Jihyun Oh

Depression and anxiety are prevalent among patients with cardiovascular disease (CVD) and detrimentally affect their health-related quality of life (HRQoL). Although current guidelines recommend screening for both conditions, the mechanisms underlying the association between depression and HRQoL, particularly through the anxiety subdomains of fear, attention, and avoidance, remain unclear. This study investigates how anxiety-related factors mediate the relationship between depression and HRQoL in patients with CVD. This cross-sectional study analyzed 204 CVD outpatients from a tertiary hospital in South Korea. Each patient completed the Patient Health Questionnaire-9 to assess depression, the Cardiac Anxiety Questionnaire to evaluate anxiety subdomains, and the 12-Item Short Form Health Survey to measure HRQoL. Serial multiple mediation analyses were conducted to examine the direct and indirect associations between depression and HRQoL. This approach allowed the potential pathways of mediators to be simultaneously tested, particularly the sequential path from fear to attention to avoidance. Higher depression scores showed a significant negative association with HRQoL (total effect: β = -0.5449, P < .001). Moreover, indirect pathways were observed: increased depression was associated with heightened levels of fear, attention, and avoidance. The direct association between depression and HRQoL remained significant when the indirect pathways were controlled (β = -0.3888, P < .001), supporting a partial mediation model. The overall mediation model explained 18% of the variance in HRQoL. Our findings suggest that a complex interplay between depression and anxiety subdomains influences quality of life among patients with CVD. Therefore, future prospective or interventional studies are needed to evaluate whether interventions targeting depressive symptoms and maladaptive anxiety responses can improve HRQoL in this population.

Environmental endocrine disruptors (EDCs) are chemicals that disrupt the endocrine system and pose significant health risks. Perceived sensitivity to illness refers to the heightened susceptibility of an individual due to genetic or environmental factors. This study aims to examine how the awareness of women on EDCs influences their motivation to adopt health behaviors, focusing on the mediating role of perceived illness sensitivity. From October to November 2024, we conducted a cross-sectional survey of 200 adult women in Seoul and Gyeonggi Province, South Korea. Participants were recruited from community-based institutions and completed an online questionnaire assessing their EDCs knowledge, perceived illness sensitivity, and motivation for health behaviors. Data were analyzed using descriptive statistics, parametric tests ( t -test, ANOVA) for normally distributed variables, and nonparametric tests (Mann–Whitney U , Kruskal–Wallis) for non-normally distributed variables. Pearson correlations and mediation analysis were also performed. The average knowledge score on EDCs was 65.9 (SD = 20.7). Perceived illness sensitivity averaged 49.5 (SD = 7.4), and health behavior motivation was 45.2 (SD = 7.5). Significant differences in EDCs knowledge, perceived illness sensitivity, and health behavior motivation were observed based on age, marital status, education level, and menopausal status. EDCs knowledge positively correlated with perceived illness sensitivity and motivation. Perceived illness sensitivity was also positively linked to motivation. Mediation analysis revealed that perceived sensitivity partially mediated the relationship between EDCs knowledge and motivation. These findings suggest that knowledge alone may not be sufficient to promote behavior change; cognitive and emotional awareness of illness risk plays a key mediating role. Therefore, effective interventions should combine education with strategies to enhance perceived illness sensitivity.

Background: Thyroid cancer is considered lower-grade cancer with a high survival rate; however, the voice changes, and the presence of other diverse symptoms following a thyroidectomy can impact a patient’s voice-related quality of life (VRQOL). Objective: This study aimed to examine the serial multiple mediating effects of voice changes, symptom experiences, and fear of cancer recurrence on the VRQOL among patients diagnosed with thyroid cancer postthyroidectomy. Methods: This cross-sectional study used a descriptive, structured self-report questionnaire. A total of 225 individuals participated who were 20 years and older, had been diagnosed with thyroid cancer and had undergone thyroidectomy surgery at comprehensive university hospitals in Daegu, Daejeon, Sejong, and Anyang in South Korea before data collection. Results: The study’s findings revealed a statistically significant direct impact between patients’ voice changes and their VRQOL. Moreover, the serial mediation model highlighted that as the severity of patients’ voice changes escalated, the intensity of their other symptom experiences and fear of cancer recurrence increased, resulting in a deterioration in their VRQOL. The study’s findings identified partial mediating effects of symptom experiences and the fear of cancer recurrence in the association between voice changes and the VRQOL. Conclusions: These findings underscore the importance of adopting a modeling approach that considers the simultaneous sequential relationships among 4 pivotal variables, namely, voice changes, symptom experiences, fear of cancer recurrence, and VRQOL. Implications for Practice: The findings highlight the crucial impact of voice changes on patients’ VRQOL, which is closely linked to various psychological aspects of the disease.

