Are Mediators of Grief Reactions Better Predictors Than Risk Factors? A Study Testing the Role of Satisfaction With Rituals, Perceived Social Support, and Coping Strategies.

The present study aimed to assess the mediating role of adjustment processes in known risk factors associated with prolonged grief disorder. Data were collected in March-April 2021 through an online survey of 542 Canadian adults bereaved since March 2020. The mediating role of satisfaction with funeral rituals, bereavement support, and coping strategies on grief outcomes was tested using structural equation modeling. Results showed that such adjustment processes played a significant role in the grief process and that they were better predictors than risk factors alone. Since they are more amenable determinants of grief reactions, they should be further studied using a longitudinal design.

Does autonomous motivation and self-efficacy mediate associations between environmental factors and physical activity in adolescents?

BACKGROUND: To analyze the associations among autonomous motivation, self-efficacy, satisfaction of basic psychological needs, social support and perceived environment with physical activity practice of adolescents aged between 12 and 15 years; and to test autonomous motivations and self-efficacy as potential mediators of the associations between these environmental factors and physical activity practice. METHODS: We evaluated 553 adolescents, that participated in the ActTeens Program. Physical activity was assessed using the Physical Activity Questionnaire for Adolescents. Autonomous motivation, self-efficacy, satisfaction of basic psychological needs, parents' social support and perceived environment were assessed using specifics questionnaires. Linear regression models were used to test the associations. RESULTS: Parents' support (ß = 0.32), satisfaction of basic psychological needs of colleagues (ß = 0.21) and teachers (ß = 0.12), and perceived environment (ß = 0.10) had significant associations with physical activity (p < 0.05). The direct effect value was reduced when autonomous motivation was added as a mediator of the association between parents' support and physical activity (ß = 0.24), with a 25% mediated effect. Autonomous motivation was mediator of the relationship between basic psychological needs of colleagues (ß = 0.13; EM = 38%), teachers (ß = 0.02; EM = 83%), and perceived environment (ß = 0.03; EM = 70%) with physical activity. CONCLUSION: Self-efficacy was not associated with physical activity and autonomous motivation was an important mediator of adolescents' physical activity.

Childhood psychosocial adjustment and midlife obesity, diabetes and hypertension: prospective study from two birth cohorts.

BACKGROUND: Understanding how childhood psychosocial adjustment (CPA) influences later life health outcomes is crucial for developing interventions to mitigate the long-term risk of cardiometabolic diseases (CMDs). AIMS: To investigate the association between CPA and incident CMDs in mid-life, and the mediating roles of educational attainment, smoking habits and depression during young adulthood. METHOD: A prospective cohort study utilised data from the 1958 National Child Development Study (NCDS; 1958-2013) and the 1970 British Cohort Study (BCS70; 1970-2018), encompassing 22 012 participants assessed for CPA in childhood, who were subsequently evaluated for educational attainment, smoking habits and depression in young adulthood, followed by assessments for CMDs in mid-life. CPA was assessed using the Bristol Social Adjustment Guides in the NCDS and the Rutter Child Behaviour Scale in the BCS70, with higher scores indicating poorer psychosocial adjustment. The primary outcomes were the mid-life incidences of hypertension, diabetes and obesity. RESULTS: Compared with children in the lowest tertile for CPA scores, those in the middle tertile had an adjusted odds ratio for hypertension of 0.98 (95% CI 0.90-1.06), whereas those in the highest tertile had an odds ratio of 1.17 (95% CI 1.08-1.26). For diabetes, the corresponding odds ratios (95% CI) were 1.15 (0.98-1.35) and 1.39 (1.19-1.62). For obesity, the corresponding odds ratios (95% CI) were 1.08 (1.00-1.16) and 1.18 (1.09-1.27). These associations were partially mediated by educational attainment (2.4-13.9%) and depression during young adulthood (2.5-14.9%). CONCLUSIONS: Poorer CPA is correlated with the development of hypertension, diabetes and obesity in mid-life. Interventions aimed at improving CPA may help in reducing the burden of these diseases in later life.

