Dietary Carotene Intake and Suicidal Ideation in Korean Females: Analysis of Data From the Korea National Health and Nutrition Examination Survey (2012, 2013, and 2015)

Objective@#The suicide rate in Korea was the highest among countries in the Organisation for Economic Co-operation and Development in 2019. In a previous study, higher intake of vegetables and fruits was associated with a lower risk of suicidal ideation, and carotene-rich fruits and vegetables lowered the risk of depression. This study aimed to examine the direct relationship between carotene intake and suicidal ideation, adjusting for the effect on depression. @*Methods@#This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2012, 2013, and 2015. Carotene intake was assessed through a food intake frequency survey with a 24-hour recall. Suicidal ideation and depression were assessed using the mental health section of the KNHANES. We applied logistic regression to assess the relationship between carotene intake and suicidal ideation, adjusting for potential confounders. @*Results@#A total of 5,480 females aged 19–64 years were included in this study. Carotene intake was significantly lower in the suicidal ideation group (3,034.5±1,756.4 μg/day) than in the nonsuicidal ideation group (3,225.4±1,795.1 μg/day) (p=0.015). We found a significant inverse association between carotene intake and the risk of suicidal ideation after adjusting for potential confounders (odds ratio=0.934, 95% confidence interval=0.873–0.999). @*Conclusion@#These results suggest that carotene intake may be inversely associated with the risk of suicidal ideation. Our findings may inform the development of new nutritional interventions to prevent increases in the risk of suicide worldwide.

Vitamin D and Resilience in Acutely Admitted Patients with Bipolar Disorder / 생물치료정신의학

Objectives@#：The purpose of this study was to investigate the relationship between serum vitamin D concentration and resilience in patients hospitalized with bipolar disorder. @*Methods@#：Serum vitamin D levels were measured on day 1 of hospitalization in 64 patients with bipolar disorder, who were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. The ConnorDavidson Resilience Scale and the Korean version of the Inventory for Depressive Symptomatology (KIDS) were administered to these patients, and symptoms of mania were evaluated using the Young Mania Rating Scale (YMRS). Patients were then categorized into vitamin D sufficient and deficient groups based on a serum vitamin D cut-off of 20 ng/ mL. Analysis of covariance (ANCOVA) was performed to compare the resilience between the two groups, and multiple linear regression was performed to determine the association between serum vitamin D levels and resilience. @*Results@#：The vitamin D deficiency group had more depressive episodes than the sufficient group (p<0.05). ANCOVA showed that the vitamin D deficient group had significantly lower resilience scores than the sufficient group (p= 0.034). Moreover, multiple regression analyses conducted by controlling age, sex, body mass index, season of blood sampling, KIDS scores, and YMRS scores, showed a significant association between serum vitamin D concentration and resilience in patients with bipolar disorder (p=0.001). @*Conclusions@#：This study suggested that vitamin D deficiency is associated with resilience as a protective factor against stress and trauma in patients with bipolar disorder. Further research is warranted to determine the causal relationship between vitamin D levels and resilience.

The Effects of Repeated Information using Visual and Video-Audio Media on Uncertainty and Anxiety in Patients undergoing Thyroidectomy

Purpose@#The purpose of this study was to identify the effects of repeated audiovisual information on the reduction of uncertainty and anxiety in patients undergoing thyroidectomy. @*Methods@#A non-equivalent control group pretest-posttest design was used. The study included 32 patients in the experimental group and 32 in the control group. Preoperative information using video-audio media was provided two times for 5 minutes and 45 seconds each in the experimental group, while the control group only received routine care. The data collection period was from November 1, 2017 to February 23, 2018. The data were analyzed using χ² test, t test, and independent t-test with SPSS/WIN 24.0. @*Results@#Significant differences were observed between the two groups in pre- and post-uncertainty scores (t = -2.06, p= .044) and anxiety scores (t = -2.06, p= .044). @*Conclusion@#Repeated information provided by using videoaudio media is effective as a nursing intervention to reduce uncertainty and anxiety in patients undergoing thyroidectomy.

