Scholarly article on topic 'Analysis of the association between problem behaviors and Sasang typology in high school students'

Analysis of the association between problem behaviors and Sasang typology in high school students Academic research paper on "Psychology"

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{"high school student" / "problem behavior" / "Sasang Personality Questionnaire" / "Youth Self-Report"}

Abstract of research paper on Psychology, author of scientific article — Mi Hwa Choi, Han Chae, Soo Jin Lee

Abstract Background Some studies have shown that Sasang typology is related to specific problem behaviors, but research on the associations between Sasang types and problem behaviors in children is scarce. The purpose of this study was to examine the associations between Sasang types and problem behaviors in Korean high school students. Methods A total of 686 Korean high school students (371 boys and 315 girls) completed the Korean version of Youth Self-Report (YSR) for describing the problem behaviors in adolescents and the Sasang Personality Questionnaire (SPQ) for measuring the temperament characteristics of Sasang typology. The correlation between YSR and SPQ subscales was investigated, and the differences of YSR among the high (30%), middle (40%), and low (30%) SPQ total score groups were examined with Analysis of variance. The profile analysis was also performed to compare YSR subscale profiles of three SPQ total score groups. Results The SPQ total score significantly (p <0.001) correlated positively with YSR externalizing problems (r =0.293 and r =0.248) and negatively with YSR internalizing problems (r =–0.211 and r =–0.150) in males and females, respectively. The YSR externalizing problem score is significantly higher in the high SPQ total score group (13.14±9.33 and 10.03±5.34 for males and females, respectively) than in the low SPQ total score group (8.18±5.53 and 8.58±5.73, respectively), and the YSR internalizing problem score is significantly higher in the low SPQ total score group (11.28±8.92 and 12.97±8.69 for males and females, respectively) than in the high SPQ total score group (9.35±9.00 and 11.28±7.58, respectively). The YSR profiles for three SPQ total score groups were significantly different for males (profile analysis, df =12.324, F =18.164, p <0.001) and females (df =12.677, F =11.601, p <0.001). Conclusion These results could be recognized as the SPQ, and Sasang typology would be useful for predicting the pathological patterns even of psychological problems in high school students. This study would be useful for the screening of psychopathological problems and character development in adolescents.

Academic research paper on topic "Analysis of the association between problem behaviors and Sasang typology in high school students"

Mii'iBITH^M MIIIHI.E IN PRESS

integr med res x x x (2016) xxx-xxx

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Original Article

Analysis of the association between problem behaviors and Sasang typology in high school students

Mi Hwa Choia, Han Chaeb, Soo Jin Leea'*

a Department of Psychotherapy, College of Nursing and Public Health, Kyungil University, Gyeongsan, Gyeongbuk, South Korea

b Division of Longevity and Biofunctional Medicine, School of Korean Medicine, Pusan National University, Busan, South Korea

article info abstract

Article history: Received 15 January 2016 Received in revised form 6 March 2016 Accepted 7 March 2016 Available online xxx

Keywords:

high school student problem behavior Sasang Personality Questionnaire Youth Self-Report

Background: Some studies have shown that Sasang typology is related to specific problem behaviors, but research on the associations between Sasang types and problem behaviors in children is scarce. The purpose of this study was to examine the associations between Sasang types and problem behaviors in Korean high school students.

Methods: A total of 686 Korean high school students (371 boys and 315 girls) completed the Korean version of Youth Self-Report (YSR) for describing the problem behaviors in ado-

lescents and the Sasang Personality Questionnaire (SPQ) for measuring the temperament characteristics of Sasang typology. The correlation between YSR and SPQ subscales was investigated, and the differences of YSR among the high (30%), middle (40%), and low (30%) SPQ total score groups were examined with Analysis of variance. The profile analysis was also performed to compare YSR subscale profiles of three SPQ total score groups. Results:The SPQ total score significantly (p <0.001) correlated positively with YSR externalizing problems (r = 0.293 and r = 0.248) and negatively with YSR internalizing problems (r = -0.211 and r = -0.150) in males and females, respectively. The YSR externalizing problem score is significantly higher in the high SPQ total score group (13.14 ± 9.33 and 10.03 ± 5.34 for males and females, respectively) than in the low SPQ total score group (8.18 ±5.53 and 8.58 ± 5.73, respectively), and the YSR internalizing problem score is significantly higher in the low SPQ total score group (11.28 ± 8.92 and 12.97 ± 8.69 for males and females, respectively) than in the high SPQ total score group (9.35 ± 9.00 and 11.28 ± 7.58, respectively). The YSR profiles for three SPQ total score groups were significantly different for males (profile analysis, df = 12.324, F = 18.164, p < 0.001) and females (df = 12.677, F = 11.601, p <0.001).

