Ordinary Responses to an Extraordinary Disaster: Sewol Ferry Sinking and the Victim Families' Experience.

Sewol Ferry sinking was a man-made disaster that happened on April 16, 2014, in South Korea, resulting in 304 deaths. In the 2 years following the disaster, the Special Investigation Commission on the Sewol Ferry Disaster conducted a qualitative study with the victim families to investigate their experience. One hundred forty-five interviews were conducted with parents, aunts, and grandparents of high school student victims by a team of clinical and community psychologists. Based on 54 in-depth interviews with parents and parent figures randomly selected out of the 145 interviews conducted, we aimed to understand the lived experience of the victim parents. The grounded theory yielded 59 codes and five categories, whose core variable was self-empowerment of the victim community. The community of victim families was supported by the engagement of other citizens, as well as the victim families themselves. The meanings implicated in the results, along with the practical implications in the community, are discussed.

Assessment of real-time PCR method for detection of EGFR mutation using both supernatant and cell pellet of malignant pleural effusion samples from non-small-cell lung cancer patients.

BACKGROUND: EGFR mutation is an emerging biomarker for treatment selection in non-small-cell lung cancer (NSCLC) patients. However, optimal mutation detection is hindered by complications associated with the biopsy procedure, tumor heterogeneity and limited sensitivity of test methodology. In this study, we evaluated the diagnostic utility of real-time PCR using malignant pleural effusion samples. METHODS: A total of 77 pleural fluid samples from 77 NSCLC patients were tested using the cobas EGFR mutation test (Roche Molecular Systems). Pleural fluid was centrifuged, and separated cell pellets and supernatants were tested in parallel. Results were compared with Sanger sequencing and/or peptide nucleic acid (PNA)-mediated PCR clamping of matched tumor tissue or pleural fluid samples. RESULTS: All samples showed valid real-time PCR results in one or more DNA samples extracted from cell pellets and supernatants. Compared with other molecular methods, the sensitivity of real-time PCR method was 100%. Concordance rate of real-time PCR and Sanger sequencing plus PNA-mediated PCR clamping was 98.7%. CONCLUSIONS: We have confirmed that real-time PCR using pleural fluid had a high concordance rate compared to conventional methods, with no failed samples. Our data demonstrated that the parallel real-time PCR testing using supernatant and cell pellet could offer reliable and robust surrogate strategy when tissue is not available.

Ethanol extract of Pinus koraiensis leaves containing lambertianic acid exerts anti-obesity and hypolipidemic effects by activating adenosine monophosphate-activated protein kinase (AMPK).

BACKGROUND: In this study, we investigated the anti-obesity and anti-hyperlipidemic mechanisms of lambertianic acid (LA) isolated from Pinus koraiensis leaves and the ethanol extract of Pinus koraiensis leaves (EPK), both in vitro and in vivo. METHODS: Differentiated 3T3L-1 cells were treated with EPK (25 or 50 µg/mL) or LA (200 µM) and analyzed by western blotting or RT-PCR. In vitro, lipid accumulation of adipocytes was observed using Oil-Red-O staining and triglyceride analysis. The contribution of AMPK to anti-obesity activity was assessed by siRNA-mediated AMPK knockdown. After AMPK silencing, expression of AMPK was observed by western blotting. To confirm the in vitro activity, an animal study was conducted by administering a normal diet, HFD, and EPK for 6 weeks. Obesity-related physiological parameters and protein levels were measured. RESULTS: LA induced the expression of p-AMPK and inhibited PPARγ, C/EBP α, adiponectin, FAS, SREBP-1, and HMGCR expression. EPK containing LA significantly decreased lipid accumulation and triglyceride levels in the differentiated 3 T3-L1 cells. EPK treatment suppressed the expression of adipogenic transcription factors, FABP, GPDH, and cholesterol-synthesis-related factors in the differentiated 3 T3-L1 cells. EPK increased the expression of p-AMPK. The effects of EPK were reversed on inhibiting AMPK by using AMPK siRNA and compound C. In vivo analysis showed that body weight gain, serum triglyceride, total cholesterol, LDL cholesterol and AI value in the EPK treatment group were lower than those in the HFD control group. EPK induced the expression of p-AMPK and inhibited PPARγ in liver and adipose tissue. CONCLUSIONS: Overall, the results suggest that EPK containing LA exerts significant anti-obesity and cholesterol-lowering effects by activating AMPK.