A Study on the Relationship between Sleep Quality and Cognitive Function in Community Elderly / 수면정신생리

Objectives@#Sleep disturbance in the elderly is associated with cognitive decline. Sleep quality is known to deteriorate with age, and prospective studies seldom have examined the relationship between sleep quality and cognitive function. This study investigates the relationship between early sleep quality and cognitive function based on six-year follow-up data of community individuals older than 60 years. @*Methods@#The participants included 622 community elderly people older than 60 years from Jinju-Si. The final analysis comprised 322 elderly people. Pittsburgh sleep quality index (PSQI) and the Korean version of Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) were used to assess early sleep quality and cognitive function after six years. Multiple linear regression analysis was performed to investigate the association between early sleep quality and cognitive function in the elderly. @*Results@#Early sleep quality (PSQI) was significantly associated with the results of the digit span test, clock drawing test (clox 1), and word recall test after six years. Sleep quality (PSQI) decreased significantly after six years, and lower quality of sleep (PSQI) score was associated with higher digit span test score (β = -0.167, p = 0.026) and higher clock drawing test score (β = -0.157, p = 0.031). Lower quality of sleep (PSQI) score was associated with higher word recall test (β = -0.140, p = 0.039). @*Conclusion@#The digit span test, word recall test, and clock drawing task (CLOX 1) shown to be significantly associated to sleep quality can be performed fast and easily in clinical practice. It is important to assess early cognitive function in the elderly with poor sleep quality, and further studies could suggest that these tests may be useful screening tests for early dementia in elderly with poor sleep quality.

The Mediating Effect of Impulsivity on Resilience and Depressive Symptoms In Korean Conscripts

OBJECTIVE: Resilience and impulsivity have opposite effects on depression in stressful situations. This study aimed to investigate the association among resilience, impulsivity, and depression in young males. METHODS: The participants consisted of 429 conscripts who underwent military training over 5 weeks. The surveys included the Connors- Davidson Resilience Scale-Korean version, the Barratt Impulsiveness Scale-11-Revised, and the Center for Epidemiological Studies- Depression Scale. The surveys were administered both before and after training. RESULTS: When simultaneously considering impulsivity and resilience, resilience was not associated with depression. Impulsivity had a complete negative mediating effect on resilience and depressive symptoms. Impulsivity is a significant negative mediating factor for the protective effect of resilience on depression. CONCLUSION: This study recommends considering impulsivity when evaluating the protective role of resilience against depression.

Chronic Medical Diseases and Depressive Symptoms in a Rural Group at High Risk for Depression: A 1-Year Follow-Up Study / 생물치료정신의학

OBJECTIVES: This study investigated the effects of chronic medical diseases on depressive symptoms in individuals at high risk for depression living in rural areas, over a 1-year period.METHODS: A community-based longitudinal study was conducted; 67 participants aged 18–79 years residing in rural areas were included. In the first survey, all participants completed a self-report questionnaire battery. An interview was also conducted to obtain data on demographic variables and current or past chronic medical diseases. In the first survey, participants with the Center for Epidemiologic Studies Depression scale(CES-D) scores of 16 or higher were categorized as being at high risk for depression; the same assessments were carried out 1 year later in a follow-up survey. Multiple regression analysis was performed to determine the association of chronic medical diseases with 1-year follow-up depressive symptoms in the high-risk group.RESULTS: In model 1, which controlled for sociodemographic variables, the number of chronic medical diseases (p =0.026), baseline severity of depressive symptoms(p =0.002), and presence of diabetes(p =0.039) were significantly associated with the follow-up CES-D scores. In model 2, which further adjusted for Alcohol Use Disorder Identification Test and Beck Anxiety Inventory scores, the number of chronic medical diseases(p =0.036), baseline severity of depressive symptoms(p =0.017), and prevalence of diabetes(p =0.037) were also significantly associated with the follow-up CES-D scores.CONCLUSION: This study suggests that the number of chronic medical diseases, prevalence of diabetes, and severity of depressive symptoms are significantly associated with 1-year follow-up depressive symptoms in individuals at high risk for depression.

