Evaluation of factors associated with medication adherence in patients with bipolar disorder using a medication event monitoring system: a 6-month follow-up prospective study.

BACKGROUND: Non-adherence in patients with bipolar disorder (BD) results in symptoms, such as aggravation, BD recurrence, emergency room visits, re-hospitalization, and poor psychosocial outcomes. Though non-adherence rates have been reported to range between 30-50% in patients with BD, the problem of adherence is often either overlooked by the physician or denied by the patient. An essential first step to enhancing medication adherence is to objectively estimate adherence. The Medication Event Monitoring System (MEMS), which is a pill bottle cap with a microprocessor, is an accurate device for assessing medication adherence. Using the MEMS, we aimed to measure medication adherence in patients with BD and evaluate the factors associated with and 6-month changes in medication adherence. METHODS: Participants with BD were recruited from the psychiatric outpatient clinic of the Korea University Guro Hospital. The medication adherence of each participant was assessed using the MEMS, a self-report, pill count, and clinician rating. MEMS-measured adherence was reassessed after 6 months. Patient demographics were recorded and clinical assessments were conducted. Data were analyzed using Kappa statistics and Pearson's correlation analysis. RESULTS: Of the 59 participants, 50 records were included in the analysis. Patient adherence and adherence rate assessed by the MEMS were lower than those assessed by the other measures. MEMS-measured adherence was correlated more closely with pill counts than with self-reports or clinician ratings. MEMS-measured adherence was negatively associated with prescription duration and the Brief Psychiatric Rating Scale-Affect Subscale Score. Six-month changes in MEMS-measured adherence were positively associated with attitude toward drugs and negatively associated with weight gain assessed by the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale. CONCLUSIONS: Clinicians may have to consider the limited accuracy of self-reporting and clinician rating methods and exercise caution when assessing the medication adherence of patients with BD using these methods. Our findings may assist clinicians in the assessment and improvement of medication adherence in patients with BD and, consequently, may be useful for the treatment and prevention of BD recurrence.

The effects of cerebral amyloidopathy on regional glucose metabolism in older adults with depression and mild cognitive impairment while performing memory tasks.

Co-occurring depression and mild cognitive impairment (MCI) in older adults are important because they have a high risk of conversion to dementia. In the present study, task-related F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) was used to analyse older adults with concomitant depression and MCI. We recruited 20 older adults with simultaneous depression and MCI and 10 older adults with normal cognition (NC). The Verbal Paired Associates test and digit span test were used for the task-related FDG-PET. The 20 older adults with depression and MCI were classified into two groups based on the F-18 florbetaben PET results: depressed MCI patients with (LLD-MCI-A[+]; n = 11) and without amyloid accumulation (LLD-MCI-A[-]; n = 9). Reduced regional cerebral glucose metabolism (rCMglc) in the left superior frontal region was observed in the LLD-MCI-A(-) group compared with the NC group. Analyses of the NC and LLD-MCI-A(+) groups showed significantly decreased rCMglc in the right inferior parietal and left middle frontal regions in the LLD-MCI-A(+) group. rCMglc in the left precuneus was lower in the LLD-MCI-A(+) group than in the LLD-MCI-A(-) group. Significant correlations between the rCMglc in the right inferior parietal/left precuneus regions and memory task scores were observed based on correlation analyses of NC and LLD-MCI-A(+) groups. The findings in the present study indicate the presence of amyloid accumulation influences glucose metabolism in depressed elderly subjects with MCI while performing cognitive tasks. Task-related FDG-PET examinations may help differentiate MCI associated with depression from comorbid depression in patients with prodromal Alzheimer's disease.

Cost-effectiveness of using amyloid positron emission tomography in individuals with mild cognitive impairment.

