1.Network Structure of Depression and Anxiety Symptoms in Older Asian Patients With Depressive Disorders: Findings From REAP-AD3
Seon-Cheol PARK ; Kiwon KIM ; Jeongsoo PARK ; Sun CHOI ; Seonhwa LEE ; Seungwon CHO ; Eunkyung KIM ; Tian-Mei SI ; Roy Abraham KALLIVAYALIL ; Andi J. TANRA ; Amir Hossein Jalali NADOUSHAN ; Kok Yoon CHEE ; Afzal JAVED ; Kang SIM ; Pornjira PARIWATCHARAKUL ; Takahiro A. KATO ; Shih-Ku LIN ; Naotaka SHINFUKU ; Norman SARTORIUS
Psychiatry Investigation 2025;22(5):552-563
Objective:
The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.
Methods:
We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.
Results:
Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).
Conclusion
This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.
2.Network Structure of Depression and Anxiety Symptoms in Older Asian Patients With Depressive Disorders: Findings From REAP-AD3
Seon-Cheol PARK ; Kiwon KIM ; Jeongsoo PARK ; Sun CHOI ; Seonhwa LEE ; Seungwon CHO ; Eunkyung KIM ; Tian-Mei SI ; Roy Abraham KALLIVAYALIL ; Andi J. TANRA ; Amir Hossein Jalali NADOUSHAN ; Kok Yoon CHEE ; Afzal JAVED ; Kang SIM ; Pornjira PARIWATCHARAKUL ; Takahiro A. KATO ; Shih-Ku LIN ; Naotaka SHINFUKU ; Norman SARTORIUS
Psychiatry Investigation 2025;22(5):552-563
Objective:
The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.
Methods:
We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.
Results:
Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).
Conclusion
This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.
3.Network Structure of Depression and Anxiety Symptoms in Older Asian Patients With Depressive Disorders: Findings From REAP-AD3
Seon-Cheol PARK ; Kiwon KIM ; Jeongsoo PARK ; Sun CHOI ; Seonhwa LEE ; Seungwon CHO ; Eunkyung KIM ; Tian-Mei SI ; Roy Abraham KALLIVAYALIL ; Andi J. TANRA ; Amir Hossein Jalali NADOUSHAN ; Kok Yoon CHEE ; Afzal JAVED ; Kang SIM ; Pornjira PARIWATCHARAKUL ; Takahiro A. KATO ; Shih-Ku LIN ; Naotaka SHINFUKU ; Norman SARTORIUS
Psychiatry Investigation 2025;22(5):552-563
Objective:
The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.
Methods:
We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.
Results:
Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).
Conclusion
This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.
4.Environmental Protective and Risk Factors for Gastric Cancer:An Umbrella Review and Reanalysis of Meta-Analyses
Seungwon KIM ; Min Seo KIM ; Yeongkeun KWON ; Jae-Seok MIN ; Ahmad ALROMI ; Jong Yeob KIM ; Jueon KIM ; Jae Il SHIN ; Dong Keon YON ; Yuhyeon CHU ; Sungsoo PARK
Journal of Gastric Cancer 2025;25(2):285-302
Purpose:
Despite extensive research on gastric cancer (GC), efforts to consolidate the numerous associations between possible factors and GC risk remain lacking. This systematic review aimed to provide an overview of potential GC-associated pairs.
Materials and Methods:
We systematically searched PubMed, Embase, and Cochrane databases, from their inception to April 23, 2022, for eligible systematic reviews and metaanalyses to investigate the association between any possible factors and GC risk. After the inclusion of 75 systematic reviews and meta-analyses, 117 association pairs were examined. We reanalyzed the included meta-analyses and produced effect estimates using uniform analytical models. The certainty of the evidence for each association pair was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.
