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Associations of regional-level perceived stress and depression with health-related quality of life in Korean adults: a multilevel analysis of 2017 Korea Community Health Survey data
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Eunsu Kim, Min-Ho Shin, Jung-Ho Yang, Soon-Ki Ahn, Baeg-Ju Na, Hae-Sung Nam
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Epidemiol Health. 2021;43:e2021062. Published online September 8, 2021
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DOI: https://doi.org/10.4178/epih.e2021062
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Abstract
OBJECTIVES
We examined the associations of individual and regional-level perceived stress and depression with health-related quality of life (HRQOL) in Korean adults.
METHODS We used data from the 2017 Korea Community Health Survey, which included 216,713 adults living within 254 municipal districts. As individual-level independent variables, perceived stress (higher vs. lower) and depression (Patient Health Questionnaire-9 ≥10) were defined. Regional-level age-adjusted rates of perceived stress (%) and depression (%) were created for 254 municipal districts and categorized into quartiles to generate regional levels of stress and depression. HRQOL was defined as the individual-level EuroQol 5-dimensional index×100. A multilevel analysis was performed to identify the relationship between individual or regional-level independent variables and individual HRQOL.
RESULTS In the null model, the proportions of individual variation in the HRQOL explained by region were 1.7% and 2.7% for men and women, respectively. When adjusted with all individual-level variables, regional stress and depression, as well as individual-level perceived stress and depression, were significantly related to HRQOL for both genders. In the full model including all variables, the decrease in HRQOL from the first to the fourth quartile group of regional stress was greater in women (-1.09; 95% confidence interval [CI], -1.87 to -0.31) than in men (-0.65; 95% CI, -1.04 to -0.26).
CONCLUSIONS Our results suggest that regional-level perceived stress and depression, as well as individual-level perceived stress and depression, are inversely associated with individual HRQOL.
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Summary
Korean summary
시군구 단위 스트레스 인지율과 우울 유병률이 개인 단위 건강관련 삶의 질 수준과 연관성을 갖는지 파악하고자 지역사회건강조사 자료를 이용하여 다수준 분석을 수행하였다. 개인 수준에서 인지된 스트레스와 우울은 건강관련 삶의 질 감소와 관련이 있었다. 스트레스와 우울 수준이 높은 시군구일수록 개인의 건강관련 삶의 질은 낮아지는 관계를 보였는데, 이는 남성보다는 여성에서 더 저명하였다.
Key Message
This study examined the associations of regional-level perceived stress and depression with individual HRQOL measured in terms of the EQ-5D using a multilevel model. Individual-level perceived stress and depression were significantly related to individual HRQOL. Regional stress and depression were also significant factors and both had greater negative impacts on HRQOL among women than among men.
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Citations
Citations to this article as recorded by  - Gender-specific secular trends and related factors of high perceived stress level among Korean older adults: a nation-wide serial cross-sectional study
Eunjeong Choi, Hyun-Ju Seo, Kye Ha Kim, Sun-Young Jung
BMC Public Health.2025;[Epub] CrossRef - Factors Related to Health-Related Quality of Life across the Life Cycle in One-Person Households among Korean Adults
Myung-Ock Chae
Research in Community and Public Health Nursing.2024; 35: 125. CrossRef - Association between seafood intake and depression in Korean adults: analysis of data from the 2014–2020 Korea National Health and Nutrition Examination Survey
Hyemin Shin, Won Jang, Yangha Kim
Journal of Nutrition and Health.2023; 56(6): 702. CrossRef - Depression before and during-COVID-19 by Gender in the Korean Population
Won-Tae Cha, Hye-Jin Joo, Yu-Shin Park, Eun-Cheol Park, Soo-Young Kim
International Journal of Environmental Research and Public Health.2022; 19(6): 3477. CrossRef - Association Between Regional Levels of Particulate Matter and Recurrent Falls in Korea
Jung-Ho Yang, Ji-An Jeong, Sun-Seog Kweon, Min-Ho Shin
Journal of Korean Medical Science.2022;[Epub] CrossRef
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