Sociodemographic factors associated with the use of mental health services in depressed adults: results from the Korea National Health and Nutrition Examination Survey (KNHANES)

Association of physical activity and stress reactivity with depression in elderly hypertensive population: A cross-sectional study from Eastern India

Objective

Depressive disorder poses an increased risk for sudden cardiac death in elderly population with existing comorbidities. Also, few international studies suggest the association of decreased stress reactivity with symptoms of depression in old age. Our cross-sectional study has attempted to explore the relationship of daily exercise and stress reactivity with depression in elderly individuals with hypertension.

Methods

Depression was assessed using Hamilton depression rating scale or HAM-D. The physical activity was assessed using the global physical activity questionnaire (GPAQ), developed by WHO. Stress reactivity is calculated from various cardiovascular parameters. The relationship of physical activity and stress reactivity scores on depression was explored using regression analysis.

Results

The prevalence rate of depressive symptoms in elderly hypertension population was around 40.2%. Significantly lower reactivity scores (P = 0.032) to deep breathing were evident in elderly hypertension population. After proper adjustment of the confounding factors, regression analysis depicted that decreased physical activity (Odds ratio = 4.48; 95% Confidence interval = 2.32-7.69) resulted in heavy risk of developing depressive symptoms besides old age and low educational status.

Conclusion

Our findings suggest that low physical activity leads to the development of depressive symptoms and decreased stress reactivity among elderly hypertensive patients.

Relationships of walking activity with depressed mood and suicidal ideation among the middle-aged Korean population: a nationwide cross-sectional study

Introduction

The suicide rate of middle-aged adults has increased rapidly, which is a significant public health concern. A depressed mood and suicidal ideation are significant risk factors for suicide, and non-pharmacological interventions such as exercise therapy have been suggested as potential treatments. Walking is a feasible and accessible form of exercise therapy for middle-aged adults.

Methods

We conducted a study based on the Seventh Korea National Health and Nutrition Examination Survey (2016-2018) data of 6,886 general middle-aged adults in South Korea to investigate the relationships of walking exercise with depressed mood and suicidal ideation. Multiple logistic regression analysis was used to adjust for confounding variables. Sampling weights were applied to obtain estimates for the general Korean population.

Results

Participants who walked ≥5 days per week had a significantly lower odds ratio (OR) for depressed mood [OR = 0.625, 95% confidence interval (CI): 0.424-0.921, p = 0.018] and suicidal ideation (OR = 0.252, 95% CI: 0.125-0.507, p < 0.001) compared to those who never walked, regardless of the duration of exercise. The same results were obtained for males after stratifying the data by sex and suicidal ideation was associated with walking in females.

Conclusion

Regular walking exercise was associated with diminished mental health problems in middle-aged adults. Light walks may serve as a useful starting point for patients with serious mental health issues, such as suicidal ideation.

Non-Pathological Psychological Distress among Mainland Chinese in Canada and Its Sociodemographic Risk Factors amidst the Pandemic

The COVID-19 pandemic has exacerbated health inequalities, with a potentially heightened mental health risk for Mainland Chinese in Canada, given the rising anti-Chinese discrimination, and barriers in assessing health services. In this context, this study aimed to assess non-pathological psychological distress towards COVID-19 and identify its sociodemographic risk factors among Mainland Chinese in Canada at the early stages of the pandemic. Methods: A sample of 731 Mainland Chinese aged 16 or older completed an on-line survey to examine their attitudes, behavioural, and psychological responses towards COVID-19. Non-pathological psychological distress was assessed with a 7-item self-report scale to capture common emotional reactions towards COVID-19. Results: A factor analysis revealed a single-factor structure of the 7-item COVID-19 psychological distress scale (Eigen λ = 3.79). A composite psychological distress index (PDI) score was calculated from these items and used as the outcome variable. Multivariate regression models identified age, financial satisfaction, health status, and perceived/experienced discrimination as significant predictors of psychological distress (ps ≤ 0.05). Conclusions: Mainland Chinese in Canada who were over 25, in poor financial/health status, or with perceived/experienced discrimination were at a higher risk for COVID-19-related psychological distress. The health inequity across these factors would inform the services to mitigate mental health risk in minority groups.

Green tea consumption and risk of depressive symptoms: Results from the TCLSIH Cohort Study

BACKGROUND

The prospective studies on the effect of particular type of tea consumption, especially green tea, on depressive symptoms are limited.

