The short-term effect of ambient particulate matter on suicide death.

BACKGROUND: Air pollution can cause various respiratory and neurological diseases and continuous exposure can lead to death. Previous studies have reported that particulate matter (PM) exposure increases the risk of depression, suicidal thoughts, and suicidal death; however, the results are inconsistent and limited. This study aimed to examine the relationship between short-term PM exposure and suicide deaths, as well as investigate the short-term effects of PM on suicide death within vulnerable groups based on factors such as sex, age group, suicide-related information (note, method, and cause), psychiatric disorders, and physical diseases. METHODS: Data on a total of 28,670 suicide deaths from 2013 to 2017, provided by the Korea Foundation for Suicide Prevention, were analyzed. The study design employed a time-series analysis with a two-stage approach. In the first step, a generalized additive model combined with a distributed lag nonlinear model was used to estimate the short-term effect of PM exposure on suicide risk specific to each city. In the second step, the estimated results from each city were pooled through a meta-analysis to derive the overall effect. We determined the effects of single lag, cumulative lag, and moving average PM concentrations from days 0-7 before suicide. RESULTS: We confirmed an association between exposure to PM10 (≤ 10 µm in diameter) and deaths due to suicide. In particular, among individuals with psychiatric disorders and those who employed non-violent suicide methods, increased exposure to PM10 was associated with a higher risk of death by suicide, with percentage changes of 5.92 (95% confidence interval [CI]: 3.95-7.92) and 11.47 (95% CI: 7.95-15.11), respectively. Furthermore, in the group with psychiatric disorders, there was an observed tendency of increasing suicide risk as PM10 levels increased up to 120 µg/m3, whereas in the group with non-violent suicide deaths, there was a pronounced trend of rapid increase in suicide risk with an increase in PM10 up to 100 µg/m3. CONCLUSIONS: These results show an association between short-term exposure to PM and suicide. Our study adds evidence for the benefits of reducing PM in preventing diseases and improving mental health.

Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships.

BACKGROUND: Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation. METHODS: The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships. RESULTS: The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation. CONCLUSIONS: Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study.

BACKGROUND: Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older. METHODS: We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model. RESULTS: In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years. CONCLUSION: Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.

Early Trauma and Relationships among Recent Stress, Depressive Symptoms, Anxiety Symptoms, and Suicidal Ideation in Korean Women.

BACKGROUND: Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history. METHODS: Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET. RESULTS: Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively. CONCLUSION: Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.

Characteristics of adolescents who visit the emergency department following suicide attempts: comparison study between adolescents and adults.

BACKGROUND: The purpose of this study was to identify the demographic and clinical characteristics of suicide attempts in adolescents who visit the emergency department compared to those of adults. METHODS: This study included 149 children under the age of 18, and 1427 people in the age of 19-65 who came to the emergency department with suicide attempt from 2009 to 2015. We compare sociodemographic, clinical, and suicide attempt-related characteristics through Chi-square test and logistic regression analysis to evaluate the difference between two groups. RESULTS: In adolescents, suicide attempters had more number of previous suicide attempt history than adults. Adolescents used more non-lethal method such as poisoning of over the counter drugs and had about 5 times higher odds ratio in suicide attempts with analgesics. The motivation of suicide attempt among adolescents was more related with interpersonal problems but less with financial or illness-related problems. The intention of suicide attempt in adolescents was less serious and lethal compared to adults. CONCLUSION: Suicide attempts among adolescents had showed different from adults in method, motivation and intention. Considering the characteristics of suicide attempt among adolescent, it is necessary to keep close attention to adolescent's suicide attempters and develop the customized intervention program to prevent the suicide attempt in this groups.

Identifying alcohol problems among suicide attempters visiting the emergency department.