The effects of maternal depression on child mental health problems based on gender of the child.

Depression is a common disorder among women with young children. Compared to non-depressed mothers, depressed mothers tend to display less positive affection, provide less emotional support, and inconsistently respond to their child's every day and emotional needs. We examined the association between maternal depression and child (middle childhood) mental health problems according to the child's gender. This study was conducted between June and August 2006 on 3,911 subjects aged 7-12 years. The data for this study was collected through a questionnaire that included the Beck Depression Inventory (BDI) and Korean Child Behavior Checklist (K-CBCL). Most of the CBCL scores were higher for children in the depressed mother group. The two way ANOVAs (depressed group by gender) found girls to have significantly higher scores than boys on somatization. Children may experience somatic complaints when they also suffer from emotional disorders, and therefore must be observed closely.

Coumestrol suppresses hypoxia inducible factor 1α by inhibiting ROS mediated sphingosine kinase 1 in hypoxic PC-3 prostate cancer cells.

Among many signals to regulate hypoxia inducible factor 1α (HIF-1α), sphingosine kinase 1 (SPHK1) is also involved in various biological activities such as cell growth, survival, invasion, angiogenesis, and carcinogenesis. Thus, in the present study, molecular mechanisms of coumestrol were investigated on the SPHK1 and HIF-1α signaling pathway in hypoxic PC-3 prostate cancer cells. Coumestrol significantly suppressed SPHK1 activity and accumulation of HIF-1α in a time- and concentration-dependent manner in hypoxic PC-3 cells. In addition, coumestrol inhibited the phosphorylation status of AKT and glycogen synthase kinase-3ß (GSK 3ß) signaling involved in cancer metabolism. Furthermore, SPHK1 siRNA transfection, sphigosine kinase inhibitor (SKI), reactive oxygen species (ROS) enhanced the inhibitory effect of coumestrol on the accumulation of HIF-1α and the expression of pAKT and pGSK 3ß in hypoxic PC-3 cells by combination index. Overall, our findings suggest that coumestrol suppresses the accumulation of HIF-1α via suppression of SPHK1 pathway in hypoxic PC-3 cells.

A pilot prospective study of the relationship among cognitive factors, shame, and guilt proneness on posttraumatic stress disorder symptoms in female victims of sexual violence.

This study prospectively examined the relationships among cognitive factors and severity of Posttraumatic stress disorder (PTSD) symptoms in female victims of sexual violence. Thirty-eight victims of sexual violence recruited from Center for Women Victims of Sexual and Domestic Violence at Ajou University Hospital. Cognitive factors and PTSD symptom were assessed within 4 months of sexual violence and 25 victims were followed-up 1 month after initial assessment. Repeated-measured ANOVA revealed that PTSD incidence and severity decreased over the month (F [1, 21]=6.61). Particularly, avoidant symptoms might decrease earlier than other PTSD symptoms (F [1, 21]=5.92). This study also showed the significant relationship between early negative trauma-related thoughts and subsequent PTSD severity. Shame and guilt proneness had significant cross-sectional correlations with PTSD severity, but did not show associations when depression severity is controlled. Our results suggest that avoidant symptoms might decrease earlier than other PTSD symptoms during the acute phase and that cognitive appraisals concerning the dangerousness of the world seem to play an important role in the maintenance of PTSD (r=0.499, P<0.05).

Essential oil of Pinus koraiensis inhibits cell proliferation and migration via inhibition of p21-activated kinase 1 pathway in HCT116 colorectal cancer cells.