* Corresponding author. Department of Psychotherapy, College of Nursing and Public Health, Kyungil University, 50 Gamasil-gil, Gyeongsan, Gyeongbuk 38428, South Korea.

E-mail address leesooj@gmail.com (S.J. Lee). http://dx.doi.org/10.10167j.imr.2016.03.002

2213-4220/© 2016 Korea Institute of Oriental Medicine. Published by Elsevier. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

ConcIusion:These results could be recognized as the SPQ, and Sasang typology would be useful for predicting the pathological patterns even of psychological problems in high school students. This study would be useful for the screening of psychopathological problems and character development in adolescents.

© 2016 Korea Institute of Oriental Medicine. Published by Elsevier. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/

by-nc-nd/4.0/).

1. Introduction

Sasang typology, used in traditional Korean medicine, categorizes people into four Sasang types, Tae-Yang, Tae-Eum, So-Yang, and So-Eum types,1,2 and provides type-specific disease susceptibility for each Sasang type. Since Sasang typology is defined as mind-body medicine,3,4 the mind or psychological approach in Sasang typology has been well studied.4-12 The personality characteristics using various personality assessments such as Myers-Briggs Type Indicator, NEO-Personality Inventory Revised (NEO-PI-R), and Temperament and Character Inventory (TCI) have been examined.

It was reported that So-Yang types are extrovert in both Myers-Briggs Type Indicator and NEO-PI-R,7,11,12 and showed a low score in NEO-PI-R neuroticism,8 and So-Eum types are introvert in Myers-Briggs Type Indicator6,11 and demonstrated a high score of neuroticism in NEO-PI-R.8,12 In addition, So-Yang types displayed a high score of novelty seeking and a low score of harm avoidance, and So-Eum types showed the opposite features of a low novelty seeking score and a high harm avoidance score in TCI.4,9,10,13,14 The features of Tae-Eum types in TCI were located in the middle between So-Eum and So-Yang types.4

While the majority of the previous studies mentioned above have focused on the general psychological aspects of Sasang types, a relatively small amount of research focused on the pathological ones.15-19 The associations between Sasang typology and psychopathology or type-specific problem behaviors are examined by such instruments as Minnesota Multiphasic Personality Inventory (MMPI), Symptom Checklist-90-Revsied, Beck Depression Inventory, State-Trait Anxiety Inventory, and so forth. For instance, So-Eum types displayed a high score in MMPI Hypochondriasis and Psychasthenia scales,15,16 and a high trait anxiety score in State-Trait Anxiety Inventory,19 and So-Yang types showed a low score in MMPI Depression scale, a high score in MMPI Mania scale,15,16 and a low trait anxiety score in State-Trait Anxiety Inventory,19 which means that So-Eum types are more anxious and depressed than So-Yang types.

In other words, So-Eum types might have internalizing problem behaviors focusing on one's self and So-Yang types have externalizing problem behaviors involving the outside world, as suggested by the previous studies on Sasang typology4,9,10,13,14 and TCI.20-22 For measuring the problem behaviors, Achenbach System of Empirically Based Assessment, which has two high-order factors of externalizing problem behaviors (i.e., aggressive, rule-breaking behaviors) and internalizing problem behaviors (i.e., depression, anxiety, and somatic complaints) was used.23 However, some studies showed contrary results that So-Yang types displayed

higher scores in somatization in the Symptom Checklist-90-Revsied18 and demonstrated significantly higher scores in depression/anxiety and somatization scales17 in Child Behavior Checklist in a clinical setting.17

To sum up, there were mixed results regarding the relationship between psychopathology and Sasang typology, especially for So-Yang and So-Eum Sasang types. Moreover, those type-specific problem behaviors are mostly investigated in adult samples in both general and clinical settings, and not in children or adolescents because of a lack of proper assessment tools for Sasang types.17,24,25

Therefore, the aim of the current study is to examine the relationship between problem behaviors and Sasang types using the recently developed Sasang Personality Questionnaire (SPQ). We tested whether So-Yang types are associated with externalizing problem behaviors and So-Eum types with internalizing problem behaviors, as illustrated in Fig. 1 with correlation and Analysis of variance. This study would provide foundations for establishing psychopathological studies on adolescents with Sasang typology.