BACKGROUND: Many suicide attempters brought to our emergency department (ED) have been found to have alcohol problems, and this should be taken serious consideration because alcohol use disorder is a risk factor for suicide reattempt. In this study, we aimed to estimate the effectiveness of alcohol-related biochemical markers and Alcohol Use Disorder Identification Test Consumption (AUDIT-C) in suicide attempters who visited our ED based on the gold standard for clinical diagnosis used by psychiatrists for alcohol use disorder. Moreover, we aimed to search for a significant standard when clinicians make correct predictions about alcohol use disorder using these markers. METHODS: Among the subjects who visited ED following a suicide attempt, a total of 203 subjects were selected. Following a psychiatric interview, the subjects who met the criteria for alcohol abuse or alcohol dependence according to DSM-IV-TR in the past year were defined as the "alcohol use disorder" group. Although some subjects did not meet these criteria, men with a weekly alcohol intake of ≥14 drinks and women with a weekly alcohol intake of ≥7 drinks were classified as the "risky drinking" group. AUDIT-C was used as a self-report; further, aspartate aminotransferase, gamma-glutamyltransferase (GGT), and carbohydrate-deficient transferrin (CDT) were assayed using standard methods, and GGT-CDT was calculated using this formula: 0.8 × ln(GGT) + 1.3 × ln(%CDT). RESULTS: In total, 88 subjects met the criteria for alcohol use disorder and 115 were included in the reference group. In the screening for alcohol use disorder, the AUC of AUDIT-C was 0.89 for men and 0.87 for women. In the screening for risky drinking, the AUC of AUDIT-C was 0.99 for men and 0.93 for women. Compared with other biochemical markers, AUDIT-C showed the highest AUC value for screening for both alcohol use disorder and risky drinking, with the trend being more prominent in men. CONCLUSIONS: Among the biochemical markers, AUDIT-C yielded the highest sensitivity, specificity, and accuracy in diagnosing alcohol use disorder among suicide attempters in ED. Comparison of results revealed that the use of AUDIT-C with biochemical markers or its use alone can help screen for alcohol use disorder or risky drinking in clinical settings.

Characteristics of the "young-old" and "old-old" community-dwelling suicidal Ideators: A longitudinal 6-month follow-up study.

BACKGROUND: Despite heterogeneity of older people in suicidal behavior, research identifying characteristics by age groups is scarce. We examined baseline features of older community-dwelling suicidal ideators by dichotomized age groups and the 6-month trajectory of their suicidal ideation along with its related psychopathology. Predictors of suicidal ideation within each group were investigated. METHODS: Older community-dwelling suicidal ideators enrolled in the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior study were subdivided into the "young-old (65-74 years)" and "old-old (≥75 years)" group. Baseline, 1-, and 6-month assessments were compared. Within each group, multiple regression analysis using rating scales (Patient Health Questionnaire-9, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, Stress Questionnaire for Korean National Health and Nutrition Examination Survey-Short Form, and Social Relationships Scale) was conducted to identify predictors of suicidal ideation measured with the intensity subscale of the Columbia-Suicide Severity Rating Scale. Two-way repeated-measures analysis of variance (RM-ANOVA) was used to compare changes in suicidal ideation, depression, anxiety between age groups over time, and one-way RM-ANOVA to examine changes within each age group. RESULTS: Among 29 "young-old" and 53 "old-old" ideators, the latter were less likely to be receiving psychiatric treatment (odds ratio [OR] = 4.065) and make suicide attempts (OR = 2.874), whereas the former revealed greater levels of anxiety and stress. Baseline depression and stress in the "young-old" group and the "old-old" group, respectively, predicted the intensity of suicidal ideation at both baseline and 1-month assessments. No significant age group x time interactions on suicidal ideation and depression were found. However, within each age group, both suicidal ideation and depression significantly decreased only during the first month with no further improvement. CONCLUSION: We speculate cautiously that more attention may need to be paid to the "old-old" ideators in the evaluation of psychiatric issues and for referral to psychiatrists. To decrease suicidal ideation, tailored approaches involving proactive, timely management of depression in the "young-old" and interventions focusing on stress reduction in the "old-old," would be helpful.

The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior: Study rationale, methodology, and baseline sample characteristics of a long-term, large-scale, multi-center, prospective, naturalistic, observational cohort study.