Physical activity and suicidal behavior in medical students from the United States.

BACKGROUND: There are little data on the relationship between physical activity and suicidal behavior in medical students. Therefore, this cross-sectional study aimed to investigate the association between physical activity and suicidal behavior and identify mediating factors involved in the association among medical students from the United States. METHODS: Data from the Healthy Minds Study (2007-2023) were used. Physical activity and suicidal behavior (i.e., suicidal ideation, suicide plans, and suicide attempts) were self-reported. Control variables included age, gender, ethnicity/race, relationship status, citizenship, current financial stress, and academic year. Mediating factors were flourishing, generalized anxiety disorder symptoms, depressive symptoms, eating disorder symptoms, binge drinking, smoking, and drug use. RESULTS: There were 6452 medical students included in the study (median [IQR] age 25.0 [3.0] years; 4032 [62.5 %] women). After adjusting for control variables, compared with <1 hour of physical activity per week, the odds of any suicidal behavior were significantly lower for 3-4 hours (OR = 0.57, 95 % CI = 0.41-0.79) and ≥5 hours of physical activity per week (OR = 0.52, 95 % CI = 0.39-0.70). The physical activity-any suicidal behavior relationship was partially explained by decreased depressive symptoms (39.4 %), increased flourishing (27.6 %), and decreased generalized anxiety disorder symptoms (18.7 %). LIMITATIONS: Data are of a cross-sectional nature. CONCLUSIONS: There was an inverse association between physical activity and suicidal behavior in medical students from the United States, while several variables were identified as mediating factors (i.e., depressive symptoms, flourishing, and general anxiety disorder symptoms). Further research is needed to corroborate these findings in other settings, while longitudinal data are urgently warranted.

Mediating Factors Associated With Physical Activity in Older Adults at Increased Dementia Risk.

While regular physical-activity (PA) is beneficial, multimorbid individuals at increased dementia risk may exhibit reduced PA levels. Thus, a more comprehensive understanding of mediating factors responsible for inactivity in this population is needed. This study investigated the impact of a multimodal intervention on PA changes at 24-month follow-up and associated mediating factors among community-dwelling patients aged 60-77, with increased dementia risk determined by the CAIDE Dementia Risk Score. Of 1030 participants recruited, 819 completed the assessment. Thus, a generalized estimating equations model initially assessed differences in PA over 24 months, followed by a tree analysis identifying mediating factors influencing PA changes post-intervention. While no significant effect on regular PA was found during the follow-up (P = .674), subgroup analysis revealed improved self-efficacy (P = .000) associated with increased engagement in PA. Incorporating self-efficacy elements into future strategies is crucial for promoting PA among individuals with multimorbidity and at increased dementia risk.

The relationship between psychological distress and weight maintenance in weight cycling: mediating role of eating behavior.

BACKGROUND: Obesity is a global public health concern. The goal of this study was to see if eating habits could mediate the relationship between psychological distress and weight maintenance in a population with a history of weight cycling. METHODS: A 3-month outpatient intervention consisting of a diet and exercise program was provided to 153 participants. Psychological distress, appetite, and behavior were assessed at the beginning and end of the study. Anthropometric measurements were taken at baseline and six months. RESULTS: After the structural equation model was developed, it was discovered that the psychological status of people with obesity and weight cycling histories correlated with the weight loss outcome effect (three and six months). This effect was mediated by factors related to eating behavior. Associative psychological factors had a direct effect on eating behavior (three months: ß = 0.181, 95% CI: 0.055-0.310; six months: ß = 0.182, 95% CI: 0.039-0.332) and appetite had a direct effect on eating behavior (three months: ß = 0.600, 95% CI: 0.514-0.717; six months: ß = 0.581, 95% CI: 0.457-0.713), both of which were significant (p < 0.01). At three months, psychological distress has a more substantial positive impact on weight change, with eating behavior acting as a partial mediator. At six months, there was no support for appetite's moderating role in eating behavior. CONCLUSIONS: The findings suggest that psychological interventions should be strengthened to improve weight loss effectiveness, particularly in participants with a history of weight cycling, making weight loss more complicated and prone to rebound. CLINICAL TRIAL REGISTRATION: The study has been registered in Clinical Trials (NCT05311462).

