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Inequality can increase the risk of poor mental health. Objective measures explain the effects of socioeconomic disparities, but individuals may perceive inequality differently.
Aim
We aimed to investigate the association between the perception of economic inequality and depressive symptoms and suicide ideation.
Method
We used data from the Survey of Korean Youths’ Lives, a nationally representative cross-sectional study of 14 918 young adults aged 19−34 years in South Korea. Multivariate logistic regression analysis was conducted to assess the association between perceived economic inequalities (i.e. income inequality and inequality of intergenerational mobility) and depressive symptoms/suicide ideation. Additionally, subgroup analyses were performed based on objective and subjective income levels.
Results
Young adults with a high perception of economic inequality were more likely to experience depressive symptoms and suicide ideation. For example, those with a high perception of intergenerational mobility inequality had higher odds of depressive symptoms (odds ratio 1.82, 95% CI 1.49, 2.23) and suicide ideation (odds ratio 1.87, 95% CI 1.35, 2.60). Statistical evidence showed no interaction between the perception of inequalities and income, suggesting that a high perception of inequalities is associated with depressive symptoms and suicidal ideation, regardless of income. Nevertheless, the strongest association with poor mental health was observed in those with high perceived inequality and low income.
Conclusions
This study shows that the way young adults perceive economic inequality could affect their depressive symptoms and suicidal ideation. The findings highlight the importance of reducing these perceptions and addressing economic inequalities to improve mental health.
Aims: There is limited real-world evidence for patients with treatment-resistant depression (TRD) receiving esketamine nasal spray in Korea. This study is aimed to evaluate the acute safety and efficacy of intranasal esketamine in patients with TRD from a university hospital in Korea.
Methods: This open-label and prospective study used data collected from the Wonkwang University Hospital. Patients with TRD received esketamine plus an oral antidepressant during the treatment period. This study comprised a 4-week screening, 2-week induction and 2-week follow-up.
Results: A total of 22 TRD patients received esketamine April 2021–April 2023. This group was predominantly female, and have several psychiatric comorbidities and high exposure to psychiatric medications. We observed significant reductions (p<0.001) in average Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impression severity (CGI-S) from baseline (HAM-D: 25.6+5.3, CGI-S: 5.1+1.5) to last available treatment(HAM-D: 19.6+3.9, CGI-S: 3.0+1.2). Suicidal thought also significantly reduced from baseline(2.33+0.7) to last treatment (1.37+0.6)(p<0.001).
Compared with the baseline, 23% of HAM-D, 43% of CGI-S and 42% of suicidal thought of TRD patients reduced in the 4 weeks. There were no reports of serious adverse events.
Conclusion: The acute safety and efficacy of esketamine in the Korean patients was generally consistent with the international studies. There was no new safety signal and no indication for abuse. Acute efficacy occurred early during the induction phase.
The choroid plexus produces cerebrospinal fluid, which is crucial for glymphatic system function. Evidence suggests that changes in the volume of the choroid plexus may be associated with glymphatic system function. Therefore, this study aimed to investigate alterations in choroid plexus volume in patients with migraines compared with healthy controls.
Methods:
We enrolled 59 patients with migraines (39 and 20 with episodic and chronic migraines, respectively) and 61 healthy controls. All participants underwent brain magnetic resonance imaging, including three-dimensional T1-weighted imaging. We analyzed and compared choroid plexus volumes between patients with episodic migraines, those with chronic migraines and healthy controls. Additionally, we evaluated the association between choroid plexus volume and the clinical characteristics of patients with migraine.
Results:
The choroid plexus volume in patients with chronic migraines was higher than that in healthy controls (2.018 vs. 1.698%, p = 0.002) and patients with episodic migraines (2.018 vs. 1.680%, p = 0.010). However, no differences were observed in choroid plexus volumes between patients with episodic migraine and healthy controls. Choroid plexus volume was positively correlated with age in patients with migraines (r = 0.301, p = 0.020) and in healthy controls (r = 0.382, p = 0.002).
Conclusion:
We demonstrated significant enlargement of the choroid plexus in patients with chronic migraine compared with healthy controls and those with episodic migraine. This finding suggests that chronic migraine may be associated with glymphatic system dysfunction.