BACKGROUND: The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study is a prospective, naturalistic, observational cohort study, aiming to identify predictors of suicide attempt and suicide characteristics in the Korean suicidal population. The findings intend to contribute to a thorough understanding of suicidal phenomena and development of suicide prevention guidelines. The present cross-section study examines the study rationale, methodology, and baseline characteristics of the participants. METHODS: Participants were enrolled via the hospital and community gateways, establishing the hospital-based cohort (HC) and community-based cohort (CC), respectively. Baseline assessment was conducted on sociodemographic, clinical, diagnostic, and psychopathological aspects. The Columbia-Suicide Severity Rating Scale was used to investigate suicidality. RESULTS: A total of 800 suicidal people aged 15 years or older were enrolled from 8 university hospitals and 8 community mental health welfare centers (CMHWCs), among whom 480 (60%) were suicidal ideators and 320 (40%) were attempters. The ideators comprised 207 CC and 273 HC participants, whereas the attempters, 34 CC and 286 HC participants. Despite their lower severity in some measures, including suicidal ideation, compared with their HC counterparts, the CC participants within each group of ideators or attempters presented clinically significant psychopathology. Moreover, alcohol use problems and past suicide attempt were more likely to be found in CC participants. Only 11.1% to 21.6% of the participants in each of the four groups (defined by the cohorts and the ideators/attempters) were on any type of psychiatric treatment. CONCLUSIONS: Suicidal visitors to CMHWCs need to be as closely monitored as suicidal patients in university hospitals, especially considering their association with problem drinking and past suicide attempt. A cautious assumption is that the high suicide rate in Korea might be partly attributable to the low proportion of patients receiving psychiatric services.

Sociodemographic and clinical characteristics of old-old suicide attempters compared with young-old and middle-aged attempters.

OBJECTIVES: The purpose of this study was to identify distinctive characteristics of old-old suicide attempters (75 years and older) from young-old (60-74 years old) and middle-aged suicide attempters (45-59 years old). METHODS: We included consecutive series of 920 patients aged 45 years and older who had visited the emergency room from 2009 to 2015 because of suicide attempts. They were divided into 3 groups according to age. Information about the suicide attempt and sociodemographic status was gathered through interviews with attempters or caregivers. Chi-square test and logistic regression analysis were performed to evaluate the differences among the 3 groups. RESULTS: We found that old-old suicide attempters had high intent to die and high medical lethality as a result of the attempt, and illness-related problems exerted a strong motivational effect on this group. Psychiatric drugs, pesticides, and herbicides were frequently used to attempt suicide. These attempts were less likely to be associated with alcohol consumption compared to other age groups. CONCLUSION: Old-old suicide attempters have different characteristics, compared with young-old and middle-aged counterparts. It is necessary to assess suicide risk and depression when examining patients with physical illness or when prescribing psychotropic drugs. High-risk groups should be given immediate intervention including psychiatric treatment before they act on high suicide intent.

Implications of Increased Trait Impulsivity on Psychopathology and Experienced Stress in the Victims of Early Trauma With Suicidality.

There is a paucity of research characterizing suicide-related factors in victims of early trauma (ET). This cross-sectional study investigated an increase in trait impulsivity of ET victims with suicidal ideation or behavior and its role in severity of psychopathologies and experienced stress. Using data of 401 Korean suicidal ideators and attempters, trait impulsivity, severity of psychopathologies, and stress levels in addition to sociodemographic and clinical characteristics were compared between the ET group and the no ET group. Three first-order factors of trait impulsivity measured in Barratt Impulsive Scale-11 (cognitive instability, motor, and [lack of] perseverance) as well as depression, anxiety, overall stress level, and stress from social relationships were significantly elevated in the ET group. Owing to the long-lasting neurobiological influences of ET, it is recommended clinically that victims be carefully monitored for the development of mental distress, such as depression and anxiety, even in adulthood.

Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior.