OBJECTIVE

The aim of this study is to investigate the prospective association between green tea consumption and depressive symptoms in a large general adult population.

METHODS

This prospective cohort study investigated 7524 participants aged 25 to 90 years from May 2013 to December 2018 and they were free of cardiovascular disease, cancer, and depressive symptoms at baseline. Green tea consumption was obtained through a validated food frequency questionnaire. Depressive symptoms were assessed by using the Self-Rating Depressive Scale (SDS). The association between green tea consumption and depressive symptoms was analyzed by Cox proportional hazards regression models.

RESULTS

A total of 1064 first incident cases of depressive symptoms (SDS ≥45) occurred during 14,661 person-years of follow-up (median follow-up of 2.0 years). In the crude model, the hazard ratios (95% confidence intervals) were 1.00 (reference), 0.95 (0.81, 1.12), 0.97 (0.83, 1.14) and 0.95 (0.79, 1.14), respectively. After adjusting for demographic characteristics, lifestyle factors, and dietary intake, the multivariable adjusted hazard ratios (95% confidence intervals) were 1.00 (reference), 0.88 (0.74, 1.05), 0.84 (0.69, 1.02) and 0.78 (0.63, 0.97), respectively.

CONCLUSIONS

The prospective study suggests that frequent green tea consumption is associated with a decreased risk of depressive symptoms in the general Chinese population.

Maintained and Delayed Benefits of Executive Function Training and Low-Intensity Aerobic Exercise Over a 3.5-Year Period in Older Adults

This is a follow-up study of our previous work, with a specific goal to examine whether older adults are able to maintain or show delayed cognitive and psychosocial benefits of executive function training and physical exercise over a period of 3.5 years on average. Thirty-four participants from the original training study (17 from the executive function training and 17 from the aerobic exercise group) returned and completed a single follow-up session on a set of cognitive and psychosocial outcome measures. The results of the returned follow-up sample showed some significant original training transfer effects in WCST-64 performance but failed to maintain these benefits at the follow-up session. Surprisingly, episodic memory performance showed some significant improvement at the follow-up relative to baseline, signaling delayed benefits. The findings add some novel implications for cognitive training schedule and highlight the possible importance of continuous engagement in long-term cognitive enhancement in healthy older adults.

COVID-19, Long COVID Syndrome, and Mental Health Sequelae in a Mexican Population

The COVID-19 pandemic is currently a worldwide threat and concern, not only because of COVID-19 itself but its sequelae. The aim of this study was to evaluate whether a relation between COVID-19, Long COVID, and the prevalence of mental health disorders exist. A total of 203 people from Tabasco were included in this study, answering a survey integrated by three dominions: General and epidemiological data, the DASS-21 test (to determine the presence of signs or symptoms suggestive of depression, anxiety, and/or stress) and an exploratory questionnaire about Long COVID syndrome. A descriptive and inferential statistical analysis was made via Microsoft Excel and Graphpad Prism software, evaluating differences through the Mann−Whitney U test and considering p < 0.05 as statistically significant. Of the 203 people surveyed, 96 (47.29%) had had COVID-19 and 107 (52.71%) had not; from the ones that had COVID-19, 29 (30.21%) presented mental health disorders and 88 (91.66%) presented at least one symptom or sign of Long COVID syndrome; meanwhile, 31 (32.29%) presented 10 or more symptoms or signs. From the comparison between the population with previous mental health disorders and COVID-19 and those without background disorders or COVID-19, the results were the following: 27.58% vs. 16.82% presented severe depression, 48.27% vs. 17.75% presented severe anxiety, and 27.58% vs. 20.56% presented severe stress. A high prevalence of mental health effects was observed in patients without COVID-19 and increased in the population with Long COVID syndrome and previous mental health disorders.