2. Methods

2.1. Participants

A total of 686 students from high schools in the Daegu metropolitan area completed the Youth Self-Report (YSR) and SPQ, which tapped the problem behaviors and Sasang personality characteristics, respectively. The procedures were approved by the Internal Review Board of Kyungil University, Gyeongsan, South Korea. All participants provided written informed consent for the study.

2.2. Sasang Personality Questionnaire

The SPQ26 is a recently developed 14-item self-report assessment tool measuring temperament characteristics from the perspective of the Sasang typology. The SPQhas shown acceptable clinical validity and reliable psychometric properties.26-28 Each item is composed of two opposite words, each describing a specific personality trait, and participants must choose one of three responses on a 3-point Likert scale (1 = delicate, 2 = average or middle, and 3 = tough).

The SPQ is based on the concepts of Yin-Yang and Confucianism and composed of three subscales that measure the behavioral (SPQ-Behavior), emotional (SPQ-Emotionality), and decision-making or cognitive components (SPQ-Cognition) of personality. Internal consistency of the SPQ for the present study was 0.76.

¡RIHMH^M AIIIHI.E IN PRESS

M.H. Choi et al/Problem Behaviors and SPQ

Fig. 1 - Sasang typology and subscales of problem behaviors in YSR. SPQ, Sasang Personality Questionnaire; YSR, Youth Self-Report.

2.3. Youth Self-Report

The problem behaviors of adolescents, in the age range of 12-17 years, was measured using the Korean version of the YSR,29 a questionnaire consisting of 118 items developed for measurement of problem behaviors in adolescents. YSR is originated from Achenbach System of Empirically Based Assessment.23 Adolescents were asked to rate the behavior for the preceding 6 months on a 3-point Likert scale (0 = not true at all, 1 = somewhat or sometimes true, and 2 = very true or often true). The Korean version of YSR was standardized and validated in 2011 and demonstrated good validity and reliability.29

The YSR yields three subscales of total score, internalizing problems, and externalizing problems, and eight empirically validated symptom clusters. Internalizing problem behaviors include anxious/depressed and withdrawn/depressed behaviors, and somatic complaints; externalizing problem behaviors includes rule-breaking behavior and aggressive behavior; and total problems include internalizing problems, externalizing problems, social problems, thought problems, attention problems, and other problems. Total, internalizing, and externalizing problems, and five empirically validated symptom clusters related to internalizing and externalizing problems are analyzed in the present study. Cronbach a values for the total, internalizing, and externalizing problem behaviors of the present study were 0.78, 0.75, and 0.90, respectively.

2.4. Statistical analysis

Descriptive statistics was used for sex and school year. The Pearson correlation coefficient was calculated to examine the correlations between the SPQ and subscales of YSR. We also divided the participants into three groups based on the SPQ

total score: groups with high (30%), middle (40%), and low (30%) SPQ scores, which conceptually corresponded to So-Yang, Tae-Eum, and So-Eum types, respectively. SPQ total score groups were compared with Analysis of variance, and Bonferroni or Dunnett's T3 post hoc analysis were applied depending on the results of Levene's homogeneity test. Finally, profile analysis for the test of parallelism and flatness was used to test the difference in the YSR profiles of high, middle, and low SPQ total score groups. Statistical analysis results were presented as frequency (%) or mean ± standard deviation, and statistical significance level was set at p < 0.05, p < 0.01, and p < 0.001, respectively. IBM SPSS Statistics 20.0 (IBM, Armonk, NY, USA) was used for all statistical analyses.

