<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.1 20151215//EN" "JATS-journalpublishing1.dtd">
<article xml:lang="KO" article-type="research-article">

<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Korean J Health Promot</journal-id>
<journal-id journal-id-type="publisher-id">KJHP</journal-id>
<journal-title-group>
<journal-title>Korean Journal of Health Promotion</journal-title>
</journal-title-group>
<issn pub-type="ppub">2234-2141</issn>
<issn pub-type="epub">2093-5676</issn>
<publisher>
<publisher-name>Korean Society for Health Promotion and Disease Prevention</publisher-name>
</publisher>
</journal-meta>

<article-meta>
<article-id pub-id-type="doi">10.15384/kjhp.2018.18.1.60</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>The Effectiveness of Problem-Solving Therapy Program Intervention in Reducing Depression of Older Cancer Patients</article-title>
</title-group>

<contrib-group>

<contrib contrib-type="author">
<name>
<surname>Yoon</surname>
<given-names>Hyunsook</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author" corresp="yes">
<name>
<surname>Kim</surname>
<given-names>Yojin</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Choi</surname>
<given-names>Kyoungwon</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Lim</surname>
<given-names>Yeon Ok</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Nam</surname>
<given-names>Ilsung</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Woonjeong</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
 
<contrib contrib-type="author">
<name>
<surname>Ham</surname>
<given-names>Hyejin</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

</contrib-group>

<aff id="A1"><label>1</label>Department of Social Welfare, Hallym University, Chuncheon, Korea.</aff>
<aff id="A2"><label>2</label>Hallym University Institute of Aging, Hallym University, Chuncheon, Korea.</aff>
<aff id="A3"><label>3</label>Department of Social Welfare, Sungkonghoe University, Seoul, Korea.</aff>

<author-notes>
<corresp>
Corresponding author: Yojin Kim, PhD. Department of Social Welfare, Hallym University, 1 Hallimdaehak-gil, Chuncheon 24252, Korea. Tel: +82-33-248-1336, Fax: +82-33-248-1776, <email>k96jin@hallym.ac.kr</email></corresp>
</author-notes>

<pub-date pub-type="ppub">
<month>03</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>31</day>
<month>03</month>
<year>2018</year>
</pub-date>
<volume>18</volume>
<issue>1</issue>
<fpage>60</fpage>
<lpage>70</lpage>

<history>
<date date-type="received">
<day>16</day>
<month>05</month>
<year>2017</year>
</date>
<date date-type="accepted">
<day>08</day>
<month>02</month>
<year>2018</year>
</date>
</history>

<permissions>
<copyright-statement>Copyright &#x00A9; 2018 Korean Society for Health Promotion and Disease Prevention</copyright-statement>
<copyright-year>2018</copyright-year>
<copyright-holder>Korean Society for Health Promotion and Disease Prevention</copyright-holder>
<license license-type="open-access" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>

<abstract>
<sec>
<title>Background</title>
<p>Appropriate intervention has not been developed and implemented because depression has been overlooked for older cancer patients. However, because depression is prevalent among this population, the need for the intervention is high. The objective of this study was to verify the effectiveness of the problem-solving therapy program in reducing depression level for older cancer patients.</p>
</sec>
<sec>
<title>Methods</title>
<p>The experimental participants were recruited by social workers in five university hospitals in Seoul, Gyeonggi, and Gangwon. Using Patient Health Questionnaire-9 (PHQ-9), older cancer patients who scored between 10&#x2013;19 points are selected. The subjects were assigned to the experimental group (30 patients) and the control group (30 patients) according to their will, and the experimental group participated in the problem solving therapy program for 6 weeks. The Center for Epidemiological Studies Depression 10 Scale and the Social Problem Solving Ability Scale were used to verify the effectiveness of the problem-solving program.</p>
</sec>
<sec>
<title>Results</title>
<p>The group homogeneity test indicated that the experimental group and the control group are homogeneous. The results of this study showed that the depression of older cancer patients had a significant positive correlation with the negative attitude toward the problem. The effectiveness of the problem solving program was significantly reduced in the experimental group (Z=&#x2212;3.534, <italic>P</italic>&#x003C;0.001). And the social problem solving ability of experimental group was significantly improved (Z=&#x2212;2.908, <italic>P</italic>=0.003).</p>
</sec>
<sec>
<title>Conclusions</title>
<p>The problem-solving therapy program is effective for depression in geriatric cancer patients and this result suggests that it can be implemented as an alternative medical treatment.</p>
</sec>
</abstract>