BACKGROUND: The essential oil of Pinus koraiensis (EOPK) is biologically active compound obtained from the leaves of P. koraiensis. The goal of this study was to investigate the anti-cancer mechanism of EOPK in HCT116 colorectal cancer cells. METHODS: HCT116 cell proliferation was assessed by conducting crystal violet and BrdU assays. To assess the effects of EOPK on cell migration, we performed a wound-healing assay. Further, the contribution of PAK1 to EOPK-induced AKT and extracellular signal-regulated kinase (ERK) suppression was assessed by siRNA-mediated PAK1 knockdown. Changes to the expression and phosphorylation of PAK1 and its effectors were determined by western blotting, and changes to the actin cytoskeleton were determined by performing an immunofluorescence assay. RESULTS: EOPK significantly decreased HCT116 cell proliferation and migration, and induced G1 arrest without affecting normal cells. Additionally, EOPK suppressed the expression of PAK1, and decreased ERK and AKT phosphorylation in HCT116 cells. Finally, EOPK suppressed ß-catenin, cyclin D1, and CDK4/6 expression. CONCLUSIONS: Our studies indicate that EOPK significantly reduced proliferation and migration of colorectal cancer cells. Furthermore, EOPK suppressed PAK1 expression in a dose-dependent manner, and this suppression of PAK1 led to inhibition of ERK, AKT, and ß-catenin activities. Our findings suggest that EOPK exerts its anticancer activity via the inhibition of PAK1 expression, suggesting it may be a potent chemotherapeutic agent for colorectal cancer.

Factor structure of the Internet Addiction Scale and its associations with psychiatric symptoms for Korean adolescents.

In this paper, we explore underlying factors of Internet Addiction Scale (IAS) and examine how the dimensions of the IAS relate to psychiatric symptoms in Korean adolescents. Exploratory factor analysis with a sample of N = 1,722 consisted of 13-15 year old Korean adolescents identified three distinctive factors of IAS and they were labeled 'time management', 'withdrawal behaviors' and 'neglect work'. Then, multiple regression models were applied to assess the association between each factor and eight psychological problems, which were evaluated by Youth Self Report. The overall IAS was significantly associated with Somatic, Immature, Thought, Attention, Delinquent and Aggressive behaviors. However, three factor scores showed different association patterns and indicated multidimensional aspects of problematic Internet use.

Effect of COVID-19 infection and vaccination on SARS-CoV-2 antibody titer change following ovarian stimulation: Prospective analysis of IVF outcomes.

The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) has affected various medical fields worldwide. However, relatively few studies have examined the impact of COVID-19 infection and vaccination on in vitro fertilization (IVF) outcomes and changes in SARS-CoV-2 antibody concentration in follicular fluid (FF). A total of 45 women were prospectively recruited and assigned to 3 groups: uninfected and non-vaccinated control group (Control group), infected group (COVID + group), and vaccinated group (Vaccination group). Serum and follicular fluid (FF) estradiol, progesterone, and SARS-CoV-2 antibody concentrations were measured. There were no statistical differences in the total number of retrieved oocytes (P = .291), mature oocytes (P = .416), and good-quality embryos (P = .694) among the 3 groups. In the vaccination group, BNT162b2 exhibited a significantly lower trigger-day serum estradiol/MII oocyte level (110.6 pg/mL) than other vaccines (289.5 pg/mL) (P = .006). No statistical differences in serum (P = .687) and FF (P = .108) SARS-CoV-2 antibody changes were noted among the 3 groups. Only FF antibody changes exhibited statistically significant differences between the BNT162b2 and other vaccine subgroups (P = .047). COVID-19 infection and vaccination do not affect IVF outcomes. However, the effect of BNT162b2 on steroidogenesis of the mature oocyte and FF SARS-CoV2 antibody titer should be further investigated.

Early risk factors for depressive symptoms among Korean adolescents: a 6-to-8 year follow-up study.

Depression during adolescence is critical to the individual's own development. Hence, identifying individuals with high-risk depression at an early stage is necessary. This study aimed to identify childhood emotional and behavioral risk factors related to depressive symptoms in Korean adolescents through a longitudinal study. The first survey took place from 1998 to 2000, and a follow-up assessment conducted in 2006, as the original participants reached 13-15 yr of age. The first assessment used the Korean version of Child Behavior Checklist and a general questionnaire on family structure, parental education, and economic status to evaluate the participants. The follow-up assessment administered the Korean Children's Depression Inventory. Multiple regression analysis revealed that childhood attention problems predicted depressive symptoms during adolescence for both boys and girls. For boys, family structure also predicted adolescent depressive symptoms. This study suggests that adolescents with attention problems during childhood are more likely to experience depressive symptoms.

Suicide among the elderly and associated factors in South Korea.