3. Results

3.1. Demographic characteristics of the participants

The school year and sex composition are described in Table 1. There were 371 (54.1%) boys and 315 (45.9%) girls, and the students comprised 250 (36.4%) sophomores, 246 juniors (35.8%), and 190 (27.7%) seniors. There were significant differences in school year and sex composition (x2 = 10.567, df =2, p <0.01).

3.2. Correlations between SPQ and YSR

Table 2 demonstrates the correlation coefficients between the SPQ and subscales of YSR. There were significant correlations between the SPQ and subscales of YSR; the correlation coefficients for internalizing problems, externalizing problems, anxious/depressed and withdrawn/depressed behaviors (related to internalizing problems), and rule-breaking and aggressive behaviors (related to externalizing problems) were, respectively, -0.211, 0.293, -0.145, -0.401, 0.220, and 0.306 in

Table 1 - Demographic characteristics of high school students

Sophomore Junior Senior Total

Boys 131 (52.4) Girls 119(47.6) Total 250 119 (48.4) 127(51.6) 246 121(63.7) 69(36.3) 190 371 (54.1) 315(45.9) 686

Data are presented as N (%). Significant differences between the frequency of school year and sex composition (x2 = 10.567, df =2, p <0.01).

4 Integr Med Res (2016) xxx-xxx

Table 2 - Correlation coefficients between SPQ and subscales of YSR in males and females

YSR Internalizing Externalizing Anxious/ Withdrawn/ Somatic Rule Aggression

total problem problem depressed depressed complaints breaking

Males SPQ 0.015 -0.211" 0.293" -0.145" -0.401" 0.033 0.220" 0.306"

Females 0.010 -0.150" 0.248" -0.118* -0.335" 0.040 0.161" 0.257"

SPQ, Sasang Personality Questionnaire; YSR, Youth Self-Report.

* p <0.05.

** p <0.01.

males and -0.150, 0.248, -0.118, -0.335, 0.161, and 0.257 in females.

3.3. SPQand YSR subscale scores for high, middle, and low SPQ score groups

The mean and standard deviation of high, middle, and low SPQ total score groups are presented in Tables 3 and 4. The subscales of YSR have significant differences among high, middle, and low SPQ total score groups in both males and females: internalizing problems, externalizing problems, anxious/depressed behavior, withdrawn/depressed behavior, rule-breaking behavior, and aggressive behavior in boys, and internalizing problems, externalizing problems, anxious/depressed, withdrawn/depressed, and aggressive behavior in girls. After post hoc analysis, the scores of internalizing problems, anxious/depressed, and withdrawn/depressed behavior were greater in the low SPQ group than in the high SPQ group of boys. The scores of externalizing problems,

rule-breaking behavior, and aggressive behavior were greater in the high SPQ group than in the low SPQ group of boys. For girls, the scores of internalizing problems, anxious/depressed behavior, and withdrawn/depressed behavior were greater in the low SPQgroup than in the high SPQgroup, and the scores of externalizing problems and aggressive behavior were greater in the high SPQ group than in the low SPQ group.

3.4. YSR profiles of high, middle, and low SPQ total score groups

YSR subscale profiles of the high, middle, and low SPQ total score groups were significantly different (Fig. 2, 3) in both boys and girls. For boys, YSR score profiles of the three groups were not flat (Greenhouse-Geisser test, df =3.218, F =173.963, p <0.001), and the interaction of three groups was significantly different (Greenhouse-Geisser correction, df =6.436, F = 30.129, p <0.001) as for the parallelism of YSR profiles. For girls, YSR score profiles of the three groups were not flat

Table 3 - SPQ and YSR subscales score (mean and SD) of high, middle, and low SPQ score groups in males

High SPQ Middle SPQ Low SPQ Total ANOVA Post hoc analysis

n (%) 116(31.27) 153(41.24) 102(27.50) 371 (100)

SPQ 34.04 ±2.56 27.54 ±1.79 21.42 ±2.23 27.89 ±5.31

YSR total 41.77 ±28.24 39.08 ±23.4 42.28 ±22.55 40.80 ± 24.77 F = 0.637, df = 2,368, p = 0.529

Internalizing 9.35 ± 9.00 10.78 ±8.46 14.23 ±8.84 11.28 ±8.92 F = 8.866, df= 2,368, p <0.001 High, middle < low