<kwd-group>
<kwd>Older cancer patients</kwd>
<kwd>Depression</kwd>
<kwd>Problem-solving therapy</kwd>
</kwd-group>

<funding-group>

<award-group>
<funding-source country="KR">
<institution-wrap>
<institution>National Research Foundation of Korea</institution>
<institution-id institution-id-type="CrossRef">http://dx.doi.org/10.13039/501100003725</institution-id>
</institution-wrap>
</funding-source>
<award-id>NRF-2014-S1A5B6A02048942</award-id>
</award-group>

</funding-group>

</article-meta>
</front>

<back>

<fn-group>
<fn fn-type="supported-by">
<p>This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2014-S1A5B6A02048942).</p>
</fn>
</fn-group>

<ref-list>
  <ref id="B1">
    <label>1</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Oh</surname>
          <given-names>CM</given-names>
        </name>
        <name>
          <surname>Won</surname>
          <given-names>YJ</given-names>
        </name>
        <name>
          <surname>Jung</surname>
          <given-names>KW</given-names>
        </name>
        <name>
          <surname>Kong</surname>
          <given-names>HJ</given-names>
        </name>
        <name>
          <surname>Cho</surname>
          <given-names>H</given-names>
        </name>
        <name>
          <surname>Lee</surname>
          <given-names>JK</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2013</article-title>
      <source>Cancer Res Treat</source>
      <year>2016</year>
      <volume>48</volume>
      <issue>2</issue>
      <fpage>436</fpage>
      <lpage>450</lpage>
    </element-citation>
  </ref>

  <ref id="B2">
    <label>2</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Kolva</surname>
          <given-names>E</given-names>
        </name>
        <name>
          <surname>Rosenfeld</surname>
          <given-names>B</given-names>
        </name>
        <name>
          <surname>Pessin</surname>
          <given-names>H</given-names>
        </name>
        <name>
          <surname>Breitbart</surname>
          <given-names>W</given-names>
        </name>
        <name>
          <surname>Brescia</surname>
          <given-names>R</given-names>
        </name>
      </person-group>
      <article-title>Anxiety in terminally ill cancer patients</article-title>
      <source>J Pain Symptom Manage</source>
      <year>2011</year>
      <volume>42</volume>
      <issue>5</issue>
      <fpage>691</fpage>
      <lpage>701</lpage>
    </element-citation>
  </ref>

  <ref id="B3">
    <label>3</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Derogatis</surname>
          <given-names>LR</given-names>
        </name>
        <name>
          <surname>Morrow</surname>
          <given-names>GR</given-names>
        </name>
        <name>
          <surname>Fetting</surname>
          <given-names>J</given-names>
        </name>
        <name>
          <surname>Penman</surname>
          <given-names>D</given-names>
        </name>
        <name>
          <surname>Piasetsky</surname>
          <given-names>S</given-names>
        </name>
        <name>
          <surname>Schmale</surname>
          <given-names>AM</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>The prevalence of psychiatric disorders among cancer patients</article-title>
      <source>JAMA</source>
      <year>1983</year>
      <volume>249</volume>
      <issue>6</issue>
      <fpage>751</fpage>
      <lpage>757</lpage>
    </element-citation>
  </ref>

  <ref id="B4">
    <label>4</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>de</surname>
          <given-names>Jonge</given-names>
          <suffix>P</suffix>
        </name>
        <name>
          <surname>Ormel</surname>
          <given-names>J</given-names>
        </name>
        <name>
          <surname>Slaets</surname>
          <given-names>JP</given-names>
        </name>
        <name>
          <surname>Kempen</surname>
          <given-names>GI</given-names>
        </name>
        <name>
          <surname>Ranchor</surname>
          <given-names>AV</given-names>
        </name>
        <name>
          <surname>van Jaarsveld</surname>
          <given-names>CH</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>Depressive symptoms in elderly patients predict poor adjustment after somatic events</article-title>
      <source>Am J Geriatr Psychiatry</source>
      <year>2004</year>
      <volume>12</volume>
      <issue>1</issue>
      <fpage>57</fpage>
      <lpage>64</lpage>
    </element-citation>
  </ref>