BACKGROUND: Amyloid positron emission tomography (PET) makes it possible to diagnose Alzheimer's disease (AD) in its prodromal phase including mild cognitive impairment (MCI). This study evaluated the cost-effectiveness of including amyloid-PET for assessing individuals with MCI. METHODS: The target population was 60-year-old patients who were diagnosed with MCI. We constructed a Markov model for the natural history of AD with the amyloid positivity (AP). Because amyloid-PET can detect the AP MCI state, AD detection can be made faster by reducing the follow-up interval for a high-risk group. The health outcomes were evaluated in quality-adjusted life years (QALYs) and the final results of cost-effectiveness analysis were presented in the form of the Incremental Cost-Effectiveness Ratio (ICER). To handle parameter uncertainties, one-way sensitivity analyses for various variables were performed. RESULTS: Our model showed that amyloid-PET increased QALYs by 0.003 in individuals with MCI. The estimated additional costs for adopting amyloid-PET amounted to a total of 1250 USD per patient when compared with the cost when amyloid-PET is not adopted. The ICER was 3,71,545 USD per QALY. According to the sensitivity analyses, treatment effect of Donepezil and virtual intervention effect in MCI state were the most influential factors. CONCLUSIONS: In our model, using amyloid-PET at the MCI stage was not cost-effective. Future advances in management of cognitive impairment would enhance QALYs, and consequently improve cost-effectiveness.

Association between brain amyloid accumulation and neuropsychological characteristics in elders with depression and mild cognitive impairment.

OBJECTIVES: To investigate the presence of cerebral amyloidopathy and its associations with performances on neurocognitive tests and clinical features in depressed elders with mild cognitive impairment (MCI). METHODS/DESIGN: In total, 94 older adults with concomitant MCI and some depressive symptoms were included in this study. Cerebral amyloidopathy was evaluated using 18 F-florbetaben-positron emission tomography. A standardized neurocognitive test battery and brain magnetic resonance imaging (MRI) were administered to all subjects. We examined the Apolipoprotein E genotype using a polymerase chain reaction-based method. RESULTS: Among the 94 initial participants, seven participants were excluded because of failure to undergo MRI or complete the neuropsychological battery. Among 87 subjects, 45 elders (51.7%) had cerebral amyloidopathy and were classified as the concomitant depression and MCI with cerebral amyloid-accumulation-positive (CDAP) group; others were classified as the concomitant depression and MCI with cerebral amyloid-accumulation-negative (CDAN) group. Poorer performances on word list recall and constructional recall were observed in the CDAP group than in the CDAN group. CONCLUSIONS: The results indicate that around half of older adults with concomitant MCI and some depressive symptoms might be prone to have Alzheimer dementia. Results of neurocognitive tests possibly aid in discerning the presence of cerebral amyloidopathy.

Diffusion tensor imaging reveals abnormal brain networks in elderly subjects with subjective cognitive deficits.

PURPOSE: Some elders with subjective cognitive deficits (SCD) develop prodromal phase of dementia over time; however, little is known about how they differ from those with normal cognition (NC). Thus, we aim to distinguish the differences in the brain network of elders with SCD and NC. METHODS: Multiple diffusion-weighted images (DWI) and T1-weighted images were obtained from 18 subjects with NC and 26 subjects with SCD. Using network-based statistics (NBS) analysis, we extracted abnormal brain subnetworks and localized abnormal brain connectivity. We also ran correlation analysis to compare the affected regions and the results of the neurocognitive assessments. RESULTS: Altered subnetworks were found in the superior parietal gyrus, angular gyrus, precuneus, posterior cingulum, putamen, precentral gyrus, postcentral gyrus, and paracentral lobule. They were also associated with scores on the word list recall, word list recognition, and Boston naming test. CONCLUSIONS: Elders with SCD had distinctive brain network alterations when compared with those of elders with NC. The results are also in line with the previously identified characteristics of mild cognitive impairment (MCI) and of Alzheimer's disease (AD) in a milder form. We speculate that it may be possible to predict AD progression early in the SCD stage using NBS analysis.

Gait Variability Can Predict the Risk of Cognitive Decline in Cognitively Normal Older People.