Effects of Emotional Stability on Insomnia through Anxiety in Patients with Cataracts

This study investigated the effect of emotional stability (ES) on insomnia through anxiety in preoperative patients with cataracts. Fifty-four subjects completed a self-questionnaire that included the Insomnia Severity Index (ISI), the International Personality Item Pool (IPIP) for ES, and the Hospital Anxiety and Depression scale (HADS). Pathway analysis was performed to analyze the mediating effects of ES, the anxiety subscale scores of the HADS, and the ISI scores. The low-ES group exhibited an insomnia severity that was significantly higher than that of the high-ES group (p=0.048). According to the pathway analysis, the significant indirect effect of ES on the ISI scores was mediated by the scores on the anxiety subscale of the HADS. Cataract patients with low ES waiting to undergo surgery have a high risk of experiencing insomnia due to anxiety. Before surgery, it is essential to identify patients’ personality characteristics and provide appropriate intervention.

More Resilience in Males with Probable Bipolar Depression than Probable Unipolar Depression among Korean Conscripts

OBJECTIVE: This study investigated whether the resilience of males with probable bipolar depression (PBD) can be strengthened and compared it to that of males with probable unipolar depression (PUD). METHODS: Prospective data for 198 participants (PBD: 66, PUD: 66, normal control: 66) were analyzed. The participants' resilience, bipolarity and severity of depressive symptoms were evaluated at baseline and after 5 weeks. Analysis of variance (ANOVA) and repeated measure ANOVA was performed for comparing resilience between three groups through a basic military training. RESULTS: The PBD group demonstrated more resilience than the PUD group at baseline. Participants with PBD became significantly more resilient than participants with PUD after 5 weeks (p<0.01, F=6.967, η²(p)=0.052). CONCLUSION: The study indicates that interventions that strengthen resilience need to be developed for males with PBD and that such interventions are more effective for males with PBD than PUD.

The Association between Suicidal Ideation, Anxiety, and Sleep Quality Among College Students in a City / 수면정신생리

OBJECTIVES: Suicide is one of the leading causes of death among young adults. We investigated whether anxiety level and sleep quality were related to suicide ideation among university students. METHODS: Questionnaires were distributed to 1094 students at a local college. The scale for suicide Ideation, the Hospital Anxiety-Depression scale, the Pittsburgh Sleep Quality Index, and Morningness-eveningness questionnaires were used. Multiple linear regression analysis was conducted to examine the relationship between these variables and suicide ideation. RESULTS: Among the 292 students who answered the suicide ideation questionnaire, 31 students had a high suicide ideation score and 261 patients had a low suicide ideation score. Demographic variables that showed significant differences between the two groups were gender, exercise, chronotype, sleep quality, depression and anxiety. The results of multiple linear regression analysis showed that suicidal ideation increased as the level of sleep quality decreased. There was no significant relationship between depression and suicidal ideation. Another multiple linear regression analysis was performed to evaluate the relationship between sleep quality sleep related factors. This suggested the quality of sleep decreased as weekend oversleep increased. CONCLUSION: The results of this study showed that when anxiety was higher and the quality of sleep was lower, the more suicide ideation increased. Therefore, improving sleep quality and reducing anxiety are important strategies for reducing suicidal ideation.

Changes in Urinary Angiotensinogen Associated with Deterioration of Kidney Function in Patients with Type 2 Diabetes Mellitus

Urinary angiotensinogen (AGT) is potentially a specific biomarker for the status of the intrarenal renin-angiotensin system (RAS) in patients with diabetes mellitus. We explored whether changes in urinary AGT excretion levels were associated with the deterioration of kidney function in type 2 diabetes patients with preserved kidney function. Urinary baseline AGT levels were measured in 118 type 2 diabetic patients who were not taking RAS blockers and who had estimated glomerular filtration rates (eGFRs) ≥ 60 mL/min/1.73 m². A total of 91 patients were followed-up for 52 months. Changes in urinary levels of AGT (ΔAGT) were calculated by subtracting urinary AGT/creatinine (Cr) at baseline from urinary AGT/Cr after 1 year. ΔAGT was significantly inversely correlated with annual eGFR change (β = −0.29, P = 0.006; β = −0.37, P = 0.001 after adjusting for clinical factors). RAS blockers were prescribed in 36.3% of patients (n = 33) during follow-up. The ΔAGT values were lower in the RAS blockers users than in the non-RAS blockers users, but the differences were not statistically significant (7.37 ± 75.88 vs. 22.55 ± 57.45 μg/g Cr, P = 0.081). The ΔAGT values remained significantly correlated with the annual rate of eGFR change (β = −0.41, P = 0.001) in the patients who did not use RAS blockers, but no such correlation was evident in the patients who did. ΔAGT is inversely correlated with annual changes in eGFR in type 2 diabetes patients with preserved kidney function, particularly in RAS blocker-naïve patients.