  <ref id="B5">
    <label>5</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Cho</surname>
          <given-names>J</given-names>
        </name>
        <name>
          <surname>Choi</surname>
          <given-names>EK</given-names>
        </name>
        <name>
          <surname>Kim</surname>
          <given-names>SY</given-names>
        </name>
        <name>
          <surname>Shin</surname>
          <given-names>DW</given-names>
        </name>
        <name>
          <surname>Cho</surname>
          <given-names>BL</given-names>
        </name>
        <name>
          <surname>Kim</surname>
          <given-names>CH</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>Association between cancer stigma and depression among cancer survivors: a nationwide survey in Korea</article-title>
      <source>Psychooncology</source>
      <year>2013</year>
      <volume>22</volume>
      <issue>10</issue>
      <fpage>2372</fpage>
      <lpage>2378</lpage>
    </element-citation>
  </ref>

  <ref id="B6">
    <label>6</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Yang</surname>
          <given-names>YL</given-names>
        </name>
        <name>
          <surname>Liu</surname>
          <given-names>L</given-names>
        </name>
        <name>
          <surname>Wang</surname>
          <given-names>Y</given-names>
        </name>
        <name>
          <surname>Wu</surname>
          <given-names>H</given-names>
        </name>
        <name>
          <surname>Yang</surname>
          <given-names>XS</given-names>
        </name>
        <name>
          <surname>Wang</surname>
          <given-names>JN</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>The prevalence of depression and anxiety among Chinese adults with cancer: a systematic review and meta-analysis</article-title>
      <source>BMC Cancer</source>
      <year>2013</year>
      <volume>13</volume>
      <fpage>393</fpage>
    </element-citation>
  </ref>

  <ref id="B7">
    <label>7</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Jorm</surname>
          <given-names>AF</given-names>
        </name>
      </person-group>
      <article-title>History of depression as a risk factor for dementia: an updated review</article-title>
      <source>Aust N Z J Psychiatry</source>
      <year>2001</year>
      <volume>35</volume>
      <issue>6</issue>
      <fpage>776</fpage>
      <lpage>781</lpage>
    </element-citation>
  </ref>

  <ref id="B8">
    <label>8</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Ell</surname>
          <given-names>K</given-names>
        </name>
        <name>
          <surname>Xie</surname>
          <given-names>B</given-names>
        </name>
        <name>
          <surname>Wells</surname>
          <given-names>A</given-names>
        </name>
        <name>
          <surname>Nedjat-Haiem</surname>
          <given-names>F</given-names>
        </name>
        <name>
          <surname>Lee</surname>
          <given-names>PJ</given-names>
        </name>
        <name>
          <surname>Vourlekis</surname>
          <given-names>B</given-names>
        </name>
      </person-group>
      <article-title>Economic stress among low-income women with cancer: effects on quality of life</article-title>
      <source>Cancer</source>
      <year>2008</year>
      <volume>112</volume>
      <issue>3</issue>
      <fpage>616</fpage>
      <lpage>625</lpage>
    </element-citation>
  </ref>

  <ref id="B9">
    <label>9</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Lim</surname>
          <given-names>YO</given-names>
        </name>
        <name>
          <surname>Yoon</surname>
          <given-names>HS</given-names>
        </name>
        <name>
          <surname>Nam</surname>
          <given-names>IS</given-names>
        </name>
        <name>
          <surname>Kim</surname>
          <given-names>YJ</given-names>
        </name>
        <name>
          <surname>Lee</surname>
          <given-names>HJ</given-names>
        </name>
        <name>
          <surname>Choi</surname>
          <given-names>KW</given-names>
        </name>
      </person-group>
      <article-title>Stress process of older cancer patient's depression undergoing Chemotherapy: focus on spirituality, optimism, and family support</article-title>
      <source>J Korean Gerontol Soc</source>
      <year>2014</year>
      <volume>34</volume>
      <issue>4</issue>
      <fpage>821</fpage>
      <lpage>842</lpage>
    </element-citation>
  </ref>

  <ref id="B10">
    <label>10</label>
    <element-citation publication-type="book">
      <person-group person-group-type="author">
        <name>
          <surname>Park</surname>
          <given-names>KS</given-names>
        </name>
        <name>
          <surname>Choi</surname>
          <given-names>ES</given-names>
        </name>
      </person-group>
      <source>Problem-Solving Therapy: A Positive Approach to Clinical Intervention.</source>
      <publisher-loc>Seoul</publisher-loc>
      <publisher-name>HAKJISA corp</publisher-name>
      <year>2008</year>
      <fpage>139</fpage>
      <lpage>143</lpage>
      <comment></comment>
    </element-citation>
  </ref>