How is Obstructive Sleep Apnea Associated with High Blood Pressure and Diabetes Mellitus Type 2? Clues from a Two-Step Mendelian Randomized Study.

Background: Obstructive sleep apnea (OSA), high blood pressure (HBP), and type 2 diabetes mellitus (T2DM) have a close clinical relationship, but whether and how OSA affects HBP and T2DM is unclear. Study Design and Methods: Two-step, two-sample Mendelian randomization techniques were applied using single-nucleotide polymorphisms as genetic instruments for exposure and mediators, thus minimizing bias due to confounding factors and reverse causality. The total effect of OSA on HBP and T2DM was categorized into direct and mediating effects based on the mediating factors. Results: Two-sample MR analysis showed that OSA increased the risk of HBP (odds ratio [OR] = 1.010, 95% confidence interval [CI], 1.002-1.018; P = 0.0121) and T2DM (OR = 1.140, 95% CI, 1.059-1.228; P = 0.0005). In the process of OSA caused by HBP, sex hormone-binding globulin (SHBG) (female, 4.47% mediation; male, 2.76% mediation), total testosterone (TT) (male, 3.72% mediation), bioavailable testosterone (BioT) (female, 7.74% mediation), high-density lipoprotein cholesterol (HDL-C) (3.25% mediation), and apolipoprotein A1 (ApoA1) (1.31% mediation) were individual contributors. SHBG (female, 4.10% mediation; male, 1.58% mediation), TT (male, 3.69% mediation), BioT (female, 2.58% mediation), HDL-C (3.32% mediation), ApoA1 (2.14% mediation), and omega-6 fatty acids (2.33% mediation) may have mediating roles to varying degrees in the process of OSA caused by T2DM. Interpretation: This MR study showed that OSA is a risk factor for HBP and T2DM, and the evaluation of mediators may help further reveal the specific mechanism by which OSA causes HBP and T2DM.

Cognitive-adaptive Functioning Gap and Mediating Factors that Impact Adaptive Functioning in Chinese Preschool-aged Children with Autism Spectrum Disorder.

This study aimed to investigate the gap between adaptive functioning and cognitive functioning, especially verbal and nonverbal intelligence quotient (IQ) in Chinese children with ASD. We systematically explored cognitive functioning, ASD severity, early signs of developmental abnormalities, and socioeconomic factors as mediating factors of adaptive functioning. We enrolled 151 children (age: 2.5?6 years) with ASD and categorized them into one group with IQ ≥ 70 and another with IQ < 70. The two groups were calibrated for age, age at diagnosis, and IQ, and the relationship of adaptive skills with vocabulary acquisition index (VAI) and nonverbal index (NVI) were separately analyzed. Results show that the gap between IQ and adaptive functioning was significant in children with ASD having IQ ≥ 70, with both VAI and NVI showing statistically significant differences (all P < 0.001). VAI correlated positively with scores for overall adaptive skills and specific domains, whereas NVI had no significant correlations with adaptive skill scores. Age of first walking unaided had an independent positive correlation (all P < 0.05) with scores of adaptive skills and specific domains. IQ-adaptive functioning gap is significant in children with ASD having IQ ≥ 70, suggesting that defining "high-functioning autism" merely on the basis of IQ is not appropriate. Verbal IQ and early signs of motor development are specific and possible predictors of adaptive functioning in children with ASD, respectively.

Cost-Effectiveness of Prolonged Physical Activity on Prescription in Previously Non-Complying Patients: Impact of Physical Activity Mediators.