Anxious/depressed 4.84 ±4.50 5.05 ± 4.08 6.42 ± 4.60 5.36 ±4.40 F = 4.263, df= 2,368, p <0.05 High, middle < low

Withdrawal/depressed 2.22 ±2.68 3.52 ±2.94 5.61 ± 3.61 3.69 ±3.32 F=33.608, df= 2,368, p <0.001 High < middle < low

Somatic complaints 2.30 ±2.98 2.22 ±2.82 2.20 ±2.07 2.24 ±2.68 F = 0.050, df= 2,368, p = 0.951

Externalizing 13.14 ±9.33 10.15 ± 6.89 8.18 ±5.53 10.54 ±7.66 F = 12.467, df= 2,368, p <0.001 High > middle > low

Rule breaking 4.53 ± 4.14 3.55 ± 3.21 3.01 ± 2.38 3.71 ± 3.38 F = 5.876, df= 2,368, p <0.01 High > low

Aggression 8.61 ± 5.75 6.60 ±4.39 5.17 ±3.76 6.84 ±4.88 F = 14.861, df= 2,368, p <0.001 High > middle > low

ANOVA, Analysis of variance; SD, standard deviation; SPQ, Sasang ; Personality Questionnaire; YSR, Youth Self-Report.

M.H. Choi et al/Problem Behaviors and SPQ

Table 4 - SPQ and YSR subscale score (mean and SD) of high, middle, and low SPQ score groups in females

High SPQ Middle SPQ Low SPQ Total ANOVA Post hoc

analysis

n (%) 94(29.84) 139(44.13) 82 (26.03) 315 (100)

SPQ 34.32 ±2.04 28.65 ±1.63 22.79 ±2.19 28.82 ±4.71

YSR total 39.8 ±18.40 39.62 ±22.31 41.05 ±22.9 40.04 ±21.32 F = 0.124, df = 2,312,

p = 0.883

Internalizing 11.28 ±7.58 12.85 ±8.58 15.1 ±9.65 12.97 ±8.69 F = 4.350, df = 2,312, High < low

p <0.05

Anxious/depressed 5.72 ±3.98 6.27 ±3.93 7.44 ±4.67 6.41 ± 4.19 F = 3.895, df =2,312, High < low

p <0.05

Withdrawal/depressed 2.09 ±1.90 3.21 ±2.73 4.70 ±3.12 3.26 ±2.79 F = 21.679, df =2,312, High <

p <0.001 middle <

Somatic complaints 3.47 ±3.23 3.37 ±3.46 2.96 ±3.09 3.30 ±3.30 F=0.583, df =2,312,

p = 0.559

Externalizing 10.03 ± 5.34 8.60 ±6.14 6.87 ±4.99 8.58 ±5.73 F=6.933, df =2,312, High > low

p <0.001

Rule breaking 2.24 ±2.11 2.22 ±2.52 1.61 ±1.61 2.07 ±2.20 F = 2.445, — H DQQ df =2,312,

Aggression 7.79 ±3.94 6.38 ±4.22 5.26 ±3.95 6.51 ± 4.16 p = 0.088 F = 8.600, df =2,312, High >

p <0.001 middle, low

ANOVA, Analysis of variance; SD, standard deviation; SPQ, Sasang ; Personality Questionnaire; YSR, Youth Self-Report.

16 -14 12 10 8 6 4 2

0 _■_■_■_■_■_■_>

Internalizing Externalizing Anxious Withdrawn Somatic Rule-Breaking Aggression problem problem /Depressed /Depressed Complaints

Fig. 2 - YSR subscale profiles of high, middle, and low SPQ score groups in males. The YSR subscale profiles of the high, middle, and low SPQ score groups were significantly different (flatness with Greenhouse-Geisser test, df = 3.218, F = 173.963, p < 0.001; parallelism with Greenhouse-Geisser correction, df = 6.436, F = 30.129, p < 0.001). SPQ, Sasang Personality Questionnaire; YSR, Youth Self-Report.

(Greenhouse-Geisser test, df= 3.435, F =217.677, p <0.001) and the interaction of the three groups was significantly different (Greenhouse-Geisser correction, df = 6.870, F = 16.357, p < 0.001) as for the parallelism of YSR profiles.