Results:
Iatrogenic factors, including antibacterial drugs, were associated with an increased risk of GC. Epstein-Barr virus and Helicobacter pylori infections were also associated with an increased risk of GC, while human T-lymphotropic virus type 1 (HTLV-1) infections were associated with a reduced risk. Dietary habit was a major factor influencing moderate to high GRADE associations. Positive associations were observed for heavy alcohol consumption (relative risk [RR], 1.13; 95% confidence interval [CI], 1.06–1.12), refined grain consumption (RR, 1.36; 95% CI, 1.21–1.53), and habitual salt intake (RR, 1.41; 95% CI, 1.04–1.91).
Conclusions
The associations between GC risk and dietary and nutritional factors were considerably heterogeneous, whereas other factors, such as lifestyle and iatrogenic and environmental exposures, were consistent across regions. Therefore, dietary interventions for GC prevention should be tailored specific to regions.
5.Environmental Protective and Risk Factors for Gastric Cancer:An Umbrella Review and Reanalysis of Meta-Analyses
Seungwon KIM ; Min Seo KIM ; Yeongkeun KWON ; Jae-Seok MIN ; Ahmad ALROMI ; Jong Yeob KIM ; Jueon KIM ; Jae Il SHIN ; Dong Keon YON ; Yuhyeon CHU ; Sungsoo PARK
Journal of Gastric Cancer 2025;25(2):285-302
Purpose:
Despite extensive research on gastric cancer (GC), efforts to consolidate the numerous associations between possible factors and GC risk remain lacking. This systematic review aimed to provide an overview of potential GC-associated pairs.
Materials and Methods:
We systematically searched PubMed, Embase, and Cochrane databases, from their inception to April 23, 2022, for eligible systematic reviews and metaanalyses to investigate the association between any possible factors and GC risk. After the inclusion of 75 systematic reviews and meta-analyses, 117 association pairs were examined. We reanalyzed the included meta-analyses and produced effect estimates using uniform analytical models. The certainty of the evidence for each association pair was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.
Results:
Iatrogenic factors, including antibacterial drugs, were associated with an increased risk of GC. Epstein-Barr virus and Helicobacter pylori infections were also associated with an increased risk of GC, while human T-lymphotropic virus type 1 (HTLV-1) infections were associated with a reduced risk. Dietary habit was a major factor influencing moderate to high GRADE associations. Positive associations were observed for heavy alcohol consumption (relative risk [RR], 1.13; 95% confidence interval [CI], 1.06–1.12), refined grain consumption (RR, 1.36; 95% CI, 1.21–1.53), and habitual salt intake (RR, 1.41; 95% CI, 1.04–1.91).
Conclusions
The associations between GC risk and dietary and nutritional factors were considerably heterogeneous, whereas other factors, such as lifestyle and iatrogenic and environmental exposures, were consistent across regions. Therefore, dietary interventions for GC prevention should be tailored specific to regions.
6.Network Structure of Depression and Anxiety Symptoms in Older Asian Patients With Depressive Disorders: Findings From REAP-AD3
Seon-Cheol PARK ; Kiwon KIM ; Jeongsoo PARK ; Sun CHOI ; Seonhwa LEE ; Seungwon CHO ; Eunkyung KIM ; Tian-Mei SI ; Roy Abraham KALLIVAYALIL ; Andi J. TANRA ; Amir Hossein Jalali NADOUSHAN ; Kok Yoon CHEE ; Afzal JAVED ; Kang SIM ; Pornjira PARIWATCHARAKUL ; Takahiro A. KATO ; Shih-Ku LIN ; Naotaka SHINFUKU ; Norman SARTORIUS
Psychiatry Investigation 2025;22(5):552-563
Objective:
The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.
Methods:
We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.
Results:
Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).
Conclusion
This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.
