Objective: Financial hardship influences depression risk, however, the pathway of the effect of financial hardship on depression and the role of self-esteem remain unclear. This study examined whether changes in financial hardship affected depression, and whether self-esteem mediated by this relationship. Methods: Data from 99,588 observations of 15,331 individuals were extracted from 10 waves of the Korean Welfare Panel Study. The association between changes in financial hardship and depression was investigated using a generalized estimation equation, and the extent to which these associations were mediated by self-esteem was assessed. Results: The results indicated that changes in financial hardship were associated with depression, with varying magnitude. Experiencing severe financial hardship over two consecutive years (odds ratio [OR]: 3.87, 95% confidence interval [CI]=3.09–4.85) or increased financial hardship over the previous year strongly influenced depression (e.g., OR: 3.88, 95% CI=3.09–4.86 for low financial hardship at t-1 year and high at t year). Self-esteem plays a mediating role in the relationship between changes in financial hardship and depression, where persistent financial hardship is associated with low self-esteem, leading to depression. Conclusion These findings highlighted the importance of monitoring and intervention for financial hardship and psychological problems to help manage depression.

Background: The association between happiness and suicide behaviour across different gender and age groups remains unclear, with few studies identifying potential confounding or mediating factors that explain this association. We aimed 1) to examine the association of happiness with suicide ideation/attempt and 2) to assess the relative contribution of potential factors in explaining the associations in South Korea. Methods: We used data from the Korea Community Health Survey 2021, with 214,070 respondents aged over 20 years. Happiness was measured by using Cantril’s ladder of life satisfaction. Suicide ideation and suicide attempt were each measured by a single question.A hierarchical logistic regression model was used to identify the association between happiness and suicide ideation/attempt and estimate the relative importance of each socioenvironmental, psychological, and health-related factor. Results: Unhappiness was associated with suicide ideation/attempt across gender and age groups. The associations appeared stronger in younger rather than older adults, particularly for women aged 20–39 and 40–59 years. Psychological factors contributed the most to explaining the association across all genders and age groups. Socio-environmental factors explained the associations more among individuals aged 40–59 years and health-related factors were more pronounced in explaining the association among those aged 60 years and above, compared to other age groups. Conclusion Unhappiness is associated with suicide ideation/attempt. Psychological factors could largely explain this association, suggesting that improving population mental health could play an important role in increasing happiness and preventing suicide behaviour.

Background: The health system's capacity to store vaccines in North Korea has been less studied. In this study, we aimed to investigate if the current vaccine cold chain in North Korea can store routine vaccines and if it has the storage capacity to handle pandemic vaccination activities (PVAs) without interrupting the country’s successful routine immunization program. Methods: We used tables extracted from an evaluation report of The Global Alliance for Vaccines and Immunization (GAVI)’ Health Systems Strengthening program in North Korea from 2007 to 2014. We then used the World Health Organization’s Immunization Supply Chain Sizing Tool to estimate gaps and the cost of scaling up cold chain storage. Results: We found that the vaccine cold chain in North Korea has adequate storage capacity for routine vaccines. While we found a deficit of 7,172 L at the central medical warehouse (CMW) and 14,256 L at the provincial medical warehouses (PMWs), the storage at the county warehouses (CoMW) had a surplus. When assessed for PVA, we found an aggregated deficit of 115,574 L (CMW), 113,160 L (PMW), and 25,133 L (CoMW). To fill the gaps, investments of 229,917 USD, and 2,262,211 USD were estimated for routine and PVA vaccination programs, respectively. Conclusion As countries and the international community work to improve systems in preparation for future pandemics, there is a need to scale up the North Korean vaccine cold chain to a pandemic-ready state.

Background: The association between happiness and suicide behaviour across different gender and age groups remains unclear, with few studies identifying potential confounding or mediating factors that explain this association. We aimed 1) to examine the association of happiness with suicide ideation/attempt and 2) to assess the relative contribution of potential factors in explaining the associations in South Korea. Methods: We used data from the Korea Community Health Survey 2021, with 214,070 respondents aged over 20 years. Happiness was measured by using Cantril’s ladder of life satisfaction. Suicide ideation and suicide attempt were each measured by a single question.A hierarchical logistic regression model was used to identify the association between happiness and suicide ideation/attempt and estimate the relative importance of each socioenvironmental, psychological, and health-related factor. Results: Unhappiness was associated with suicide ideation/attempt across gender and age groups. The associations appeared stronger in younger rather than older adults, particularly for women aged 20–39 and 40–59 years. Psychological factors contributed the most to explaining the association across all genders and age groups. Socio-environmental factors explained the associations more among individuals aged 40–59 years and health-related factors were more pronounced in explaining the association among those aged 60 years and above, compared to other age groups. Conclusion Unhappiness is associated with suicide ideation/attempt. Psychological factors could largely explain this association, suggesting that improving population mental health could play an important role in increasing happiness and preventing suicide behaviour.

Background: The health system's capacity to store vaccines in North Korea has been less studied. In this study, we aimed to investigate if the current vaccine cold chain in North Korea can store routine vaccines and if it has the storage capacity to handle pandemic vaccination activities (PVAs) without interrupting the country’s successful routine immunization program. Methods: We used tables extracted from an evaluation report of The Global Alliance for Vaccines and Immunization (GAVI)’ Health Systems Strengthening program in North Korea from 2007 to 2014. We then used the World Health Organization’s Immunization Supply Chain Sizing Tool to estimate gaps and the cost of scaling up cold chain storage. Results: We found that the vaccine cold chain in North Korea has adequate storage capacity for routine vaccines. While we found a deficit of 7,172 L at the central medical warehouse (CMW) and 14,256 L at the provincial medical warehouses (PMWs), the storage at the county warehouses (CoMW) had a surplus. When assessed for PVA, we found an aggregated deficit of 115,574 L (CMW), 113,160 L (PMW), and 25,133 L (CoMW). To fill the gaps, investments of 229,917 USD, and 2,262,211 USD were estimated for routine and PVA vaccination programs, respectively. Conclusion As countries and the international community work to improve systems in preparation for future pandemics, there is a need to scale up the North Korean vaccine cold chain to a pandemic-ready state.