4. Discussion

There have been extensive studies regarding the Sasang type-specific psychological characteristics. However, those studies have focused mostly on general personality aspects of adults,

and not children or adolescents. Therefore, the purpose of the current study is to examine the relationship between Sasang typology and problem behaviors in high school students with the recently developed and validated SPQ. We hypothesized that distinct psychopathology would emerge from the different Sasang types: internalizing problems are associated with So-Eum types and externalizing problems with So-Yang types. Additionally, the participants were divided according to sex, as previous studies supported that there were significant differences in psychological traits depending on sex in Sasang types.30'31

16 14 12 10 8 6 4 2 0

---0--- High SPQ

— o - Middle SPQ

—•— Low SPQ

Internalizing Externalizing Depression Withdrawal Somatization Rule violation Aggression problem problem Anxiety

Fig. 3 - YSR subscales of high, middle, and low SPQ score groups in females. The YSR subscale profiles of the high, middle, and low SPQ score groups were significantly different (flatness with Greenhouse-Geisser test, df = 3.435, F = 217.677, p <0.001; parallelism with Greenhouse-Geisser correction, df =6.870, F = 16.357, p <0.001). SPQ, Sasang Personality Questionnaire; YSR, Youth Self-Report.

The results demonstrated that there were significant correlations between the SPQ and subscales of YSR. The SPQ is negatively correlated with YSR internalizing problems, anxious/depressed behavior, and withdrawn/depressed behavior, which are associated with anxious, shy, and pessimistic behaviors of TCI harm avoidance.4,9 Such descriptions coincide with the So-Eum type as negative, nervous, and mild characteristics in Jema Lee's book Longevity and Life Preservation in Eastern Medicine.1 In addition, the SPQ is positively correlated with externalizing problems, and rule breaking and aggressive behaviors, which are associated with impulsivity, excitability, and risk-takingbehaviors of TCI novelty seeking4,9 and with extroversion of NEO-PI-R.4,9 Such explanations also concur with the statement of the So-Yang type as quick tempered, unstable, easily gettingbored, and externally oriented.1 These associations were also confirmed with the comparison of YSR subscale scores among SPQ groups. The participants were classified into three groups, high, middle, and low SPQ total score groups, which conceptually corresponded to So-Yang, Tae-Eum, and So-Eum types, respectively. There were significant differences in YSR subscales between the high and low SPQ total groups: externalizing problem and its subscales (e.g., rule-breaking and aggressive behaviors) and internalizing problem and its subscales (e.g., anxious/depressed and withdrawn/depressed behaviors). A post hoc analysis showed that the high SPQ total score group significantly scores higher than the low SPQ total score group in externalizing, rule-breaking, and aggressive behaviors and that the low SPQ total score group significantly scores higher than the high SPQ total score group in internalizing, anxious/depressed, and withdrawn/depressed behaviors. These findings corroborate with the results of correlation analysis described above.

To sum up, those who have high scores of SPQ would tend to have externalizing problem behaviors associated with the So-Yang type and those who have low scores of SPQ would tend to have internalizing problem behaviors associated with the So-Eum type. The middle SPQ score group corresponding to Tae-Eum type is in the middle of the high and low SPQ score groups as for the internalizing and externalizing problems of YSR, which can be expected from the previous studies that the novelty seeking and harm avoidance of Tae-Eum type are located between those of So-Yang and So-Eum Sasang types. Moreover, there might be a possibility of psychological symptoms or vulnerability according to each Sasang type similar to the physical type-specific symptoms. The present findings suggest that the distinct Sasang type would have its own psychological problems or symptoms that could be utilized for the preventive intervention of certain Sasang types.

Finally, regarding somatic complaints of YSR subscales (hypochondriasis in MMPI or somatization in Symptom Checklist-90-Revsied), there was no difference among the high, middle, or low SPQ total score groups. This result is not consistent with the findings of the previous studies.16,17 and it is prominent in profile analysis. That is, the high, middle, and low SPQ total score groups are different from each other except in somatic complaint subscales. It could possibly result from the differences in definitions of somatic complaints in the East and West. The difference in expression of somatiza-tion is often described to be a result of the cultural difference between the East and the West,32,33 and further research is needed to verify this result.