  <ref id="B11">
    <label>11</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Zhang</surname>
          <given-names>AY</given-names>
        </name>
        <name>
          <surname>Cooper</surname>
          <given-names>GS</given-names>
        </name>
      </person-group>
      <article-title>Recognition of depression and anxiety among elderly colorectal cancer patients</article-title>
      <source>Nurs Res Pract</source>
      <year>2010</year>
      <volume>2010</volume>
      <fpage>693961</fpage>
    </element-citation>
  </ref>

  <ref id="B12">
    <label>12</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Gellis</surname>
          <given-names>ZD</given-names>
        </name>
        <name>
          <surname>Bruce</surname>
          <given-names>ML</given-names>
        </name>
      </person-group>
      <article-title>Problem solving therapy for subthreshold depression in home healthcare patients with cardiovascular disease</article-title>
      <source>Am J Geriatr Psychiatry</source>
      <year>2010</year>
      <volume>18</volume>
      <issue>6</issue>
      <fpage>464</fpage>
      <lpage>474</lpage>
    </element-citation>
  </ref>

  <ref id="B13">
    <label>13</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Are&#x00E1;n</surname>
          <given-names>PA</given-names>
        </name>
        <name>
          <surname>Raue</surname>
          <given-names>P</given-names>
        </name>
        <name>
          <surname>Mackin</surname>
          <given-names>RS</given-names>
        </name>
        <name>
          <surname>Kanellopoulos</surname>
          <given-names>D</given-names>
        </name>
        <name>
          <surname>McCulloch</surname>
          <given-names>C</given-names>
        </name>
        <name>
          <surname>Alexopoulos</surname>
          <given-names>GS</given-names>
        </name>
      </person-group>
      <article-title>Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction</article-title>
      <source>Am J Psychiatry</source>
      <year>2010</year>
      <volume>167</volume>
      <issue>11</issue>
      <fpage>1391</fpage>
      <lpage>1398</lpage>
    </element-citation>
  </ref>

  <ref id="B14">
    <label>14</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Nezu</surname>
          <given-names>AM</given-names>
        </name>
        <name>
          <surname>Nezu</surname>
          <given-names>CM</given-names>
        </name>
        <name>
          <surname>Houts</surname>
          <given-names>PS</given-names>
        </name>
        <name>
          <surname>Friedman</surname>
          <given-names>SH</given-names>
        </name>
        <name>
          <surname>Faddis</surname>
          <given-names>S</given-names>
        </name>
      </person-group>
      <article-title>Relevance of problem-solving therapy to psychosocial oncology</article-title>
      <source>J Psychosoc Oncol</source>
      <year>1999</year>
      <volume>16</volume>
      <issue>3-4</issue>
      <fpage>5</fpage>
      <lpage>26</lpage>
    </element-citation>
  </ref>

  <ref id="B15">
    <label>15</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Nezu</surname>
          <given-names>AM</given-names>
        </name>
        <name>
          <surname>Nezu</surname>
          <given-names>CM</given-names>
        </name>
        <name>
          <surname>Felgoise</surname>
          <given-names>SH</given-names>
        </name>
        <name>
          <surname>McClure</surname>
          <given-names>KS</given-names>
        </name>
        <name>
          <surname>Houts</surname>
          <given-names>PS</given-names>
        </name>
      </person-group>
      <article-title>Project Genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients</article-title>
      <source>J Consult Clin Psychol</source>
      <year>2003</year>
      <volume>71</volume>
      <issue>6</issue>
      <fpage>1036</fpage>
      <lpage>1048</lpage>
    </element-citation>
  </ref>

  <ref id="B16">
    <label>16</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Hopko</surname>
          <given-names>DR</given-names>
        </name>
        <name>
          <surname>Armento</surname>
          <given-names>ME</given-names>
        </name>
        <name>
          <surname>Robertson</surname>
          <given-names>SM</given-names>
        </name>
        <name>
          <surname>Ryba</surname>
          <given-names>MM</given-names>
        </name>
        <name>
          <surname>Carvalho</surname>
          <given-names>JP</given-names>
        </name>
        <name>
          <surname>Colman</surname>
          <given-names>LK</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomized trial</article-title>
      <source>J Consult Clin Psychol</source>
      <year>2011</year>
      <volume>79</volume>
      <issue>6</issue>
      <fpage>834</fpage>
      <lpage>849</lpage>
    </element-citation>
  </ref>

