Nonpharmaceutical interventions reduce the incidence and mortality of COVID-19: A study based on the survey from the International COVID-19 Research Network (ICRN).

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19.

A marginal structural model to estimate the effect of antidepressant medication treatment on major cardiovascular events among people with post-traumatic stress disorder.

BACKGROUND: Previous evidence on antidepressant medication and cardiovascular disease (CVD) among patients with posttraumatic stress disorder (PTSD) has been inconclusive. We estimated the association between antidepressant medication and CVD by applying a marginal structural model. METHODS: We analyzed medical utilization records of 27 170 people with PTSD without prior major cardiovascular events in the Korean National Health Insurance Database (NHID). PTSD and CVD were defined in accordance with the recorded ICD-10 diagnostic codes. We acquired information on antidepressant use from the NHID and categorized them by medication type. A composite major adverse cardiovascular events (MACE) outcome was defined as coronary artery disease with revascularization, ischaemic stroke, and/or haemorrhagic stroke. We used inverse probability of treatment weighting to estimate the parameters of a marginal structural discrete-time survival analysis regression model, comparing the resulting estimates to those derived from traditional time-fixed and time-varying Cox proportional hazards regression. We calculated cumulative daily defined doses to test for a dose-response relationship. RESULTS: People exposed to antidepressants showed a higher hazard of MACE [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.18-1.53]. The estimated effects were strongest for selective serotonin reuptake inhibitors (HR 1.24, 95% CI 1.08-1.44) and TCAs (HR 1.33, 95% CI 1.13-1.56). Exposure to serotonin-norepinephrine reuptake inhibitors did not appear to increase the risk of MACE. People exposed to higher doses of antidepressants showed higher risk of MACE. CONCLUSIONS: In a national cohort of people with PTSD, exposure to antidepressant medications increased the risk of MACE in a dose-response fashion.

Urbanicity, posttraumatic stress disorder, and effect modification by socioeconomic position: A nested case-control study of the Korean National Health Insurance Database.

BACKGROUND: We aimed to estimate the association between urbanicity and the onset of posttraumatic stress disorder (PTSD) and to investigate heterogeneity therein according to age and socioeconomic position (SEP). METHODS: We analyzed administrative data from the Korean National Health Insurance Database for patients with PTSD from 2004 to 2018 (N = 109,230) and for a 1:4 sample of age-, sex-, and enrollment year-matched controls. Information on eligibility, SEP (proxied by insurance premium), place of residence, diagnosis, and medical claims was obtained. Urbanicity of administrative districts was assessed using data from the Korean Statistical Information Service, 2005-2018. We estimated hazard ratios (HRs) from baseline and time-dependent models. Subgroup analyses and polynomial splines were used to investigate heterogeneity by age and SEP. RESULTS: Urbanicity was associated with an increased risk of PTSD (per 10%p increase, HR = 1.056, 95% CI 1.050-1.061). A positive association was estimated among patients aged 0-29 years (HR = 1.115, CI 1.106-1.124), while negative associations were estimated among patients aged 30-64 years (HR = 0.990, CI 0.987-0.994) and 65 years or older (HR = 0.992, CI 0.979-1.014). The estimated associations with urbanicity were more prominent at the extremes of SEP, but only among younger participants. CONCLUSION: Urban residence was associated with an increased risk of PTSD diagnosis. The estimated association was larger among younger individuals (but not among middle-aged and older individuals). Among younger individuals, the estimated association was larger at both extremes of SEP.

Association between social networks and symptoms of post-traumatic stress during the pandemic: Cohort study in South Korea.