Several limitations of this study should be acknowledged. First, the SPQ is not a categorical diagnostic tool like the Questionnaire for the Sasang Constitution Classification II.34 However, there is no diagnostic tool for assessment of children

M.H. Choi et al/Problem Behaviors and SPQ

or adolescents except for the SPQ, which is the only instrument, with acceptable validity and clinical reliability, available for assessing Sasang types with a dimensional approach. Standardization of the SPQ in children and adolescents is required for future research on the association between Sasang types and psychopathology.

Second, there are a scarcity of research and inconsistency among the previous studies to study the type-specific psychopathology. Type-specific problem behaviors should be investigated in adults as well as in children with in clinical and nonclinical settings after standardization and utilization of the SPQ.

Last, we should be careful not to generalize the results of the present study to clinical samples. Psychological vulnerability expressed in the present study, which involved a community sample, might be different from the chief complaints reported in clinical settings.

This study showed that Sasang typology and SPQ would be useful and reliable for screening and predicting the pathophysiological profiles and suggest ways for prevention, treatment,24,25 and character development in high school students.

Conflicts of interest

The authors declare no conflicts of interest related to affiliated or sponsoring organizations.

references

1. Lee JM. Dong-Yi-Soo-Se-Bo-Won (Longevity and life preservation in oriental medicine). Seoul, Korea: Jae Ma Lee; 1894.

2. Chae H, Lyoo IK Lee SJ, Cho S, Bae H, Hong M, et al. An alternative way to individualized medicine: psychological and physical traits of Sasang typology. J Altern Complement Med 2003;9:519-28.

3. Kim JY, Pham DD. Sasang constitutional medicine as a holistic tailored medicine. Evid Based Complement Alternat Med 2009;6:11-9.

4. Park SH, Kim MG, Lee SJ, Kim JY, Chae H. Temperament and character profiles of Sasang typology in an adult clinical sample. Evid Based Complement Alternat Med 2011;2011:794795.

5. Chae H, Park SH, Lee SJ, Kim M-G, Wedding D, Kwon Y-K. Psychological profile of Sasang typology: a systematic review. Evid Based Complement Alternat Med 2009;6:21-9.

6. Cho YT, Koh B, Song IB. The validation study of the questionnaire of Sasang constitution classification: comparative analysis with sixteen personality factor questionnaire (16PF) & Myers Briggs Type Indicator (MBTI). Sasang 1994;6:21-39 [In Korean, English abstract].

7. Park HG, Lee JW. A study on the associations between Je-Ma Sasang constitutions and C. G. Jung's psychological tests. J Sasang Const Med 1998;10:41-50 [In Koran, English abstract].

8. Park HI. An analysis of Jung's psychological types, Sasang constitutions and the personality traits of undergraduates and comparisons of the three. Shim-Song Yon-Gu 2000;15:87-177 [In Korean].

9. Lee SJ, Park SH, Chae H. Temperament profiles of Sasang typology in a child clinical sample. Integr Med Res 2012;1:21-5.

10. Chae H, Lee SJ. Personality construct of Sasang Personality Questionnaire in an adolescent sample. Integr Med Res 2015;4:29-33.

11. Choi S, Chi S, Jung B, Ahn K, Koh B, Sung H. The study on the relationship between Sasang constitutions and Myers-Briggs type indicator. Korean J Orient Med 2000;6:47-57 [In Korean, English abstract].

12. Cho CH, Cho YS, Lee SK. Study of personality traits in So-yang, So-eum and Tae-eum using NEO-PI-R. Korean J Orient Med Physiol Pathol 2005;19:1491-5 [In Korean, English abstract].

13. Sung WY, Kim JY, Kim LH. Temperament and character profiles of Sasang Constitution in middle school students. J Orient Neuropsychiatry 2011;22:55-64 [In Korean, English abstract].

14. Choi DS, Kim LH, Sung WY, Han SJ, Shin DY, SongJM. Characteristics of each Sasang constitutional type as assessed by the Temperament and Character Inventory (TCI). J Sasang Const Med 2011;23:351-60 [In Korean, English abstract].