 <ref id="B17">
    <label>17</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Fann</surname>
          <given-names>JR</given-names>
        </name>
        <name>
          <surname>Fan</surname>
          <given-names>MY</given-names>
        </name>
        <name>
          <surname>Un&#x00FC;tzer</surname>
          <given-names>J</given-names>
        </name>
      </person-group>
      <article-title>Improving primary care for older
adults with cancer and depression</article-title>
      <source>J Gen Intern Med</source>
      <year>2009</year>
      <volume>24</volume>
      <supplement>Suppl 2</supplement>
      <fpage>S417</fpage>
      <lpage>S424</lpage>
    </element-citation>
  </ref>

  <ref id="B18">
    <label>18</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Malouff</surname>
          <given-names>JM</given-names>
        </name>
        <name>
          <surname>Thorsteinsson</surname>
          <given-names>EB</given-names>
        </name>
        <name>
          <surname>Schutte</surname>
          <given-names>NS</given-names>
        </name>
      </person-group>
      <article-title>The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis</article-title>
      <source>Clin Psychol Rev</source>
      <year>2007</year>
      <volume>27</volume>
      <issue>1</issue>
      <fpage>46</fpage>
      <lpage>57</lpage>
    </element-citation>
  </ref>

  <ref id="B19">
    <label>19</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Bell</surname>
          <given-names>AC</given-names>
        </name>
        <name>
          <surname>D'Zurilla</surname>
          <given-names>TJ</given-names>
        </name>
      </person-group>
      <article-title>Problem-solving therapy for depression: a meta-analysis</article-title>
      <source>Clin Psychol Rev</source>
      <year>2009</year>
      <volume>29</volume>
      <issue>4</issue>
      <fpage>348</fpage>
      <lpage>353</lpage>
    </element-citation>
  </ref>

  <ref id="B20">
    <label>20</label>
    <element-citation publication-type="book">
      <person-group person-group-type="author">
        <name>
          <surname>Nezu</surname>
          <given-names>AM</given-names>
        </name>
        <name>
          <surname>D'Zurilla</surname>
          <given-names>TJ</given-names>
        </name>
      </person-group>
      <source>Problem-solving therapy : a positive approach to clinical intervention</source>
      <publisher-loc>New York</publisher-loc>
      <publisher-name>Springer Publishing Company</publisher-name>
      <year>2006</year>
    </element-citation>
  </ref>

  <ref id="B21">
    <label>21</label>
        <element-citation publication-type="webpage">
      <collab>Advancing Integrated Mental Health Solutions (AIMS) CENTER</collab>
      <source>IMPACT: Improving Mood -- Promoting Access to Collaborative
Treatment [Internet]</source>
      <publisher-loc>Seattle</publisher-loc>
      <publisher-name>AIMS CENTER</publisher-name>
      <date-in-citation content-type="access-date">Mar 15, 2017</date-in-citation>
      <comment>Available from: <ext-link ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://aims.uw.edu/impact-improving-mood-promoting-access-collaborative-treatment">http://aims.uw.edu/impact-improving-mood-promoting-access-collaborative-treatment</ext-link></comment>
    </element-citation>
  </ref>


  <ref id="B22">
    <label>22</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Yoon</surname>
          <given-names>HS</given-names>
        </name>
        <name>
          <surname>Koo</surname>
          <given-names>BM</given-names>
        </name>
        <name>
          <surname>Lee</surname>
          <given-names>K</given-names>
        </name>
        <name>
          <surname>Lee</surname>
          <given-names>JY</given-names>
        </name>
      </person-group>
      <article-title>The effectiveness of problem-solving treatment on geriatric depression</article-title>
      <source>J Korean Gerontol Soc</source>
      <year>2010</year>
      <volume>30</volume>
      <issue>3</issue>
      <fpage>871</fpage>
      <lpage>894</lpage>
    </element-citation>
  </ref>

  <ref id="B23">
    <label>23</label>
    <element-citation publication-type="book">
      <person-group person-group-type="author">
        <name>
          <surname>Lee</surname>
          <given-names>HK</given-names>
        </name>
      </person-group>
      <source>Handbook of Positive psychology</source>
      <publisher-loc>Seoul</publisher-loc>
      <publisher-name>HAKJISA corp</publisher-name>
      <year>2008</year>
    </element-citation>
  </ref>