In Sweden, physical activity on prescription (PAP) is used to support patients in increasing their levels of physical activity (PA). The role of healthcare professionals in supporting PA behavior change requires optimization in terms of knowledge, quality and organization. This study aims to evaluate the cost-effectiveness of support from a physiotherapist (PT) compared to continued PAP at a healthcare center (HCC) for patients who remained insufficiently active after 6-month PAP treatment at the HCC. The PT strategy was constituted by a higher follow-up frequency as well as by aerobic physical fitness tests. The analysis was based on an RCT with a three-year time horizon, including 190 patients aged 27-77 with metabolic risk factors. The cost per QALY for the PT strategy compared to the HCC strategy was USD 16,771 with a societal perspective (including individual PA expenses, production loss and time cost for exercise, as well as healthcare resource use) and USD 33,450 with a healthcare perspective (including only costs related to healthcare resource use). Assuming a willingness-to-pay of USD 57,000 for a QALY, the probability of cost-effectiveness for the PT strategy was 0.5 for the societal perspective and 0.6 for the healthcare perspective. Subgroup analyses on cost-effectiveness based on individual characteristics regarding enjoyment, expectations and confidence indicated potential in identifying cost-effective strategies based on mediating factors. However, this needs to be further explored. In conclusion, both PT and HCC interventions are similar from a cost-effectiveness perspective, indicating that both strategies are equally valuable in healthcare's range of treatments.

The relationship between big five personality traits, coping strategies, and emotional problems through the COVID-19 pandemic.

Considering the impact of pandemic condition on mental health and functioning in daily life, the main purpose of this study was to investigate the relationship between Big Five personality traits, coping strategies and emotional problems such as symptoms of depression and anxiety, during the COVID-19 pandemic period. Specifically, the purpose of this study is to create a model of the impact of coping strategies as mediating factors in the relationship between Big Five personality traits personality traits and emotional problems. For the purposes of this study, a sample of 200 Kosovar respondents was used, where the age of the participants varies from 18 to 54 years. As a result of the pandemic situation created, the method of data collection for this study was done in the form of self-reporting, divided into physical questionnaires and online ones. The BFI Personality Inventory is used to classify Big Five personality traits, the Coping Control Checklist (WCCL) to classify coping strategies, and the Adult Self-Reporting Questionnaire (ASR) used to identify emotional problems. The analysis of the results in this study was done by means of the statistical package of SPSS and R program. After the analysis, it is seen that there is a significant correlation between Big Five personality traits (extraversion and neuroticism) and coping strategies (seeking social support and avoidance), as well as there is a correlation between Big Five personality traits (compliance and neuroticism) and emotional problems (symptoms of anxiety and depression). An association was also found between coping strategies (avoidance) and emotional problems (anxiety symptoms). As for gender differences in experiencing anxiety and depression symptoms and using desired thoughts as coping strategies, it was found that women are more predisposed to experience anxiety symptoms and use desired thoughts than men. The findings highlighted the part that coping strategies are significant mediator factors in the relationship between Big Five personality traits and emotional problems.

Understanding Serial Mediators of Problematic Pornography Use in Pakistani Men and Women.

In the current digital environment, satisfying sexual needs via Internet pornography use has the potential to develop into a problem that affects one's psychological health and daily functioning. The aim of this study was to examine potential cognitive and affective factors that could help explain the maintenance and exacerbation of self-defined problematic internet pornography use. METHODS: 280 Pakistani men and women (mean age = 25.40; SD = 5.271, range 18-50) who were current pornography users were recruited through social networking sites (Facebook, Instagram, LinkedIn, WhatsApp groups) to participate in an online study about pathways to problematic pornography use (PPU). Structural equation modeling was used to estimate path analysis coefficients extending from predisposing variables (depression, anxiety, self-esteem, and loneliness) to PPU via the mediating variables of craving, dysfunctional sexual coping, and stimulus-specific inhibitory control. RESULTS: Craving mediated the relationship between three predisposing variables (depression, anxiety, and self-esteem) and PPU, though not the fourth, namely loneliness. Indirect effects of depression, anxiety, and self-esteem were significantly linked to PPU through two serial mediation pathways: (a) craving and stimulus-specific inhibitory control, and (b) craving and dysfunctional sexual coping. CONCLUSION: These findings demonstrate that craving, stimulus-specific inhibitory control, and dysfunctional coping serve as important mediators in maintaining and exacerbating the cycle between negative predisposing variables and PPU. These results are interpreted within the general framework of therapeutic interventions that can help develop positive coping skills in individuals seeking to alter self-perceived bothersome or unwanted habits related to pornography use.