The Impact of Leisure Activities on the Mental Health of Older Adults: The Mediating Effect of Social Support and Perceived Stress

As the aging continues, China has become the country with the largest older population. In order to ensure the well-being of older adults in their later years, the whole society is increasingly concerned about the mental health of older adults. In 2019, we conduct a questionnaire survey in Shaanxi Province. Stratified random sampling is used to select three representative cities, and 677 samples are selected from the survey results for research. By using the structural equation model, we aim to reveal the mechanism of leisure activities' influence on mental health of the older adults and verify whether social support and perceived stress play a mediating role. The study finds that the older adults' leisure activities have no significant direct impact on mental health. Social support has a significant mediating effect between leisure activities and mental health of the older adults. Leisure activities indirectly affect the mental health of the older adults through social support, and participation in leisure activities can improve the social support of the older adults, thus improving the mental health level of the older adults. Perceived stress plays a significant mediating role between leisure activities and mental health of the older adults. By participating in leisure activities, the perceived stress of the older adults will be reduced, thus improving their mental health. Social support and perceived stress play a sufficient mediating role in the influence of leisure activities on mental health.

Association between Soft-Drink Intake and Obesity, Depression, and Subjective Health Status of Male and Female Adults

This study explores the association between soft-drink intake and obesity, depression, and subjective health status in male and female adults. Soft-drink consumption has become a serious public health issue worldwide. Participants of this study were selected (n = 3086) from the respondents in the Seventh Korea National Health and Nutrition Examination Survey 2016 and divided into the non-soft-drink group (men, 502; women, 1117) and the soft-drink group (men, 684; women, 783). Soft-drink intake data were obtained, using a validated quantitative food frequency questionnaire and the 24 h dietary recall. Total energy intake and fat density were significantly higher, but the nutrient densities of carbohydrate, total dietary fiber, and micronutrients were significantly lower in the soft-drink group than in the non-soft-drink group. In men, soft-drink intake was found to be significantly associated with a lower risk of depression. Conversely, in women, soft-drink intake was found to be significantly associated with the higher risks of depression, obesity, and poor subjective health status. Therefore, less frequent soft-drink intake may prevent obesity and depression in Korean women.

Sociodemographic, Lifestyle, and Health Factors Associated With Depression and Generalized Anxiety Disorder Among Malaysian Adults

Objectives: Lowering the prevalence of mental health illness is one of the main public health concerns. The objective of the present study was to examine factors associated with depression and generalized anxiety disorder (GAD) among adults in Malaysia. Methods: Data were extracted from the National Health and Morbidity Survey 2011 (NHMS 2011), which is a nationally representative sample collected using a 2-stage stratified sampling method. A bivariate probit model was utilized to examine the influences of sociodemographic, lifestyle, and health factors on the likelihood of suffering from depression and GAD. Results: Age, gender, ethnicity, education, marital status, and self-rated health were significantly associated with depression and GAD. In particular, there were positive relationships between depression and GAD, and younger adults, females, Indian ethnic group, lower level of education, being unmarried, and self-rated poor health. Conclusions: Sociodemographic and health factors were associated with determining the risks of depression and GAD in Malaysia. With this information, future policies (eg, screening and treatment) could be targeted at those at most risk to develop depression and GAD.

Use of Mental Health Services for Patients Diagnosed with Major Depressive Disorders in Primary Care

Major depressive disorder (MDD) is one of the most disabling diseases worldwide, generating high use of health services. Previous studies have shown that Mental Health Services (MHS) use is associated with patient and Family Physician (FP) factors. The aim of this study was to investigate MHS use in a naturalistic sample of MDD outpatients and the factors influencing use of services in specialized psychiatric care, to know the natural mental healthcare pathway. Non-randomized clinical trial including newly depressed Primary Care (PC) patients (n = 263) with a 12-month follow-up (from 2013 to 2015). Patient sociodemographic variables were assessed along with clinical variables (mental disorder diagnosis, severity of depression or anxiety, quality of life, disability, beliefs about illness and medication). FP (n = 53) variables were also evaluated. A multilevel logistic regression analysis was performed to assess factors associated with public or private MHS use. Subjects were clustered by FP. Having previously used MHS was associated with the use of MHS. The use of public MHS was associated with worse perception of quality of life. No other sociodemographic, clinical, nor FP variables were associated with the use of MHS. Patient self-perception is a factor that influences the use of services, in addition to having used them before. This is in line with Value-Based Healthcare, which propose to put the focus on the patient, who is the one who must define which health outcomes are relevant to him.