  <ref id="B24">
    <label>24</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Irwin</surname>
          <given-names>M</given-names>
        </name>
        <name>
          <surname>Artin</surname>
          <given-names>KH</given-names>
        </name>
        <name>
          <surname>Oxman</surname>
          <given-names>MN</given-names>
        </name>
      </person-group>
      <article-title>Screening for depression in the older adult: criterion validity of the 10-item center for epidemiological studies depression scale (CES-D)</article-title>
      <source>Arch Intern Med</source>
      <year>1999</year>
      <volume>159</volume>
      <issue>15</issue>
      <fpage>1701</fpage>
      <lpage>1704</lpage>
    </element-citation>
  </ref>

  <ref id="B25">
    <label>25</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Kim</surname>
          <given-names>HS</given-names>
        </name>
        <name>
          <surname>Park</surname>
          <given-names>SM</given-names>
        </name>
        <name>
          <surname>Jang</surname>
          <given-names>SN</given-names>
        </name>
        <name>
          <surname>Kwon</surname>
          <given-names>S</given-names>
        </name>
      </person-group>
      <article-title>Depressive symptoms, chronic medical illness, and health care utilization: findings from the Korean Longitudinal Study of Ageing (KLoSA)</article-title>
      <source>Int Psychogeriatr</source>
      <year>2011</year>
      <volume>23</volume>
      <issue>8</issue>
      <fpage>1285</fpage>
      <lpage>1293</lpage>
    </element-citation>
  </ref>

  <ref id="B26">
    <label>26</label>
    <element-citation publication-type="book">
  <person-group person-group-type="author">
        <name>
          <surname>D'Zurilla</surname>
          <given-names>TJ</given-names>
        </name>
        <name>
          <surname>Nezu</surname>
          <given-names>AM</given-names>
        </name>
        <name>
          <surname>Maydeu-Olivares</surname>
          <given-names>Cancer</given-names>
        </name>
      </person-group>
      <source>Social problem-solving inventory Revised (SPSI-R): Technical manual</source>
      <publisher-loc>North Tonawanda</publisher-loc>
      <publisher-name>Multi-Health Systems</publisher-name>
      <year>2002</year>
    </element-citation>
  </ref>

  <ref id="B27">
    <label>27</label>
    <element-citation publication-type="confproc">
      <person-group person-group-type="author">
        <name>
          <surname>Kim</surname>
          <given-names>SY</given-names>
        </name>
      </person-group>
      <source>Statistical analysis based on experimental studies</source>
      <conf-name>Survey Research Spring Conference</conf-name>
      <conf-date>June 9, 2007</conf-date>
      <conf-loc>Seoul National University</conf-loc>
      <publisher-loc> Seoul</publisher-loc>
      <publisher-name>The Korean Association for Survey Research</publisher-name>
      <year>2007</year>
    </element-citation> 
  </ref>

  <ref id="B28">
    <label>28</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Baer</surname>
          <given-names>RA</given-names>
        </name>
      </person-group>
      <article-title>Mindfulness training as a clinical intervention: a conceptual and empirical review.</article-title>
      <source>CLIN PSYCHOL-SCI PR</source>
      <year>2003</year>
      <volume>10</volume>
      <issue>2</issue>
      <fpage>125</fpage>
      <lpage>143</lpage>
    </element-citation>
  </ref>

  <ref id="B29">
    <label>29</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Panza</surname>
          <given-names>F</given-names>
        </name>
        <name>
          <surname>Frisardi</surname>
          <given-names>V</given-names>
        </name>
        <name>
          <surname>Capurso</surname>
          <given-names>C</given-names>
        </name>
        <name>
          <surname>D'Introno</surname>
          <given-names>A</given-names>
        </name>
        <name>
          <surname>Colacicco</surname>
          <given-names>AM</given-names>
        </name>
        <name>
          <surname>Imbimbo</surname>
          <given-names>BP</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>Late-life depression, mild cognitive impairment, and dementia: possible continuum?</article-title>
      <source>Am J Geriatr Psychiatry</source>
      <year>2010</year>
      <volume>18</volume>
      <issue>2</issue>
      <fpage>98</fpage>
      <lpage>116</lpage>
    </element-citation>
  </ref>