BACKGROUND: The aim of this study was to investigate the association of gait speed and gait variability, an index of how much gait parameters, such as step time, fluctuate step-to-step, with risk of cognitive decline in cognitively normal elderly individuals. While high gait variability is emerging as an early indicator of dementing illnesses, there is little research on whether high gait variability predicts cognitive decline in cognitively normal elderly who have no evidence of cognitive impairment. METHODS: In this 4-year prospective cohort study on 91 community-dwelling cognitively normal elderly individuals without cerebral ischemic burden or Parkinsonism, we evaluated gait speed and step time variability using a tri-axial accelerometer placed on the center of body mass, and diagnosed mild cognitive impairment (MCI) according to the International Working Group on MCI. We performed Kaplan-Meier analysis with consecutive log-rank testing for MCI-free survival by cohort-specific tertiles of gait speed; hazard ratios (HR) of incident MCI were estimated using Cox proportional hazards regression analysis adjusted for age, sex, education level, Cumulative Illness Rating Scale score, GDS score, and presence of the apolipoprotein E ε4 allele. RESULTS: Out of the 91 participants in the baseline assessment, 87 completed one or more 2-year follow-up assessments, and the median duration of follow-up was 47.1 months. Kaplan-Meier curves of incident MCI show evident differences in risk by gait variability group (χ2 = 9.64, p = 0.002, log-rank test). Mean MCI-free survival in the high variability group was 12% shorter than in the mid-to-low tertile group (47.4 ± 1.74 [SD] vs. 54.04 ± 0.52 months), while it was comparable between gait speed groups (51.59 ± 0.70 vs. 50.64 ± 1.77 months; χ2 = 1.16, p = 0.281). In multivariate analysis, subjects with high gait variability showed about 12-fold higher risk of MCI (HR = 11.97, 95% CI = 1.29-111.37) than those with mid-to-low variability. However, those with slow gait speed showed comparable MCI risk to those with mid-to-high speed (HR = 5.04, 95% CI = 0.53-48.18). CONCLUSIONS: Gait variability may be a better predictor of cognitive decline than gait speed in cognitively normal elderly individuals without cerebral ischemic burden or Parkinsonism.

Characteristics of neurocognitive functions in mild cognitive impairment with depression.

BACKGROUND: Previous studies suggest that there is a strong association between depression and cognitive decline, and that concurrent depressive symptoms in MCI patients could contribute to a difference in neurocognitive characteristics compared to MCI patients without depression. The authors tried to compare neurocognitive functions between MCI patients with and without depression by analyzing the results of neuropsychological tests. METHODS: Participants included 153 MCI patients. Based on the diagnosis of major depressive disorder, the participants were divided into two groups: depressed MCI (MCI/D+) versus non-depressed MCI (MCI/D-). The general cognitive and functional statuses of participants were evaluated. And a subset of various neuropsychological tests was presented to participants. Demographic and clinical data were analyzed using Student t-test or χ 2 test. RESULTS: A total of 153 participants were divided into two groups: 94 MCI/D+ patients and 59 MCI/D- patients. Age, sex, and years of education were not significantly different between the two groups. There were no significant differences in general cognitive status between MCI/D+ and MCI/D- patients, but MCI/D+ participants showed significantly reduced performance in the six subtests (Contrasting Program, Go-no-go task, Fist-edge-palm task, Constructional Praxis, Memory Recall, TMT-A) compared with MCI/D- patients. CONCLUSIONS: There were significantly greater deficits in neurocognitive functions including verbal memory, executive function, attention/processing speed, and visual memory in MCI/D+ participants compared to MCI/D-. Once the biological mechanism is identified, distinct approaches in treatment or prevention will be determined.

Incidence of and risk factors for Alzheimer's disease and mild cognitive impairment in Korean elderly.