BACKGROUND: This study estimated the association between pre-pandemic social network properties and symptoms of posttraumatic stress during the coronavirus disease 2019 (COVID-19) pandemic in South Korea. METHODS: We conducted four online mental health surveys during COVID-19 (from March 14, 2020, to December 11, 2021) among individuals enrolled in a community-based cohort study (previously recruited from 2013 to 2018). Among 4060 people interviewed at the pre-pandemic baseline, 2652 individuals (men = 951, women = 1701) who responded to at least one of the four surveys conducted were included. At baseline, each individual's social network, including size and average closeness, was measured in an egocentric way. Post Traumatic Stress Disorder Checklist for DSM-5 (PCL-5) was measured at each survey point. A generalized linear model and a generalized linear mixed model were used after stratified by sex. RESULTS: Among men, network size was negatively associated with total PCL-5 score (b = -0.42, SE = 0.16, p = 0.002). The magnitude of the association increased over time and was maximal by the 4th survey (b = -0.65, SE = 0.31, p = 0.037). Among women, average closeness was negatively associated with the total PCL-5 score (b = -1.16, SE = 0.37, p = 0.002). In analyses disaggregated by symptom clusters, social networks were associated explicitly with symptoms of intrusion and mood but not with avoidance and arousal symptoms. CONCLUSION: In this cohort of adults followed for more than a year during the outbreak of COVID-19 in South Korea, social networks established before the onset of the COVID-19 pandemic had a protective association against developing symptoms of PTSD during the first two years of the pandemic.

Social media use and mental health during the COVID-19 pandemic in young adults: a meta-analysis of 14 cross-sectional studies.

BACKGROUND: Public isolated due to the early quarantine regarding coronavirus disease 2019 (COVID-19) increasingly used more social media platforms. Contradictory claims regarding the effect of social media use on mental health needs to be resolved. The purpose of the study was to summarise the association between the time spent on social media platform during the COVID-19 quarantine and mental health outcomes (i.e., anxiety and depression). METHODS: Studies were screened from the PubMed, Embase, and Cochrane Library databases. Regarding eligibility criteria, studies conducted after the declaration of the pandemic, studies that measured mental health symptoms with validated tools, and studies that presented quantitative results were eligible. The studies after retrieval evaluated the association between time spent on social media platform and mental health outcomes (i.e. anxiety and depression). The pooled estimates of retrieved studies were summarised in odds ratios (ORs). Data analyses included a random-effect model and an assessment of inter-study heterogeneity. Quality assessment was conducted by two independent researchers using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). This meta-analysis review was registered in PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ , registration No CRD42021260223, 15 June 2021). RESULTS: Fourteen studies were included. The increase in the time spent using social media platforms were associated with anxiety symptoms in overall studies (pooled OR = 1.55, 95% CI: 1.30-1.85), and the heterogeneity between studies was mild (I2 = 26.77%). Similarly, the increase in social media use time was also associated with depressive symptoms (pooled OR = 1.43, 95% CI: 1.30-1.85), and the heterogeneity between studies was moderate (I2 = 67.16%). For sensitivity analysis, the results of analysis including only the "High quality" studies after quality assessment were similar to those of the overall study with low heterogeneity (anxiety: pooled OR = 1.45, 95% CI: 1.21-1.96, I2 = 0.00%; depression: pooled OR = 1.42, 95% CI: 0.69-2.90, I2 = 0.00%). CONCLUSIONS: The analysis demonstrated that the excessive time spent on social media platform was associated with a greater likelihood of having symptoms of anxiety and depression.

Association between the change of total cholesterol during adolescence and depressive symptoms in early adulthood.

Increasing evidence suggests that serum lipids are associated with depressive symptoms. However, previous studies have mostly employed a cross-sectional design and assessed middle-aged or older adult populations, making it difficult to discern the impact of lipid changes early in life on the development of depression. Accordingly, we sought to investigate changes in blood cholesterol levels during adolescence and the development of depressive symptoms in early adulthood. This prospective cohort study included participants aged 15-16 years from the JS High School Study (JSHS), with an average follow-up of 6 years. Participants had no diagnosed depression at baseline. Multivariable linear regression models were used to estimate associations between changes in total cholesterol during adolescence and depressive symptoms in adulthood. Changes in total cholesterol during adolescence were classified as "consistently low," "decreased," "moderate," "increased," or "consistently high". In men, depressive symptoms were higher in the consistently low (ß = 3.20, p = 0.036) and increased total cholesterol groups (ß = 3.48, p = 0.017), compared with the moderate group. In the consistently high group, although a positive linear association was observed, it lacked statistical significance (ß = 2.71, p = 0.067). While similar tendencies were noted in women, the associations were not statistically significant. Consistently low or increased total cholesterol levels during adolescence may pose an increased risk of depressive symptoms in early adulthood. These findings suggest that different strategies should be adopted to manage the lipid risk factors with consideration of age and sex.

Racial characteristics of alopecia areata in the United States.

