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This study aimed to compare brain structural connectivity using graph theory between patients with alcohol dependence and social drinkers. The participants were divided into two groups; the alcohol group (N=23) consisting of patients who had been hospitalized and had abstained from alcohol for at least three months and the control group (N=22) recruited through advertisements and were social drinkers. All participants were evaluated using 3T magnetic resonance imaging. A total of 1000 repeated whole-brain tractographies with random parameters were performed using DSI Studio. Four hundred functionally defined cortical regions of interest (ROIs) were parcellated using FreeSurfer based on the Schaefer Atlas.The ROIs were overlaid on the tractography results to generate 1000 structural connectivity matrices per person, and 1000 matrices were averaged into a single matrix per subject. Graph analysis was performed through igraph R package. Graph measures were compared between the two groups using analysis of covariance, considering the effects of age and smoking pack years. The alcohol group showed lower local efficiency than the control group in the whole-brain (F=5.824, p=0.020), somato-motor (F=5.963, p=0.019), and default mode networks (F=4.422, p=0.042). The alcohol group showed a lower global efficiency (F=5.736, p=0.021) in the control network. The transitivity of the alcohol group in the dorsal attention network was higher than that of the control (F=4.257, p=0.046). Our results imply that structural stability of the whole-brain network is affected in patients with alcohol dependence, which can lead to ineffective information processing in cases of local node failure.
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Objectives@#To investigate the relationship between brain structure and empathy in early adolescents with attention-deficit/hyperactivity disorder (ADHD). @*Methods@#Nineteen early adolescents with ADHD and 20 healthy controls underwent 3T MRI. All the participants were assessed for different aspects of empathy using measures including the Interpersonal Reactivity Index and Empathy Quotient. Cortical thickness and subcortical structural volume based on T1-weighted scans were analyzed using FreeSurfer. @*Results@#Cognitive empathy (t=-2.52, p=0.016) and perspective taking (t=-2.10, p=0.043) were impaired in the ADHD group compared with the control group. The cluster encompassing the left posterior insular, supramarginal, and transverse temporal cortices [cluster-wise p-value (CWP)=0.001], which are associated with emotional empathy, was significantly smaller in the ADHD group, and the volume of the left nucleus accumbens was greater than that of the control group (F=10.12, p=0.003, effect size=0.22). In the control group, the left superior temporal (CWP=0.002) and lingual cortical (CWP=0.035) thicknesses were positively associated with cognitive empathy, while the right amygdala volume was positively associated with empathic concern (Coef=14.26, t=3.92, p=0.001). However, there was no significant correlation between empathy and brain structure in the ADHD group. @*Conclusion@#The ADHD group had a smaller volume of the cortical area associated with emotional empathy than the control group, and there was no brain region showing significant correlation with empathy, unlike in the control group.
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Depression in the elderly population has shown increased likelihood of neurological disorders due to structural changes in the subcortical area. However, further investigation into depression related subcortical changes is needed due to mismatches in structural analysis results between studies as well as scarcities in research regarding subcortical connectivity patterns of subclinical depression populations. This study aims to investigate structural differences in subcortical regions of aged participants with subclinical depression using 3Tesla MRI. In structural analysis, volumes of each subcortical region were measured to observe the volumetric difference and asymmetry between groups, but no significant difference was found. In addition, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) did not show any significant differences between groups.Structural analysis using probabilistic tractography indicated that the connection strength between left nucleus accumbens-right hippocampus, and right thalamus-right caudate was higher in the control group than the subclinical depression group. The differences in subcortical connection strength of subclinical depression groups, have shown to correlate with emotional and cognitive disorders, such as anxiety and memory impairment. We believe that the analysis of structural differences and cross-regional network measures in subcortical structures can help identify neurophysiological changes occurring in subclinical depression.