With the population of the elderly increasing, suicides among elderly people present a serious problem for global societies. However, there are few studies on suicide among elderly subjects, especially in Asia. The study aimed to determine the relationship between physical health, mental health, social environmental condition, and the suicide behavior among elderly subjects in the city of Suwon, located southeast of Seoul. We analyzed 1548 Korean aged over 60 years from baseline data of a larger prospective study called the Suwon Project. The study protocol included sociodemographic variables, mental health factors, and physical health factors. In the interview, the subjects were asked about suicide ideation and history of suicide attempt. Of the total subjects, 7.42% reported suicide ideation and 1.42% reported a history of suicide attempt. A logistic regression analysis showed that physical illness, five stroke warning signs, anxiety and depression associated with suicide ideation, and depression strongly corresponded to the suicide ideation. Anxiety, depression, and stroke warning signs were associated with history of suicide attempt among the elderly. Additionally, stroke warning signs and depression are independently associated with history of suicide attempt. This study revealed that stroke warning signs have a high correlation with history of suicide attempt in the elderly, independent from the depression factors. This study suggests that there is an independent relationship between physical health status and suicide behavior in the case of elders.

Particled Mica, STB-HO has chemopreventive potential via G1 arrest, and inhibition of proliferation and vascular endothelial growth factor receptor 2 in HCT colorectal cancer cells.

BACKGROUND: Though Mica, a thin and sheet like mineral, has been used as a mineral medicine for treatment of bleeding, dysentery and inflammation in traditional medicine including Ayurveda, the biological evidences of Mica were not clearly elucidated so far. Thus, in the present study, the antitumor mechanism of particled Mica (STB-HO) was examined in colorectal cancers. METHODS: Athymic nude mice were inoculated with HCT116 colon cancer cells and orally administered STB-HO daily for 41 days, and HCT116 and human umbilical vein endothelial cells (HUVECs) were treated with STB-HO for 0 ~ 24 hours to perform immunoblotting, cytotoxicity assay, FACs analysis and measurement of matrix metalloproteinase 9 (MMP-9) secretion and other experiments. Significant differences of all date were evaluated using Student's t-test and a Turkey-Kramer multiple-comparison post test. RESULTS: STB-HO significantly suppressed the tumor volume and weight in athymic nude mice inoculated with HCT116 cells at a dose of 100 mg/kg. Thus, the in vivo antitumor mechanism of STB-HO was to elucidated in vitro as well. STB-HO exerted cytotoxicity in HCT116, SW620 and HCT15 colorectal cancer cells. Also, STB-HO increased G1 cell population in a time and concentration dependent manner, enhanced the expression of p21, p27, p53 as cyclin dependent kinase (CDK) inhibitors, attenuated the expression of proliferating cell nuclear antigen (PCNA) and cyclin D1 and also reduced the production of vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) in HCT116 cells. Consistently, STB-HO suppressed the phosphorylation of VEGFR2 in HCT116, SW620 and HCT15 cells. Also, STB-HO inhibited the VEGF mediated proliferation and also attenuated the phosphorylation of VEGFR2 and Akt in human umbilical vein endothelial cells (HUVECs). CONCLUSIONS: Collectively, these findings suggest that STB-HO has chemopreventive potential via G1 arrest and inhibition of proliferation and VEGFR2 in HCT116 colorectal cancer cells.

Does psychopathology in childhood predict internet addiction in male adolescents?

This study investigated childhood psychopathology and Internet addiction in adolescents. Initial assessment data were obtained from 1998 to 1999, and a follow-up assessment was performed in 2006, when the original subjects entered middle school. Personal information for the 524 male subjects was obtained from the original data. The subjects were evaluated with the Korean version of the child behavior checklist, which was administered to the children's parents. Demographic and psychosocial factors were also evaluated. Children were reassessed with the self-reported Korea Internet Addiction Scale. Our results indicated that 3.6 % of the subjects had Internet addiction, and revealed a significant relationship between withdrawal and anxiety/depression and future Internet addiction. The results suggest that withdrawal and anxiety/depression during childhood should be considered in the etiology of problematic Internet use in boys. Accordingly, clinicians should consider anxiety/depression and withdrawal during childhood to prevent Internet addiction.