15. Kim JW, Kim JW, Koh BH, Song IB. The study of Sasang constitution discrimination and personal characteristics in Sasang constitution according to comparative analysis of QSCC & MMPI. J Korean Orient Med 1994;15:66-74 [In Korean, English abstract].

16. Kim JU, Kim JH, Hwang UW. Clinical study on personality characteristics of the alcoholic patients-with MMPI & Sasang constitution. J Orient Neuropsychiatry 1992;3:65-85 [In Korean, English abstract].

17. Lee SJ, Sim Y,Kim HJ, Kim HJ, Kim MG, Kim KS, et al. Analysis of Child Behavior Checklist (CBCL) problem behaviors of Sasang types in a child clinical sample. Pediatr Korean Med 2013;27:7-14 [In Korean, English abstract].

18. Chae H, Lee SJ, Park SJ, Kim B, Hong J, Hwang M, et al. Neurotic characteristics of Sasang types with SCL-90-R. Korean J Orient Physiol Pathol 2010;24:722-6 [In Korean, English abstract].

19. Seo W, Kim LH, Kwon BH, Song JM. A study on the psychological characteristics of Sasang constitution by using BDI and STAI. J Sasang Const Med 2000;12:136-43 [In Korean, English abstract].

20. Luby JL, Svrakic DM, McCallum K, Przybeck TR, Cloninger CR. The Junior Temperament and Character Inventory: preliminary validation of a child self-report measure. Psychol Rep 1999;84:1127-38.

21. Ruchkin V, Eisemann M, Cloninger C. Behaviour/emotional problems in male juvenile delinquents and controls in Russia: the role of personality traits. Acta Psychiatr Scand 1998;98:231-6.

22. Schmeck K, Poustka F. Temperament and disruptive behavior disorders. Psychopathology 2001;34:159-63.

23. Achenbach TM, Rescorla L. ASEBA school-age forms & profiles. Burlington, VT: Aseba Burlington; 2001.

24. Jung H, Ha HY, Lee SJ, Chae H. Effects of parenting attitude on K-CBCL scales. J Pediatr Korean Med 2013;27:1-10.

25. Ha HY, Jung H, Lee SJ, Chae H. Studies on relations between goodness of fit in mother-children temperament interaction and problem behaviors of children. Korean J Orient Physiol Pathol 2013;27:11-9.

26. Chae H, Lee S, Park SH, Jang E, Lee SJ. Development and validation of a personality assessment instrument for traditional Korean medicine: Sasang Personality Questionnaire. Evid Based Complement Alternat Med 2012;2012:657013.

27. Lee SJ, Park SH, Chae H. Study on the temperament construct of Sasang typology with biopsychological measures. Korean J Orient Physiol Pathol 2013;27:261-7 [In Korean, English abstract].

28. Chae H, Lee SJ, Park SH, Jang ES, Lee SW. Validation of Sasang Personality Questionnaire (SPQ) with positive and negative affection schedule and body mass index. J Sasang Constitut Med 2012;24:39-46 [In Korean, English abstract].

29. Oh KJ, Kim YA. Korean version of Youth Self Report. Seoul: Huno Consulting Inc.; 2011.

30. Lee SJ, Park SH, Cloninger CR, Kim YH, Hwang M, Chae H. Biopsychological traits of Sasang typology based on Sasang Personality Questionnaire and body mass index. BMC Complement Altern Med 2014;14:315.

31. Chae H, Kim YH, Park SH, Hwang EH, Kwon YK, Lee SJ. Study on the effects of Sasang psychobiological factors on general

health status. Korean J Orient Physiol Pathol 2014;28:452-9 [In Korean, English abstract].

32. Draguns JG. Culture in psychopathology: psychopathology in culture: taking a new look at an old problem. In: Plante TG, editor. Mental disorders of the new millennium. Vol. 2: Public and social problems. Westport (CT): Praeger Publishers; 2006.

33. Kleinman A. Anthropology and psychiatry: the role of culture in cross-cultural research on illness. Br J Psychiatry 1987;151:447-54.

34. Kim SH, Ko BH, Song IB. A study on the standardization of QSCC II. J Sasang Const Med 1996;8:187-246 [In Korean, English abstract].