Neuron-Microglia Crosstalk in Neuropsychiatric Disorders.

Numerous studies have investigated the causes and mechanisms of psychiatric disorders through postmortem examination of patients with a history of a schizophrenia, mood disorder, or neurocognitive disorder. In addition, the search for specific mechanism-based treatments for psychiatric disorders has been intensified through the use of transgenic animal models involving specific genes tightly associated with psychiatric disorders. As a result, many studies with patients or animal models have reported a close association of neuroglia with major psychiatric disorders. Recently, research has focused on the associations between microglia and major psychiatric disorders and on the role of the immune response and abnormal microglia in the onset and symptoms of psychiatric disorders, in particular. Postmortem studies of brain tissue and animal models recapitulating human mental disorders have also confirmed association between psychiatric disorders and quantitative, structural, or functional abnormalities of neuron-microglia crosstalk. This review aims to describe the relationships between microglia and major psychiatric disorders and to specifically examine studies of gene expression and function of microglia in depression, schizophrenia, and Alzheimer's disease.

A Randomized, Open-Label, Single-Dose, Crossover Study of the Comparative Bioavailability of EPA and DHA in a Novel Liquid Crystalline Nanoparticle-Based Formulation of ω-3 Acid Ethyl Ester Versus Omacor® Soft Capsule among Healthy Adults.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are well known for their capacity to lower triglyceride levels, but the clinical effectiveness is hindered by limited bioavailability and patient adherence. To address this challenge, we introduce a novel liquid crystalline nanoparticle-based formulation, the innovative medicine and drug delivery (IMD)-Omega soft capsule (cap), designed to optimize the pharmacokinetics (PK) and safety of EPA and DHA. This randomized, open-label, crossover study engages a cohort of 24 healthy adult subjects, utilizing key PK parameters like Cmax, AUC, Tmax, t½, and Ke to conduct a comprehensive evaluation. The trial compares the performance of the IMD-Omega soft cap with the well-established Omacor® soft cap. The IMD-Omega soft cap exhibited an impressive 110% increase in bioavailability for EPA and a remarkable 134% surge for DHA in comparison to the Omacor® soft cap over a span of 72 h. The key success can be attributed to the innovative liquid crystalline nanoparticle design, bolstering the dissolution and permeability of these essential fatty acids. Intriguingly, intra-participant variability for AUC0-72 h and Cmax were calculated at 45.04% and 34.26%, respectively. It is noteworthy that the parameters of Tmax for EPA (≈6.00 h) and DHA (≈5.00 h), t½ for both EPA and DHA ≈ 30-40 h, and Kel around 0.18-0.22 h-1 for EPA and ≈0.008-0.02 h-1 for DHA, displayed comparability between the IMD-Omega and Omacor® formulations. Encouragingly, the IMD-Omega soft cap showed excellent tolerability. The promise of optimized patient compliance and reduced dosages adds further weight to its potential significance.

Association Between Gut Microbiota and Depressive Symptoms: A Cross-Sectional Population-Based Study in South Korea.

OBJECTIVE: This study aimed to investigate the association between gut microbiota and depressive symptoms in a large population cohort of Korean adults. METHODS: Overall, 1238 participants were included in the study. Participants were categorized into depressed or non-depressed groups, based on the depressive symptoms reported on the Center for Epidemiologic Studies Rating Scale for Depression, with a cutoff score of 16, and their fecal microbiota was profiled using 16S ribosomal RNA gene sequencing. Several alpha and beta diversity measures were also estimated. The association between depressive symptoms and gut microbiota was analyzed using generalized linear models. The inferred function of the metagenomes was compared between the two groups. RESULTS: There were no consistent differences in alpha and beta diversity between the depressed and non-depressed groups. However, the continuous measure of depressive symptoms was inversely associated with one of four measures of alpha diversity (Shannon's diversity, p = .021). We also found a substantial difference between the depressed and non-depressed groups in the Bray-Curtis dissimilarity among the four beta diversity indices ( p = .004). Participants whose depressive symptoms exceeded a clinical cutoff score had a lower relative abundance of the genus Faecalibacterium when compared with controls (coefficient = -0.025, q = 0.047). However, the depressed group had a significantly higher abundance of the genus Oscillospira than did the non-depressed group (coefficient = 0.002, q = 0.023). CONCLUSIONS: Our findings contribute to the identification of potential relationships between the gut microbiota and depressive symptoms and provide useful insights for developing microbiota-based interventions for patients with depressive symptoms.

