Impaired facial expression recognition in patients with social anxiety disorder: a case-control study.

INTRODUCTION: The aim of this study was to investigate whether social anxiety disorder (SAD) patients have low emotion recognition accuracy, take longer for emotion recognition and tended to interpret a stimulus more negatively than controls. METHODS: Fifty-six SAD patients and 56 healthy controls were participated in this study. We evaluated facial emotion recognition using a computer program in which participants chose one of seven emotions as displayed in each of 55 photographs of faces. We compared the accuracy and reaction times of the patients and controls. We further analysed which emotions were selected in the incorrect answers. RESULTS: SAD patients showed delayed reaction times for all emotions except anger and lower accuracy for fear, surprise, neutrality and happiness compared to controls. After applying Bonferroni correction, only delayed reaction time for surprise and happiness were remain significant. Neutrality was not mistaken for a negative emotion at a higher rate by SAD patients than by controls. CONCLUSION: This result suggests that the alterations of reaction time and accuracy of emotion recognition of SAD patients, especially in emotions with positive valence, play a more important role than negative bias in the cognitive aspects of SAD.

Binge eating is associated with trait anxiety in Korean adolescent girls: a cross sectional study.

BACKGROUND: Binge eating occurs more frequently in women than in men, and is known to be related to psychological factors such as stress, depression, and anxiety. This study examined the relationship between binge eating and depression, trait anxiety, and perceived stress in Korean adolescents. METHODS: Four hundred girls (aged 17-18 years) from two high schools located in Seoul completed self-report questionnaires. In total, 327 participants returned reliable responses, and were included in the final study. Binge eating was measured using the Bulimic Inventory Test Edinburgh. The questionnaire also included the Perceived Stress Scale (PSS), Trait Anxiety (TA) of State-Trait Anxiety Inventory, Anxiety Sensitivity Inventory (ASI), and Beck Depression Inventory (BDI). RESULTS: The binge-eating group had higher BMI than the control group. The binge-eating group showed higher scores than control on the PSS, BDI, ASI, and TA. The TA was most highly correlated with binge eating. From logistic regression analysis, TA was revealed to be the only factor that raised the risk of binge eating, whereas PSS, BDI, and ASI showed no statistical significance. CONCLUSION: Although binge eating was correlated with perceived stress, depression, and trait anxiety, when their influences were controlled, only binge eating appeared to be associated with trait anxiety.

Early menarche is associated with non-alcoholic fatty liver disease in adulthood.

BACKGROUND: The aim of this study was to examine the association between early menarche (<12 years) and non-alcoholic fatty liver disease (NAFLD) in premenopausal women and to explore whether it is mediated by adult obesity and insulin resistance. METHODS: We analyzed data of premenopausal women, aged ≥15 years, from the Korea National Health and Nutrition Examination Survey (2007-2009). We divided the women into three groups: early menarche, reference (12.00-15.99 years), and late menarche. The presence of NAFLD was determined using hepatic steatosis index >36.0. RESULTS: Of the 4,387 women evaluated, 673 (15.4%) met the criteria for NAFLD. The prevalence of NAFLD was higher in both women with early and late menarche compared with the reference (early, 23.4%; reference, 14.0%; late, 19.9%, P < 0.001). After adjustment of confounders including age, the OR for NAFLD in early menarche compared with the reference was 3.04 (95%CI: 1.99-4.65). Further adjustment of mediators, such as central obesity or insulin resistance, attenuated the association to 1.91-2.17. There was no association, however, between late menarche and NAFLD after adjustment of confounders. CONCLUSIONS: Early menarche was associated with an increased risk of NAFLD in young and middle-aged premenopausal Korean women.

What Kind of Stress Is Associated with Depression, Anxiety and Suicidal Ideation in Korean Employees?

Various types of stress affect mental health in the form of mood disorders, anxiety disorders, and suicidal ideation. Recently, the increasing suicide rate in the working-age population has become a major mental health concern in Korea. Thus, we investigated what kind of stress influence depression, anxiety, and suicidal ideation in Korean employees. The study participants were 189,965 employees who attended health screenings and responded to the Center for Epidemiologic Study-Depression Scale, the Beck Anxiety Inventory, and a questionnaire on the major causes of stress and suicidal ideation. We investigated the major causes of stress by gender and age categories and used binary logistic regression to determine the impact of the causes of stress on depression, anxiety and suicidal ideation. Of several stress causes, work-related stress was the most prevalent, regardless of age category and gender, followed by interpersonal relationships. However, interpersonal relationships and financial problems were the predominant causes of stress related to depression or suicidal ideation. This research suggests that despite the fact that work is the most common cause of stress for Korean employees, stress related to life problems other than work has a greater influence on the mental health of Korean employees.