Cost-Effectiveness Analysis of Germline and Somatic BRCA Testing in Patients With Advanced Ovarian Cancer.

Background: BRCA testing is necessary for establishing a management strategy for ovarian cancer. Several BRCA testing strategies, including germline and somatic testing, are implemented in clinical practice in Korea. We aimed to comparatively evaluate their cost-effectiveness from patients' perspective. Methods: We developed a decision model comprising five BRCA testing strategies implemented in Korea: (1) germline testing first, followed by somatic tumor testing for patients without a germline variant; (2) somatic testing first, followed by germline testing for patients with a variant detected by somatic testing; (3) both germline and somatic testing; (4) germline testing alone; and (5) somatic testing alone, with no testing as the comparator. One-way sensitivity analysis was conducted to test the uncertainty of key parameters. Results: Assuming a willingness-to-pay of $20,000 per progression-free life-year gain (PF-LYG), all five strategies were considered cost-effective. Strategy 4 was the most cost-effective option, with an incremental cost-effectiveness ratio (ICER) of $2,547.7 per PF-LYG, followed by strategy 1, with an ICER of $3,978.4 per PF-LYG. Even when the parameter values were varied within the possible range, the ICERs of all strategies did not exceed the willingness-to-pay threshold. Conclusions: Considering the importance of knowing a patient's BRCA gene status, germline testing first, followed by somatic testing, may be a reasonable option.

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

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

The pathway of internalizing and externalizing problems from childhood to adolescence: a prospective study from age 7 to 14-16 in Korea.

This study prospectively investigated developmental psychopathology pathway from the age of 7 to ages 14-16. The subjects (N = 1,857) were evaluated using the Korean version of the Child Behavior Checklist and reassessed using the Korean Youth Self Report. In path analyses, total problems, externalizing problems, and internalizing problems in childhood associated significantly with problems in adolescence. In particular, childhood externalizing problems associated with adolescent externalizing problems, for both genders. However, our results differ from those of previous studies in that internalizing problems showed a restrictive stability by gender and in that early externalizing problems correlated negatively with later internalizing problems for girls. In the syndrome scales analyses, we confirmed that some syndromes showed heterotypic pathways, despite the general continuity of the developmental psychopathology. The importance of Anxiety/Depression and Attention problems in childhood suggested that adolescent difficulties are a consequence of an accumulation of such risk factors.

Psychosis Relapse Prediction Leveraging Electronic Health Records Data and Natural Language Processing Enrichment Methods.

Background: Identifying patients at a high risk of psychosis relapse is crucial for early interventions. A relevant psychiatric clinical context is often recorded in clinical notes; however, the utilization of unstructured data remains limited. This study aimed to develop psychosis-relapse prediction models using various types of clinical notes and structured data. Methods: Clinical data were extracted from the electronic health records of the Ajou University Medical Center in South Korea. The study population included patients with psychotic disorders, and outcome was psychosis relapse within 1 year. Using only structured data, we developed an initial prediction model, then three natural language processing (NLP)-enriched models using three types of clinical notes (psychological tests, admission notes, and initial nursing assessment) and one complete model. Latent Dirichlet Allocation was used to cluster the clinical context into similar topics. All models applied the least absolute shrinkage and selection operator logistic regression algorithm. We also performed an external validation using another hospital database. Results: A total of 330 patients were included, and 62 (18.8%) experienced psychosis relapse. Six predictors were used in the initial model and 10 additional topics from Latent Dirichlet Allocation processing were added in the enriched models. The model derived from all notes showed the highest value of the area under the receiver operating characteristic (AUROC = 0.946) in the internal validation, followed by models based on the psychological test notes, admission notes, initial nursing assessments, and structured data only (0.902, 0.855, 0.798, and 0.784, respectively). The external validation was performed using only the initial nursing assessment note, and the AUROC was 0.616. Conclusions: We developed prediction models for psychosis relapse using the NLP-enrichment method. Models using clinical notes were more effective than models using only structured data, suggesting the importance of unstructured data in psychosis prediction.

Network modeling of anxiety and psychological characteristics on suicidal behavior: Cross-sectional study.