Gender and age differences in the association between work stress and incident depressive symptoms among Korean employees: a cohort study.

PURPOSE: The aim of this study was to identify gender- and age-specific occupational stress associated with depressive symptoms among Korean employees. METHODS: Data of 73,014 employees aged 18 and above who had undergone comprehensive health examinations at Kangbuk Samsung Hospital Health Screening Center, South Korea, in January 2012 and who were followed up until December 2017 were collected, and 63,959 (participation rate: 87.59%, men: 50,413, women: 13,546) were finally analyzed. A Cox proportional hazards model was used to estimate the hazard ratios and 95% confidence intervals of the relationship between occupational stress and depressive symptoms. In light of gender and age differences in the association between occupational stress and depressive symptoms, interaction and stratification by gender and age groups were tested. RESULTS: During 238,630 person-years of follow-up, case-level depressive symptoms developed in 4227 participants (an incident rate of 1.8%). There were gender differences in the relationship between job stress and incident depressive symptoms. For men, high job demand, job insecurity, lack of reward, and discomfort in their organizational climate were associated with incident depressive symptoms in all age groups. Insufficient job control was associated with the development of depressive symptoms only in midlife and organizational injustice only in early adulthood. For women, the results for high job demand, organizational injustice, and discomfort in an organizational climate were associated with the onset of depressive symptoms from early adulthood to the midlife decade. CONCLUSION: The results suggest gender and age differences in the relationship between occupational stress and incident depressive symptoms.

Role of Inflammation in Psychiatric Disorders.

Psychiatric disorders are too multifactorial to be defined as a primarily inflammatory disorder, and increased inflammatory response is not specific to mental disorder only. Numerous factors are involved in neuroinflammation, and there also are many confounding variables, making it difficult to obtain consistent outcomes. Therefore, it is necessary to specify genetic, physiological, and epidemiological attributes of particular population groups vulnerable to inflammatory response as well as the disease subtypes. As of now, definitive inflammatory markers for psychiatric disorders have not been identified, but they could be very useful in patients with minimal vulnerability. In addition, it is possible to use inflammatory markers as depression biomarkers in subtypes of depression, which can serve as bases to develop medications to treat the disorder.

Resilience as a Protective Factor for Depressive Mood and Anxiety among Korean Employees.

BACKGROUND: This study aimed to investigate resilience as a protective factor for depressive mood and anxiety among Korean employees. METHODS: Participants were employees of eight private and local government organizations in Korea, aged 19 to 65 years. A self-report questionnaire that included items on resilience, job stress, levels of depression and anxiety, and socio-demographic factors, was administered to 1,079 Korean employees, with 1,076 valid responses. We performed hierarchical linear regression analyses with the levels of depression and anxiety scores as dependent variables. RESULTS: Being women and having a high level of job stress were associated with greater depressive mood and anxiety. In contrast, resilience was negatively related to depressive mood and anxiety, after adjusting for demographic variables and the level of job stress. Among the five factors for resilience, "support" and "hardiness" were protective factors for depressive mood and anxiety after adjusting for demographic variables and the level of job stress. CONCLUSION: Based on the results of the current study, we suggest that focusing on the resilience of employees, especially on "support" and "hardiness," factors as well as developing and engaging in interventions that increase resilience in the workplace, can protect against depressive mood and anxiety, especially for those with high levels of job stress.

Adjunctive Brexpiprazole as a Novel Effective Strategy for Treating Major Depressive Disorder: A Systematic Review and Meta-Analysis.

PURPOSE/BACKGROUND: Brexpiprazole was approved for adjunctive treatment of major depressive disorder (MDD) in 2015. Because only a small number of randomized controlled trials have investigated the use of brexpiprazole in MDD, we performed a meta-analysis. METHODS/PROCEDURES: We systematically searched literatures in PubMed, Cochrane Library database, EMBASE, Google Scholar, and clinicaltrials.gov up to January 2016. The primary efficacy measure was the mean change in total Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline. Secondary efficacy measures were the mean change in total Hamilton Rating Scale for Depression (17 items) score from baseline and the response (≥50% reduction in MADRS total score) and remission (MADRS total score ≤ 10 with ≥50% reduction) rates. FINDINGS/RESULTS: Four studies fulfilled the inclusion criteria and were included in the analysis. Brexpiprazole showed superior efficacy over placebo with effect sizes (mean differences) of -1.76 (95% confidence interval [CI], -2.45 to -1.07) for MADRS and -1.21 (95% CI, -1.71 to -0.72) for the 17-item Hamilton Rating Scale for Depression. The risk ratios for response and remission were 1.57 (95% CI, 1.29-1.91) and 1.55 (95% CI, 1.22-1.96), respectively. The incidences of discontinuation due to adverse events, akathisia, and weight increase were higher in the brexpiprazole group than in the placebo group, with risk ratios of 3.44 (95% CI, 1.52-7.80), 3.39 (95% CI, 2.08-5.51), and 4.36 (95% CI, 2.45-7.77), respectively, and the incidence of akathisia was related to the brexpiprazole dose. IMPLICATIONS/CONCLUSIONS: Although our results suggest that brexpiprazole could be an effective adjunctive agent for MDD, they should be cautiously translated into clinical practice because the meta-analysis was based on only a handful of randomized controlled trials.