Early menarche is associated with metabolic syndrome and insulin resistance in premenopausal Korean women.

In pediatrics, identifying risk factors is important in planning the prevention of cardiovascular disease. The aim of this study was to determine whether there is an independent association between early menarche (<12 years) and metabolic syndrome (MetS) in Korean women. We analyzed data from 4463 premenopausal women from the Fourth Korea National Health and Nutrition Examination Survey-IV (2007-2009). MetS was defined by the International Diabetes Federation for Asians and insulin resistance (IR) was defined as HOMA-IR more than 3.05. The prevalence of MetS and IR was 7.9 and 15.0%. Women (55.6%) with MetS also showed IR. The prevalence of MetS was higher in both women with early menarche and late menarche (≥16 years) compared with the reference group (early, 12.8%; reference, 7.0%; late, 11.0%, both P = 0.002). However, the odds ratio for MetS was 3.54 (95% confidence interval (CI), 2.14-5.87) and for IR was 2.98 (95% CI, 1.99-4.47) after adjusting for age and other confounders such as lifestyle variables, reproductive variables and sociodemographic variables only in women with early menarche CONCLUSION: Early menarche was associated with an increased risk of MetS and IR in premenopausal Korean women. WHAT IS KNOWN: Early menarche is associated with higher risk of CVD-related death and all-cause mortality in Western studies. Early menarche is associated with higher risk of diabetes in Korean premenopausal women. WHAT IS NEW: Early menarche (<12 years) is associated with metabolic syndrome and insulin resistance in nationally representative Korean premenopausal women. However, late menarche (>16 years) is not associated with metabolic syndrome after controlling for age and other confounders.

Pharmacotherapy and group cognitive behavioral therapy enhance follow-up treatment duration in gambling disorder patients.

BACKGROUND: Longer treatment duration is important for the successful treatment of gambling disorder (GD). This retrospective study investigated the factors and interventions that might enhance treatment duration in GD patients in South Korea. METHODS: A total of 758 outpatients with a primary diagnosis of GD, who were treated in a clinical practice from 2002 to 2011, were assessed by retrospective chart review. We compared the treatment duration according to pharmacotherapy and group cognitive behavioral therapy (CBT). RESULTS: Pharmacotherapy contributed to a longer duration of treatment maintenance, despite the patients' gambling severity (p < 0.001). Participation in group CBT (p < 0.001) and antidepressants (p = 0.009) were associated with a longer treatment duration after adjusting for age, depression, and gambling severity. The treatment maintenance duration was the longest in those receiving combined antidepressant pharmacotherapy and group CBT (F = 35.79, p < 0.001). CONCLUSIONS: Group CBT and antidepressants seem to enhance treatment follow-up duration in GD patients. Additional studies are needed to advance GD prevention and treatment strategies.

Clinical symptoms associated with suicidality in patients with panic disorder.

BACKGROUND: Patients with panic disorder have higher rates of suicide than the general population. Among panic disorder subjects, early onset, female gender, alcohol abuse, and mood disorder increase the risk of suicidality. However, less is known about the unique relationships between discrete DSM-IV panic symptoms and higher suicidality. Therefore, in the current study we examined the panic symptom profile that is associated with higher suicidality in a sample of outpatients with panic disorder. METHODS: This cross-sectional study included 427 patients diagnosed with current panic disorder on the basis of the DSM-IV-TR. In order to assess the contribution of the clinical variables, a univariate logistic regression was carried out examining the relationships between the demographic variables, suicidality from the suicide module of the Korean version of the MINI International Neuropsychiatric Interview Plus, and DSM-IV panic symptoms. Additionally, a multivariate logistic regression was performed to identify specific panic symptoms that were significant risk factors for suicidality among patients with current panic disorder. RESULTS: We found that 74 (17.33%) panic disorder patients experienced high suicidality. Univariate analyses showed that high suicidality was significantly associated with a younger age (OR = 13.66; 95% CI 2.68-69.70), comorbid depressive disorders (OR = 4.57; 95% CI 2.57-8.11), and the following panic symptoms: palpitations (OR = 2.20; 95% CI 0.90-5.35), trembling (OR = 0.61; 95% CI 0.362-1.18), nausea or abdominal distress (OR = 1.77; 95% CI 0.96-3.27), fear of losing control or going crazy (OR = 2.18; 95% CI 1.12-4.23), and paresthesia (OR = 1.57; 95% CI 0.83-2.98). Multivariate logistic regression analyses demonstrated that specific panic symptoms, such as palpitations (adjusted OR = 2.69; 95% CI 1.08-6.73) and fear of losing control or going crazy (adjusted OR = 2.28; 95% CI 1.21-4.31), were related to suicidality after controlling for confounding factors. CONCLUSION: Some panic symptoms (e.g. palpitations and fear of losing control or going crazy) are associated with a risk of suicidality among patients with panic disorder. A priori identification of high-risk suicidal subjects could lead to effective treatment strategies for panic disorder.