BACKGROUND/AIMS: Knowledge of incidence rates and risk factors is essential for the development of strategies to treat patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS: A subpopulation of the Nationwide Survey on Dementia Epidemiology (460 Korean subjects aged ≥65 years from 2 rural and 2 urban districts) was followed up for 3.5 years. The age-specific incidence was estimated and risk factors were identified. RESULTS: The age-standardized incidence of AD and MCI was 7.9 and 28.1 cases per 1,000 person-years, respectively. MCI was associated with a 6-fold increased risk of AD. Depression was a risk factor for AD with MCI. Age, lack of formal education, illiteracy, rural residence, and marital status were associated with the risk of AD. CONCLUSION: Strategies to control modifiable risk factors should be implemented to decrease the incidence of AD.

The impact of 3D and 2D TV watching on neurophysiological responses and cognitive functioning in adults.

BACKGROUND: Watching three-dimensional television (3D TV) may strain the eyes. However, other potential harmful effects of 3D TV watching have been rarely investigated. The current study examined the impact of 3D TV watching on neurophysiological responses and cognitive functioning as compared with two-dimensional TV (2D TV) watching. METHODS: A total of 72 individuals were randomly assigned to either a 3D TV watching group or a 2D TV watching group. Electroencephalography (EEG) was used to measure neurophysiological responses, and computerized neurocognitive tests were conducted immediately before and after TV watching. The Simulator Sickness Questionnaire (SSQ) was used to assess visual discomfort. RESULTS: There was a significant change in visual discomfort between the two groups (SSQ score at baseline: 2.28 ± 3.05 for the 3D TV group and 3.69 ± 3.49 for the 2D TV group; SSQ score after watching TV: 4.6 ± 3.35 for the 3D TV group and 4.03 ± 3.47 for the 2D TV group), and this change was greater for the 3D TV watching group (P = 0.025). However, 3D TV watching did not have a differential impact on EEG responses. Furthermore, there were no significant differences between the groups in terms of changes in cognitive performance, except for a subtle difference in backward digit span performance. CONCLUSION: Our findings suggest that 3D TV watching is as safe as 2D TV watching in terms of neurophysiological responses and cognitive functioning. Potential harmful effects of TV viewing might be similar regardless of whether 3D or 2D TV is viewed.

Effect of Frailty on Depression among Patients with Late-life Depression: A Test of Anger, Anxiety, and Resilience as Mediators.

Objective: While the association between depression and frailty in the elderly population has been investigated, the psychological factors that mediate such a relationship remain unknown. The identification of psychological factors in interventions for depression treatment in the elderly may assist in the treatment and care. We aimed to explore the mediating effects of anger, anxiety, and resilience on the link between frailty and depression symptoms in patients with late-life depression. Methods: A sample of 203 older adults completed questionnaires that assessed depression, anger, resilience, and anxiety. To measure frailty, participants were evaluated using a self-rated health questionnaire, weight-adjusted waist index related to sarcopenia, and weight-adjusted handgrip strength to evaluate weakness. A mediation model was tested, hypothesizing that anger, anxiety, and resilience would partially mediate the strength of the frailty-depression link in the elderly. Results: Only self-rated health showed a significant association with depressive symptoms in late-life depression. Our study demonstrated that frailty has both direct and indirect associations with depression, mediated by anger, resilience, and anxiety. Conclusion: Given that anger, resilience, and anxiety influence the link between self-rated health and depression, interventions that lead to increased resilience and decreased anger and anxiety may be promising to reduce depressive symptoms in older adults with depression.

Embitterment in Vietnam War Veterans Predicted by Symptoms of Posttraumatic Stress Disorder.