Prevalence and Associated Factors of Depression in General Population of Korea: Results from the Korea National Health and Nutrition Examination Survey, 2014.

Depressive disorder is a common mental illness and remains a major cause of morbidity worldwide. The present study, a cross-sectional, nationwide, population-based survey assessed the prevalence of depression in the general population of Korea through a random sampling of the non-institutionalized population for the Korea National Health and Nutrition Examination Survey (KNHANES) VI. The Patient Health Questionnaire (PHQ)-9 was first introduced into the KNHANES to detect depression. The point prevalence of depression (PHQ score of 10 or higher) was 6.7% (95% confidence interval [CI], 5.7-7.6) in 4,949 subjects. Based on the analysis using the diagnostic algorithm of the PHQ-9, the prevalence of major depressive disorder was 2.7% (95% CI, 2.2-3.3). Multiple logistic regression analysis, after adjusting the sociodemographic variables, also showed that the factors associated with depression were perceived stress and health status. This study reported for the first time that the point prevalence of depression screened using the PHQ-9 in this nationwide survey of the Korean population was similar to that of the western countries. As the KNHANES to detect depression is conducted biennially, further studies on the accumulated data are expected in the future.

Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome.

Atypical antipsychotics (AAP) are the prevailing form of schizophrenia treatment today due to their low side effects and superior efficacy. Nevertheless, some issues still need to be addressed. First, there are still a large number of patients with treatment-resistant schizophrenia (TRS), which has led to a growing trend to resort to AAP polypharmacy with few side effects. Most clinical treatment guidelines recommend clozapine monotherapy in TRS, but around one third of schizophrenic patients fail to respond to clozapine. For these patients, with clozapine-resistant schizophrenia AAP polypharmacy is a common strategy with a continually growing evidence base. Second, AAP generally have great risks for developing metabolic syndrome, such as weight gain, abnormality in glucose, and lipid metabolism. These metabolic side effects have become huge stumbling blocks in today's schizophrenia treatment that aims to improve patients' quality of life as well as symptoms. The exact reasons why this particular syndrome occurs in patients treated with AAP is as yet unclear though factors such as interaction of AAP with neurotransmitter receptors, genetic pholymorphisms, type of AAPs, length of AAP use, and life style of schizophrenic patients that may contribute to its development. The present article aimed to review the evidence underlying these key issues and provide the most reasonable interpretations to expand the overall scope of antipsychotics usage.

Characteristics of neurocognitive functions in mild cognitive impairment with depression.

BACKGROUND: Previous studies suggest that there is a strong association between depression and cognitive decline, and that concurrent depressive symptoms in MCI patients could contribute to a difference in neurocognitive characteristics compared to MCI patients without depression. The authors tried to compare neurocognitive functions between MCI patients with and without depression by analyzing the results of neuropsychological tests. METHODS: Participants included 153 MCI patients. Based on the diagnosis of major depressive disorder, the participants were divided into two groups: depressed MCI (MCI/D+) versus non-depressed MCI (MCI/D-). The general cognitive and functional statuses of participants were evaluated. And a subset of various neuropsychological tests was presented to participants. Demographic and clinical data were analyzed using Student t-test or χ 2 test. RESULTS: A total of 153 participants were divided into two groups: 94 MCI/D+ patients and 59 MCI/D- patients. Age, sex, and years of education were not significantly different between the two groups. There were no significant differences in general cognitive status between MCI/D+ and MCI/D- patients, but MCI/D+ participants showed significantly reduced performance in the six subtests (Contrasting Program, Go-no-go task, Fist-edge-palm task, Constructional Praxis, Memory Recall, TMT-A) compared with MCI/D- patients. CONCLUSIONS: There were significantly greater deficits in neurocognitive functions including verbal memory, executive function, attention/processing speed, and visual memory in MCI/D+ participants compared to MCI/D-. Once the biological mechanism is identified, distinct approaches in treatment or prevention will be determined.