BACKGROUND: Epidemiologic studies on the association between race and alopecia areata (AA) are limited. OBJECTIVE: To characterize racial differences of AA in the United States. METHODS: Cross-sectional study of self-registered AA patients and noncases in the National Alopecia Areata Registry (NAAR). We evaluated odds of AA and its subtypes for 5 ethnic/racial groups using logistic regression. A sex-stratified analysis and a sensitivity analysis among dermatologist-confirmed cases were also performed. RESULTS: We identified 9340 AA patients and 2064 noncases. Compared with whites, African Americans had greater odds of AA (odds ratio, 1.77; 95% confidence interval, 1.37-2.28) and Asians had lower odds (odds ratio, 0.40; 95% confidence interval, 0.32-0.50) of AA. The results were consistent in AA subtypes, dermatologist-confirmed cases, and by sex. LIMITATIONS: Residual confounding due to limited number of covariates. Recall or recruitment bias not representative of the entire disease spectrum. Also, outcome misclassification was possible because not all AA cases in the registry were confirmed by dermatologists. CONCLUSION: Our findings suggest higher odds of AA in African Americans and lower odds in Asians compared with whites. Future studies examining racial disparity in AA from clinical and genetic perspectives are warranted for a better understanding of the disease pathogenesis.

Posttraumatic stress disorder and incidence of thyroid dysfunction in women.

BACKGROUND: Abnormal thyroid function is prevalent among women and has been linked to increased risk of chronic disease. Posttraumatic stress disorder (PTSD) has been linked to thyroid dysfunction in some studies; however, the results have been inconsistent. Thus, we evaluated trauma exposure and PTSD symptoms in relation to incident thyroid dysfunction in a large longitudinal cohort of civilian women. METHODS: We used data from 45 992 women from the ongoing Nurses' Health Study II, a longitudinal US cohort study that began in 1989. In 2008, history of trauma and PTSD were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, PTSD, and incident thyroid dysfunction was determined by participants' self-report in biennial questionnaires of physician-diagnosed hypothyroidism and Graves' hyperthyroidism. The study period was from 1989 to 2013. Proportional hazard models were used to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for incident hypothyroidism and Graves' hyperthyroidism. RESULTS: In multivariable-adjusted models, we found significant associations for PTSD only with hypothyroidism [p-trend <0.001; trauma with no PTSD symptoms, 1.08 (95% CI 1.02-1.15); 1-3 PTSD symptoms, 1.12 (95% CI 1.04-1.21); 4-5 PTSD symptoms, 1.23 (95% CI 1.13-1.34); and 6-7 PTSD symptoms, 1.26 (95% CI 1.14-1.40)]. PTSD was not associated with risk of Graves' hyperthyroidism (p-trend = 0.34). Associations were similar in sensitivity analyses restricted to outcomes with onset after 2008, when PTSD was assessed. CONCLUSIONS: PTSD was associated with higher risk of hypothyroidism in a dose-dependent fashion. Highlighted awareness for thyroid dysfunction may be especially important in women with PTSD.

Pressure and Temperature Dependence of Field-Induced Oscillation in Two-Terminal Device Based on Vanadium Dioxide Thin Film.

In this paper, we investigated the pressure and temperature dependence of the frequency and amplitude of the field-induced oscillation created in a two-terminal device based on a vanadium dioxide (VO2) thin film. First, a simple oscillation circuit was constructed using a VO2-based two-terminal device, a standard resistor, and a DC power supply. Then, the frequency and amplitude variation of the field-induced oscillation was observed for pressure changes applied to the VO2 device in a pressure chamber. This variation of the oscillation characteristics was also examined for ambient temperature changes applied to the VO2 device using a plate heater. When the chamber pressure increased from 0 to 5 MPa with a step of 1 MPa at 25 °C, the oscillation frequency increased from ~592 to ~739 kHz, and the oscillation amplitude decreased from ~12.60 to ~11.40 V. Similarly, when the heater temperature increased from 25 to 50 °C (step: 5 °C) without applied pressure, the oscillation frequency increased from ~592 to ~819 kHz, and the oscillation amplitude decreased from ~12.60 to ~7.16 V. Owing to linear pressure and temperature responses of the VO2 oscillation, the pressure and temperature sensitivities of the oscillation frequency and amplitude could be obtained as four different constant coefficients from the measurement results. These coefficients can be directly utilized for simultaneously measuring pressure and temperature variation applied to the VO2 device, which can be beneficially applied to localized temperature and pressure sensing at a very small area less than 1 mm².