Effectiveness of paliperidone extended-release for patients with schizophrenia: focus on subjective improvement.

OBJECTIVE: This study assessed whether the subjective experience of patients with schizophrenia improved after switching from an oral antipsychotic to flexibly-dosed paliperidone extended-release. METHODS: We conducted a 24-week, multicenter, non-comparative, open-label trial. A total of 387 patients with schizophrenia participated the study. The primary study outcome was the change in subjective symptoms measured by the Symptom Checklist-90-Revised version (SCL-90-R) from baseline. Visual analogue scales were used for sleep and daytime somnolence as secondary subjective assessments. The clinical global impression-schizophrenia-severity scale was used to assess overall symptom severity. Social functioning was evaluated by the personal and social performance scale. Adverse events were also evaluated. RESULTS: All subjective symptoms measured by the SCL-90-R improved significantly. The early responders, who achieved >20% reduction in the SCL-90-R within 1 week, maintained significantly lower severity through the 24 weeks. The clinical global impression-schizophrenia-severity scale and personal and social performance scores also improved significantly. The visual analogue scales revealed that daytime somnolence improved significantly, whereas nocturnal sleep quality was unaltered. CONCLUSION: Our results suggest that switching to paliperidone extended-release was associated with improvements in various subjective symptoms, decreased overall symptom severity, and increased social functioning. The results also suggest that early detection and reduction of subjective symptoms are important for treatment outcome.

Evaluation of the Effects of Differences in Metal Artifact Type and Location on Image Quality in Computed Tomography Scans.

Artifacts in computed tomography scans distort anatomical information and prevent an accurate diagnosis. Therefore, this study aims to determine the most effective method for reducing metal-induced artifacts by evaluating the effects of the metal artifact type and location, and the tube voltage on the image quality. Fe and Cu wires were inserted into a Virtual Water™ phantom at 6.5 and 11 cm distances from the center point (DPs). The contrast-to-noise ratios (CNRs) and signal-to-noise ratios (SNRs) were calculated to compare the images. The results reveal higher CNRs and SNRs when using standard and Smart metal artifact reduction (Smart MAR) algorithms for Cu and Fe insertions, respectively. The standard algorithm leads to a higher CNR and SNR for Fe and Cu at DPs of 6.5 and 11 cm, respectively. The Smart MAR algorithm provides effective outcomes at voltages of 100 and 120 kVp for wires located at 11 and 6.5 cm DP, respectively. The most effective imaging conditions for MAR is generated by the Smart MAR algorithm with a tube voltage for 100 kVp for Fe located at a DP of 11 cm. MAR can be improved by setting suitable tube voltage conditions according to the type and location of inserted metal.

Multidimensional comparison of personality characteristics of the Big Five model, impulsiveness, and affect in pathological gambling and obsessive-compulsive disorder.

The phenomenological resemblance between pathological gambling (PG) and obsessive-compulsive disorder (OCD) has led to suggestions that PG be categorized as an obsessive-compulsive-spectrum disorder (OCSD). This study aimed to explore whether PG resembles OCD in terms of personality and temperament. Fifteen patients with PG, 18 patients with OCD, and 33 healthy control subjects were included in the study. The study subjects were all male and drug naïve. We analyzed data obtained from three self-report questionnaires assessing personality, impulsiveness, and affect: the short version of the NEO Personality Inventory-Revised (NEO-PI-R), the Barratt Impulsiveness Scale-11 (BIS-11), and the Positive Affect and Negative Affect Schedule (PANAS). Participants with PG and OCD demonstrated less conscientiousness (F = 7.089, P = .002) and less openness to experience (F = 6.268, P = .003) and less positive affect (F = 15.816, P < .001) than did healthy controls. The two diagnostic groups did not differ from each other with respect total BIS-11 scores, but those with OCD showed more neuroticism than did those with PG and healthy controls ( F = 9.556, P < .001), and those with PG obtained higher scores on the non-planning impulsiveness factor of BIS-11 than did those with OCD or healthy controls ( F = 9,835, P < .001). PG and OCD share similar profiles in terms of personality and temperament. This study provides phenomenological evidence supporting the conceptualization of PG as an OCSD.