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Objectives@#To investigate the relationship between brain structure and empathy in early adolescents with attention-deficit/hyperactivity disorder (ADHD). @*Methods@#Nineteen early adolescents with ADHD and 20 healthy controls underwent 3T MRI. All the participants were assessed for different aspects of empathy using measures including the Interpersonal Reactivity Index and Empathy Quotient. Cortical thickness and subcortical structural volume based on T1-weighted scans were analyzed using FreeSurfer. @*Results@#Cognitive empathy (t=-2.52, p=0.016) and perspective taking (t=-2.10, p=0.043) were impaired in the ADHD group compared with the control group. The cluster encompassing the left posterior insular, supramarginal, and transverse temporal cortices [cluster-wise p-value (CWP)=0.001], which are associated with emotional empathy, was significantly smaller in the ADHD group, and the volume of the left nucleus accumbens was greater than that of the control group (F=10.12, p=0.003, effect size=0.22). In the control group, the left superior temporal (CWP=0.002) and lingual cortical (CWP=0.035) thicknesses were positively associated with cognitive empathy, while the right amygdala volume was positively associated with empathic concern (Coef=14.26, t=3.92, p=0.001). However, there was no significant correlation between empathy and brain structure in the ADHD group. @*Conclusion@#The ADHD group had a smaller volume of the cortical area associated with emotional empathy than the control group, and there was no brain region showing significant correlation with empathy, unlike in the control group.
ABSTRACT
Depression in the elderly population has shown increased likelihood of neurological disorders due to structural changes in the subcortical area. However, further investigation into depression related subcortical changes is needed due to mismatches in structural analysis results between studies as well as scarcities in research regarding subcortical connectivity patterns of subclinical depression populations. This study aims to investigate structural differences in subcortical regions of aged participants with subclinical depression using 3Tesla MRI. In structural analysis, volumes of each subcortical region were measured to observe the volumetric difference and asymmetry between groups, but no significant difference was found. In addition, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) did not show any significant differences between groups.Structural analysis using probabilistic tractography indicated that the connection strength between left nucleus accumbens-right hippocampus, and right thalamus-right caudate was higher in the control group than the subclinical depression group. The differences in subcortical connection strength of subclinical depression groups, have shown to correlate with emotional and cognitive disorders, such as anxiety and memory impairment. We believe that the analysis of structural differences and cross-regional network measures in subcortical structures can help identify neurophysiological changes occurring in subclinical depression.
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Objectives@#：Firefighters are always under stress due to their job environment, and they are likely to become psychologically vulnerable due to continuous exposure to traumatic events, which is a stressful situation that requires emergency standby at all times. The aims of this study were to examine mental health factors for each division of firefighters and to see the relationship between sleep and somatization symptoms among them. @*Methods@#：General characteristics and related inspections were conducted through self-reporting questionnaires for 1,264 firefighters working at Chungbuk fire stations. Several mental health factors were investigated by the Insomnia Severity Index, Severity of somatic symptoms, Impact of Event Scale, Perceived Stress Scale, Resilience Scale, Alcohol Dependent Screening Scale, and the Center for Epidemiologic Studies Depression Scale Depression Scale and Mini-International Neuropsychiatric Interview. @*Results@#：Among the mental health variables, the relationship between insomnia and somatization varies significantly depending on types of work. It was reported that the first aid team was significantly higher than the fire suppression and rescue team. Post-traumatic stress, depression and drinking also differ significantly depending on types of work. The first aid team reported more posttraumatic stress than the fire suppression team and more depressed mood than the rescue team. The administration part had more alcohol consumption than the fire suppression or first aid team. Resilience was significantly higher in the rescue team than the first aid team. No significant differences between the types of work about stress and suicide risks. Insomnia, stress, and post-traumatic stress were significant predictors of somatization among firefighters. Above all, insomnia was significant mental health variable affecting somatization. @*Conclusions@#：Various mental health factors were different according to the types of work in firefighters. The First aid team was more vulnerable to mental health variables such as insomnia and somatization than other divisions. Insomnia is the most important cause of somatization in firefighters, so it is recommended that they be treated for insomnia and to prepare institutional policies.