Posttraumatic stress disorder and development of premenstrual syndrome in a longitudinal cohort of women.

We examined the association between posttraumatic stress disorder (+PTSD) symptoms and incident premenstrual syndrome (PMS) in a longitudinal study with 14 years follow-up of 2924 women aged 27-44. Compared to women with no trauma exposure, women with trauma/PTSD were at significantly increased risk of PMS (p-trend < .001): 1) trauma/no PTSD odds ratio (OR) = 1.31 [95% confidence interval (CI) 1.05-1.63], 2) 1-3 PTSD symptoms OR = 1.71 [95% CI = 1.33-2.20], 3) 4-5 PTSD symptoms OR = 2.90 [95% CI = 2.07-4.05], and 4) 6-7 PTSD symptoms OR = 3.42 [95% CI = 2.18-5.36].

Trends in prescriptions for sedative-hypnotics among Korean adults: a nationwide prescription database study for 2011-2015.

PURPOSE: This study investigated prescriptions for sedative-hypnotics via data obtained from the Health Insurance Review and Assessment (HIRA) service. METHODS: Data on sedative-hypnotic prescriptions from the HIRA service of the Republic of Korea were analyzed from 2011 to 2015. We included prescriptions for subjects > 18 years of age from hospitals and community healthcare centers. In addition, subgroup analyses with a subsample restricted to prescriptions from patients with diagnostic codes F510 (nonorganic insomnia) or G470 (insomnia) were performed. After analyzing the number of prescriptions by individual pharmacy items, the prescription codes were grouped as: (1) benzodiazepines; (2) non-benzodiazepines, including zolpidem; (3) antidepressants; and (4) antipsychotics. We calculated the monthly percent change in the number of prescriptions by drug group using Joinpoint regression. RESULTS: Among the sedative-hypnotic groups, benzodiazepines were the most commonly prescribed drugs in Korea during the study period. As a single sedative-hypnotic item, zolpidem was the most frequently prescribed medication for patients with insomnia. Prescriptions for all groups of sedative-hypnotics increased significantly during the study period. When stratified by age group, antipsychotic prescriptions increased significantly by 0.19-0.21% per month among men and women aged 50-59 years and > 70 years. Prescriptions for antidepressants in 30-39-year-old men increased significantly by 0.20%. CONCLUSIONS: Benzodiazepine prescriptions as well as those for antipsychotics and antidepressants to treat insomnia increased during 2011-2015 in Korea. Monitoring the use of sedative-hypnotics at the national level is necessary, especially in the elderly population.

Association between body size, weight change and depression: systematic review and meta-analysis.

BackgroundThe association between body size, weight change and depression has not been systematically summarised, especially for individuals who are underweight.AimsTo conduct a systematic review and a meta-analysis to examine the association between indices of body size, weight change and depression.MethodA total of 183 studies were selected. Fully adjusted hazard ratios (HRs) or odds ratios (ORs) were extracted. A total of 76 studies contributed to data synthesis with a random-effect model, and subgroup analyses were conducted to evaluate the effect of potential moderators.ResultsIn cohort studies, underweight at baseline increased the risk of subsequent depression (OR = 1.16, 95% CI 1.08-1.24). Overweight (BMI 25-29.9 kg/m2) showed no statistically significant relationship with depression overall; however, the subgroup analyses found different results according to gender (men: OR = 0.84, 95% CI 0.72-0.97, women: OR = 1.16, 95% CI 1.07-1.25). In cross-sectional designs, obesity with BMI >40 kg/m2 showed a greater pooled odds ratio than obesity with BMI >30 kg/m2ConclusionsBoth underweight and obesity increase the risk of depression. The association between overweight and depression differs by gender.

Body mass index at age 18-20 and later risk of spontaneous abortion in the Health Examinees Study (HEXA).