Background: The association between happiness and suicide behaviour across different gender and age groups remains unclear, with few studies identifying potential confounding or mediating factors that explain this association. We aimed 1) to examine the association of happiness with suicide ideation/attempt and 2) to assess the relative contribution of potential factors in explaining the associations in South Korea. Methods: We used data from the Korea Community Health Survey 2021, with 214,070 respondents aged over 20 years. Happiness was measured by using Cantril’s ladder of life satisfaction. Suicide ideation and suicide attempt were each measured by a single question.A hierarchical logistic regression model was used to identify the association between happiness and suicide ideation/attempt and estimate the relative importance of each socioenvironmental, psychological, and health-related factor. Results: Unhappiness was associated with suicide ideation/attempt across gender and age groups. The associations appeared stronger in younger rather than older adults, particularly for women aged 20–39 and 40–59 years. Psychological factors contributed the most to explaining the association across all genders and age groups. Socio-environmental factors explained the associations more among individuals aged 40–59 years and health-related factors were more pronounced in explaining the association among those aged 60 years and above, compared to other age groups. Conclusion Unhappiness is associated with suicide ideation/attempt. Psychological factors could largely explain this association, suggesting that improving population mental health could play an important role in increasing happiness and preventing suicide behaviour.

Background: The health system's capacity to store vaccines in North Korea has been less studied. In this study, we aimed to investigate if the current vaccine cold chain in North Korea can store routine vaccines and if it has the storage capacity to handle pandemic vaccination activities (PVAs) without interrupting the country’s successful routine immunization program. Methods: We used tables extracted from an evaluation report of The Global Alliance for Vaccines and Immunization (GAVI)’ Health Systems Strengthening program in North Korea from 2007 to 2014. We then used the World Health Organization’s Immunization Supply Chain Sizing Tool to estimate gaps and the cost of scaling up cold chain storage. Results: We found that the vaccine cold chain in North Korea has adequate storage capacity for routine vaccines. While we found a deficit of 7,172 L at the central medical warehouse (CMW) and 14,256 L at the provincial medical warehouses (PMWs), the storage at the county warehouses (CoMW) had a surplus. When assessed for PVA, we found an aggregated deficit of 115,574 L (CMW), 113,160 L (PMW), and 25,133 L (CoMW). To fill the gaps, investments of 229,917 USD, and 2,262,211 USD were estimated for routine and PVA vaccination programs, respectively. Conclusion As countries and the international community work to improve systems in preparation for future pandemics, there is a need to scale up the North Korean vaccine cold chain to a pandemic-ready state.

Background: The association between happiness and suicide behaviour across different gender and age groups remains unclear, with few studies identifying potential confounding or mediating factors that explain this association. We aimed 1) to examine the association of happiness with suicide ideation/attempt and 2) to assess the relative contribution of potential factors in explaining the associations in South Korea. Methods: We used data from the Korea Community Health Survey 2021, with 214,070 respondents aged over 20 years. Happiness was measured by using Cantril’s ladder of life satisfaction. Suicide ideation and suicide attempt were each measured by a single question.A hierarchical logistic regression model was used to identify the association between happiness and suicide ideation/attempt and estimate the relative importance of each socioenvironmental, psychological, and health-related factor. Results: Unhappiness was associated with suicide ideation/attempt across gender and age groups. The associations appeared stronger in younger rather than older adults, particularly for women aged 20–39 and 40–59 years. Psychological factors contributed the most to explaining the association across all genders and age groups. Socio-environmental factors explained the associations more among individuals aged 40–59 years and health-related factors were more pronounced in explaining the association among those aged 60 years and above, compared to other age groups. Conclusion Unhappiness is associated with suicide ideation/attempt. Psychological factors could largely explain this association, suggesting that improving population mental health could play an important role in increasing happiness and preventing suicide behaviour.

Background: The health system's capacity to store vaccines in North Korea has been less studied. In this study, we aimed to investigate if the current vaccine cold chain in North Korea can store routine vaccines and if it has the storage capacity to handle pandemic vaccination activities (PVAs) without interrupting the country’s successful routine immunization program. Methods: We used tables extracted from an evaluation report of The Global Alliance for Vaccines and Immunization (GAVI)’ Health Systems Strengthening program in North Korea from 2007 to 2014. We then used the World Health Organization’s Immunization Supply Chain Sizing Tool to estimate gaps and the cost of scaling up cold chain storage. Results: We found that the vaccine cold chain in North Korea has adequate storage capacity for routine vaccines. While we found a deficit of 7,172 L at the central medical warehouse (CMW) and 14,256 L at the provincial medical warehouses (PMWs), the storage at the county warehouses (CoMW) had a surplus. When assessed for PVA, we found an aggregated deficit of 115,574 L (CMW), 113,160 L (PMW), and 25,133 L (CoMW). To fill the gaps, investments of 229,917 USD, and 2,262,211 USD were estimated for routine and PVA vaccination programs, respectively. Conclusion As countries and the international community work to improve systems in preparation for future pandemics, there is a need to scale up the North Korean vaccine cold chain to a pandemic-ready state.