Do Somatic Symptoms Predict the Severity of Depression? A Validation Study of the Korean Version of the Depression and Somatic Symptoms Scale.

This study aimed at exploring the psychometric characteristics of the Korean Version of the Depression and Somatic Symptoms Scale (DSSS) in a clinical sample, and investigating the impact of somatic symptoms on the severity of depression. Participants were 203 consecutive outpatients with current major depressive disorders (MDD) or lifetime diagnosis of MDD. The DSSS was compared with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the 17-items Hamilton Depression Rating Scale (HAMD). The DSSS showed a two-factor structure that accounted for 56.8% of the variance, as well as excellent internal consistency (Cronbach's alpha = 0.95), concurrent validity (r = 0.44-0.82), and temporal stability (intraclass correlation coefficient = 0.79). The DSSS had a high ability to identify patients in non-remission (area under receiver operating characteristic [ROC] curve = 0.887). Maximal discrimination between remission and non-full remission was obtained at a cut-off score of 22 (sensitivity = 82.1%, specificity = 81.4%). The number of somatic symptoms (the range of somatic symptoms) and the scores on the somatic subscale (SS, the severity of somatic symptoms) in non-remission patients were greater than those in remission patients. The number of somatic symptoms (slope = 0.148) and the SS score (slope = 0.472) were confirmed as excellent predictors of the depression severity as indicated by the MADRS scores. The findings indicate that the DSSS is a useful tool for simultaneously, rapidly, and accurately measuring depression and somatic symptoms in clinical practice settings and in consultation fields.

Molecular Neurobiology and Promising New Treatment in Depression.

The limited effects of currently available antidepressants are becoming an urgent issue in depression research. It takes a long time to determine treatment effects, and the overall remission rate is low. Although we expect the development of non-monoamine antidepressants in the near future, efforts in this regard over the past several decades have not yet been compensated. Thus, researchers and clinicians should clarify the neurobiological mechanisms of integrated modulators that regulate changes in genes, cells, the brain, and behaviors associated with depression. In this study, we review molecular neurobiological theories and new treatments for depression. Beyond neuroanatomy and monoamine theory, we discuss cells and molecules, neural plasticity, neurotrophisms, endocrine mechanisms, immunological mechanisms, genetics, circadian rhythms, and metabolic regulation in depression. In addition, we introduce the possibility of new antidepressant drug development using protein translation signaling (mTOR) pathways.

Effect of Frailty on Depression among Patients with Late-life Depression: A Test of Anger, Anxiety, and Resilience as Mediators.

Objective: While the association between depression and frailty in the elderly population has been investigated, the psychological factors that mediate such a relationship remain unknown. The identification of psychological factors in interventions for depression treatment in the elderly may assist in the treatment and care. We aimed to explore the mediating effects of anger, anxiety, and resilience on the link between frailty and depression symptoms in patients with late-life depression. Methods: A sample of 203 older adults completed questionnaires that assessed depression, anger, resilience, and anxiety. To measure frailty, participants were evaluated using a self-rated health questionnaire, weight-adjusted waist index related to sarcopenia, and weight-adjusted handgrip strength to evaluate weakness. A mediation model was tested, hypothesizing that anger, anxiety, and resilience would partially mediate the strength of the frailty-depression link in the elderly. Results: Only self-rated health showed a significant association with depressive symptoms in late-life depression. Our study demonstrated that frailty has both direct and indirect associations with depression, mediated by anger, resilience, and anxiety. Conclusion: Given that anger, resilience, and anxiety influence the link between self-rated health and depression, interventions that lead to increased resilience and decreased anger and anxiety may be promising to reduce depressive symptoms in older adults with depression.

Association between intra-individual variability and prefrontal cortex activity measured by functional Near Infrared Spectroscopy (fNIRS) in children with ADHD.

