Effects of life-sustaining treatment plans on healthcare expenditure and healthcare utilization.

PURPOSE: To develop an ethical and cultural infrastructure for Life-Sustaining Treatment (LST) plan, it is crucial to carefully analyze its impact and ensure that healthcare utilization is maintained at an appropriate level, avoiding excessive medical interventions. This study aims to investigate the effects of LST decisions on both healthcare expenditure and utilization. METHODS: This cohort study utilized claims data from the National Health Insurance Service, encompassing all medical claims in South Korea. We included individuals who had planned to withdraw or withhold their LST between January and December 2018, identified by claim code IA71, IA72, IA73. We followed a total of 28,295 participants with documented LST plan who were deceased by June 2020. Participants were categorized into LST withdrawal / withholding and LST continuation groups. The dependent variables were healthcare expenditure and utilization. We construct a generalized linear model to analyze the association between these variables. RESULTS: Out of the 28,295 participants, 24,436 (86.4%) chose to withdraw or withhold LST, while the rest opted for its continuation. Compared to the LST continuation group, those who chose to withdraw or withhold LST had 0.91 times lower odds for total cost. Additionally, they experienced 0.91 times fewer hospitalization days and 0.92 times fewer outpatient visits than those in the LST continuation group. CONCLUSION: Healthcare expenditure and utilization deceased among those choosing to withdraw or withhold LST compared to those continuing it. These findings underscore the significance of patients actively participating in decision regarding their treatment to ensure appropriate levels of medical intervention for LST. Furthermore, they emphasize the critical role of proper education and the establishment of a cultural framework for LST plans.

Effects of material hardship on depression among adults in South Korea: insights from by the Korea Welfare Panel Study 2008-2017.

BACKGROUND: Low socioeconomic status deemed by income-based measures is a risk factor for depression. Material hardship is commonly used as a multidimensional socioeconomic indicator to identify the struggles that low-income households encounter that are not captured by conventional income-based measures. The aim of this study was to examine the effect of material hardship on depression. METHODS: We used wave 3 (2008) to wave 12 (2017) panel data collected by the Korea Welfare Panel Study. The material hardship measure included six dimensions: food, housing, medical care, paying utility bills, education, and financial hardship. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CESD-11). A generalised estimating equation model was applied to test the causal association between material hardship and log transferred CESD-11. RESULTS: The first time point comprised 3,866 participants. Those who continually experienced material hardship had higher depression scores (male: ß = 2.82, female: ß = 3.98, p-value: < .0001). Food hardship was the most critical risk factor (male: ß = 3.29, female: ß = 4.05, p-value: < .0001). CONCLUSIONS: Material hardship is associated with increased risk of depression, especially food hardship. We should consider guaranteeing food security, and community and policy makers should consider material hardship in their approach when identifying low-income populations at high risk for depression.

Association between successful aging transitions and depressive symptoms among older Korean adults: findings from the Korean longitudinal study of aging (2006-2018).

BACKGROUND: The importance of SA (Successful aging) has been emphasized in recent years, with focus shifting towards attaining healthier aging rather than longevity. However, the influence of SA and its changes on mental health such as depression remains a relatively unexplored area in gerontology. Therefore, we investigated the longitudinal association between changes in SA and depressive symptoms in Korean older adults. METHODS: This study comprised a longitudinal sample of older adults aged ≥ 45 years, drawn from the Korean Longitudinal Study of Aging (2006-2018). Changes in SA status was determined using the Rowe and Kahn model over two consecutive years. Using an adjusted generalized estimating equation model, we examined the association between changes in successful aging status, namely SA and NSA (Non-successful aging), and depressive symptoms. RESULTS: Compared to the SA→SA group, depressive symptom risk in the NSA→NSA and SA→NSA groups were higher in men [(OR, 1.16; 95 % CI, 1.13-1.18), (OR, 1.11; 95 % CI, 1.08-1.13), respectively] and in women [(OR, 1.15; 95 % CI, 1.13-1.18), (OR, 1.11; 95 % CI, 1.09-1.14), respectively]. Subgroup analysis of the dimensions of successful aging revealed that low or worsening criteria of successful aging status in men and women were associated with depressive symptoms. CONCLUSIONS: Korean older adults who continuously failed to attain or maintain successful aging status had the highest risk of depressive symptoms. These results could further assist in establishing policies and interventions that promote successful aging and subsequently protect the mental health of the Korean older adult population.