Childhood trauma can cause deficits in emotional regulation. However, few studies have investigated childhood trauma and emotional regulation skills in patients with mood disorders. We aimed to investigate how childhood trauma and Emotion Regulation Skills Questionnaire (ERSQ) scores are associated with mood disorders.
This study included 779 patients with mood disorders (major depressive disorder [MDD, n = 240], bipolar I disorder [BDI, n = 121], and bipolar II disorder [BDII, n = 418]). We used their Childhood Trauma Questionnaire-Short Form (CTQ) and ERSQ scores for the evaluation.
The between-group differences in CTQ and ERSQ scores were examined. The CTQ and ERSQ total scores were negatively correlated. Among the CTQ subscales, emotional neglect showed a significant correlation with the ERSQ total score, whereas acceptance and tolerance showed higher negative correlations with the CTQ than with the other ERSQ subscales. The negative relationship between emotional regulation and childhood trauma varied significantly depending on the group, with the BDI group showing a more prominent association than the other groups.
Based on various mood disorders, we observed associations between childhood trauma and emotional regulation skills. Consequently, our study offers notable insights for future research on the impact of childhood trauma on ERSQ.
We derive a sufficient condition for a sparse random matrix with given numbers of non-zero entries in the rows and columns having full row rank. The result covers both matrices over finite fields with independent non-zero entries and $\{0,1\}$-matrices over the rationals. The sufficient condition is generally necessary as well.
Resilience has been recently considered one of the possible mechanisms for the association between morningness–eveningness and depression. Meanwhile, anxiety is closely associated with mood disorder, but its association with morningness–eveningness is unclear. Therefore, this study aimed to explore the mediating effects of resilience and anxiety on morningness–eveningness and depression as the possible mechanisms.
Methods:
This study included patient group and nonpatient group. Patient group consists of 743 patients with mood disorders [Major Depressive Disorder (MDD), 233; Bipolar Disorder I (BDI), 113; Bipolar Disorder II (BDII), 397] whereas nonpatient group consists of 818 individuals without mood disorder. The Composite Scale of Morningness, Connor–Davidson Resilience Scale, Self-Rating Depression Scale, and Beck Anxiety Inventory were used to evaluate morningness–eveningness, resilience, anxiety, and depression, respectively.
Results:
Our model provided a good fit for the data. The association between morningness–eveningness and depression symptoms was partially serially mediated by resilience and anxiety in both the patient and nonpatient groups. The patient group exhibited significantly stronger morningness–eveningness toward resilience and anxiety than the nonpatient group. In the indirect effect of morningness–eveningness on depression, group differences exist only through each mediation of resilience and anxiety, not through serial mediation.
Conclusion:
Our results expand on the mechanism underlying the association between morningness–eveningness and depression. They highlight the importance of morningness–eveningness modification to increase resilience and the need to consider anxiety jointly in this process.
This study aimed to investigate the diverse clinical manifestations and simple early biomarkers predicting mortality of COVID-19 patients admitted to the emergency department (ED). A total of 710 patients with COVID-19 were enrolled from 6,896 patients presenting to the ED between January 2022 and March 2022. During the study period, a total of 478 patients tested positive for COVID-19, among whom 222 (46.4%) presented with extrapulmonary manifestations of COVID-19; 49 (10.3%) patients displayed gastrointestinal manifestations, followed by neurological (n = 41; 8.6%) and cardiac manifestations (n = 31; 6.5%). In total, 54 (11.3%) patients died. A Cox proportional hazards model revealed that old age, acute kidney injury at presentation, increased total leukocyte counts, low platelet counts, decreased albumin levels, and increased LDH levels were the independent predictors of mortality. The albumin levels exhibited the highest area under the curve in receiver operating characteristic analysis, with a value of 0.860 (95% confidence interval, 0.796–0.875). The study showed the diverse clinical presentations and simple-to-measure prognostic markers in COVID-19 patients presenting to the ED. Serum albumin levels can serve as a novel and simple early biomarker to identify COVID-19 patients at high risk of death.
The menopause transition is a vulnerable period that can be associated with changes in mood and cognition. The present study aimed to investigate whether a symptomatic menopausal transition increases the risks of depression, anxiety, and sleep disorders.