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Objectives@#：Chronic alcohol ingestion is associated with structural alterations in the brain. In patients with alcohol dependence, thalamic volume is frequently diminished, commensurate with the amount of alcohol consumption, duration of illness, and cognitive impairment. Since the thalamus is composed of histologically and functionally distinct nuclei, we aimed to investigate volumetric changes of these nuclei in patients with alcohol dependence. @*Methods@#：Twenty-three participants with alcohol dependence who had abstained from drinking for at least 3 months (alcohol group) and 21 age-matched healthy controls (control group) underwent 3T magnetic resonance imaging. The volumes of 50 individual thalamic nuclei were reconstructed using FreeSurfer 6.0.0. We compared normalized volumes of thalamic nuclei between the two groups using analysis of covariance, controlling for age. The p-values were corrected using False Discovery Rate (p<0.05). @*Results@#：The alcohol group demonstrated atrophy of the whole thalamus and nuclei in the anterior, ventral, intralaminar, and medial thalamus. However, the volumes of bilateral lateral geniculate, medial geniculate, suprageniculatelimitans, pulvinar lateral, and right pulvinar inferior nuclei which are included in posterior thalamus, were not significantly different between the two groups. @*Conclusion@#：In the alcohol group, atrophy of most thalamic nuclei which are associated with language processing, visuospatial memory, autobiographical memory, executive function and attention were not normalized after 3 months of sobriety. Furthermore, thalamic nuclei volumes, which are associated with visual and auditory information processing, were not significantly different compared to controls. We suggest that this could be microstructural evidence of relatively preserved visual attention and auditory startle response in patients with alcohol dependence.
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Objectives@#We investigated the differences in cognitive and emotional empathic ability between adolescents and adults, and the differences of the brain activation during cognitive and emotional empathy tasks. @*Methods@#Adolescents (aged 13–15 years, n=14) and adults (aged 19–29 years, n=17) completed a range of empathic ability questionnaires and were scanned functional magnetic resonance imaging (fMRI) during both cognitive and emotional empathy task. Differences in empathic ability and brain activation between the groups were analyzed. @*Results@#Both cognitive and emotional empathic ability were significantly lower in the adolescent compared to the adult group. Comparing the adolescent to the adult group showed that brain activation was significantly greater in the right transverse temporal gyrus (BA 41), right insula (BA 13), right superior parietal lobule (BA 7), right precentral gyrus (BA 4), and right thalamus whilst performing emotional empathy tasks. No brain regions showed significantly greater activation in the adolescent compared to the adult group while performing cognitive empathy task. In the adolescent group, scores of the Fantasy Subscale in the Interpersonal Reactivity Index, which reflects cognitive empathic ability, negatively correlated with activity of right superior parietal lobule during emotional empathic situations (r=-0.739, p=0.006). @*Conclusion@#These results strongly suggest that adolescents possess lower cognitive and emotional empathic abilities than adults do and require compensatory hyperactivation of the brain regions associated with emotional empathy or embodiment in emotional empathic situation. Compensatory hyperactivation in the emotional empathy-related brain areas among adolescents are likely associated with their lower cognitive empathic ability.
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OBJECTIVES: The purpose of this study was to investigate the differences between adolescents and adults, in the perspective-taking ability, as well as the brain activation patterns during the perspective-taking situation.METHODS: We recruited healthy adolescents aged 13 years to 15 years (n = 20) and adults aged 19 years to 29 years (n = 20). All the subjects were scanned while performing the perspective-taking task, in which an emotional situation was presented in the form of statements comprising first person, as well as third person perspectives. Differences in brain activation between groups were assessed by contrasting neural activity during the tasks.RESULTS: In the between-group analysis, while performing the third-person perspective-taking task, the adolescent group showed greater neural activities in the middle frontal gyrus and precentral gyrus as compared to the adult group. Positive correlation was observed between the activity in the frontal areas (Brodmann area 6/9) and the score of scales related to perspective-taking and social cognition in the adolescent group.CONCLUSIONS: This study suggests that several frontal brain areas of adolescents needs to be overactivated in order to compensate for low perspective-taking ability when they ought to take another person's point of view.
Subject(s)
Adolescent , Adult , Humans , Brain , Cognition , Frontal Lobe , Magnetic Resonance Imaging , Weights and MeasuresABSTRACT
Subject(s)
Aged , Humans , Alzheimer Disease , Dementia , Depression , Diagnosis , Education , Executive Function , Memory , Cognitive Dysfunction , Program Development , Stroop TestABSTRACT
OBJECTIVES: The purpose of this study was to investigate whether the neural activity of autism spectrum disorder (ASD) patients is different from that of normal individuals when performing aesthetic judgments. METHODS: We recruited typical ASD patients without savant skills (ASD group, n=17) and healthy controls (HC group, n=19) for an functional magnetic resonance imaging study. All subjects were scanned while performing aesthetic judgment tasks on two kinds of artwork (magnificent landscape images and fractal images). Differences in brain activation between the two groups were assessed by contrasting neural activity during the tasks. RESULTS: The aesthetic judgment score for all images was significantly lower in the ASD group than in the HC group. During the aesthetic judgment tasks, the ASD group showed less activation than the HC group in the anterior region of the superior frontal gyrus, and more activation in the temporoparietal area and insula, regardless of the type of images being judged. In addition, during the aesthetic judgment task for the fractal images, the ASD group exhibited greater neural activity in the amygdala and the posterior region of the middle/inferior temporal gyrus (Brodmann area 37) than the HC group. CONCLUSION: The results of this study suggest that the brain activation patterns associated with aesthetic experiences in ASD patients may differ from those of normal individuals.