Childhood Maltreatment and Relationship Quality: A Review of Type of Abuse and Mediating and Protective Factors.

Childhood maltreatment (CM) has long been recognized as a risk factor for good intimate relationships. Research on the effects of CM on relationship functioning has focused on sexual abuse in girls. However, CM also includes emotional and physical abuse and neglect and is also common in boys. Moreover, prior research has mostly focused on individuals in isolation, ignoring that marriage is a system in which two partners mutually influence each other. Questions also remain about mediating and protective factors for healthy relationships in the context of CM. This article reviews the literature on the link between different forms of CM and one's own and one's partner relationship quality. It reviews 43 empirical studies that assessed associations between CM in any form and relationship quality. Also, mediating and protective factors and major methodological topics are examined. The review indicated that CM (neglect, sexual, emotional, or physical abuse) is associated with lower relationship quality in men and women. Psychological distress, cognitive and behavioral problems, insecure attachment, and self-dysregulation were identified as mediating factors. Protective processes involve good coping strategies, emotion regulation, parental support, and early secure attachment, but not partner characteristics. The results regarding gender are inconclusive. It is crucial to broaden the research on the dyadic effects of CM of various forms on relationship quality and study mediating and protective factors. More studies on neglect and diverse populations are needed, as well as prospective studies. This will enable the development of prevention programs for couples with a partner exposed to CM.

The Effects of Horticultural Activity Program on Vegetable Preference of Elementary School Students.

This study was conducted to investigate effects of a horticultural activity program based on a mediating variable model for improving vegetable preference among elementary students. A quasi-experimental design was employed with 136 students and 136 primary carers in Seoul, South Korea. Based on the mediation model for improving children's vegetable preference, 12 sessions were conducted, including gardening, nutrition education, and cooking activities using harvests. The program was conducted weekly for 12 weeks from March to July 2019. To investigate the effect of this program, mediating factors of the children were evaluated before and after the program. Pearson correlation analysis was used to identify the mediating factors. The nutrition index, attitude, knowledge, and eating habits of the primary carers were evaluated. Results showed children's nutrition and gardening knowledge, dietary self-efficacy, outcome expectancies, and vegetable preference were significantly improved (p < 0.001). Primary carers showed significant improvement in the nutrition index, knowledge, and attitude (p < 0.05). The correlation analysis confirmed that most of the mediating factors had significant correlations (p < 0.05). Therefore, administering a structured program involving horticultural activities and nutrition education as mediating factors for 12 sessions was effective in improving eating behavior for vegetables elementary school students and primary carers.

Mediating Factors between Childhood Traumatic Experiences and Eating Disorders Development: A Systematic Review.

BACKGROUND: Many people with eating disorders often report having suffered some kind of childhood trauma. For this reason, many studies have attempted to explore the mediating factors between traumatic experiences and the development of eating disorders. The aim of our study is to conduct a systematic review of published works on the mediating factors between childhood trauma and the development of eating disorders. METHOD: This review was carried out up to 5 December, 2020, using the databases PsycInfo and PubMed, combining the keywords, and applying a set of inclusion and exclusion criteria. RESULTS: A total of 18 articles were retrieved. After the articles were analyzed, a set of mediating factors between childhood trauma and the development of eating disorders was established, including pathological dissociation, difficulty with emotion self-regulation, body dissatisfaction, negative affect/depression, anxiety, general distress, self-criticism, and alexithymia, among others. CONCLUSIONS: In addition to evaluating trauma in eating disorders, these results highlight the importance of paying special attention to the presence of various possible mediating factors, which must be taken into account in the planning of therapeutic treatment. Identifying symptoms of trauma or eating disorders early on could prevent onset of more severe psychopathology during adulthood.