Methods
This population-based, retrospective cohort study analysed data from five electronic health record databases in South Korea. Women aged 45–64 years with and without symptomatic menopausal transition were matched 1:1 using propensity-score matching. Subgroup analyses were conducted according to age and use of hormone replacement therapy (HRT). A primary analysis of 5-year follow-up data was conducted, and an intention-to-treat analysis was performed to identify different risk windows over 5 or 10 years. The primary outcome was first-time diagnosis of depression, anxiety, and sleep disorder. We used Cox proportional hazard models and a meta-analysis to calculate the summary hazard ratio (HR) estimates across the databases.
Results
Propensity-score matching resulted in a sample of 17,098 women. Summary HRs for depression (2.10; 95% confidence interval [CI] 1.63–2.71), anxiety (1.64; 95% CI 1.01–2.66), and sleep disorders (1.47; 95% CI 1.16–1.88) were higher in the symptomatic menopausal transition group. In the subgroup analysis, the use of HRT was associated with an increased risk of depression (2.21; 95% CI 1.07–4.55) and sleep disorders (2.51; 95% CI 1.25–5.04) when compared with non-use of HRT.
Conclusions
Our findings suggest that women with symptomatic menopausal transition exhibit an increased risk of developing depression, anxiety, and sleep disorders. Therefore, women experiencing a symptomatic menopausal transition should be monitored closely so that interventions can be applied early.
Children are frequently exposed to unhealthy food marketing on digital media. This marketing contains features that often appeal to children, such as cartoons or bold colours. Additional factors can also shape whether marketing appeals to children. In this study, in order to assess the most important predictors of child appeal in digital food marketing, we used machine learning to examine how marketing techniques and children’s socio-demographic characteristics, weight, height, BMI, frequency of screen use and dietary intake influence whether marketing instances appeal to children.
Design:
We conducted a pilot study with thirty-nine children. Children were divided into thirteen groups, in which they evaluated whether food marketing instances appealed to them. Children’s agreement was measured using Fleiss’ kappa and the S score. Text, labels, objects and logos extracted from the ads were combined with children’s variables to build four machine-learning models to identify the most important predictors of child appeal.
Setting:
Households in Calgary, Alberta, Canada.
Participants:
39 children aged 6–12 years.
Results:
Agreement between children was low. The models indicated that the most important predictors of child appeal were the text and logos embedded in the food marketing instances. Other important predictors included children’s consumption of vegetables and soda, sex and weekly hours of television.
Conclusions:
Text and logos embedded in the food marketing instances were the most important predictors of child appeal. The low agreement among children shows that the extent to which different marketing strategies appeal to children varies.
Predicting the course of depression is necessary for personalized treatment. Impaired glucose metabolism (IGM) was introduced as a promising depression biomarker, but no consensus was made. This study aimed to predict IGM at the time of depression diagnosis and examine the relationship between long-term prognosis and predicted results.
Methods
Clinical data were extracted from four electronic health records in South Korea. The study population included patients with depression, and the outcome was IGM within 1 year. One database was used to develop the model using three algorithms. External validation was performed using the best algorithm across the three databases. The area under the curve (AUC) was calculated to determine the model’s performance. Kaplan–Meier and Cox survival analyses of the risk of hospitalization for depression as the long-term outcome were performed. A meta-analysis of the long-term outcome was performed across the four databases.
Results
A prediction model was developed using the data of 3,668 people, with an AUC of 0.781 with least absolute shrinkage and selection operator (LASSO) logistic regression. In the external validation, the AUCs were 0.643, 0.610, and 0.515. Through the predicted results, survival analysis and meta-analysis were performed; the hazard ratios of risk of hospitalization for depression in patients predicted to have IGM was 1.20 (95% confidence interval [CI] 1.02–1.41, p = 0.027) at a 3-year follow-up.
Conclusions
We developed prediction models for IGM occurrence within a year. The predicted results were related to the long-term prognosis of depression, presenting as a promising IGM biomarker related to the prognosis of depression.