OBJECTIVE: Research on the association between posttraumatic embitterment disorder (PTED) and other psychopathologies in veterans and adults aged ≥65 years is lacking. This study aimed to assess embitterment among elderly war veterans and its association with major psychopathological factors. METHODS: Participants included Vietnam War veterans who visited a psychiatric clinic. Based on the Posttraumatic Embitterment Disorder Self-Rating Scale (PTEDS) score, the participants were divided into the embitterment (PTED(+), mean score of PTEDS items [mPTEDS] ≥1.6) and non-embitterment (PTED(-), mPTEDS <1.6) groups. Demographic characteristics, combat exposure severity, depression, anxiety, sleep, and alcohol use disorder symptom scores of the participants were collected and compared between the PTED(+) and PTED(-) groups. A correlation analysis between symptom measure scores and the mPTEDS was conducted. The influence of psychopathology on embitterment was investigated using stepwise multiple linear regression analysis. RESULTS: In total, 60 participants (28 in PTED(+) and 32 in PTED(-)) were included. Among those in PTED(+), 21 (35.0%) showed mild embitterment symptoms (1.6≤ mPTEDS <2.5) and 7 (11.7%) reported moderate or severe embitterment symptoms (mPTEDS ≥2.5). The mean scores of posttraumatic stress disorder (PTSD), depression, and anxiety were significantly higher in the PTED(+) than in the PTED(-) group. The mPTEDS were significantly correlated with PTSD, depression, anxiety, and sleep disorder scores. The PTSD symptoms significantly explained the higher mPTEDS score in a regression model. CONCLUSION: Embitterment symptoms were associated with PTSD, depression, anxiety, and insomnia symptoms in elderly veterans, similar to the results of prior studies involving only the general population.

Role of severity and gender in the association between late-life depression and all-cause mortality.

BACKGROUND: Mortality associated with depression may be influenced by severity of depression and gender. We investigated the differential impacts on all-cause mortality of late-life depression by the type of depression (major depressive disorder, MDD; minor depressive disorder, MnDD; subsyndromal depression, SSD) and gender after adjusting comorbid conditions in the randomly sampled elderly. METHODS: One thousand community-dwelling elderly individuals were enrolled. Standardized face-to-face clinical interviews, neurological examination, and physical examination were conducted to diagnose depressive disorders and comorbid cognitive disorders. Depressive disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and SSD to study-specific operational criteria. Five-year survivals were compared between groups using Cox proportional hazards models. RESULTS: By the end of 2010, 174 subjects (17.4%) died. Depressive disorder (p = 0.001) and its interaction term with gender (p < 0.001) were significant in predicting five-year survival. MDD was an independent risk factor for mortality in men (hazard ratio = 3.65, 95% confidence interval = 1.67-7.96) whereas MnDD and SSD were not when other risk factors were adjusted. CONCLUSIONS: MDD may directly confer the risk of mortality in elderly men whereas non-major depression may be just an indicator of increased mortality in both genders.

Associations between Pharmacological Treatment Patterns during the Initial Treatment Period and the Relapse or Recurrence of Anxiety Disorders: A Nationwide Retrospective Cohort Study.

Although the importance of proper pharmacological treatment for preventing the relapse/recurrence of anxiety disorders is well known, a real-world data-based study has not been conducted. We aimed to investigate the effect of the initial pharmacological patterns related to continuous treatment and the choice of medication on the relapse/recurrence of anxiety disorders. We used claim data from the Health Insurance Review and Assessment Service, South Korea, of 34,378 adults who received psychiatric medications, including antidepressants, after being newly diagnosed with anxiety disorders. We compared the relapse/recurrence rate in the patients receiving continuous pharmacological treatment with those who discontinued treatment early using Cox's proportional-hazards model. Patients receiving continuous pharmacological treatment experienced a higher risk of relapse/recurrence than those who discontinued treatment. Using three or more antidepressants during the initial treatment period decreased the risk of relapse/recurrence (adjusted hazard ratio (aHR) = 0.229 (0.204-0.256)); however, the combined use of antidepressants from the beginning of treatment increased the risk (aHR = 1.215 (1.131-1.305)). Factors other than continuous pharmacological treatment should be considered to effectively prevent the relapse/recurrence of anxiety disorders. The active use of antidepressants, including switching or adding medications based on progress and frequent follow-up visits during the acute phase, were significantly associated with a reduction in the relapse/recurrence of anxiety disorders.