Subject(s)
Humans , Amygdala , Autism Spectrum Disorder , Autistic Disorder , Beauty , Brain , Fractals , Judgment , Magnetic Resonance Imaging , Prefrontal Cortex , Temporal LobeABSTRACT
OBJECTIVES: It is well known that problem drinking is associated with alterations of brain structures and functions. Brain functions related to alcohol consumption can be determined by the resting state functional connectivity in various resting state networks (RSNs). This study aims to ascertain the alcohol effect on the structures forming predetermined RSNs by assessing their cortical thickness. METHODS: Twenty-six abstinent male patients with alcohol dependence and the same number of age-matched healthy control were recruited from an inpatient mental hospital and community. All participants underwent a 3T MRI scan. Averaged cortical thickness of areas constituting 7 RSNs were determined by using FreeSurfer with Yeo atlas derived from cortical parcellation estimated by intrinsic functional connectivity. RESULTS: There were significant group differences of mean cortical thicknesses (Cohen's d, corrected p) in ventral attention (1.01, < 0.01), dorsal attention (0.93, 0.01), somatomotor (0.90, 0.01), and visual (0.88, 0.02) networks. We could not find significant group differences in the default mode network. There were also significant group differences of gray matter volumes corrected by head size across the all networks. However, there were no group differences of surface area in each network. CONCLUSIONS: There are differences in degree and pattern of structural recovery after abstinence across areas forming RSNs. Considering the previous observation that group differences of functional connectivity were significant only in networks related to taskpositive networks such as dorsal attention and cognitive control networks, we can explain recovery pattern of cognition and emotion related to the default mode network and the mechanisms for craving and relapse associated with task-positive networks.
Subject(s)
Humans , Male , Alcohol Drinking , Alcoholism , Brain , Cognition , Craving , Drinking , Gray Matter , Head , Hospitals, Psychiatric , Inpatients , Magnetic Resonance Imaging , RecurrenceABSTRACT
OBJECTIVES: Insomnia may be one of the risk factor for suicidal ideation, but little is known about the mechanism by which sleep disturbances confer risk for suicide. The aim of this study was to investigate examine whether insomnia severity would be associated with resilience and suicidal ideation, and whether resilience would mediate the relationship between insomnia and suicidal ideation. METHODS: A total of 432 community-dwelling adults(227 male, 205 female,) completed the self-report questionnaire that covered basic socio-demographic data. To assess the psychological variables, the following instruments were applied: Insomnia Severity Index(ISI), Korean Version of the Connor-Davidson Resilience Scale(K-CD-RISC), Beck Hopelessness Scale(BHOP) and Scale for Suicidal Ideation(SSI-Beck). People with an ISI score of 8 or higher were defined as insomnia. RESULTS: Greater insomnia symptom severity was significantly associated with higher level of suicidal ideation and lower level of resilience, adjusting for hopelessness, age, sex, presence of family members living together, and household income. Additional analysis revealed that disturbance of sleep initiation and disturbance of sleep maintenance were significantly associated with suicidal ideation. Mediation analyses revealed that resilience significantly accounted for the relationship between insomnia symptom severity and suicidal ideation. CONCLUSIONS: These findings suggest that the evaluation and control of insomnia and resilience may be needed to reduce the risk of suicide.