Nut consumption, risk of cardiovascular mortality, and potential mediating mechanisms: The Women's Health Study.

BACKGROUND: The link between nut consumption and cardiovascular (CV) mortality remains unclear. OBJECTIVE: to examine whether nut consumption is associated with CV mortality and estimate the proportion of reduced risk of CV mortality explained by intermediate factors. METHODS: We studied 39,167 women from the Women's Health Study; 28,034 provided blood samples. Nut consumption was self-reported at baseline and at follow-up using a food frequency questionnaire. Our primary outcome was cardiovascular death, which was ascertained via medical records, confirmed with the national death index and death certificates. RESULTS: During a mean follow-up of 19 years, 959 CV deaths occurred. In a multivariable Cox regression model adjusting for age, body mass index, smoking, alcohol use, physical activity, postmenopausal status, marital status, family history of premature myocardial infarction and the alternate healthy eating index score, hazard ratios for CV mortality were 0.93 (0.76-1.14) for nut consumption of 1-3 times/month, 0.84 (0.69-1.01) for nut intake of 1 time/week, and 0.73 (0.61-0.87) for nut consumption of ≥2 times/week when compared to women who did not consume nuts (p = 0.0004). LDL and total cholesterol accounted for about 19%, HbA1c 18% and all mediating factors together accounted for about 6.6% of the lower risk of CV mortality for those who consumed nuts ≥2 times/week. For the secondary outcome of CV events, although the effect was noted to be in the same direction with increasing nut consumption associated with lower risk of CV events, it was not statistically significant (p = 0.07). CONCLUSION: This study suggests that nut consumption is inversely associated with cardiovascular mortality in women. Lipids, inflammatory markers and glucose metabolism account for a modest proportion of the lowered CV mortality observed with nut consumption, assuming a causal nut-CV mortality association.

Garden-Based Integrated Intervention for Improving Children's Eating Behavior for Vegetables.

This study was conducted to develop and verify the effects of a garden-based integrated intervention for improving children's eating behavior for vegetables. A pre-post-test experimental design was employed. The participants were 202 elementary school students (average age: 11.6 ± 1.5 years). The garden-based integrated intervention program was conducted during regular school hours for a total of 12 weeks. The program, based on a mediator model for improving children's eating behavior, included gardening, nutritional education, and cooking activities utilizing harvests. In order to examine effects of the program, the mediating factors related to children's eating behavior were evaluated using pre-post questionnaires. As a result of the program, dietary self-efficacy, outcome expectancies, gardening knowledge, nutrition knowledge, vegetable preference, and vegetable consumption were significantly increased, and food neophobia was significantly decreased. In addition, there were positive correlations between most mediating factors. Thus, the garden-based integrated intervention developed in this study was effective in improving children's eating behavior for vegetables.

Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort.

Background: There is convincing evidence that high physical activity lowers the risk of colon cancer; however, the underlying biological mechanisms remain largely unknown. We aimed to determine the extent to which body fatness and biomarkers of various biologically plausible pathways account for the association between physical activity and colon cancer. Methods: We conducted a nested case-control study in a cohort of 519 978 men and women aged 25 to 70 years followed from 1992 to 2003. A total of 713 incident colon cancer cases were matched, using risk-set sampling, to 713 controls on age, sex, study centre, fasting status and hormonal therapy use. The amount of total physical activity during the past year was expressed in metabolic equivalent of task [MET]-h/week. Anthropometric measurements and blood samples were collected at study baseline. Results: High physical activity was associated with a lower risk of colon cancer: relative risk ≥91 MET-h/week vs <91 MET-h/week = 0.75 [95% confidence interval (CI): 0.57 to 0.96]. In mediation analyses, this association was accounted for by waist circumference: proportion explained effect (PEE) = 17%; CI: 4% to 52%; and the biomarkers soluble leptin receptor (sOB-R): PEE = 15%; 95% CI: 1% to 50% and 5-hydroxyvitamin D (25[OH]D): PEE = 30%; 95% CI: 12% to 88%. In combination, these factors explained 45% (95% CI: 20% to 125%) of the association. Beyond waist circumference, sOB-R and 25[OH]D additionally explained 10% (95% CI: 1%; 56%) and 23% (95% CI: 6%; 111%) of the association, respectively. Conclusions: Promoting physical activity, particularly outdoors, and maintaining metabolic health and adequate vitamin D levels could represent a promising strategy for colon cancer prevention.