BACKGROUND: Spontaneous abortion (SA) affects 11.2% of recognized pregnancies in Korea. Many studies have focused on the increased risk of SA in obese populations, but there are few studies that have focused on underweight (Body mass index (BMI) <18.5 kg/m2) women, especially in relation to pre-pregnancy BMI. The aim of this study was to examine the role of pre-pregnancy BMI at age 18-20 in later SA. METHODS: Among the women who were ever pregnant in the Health Examinees Study (HEXA), which was one of the cohorts studied in the KoGES (Korean Genome and Epidemiology Study) from 2004 to 2012 (N = 80,447), the likelihood of SA based on pre-pregnancy BMI, classified by the criteria for Asians (Underweight: <18.5 kg/m2; Normal range: 18.5-22.9 kg/m2; Overweight at risk: 23-24.9 kg/m2; Obese I: 25-29.9 kg/m2; Obese II: ≥30 kg/m2), was presented as odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression models. RESULTS: Being underweight or obese relative to the normal weight range was associated with a higher likelihood of SA (OR = 1.10 [95% CI = 1.05-1.15] in underweight women and OR = 1.06 [95% CI = 0.96-1.16] in obese women), and this effect was much greater in women who experienced recurrent SAs (for three or more SAs: OR = 1.29 [95% CI 1.14-1.46] in underweight women and OR = 1.39 [95% CI 1.09-1.78] in obese women). Obesity was associated with an increased likelihood of SA at a younger age (≤25 years), whereas underweight was associated with an increased OR of SA at an older age (≥26 years). DISCUSSION: As this study was conducted with baseline data of original cohort which focused on other chronic diseases, recall for previous pregnancy-related information might be less accurate. However, this study shows strength in its large size and prospective potential. CONCLUSIONS: Pre-pregnancy BMI at ages 18-20 years revealed a U-shaped association with SA, and underweight and obese women showed increased likelihood for SA during different age periods.

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

BACKGROUND: The relationship between tobacco smoking, including secondhand smoking, and depression has been assessed. The purpose of this study was to evaluate the association between secondhand smoking among current, former and never smokers and depressive symptoms. For secondhand smoking, gender differences and sources of exposure were examined. METHODS: Data from 34,693 participants from the fourth and fifth Korean Health and Nutritional Examination Survey (2007-2012) were analyzed in 2014. Self-reported exposure to active (current, former or never) and secondhand smoking and depressive symptoms experienced during the past year were analyzed using logistic regression. The dose-response relationship between duration of secondhand smoke exposure and depression was assessed with stratification by gender and sources of exposure (at home only, at the workplace only or both). RESULTS: Regardless of their smoking status, all women who had secondhand smoke exposure at home reported more depressive symptoms than non-smoking women without any exposure to secondhand cigarette smoking (OR 1.43, 95 % CI 1.04-1.96 for current smokers; OR 2.32, 95 % CI 1.04-5.16 for former smokers; OR 1.25, 95 % CI 1.08-1.43 for never smokers). There was also a significant dose-response pattern (p-trend <0.001) for the duration of secondhand smoke exposure at home among women. No significant association was found between smoking and depressive symptoms in men. CONCLUSIONS: There was a significant association between secondhand smoke exposure at home and depressive symptoms in women. Secondhand smoke exposure at home was associated with depressive symptoms in a dose-response manner.

Role of individual deprivation and community-level deprivation on suicidal behaviors: Insights from the UK Biobank study.

Introduction: This study aimed to investigate the impact of individual- and community-level deprivation on suicidal behaviors among community members. Methods: Data from 350,884 UK Biobank participants were employed to construct an individual deprivation index. Absolute poverty was defined as a pre-tax annual household income below £18,000. Predictors for absolute poverty incorporated variables such as sex, ethnicity, type of accommodation, tenure status, number of vehicles owned, educational qualifications, current employment status, and subjective health rating. The individual deprivation index was constructed using a logistic regression model to predict absolute poverty. Townsend Deprivation Index (TDI) was employed to represent community-level deprivation. The associations between the individual deprivation index, TDI, and suicidal behaviors were examined through multivariate linear regression. Interaction analyses were conducted to investigate effect modification. Results: The logistic regression model demonstrated high predictive accuracy for absolute poverty (area under the receiver operating curve = 0.840). The associations between individual deprivation index and suicidal behaviors were observed to be more substantial than those between TDI and suicidal behaviors. A positive interaction between the individual deprivation index and TDI was detected, indicating an amplifying effect of community-level deprivation on the impact of individual-level deprivation on suicidal behaviors. Conclusion: Our study successfully constructed a comprehensive individual deprivation index that could be applied widely to measure individual-level deprivation. Our findings revealed that individual-level deprivation and community-level deprivation have a synergistic effect on suicidal behaviors, underscoring the importance of multilevel interventions in suicide prevention.