In this cross-sectional study, we aimed to identify distinguishing factors between populations with suicidal ideation recruited from hospitals and communities to make an efficient allocation of limited anti-suicidal resources according to group differences. We analyzed the baseline data from 120 individuals in a community-based cohort (CC) and 137 individuals in a hospital-based cohort (HC) with suicidal ideation obtained from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study. First, their sociodemographic factors, histories of medical and psychiatric illnesses, and suicidal behaviors were compared. Second, diagnosis by the Korean version of the Mini International Neuropsychiatric Interview, scores of psychometric scales were used to assess differences in clinical severity between the groups. The results revealed that the HC had more severe clinical features: more psychiatric diagnosis including current and recurrent major depressive episodes (odds ratio [OR], 4.054; P < 0.001 and OR, 11.432; P < 0.001, respectively), current suicide risk (OR, 4.817; P < 0.001), past manic episodes (OR, 9.500; P < 0.001), past hypomanic episodes (OR, 4.108; P = 0.008), current alcohol abuse (OR, 3.566; P = 0.020), and current mood disorder with psychotic features (OR, 20.342; P < 0.001) besides significantly higher scores in depression, anxiety, alcohol problems, impulsivity, and stress. By comparison, old age, single households, and low socioeconomic status were significantly associated with the CC. These findings indicate the necessity of more clinically oriented support for hospital visitors and more socioeconomic aid for community-dwellers with suicidality.

Effects of robot-assisted walking training on balance, motor function, and ADL depending on severity levels in stroke patients.

BACKGROUND: Despite the explosive increase in interest regarding Robot-Assisted Walking Training (RAWT) for stroke patients, very few studies have divided groups according to the severity levels of patients and conducted studies on the effects of RAWT. OBJECTIVE: The purpose of this study was to present a definite basis for physical therapy using the robot-assisted walking device through a more detailed comparison and analysis and to select the optimal target of RAWT. METHODS: This study was designed as a prospective and randomized controlled trial to investigate the effect of RAWT on balance, motor function, and Activities of Daily Living (ADL) depending on severity levels in stroke patients. 100 participants were randomly divided into study and control groups in equal numbers. The study group was 49 and the control group was 47. One from the study group and three from the control group were eliminated. The study period is four weeks in total, and RAWT is performed five times a week for 40 minutes only for study group. During the same period, all group members had 30 minutes of Conventional Physiotherapy (CP) five times a week. RESULTS: The results of this study clearly confirmed that RAWT combined with CP produces more significant improvement in patients with stroke than the CP alone. And they indicated that RAWT had a more considerable effect in the poor or fair trunk control group for trunk balance and in the high fall risk group for balance. In motor function, RAWT showed its value in the severe and marked motor impairment group. The total or severe dependence group in ADL experienced more improvements for RAWT. CONCLUSION: This study can be concluded that the lower the level of physical functions, the more effective it responds to RAWT. As demonstrated in the results of this study, the potential of current robotic technology appears to be greatest at very low functional levels of stroke patients. Patients with low functional levels among stroke patients may benefit from robot rehabilitation.

Developing prediction algorithms for late-life depression using wearable devices: a cohort study protocol.

INTRODUCTION: Despite the high prevalence of major depressive disorder (MDD) among the elderly population, the rate of treatment is low due to stigmas and barriers to medical access. Wearable devices such as smartphones and smartwatches can help to screen MDD symptoms earlier in a natural setting while forgoing these concerns. However, previous research using wearable devices has mostly targeted the younger population. By collecting longitudinal data using wearable devices from the elderly population, this research aims to produce prediction algorithms for late-life depression and to develop strategies that strengthen medical access in community care systems. METHODS AND ANALYSIS: The current cohort study recruited a subsample of 685 elderly people from the Korean Genome and Epidemiology Study-Cardiovascular Disease Association Study, a national large cohort established in 2004. The current study has been conducted over a 3-year period to explore the development patterns of late-life depression. Participants have completed three annual face-to-face interviews (baseline, the first follow-up and the second follow-up) and 2 years of app-based surveys and passive sensing data collection. All the data collection will end at the second follow-up interview. The collected self-report, observational and passive sensing data will be primarily analysed by machine learning. ETHICS AND DISSEMINATION: This study protocol has been reviewed and approved by the Yonsei University Mirae Campus Institutional Review Board (1041849-2 02 111 SB-180-06) in South Korea. All participants provided written informed consent. The findings of this research will be disseminated by academic publications and conference presentations.

Development and external validation of a logistic and a penalized logistic model using machine-learning techniques to predict suicide attempts: A multicenter prospective cohort study in Korea.