Identification of geographical areas with high burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in schools using spatial analyses has become an important tool to guide targeted interventions in educational setting. In this study, we aimed to explore the spatial distribution and determinants of coronavirus disease 2019 (COVID-19) among students aged 3–18 years in South Korea. We analysed the nationwide epidemiological data on laboratory-confirmed COVID-19 cases in schools and in the communities between January 2020 and October 2021 in South Korea. To explore the spatial distribution, the global Moran's I and Getis-Ord's G using incidence rates among the districts of aged 3–18 years and 30–59 years. Spatial regression analysis was performed to find sociodemographic predictors of the COVID-19 attack rate in schools and in the communities. The global spatial correlation estimated by Moran's I was 0.647 for the community population and 0.350 for the student population, suggesting that the students were spatially less correlated than the community-level outbreak of SARS-CoV-2. In schools, attack rate of adults aged 30–59 years in the community was associated with increased risk of transmission (P < 0.0001). Number of students per class (in kindergartens, primary schools, middle schools and high schools) did not show significant association with the school transmission of SARS-CoV-2. In South Korea, COVID-19 in students had spatial variations across the country. Statistically significant high hotspots of SARS-CoV-2 transmission among students were found in the capital area, with dense population level and high COVID-19 burden among adults aged 30–59 years. Our finding suggests that controlling community-level burden of COVID-19 can help in preventing SARS-CoV-2 infection in school-aged children.
The present study enhances knowledge of the biodiversity of diatoms in Chuuk, Micronesia following our 2018 study on the seaweed-associated diatoms. We collected planktonic samples of diatoms from five sites of reef flats using a 20 μm mesh net, and two samples of seaweeds with epiphytes by hand from an islet on the barrier reef. In addition, the seaweed-associated diatoms from our 2018 study were analysed using scanning electron microscopy. A total of 109 diatom taxa are documented in the present study. Of these, 70 species were from net samples, and 39 species from the seaweed-associated diatoms. Thirty-one species are newly recorded from Micronesian waters. Most taxa are benthic or tychoplanktonic; euplanktonic diatoms were rare. The occurrence of benthic diatoms from the water column might be related to the Chuuk environmental conditions which include shallow water, strong light intensity and high grazing pressure, to which benthic diatoms seem to be able to better adapt than planktonic diatoms.
The term “biomarker,” a portmanteau of “biological marker,” has been defined by Hulka and colleagues (Hulka, 1990) as “cellular, biochemical or molecular alterations that are measurable in biological media such as human tissues, cells, or fluids.” In 1998, the definition was broadened as the National Institutes of Health Biomarkers Definitions Working Group defined a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” (Biomarkers Definition Working Group, 2001). In practice, the discovery and quantification of biomarkers require tools and technologies that help us predict and diagnose diseases; understand the cause, progression, and regression of diseases; and understand the outcomes of disease treatments. Different types of biomarkers have been used by generations of epidemiologists, physicians, and scientists to study all sorts of diseases. The importance of biomarkers in the diagnosis and management of cardiovascular diseases, infections, immunological and genetic disorders, and cancers is well known (Hulka, 1990; Perera and Weinstein, 2000).
There are growing concerns about the impact of the COVID-19 pandemic on the mental health of older adults. We examined the effect of the pandemic on the risk of depression in older adults.
Methods
We analyzed data from the prospective cohort study of Korean older adults, which has been followed every 2 years. Among the 2308 participants who completed both the third and the fourth follow-up assessments, 58.4% completed their fourth follow-up before the outbreak of COVID-19 and the rest completed it during the pandemic. We conducted face-to-face diagnostic interviews using Mini International Neuropsychiatric Interview and used Geriatric Depression Scale. We performed generalized estimating equations and logistic regression analyses.
Results
The COVID-19 pandemic was associated with increased depressive symptoms in older adults [b (standard error) = 0.42 (0.20), p = 0.040] and a doubling of the risk for incident depressive disorder even in euthymic older adults without a history of depression (odds ratio = 2.44, 95% confidence interval 1.18–5.02, p = 0.016). Less social activities, which was associated with the risk of depressive disorder before the pandemic, was not associated with the risk of depressive disorder during the pandemic. However, less family gatherings, which was not associated with the risk of depressive disorder before the pandemic, was associated with the doubled risk of depressive disorder during the pandemic.
Conclusions
The COVID-19 pandemic significantly influences the risk of late-life depression in the community. Older adults with a lack of family gatherings may be particularly vulnerable.
Accurate prognostication is important for patients and their families to prepare for the end of life. Objective Prognostic Score (OPS) is an easy-to-use tool that does not require the clinicians’ prediction of survival (CPS), whereas Palliative Prognostic Score (PaP) needs CPS. Thus, inexperienced clinicians may hesitate to use PaP. We aimed to evaluate the accuracy of OPS compared with PaP in inpatients in palliative care units (PCUs) in three East Asian countries.