Comparison of anxiety-related traits between generalized and nongeneralized subtypes of social anxiety disorder.

This study aimed to investigate the possible difference in anxiety-related traits between the generalized and nongeneralized subtypes of social anxiety disorder (SAD). Two hundred seventy-three SAD Korean outpatients completed the Anxiety Sensitivity Index (ASI), the Trait Form of the State-Trait Anxiety Inventory (STAI-T), Retrospective Self-Report of Inhibition (RSRI), and the Liebowitz Social Anxiety Scale (LSAS) as part of their assessments. The unadjusted total scores of the ASI, STAI-T, RSRI, and LSAS differed between the two subtypes, according to an independent t-test. However, this result was not significant (ASI: F = 2.363, p = 0.127; STAI-T: F = 0.004, p = 0.949; RSRI: F = 1.518, p = 0.220) after adjusting for LSAS total score. The comparison of anxiety-related traits did not show any difference between the subtypes after adjusting for illness severity. These results may suggest that the two SAD subtypes are on a continuum of the same illness, differentiated only by symptom severity.

Associations between the serotonin-1A receptor C(-1019)G polymorphism and disordered eating symptoms in female adolescents.

The purpose of this study was to examine the relationship between the C(-1019)G polymorphism of the serotonin-1A receptor gene and eating behavior in female adolescents. A total of 204 post-menarche, adolescent women, aged 16-17 years, were recruited from two neighboring high schools in Seoul. Polymerase chain reaction (PCR) was used to isolate and examine the C(-1019)G polymorphism in the serotonin-1A receptor genes (rs6295) of all participants. The Bulimia Investigatory Test, Edinburgh (BITE) and the Eating Attitude Test-26 (EAT-26) were administered to all participants. The total score of the EAT-26 differed significantly among the three genotype groups [CC, CG, GG (F = 4.844, p = 0.009)]. Both the EAT-26 (F = 9.69, p = 0.002) and the BITE (F = 5.22, p = 0.023) scores were higher in the participants who were G allele carriers than in the non-carrier group. The dieting subscale of the EAT-26 was higher among the G allele carriers (F = 12.941, p < 0.001), and these results were maintained even after adjusting for depression and anxiety. These findings suggest that the C(-1019)G polymorphism in the 5-HT1A receptor gene is associated with disordered eating symptoms in Korean female adolescents.

Association study between antipsychotic-induced restless legs syndrome and polymorphisms of monoamine oxidase genes in schizophrenia.

OBJECTIVE: This study aimed to investigate whether the monoamine oxidase (MAO) A and B genes are associated with antipsychotic-induced restless legs syndrome (RLS) in schizophrenia. METHODS: We assessed antipsychotic-induced RLS symptoms in 190 Korean schizophrenic patients and divided the subjects into two groups: those with RLS symptoms (n = 96) and those without RLS symptoms (n = 94). Genotyping was performed for the variable number of tandem repeat (VNTR) polymorphism of the MAOA gene and A644G polymorphism of the MAOB gene. RESULTS: There was no significant difference in the genotype and allele frequencies of all polymorphisms investigated between these two groups. However, the result of global haplotype analysis showed a significant difference in haplotype frequencies between male subjects with and without RLS symptoms (p = 0.013). The interaction between two polymorphisms had a significant effect on the RLS scores of both male (p = 0.047) and female (p = 0.028) patients. CONCLUSIONS: These data do not suggest that the MAOA gene VNTR and MAOB gene A644G polymorphisms are associated with antipsychotic-induced RLS symptoms in schizophrenia. However, we found that the haplotype frequencies differed between the male schizophrenic patients with and without RLS symptom and the interaction between the two polymorphisms had a significant influence on the RLS scores of patients with schizophrenia.

Bidirectional association between blood pressure and depressive symptoms in young and middle-age adults: A cohort study.