This study uses fNIRS to determine whether there is a difference in the relationship between intra-individual variability and frontal lobe activity between ADHD patients and typically developing children. A total of 28 subjects (14 in ADHD patient group and 14 in control group) participated in this study. The subjects were tested for K-SADS and intelligence, and then the frontal lobe activity of the subjects was measured by continuous performance test, using functional near-infrared spectroscopy (NIRSIT). Processing speed index was significantly lower in the ADHD patient group than in the control group (p = .04). The CPT test results showed a positive correlation in the activity of the right dorsolateral prefrontal region in the patient group, but not at a statistically significant level. In the control group, activity showed a significant level of negative correlation with commission and hit reaction time standard deviation (p = .023; p = .063 respectively). In contrary to ADHD patient group, activation of the right dorsolateral prefrontal area was significantly correlated with reduction of intra-individual variability. This result showing that the relationship between activation of the right dorsolateral prefrontal area of the ADHD patient group and intra-individual variability shows a different pattern from typically developing children.

Reliability and Validity of the Korean Version of the Brief Resilience Scale.

Objective: : To translate the Brief Resilience Scale into Korean and evaluate its reliability and validity. Methods: : To investigate the factor structure of the Brief Resilience Scale, we examined a two-factor model comprising positively and negatively worded items. Congruent and divergent validity of the Brief Resilience Scale were investigated using correlation analysis between the Brief Resilience Scale and resilience, depression, and perceived stress. By conducting an analysis of variance among groups classified by suicidality (no suicidality, only suicidal ideation, and suicidal ideation or suicidal plan groups), we evaluated how well the Brief Resilience Scale could detect people with a high risk of suicide. Results: : Confirmatory factor analysis results supported the construct validity of the Brief Resilience Scale using a two-factor model. Cronbach's alpha (0.91) and McDonald's omega (0.91) scores indicated high internal consistency. Correlation analysis showed that the Brief Resilience Scale scores were strongly associated with a questionnaire evaluating resilience, depression, and perceived stress. Analysis of variance and post-hoc tests showed that he Brief Resilience Scale scores were highest in the no suicidality group (p ＜ 0.001). Conclusion: : The Korean version of the Brief Resilience Scale is a valid and reliable instrument for evaluating resilience as the capacity to recover from adversity and endure obstacles or stress. This study also provides important evidence regarding the sensitivity of the Brief Resilience Scale to suicidal risk.

Association of changes in sleep duration and quality with incidence of depression: A cohort study.

BACKGROUND: The longitudinal relationship between sleep duration, sleep quality, and their changes with the risk of depressive symptoms is unclear. We examined the association between sleep duration, sleep quality, and their changes with incident depressive symptoms. METHODS: A total of 225,915 Korean adults without depression at baseline with a mean age of 38.5 years were followed for an average of 4.0 years. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index. The presence of depressive symptoms was assessed using the Center for Epidemiologic Studies Depression scale. Flexible parametric proportional hazard models were used to determine hazard ratios (HRs) and 95 % confidence intervals (CIs). RESULTS: In total, 30,104 participants with incident depressive symptoms were identified. Multivariable-adjusted HRs (95 % CIs) for incident depression comparing sleep durations of ≤5, 6, 8, and ≥9 h with 7 h were 1.15 (1.11-1.20), 1.06 (1.03-1.09), 0.99 (0.95-1.03), and 1.06 (0.98-1.14), respectively. A similar trend was observed in patients with poor sleep quality. Compared with participants with persistently good sleep quality, participants with persistently poor sleep quality or who developed poor sleep quality were associated with the risk of incident depressive symptoms [HRs (95 % CIs) of 2.13 (2.01-2.25) and 1.67 (1.58-1.77), respectively]. LIMITATIONS: Sleep duration was assessed using self-reported questionnaire and the study population may not reflect general population. CONCLUSIONS: Sleep duration, sleep quality and their changes were independently associated with incident depressive symptoms in young adults, suggesting that inadequate sleep quantity and quality play a role in depression risk.

Characteristics of Korean Employees Without Depression but Having Suicidal Ideation.

OBJECTIVE: The aim of this study was to identify the factors related to suicidal ideation targeting the risk group showing suicidal ideation despite the absence of depression in Korean workers. METHODS: The data of 14,425 participants who were employees aged of 18 to 75 years who attended a mental health checkup program at the Workplace Mental Health Institute, Kangbuk Samsung Hospital from June 2015 to October 2019 were analyzed. A self-report questionnaire consisting of sociodemographic factors, suicidal ideation, job stress, levels of depression and anxiety, and resilience was administered. A Hierarchical logistic regression model was used with suicidal ideation as dependent variable. Separate analyses were conducted according to depressive symptoms using the 20-item Center for Epidemiological Studies Depression (CES-D) scale. RESULTS: Being women, older, and having low resilience, more perceived stress, more severe anxiety and less sleeping hours were associated with suicidal ideation in no-depression group (CES-D <16). In the subcategories of job stress, lack of reward was significantly associated with suicidal ideation in no-depression group. CONCLUSION: This study identified the characteristics of a group that has no depression but has suicidal ideation in Korean workers. Among job stress items, lack of reward is a clear characteristic to be considered with caution in this group.