Antidepressant-induced mania in panic disorder: a single-case study of clinical and functional connectivity characteristics.

Background: Mental health issues, including panic disorder (PD), are prevalent and often co-occur with anxiety and bipolar disorders. While panic disorder is characterized by unexpected panic attacks, and its treatment often involves antidepressants, there is a 20-40% risk of inducing mania (antidepressant-induced mania) during treatment, making it crucial to understand mania risk factors. However, research on clinical and neurological characteristics of patients with anxiety disorders who develop mania is limited. Methods: In this single case study, we conducted a larger prospective study on panic disorder, comparing baseline data between one patient who developed mania (PD-manic) and others who did not (PD-NM group). We enrolled 27 patients with panic disorder and 30 healthy controls (HCs) and examined alterations in amygdala-based brain connectivity using a seed-based whole-brain approach. We also performed exploratory comparisons with healthy controls using ROI-to-ROI analyses and conducted statistical inferences at a threshold of cluster-level family-wise error-corrected p < 0.05, with the cluster-forming threshold at the voxel level of uncorrected p < 0.001. Results: The patient with PD-mania showed lower connectivity in brain regions related to the default mode network (left precuneous cortex, maximum z-value within the cluster = -6.99) and frontoparietal network (right middle frontal gyrus, maximum z-value within the cluster = -7.38; two regions in left supramarginal gyrus, maximum z-value within the cluster = -5.02 and -5.86), and higher in brain regions associated with visual processing network (right lingual gyrus, maximum z-value within the cluster = 7.86; right lateral occipital cortex, maximum z-value within the cluster = 8.09; right medial temporal gyrus, maximum z-value within the cluster = 8.16) in the patient with PD-mania compared to the PD-NM group. One significantly identified cluster, the left medial temporal gyrus (maximum z-value within the cluster = 5.82), presented higher resting-state functional connectivity with the right amygdala. Additionally, ROI-to-ROI analysis revealed that significant clusters between PD-manic and PD-NM groups differed from HCs in the PD-manic group but not in the PD-NM group. Conclusion: Here, we demonstrate altered amygdala-DMN and amygdala-FPN connectivity in the PD-manic patient, as reported in bipolar disorder (hypo) manic episodes. Our study suggests that amygdala-based resting-state functional connectivity could serve as a potential biomarker for antidepressant-induced mania in panic disorder patients. Our findings provide an advance in understanding the neurological basis of antidepressant-induced mania, but further research with larger cohorts and more cases is necessary for a broader perspective on this issue.

Reliability and Validity of the Korean Version of the Brief Resilience Scale.

Objective: : To translate the Brief Resilience Scale into Korean and evaluate its reliability and validity. Methods: : To investigate the factor structure of the Brief Resilience Scale, we examined a two-factor model comprising positively and negatively worded items. Congruent and divergent validity of the Brief Resilience Scale were investigated using correlation analysis between the Brief Resilience Scale and resilience, depression, and perceived stress. By conducting an analysis of variance among groups classified by suicidality (no suicidality, only suicidal ideation, and suicidal ideation or suicidal plan groups), we evaluated how well the Brief Resilience Scale could detect people with a high risk of suicide. Results: : Confirmatory factor analysis results supported the construct validity of the Brief Resilience Scale using a two-factor model. Cronbach's alpha (0.91) and McDonald's omega (0.91) scores indicated high internal consistency. Correlation analysis showed that the Brief Resilience Scale scores were strongly associated with a questionnaire evaluating resilience, depression, and perceived stress. Analysis of variance and post-hoc tests showed that he Brief Resilience Scale scores were highest in the no suicidality group (p ＜ 0.001). Conclusion: : The Korean version of the Brief Resilience Scale is a valid and reliable instrument for evaluating resilience as the capacity to recover from adversity and endure obstacles or stress. This study also provides important evidence regarding the sensitivity of the Brief Resilience Scale to suicidal risk.