Subject(s)
Humans , Male , Family Characteristics , Negotiating , Risk Factors , Sleep Initiation and Maintenance Disorders , Suicidal Ideation , SuicideABSTRACT
OBJECTIVE: Alcohol causes damage to the brain and is associated with various functional impairments. However, much of the brain damage can be reversed by abstaining for enough time. This study aims to investigate the patterns and degrees of brain function in abstinent patients with alcohol dependence by using resting-state functional connectivity. METHODS: 26 male patients with alcohol dependence (alcohol group) and 28 age-matched male healthy volunteers (control group) were recruited from a mental hospital and the community, respectively. Using 3T MRI scan data, the resting-state functional connectivity of the task-negative and task-positive networks was determined and compared between the groups. RESULTS: There were no significant group differences in the resting-state functional connectivity in the default mode or in the salience and sensorimotor networks. Compared with the control group, the alcohol group showed significantly lower functional connectivity in the executive control network, especially in the cingulo-opercular network and, in some regions of interest, the dorsal attention network. CONCLUSION: This finding suggests that some brain networks do not normalize their functions after abstinence from drinking, and these results may be helpful in future research to investigate the mechanisms for craving alcohol and alcohol relapse prevention.
Subject(s)
Humans , Male , Alcoholism , Brain , Craving , Drinking , Executive Function , Healthy Volunteers , Hospitals, Psychiatric , Magnetic Resonance Imaging , Secondary PreventionABSTRACT
OBJECTIVES: Individuals with autism spectrum disorder (ASD) are considered to have problems with empathy. It has recently been suggested that there are two systems for empathy; cognitive and emotional. We aimed to investigate the neural response to cognitive and emotional empathy and elucidate the neurobiological aspects of empathy in patients with ASD. METHODS: We recruited patients with ASD (N=17, ASD group) and healthy controls (HC) (N=22, HC group) for an functional magnetic resonance imaging study. All of the subjects were scanned while performing cognitive and emotional empathy tasks. The differences in brain activation between the groups were assessed by contrasting their neural activity during the tasks. RESULTS: During both tasks, the ASD group showed greater neural activities in the bilateral occipital area compared to the HC group. The ASD group showed more activation in the bilateral precunei only during the emotional empathy task. No brain regions were more activated in the HC group than in the ASD group during the cognitive empathy task. While performing the emotional empathy task, the HC group exhibited greater neural activities in the left middle frontal gyrus and right anterior cingulate gyrus than the ASD group. CONCLUSION: This study showed that the brain regions associated with cognitive and emotional empathy in ASD patients differed from those in healthy individuals. The results of this study suggest that individuals with ASD might have defects both in cognitive empathy and in emotional empathy.
Subject(s)
Humans , Autism Spectrum Disorder , Autistic Disorder , Brain , Empathy , Gyrus Cinguli , Magnetic Resonance ImagingABSTRACT
OBJECTIVE: The structural alteration of brain shown in patients with alcohol use disorder (AUD) can originate from both alcohol effects and genetic or developmental processes. We compared surface-based parameters of patients with AUD with healthy controls to prove the applicability of surface-based morphometry with head size correction and to determine the areas that were sensitive to brain alteration related to AUD. METHODS: Twenty-six abstinent male patients with AUD (alcohol group, mean abstinence=13.2 months) and twenty-eight age-matched healthy participants (control group) were recruited from an inpatient mental hospital and community. All participants underwent a 3T MRI scan. Surface-based parameters were determined by using FreeSurfer. RESULTS: Every surface-based parameter of the alcohol group was lower than the corresponding control group parameter. There were large group differences in the whole brain, grey and white matter volume, and the differences were more prominent after head size correction. Significant group differences were shown in cortical thicknesses in entire brain regions, especially in parietal, temporal and frontal areas. There were no significant group differences in surface areas, but group difference trends in surface areas of the frontal and parietal cortices were shown after head size correction. CONCLUSION: Most of the surface-based parameters in alcohol group were altered because of incomplete recovery from chronic alcohol exposure and possibly genetic or developmental factors underlying the risk of AUD. Surface-based morphometry with controlling for head size is useful in comparing the volumetric parameters and the surface area to a lesser extent in alcohol-related brain alteration.
