2017, with the United States being the predominant research hub (50.0%) and nursing representing the primary academic sector (55.6%). The research designs were mainly quantitative (33.3%) and mixed-method studies (33.3%). Quantitative studies predominantly utilized surveys, while qualitative research employed observations, in-depth interviews, and focus group discussions. Most of the participants were nurses, doctors, and allied health professionals. As a result of analyzing the main variables measured in the literature through WordCloud, variables such as “stress,” “care,” and “knowledge” had the highest frequency. Three studies incorporated or adapted tools to assess trauma-informed care.
Conclusions
The findings of this review serve as foundational data for proposing future research trajectories in trauma-informed care and for enhancing awareness and strategic planning in clinical practice.

Citations

Citations to this article as recorded by

Korean nurses’ knowledge, opinions and current practice of trauma-informed pediatric nursing care in South Korea: a descriptive study
Kyung-Sook Bang, Sun Woo Hong, Hwal Lan Bang, Ji-Hye Choe, Sinyoung Choi
Child Health Nursing Research.2024; 30(4): 309. CrossRef

Influence of the Negative Life Changes Experienced after Becoming Single Mothers on Parenting Stress: Focusing on the Moderated Mediation Effect of Depression by Low-Income Status: RaeHyuck Lee; STRESS. 2024;32(2):85-93. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.85

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Abstract PDF: Background
This study examines the influence of negative life changes experienced after becoming single mothers and their influence on parenting stress, focusing on the moderated mediation effect of depression influenced by low-income status.
Methods
The research questions were tested by using raw data from the Survey of Single-parent Families and applying the PROCESS macro method.
Results
First, the negative life changes experienced after becoming single mothers were found to positively and significantly influence parenting stress. Second, a partial mediation effect was observed: The levels of negative life changes increased the levels of depression, which, in turn, increased the levels of parenting stress. Third, the mediating effect of depression on the relationship between single mothers’ negative life changes and parenting stress was more pronounced for those with low income compared to those with medium and high income.
Conclusions
This study suggests strategies to address single mothers’ parenting stress.

Stress and Coping of Self-Quarantined People Focusing on Negative Cases of the Coronavirus Disease: A Qualitative Study: Kyung Im Kang, Chanhee Kim, Min Hye Lee; STRESS. 2024;32(2):74-84. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.74

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Abstract PDF: Background
In South Korea, many people have experienced self-quarantine due to coronavirus disease (COVID-19). This study explored stress, coping, and post-quarantine changes among people who were self-quarantined because of close contact but tested negative for COVID-19 in the early days of the pandemic.
Methods
Qualitative interviews were conducted with four focus groups, each comprising five people. Data were analyzed using inductive content analysis.
Results
Three categories of stress and coping during self-quarantine and post-quarantine changes emerged. First, the category of content related to stress comprised “problems that are difficult to handle alone.” The subcategories were “painful body and mind,” “the experience of being in a jail without bars,” and “repeated internal and external conflicts.” Second, the category for various stress-coping methods was labeled “struggling my way,” and the subcategories were “coping methods that helped me overcome” and “coping methods that added difficulty.” Finally, the category for changes after self-quarantine was labeled “more mature me.” The subcategories involved “thorough observation of infection prevention measures in daily life,” “living together,” and “a new realization of life.”
Conclusions
Our findings contribute toward developing online or offline health programs to help individuals who self-quarantined but tested negative for infectious diseases, allowing them to feel confident to self-quarantine in good health.

Academic Mental Health and Stress Mindset among High School Students: Job Demands-Resources Model: Ji-Eon Kim, Hyo-Shim Cho, Tae-Hyung Kwon, Eun-Young Kim, Ochir Erdenezaya Tsogt, Soohyun Cho; STRESS. 2024;32(2):66-73. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.66

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Abstract PDF: Background
This study aimed to identify stress mindset as an intervention factor for academic stress management within the framework of the Job Demands-Resources Model. We investigated the role of a stress mindset in the relationship between academic demands, resources, burnout, engagement as academic mental health.
Methods
From the perspective of academic interpersonal perceptions, 391 first- and second-year high school students were analyzed using a structural equation model consisting of observed variables with demands and resources from parents, teachers, and peers.
Results
The low-stress mindset group showed a significant pathway from academic demands to academic burnout. The high-stress mindset group demonstrated pathways from academic resources to academic burnout and engagement.
Conclusions
These findings highlight the significance of a stress mindset in enhancing the academic mental health of high school students.