AIMS: To evaluate the bidirectional relationship between blood pressure (BP) and depressive symptoms using a large prospective cohort study. METHODS: Prospective cohort study was performed in 276 244 adults who participated in a regular health check-up and were followed annually or biennially for up to 5.9 years. BP levels were categorised according to the 2017 American College of Cardiology and American Heart Association hypertension guidelines. Depressive symptoms were assessed using Centre for Epidemiologic Studies-Depression (CESD) questionnaire and a cut-off score of ≥25 was regarded as case-level depressive symptoms. RESULTS: During 672 603.3 person-years of follow-up, 5222 participants developed case-level depressive symptoms. The multivariable-adjusted hazard ratios (HRs) [95% confidence interval (CI)] for incident case-level depressive symptoms comparing hypotension, elevated BP, hypertension stage 1 and hypertension stage 2 to normal BP were 1.07 (0.99-1.16), 0.93 (0.82-1.05), 0.89 (0.81-0.97) and 0.81 (0.62-1.06), respectively (p for trend <0.001). During 583 615.3 person-years of follow-up, 27 787 participants developed hypertension. The multivariable-adjusted HRs (95% CI) for incident hypertension comparing CESD 16-24 and ⩾25 to CESD < 16 were 1.05 (1.01-1.11) and 1.12 (1.03-1.20), respectively (p for trend <0.001) and in the time-dependent models, corresponding HRs (95% CI) were 1.12 (1.02-1.24) and 1.29 (1.10-1.50), respectively (p for trend <0.001). CONCLUSIONS: In this large cohort study of young and middle-aged individuals, higher BP levels were independently associated with a decreased risk for developing case-level depressive symptoms and depressive symptoms were also associated with incident hypertension. Further studies are required to elucidate the mechanisms underlying the bidirectional association between BP levels and incident depression.

Comparison of temperament and character between early- and late-onset Korean male pathological gamblers.

PURPOSES: We investigated differences in temperament and character between early and late onset Korean pathological gamblers to identify whether the age of onset of pathological gambling (PG) could discriminate PG subtypes, like in alcoholism. METHODS: Male subjects (N = 104) with DSM-IV PG were tested with Cloninger's temperament and character inventory (TCI). We divided patients into two groups: early onset (N = 34) with gambling problems before reaching 25 years old, and late onset (N = 70) with gambling after the age of 25. RESULTS: Early-onset patients showed a higher score in novelty seeking (NS) and harm avoidance (HA), but lower scores of self-transcendence. There was no difference in reward dependence, persistence, self-directedness, or cooperativeness between two groups. After adjusting for age differences by ANCOVA (using age as a covariate), the early onset group showed a significantly higher score in both HA (F1,101 = 4.932, P = 0.029) and NS (F1,101 = 3.948, P = 0.050) but not in any other TCI dimensions. CONCLUSIONS: Early- and late-onset Korean male pathological gamblers showed several distinct differences in temperament and character, indicating that age of onset may help discriminate PG subgroups.

Metabolic syndrome and incident depressive symptoms in young and middle-aged adults: A cohort study.

BACKGROUND: Recent studies on the prospective association between metabolic syndrome (MetS) and depression have reported conflicting findings. METHODS: A cohort study was performed with 115,223 middle-aged adults, free of depression at baseline, who underwent at least 2 comprehensive exams between 2012 and 2015. MetS was assessed according to the National Cholesterol Education Program Adult Treatment Panel III. The study endpoint was new onset of depression, defined as a Center for Epidemiologic Studies-Depression Scale score ≥ 16. RESULTS: Over 253,451.6 person-years, 6,833 participants developed depression. When the participants with 0 MetS components were set as a reference, the multivariable-adjusted hazard ratio (HR, 95% confidence interval [CI]) for incident depression formed a U-shaped curve with the number of MetS components (p for trend = 0.229): 1 (1.07 [1.02-1.15]); 2 (0.92 [0.82-1.06]); 3 (0.85 [0.78-1.07]); 4 (1.16 [1.06-1.32]); and 5 MetS components (1.25 [1.10-1.54]). The presence or absence of MetS was not significant in new-onset depression. In examining potential clustering and synergistic effects of the constituent parts, waist circumference was the major driving factor of incident depression, and its relative excess risk due to interaction increased with the number of combinations. LIMITATIONS: We used a self-reported depression scale, and the follow-up period was relatively short. CONCLUSIONS: Future studies investigating the risk for incident depression should place more focus on the number of MetS abnormalities and specific MetS factors, such as waist circumference, than the presence or absence of MetS.

No association between the brain-derived neurotrophic factor gene Val66Met polymorphism and tardive dyskinesia in schizophrenic patients.