The Effect of Social Support for Metabolic Syndrome on Elderly in a City in Korea

OBJECTIVE: This study examined the effect of social support on metabolic syndrome (MetS) among elderly population in a city in Korea. METHODS: A total of 352 people all over 60 years of age were analyzed from the data of the Korean Longitudinal Study on Cognitive Aging and Dementia. This study was started in 2010 and is in progress till date. We compared the documented diagnoses of MetS and Medical Outcome Study Social Support Survey at the baseline of the study and two years later. RESULTS: 315 were normal, 37 were developed after two years among subjects without MetS at baseline. When the level of social support was compared at baseline and then at the time of the reassessment two years later, the level had increased in the normal group and the level had not significantly changed for the MetS group. The findings documented at the two year mark indicate that the higher and stronger the level of social support, the lower the risk of developing MetS (odds ratio=0.053, p=0.040). CONCLUSION: The elderly with good social support are noted to be at lower risk in developing MetS as opposed to those with poor social support. It is apparent that adequate social support shows reduced prevalence of MetS among the elderly. Methods to identify strategies in improving social support networks are needed to expand public health resources and to better accommodate the community-based care of the elderly.

The Relationships Among Highly Caffeinated Beverage Intake and Depressive Symptom, Suicide in Adolescents / 정신신체의학

OBJECTIVES: Despite the increased popularity of highly caffeinated beverages, there is little research examining psychiatric adverse effects. The purpose of this study was to investigate the relationships among pattern of highly caffeinated beverage intake and depressive symptom, suicidal ideation, suicidal plan, suicidal attempt in Korean adolescents. METHODS: The data was obtained from the 2014 Korean Youth's Risk Behavior Web-based Study by Korea Centers for Disease Control & Prevention. All participants conducted web-based questionnaire survey. Chisquare test and multiple logistic regression analysis were performed to determine the association among highly caffeinated beverage intake pattern, depressive symptom, suicidal ideation, suicidal plan and suicidal attempt adjusting for differences in age, gender, academic achievement, socioeconomic status. RESULTS: A total of 71,638 participants were enrolled in this study. Depressive symptom, suicidal ideation, suicidal plan and suicidal attempt were significantly more frequent in the group with presence of highly caffeinated beverage intake within 1 week than in non-drinker group(p<0.01). Highly caffeinated beverage intake was significantly associated with suicidal attempt(OR=1.99 ; 95% CI, 1.77–2.22). In addition, depressive symptom, suicidal ideation, suicidal plan and suicidal attempt were significantly more common in the group with heavydrinker who exceed recommended daily intake dose of caffeine than in the group with light-drinker(p<0.01). Heavy drinking of caffeinated beverage was significantly associated with suicidal attempt(OR=4.05 ; 95% CI, 3.02–5.43). CONCLUSIONS: We found that highly caffeinated beverage intake was related to more frequent depressive symptom, suicidal ideation, plan, attempt in adolescents. Also, caffeine intake which exceed recommended daily intake dose identified the predictor of suicidal attempt. Our result suggested that clinicians need to be aware of the possible psychiatric adverse effects of highly caffeinated beverage in vulnerable population including young adolescents.

Risk Factors for Depression of Patients with Tuberculosis in Tuberculosis Specialty Hospital / 정신신체의학

OBJECTIVES: This study aimed to investigate the risk factors of depression for patients with tuberculosis(TB). METHODS: A total of 57 patients with TB were recruited. All participants completed the Becks Depression Inventory-II for evaluating depressive symptoms. The risk factor for depression was analyzed by binary logistic regression analysis. Nomogram was performed for probability of depression. RESULTS: Low body mass index(BMI, OR 0.801, 95% CI 0.65, 0.98), interruption of treatment for TB(OR 5.908, 95% CI 1.19, 29.41), past history of depression(OR 24.653, 95% CI 1.99, 308.44) were associated with increased risk for depression. The calibration curve for predicting probability of survival showed a good agreement between the nomogram and actual observation(Original C-index=0.789, bias corrected C-index=0.754). CONCLUSIONS: The result of the present study indicate that low BMI, interruption of treatment for TB, and past history of depression were risk factors for depression in patients with TB. The psychiatric intervention may be needed to prevent depression if the patients with TB have risk factor during treatment for TB.