Association between Reallocation Behaviors and Subjective Health and Stress in South Korean Adults: An Isotemporal Substitution Model

This study used an isotemporal substitution (IS) model to determine the potential reallocation effects of sedentary behavior (SB) and physical activity (PA) on subjective health and stress in South Koreans with data from the Sixth Korean National Health and Nutrition Examination Survey 2015. The analysis included 791 participants whose accelerometer-measured PA was available, divided into three age groups (young adults = 151; mid-age adults = 334; older adults = 306). We adopted SB, light PA (LPA), and moderate-to-vigorous PA (MVPA) to determine how time was allocated to each activity level, then examined the effects of reallocation on subjective health and stress across age groups. The analyses were performed in three steps: single-activity, partition, and IS model. An additional ANCOVA was conducted on statistically significant outcomes (i.e., subjective health of young and older adults). We found that among young adults, reallocating 30 min/week of SB to LPA and to MVPA was linked to high levels of subjective health. In older adults, reallocating 30 min/week of SB and LPA to MVPA was associated with high subjective health. However, this relationship was not observed in mid-age adults. None of the age groups showed a relationship between any activity reallocation and stress. Our findings provide the first insight on the development of interventions aimed at promoting active, healthier lifestyles on the basis of behavior reallocation in South Koreans.

Comparison of past-year mental health services use in Canadian Army, Navy, and Air Force personnel

Introduction: What causes the excess burden of mental disorders and related outcomes in the Army remains unclear. Deployment-related trauma has been one intuitive explanation. However, there may be other factors at play – for example, lower mental health services use (MHSU) in Army personnel. This study compares MHSU across the Canadian Army, Navy, and Air Force. Methods: Data were drawn from the 2013 Canadian Forces Mental Health Survey. The sample consisted of Regular Force members ( N = 6,696). The primary outcomes for past-year MHSU were: (1) any past-year MHSU; (2) intensity of care (total clinical contact hours), and (3) perceived helpfulness of care (PHC). ­Modified Poisson regression and analysis of covariance (ANCOVA) were used to assess the relationship between the elements (Army, Navy, Air Force) and each outcome, adjusting for sociodemographic and military characteristics, as well as clinical variables such as the presence of five past-year mental disorders. Results: In unadjusted analyses, Army personnel had significantly greater past-year MHSU and intensity of care relative to Air Force personnel. No significant relationship was found between the element and any of the MHSU parameters after adjustment. Discussion: Differences in past-year MHSU are an unlikely contributing factor to the higher risk of mental disorders and related outcomes among Army personnel; the true explanation must lie elsewhere. Findings argue for a system-wide, and not element-specific, approach to improving Canadian Armed Forces (CAF) programs and services.

Sociodemographic Variation in Increasing Needs for Mental Health Services among Canadian Adults from 2002 to 2012

BACKGROUND

Numerous countries have developed public health programs and restructured mental health service delivery to alleviate the growing burden of mental illness. These initiatives address increased needs for mental health services, as individuals become better-informed and more open-minded concerning psychiatric symptoms and mental health care. This study aimed to investigate how needs for mental health services have increased among Canadian adults in recent years, and how needs may differ across different sociodemographic groups.

DATA AND METHODS

The study compared data from the Canadian Community Health Survey for 2002 (n = 31,744), and 2012 (n = 23,319), including respondents 18 years old and over. Needs for mental health services were defined in terms of major depression (MD), psychological distress (PD), consultations with various health professionals, and by objective and perceived unmet needs (PUNs). Odds ratios were estimated using hierarchical logistic regressions, controlling for sociodemographic variables.

RESULTS

Overall, needs for mental health services were higher in 2012 than in 2002, with increases affecting some sociodemographic groups more than others. MD and PD grew disproportionately among lower income individuals and women. Individuals hospitalized for psychiatric reasons, those unemployed, and men accounted for most of the increase in healthcare consultations. PUNs were more pronounced among unemployed individuals, and respondents born in Canada.

CONCLUSION

Findings from this study confirm the increasing and need for mental health services in Canada, and suggest that public health campaigns should be geared to specific sociodemographic groups.

