The Risk of Neuropsychiatric Adverse Events With Use of Leukotriene Receptor Antagonists in Patients With Asthma: Analysis of Korea's National Health Insurance Sharing Service Database.

BACKGROUND: Montelukast, a selective leukotriene receptor antagonist, is a commonly prescribed allergy medication but its potential association with neuropsychiatric adverse events is concerning. OBJECTIVE: To analyze Korea's National Health Insurance System claims records to identify the risk of neuropsychiatric adverse events in patients with asthma treated with montelukast. METHODS: This retrospective population-based study analyzed the National Health Insurance claims records of the entire Korean population between 2008 and 2015. We compared the risk of neuropsychiatric adverse events among patients with asthma using inhaled corticosteroids and/or long-acting ß2-agonists with montelukast or pranlukast and those not using leukotriene receptor antagonists (control group). RESULTS: There was no increased risk of the composite outcome of all measured neuropsychiatric adverse events in patients with asthma who were prescribed montelukast or pranlukast compared with those who were not. However, montelukast use was associated with an increased risk of hallucinations (inverse probability treatment weighting hazard ratio, 1.45; 95% CI, 1.07-1.96) and attention problems (inverse probability treatment weighting hazard ratio, 1.24; 95% CI, 1.01-1.52). Significant negative hazards for disorientation, anxiety, stress reactions, and somatic symptoms were observed in the montelukast group. When grouped by sex, the risk of hallucinations and attention problems was higher in men prescribed montelukast compared with the controls. CONCLUSIONS: We did not observe an increase in all neuropsychiatric adverse events in the leukotriene receptor antagonist-treated group; however, an increased risk of hallucinations and attention problems was observed in those taking montelukast, regardless of the medication administration period.

Mediating Effect of Public Service Motivation and Resilience on the Association Between Work-Related Stress and Work Engagement of Public Workers in the COVID-19 Pandemic.

OBJECTIVE: We aimed to explore the influence of public workers' distress or viral anxiety on their level of depression and work engagement during the coronavirus disease (COVID-19) pandemic. Additionally, we ascertain the mediation effect of resilience and public service motivation on this association. METHODS: A total of 300 public workers participated in this online survey. Their demographic characteristics and responses to survey items were collected using the Stress and Anxiety to Viral Epidemics-6 items Scale, the Patient Health Questionnaire-9 items Scale, the Public Service Motivation (PSM) Scale, the Nine-item Utrecht Work Engagement Scale, the Korean Occupational Stress Scale-Short Form, and the Brief Resilience Scale. RESULTS: Work engagement of public workers was expected by PSM (ß=0.28, p<0.001), resilience (ß=0.30, p<0.001), and work-related stress (ß=-0.40, p<0.001) (F=57.4, p<0.001). Depression was expected by fewer years of employment (ß=-0.12, p=0.02), viral anxiety (ß= 0.21, p<0.001), and low resilience (ß=-0.42, p<0.001) (F=22.1, p<0.001). Resilience and PSM partially mediated the effects of work-related stress on work engagement. Depression was influenced by COVID-19-induced viral anxiety, and their resilience-but not PSM-mediated the association. CONCLUSION: Public workers' resilience and PSM partially mediated the effects of work-related stress on work engagement. The influence of viral anxiety on public workers' depression was mediated by their resilience but not PSM.