7.Environmental Protective and Risk Factors for Gastric Cancer:An Umbrella Review and Reanalysis of Meta-Analyses
Seungwon KIM ; Min Seo KIM ; Yeongkeun KWON ; Jae-Seok MIN ; Ahmad ALROMI ; Jong Yeob KIM ; Jueon KIM ; Jae Il SHIN ; Dong Keon YON ; Yuhyeon CHU ; Sungsoo PARK
Journal of Gastric Cancer 2025;25(2):285-302
Purpose:
Despite extensive research on gastric cancer (GC), efforts to consolidate the numerous associations between possible factors and GC risk remain lacking. This systematic review aimed to provide an overview of potential GC-associated pairs.
Materials and Methods:
We systematically searched PubMed, Embase, and Cochrane databases, from their inception to April 23, 2022, for eligible systematic reviews and metaanalyses to investigate the association between any possible factors and GC risk. After the inclusion of 75 systematic reviews and meta-analyses, 117 association pairs were examined. We reanalyzed the included meta-analyses and produced effect estimates using uniform analytical models. The certainty of the evidence for each association pair was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.
Results:
Iatrogenic factors, including antibacterial drugs, were associated with an increased risk of GC. Epstein-Barr virus and Helicobacter pylori infections were also associated with an increased risk of GC, while human T-lymphotropic virus type 1 (HTLV-1) infections were associated with a reduced risk. Dietary habit was a major factor influencing moderate to high GRADE associations. Positive associations were observed for heavy alcohol consumption (relative risk [RR], 1.13; 95% confidence interval [CI], 1.06–1.12), refined grain consumption (RR, 1.36; 95% CI, 1.21–1.53), and habitual salt intake (RR, 1.41; 95% CI, 1.04–1.91).
Conclusions
The associations between GC risk and dietary and nutritional factors were considerably heterogeneous, whereas other factors, such as lifestyle and iatrogenic and environmental exposures, were consistent across regions. Therefore, dietary interventions for GC prevention should be tailored specific to regions.
8.Network Structure of Depression and Anxiety Symptoms in Older Asian Patients With Depressive Disorders: Findings From REAP-AD3
Seon-Cheol PARK ; Kiwon KIM ; Jeongsoo PARK ; Sun CHOI ; Seonhwa LEE ; Seungwon CHO ; Eunkyung KIM ; Tian-Mei SI ; Roy Abraham KALLIVAYALIL ; Andi J. TANRA ; Amir Hossein Jalali NADOUSHAN ; Kok Yoon CHEE ; Afzal JAVED ; Kang SIM ; Pornjira PARIWATCHARAKUL ; Takahiro A. KATO ; Shih-Ku LIN ; Naotaka SHINFUKU ; Norman SARTORIUS
Psychiatry Investigation 2025;22(5):552-563
Objective:
The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.
Methods:
We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.
Results:
Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).
Conclusion
This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.
9.Effectiveness Analysis of School-Based Self-Harm Prevention Program for Children and Adolescent Using Brief Dialectical Behavior Therapy Skills Training: Based on Age, Sex, Self-Harm History and Program Implementation Methods
Je Jung LEE ; Cheolgyu SHIN ; Hyunjeong KIM ; Sunkyu PARK ; Inyoung NOH ; Jonggook LEE ; Keun OH ; Heeyoung SEO ; Seungwon CHUNG
Korean Journal of Psychosomatic Medicine 2024;32(2):87-97
Objectives:
:This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation.
Methods:
:The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation.
Results:
:Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased.
Conclusions
:Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.
10.Effectiveness Analysis of School-Based Self-Harm Prevention Program for Children and Adolescent Using Brief Dialectical Behavior Therapy Skills Training: Based on Age, Sex, Self-Harm History and Program Implementation Methods
Je Jung LEE ; Cheolgyu SHIN ; Hyunjeong KIM ; Sunkyu PARK ; Inyoung NOH ; Jonggook LEE ; Keun OH ; Heeyoung SEO ; Seungwon CHUNG
Korean Journal of Psychosomatic Medicine 2024;32(2):87-97
Objectives:
:This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation.
Methods:
:The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation.
Results:
:Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased.
Conclusions
:Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

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