  <ref id="B30">
    <label>30</label>
    <element-citation publication-type="journal">
      <person-group person-group-type="author">
        <name>
          <surname>Richard</surname>
          <given-names>E</given-names>
        </name>
        <name>
          <surname>Reitz</surname>
          <given-names>C</given-names>
        </name>
        <name>
          <surname>Honig</surname>
          <given-names>LH</given-names>
        </name>
        <name>
          <surname>Schupf</surname>
          <given-names>N</given-names>
        </name>
        <name>
          <surname>Tang</surname>
          <given-names>MX</given-names>
        </name>
        <name>
          <surname>Manly</surname>
          <given-names>JJ</given-names>
        </name>
        <etal/>
      </person-group>
      <article-title>Late-life depression, mild cognitive impairment, and dementia</article-title>
      <source>JAMA Neurol</source>
      <year>2013</year>
      <volume>70</volume>
      <issue>3</issue>
      <fpage>374</fpage>
      <lpage>382</lpage>
    </element-citation>
  </ref>
</ref-list>


</back>

<floats-group>

<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption>
<title>Organization and contents of sessions</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjhp-18-60-i001"></graphic>
</table-wrap>

<table-wrap position="float" id="T2">
<label>Table 2</label>
<caption>
<title>General and disease characteristics<sup>a</sup></title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjhp-18-60-i002"></graphic>
<table-wrap-foot>
<fn>
<p>Abbreviations: GIST, gastrointestinal stromal tumor; GB, gallbladder.</p>
<p>Values are presented as number (%) unless otherwise indicated.</p>
<p><sup>a</sup><italic>P</italic>-values using the results of the fisher's exact test.</p>
</fn>
</table-wrap-foot>
</table-wrap>

<table-wrap position="float" id="T3">
<label>Table 3</label>
<caption>
<title>Normality test in experimental and control group</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjhp-18-60-i003"></graphic>
<table-wrap-foot>
<fn>
<p>Abbreviations: W, Shapiro-Wilk's W statistic; CES-D10, Center for Epidemiological Studies Depression 10 Scale.</p>
<p>The normality test was performed using the Shapiro-Wilk test.</p>
</fn>
</table-wrap-foot>
</table-wrap>

<table-wrap position="float" id="T4">
<label>Table 4</label>
<caption>
<title>Pre-homogeneity test of experimental and control group</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjhp-18-60-i004"></graphic>
<table-wrap-foot>
<fn>
<p>Abbreviations: CES-D10, Center for Epidemiological Studies Depression 10 Scale.</p>
</fn>
</table-wrap-foot>
</table-wrap>

<table-wrap position="float" id="T5">
<label>Table 5</label>
<caption>
<title>Correlation between major variables, depression and social problem solving ability</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjhp-18-60-i005"></graphic>
<table-wrap-foot>
<fn>
<p>Abbreviations: CES-D10, Center for Epidemiological Studies Depression 10 Scale; SPS, social problem solving; PPO, positive problem orientation; NPO, negative problem orientation; RPS, rational problem solving style; ICS, impulsive careless style.</p>
<p>Analysis was used to Spearman's correlation sign ranked.</p>
<p><sup>a</sup><italic>P</italic>&#x003C;0.01, <sup>b</sup><italic>P</italic>&#x003C;0.05.</p>
</fn>
</table-wrap-foot>
</table-wrap>

<table-wrap position="float" id="T6">
<label>Table 6</label>
<caption>
<title>Pre and post-ranking analysis of CES-D10 (depression) and social problem solving ability</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjhp-18-60-i006"></graphic>
<table-wrap-foot>
<fn>
<p>Abbreviations: CES-D10, Center for Epidemiological Studies Depression 10 Scale; N, number; Exp., experimental group; Cont., control group. When comparing pretest and posttest of experimental and control group was used for nonparametric statistics of Wilcoxon signed rank test (posttest-pretest).</p>
<p><sup>a</sup>Posttest&#x003C;pretest.</p>
<p><sup>b</sup>Posttest=pretest.</p>
<p><sup>c</sup>Posttest&#x003E;pretest.</p>
<p><sup>d</sup>Based on positive ranks.</p>
<p><sup>e</sup>Based on negative ranks.</p>
</fn>
</table-wrap-foot>
</table-wrap>

</floats-group>

</article>