Association between gut microbiota and anxiety symptoms: A large population-based study examining sex differences.

BACKGROUND: This study aimed to examine the association between anxiety symptoms and gut microbial composition and to infer their functional pathways. METHODS: In total, 605 participants were included in this study. Participants were categorized into anxious and non-anxious groups according to their Beck Anxiety Inventory scores, and their fecal microbiota was profiled using 16S ribosomal RNA gene sequencing. The microbial diversity and taxonomic profiles of the participants with anxiety symptoms were analyzed using generalized linear models. The function of the gut microbiota was inferred by comparing 16S rRNA data between the anxious and non-anxious groups. RESULTS: The gut microbiome of the anxious group showed lower alpha diversity than that of the non-anxious group, and there were prominent differences in the community structure of the gut microbiota between the two groups. Male participants with anxiety had lower relative abundances of the family Oscillospiraceae, fibrolytic bacteria including those of the family Monoglobaceae, and short-chain fatty acid-producing bacteria such as those of the genus Lachnospiraceae_NK4A136 than those without anxiety symptoms. Female participants with anxiety symptoms had a lower relative abundance of the genus Prevotella than those without anxiety symptoms. LIMITATION: The direction of causality between anxiety symptoms and the gut microbiota was unclear owing to the cross-sectional design of the study. CONCLUSION: Our results elucidate the association between anxiety symptoms and gut microbiota and provide insights for developing interventions to treat anxiety symptoms.

Examining the links between burnout and suicidal ideation in diverse occupations.

Introduction: It is uncertain whether burnout is associated with suicidal ideation among workers not in health care services. The aim of this study was to identify how burnout and suicidal ideation are linked among employees in various occupations and whether depression affects this link. Methods: This cross-sectional study collected data from 12,083 participants aged 19-65 years from 25 companies and public institutions who underwent workplace mental health screening. Burnout and depression were assessed using both the Oldenburg Burnout Inventory and the Center for Epidemiologic Studies Depression Scale. Suicidal ideation was assessed by a self-rated questionnaire from the Korea National Health and Nutrition Examination Survey. Results: Exhaustion but not the cynicism dimension of burnout was associated with increased odds of suicidal ideation after adjustment for depression and other covariates (odds ratio [OR] = 1.47, 95% CI = 1.26-1.72). The association of exhaustion with suicidal ideation was significant in both depressed (OR = 1.36, 95% CI = 1.14-1.61) and not depressed (OR = 1.77, 95% CI = 1.13-2.76) participants. In exhausted participants, insufficient job control, an unfavorable occupational climate, low educational level, and depression were associated with increased odds of suicidal ideation. Conclusion: Exhaustion is linked with risk of suicidal ideation in employees not in health care service, regardless of depression status. Exhausted employees, particularly those having poor job resources, should be recognized as an at-risk group.

Use of eye tracking to improve the identification of attention-deficit/hyperactivity disorder in children.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. Although it requires timely detection and intervention, existing continuous performance tests (CPTs) have limited efficacy. Research suggests that eye movement could offer important diagnostic information for ADHD. This study aimed to compare the performance of eye-tracking with that of CPTs, both alone and in combination, and to evaluate the effect of medication on eye movement and CPT outcomes. We recruited participants into an ADHD group and a healthy control group between July 2021 and March 2022 from among children aged 6-10 years (n = 30 per group). The integration of eye-tracking with CPTs produced higher values for the area under the receiver operating characteristic (AUC, 0.889) compared with using CPTs only (AUC, 0.769) for identifying patients with ADHD. The use of eye-tracking alone showed higher performance compare with the use of CPTs alone (AUC of EYE: 0.856, AUC of CPT: 0.769, p = 0.029). Follow-up analysis revealed that most eye-tracking and CPT indicators improved significantly after taking an ADHD medication. The use of eye movement scales could be used to differentiate children with ADHD, with the possibility that integrating eye movement scales and CPTs could improve diagnostic precision.