Method
This study was a secondary analysis of a cross-cultural, multicenter cohort study. We enrolled inpatients with far-advanced cancer in PCUs in Japan, Korea, and Taiwan from 2017 to 2018. We calculated the area under the receiver operating characteristics (AUROC) curve to compare the accuracy of OPS and PaP.
Results
A total of 1,628 inpatients in 33 PCUs in Japan and Korea were analyzed. OPS and PaP were calculated in 71.7% of the Japanese patients and 80.0% of the Korean patients. In Taiwan, PaP was calculated for 81.6% of the patients. The AUROC for 3-week survival was 0.74 for OPS in Japan, 0.68 for OPS in Korea, 0.80 for PaP in Japan, and 0.73 for PaP in Korea. The AUROC for 30-day survival was 0.70 for OPS in Japan, 0.71 for OPS in Korea, 0.79 for PaP in Japan, and 0.74 for PaP in Korea.
Significance of results
Both OPS and PaP showed good performance in Japan and Korea. Compared with PaP, OPS could be more useful for inexperienced physicians who hesitate to estimate CPS.
To investigate the feasibility of using an ultraviolet light-emitting diode (UV LED) robot for the terminal decontamination of coronavirus disease 2019 (COVID-19) patient rooms.
Methods:
We assessed the presence of viral RNA in samples from environmental surfaces before and after UV LED irradiation in COVID-19 patient rooms after patient discharge.
Results:
We analyzed 216 environmental samples from 17 rooms: 2 from airborne infection isolation rooms (AIIRs) in the intensive care unit (ICU) and 15 from isolation rooms in the community treatment center (CTC). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected in 40 (18.5%) of 216 samples after patient discharge: 12 (33.3%) of 36 samples from AIIRs in the ICU, and 28 (15.6%) of 180 samples from isolation rooms in the CTC. In 1 AIIR, all samples were PCR negative after UV LED irradiation. In the CTC rooms, 14 (8.6%) of the 163 samples were PCR positive after UV LED irradiation. However, viable virus was not recovered from the culture of any of the PCR-positive samples.
Conclusions:
Although no viable virus was recovered, SARS-CoV-2 RNA was detected on various environmental surfaces. The use of a UV LED disinfection robot was effective in spacious areas such as an ICU, but its effects varied in small spaces like CTC rooms. These findings suggest that the UV LED robot may need enough space to disinfect rooms without recontamination by machine wheels or insufficient disinfection by shadowing.
Environmental surface testing was performed to search for evidence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) environmental contamination by an asymptomatic SARS-CoV-2 carrier with persistently high viral loads under isolation. No evidence of environmental contamination was found. Further studies are needed to measure environmental contamination by SARS-CoV-2 carriers and to determine reasonable isolation periods.
The aim of the study was to investigate the psychological factors influence the symptoms of gastroesophageal reflux disease (GERD) and their effect on quality of life in Korean Fire Fighters.
Methods
This study examined data collected from 1217 fire fighters. Depression and Anxiety were identified using the Patient health questionnaire-9(PHQ-9) and the 7-item Generalized Anxiety Disorder Scale. Occupational stress and Stress coping were identified using the KOSS-26 and the Ways of Coping Checklist-Revised. Self-esteem and quality of life were identified using the Rosenberg's Self-Esteem Scale and World Health Organization quality of life scale abbreviated version (WHOQOL-BREF). The scores for anxiety, depression and QoL of the two groups were analyzed. The correlation between psychological factors and QoL was also analyzed.
Results
Current psychological variables were associated with increased odds of concurrent GERD-related symptoms. Current depression, anxiety and stress were associated with increased odds of GERD-related symptoms. According to the WHOQOL-BREF, depression, anxiety, stress, stress coping and self-esteem were significantly correlated with quality of life in patients with GERD. Quality of life was obviously affected by psychological variables in patients with GERD.
Conclusions
These results indicate that psychological symptomatology, depression, anxiety, occupational stress and self-esteem are associated with GERD-related symptoms. Acknowledging this common comorbidity may facilitate recognition and treatment, and opens new questions as to the pathways and mechanisms of the association.
Disclosure of interest
The authors have not supplied their declaration of competing interest.