OBJECTIVE: This study investigated whether the brain-derived neurotrophic factor (BDNF) gene Val66Met single-nucleotide polymorphism (SNP) is associated with antipsychotic-induced tardive dyskinesia (TD) in schizophrenia. METHODS: Genotyping was performed for the BDNF gene Val66Met SNP in Korean schizophrenic patients with (n=83) and without TD (n=126) who were matched for antipsychotic drug exposure and other relevant variables. RESULTS: The frequencies of genotypes (chi2=2.37, p=0.306) and alleles (chi2=0.03, p=0.867) did not differ significantly between these two groups. CONCLUSION: These findings suggest that the BDNF polymorphism does not play a major role in the susceptibility to TD in schizophrenic patients.

Association between physical activity and depressive symptoms in general adult populations: An analysis of the dose-response relationship.

This study investigated the dose-response relationship between physical activity and depression. We collected data from 99,846 participants who had no medical contraindications to exercise. Using the short-form Korean version of the International Physical Activity Questionnaire, total physical activity was computed in metabolic equivalents (METs). We used the Center for Epidemiologic Studies Rating Scale for Depression to assess depressive symptoms and set a cut off score of 21. Logistic regression analyses were used to determine any relationships. To assess the effect of sex difference on the association between physical activity and depression, we stratified our data by sex. Compared with the sedentary group (0-600 METs-min/week), 1-15 times the recommended minimum physical activity was associated with a significantly lower risk of depression in all adults. The optimal range for a lower risk of depression was 2-3 times the recommended minimum. After stratifying our data by sex, we found that optimal ranges were 10-15 times the recommended minimum physical activity in men and 3-5 times in women. This study established a U-shaped dose-response relationship between physical activity and depression. The optimal range and upper threshold for anti-depression effect of physical activity were higher in men than in women.

The Relationship between Plasma Oxytocin Levels and Social Anxiety Symptoms.

OBJECTIVE: The pathophysiology of social anxiety disorder (SAD) is not yet well understood, but previous research has suggested that oxytocin is associated with social behavior and may play a role in human anxiety states and anxiety-related traits. The aim of this study was to investigate the possible relationship between social anxiety symptoms and plasma oxytocin levels. METHODS: Twenty-three male patients with SAD and 28 healthy male controls participated in this study. All participants were assessed using the Mini International Neuropsychiatric Interview (MINI) and the Liebowitz Social Anxiety Scale (LSAS). Multivariate regression analysis was performed to identify associations between plasma oxytocin levels and SAD. RESULTS: In multiple regression models, after controlling for age and years of education, we found that higher oxytocin levels were significantly associated with higher total LSAS scores (R2 =0.157, coefficient=0.145, 95% CI=-0.0005-0.291, p=0.051) and fear subscale scores (R2 =0.134, coefficient=0.083, 95% CI=0.007-0.159, p=0.034) in the SAD group. CONCLUSION: In this study, increased plasma oxytocin levels were associated with higher social anxiety symptoms among SAD patients, but not among controls. This might be because among SAD patients, higher oxytocin (OT) secretion is an insufficient compensatory attempt to reduce social anxiety symptoms.

Gender Differences of Occupational Stress Associated with Suicidal Ideation among South Korean Employees: The Kangbuk Samsung Health Study.

OBJECTIVE: In this study, the relationship between occupational stress and suicidal ideation was investigated, focusing on gender differences among Korean employees. METHODS: Cross-sectional data for 53,969 workers were collected at Kangbuk Samsung Hospital health screening centers. Risk of suicidal ideation was assessed using a self-reported questionnaire examining suicidal ideation during the past year. Occupational stress was measured using 24 items of the Korean Occupational Stress Scale-Short Form (KOSS-SF). Logistic regression analysis was employed to estimate the odds ratios and 95% confidence intervals of the relationships between suicidal ideation and components of occupational stress. RESULTS: In multivariable-adjusted models, all job stress contributed to increased risk of suicidal ideation in males. Most subscales, except insufficient job control and organizational system, were risk factors of suicidal ideation in females. Further adjustments for depression markedly attenuated this relationship. However, the effects of insufficient job control and lack of reward on suicidal ideation remained significant in males, and interpersonal conflict remained significant in females. CONCLUSION: The results suggest that occupational stress plays a significant role in increasing risk of suicidal ideation through elevation of depressive symptoms. Gender differences in components of occupational stress associated with suicidal ideation were also observed.