Subject(s)
Humans , Male , Brain , Head , Healthy Volunteers , Hospitals, Psychiatric , Inpatients , Magnetic Resonance Imaging , Neuroimaging , Parietal Lobe , Rabeprazole , White MatterABSTRACT
OBJECTIVES: Standardization of head size is essential for the volume study. Cortical thickness analyses are increasingly being used in many fields of neuroscience. However, it is not established whether head size correction should be done for thickness study. METHODS: Using the Open Access Series of Imaging Studies data, we determined cortical thickness of 316 cognitively normal participants aged 18-94 with FreeSurfer. The association between head size and cortical thickness of whole cortical mantle and in each lobe among age tertile groups was assessed. Estimated total intracranial volume (eTIV) was calculated for determining head size. RESULTS: Across all participants, cortical thickness in whole brain except some areas in cingulate and insula decreased with aging. eTIV had positive correlation with the thickness of frontal, parietal, occipital and whole brain areas. However, the age effect was not shown in whole brain of the first tertile group and in cingulate areas of the third tertile group. eTIV had negative correlation with the thickness of cingulate in the third tertile group. Gender effects were shown in some areas in third tertile group, but it would be due to difference of head size. CONCLUSIONS: These findings suggest that head size standardization might be done especially in older population and in studies of paralimbic areas.
Subject(s)
Aging , Brain , Head , Neurosciences , RabeprazoleABSTRACT
OBJECTIVES: Total intracranial volume (TIV) is a major nuisance of neuroimaging research for interindividual differences of brain structure and function. Authors intended to prove the reliability of the atlas scaling factor (ASF) method for TIV estimation in FreeSurfer by comparing it with the results of manual tracing as reference method. METHODS: The TIVs of 26 normal children and 26 children with attention-deficit hyperactivity disorder (ADHD) were obtained by using FreeSurfer reconstruction and manual tracing with T1-weighted images. Manual tracing performed in every 10th slice of MRI dataset from midline of sagittal plane by one researcher who was blinded from clinical data. Another reseacher performed manual tracing independently for randomly selected 20 dataset to verify interrater reliability. RESULTS: The interrater reliability was excellent (intraclass coefficient = 0.91, p < 7.1e-07). There were no significant differences of age and gender distribution between normal and ADHD groups. No significant differences were found between TIVs from ASF method and manual tracing. Strong correlation between TIVs from 2 different methods were shown (r = 0.90, p < 2.2e-16). CONCLUSIONS: The ASF method for TIV estimation by using FreeSurfer showed good agreement with the reference method. We can use the TIV from ASF method for correction in analysis of structural and functional neuroimaging studies with not only elderly subjects but also children, even with ADHD.
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PURPOSE: This study was conducted to examine the influencing factors of social support, self efficiency and depression among the hearing-impaired and physically disabled on their job stress. METHODS: The data were collected from Jan.1 to Aug. 30, 2010 from 151 disabled workers. The instruments for this study were the Korean Occupational Stress Scale (KOSS), Social Support Scale, General Self-Efficacy Scale and Beck Depression Inventory-Korean Version (K-BDI). The data were analyzed using t-test, Pearson correlation coefficient and multiple regression with the SPSS/WIN 18.0. RESULTS: The physically disabled show higher social support (t=0.284, p= .001) and self efficacy (t=0.165, p= .024) but lower in depression (t=0.789, p<.001) than the hearing-impaired. There are negative correlation between job stress and social support, job stress and self efficacy but a positive correlation between job stress and depression. These three factors explained 42.9% of the variance in job stress. CONCLUSION: Social support and self efficacy have positive impacts on job stress but depression has negative impact.
Subject(s)
Humans , Depression , Disabled Persons , Self EfficacyABSTRACT
PURPOSE: This study was conducted to examine the influencing factors of social support, self efficiency and depression among the hearing-impaired and physically disabled on their job stress. METHODS: The data were collected from Jan.1 to Aug. 30, 2010 from 151 disabled workers. The instruments for this study were the Korean Occupational Stress Scale (KOSS), Social Support Scale, General Self-Efficacy Scale and Beck Depression Inventory-Korean Version (K-BDI). The data were analyzed using t-test, Pearson correlation coefficient and multiple regression with the SPSS/WIN 18.0. RESULTS: The physically disabled show higher social support (t=0.284, p= .001) and self efficacy (t=0.165, p= .024) but lower in depression (t=0.789, p<.001) than the hearing-impaired. There are negative correlation between job stress and social support, job stress and self efficacy but a positive correlation between job stress and depression. These three factors explained 42.9% of the variance in job stress. CONCLUSION: Social support and self efficacy have positive impacts on job stress but depression has negative impact.