Feasibility of the virtual reality-based assessments in patients with panic disorder.

Introduction: Recurrences and diagnostic instability of panic disorder (PD) are common and have a negative effect on its long-term course. Developing a novel assessment tool for anxiety that can be used in a multimodal approach may improve these problems in panic disorder patients. This study assessed the feasibility of virtual reality-based assessment in panic disorder (VRA-PD). Methods: Twenty-five patients with PD (ANX group) and 28 healthy adults (CON group) participated in the study. VRA-PD consisted of four modules based on the key components of cognitive behavior therapy for an anxiety disorder: "Baseline evaluation module" (M0), "Daily environment exposure module" (M1), "Relaxation module" (M2), and "Interoceptive exposure module" (M3). Multiple evaluations, including self-rating anxiety scores (AS) and physiological responses [heart rate variability (HRV) index], were performed in three steps at M1, M2, and M3, and once at M0. Comparisons between patients with PD and healthy controls, factor analysis of variables in VRA-PD, changes in responses within modules, and correlation analysis between variables in VRA-PD and anxiety symptoms assessed by psychological scales were performed. Results: All participants completed the VRA-PD without discontinuation. The ANX group reported significantly higher AS for all steps and a smaller HRV index in M1 (steps 1 and 2) and M2 (step 1). Repeated-measures analysis of covariance (ANCOVA) revealed significant interaction effects for AS in M1 (F = 4.09, p = 0.02) and M2 (F = 4.20, p = 0.02), and HRV index in M2 (F = 16.22, p < 0.001) and M3 (F = 21.22, p = 0.02). The HRV index only indicated a good model fit for the three-factor model, reflecting the construct of the VRA-PD. Both AS and HRV indexes were significantly correlated with anxiety and depression symptoms. Discussion: The current study provides preliminary evidence that the VRA-PD could be a valid anxiety behavior assessment tool.

Investigating the effectiveness of a smart mental health intervention (inMind) for stress reduction during pharmacological treatment for mild to moderate major depressive disorders: Study protocol for a randomized control trial.

Background: Although psychological interventions for stress relief, such as cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), have been developed, they have not been widely used in treating depression. The use of mobile devices can increase the possibility of actual use by integrating interventions and reducing the difficulty and cost burden of treatment application. This study aims to determine whether "inMind," an integrated mobile application for stress reduction, developed for the general population, decreases stress for patients with mild to moderate major depressive disorder during the pharmacological treatment period. Methods: This study is a single-blind, multicenter, randomized, controlled crossover trial. The App, developed in Republic of Korea, provides integrated interventions for stress reduction for the general population through three modules based on mindfulness-based stress reduction, cognitive behavior therapy, and relaxation sounds that are known to be effective in stress reduction ("meditation," "cognitive approach," and "relaxation sounds," respectively). Participants (n = 215) recruited via medical practitioner referral will be randomized to an App first group (fAPP) or a wait list crossover group (dAPP). The study will be conducted over 8 weeks; the fAPP group will use the App for the first 4 weeks and the dAPP group for the next 4 weeks. During all study periods, participants will receive their usual pharmacological treatment. The Depression Anxiety Stress Scale-21 is the primary outcome measure. The analysis will employ repeated measurements using a mixed-model approach. Discussion: The App can potentially be an important addition to depression treatment because of its applicability and the comprehensive nature of the interventions that covers diverse stress-relieving models. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT05312203, identifier 2021GR0585.

Association between work-family conflict and depressive symptoms in female workers: An exploration of potential moderators.