Despite previous efforts to build statistical models for predicting the risk of suicidal behavior using machine-learning analysis, a high-accuracy model can lead to overfitting. Furthermore, internal validation cannot completely address this problem. In this study, we created models for predicting the occurrence of suicide attempts among Koreans at high risk of suicide, and we verified these models in an independent cohort. We performed logistic and penalized regression for suicide attempts within 6 months among suicidal ideators and attempters in The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS). We then validated the models in a test cohort. Our findings indicated that several factors significantly predicted suicide attempts in the models, including young age, suicidal ideation, previous suicidal attempts, anxiety, alcohol abuse, stress, and impulsivity. The area under the curve and positive predictive values were 0.941 and 0.484 after variable selection and 0.751 and 0.084 in the test cohort. The corresponding values for the penalized regression model were 0.943 and 0.524 in the original training cohort and 0.794 and 0.115 in the test cohort. The prediction model constructed through a prospective cohort study of the suicide high-risk group showed satisfactory accuracy even in the test cohort. The accuracy with penalized regression was greater than that with the "classical" logistic model.

Efficacy and Safety of Lurasidone vs. Quetiapine XR in Acutely Psychotic Patients With Schizophrenia in Korea: A Randomized, Double-Blind, Active-Controlled Trial.

OBJECTIVE: This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. METHODS: Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. RESULTS: Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35-4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. CONCLUSION: Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Impact of Parental Mental Health and Help-Seeking on Adolescents' Suicidal Ideations and Help-Seeking Behaviors.

This study aimed to evaluate the impact of parental mental health on adolescent offspring. Data regarding 6512 families from the 2010-2021 Korean National Health and Nutrition Examination Survey were analyzed; among them, 428 were placed in the suicidal ideation (SI) group and 421 were placed in the matched control (MC) group. This number was selected for the use of the propensity score matching method. The findings highlighted significant associations between parental mental health and adolescent suicidal ideation, with mothers in the SI group having higher odds of Diagnosed Depression (OR 2.109, 1.023-4.350 95% CI), Depressive Mood (OR 2.155, 1.224-3.793 95% CI), and Suicidal Ideation (OR 2.532, 1.322-4.851 95% CI) compared to the MC group. Regarding the fathers, paternal Suicidal Ideation (OR 4.295, 1.747-10.599 95% CI) was the only significant factor for adolescent suicidal ideation. In contrast, maternal depressive symptoms and help-seeking behavior significantly impacted adolescent help-seeking; Maternal Depressive Mood increased with adolescent Help-Seeking (OR 4.486, 1.312-15.340 95% CI) while Maternal Suicidal Ideation reduced the probability of Help-Seeking in the SI group (OR 0.15, 0.031-0.721, 95% CI). Chronic and severe depressive symptoms in mothers could make adolescents less likely to seek help for their suicidal ideations. Therefore, clinicians working with adolescents should prioritize a family-oriented approach.

Monitoring arsenic species concentration in rice-based processed products distributed in South Korean markets and related risk assessment.

Rice is an important grain as a major source of carbohydrates in Asia but contains more arsenic (As) than other grains. A total of 239 rice-based processed foods (rice, n = 30; rice cake, n = 30; porridge, n = 39; noodles, n = 33; bread, n = 20; snack, n = 59; powder, n = 28) were purchased in 2019 from domestic markets to measure total As (tAs) and As species. The average tAs and inorganic As (iAs) in each sample group ranged from 20 to 180 µg/kg (porridge for baby to noodle) and 4.4-85 µg/kg (porridge for baby to powder), respectively. The correlation between the iAs and tAs was affected by the variety of ingredients, such as the presence of seaweed (tAs) and the milling type of rice (iAs). Although rice cakes and baby rice-based powders are a source of concern for both adults and children, respectively, risk assessments indicate that most rice-based foods are generally safe to consume in South Korea. Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-023-01270-9.

Sex differences in the factors that affect medical lethality in elderly suicide attempters.