Is Work Hour Mismatch Associated with Depression?

BACKGROUND: Many studies have reported noticeable increases in the proportion of employees working either relatively short or relatively long hours. Such trends have been accompanied by an increasing concern regarding work hour mismatches defined as a discrepancy between actual and preferred work hours. The aim of this study was to investigate association between work hour mismatch and depression. METHODS: Data regarding work hour mismatches for 47,551 adults were extracted from the 2017 Korean Working Conditions Survey. The World Health Organization-Five Well-Being Index was used to measure depression. Multiple logistic regression analyses were performed to examine the association between work hour mismatch and depression. RESULTS: Men and women workers with work hour mismatch were more likely to have depression [underemployed males: odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.14-1.49, overemployed males: OR = 1.28, 95% CI = 1.18-1.40; underemployed females: OR = 1.37, 95% CI = 1.20-1.56, overemployed females: OR = 1.12, 95% CI = 1.02-1.23]. Underemployed workers, workers who worked more than 52 hours per week, and workers with a high income level, all had higher ORs for depression. The greater the discrepancy between actual and preferred work hours, the higher OR for depression among both underemployed and overemployed workers. CONCLUSIONS: A difference between actual and preferred work hours was associated with depression. Underemployed workers had a higher risk of depression than that of overemployed workers. As a work hour mismatch negatively affected workers' mental health, it is important to reduce work hours mismatches as well as shorten the absolute number of work hours.

Associations between substandard housing and depression: insights from the Korea welfare panel study.

BACKGROUND: Housing is an important social determinant of health. Poor housing conditions are associated with a wide range of health conditions, including mental health. The study aimed to investigate the association between substandard housing and depression. METHODS: We used panel data collected by the Korea Welfare Panel Study and a sample drawn from waves 11 (2016) to 13 (2018). Substandard housing was defined via three criteria: the minimum residential area and number of rooms by application, essential facility standards, and environmental standards. Depression was measured with the CESD-11. A generalized estimating equation model was used to investigate associations between substandard housing and CESD-11 scores. RESULTS: Participants living in substandard housing have higher depression scores (male: ß = 0.63, female: ß = 0.40) than participants who do not live in substandard housing. Participants who do not meet environmental standards have higher depression scores (male: ß = 0.85, female: ß = 0.66) than participants who do not live in substandard housing; the findings are seen in both men and women. CONCLUSION: This study identified an association between substandard housing and depression by gender, and the results were significant. We found that among the three criteria, environmental standards are most likely to be associated with depression. In practical terms, we should consider improving environmental factors of housing to mitigate mental health issues related to substandard housing.

Effects of spouse's employment status on depression.

OBJECTIVES: Whether the spouse's employment status would be associated with individual's mental health condition is uncertain. Therefore, the aim of this study was to investigate the effects of spouse's employment status on depression. METHODS: Data included the second to sixth wave of the Korean Longitudinal Study of Ageing (KLoSA). Depression was measured based on the CES-D10. Spouse's employment status was divided into 4 categories based on their employment changes. RESULTS: Participants with still unemployed spouse were more likely to have high scores of depression (male: ß = 0.32, female: ß = 0.42). Participants who are employed and have unemployed spouse have higher depression scores (male: ß = 0.45, female: ß = 0.77). CONCLUSION: This study identified the effect of spouse's employment status on depression by gender, and the results were significant. We should consider the possibility of conducting interventions with people who are remained unemployed.

Association between relative handgrip strength and prediabetes among South Korean adults.