Work-family conflict (WFC), an inter-role conflict between work and family, negatively affects mental health. Using a nationally representative systematic sample, this study aimed to investigate the association between WFC, depressive symptoms, and potential moderators in the association of adult female workers. Data of 4714 female workers (aged ≥19 years) were obtained cross-sectionally from the 2018 nationwide Korean Longitudinal Survey of Women and Families (KLoWF). WFC was assessed using a 7-item questionnaire, based on which scores were classified into high (>75th percentile score) and low (≤75th percentile score) levels of WFC. Significant depressive symptoms were defined as a score of ≥10 on the 10-item version of the Center for Epidemiologic Studies for Depression Scale. Female workers with high WFC levels were more likely to have depressive symptoms than those with low WFC levels (odds ratio = 2.29, 95% confidence interval = 1.91-2.74). In stratified analyses, high WFC levels were associated with the highest odds of depressive symptoms in the following groups: young adults (19-39 years), those with a college degree or above or with high income, never-married individuals, those with a family size of three or a single child, nonstandard workers, and pink-collar workers. This study replicated and extended previous findings on the association between WFC and depressive symptoms. The association was moderated by age, education and income levels, marital status, family size, number of children, and job conditions.

Gender discrimination in workplace and depressive symptoms in female employees in South Korea.

BACKGROUND: Workplace gender discrimination (WGD) may have long-term negative impacts on female workers' mental health. We aimed to investigate the association between WGD and the prevalence of depressive symptoms using a nationally representative sample of female employees in South Korea. METHODS: Data of 3190 adult female employees were obtained from the 2018 nationwide Korean Longitudinal Survey of Women and Families. Women's perception of WGD was assessed using a 6-item questionnaire. Respondents were classified into high, medium, and low levels of WGD according to the 25th and 75th percentile scores. A score of ≥10 on the 10-item version of the Center for Epidemiologic Studies for Depression Scale was defined as having significant depressive symptoms. RESULTS: A high level of WGD was significantly associated with a higher odds ratio (OR) for depressive symptoms compared to the low level (OR = 1.87, 95% confidence interval = 1.45-2.41). In the subgroup analyses, high WGD levels were associated with the highest OR for depressive symptoms in the following subgroups: younger age (19-39 years), those with a college degree, non-standard workers, pink collar workers, those with a workplace size of 10-29 employees, those with high levels of job autonomy, or low levels of emotional labor. LIMITATIONS: Causal interpretation is limited owing to the study's cross-sectional design. CONCLUSIONS: A high level of perceived WGD was associated with depressive symptoms among female employees. Certain groups of female employees may be particularly vulnerable to the detrimental effects of WGD on depression.

Preferences for life-sustaining treatment in Korean adults: a cross-sectional study.

OBJECTIVES: Life-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical conditions, and includes cardiopulmonary resuscitation, mechanical ventilation, haemodialysis and left ventricular assist devices. This study aimed to investigate the thoughts on life-sustaining treatment of Koreans and to assess the factors associated with deciding to not receive life-sustaining treatment if they develop a terminal disease. DESIGN: Cross-sectional study. SETTING: Guro-gu centre for dementia from 1 May 2018 to 31 December 2019. PARTICIPANTS: In total, 150 individuals participated in this study. OUTCOME MEASURES: The questionnaire consisted of self-report items with some instructions, demographic characteristics, thoughts on life-sustaining treatment and psychosocial scales. The preferences of the participants were investigated on the assumption that they develop terminal cancer. The psychosocial scales included the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Connor-Davidson Resilience Scale and Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: We classified our participants into two groups: individuals who wanted to receive life-sustaining treatment (IRLT) and individuals who wanted to not receive life-sustaining treatment (INLT). There were twice as many participants in the INLT group than there were in the IRLT. In making this decision, the INLT group focused more on physical and mental distress. Additionally, 32.7% of participants responded that terminal status was an optimal time for this decision, but more participants want to decide it earlier. The GAD-7 and PHQ-9 scores were significantly higher in the INLT group than in the IRLT group. However, the INLT group had significantly lower MSPSS family scores. CONCLUSION: Our findings can help assess issues regarding advance directives and life-sustaining treatment, and will be a reference for designing future studies on this issue.