Predictors of mental health service use among individuals with high psychological distress and mental disorders

This study identified predictors of mental health service use over 12 months among 746 individuals with mental disorders and high psychological distress from a catchment area in southwest Montreal, Quebec (Canada). Data collected in 2011 and 2014 were analyzed using Andersen's Behavioral Model of Health Services Use. A hierarchical logistic regression identified predictors of mental health service use. In all, 29% of participants reported using mental health services in the previous 12 months. Three key enabling variables predicted mental health service use: having a family doctor, previous experience with mental health services, and employment. Self-perception of mental health, stressful events, and unmet needs marginally (Needs factors: non-clinical variables) were also associated with the outcome variable. Mental health service utilization depends primarily on organization of the health system, and patient perceptions of its condition (non-clinical needs). Mental health policy should focus on increasing the availability of services and professionals, especially family doctors. Other measures for encouraging service use and overall population wellbeing include raising public awareness around the signs and symptoms of mental illness as a way to promote more rapid response to patient needs, and protecting workplace mental health by reducing stress and stigma toward individuals affected by mental distress.

Impact of Physical Activity and Sleep Duration on Depressive Symptoms in Hypertensive Patients: Results from a Nationally Representative Korean Sample

Depressive symptoms among individuals with hypertension may increase the risk of cardio-cerebrovascular disease, disease burden, and mortality. However, few studies have examined the relationships among physical activity, sleep duration, and depressive symptoms. Thus, this cross-sectional study examined the associations of physical activity and sleep duration with depressive symptoms in individuals with hypertension. We analyzed data collected as part of the 2014 Korea National Health and Nutrition Examination Survey, which included 846 patients with hypertension aged 19 or older. The prevalence rate of depressive symptoms was around 11.2%. A logistic regression analysis showed that moderate to vigorous physical activity (odds ratio (OR) = 4.42; 95% confidence interval (CI) = 2.19–8.89) and short (OR = 2.18; 95% CI = 1.11–4.28) and long sleep duration (OR = 4.09; 95% CI = 1.83–9.13) increased the risk of depressive symptoms after adjusting for confounding factors. Additionally, older age and low educational levels were associated with depressive symptoms. Our findings highlight that physical activity and sleep duration should be key components of lifestyle modification among hypertensive patients with depressive symptoms. Further investigation might benefit from validating these findings using a longitudinal design and examining the mediating effects of physical activity and/or sleep duration on the relationship between individual characteristics and depressive symptoms.

A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.

Green Tea, Coffee, and Caffeine Consumption Are Inversely Associated with Self-Report Lifetime Depression in the Korean Population

This study investigated the associations of green tea, coffee, and caffeine consumption with self-report lifetime depression in the Korean population using data from the Korean National Health and Nutrition Examination Survey. In total, 9576 participants (3852 men and 5724 women) aged 19 years or older were selected for the present study. Green tea, coffee, and caffeine consumption levels were assessed with a validated food frequency questionnaire. Multivariate logistic regression analysis was used to determine the odds ratios (OR) and 95% confidence intervals (CIs) for depression according to green tea, coffee, and caffeine consumption. Frequent green tea consumers (≥3 cups/week) had 21% lower prevalence of depression (OR = 0.79, 95% CI = 0.63–0.99, p for trend = 0.0101) than green tea non-consumers after adjustment for potential confounders. Likewise, frequent coffee drinkers (≥2 cups/day) had 32% lower prevalence of depression (OR = 0.68, 95% CI = 0.55–0.85, p for trend = 0.0026) than coffee non-drinkers after adjustment for potential confounders. Also, participants in the highest quartile of caffeine consumption had 24% lower prevalence of depression than those in the lowest quartile (OR = 0.76, 95% CI = 0.62–0.92, p for trend = 0.0032). Frequent consumption of green tea, coffee, or caffeine was associated with a reduced prevalence of self-report lifetime depression in Korean adults. A prospective study and randomized clinical trials should be conducted to confirm the inverse relationships of green tea and coffee consumption with risk of depression.

Precarious employment associated with depressive symptoms and suicidal ideation in adult wage workers

BACKGROUND

Precarious employment is one of the most important indicators of social disadvantage and is associated with poor mental health. This study aimed to investigate the association of precarious employment with depressive mood and suicidal ideation in adult wage workers, and the possible mediating or moderating effect of socioeconomic factors in the association between precarious work and mental health status.

METHOD

Data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V) conducted between 2010 and 2012 were analyzed. Among the 24,173 participants, 6266 adult wage workers (3206 precarious and 3060 non-precarious workers) aged ≥19 years were included. Socioeconomic and health-related characteristics as well as depressive mood and suicidal ideation were investigated.