Objectives: This study aimed to identify sex differences in the factors that affect medical lethality in elderly suicide attempters. Methods: A total of 253 elderly suicide attempters and 351 middle-aged attempters (comparison group) who visited the emergency room at a general hospital were included. The sociodemographic and clinical characteristics of the patients were investigated. The Chi-squared test and logistic regression analysis were performed. And Spearman's correlation coefficient was calculated. Results: In older males, the risk of high lethality was lower when attempting suicide due to the loss of family members [adjusted odds ratio (AOR): 0.08]. The risk increased as the intent to die became more certain (some AOR: 11.31, certain AOR: 28.75), and this association became more pronounced with age (rho middle-aged: 0.329; young-old: 0.387; old-old: 0.415). In older females, the risk was lower when employed (AOR: 0.28). The method of suicide attempt also affected lethality (agricultural chemicals AOR: 3.71; psychiatric medication AOR: 0.31). Conclusion: Sex differences in the factors that affect medical lethality were identified among elderly suicide attempters. In particular, medical lethality can be predicted by the degree of suicide intention in older males. These findings will help to establish more efficient preventive strategies with specific targets.

Childhood adversity and late-life depression: moderated mediation model of stress and social support.

Background: As life expectancy increases, understanding the mechanism for late-life depression and finding a crucial moderator becomes more important for mental health in older adults. Childhood adversity increases the risk of clinical depression even in old age. Based on the stress sensitivity theory and stress-buffering effects, stress would be a significant mediator, while social support can be a key moderator in the mediation pathways. However, few studies have tested this moderated mediation model with a sample of older adults. This study aims to reveal the association between childhood adversity and late-life depression in older adults, taking into consideration the effects of stress and social support. Methods: This study used several path models to analyze the data from 622 elderly participants who were never diagnosed with clinical depression. Results: We found that childhood adversity increases the odds ratio of depression by approximately 20% in older adults. Path model with mediation demonstrates that stress fully mediates the pathway from childhood adversity to late-life depression. Path model with moderated mediation also illustrates that social support significantly weakens the association between childhood adversity and perceived stress. Conclusion: This study provides empirical evidence to reveal a more detailed mechanism for late-life depression. Specifically, this study identifies one crucial risk factor and one protective factor, stress and social support, respectively. This brings insight into prevention of late-life depression among those who have experienced childhood adversity.

Maximum Voided Volume Is a Better Clinical Parameter for Bladder Capacity Than Maximum Cystometric Capacity in Patients With Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: A Prospective Cohort Study.

PURPOSE: Bladder capacity is an important parameter in the diagnosis of lower urinary tract dysfunction. We aimed to determine whether the maximum bladder capacity (MCC) measured during a urodynamic study was affected by involuntary detrusor contraction (IDC) in patients with Lower Urinary Tract Symptoms (LUTS)/Benign Prostatic Hyperplasia (BPH). METHODS: Between March 2020 and April 2021, we obtained maximum voided volume (MVV) from a 3-day frequency-volume chart, MCC during filling cystometry, and maximum anesthetic bladder capacity (MABC) during holmium laser enucleation of the prostate under spinal or general anesthesia in 139 men with LUTS/BPH aged >50 years. Patients were divided according to the presence of IDC during filling cystometry. We assumed that the MABC is close to the true value of the MCC, as it is measured under the condition of minimizing neural influence over the bladder. RESULTS: There was no difference in demographic and clinical characteristics between the non-IDC (n=20) and IDC groups (n=119) (mean age, 71.5±7.4) (P>0.05). The non-IDC group had greater bladder volume to feel the first sensation, first desire, and strong desire than the IDC group (P<0.001). In all patients, MABC and MVV were correlated (r=0.41, P<0.001); however, there was no correlation between MCC and MABC (r=0.19, P=0.02). There was no significant difference in MABC between the non-IDC and IDC groups (P=0.19), but MVV and MCC were significantly greater in the non-IDC group (P<0.001). There was no significant difference between MABC and MVV (MABC-MVV, P=0.54; MVV/MABC, P=0.07), but there was a significant difference between MABC and MCC between the non-IDC and IDC groups (MABC-MCC, P<0.001; MCC/MABC, P<0.001). CONCLUSION: Maximum bladder capacity from a urodynamic study does not represent true bladder capacity because of involuntary contractions.