Early symptomatic improvement affects treatment outcome in a study of major depressive disorder.

Early symptomatic improvement immediately following randomization can affect signal detection in clinical trials. The impact of early improvement of the Montgomery-Asberg depression rating scale (MADRS) on eventual treatment outcome was examined in a 6-week, double-blind, placebo-controlled trial of a putative antidepressant (CX157) versus placebo in depressed subjects with major depressive disorder (MDD) who had had an inadequate response to ongoing antidepressant treatment (NCT00739908). MADRS score changes within one week after randomization directly affected treatment outcome at the study endpoint (week 6). The response and remission rates at week 6 increased significantly as the percent of MADRS score improvement increased between baseline and week 1 regardless of treatment assignment. Less MADRS improvement or actual worsening within the first week after randomization was associated with minimal overall MADRS score changes by week 6 in either treatment assignment. Alternatively, CX157 assigned subjects who had ≥30% improvement by week 1 achieved a significantly greater treatment response rate than the matched placebo group at the study endpoint (p = 0.025) that converted the lack of signal detection in the mITT population. This post-hoc analysis highlights the potent effect that early symptomatic improvement immediately following randomization can have on treatment outcome, and is particularly relevant for antidepressant drugs with rapid onset of action. The findings compel further exploration of possible moderating and mediating factors, including the experimental condition itself that can influence early response, and the need to identify "bio-types" within the population of MDD subjects.

Neo-Marxian social class inequalities in self-rated health among the employed in South Korea: the role of material, behavioral, psychosocial, and workplace environmental factors.

BACKGROUND: The aim of this study was to examine the pattern of social inequality in self-rated health among the employed using the Wright's social class location indicator, and to assess the roles of material, behavioral, psychosocial, and workplace environmental factors as mediating factors in explaining the social class inequality in self-rated health in South Korea. METHODS: This study used data from the 4th Korea National Health and Nutrition Examination Survey from 2007 to 2009. Study subjects included the employed population of 4392 men and 3309 women aged 19-64 years. Subjects were classified into twelve social class positions based on the Wright's social class map. The health outcome was self-rated health. Material, psychosocial, behavioral, and workplace environmental factors were considered as potential mediators in explaining social class health inequality. We calculated prevalence ratios of poor self-rated health according to social class, adjusted for age and mediating factors using Poisson regression models. RESULTS: Nonskilled workers and petty bourgeoisie reported worse self-rated health than other social classes among men. The age-adjusted prevalence of petty bourgeoisie and nonskilled workers were about four-fold greater than that of managers. Expert supervisors in the contradictory class location had a greater prevalence of poor self-rated health than experts in men. In women, the prevalence of poor self-rated health was greater in most social classes than their male counterparts, while the differences among social classes within women were not statistically significant. Workplace environmental factors explained the social class inequality by from 24 to 31% in nonskilled and skilled workers and nonskilled supervisors, respectively, and material factors showed an explanatory ability of about 8% for both nonskilled workers and petty bourgeoisie in men. CONCLUSIONS: We showed the inequality in self-rated health according to the Wright's social class in an industrialized Asian country. Policy efforts to improve workplace environments in nonskilled and skilled workers and nonskilled supervisors would have a moderate effect on reducing the magnitude of social class inequality in self-rated health. Furthermore, the means to improve power relations in the workplace should be devised to further reduce the social class inequalities in health.