RESULTS

Precarious employment was significantly associated with depressive mood in the logistic regression analyses adjusting for all potential confounding factors as covariates. The socioeconomic variables including age, gender, education level, marital status, household income, and occupation type were significantly related with depressive mood and suicidal ideation in adult wage workers. We also found that gender and household income had possible moderating effects on the association between precarious employment and suicidal ideation. Precarious work was associated with suicidal ideation only for male workers and worker with low or middle-lower income levels.

LIMITATIONS

Our study is based on a cross-sectional design, thus, we could not elucidate the causal relationship between the variables.

CONCLUSIONS

Our study suggested that precarious employment plays a pivotal role in the mental health status of adult wage workers.

Relationship between Chronic Kidney Disease and Depression in Elderly Koreans Using the 2013 Korea National Health and Nutrition Examination Survey Data

BACKGROUND

Depression is prevalent in patients with chronic kidney disease (CKD) and continues to increase in elderly adults. Therefore, the aim of our study was to examine the relationship between CKD and depression in older patients.

METHODS

We conducted a cross-sectional study based on 2013 Korea National Health and Nutrition Examination Survey data. In total, data of 973 subjects aged ≥65 years were analyzed, and the estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation.

RESULTS

The prevalence of depression in older adults was 4.1% in men and 8.8% in women (P=0.004). The prevalence of depression did not differ according to CKD stage in women (normal eGFR and CKD stages 1 and 2 women, 41/474 [8.6%]) vs. CKD stages 3-5 women, 6/63 [9.5%]); however, the prevalence of depression in men with CKD stages 3-5 (8/83 [9.6%]) was significantly higher than in men with normal eGFR and CKD stage 1 and 2 (10/353 [2.8%], P=0.010). Multivariate logistic regression analysis showed that the odds ratio for depression in men with CKD stages 3-5 was 3.822 (95% confidence interval, 1.229 to 11.879) after adjusting for social status and chronic diseases (P=0.021).

CONCLUSION

The prevalence of depression was higher in elderly women than in men, while the prevalence of depression increased in elderly men with CKD stages 3-5 and was almost equal to that of women. Therefore, elderly men with progressive renal function impairment should be counseled and monitored for psychological problems.

Vitamin D deficiency is significantly associated with depression in patients with chronic kidney disease

Background

Depression is reported to be the most common psychological problem in patients with chronic kidney disease (CKD). Several studies have reported that lower levels of serum vitamin D are significantly associated with depression. Both vitamin D deficiency and depression are prevalent in patients with CKD, yet the relationship between these two factors remains poorly understood. This study aimed to investigate the association between vitamin D levels and depression among CKD patients.

Methods

Totally, 21,257 individuals who participated in the Korean National Health and Nutrition Examination Survey (KNHANES V, VI) from 2010–2014 were screened for the study; 533 CKD patients were included. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D3 [25(OH)D3] ≤10 ng/mL. Patients were divided into vitamin D deficient or sufficient groups. Depression was screened for using the Korean version of the WHO Composite International Diagnostic Interview-Short Form. The association between vitamin D deficiency and depression was evaluated by multivariate logistic regression analysis.

Results

The mean participant age was 70.1±9.4 years; 262 patients (49.2%) were male. The median 25(OH)D₃ level was 19.1±6.9 ng/mL. The prevalence of depression was higher in CKD patients than in the general population (14.3 vs. 11.1%, P = 0.03). Additionally, the prevalence of depression was significantly higher in CKD patients with (vs. without) vitamin D deficiency (32.5% vs. 50.0%, P<0.001). Multivariate logistic regression analysis showed that vitamin D deficiency was a significant independent predictor of depression after adjusting for confounding factors (adjusted odds ratio, 6.15; 95% confidence interval, 2.02–8.75; P = 0.001).

Conclusion

Depression was highly prevalent in CKD patients, in whom vitamin D deficiency was a significant independent predictor of depression. Therefore, management of vitamin D deficiency might help prevent depression in CKD patients.

Association between Stroke Status and Depression in a Community Setting: The 2014 Korea National Health and Nutrition Examination Survey

BACKGROUND AND PURPOSE

Previous studies have examined the risk factors for depression in stroke patients, but little information is available on the relationship between stroke status and depression in the community-dwelling general population. We evaluated the association between stroke status and depression using representative nationwide data.