Development and Preliminary Efficacy of a Mindfulness-Based Counseling Program as Part of Comprehensive Cardiac Rehabilitation: A Pilot Study: Ji Young Jung, Min Jung Kim, Sol Bin Yoon, Hyo Jin Kim, Jin A Yoo, Mi Kyung Lee, Sang Hee Shin, Justin Y. Jeon, Sung Nim Han, Jung Eun Lee, Chan Joo Lee, Jong Young Lee, Ick-Mo Chung, Jong Nam Kim; STRESS. 2024;32(2):53-65. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.53

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1 Citations

Abstract PDF

Background
While psychological intervention is recognized as a core component of cardiac rehabilitation (CR), its application in CR remains limited. This study aimed to develop a psychological counseling program (the Mindfulness-Based Counseling Program [MBCP]) as a component of comprehensive CR for the patients with cardiovascular disease and to explore its preliminary efficacy.
Methods
We developed a psychological counseling program (MBCP) as part of comprehensive CR. The MBCP consisted of six-week psychological counseling and mindfulness practice. Through this program, we aimed to promote health maintenance behaviors and stress management. Thirteen subjects with either acute myocardial infarction or congestive heart failure with reduced EF (≤40%) participated, randomized into either comprehensive CR including MBCP (n=7) or exercise-based CR (n=6). Psychological-status assessments included life satisfaction (DSQ), health-related quality of life (HRQoL), depression (PHQ-9), anxiety (GAD-7), type D personality, and stress (PSS).
Results
The comprehensive CR group (n=7) experienced a significant decrease in anxiety and improvements in general health and mental aspects of HRQoL. The exercise CR group (n=6) experienced reduced depression and significantly increased mental aspects of HRQoL. Additionally, the overall satisfaction and participation rate for MBCP was high.
Conclusions
The MBCP developed in this study showed preliminary efficacy for CR and is anticipated to enhance psychological wellbeing and the quality of life among cardiac patients.

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Cardiac Rehabilitation Exercise in Korea
Yun-cheol HA, Nan-soo KIM
Physical Therapy Research.2025; 28(2): 85. CrossRef

Effect of Emotional Regulation Strategies on Psychological Distress in Obsessive-Compulsive Tendency: Woo-Jin Cha, Myoung-Ho Hyun; STRESS. 2024;32(2):104-110. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.104

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Abstract PDF: Background
This study examined the effects of emotion regulation strategies on psychological distress in individuals with obsessive-compulsive tendencies.
Methods
A total of 339 adults completed online and offline surveys administered to determine the level of obsessive-compulsive symptoms. Among them, 56 were categorized into the obsessive-compulsive tendency group and randomly assigned to the reappraisal, acceptance, and suppression groups, where each participated in emotion regulation strategy training. Their psychological distress was assessed before and after the training.
Results
The results of the repeated-measures analysis of variance (ANOVA) showed that the main effects of neither group nor time were significant, but the interaction between group and time was significant. The acceptance group showed a significant decrease in psychological distress post-training, whereas the suppression group showed a significant increase. The reappraisal group showed no significant changes in psychological distress before and after the training.
Conclusions
This study demonstrated that the acceptance strategy was especially effective and adaptive in reducing psychological distress. These findings expand our understanding of emotion regulation strategies and have therapeutic implications. Finally, the implications and limitations of this study are discussed, presenting directions for future research.

Relationship between Childhood Trauma and Depression in Youths in the Transition to Independent Living: The Mediating Effect of Disconnection-Rejection Schemas Moderated by Out-of-Home Care Types: Shin Young Park, Myoung-Ho Hyun, Min Jin Jin; STRESS. 2024;32(1):9-18. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.9

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Abstract PDF: Background
This study explored the relationship between childhood trauma, disconnection-rejection schemas, and depression among youths in the transition to independent living. Additionally, this study examined whether the impact of childhood trauma on depression, mediated by disconnection-rejection schemas, was moderated by the type of out-of-home care (residential care centers, group homes, and foster homes).
Methods
A survey questionnaire measuring childhood trauma, disconnection-rejection schemas, and depression was administered to 201 participants.
Results
Mistrust-abuse and defectiveness-shame schemas mediated the relationship between childhood trauma and depression. In all types of out-of-home care, both the mistrust-abuse and defectiveness-shame schemas mediated the relationship between childhood trauma and depression. There were no significant differences in mediating effects based on the type of out-of-home care.
Conclusions
The findings of this study can be applied to the treatment of depression during the transition to independent living in individuals who have experienced childhood trauma.