Assessment Tools for Psychological Trauma in Children and Adolescent after a Disaster / 신경정신의학

Psychological trauma that can influence development of children and adolescents is common. Evaluation of the trauma is important for treatment and predicting prognosis for children and adolescents. There are many ways to evaluate the effect of psychological trauma, but few articles reviewing assessment tools used in Korea have been reported. Therefore we reviewed various checklists, structure and semi-structure interviews for choosing well and useful usage of these resources in the future. We would suggest usage of the Korean Version of Impact of Event Scale-Revised and Korean Version of the Children's Response to Traumatic Events Scale-Revised as a self-report. Korean Version of Clinician Administered posttraumatic stress disorder scale for Children and Adolescents will also be useful for interview of trauma in Korean children and adolescents. Other various tools that have been used in foreign countries reflecting Korean culture and society will need to be standardized.

Psychosocial Intervention and Practical Experience in Children and Adolescent before and after a Disaster / 신경정신의학

Evidence-based studies have begun to identify the most promising interventions for use with disaster survivors. Interventions are provided in a staged sequence across a timeline. Relationship among agencies associated with a disaster, training professionals and prepared programs for disaster will be needed in pre-disaster stage. After a disaster, children's mental health needs range from support utilizing psychological first aid to psycho-education. The skills for psychological recovery, trauma focused cognitive behavioral therapy, and cognitive behavioral intervention for trauma school will also be needed when children and adolescents keep suffering from various psychiatric symptoms such as insomnia, anxiety, depressive mood, re-experience, and so on. Evaluation and consideration of the developmental needs of children and adolescents, as well as the needs of parents, families, and schools is also important. Domestic standardization of intervention and psychotherapeutic treatment should be performed for more effective interventions for a disaster in Korea.

Association between Quality of Life and Eveningness as well as Sleep Quality among Medical Students / 수면정신생리

OBJECTIVES: We investigated whether sleep behaviors, severity of insomnia and circadian typology are associated with quality of life among Gyeongsang National University (GNU) medical students. METHODS: Questionnaires were distributed to 46 fourth-year students of GNU Medical School. The hospital anxiety-depression scale, insomnia severity index (ISI), morningness-eveningness questionnaire (MEQ) and WHO Quality of Life-BREF (WHOQOL-BREF) were used. RESULTS: Quality of life in terms of physical health was associated with age, weekday total sleep time (TST), weekend TST, catch up sleep, depression, ISI score, and MEQ score. Quality of life in terms of psychological health was correlated to weekday and weekend TST, anxiety, ISI score and MEQ score. Sex, weekday TST, depression, and ISI score were revealed to influence the social aspect of quality of life, and weekday and weekend TST, and ISI score were associated with quality of life in terms of environment. Multiple regression analysis showed that better sleep quality predicted to a higher quality of life in terms of physical, psychological and environmental health, and eveningness was associated with a better quality of life in terms of physical and psychological health. CONCLUSION: It is concluded that physical, psychological, and environmental aspects of quality of life were associated with quality of sleep and that physical and psychological aspects of quality of life were related to eveningness in GNU medical students. Therefore, it is equally important to treat emotional problem as well as improve sleep quality.

Gender Differences in Factors Influencing The Framingham Risk Score-Coronary Heart Disease by BMI

PURPOSE: This study was to investigate factors influencing the Framingham risk score-Coronary heart disease (FRS-CHD) according to gender and body mass index (BMI) of adults who participated in the 5th Korea National Health and Nutrition Examination Survey (KNHANES V-3). METHODS: This study used a cross-sectional design with secondary analysis with KNHANES V-3. The FRS-CHD scores were measured with ages, sex, blood pressure, cholesterol, high density lipoprotein, smoking, and diabetes mellitus. With demographic characteristics, family history of ischemic heart disease, types (intensity) and days of physical activities, perceived stress, drinking, menopause (in female), and BMI scores were measured. The data were analyzed with descriptive statistics, Pearson's correlation coefficients, and multiple regressions. RESULTS: FRS-CHD was significantly associated with types (intensity) and days of physical activities, educational level, occupation, and marital status, explaining 19.1~76.8% of the variance in men. FRS-CHD was significantly associated with types (intensity) and days of physical activities, menopause, and education level, explaining 55.0~59.5% of the variance in women. CONCLUSION: Factors influencing FRS-CHD were significantly different according to gender and BMI. To reduce the risk of coronary artery disease, it is necessary to develop gender-specific physical activity programs according to BMI.