BACKGROUND: Suicide is influenced by complex interactions among various psychopathological features. We aimed to examine the relationship between suicide risk and psychological risk factors such as defense mechanisms, personality, and anxiety. METHODS: We established a psychiatric database by utilizing the Observational Medical Outcomes Partnership Common Data Model. We conducted a 1:1 propensity score matching with age, sex, and depression severity, and identified a sample (n = 258) with two groups: those with suicidal behavior and those with non-suicidal behavior. Using principal component analysis, we extracted nine psychological scales and applied network analysis to compare relationships among psychological factors between the two groups. RESULTS: Patients with non-suicidal behaviors showed associations between trait anxiety and defense mechanisms, while those with suicidal behaviors did not. For patients with suicidal ideation there was an association between somatization and trait anxiety. Patients with suicide attempts showed associations between paranoia and dissociation connected to trait anxiety. LIMITATIONS: Longitudinal research is required to fully observe transitions from suicidal ideation to attempts and recurrent suicidal events. In addition, these networks may not generalize suicidal behaviors because the group participants are not homogeneous. Lastly, data from self-report questionnaires limits the reliability of responses. CONCLUSIONS: We presented important new insights on suicidal behavior by estimating psychological networks. Patients with non-suicidal behavior may exhibit discrete relationships between defense mechanisms and anxiety, compared to those with suicidal behavior. Patients with suicidal ideation and suicide attempts may show distinct associations between anxiety and psychopathological features.

Posttraumatic stress disorder and complicated grief in bereaved parents of the Sewol Ferry disaster exposed to injustice following the loss.

BACKGROUND: Perceived justice after man-made disaster bereavement may involve as a protective factor in the recovery process. However, perceived justice related to posttraumatic stress disorder (PTSD) or complicated grief (CG) after disaster bereavement has not been sufficiently discussed in previous studies. AIMS: This study aims to assess PTSD and CG in bereaved parents of Sewol disaster and to explore whether perceived justice is related with the diagnostic groups. METHODS: Bereaved parents of Sewol disaster (N = 122) were interviewed approximately 2 years after the incident. Structured interviews for PTSD and CG were assessed, and perceived institutional justice surrounding the incident was measured. Symptom groups were identified, and multinomial logistic regression was conducted to find whether perceived justice was related with PTSD or CG. RESULTS: Participants showed high rates of CG and PTSD, and were classified into the both PTSD and CG group, the CG-only group and the resilient group. The analysis revealed that less perceived justice and being a mother increased the likelihood of having both PTSD and CG. Less perceived justice also showed a tendency to be associated with having CG without PTSD. CONCLUSION: Parents bereaved by the Sewol disaster had high PTSD and CG related to lower levels of perceived justice surrounding the post-disaster period. Post-disaster environment seeking justice may facilitate the natural grieving process or encourage access to effective individual interventions.

A 12-week multidomain intervention for late-life depression: a community-based randomized controlled trial.

BACKGROUND: Given that current unimodal strategies for treating late-life depression are insufficient, the awareness of the necessity and importance of multidomain intervention has increased. We assessed the efficacy of multidomain intervention in reducing symptoms of late-life depression. METHODS: This was a 12-week community-based randomized controlled trial in 78 older adults diagnosed with major depressive disorder. Participants were randomly assigned to the multidomain intervention or supportive therapy group. We provided four home visits and 12 telephone calls over 12 weeks. Four therapeutic approaches (physical activity, healthy diet, social activity, and brief cognitive restructuring) were incorporated into the multidomain intervention. The primary outcome was the change in depressive symptoms, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). Secondarily, we investigated changes in resting-state functional connectivity. RESULTS: The MADRS total score was reduced more in the multidomain intervention group than in the supportive therapy group during the 12 weeks (intervention × time interaction, P = =0.007). After correction for multiple comparisons, the multidomain intervention group exhibited a lower MADRS total score at week 12 (score difference 5.117; P = =0.029). At follow-up, the multidomain intervention group also exhibited less functional connectivity between the posterior cingulate cortex and left inferior parietal lobule within the default mode network (FDR < 0.1). LIMITATIONS: Caution is needed in the interpretation of the results, considering the small sample size and high percentage of female participants. CONCLUSIONS: A 12-week multidomain intervention resulted in a greater reduction of depressive symptoms among the elderly with major depressive disorder than their counterparts who received supportive therapy.