Association between Suicidal Ideation and Blood Cadmium Levels Based on the 3rd to 7th Korea National Health and Nutrition Examination Surveys: Sunmi Kim; STRESS. 2024;32(1):46-52. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.46

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Abstract PDF: Background
This study aimed to determine the association between blood cadmium levels and suicidal ideation.
Methods
Using data from the 3rd to 7th Korea National Health and Nutrition Examination Surveys, the geometric mean of blood cadmium levels according to suicidal ideation was compared using multiple linear regression analyses in male and female adults. The frequency of suicidal ideation according to the blood cadmium levels was also compared using multiple logistic regression models.
Results
In total, 6,877 men and 6,698 women were included in the study. When adjusting for all potential confounding factors, the geometric mean of blood cadmium levels was significantly higher in participants with suicidal ideation than in those without suicidal ideation in both men (0.92 ng/ml [95% confidence interval 0.87∼0.97 ng/ml] vs. 0.86 ng/ml [0.84∼0.88 ng/ml]; p=.026) and women (1.05 ng/ml [95% confidence interval 1.01∼1.10 ng/ml] vs. 0.99 ng/ml [0.98∼1.02 ng/ml]; p=.006). After adjusting for potential confounders, the frequency of suicidal ideation significantly increased as blood cadmium levels increased in men (p for trend=.014) and women (p for trend=.034).
Conclusions
Results revealed an association between blood cadmium levels and suicidal ideation in Korean adults.

Effect of Cognitive Processing Style on Attentional Blink during Analogue Trauma: Ye Ji Son, Yun-Kyeung Choi; STRESS. 2024;32(1):38-45. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.38

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Abstract PDF: Background
This study attempted to examine the impact of each cognitive processing style (bottom-up, top-down) on attention patterns following a traumatic experience by measuring attentional blink (AB).
Methods
Participants were 37 university students with no direct experience of traffic accidents. They were randomly assigned to either a single-task (bottom-up processing) group or a dual-task (top-down processing) group, who performed the Rapid Serial Visual Presentation (RSVP) after watching an analogue trauma video. The correct response rate to target stimuli was then compared between groups based on stimulus type and stimulus presentation interval.
Results
In the dual-task group, no significant differences were found. However, in the single-task group, a trend towards a decrease in the correct response rate to the target stimulus was observed 200 ms after the presentation of the traumatic stimulus (i.e., AB).
Conclusions
This tendency can be explained by the phenomenon of automatic attentional capture by traumatic stimuli, suggesting a relationship between bottom-up processing and attentional bias.

The Relationship between Level of Therapist Support and Efficacy and Adherence in Internet-Based Cognitive Behavioral Therapy for Disordered Eating Behaviors: Seyeom Kim, Eun-Jung Shim; STRESS. 2024;32(1):29-37. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.29

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Abstract PDF: Background
Therapist support is an important intervention design factor in internet-delivered psychotherapy. However, the relationship between therapist support and intervention outcomes is not well established. This study examined the relationship between therapist support, efficacy, and adherence to Internet-based Cognitive Behavioral Therapy (I-CBT) for disordered eating behaviors.
Methods
Thirty-six women with disordered eating behaviors were recruited and randomly assigned to three groups: low, medium, and high levels of therapist support. The participants received eight sessions of I-CBT, twice a week, with varying levels of therapist support.
Results
While all three groups showed a reduction in eating disorder risk factors (i.e., body image disturbance, disordered eating behaviors, depression, and anxiety), there were no significant differences in these improvements by therapist support level. However, there were significant differences in intervention completion rates by therapist support level, with higher levels of support associated with increased intervention completion rates.
Conclusions
Therapist support can potentially improve adherence to internet-based interventions.

Relationship between Mindfulness and Stress Response in High School Students: Mediating Effect of Self-Regulation Ability: Yoonjung Choi, Mihee Lee, Jeongik Choi; STRESS. 2024;32(1):19-28. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.19

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Abstract PDF: Background
This study explored the applicability of mindfulness meditation as an intervention approach in school counseling for managing daily stress in high school students. The study investigated the mediating effect of self-regulation ability on the relationship between mindfulness and stress response.
Methods
Data from 244 high school students (119 men and 125 women) were used to examine the mediating effect, controlling for academic variables using Hayes’ (2013) Process Macro Model 4.
Results
There was a positive correlation between mindfulness and self-regulation abilities, and mindfulness and self-regulation abilities were negatively correlated with stress response. Moreover, for students who perceived higher academic achievement levels, self-regulation abilities were positively correlated, and stress response were negatively correlated. Results showed a full mediating effect of self-regulation ability on the adverse relationship between mindfulness and stress response. The mediating effects of self-regulation modes were differentially observed in the adverse relationship between mindful consciousness and attitude dimensions of stress response.
Conclusions
These findings suggest that when applying mindfulness meditation as a daily stress management strategy for high school students, enhancing their self-regulation ability should be the focus of intervention.

