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There is growing evidence that suggests a potential association between particulate matter (PM) and suicide. However, it is unclear that PM exposure and suicide death among major depressive disorder (MDD) patients, a high-risk group for suicide. We aimed to assess the effect of short-term exposure to PM on the risk of suicide in MDD patients who are at high risk for suicide. We investigated the risk of suicide among 922,062 newly-diagnosed MDD patients from 2004 to 2017 within the Korean National Health Insurance Service (NHIS) database. We identified 3,051 suicide cases from January 1, 2015, to December 31, 2017, within the death statistics database of the Korean National Statistical Office. PMs with aerodynamic diameter less than 2.5 µm (PM2.5), less than 10 µm (PM10), and 2.5-10 µm (PM2.5-10) were considered, which were provided from the National Ambient Air Monitoring System in South Korea. Time-stratified case-crossover analysis was performed to investigate the association of particulate matter exposure to suicide events. The risk of suicide was significantly high upon the high level of exposure to PM2.5, PM2.5-10 (coarse particle) and PM10 on lag 1 (p for trend < 0.05). Short-term exposure to a high level of PM was associated with an elevated risk for suicide among MDD patients. There is a clear dose-response relationship between short-term PM exposures with suicide death among MDD patients. This result will be used as an essential basis for consideration when establishing an air pollution alarm system for reducing adverse health outcomes by PM.

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BACKGROUND: The effect of antipsychotics adherence on the risk of cardiovascular disease (CVD) among schizophrenia patients has not been studied. While antipsychotic adherence is favorable for all-cause mortality, its association with CVD incidence is unclear due to the potential risk of CVD caused by antipsychotics. METHODS: Using the Korean National Health Insurance Service Database, we constructed a case-cohort of 80,581 newly-diagnosed schizophrenia patients between 2004 and 2013 from a cohort of all Koreans 20-40 years old. Patients were divided into quartiles by adherence determined by their two-year medication possession ratio. Patients were followed from two years following the diagnosis of schizophrenia until Dec. 31st, 2017 for the primary outcome of incident CVD and secondary outcomes of stroke, myocardial infarction, and all-cause mortality. Cox proportional hazards analysis was performed adjusting for conventional risk factors. OUTCOMES: Newly diagnosed schizophrenia patients were followed for a median of 7.0 years resulting in 1396 incident CVD cases over 5.73 × 105 person-years. When adjusted for potential confounders, the best adherence quartile group had significantly lower risk of CVD (HR, 95%CI; 0.78, 0.66-0.92; p-trend, 0.003), stroke (HR, 95%CI; 0.79, 0.66-0.94; p-trend, 0.015), and all-cause mortality (HR, 95%CI; 0.86, 0.78-0.95; p-trend, 0.003) compared to the worst adherent quartile group. Subgroup analysis by antipsychotics generation, concurrent medication, and comorbidities did not significantly alter results. INTERPRETATION: Among newly diagnosed schizophrenia patients, better adherence to antipsychotics lowered the risk CVD incidence despite previously suggested antipsychotic-associated CVD risk. Thus, efforts to improve antipsychotics adherence may improve CVD outcomes in schizophrenia patients.

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OBJECTIVES: The European Organization for Research and Treatment of Cancer (EORTC) QLQ-ELD14 is a validated tool that measures Health-related Quality-of-life (HRQOL) for elderly patients with cancer. This study was conducted to evaluate the psychometric properties of the Korean version of the EORTC QLQ-ELD14 to determine if this tool can be used to evaluate HRQOL for older Korean patients with cancer. MATERIALS AND METHODS: We recruited 439 elderly patients with cancer aged ≥60years from 11 cancer centers and completed the EORTC QLQ-ELD14 questionnaires. The reliability and validity of the EORTC QLQ-ELD14 questionnaire were assessed via Cronbach alpha, multitrait scaling analyses, correlation analyses with the EORTC QLQ-C30, and known-group comparisons. Known-group comparisons were conducted by dividing the patients into groups based on the cancer stage, depression level, and loss of mobility. RESULTS: The scale structure of the Korean version of the EORTC QLQ-ELD14 was consistent with the originally hypothesized scale structure. Cronbach alpha coefficients ranged 0.65-0.88. Multitrait scaling analysis showed good item convergent and discriminant validity. Low scaling errors (3.1%) were observed. Divergent validity was demonstrated by no strong correlation with the EORTC QLQ C30. The clinical validity of the Korean version of the EORTC QLQ-ELD14 was demonstrated by its ability to discriminate among patient subgroups categorized by AJCC stage, depression level, and loss of mobility. CONCLUSION: Our findings indicate that the Korean version of the EORTC QLQ-ELD14 questionnaire is reliable and valid for measuring QOL of older Korean patients with cancer.

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BACKGROUND: This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors. METHODS: A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire. RESULTS: We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81-14.02) was associated with the increased risk of depression. CONCLUSION: These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation.

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BACKGROUND: Research suggests that mental health is affected not only by smoking, but also by secondhand smoking. But the most researches have been conducted in North America and/or Europe. We examined whether this relationship remains evident within the South Korean population. Specifically, we investigated the effect of secondhand smoking on depressive symptoms and suicidal ideation. METHODS: We analyzed data from 6,043 non-smoking adults who participated in the 2010-2012 Korea National Health and Nutrition Examination Survey. We compared the presence of depressive symptoms and suicidal ideation in 3,006 participants who were exposed to secondhand smoking in the office or at home with 3,037 non-exposed participants. RESULTS: In unadjusted logistic regression analysis, secondhand smoking exposure group had more suicidal ideations than no secondhand smoking exposure (16.1% vs. 12.2%; odds ratio [OR], 1.50; 95% confidence interval [CI], 1.241-1.804), but risk of depressive symptoms was not significantly different between two groups (15.2% vs. 12.2%; OR, 1.21; 95% CI, 0.997-1.460). In multivariate logistic regression analysis, Among those exposed to secondhand smoking, the OR for depressive symptoms was 1.02 (95% CI, 0.866-1.299) and 1.43 (95% CI, 1.139-1.802) for suicidal ideation. Overall, secondhand smoking at home was significantly related to depressive symptoms and suicidal ideation. Among females, secondhand smoking exposure at home only (not in the office) was related to depressive symptoms and suicidal ideation. CONCLUSION: Exposure to secondhand smoking, especially at home, may be associated with an increase in especially in female depressive symptoms and suicidal ideation among adults in South Korea.