METHODS

In total, 3,487 subjects (aged ≥40 years) who participated in version VI-2 of the sixth Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2014 were included. We compared the prevalence of depression in 120 community-dwelling stroke patients and 3,367 nonstroke controls using the nine-item Patient Health Questionnaire (PHQ-9).

RESULTS

The prevalence of depression (PHQ-9 score ≥10) was 16.7% in stroke patients and 6.4% in controls. In the unadjusted model, depression was more common in stroke patients than in nonstroke controls [odds ratio (OR), 2.95; 95% confidence interval (CI), 1.79-4.86]. After adjusting for demographic characteristics, socioeconomic status, health-related behaviors, and comorbidities, stroke diagnosis was a significant risk factor for depression (OR, 1.85; 95% CI, 1.06-3.24). Specifically, a diagnosis of stroke in patients aged <60 years (OR, 3.82; 95% CI, 1.81-8.09) and the presence of stroke complications (OR, 2.77; 95% CI, 1.25-6.13) remained significant risk factors for depression even after adjusting for potential confounders.

CONCLUSIONS

In a community setting, poststroke survivors had a higher prevalence of depression, and stroke was an independent risk factor for depression. Public psychosocial interventions are needed to improve the mental health care of community-dwelling stroke survivors.

Mental health service use in adults with suicidal ideation within a nationally representative sample of the Korean population

BACKGROUND

Use of mental health services (MHS) by people with suicidal ideation is critical in prevention of suicide, and identification of the factors that influence MHS use may assist in providing efficient interventions and treatments for suicidal individuals. Thus, we investigated the association between socioeconomic factors and use of MHS in people with suicidal ideation.

METHOD

We analyzed the data of the Fifth Korea National Health and Nutrition Examination Survey 2010-2012, a nationally representative cross-sectional study of the Korean population. Among the 24,173 people from the national health survey, we investigated the socioeconomic, clinical, and health-related characteristics of 2616 participants aged 19 years and older with suicidal ideation within the previous year.

RESULTS

In the logistic regression analyses, after adjusting for potentially confounding factors, the odds ratio (OR) for nonuse of MHS was significant in the subjects aged 65 years or older (OR=4.90), aged 50-64 years (OR=2.11), with 10-12 years of education (OR=1.87), widowed (OR=2.75), with economic activity (OR=1.60), with an employment status of paid employee (OR=1.97), without depressive mood (OR=2.73), having not attempted suicide (OR=4.04), and with no reported problems in their usual activities (OR=2.17).

LIMITATIONS

We did not use standardized assessment tools to evaluate suicidal ideation and depressive mood.

CONCLUSIONS

We observed a significant influence of several socioeconomic factors, depressive mood, and suicide attempts on the MHS use of adults with suicidal ideation, based on a nationally representative sample of the Korean population.

Active smoking and exposure to secondhand smoke and their relationship to depressive symptoms in the Korea national health and nutrition examination survey (KNHANES)

BACKGROUND

The relationship between tobacco smoking, including secondhand smoking, and depression has been assessed. The purpose of this study was to evaluate the association between secondhand smoking among current, former and never smokers and depressive symptoms. For secondhand smoking, gender differences and sources of exposure were examined.

METHODS

Data from 34,693 participants from the fourth and fifth Korean Health and Nutritional Examination Survey (2007-2012) were analyzed in 2014. Self-reported exposure to active (current, former or never) and secondhand smoking and depressive symptoms experienced during the past year were analyzed using logistic regression. The dose-response relationship between duration of secondhand smoke exposure and depression was assessed with stratification by gender and sources of exposure (at home only, at the workplace only or both).

RESULTS

Regardless of their smoking status, all women who had secondhand smoke exposure at home reported more depressive symptoms than non-smoking women without any exposure to secondhand cigarette smoking (OR 1.43, 95 % CI 1.04-1.96 for current smokers; OR 2.32, 95 % CI 1.04-5.16 for former smokers; OR 1.25, 95 % CI 1.08-1.43 for never smokers). There was also a significant dose-response pattern (p-trend <0.001) for the duration of secondhand smoke exposure at home among women. No significant association was found between smoking and depressive symptoms in men.

CONCLUSIONS

There was a significant association between secondhand smoke exposure at home and depressive symptoms in women. Secondhand smoke exposure at home was associated with depressive symptoms in a dose-response manner.