Effect of Daily Stress on School Adjustment among Children at Community Child Centers: Mediating Roles of Inattention and Social Withdrawal: RaeHyuck Lee; STRESS. 2024;32(1):1-8. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.1

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6 Citations

Abstract PDF

Background
This study verifies the influence of daily stress on school adjustment through inattention and social withdrawal among children at community child centers.
Methods
Analyses were performed on data collected from the Child Panel Survey of the Community Child Centers, followed by a series of regression analyses.
Results
First, daily stress had a negative and significant influence on school adjustment. Second, both inattention and social withdrawal among children mediated the influence of daily stress on school adjustment. Finally, the influence of daily stress on school adjustment was serially dual-mediated through inattention and social withdrawal.
Conclusions
This study presents evidence-based strategies that could help the school adjustment of children at community child centers.

Citations

Citations to this article as recorded by

Acculturative stress and social isolation in multicultural adolescents: A moderated mediation model of social withdrawal and in-school support
Woo Gwan Jo, Joseph Ahn, Wonjong Horace Lee
International Journal of Intercultural Relations.2026; 110: 102324. CrossRef
The Influence of Attention-Deficit/Hyperactivity on School Adjustment among Adolescents: Focusing on the Moderated Mediation Effect of Depression by Household Economic Status
RaeHyuck Lee
STRESS.2025; 33(1): 13. CrossRef
Happiness experiences among South Korean elementary school students receiving local children’s center services: a qualitative study using Giorgi’s phenomenological method
Hae Kyung Jo
Child Health Nursing Research.2025; 31(2): 96. CrossRef
Association between Daily Stress, Sleep Duration, and Attention-Deficit or Hyperactivity Problems among Teenagers: Focusing on the Moderated Mediating Effect of Positive Family Relationships
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STRESS.2025; 33(4): 201. CrossRef
Moderated Mediating Effect of Anxiety by Household Type on the Relationship between Daily Life Stress and Non-Suicidal Self-Injury among Adolescents
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Efficacy of a Serious Game for Individuals with Interpersonal Trauma: Hyae Young Yoon, Sang-Hyun Cho, Yun-Kyeung Choi; STRESS. 2023;31(4):205-219. Published online December 28, 2023; DOI: https://doi.org/10.17547/kjsr.2023.31.4.205

3,606 View
74 Download
1 Citations

Abstract PDF

Background
This study aimed to develop a serious game for college students with interpersonal trauma to practice adopting an alternative perspective mentoring a game character with similar experiences.
Methods
We recruited 44 college students with high levels of distress after experiencing interpersonal trauma. They were assigned to either the serious game+relaxation training (SG+RX, n=22) or the virtual reality+relaxation training condition (VR+RX, n=22). Cognitive, emotional, and self-efficacy aspects related to trauma were compared in both groups before and after treatment. In addition, interpersonal perceptions of "warmth, dominance, trust, and accessibility" for facial expressions of happiness, anger, and neutrality were compared in both groups before and after treatment.
Results
Both groups showed positive changes in relaxation, post-traumatic cognition, and post-traumatic emotion after treatment. The SG+RX group showed greater increases in behavioral competence and confidence in the future and rated accessibility to angry/happy facial expressions higher than the VR+RX group.
Conclusions
These findings suggest that an interactive serious game promoting empathy, coping skills, and an alternative perspective effects positive changes for individuals with interpersonal trauma.

Citations

Citations to this article as recorded by

Do Anthropomorphic Features Affect User Engagement? Exploring the Dual-Path Effects of Anthropomorphic Design on MCI User Engagement Efficacy
HeSen Li, WanQing Zhang, WeiCheng Pan, Hong Chen, LiYan Bu, ShuYi Wang
International Journal of Human–Computer Interaction.2025; : 1. CrossRef

The Moderating Role of Perceived Social Support in the Relation between Type D Personality and PTSD Symptoms among ICU and ER Nurses: Sohyeon Kim, Myung-Ho Hyun; STRESS. 2023;31(4):197-204. Published online December 28, 2023; DOI: https://doi.org/10.17547/kjsr.2023.31.4.197

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Abstract PDF: Background
This study examined the moderating effects of four types of perceived social support on the relation between type D personality and post-traumatic stress disorder (PTSD) symptoms among ICU and ER nurses.
Methods
Data were collected from 223 ICU and ER nurses in university or general hospitals located in Seoul. A questionnaire survey method was used for data collection and SPSS Windows 28.0 and PROCESS Macro Program were used for data analysis.
Results
The results showed that only the moderating effect of senior support was statistically significant, while perceived support from family, friends, and coworkers were not. Specifically, the effect of type D personality on post-traumatic stress disorder (PTSD) symptoms was weaker in ICU and ER nurses who perceived higher social support from senior nurses.
Conclusions
The study highlighted the significance of senior support in protecting the psychological health of ICU and ER nurses. Additionally, it addressed the major considerations in developing practical interventions in hospital settings.

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