BACKGROUND: Diabetes is a progressive disease, and thus, it is important to prevent diabetes at the prediabetes stage. Although the loss of muscle strength and prediabetes are associated, few studies have examined relative handgrip strength (RHGS), which can be an indicator of both muscle strength and adiposity. Therefore, our study aimed to examine the association between RHGS and prediabetes (HbA1c level >5.7%) stratified by sex due to sex differences in strength. METHODS: We analyzed data from the 2016-2018 Korean National Health and Nutrition Examination Survey. Prediabetes was defined using the HbA1c cut-off level of 5.7-6.4%, identified by the American Diabetes Association. RHGS was calculated as the maximal absolute handgrip strength of both hands divided by body mass index and was divided into sex-specific quartiles. Multiple logistic regression analysis was performed to determine the association between sex-specific RHGS and prediabetes. RESULTS: Among the total participants, 13,384 did not have diabetes. In men, the low and mid-low RHGS groups had increased odds of prediabetes (low group, odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.10-1.82; mid-low group, OR: 1.32, 95% CI: 1.04-1.67). However, no significant differences were observed between the corresponding female groups. Moreover, central obesity and lower RHGS were strongly associated with prediabetes in men (low group, OR: 2.40, 95% CI: 1.52-3.80; mid-low group, OR: 2.00, 95% CI: 1.26-3.17; mid-high group, OR: 1.76, 95% CI: 1.11-2.81), and a trend was observed (p = 0.0026). CONCLUSION: RHGS could be a practical and inexpensive tool for predicting diabetes in men. Programs aimed at preventing diabetes need to include exercise routines for improving muscle strength, and further research through longitudinal studies is required to investigate the causality of RHGS on the risk of prediabetes.

Association of Bedtime with both Suicidal Ideation and Suicide Planning among Korean Adolescents.

STUDY OBJECTIVES: In comparison to other countries, the South Korean population has a short average sleep duration, and studies have suggested that insufficient sleep is a risk factor for suicidal behavior. This study aimed to examine the association of bedtime with suicidal ideation and with suicide planning, respectively, among Korean adolescents. METHODS: This study included 48,218 participants from the 2017 Korea Youth Risk Behavior Web-based Survey. Participants were divided into three categories: pre-23:00 bedtime, 23:00-01:30 bedtime, and post-01:30 bedtime. Suicidal ideation and suicide planning were the main dependent variables, and multiple logistic regression analysis was performed to examine the target association. RESULTS: For both male and female respondents, compared to those who had a pre-23:00 bedtime, those whose bedtime was after 01:30 were more likely to have suicidal ideation (post-01:30 bedtime for men: OR = 1.29, 95% CI = 1.16-1.45; for women: OR = 1.32, 95% CI = 1.20-1.44). For suicide planning, the results were also significant for both genders (post-01:30 bedtime for men: OR = 1.41, 95% CI = 1.16-1.70; for women: OR = 1.21, 95% CI = 1.03-1.43). Odds of suicidal ideation were higher for those who had a post-01:30 bedtime on weekdays but not weekends. CONCLUSIONS: We found that, among adolescents, going to bed after 01:30 is significantly associated with suicidal ideation and suicide planning, after adjusting for demographic, socioeconomic, and health-related characteristics. Therefore, late bedtime should be the timepoint of a suicide intervention for adolescents, in order to prevent developing suicidal ideations and suicide planning.

Gender Differences With Regard to Perceived Job Insecurity and Insomnia in a Working Population.

OBJECTIVES: Insomnia is one of the most prevalent disorders, and it is associated with various factors. Therefore, this study aimed to examine the association between perceived job insecurity and insomnia. METHODS: Multiple logistic regression analysis was used to examine the association between three levels of perceived job insecurity and insomnia using the 2017 Korean Working Conditions Survey. RESULTS: Approximately 10.2% of the total study population has insomnia. The higher the perception of job insecurity, the greater the chance for insomnia in both men (odds ratio = 4.03, 95% confidence interval [CI] = 3.18 to 5.11) and women (odds ratio = 4.44, 95% CI = 3.41 to 5.77). CONCLUSION: These findings reveal the sex differences in insomnia, thus suggesting the need to implement different approaches to deal with perceived job insecurity based on sex.