Parent-Offspring Associations of Ideal Cardiovascular Health Metrics: Findings From the 2014 to 2021 Korea National Health and Nutrition Examination Survey.

BACKGROUND: Studies have reported the strength of cardiovascular health (CVH) metrics in parent-offspring relationships. This study aimed to describe the sex-specific associations between CVH in parents and adult offspring. METHODS AND RESULTS: This study was conducted on the Korea National Health and Nutrition Examination Survey data set, which analyzed trios of mother-father-child, with the child's age from 20 to 39 years. To use the nature of sampling design, survey weighting was applied to all our analyses. Ideal CVH was defined as a cluster of at least 5 ideal individual CVH metrics. We examined the association between parents and their adult offspring regarding clustering CVH and individual CVH metrics through odds ratios and 95% CIs using multiple logistic regression with standard errors adjusted for within-family clustering. The study included 1267 married couples comprising 748 sons and 819 daughters. After adjusting for household income and offspring's sex, age, education, and alcohol consumption, an offspring with either parent attaining a nonideal CVH was 3.52 times more likely to have nonideal CVH. Fathers' nonideal CVH was significantly positively associated with the daughters' nonideal CVH. Maternal nonideal CVH was significantly positively associated with the son's nonideal CVH. When analyzing individual CVH metrics, ideal status in fathers or mothers reduced the likelihood of their offspring having a nonideal status. CONCLUSIONS: This cross-sectional study showed positive and differential associations of CVH and its components between parents' and offsprings' nonideal status. Our hypothesis-generating results suggest the relevance of using CVH as a composite indicator in family-centered approaches and heart-health interventions.

Depressive symptoms and neuroticism mediate the association between traumatic events and suicidality - A latent class mediation analysis of UK Biobank Database.

BACKGROUND: Mental disorders that follow traumatic experience may increase risk of suicidality, but a comprehensive approach to understand how these mental disorders mediate the association between psychological traumatic experience and suicidality should be elucidated. In this study, we attempted to provide comprehensive evidence on how depressive symptoms and neuroticism can mediate the association between psychological traumatic experiences and suicidal behaviours including suicidal ideation, suicidal planning, and suicide attempts. METHODS: We analyzed 111,931 participants from UK Biobank who had completed mental health web-based questionnaire from 2016 to 2017. "Self-harm and suicidal behaviour and ideation (SSBI) score" was calculated by the response from suicidal behaviours and self-harm questionnaires. Conducting multivariate linear regression, depressive symptoms, anxiety symptoms, and neuroticism were selected as potential mediators. We constructed a latent class mediation model estimated direct effect of psychological traumatic events on suicidality and indirect effect of psychological traumatic events mediated by depressive symptoms and neuroticism. RESULTS: Psychological traumatic events were positively associated with suicidal behaviours. Depressive symptoms and neuroticism significantly mediated the effect of psychological traumatic events on suicidality. Anxiety symptoms did not mediate the association between psychological traumatic events and suicidality. CONCLUSION: Psychological traumatic events, irrespective of life stage of occurrence, are associated with suicidality. The association between psychological traumatic events and suicidality can be partially explained by depressive symptoms and neuroticism of those who were exposed to psychological trauma.

In-Person Social Interactions and Anxiety During the COVID-19 Pandemic: Exploring the Role of Household Size and Virtual Social Contact Among Midlife and Older Black South African Adults.