Mediating Effect of Depressive Symptoms on the Relationship between Adult Attention Deficit Hyperactivity Disorder and Quality of Life

OBJECTIVE: The aim of this study was to investigate whether depressive symptoms affect the relationship between adult attention deficit hyperactivity disorder (ADHD) and the quality of life (QOL) in Korean soldiers. METHODS: We evaluated past and present symptoms of adult ADHD (the Korean Adult Attention-Deficit/Hyperactivity Disorder Scale and the Wender Utah Rating Scale), depression (the Center for Epidemiological Studies Depression Scale) and QOL (the Korean version of the SmithKline Beecham 'Quality of Life' scale) in 131 soldiers during mental health screenings performed by a local mental health center. A structured equation model using AMOS 19.0 was used to evaluate the mediating effect of depression. RESULTS: In our first model (without depressive symptoms), adult ADHD significantly affected QOL (standardized regression weight=-0.51, p<0.01). After depressive symptoms were added to this model, the direct effect of adult ADHD on QOL was not significant (standardized regression weight=0.10, p=0.43). Regarding the indirect effect, adult ADHD significantly affected depression (standardized regression weight=0.78, p<0.01), and depression also affected QOL (standardized regression weight=-0.79, p<0.01). CONCLUSION: Through structural equation modeling, the complete mediation model for the influence of depressive symptoms on ADHD and QOL was confirmed. These findings indicated that it might be important to consider comorbidities, such as depression, when adult ADHD is being evaluated.

Metabolic Syndrome and Suicidal Ideation in Korean Based on the 2010 Korean National Health and Nutrition Examination Survey

The aim of this study was to investigate the relationship between metabolic syndrome and suicidal ideation in Korean. This study was based on the 2010 Korean National Health and Nutrition Examination Survey. A questionnaire was used to measure suicidal ideation and physical examination was performed to measure waist circumference, blood pressure, fasting glucose, cholesterol and triglyceride levels. Complex samples logistic regression was performed to estimate the relationship between metabolic syndrome and suicidal ideation among adults and adolescents. Subjects with metabolic syndrome were more likely to have suicidal ideation in adult. There would be essential needs to evaluate suicidal ideation in adult with metabolic syndrome and to follow up suicidal ideation in adolescents with metabolic syndrome.

Resilience and Characteristics of Sleep and Defense among Shift Work Nurses / 수면정신생리

OBJECTIVES: Shift work is a stressful situation. It is important to know the factors associated with the ability to adapt to a shift work schedule. The aim of the present study was to investigate the association between sleep, as well as personality variables, and the resilience of shift work nurses. METHOD: Self-report questionnaires were administered to 95 nurses who worked in one national university hospital. Connor-Davidson resilience scale, hospital anxiety and depression scale, morningness-eveningness scale, Pittsburgh sleep quality index, other sleep-related questionnaires, and Korean defense style questionnaires were used. RESULTS: Age, shift work duration, off-day oversleep, depression, anxiety, adaptive defense style, and self-suppressive defense style were significantly associated with resilience (p < 0.05). Multiple regression analysis showed that age (beta = 0.34, p < 0.05), depression (beta = -0.25, p < 0.05), adaptive defense style (beta = 0.45, p < 0.001), and self-suppressive defense style (beta = -0.19, p < 0.05) significantly predicted the resilience of shift work nurses. Concerning individual defense mechanisms, resignation (beta = -0.20, p < 0.05), sublimation (beta = 0.19, p < 0.05), omnipotence (beta = 0.19, p < 0.05), and humor (beta = 0.20, p < 0.05) significantly predicted the resiliency. CONCLUSION: The findings indicate that a specific defense style and other mechanisms were associated with the resilience of shift work nurses. A future prospective study with more participants could further clarify the relationship between sleep-related variables, as well as personality factors, and resilience of shift work nurses.