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Mental Health and Extracurricular Education in Korean First Graders: A School-Based Cross-Sectional Study

Hyun Ju Hong, MD, PhD; Young Shin Kim, MD, MPH, PhD; Duk-In Jon, MD, PhD; Jeong Ho Soek, MD, PhD; Narei Hong, MD, PhD;   Jill M. Harkavy-Friedman, PhD; Ann M. Miller, MD, PhD; and Laurence L. Greenhill, MD

Published: February 8, 2011

Article Abstract

Objective: This study explores the results of mental health screening in Korean first graders in association with the amount of time the children spent in extracurricular education.

Method: The study included a community sample of 761 boys and girls, with a mean age of 6.6 years, collected from 5 elementary schools in Gunpo-si, South Korea, in July 2007. Primary caregivers completed a questionnaire that included information on demographic characteristics, the amount of time the children spent in extracurricular education and other activities, and an adapted form of the Behavior Assessment System for Children, Second Edition (BASC-2) to screen for mental health problems.

Results: These first graders spent a mean of a little over 2 hours each day in extracurricular education. Extracurricular education demonstrated positive correlations with 4 BASC-2 domains, including hyperactivity (r = 0.092, P < .05), aggression (r = 0.073, P < .05), conduct problems (r = 0.073, P < .05) and depression (r = 0.137, P < .01). A positive linear relationship between depression and extracurricular education was also evident in regression analyses (F = 2.25, R2 = 0.022, P = .001). The relationship held true even when controlling for time spent with parents, time spent with friends, and time spent asleep. Post hoc analyses revealed that children receiving more than 4 hours of extracurricular education per day showed a sharp increase in depressive symptoms as well as a decrease in the amount of time spent with caregivers.

Conclusions: Results of this study demonstrate that excessive amounts of time spent in extracurricular education (greater than 4 hours per day) may be associated with depression in school-aged children. These findings have relevance for mental health screening and educational policy.

J Clin Psychiatry

Submitted: December 12, 2009; accepted June 14, 2010.

Online ahead of print: February 8, 2011 (doi:10.4088/JCP.09m05907gry).

Corresponding author: Hyun Ju Hong, MD, PhD, Department of Psychiatry, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong Dongan-gu Anyang-si Gyeonggido, Republic of Korea (

Volume: 72

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