OBJECTIVES: The current study investigates how physical distancing during the coronavirus disease 2019 (COVID-19) pandemic was associated with increased anxiety among a cohort of midlife older Black South African adults and the extent to which household size and virtual social contact modify this association for men and women. METHODS: We analyze data from a phone survey conducted from July 2021 to March 2022 as part of Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (n = 2,080). We employ logistic regression to estimate the association between changes in in-person social interactions and anxiety symptoms and examine whether the association is modified by household size and changes in virtual social contact. We perform analyses separately for women and men. RESULTS: Declines in in-person social interactions were associated with increased anxiety for women and men (odds ratios [OR] = 2.52, p < .001). For women only, declines were greater for those living in larger households (OR = 1.11, p = .032). Declines were buffered by increased virtual social contact for both women (OR = 0.55, p = .025) and men (OR = 0.45, p = .019). DISCUSSION: Although the anxiety symptoms of women and men were similarly affected by declines in in-person social interaction, the modifying influence of household size is unique to women, likely due to gender-specific social roles. For women, living in larger households may mean greater caregiving burden, exacerbating the detrimental association between physical distancing and anxiety. On the other hand, both women and men may have used virtual means to connect with friends and family living outside their homes, buffering against increased anxiety.

Association between depressive symptoms and cardiovascular diseases in the Korean geriatric population: A nationwide retrospective cohort study.

INTRODUCTION: Depression has emerged as a modifiable risk factor for cardiovascular disease (CVD). However, evidence on whether depressive symptoms measured using a self-report questionnaire are associated with CVD incidence is scarce. Therefore, we aimed to investigate the association between depressive symptoms and CVD risk using data from national health examinations and insurance claim records. METHODS: This retrospective cohort study included participants who underwent the Korean National Screening Program for Transitional Ages at age 66 years between 2007 and 2017. The presence of depressive symptoms was defined as affirmative responses to any of three questions (loss of activities and interests, worthlessness, and hopelessness) selected from the Geriatric Depression Scale. Incident composite CVD event included myocardial infarction, stroke, heart failure, and CVD death. The association between depressive symptoms and CVD risk was evaluated using hazard ratios (HRs) and 95 % confidence intervals (CIs) estimated with Cox proportional hazards models. RESULTS: Among 88,765 participants (48.5 % women) aged 66 years, 4036 incident CVD events occurred during a mean follow-up of 6.8 years. Participants with depressive symptoms had a significantly higher risk of CVD than those without depressive symptoms (adjusted HR = 1.16 [95 % CI: 1.07-1.24]). The three individual depressive symptoms showed similar associations with CVD risk (loss of activities and interests, adjusted HR = 1.17 [95 % CI: 1.08-1.26]; worthlessness, 1.15 [1.03-1.29]; hopelessness, 1.13 [1.01-1.26]). LIMITATIONS: The study was limited to participants aged 66 years. Despite extensive adjustment for potential confounders and multiple sensitivity analyses, residual confounding and reverse causality could not be ruled out. CONCLUSION: The presence of depressive symptoms was associated with an increased risk of CVD. Screening for depressive symptoms in the general population may effectively mitigate the burden of CVD.

Validation of the Korean Academy of Geriatric Dentistry screening questionnaire and oral frailty diagnostic criteria in community-dwelling older adults.

OBJECTIVES: This study aimed to establish the validity-specifically, the sensitivity and specificity-of the screening questionnaire and diagnostic criteria for oral frailty proposed by the Korean Academy of Geriatric Dentistry (KAGD) among community-dwelling older adults. METHODS: This study enrolled 100 participants. Among various definitions of oral frailty, this study used the criteria proposed by Tanaka as the reference test. The screening questionnaire consisted of 11 items for screening physical frailty, chewing ability, swallowing difficulties, oral dryness, and tongue and lip motor function. Each question had a different scoring weight, and if the total score was 1 or higher, an oral frailty diagnostic examination proposed by the KAGD would be recommended. The diagnostic test was the oral frailty diagnostic criteria proposed by the KAGD including 6 measures: chewing ability, occlusal force, tongue pressure, oral dryness, swallowing difficulty, and oral hygiene. If a participant exhibited 2 or more positive measures, this participant was classified as "oral frail." The screening questionnaire was analyzed using a cut-off value of 1 or higher, while the diagnostic criteria utilized a cut-off of 2 or more positive measures. Sensitivity and specificity were calculated. RESULTS: The screening questionnaire showed significant power for screening oral frailty (area under the receiver operating characteristic curve, 0.783; sensitivity, 87.8%; specificity, 52.5%). The diagnostic accuracy of the newly proposed diagnostic criteria was acceptable (sensitivity, 95.1%; specificity, 42.4%). CONCLUSIONS: The newly proposed screening questionnaire and diagnostic criteria in Korea appear to be a useful tool to identify oral frailty in community-dwelling older adults.