During clinical placement, nursing students may experience unease and moral distress, which negatively impacts their professional values and vocational choices. However, no instrument exists to measure moral distress in nursing students. Thus, this study constructs measurement items for moral distress and explores the factors that influence the vocational choices of nursing students. The participants were recruited from three universities in South Korea Between September and October 2021. This study was adopted with a convenience sample of 270 Korean fourth-year nursing students who completed their clinical practice at tertiary general hospitals in three provinces in the North, Middle, and South areas of South Korea. Data were collected through a self-administered structured questionnaire. The study developed the items and subscales of the Moral Distress Scale using multistep methods following the recommendations of the Consensus-Based Standards for the Selection of Health Status Measurement Instrument. The study constructed 22 items of the three factors of Moral Distress Scale. The three factors of the Moral Distress Scale were “moral distress by low quality of care,” “moral distress by a heavy workload and an insufficient workforce,” and “unfair and distrust.” The factors influencing the vocational choice of the nursing students were high professional values, intention not to choose nursing as a future career, lacking vision for choosing nursing, democratic family climate, and having at least one parent who was a medical professional. Moral distress in undergraduate nursing students may not influence their intention to choose the nursing profession. Fostering the professionalism and professional values of nursing students through university education curricula may help maintain their professional identity.

Health-related quality of life (HRQoL) in patients with chronic diseases is an important tool to measure patient-reported health outcomes and evaluate the usefulness of treatment, management, and rehabilitation programs. Patients with chronic diseases are more likely than those without to experience psychological problems such as depression, anxiety, and stress, all of which can affect HRQoL. This study evaluated the impact of psychological problems such as depression, anxiety, and stress on HRQoL in people with and without chronic diseases in South Korea. The study’s descriptive survey included 501 participants (191 with and 310 without chronic diseases). Data were collected using structured questionnaires between April and May 2021. The general characteristics, DASS-21, and HRQOL of this study were analyzed using descriptive statistics. Differences in DASS-21 and HRQoL based on general characteristics were analyzed using t tests and ANOVA. The study analyzed the factors influencing the participants’ HRQoL using stepwise multiple regression analysis with SPSS Win 27.0. HRQoL was generally lower for patients with chronic diseases than for patients without. In patients with chronic diseases, the major variables affecting HRQoL were depression (β = −0.244, t = −3.582, P < .001), exercise (β = 0.201, t = 2.927, P = .004), and economic status (β = −0.150, t = −2.184, P = .030), of which depression was the most influential. These variables explained 12.5% of the variance in the regression model for total HRQoL. These results emphasize the need to explore intervention measures that can reduce depression in patients with chronic diseases and anxiety in patients without chronic diseases to improve their HRQoL. In addition, national efforts are needed to provide economic support, as economic status is an influential factor in HRQoL regardless of the presence of chronic disease. The study’s limitations include the fact that neither did it consider disease severity among chronically ill patients nor did it examine all the variables affecting HRQoL.

In modern society, demanding and stressful events contribute to increased fatigue in adults. Moreover, fatigue is the most prevalent symptom of long coronavirus disease 2019. Fatigue is a subjective feeling of tiredness that can be attributed to various causes. This cross-sectional study investigated factors affecting physical and mental fatigue in adults living in South Korea. Self-reported data were collected through an online survey conducted between July 11 and July 17, 2021. The final sample comprised 362 participants, excluding those with uncertain responses. The collected data were analyzed using IBM SPSS version 27.0. General characteristics and variables of the participants were examined through descriptive statistical analysis. Differences in fatigue level according to the general characteristics of the participants were analyzed using t tests and one-way analysis of variance. The correlation between variables was analyzed using Pearson correlation coefficients. To investigate factors affecting fatigue, stepwise multiple regression analysis was conducted. The overall level of fatigue according to participants’ general characteristics differed significantly based on alcohol use, economic status, number of chronic diseases, stress, depression, and sleep problems. Factors affecting physical fatigue were depression, sleep problems, General Health Questionnaire (GHQ-12) scores, and number of chronic diseases. The factors affecting mental fatigue were depression, GHQ-12 score, and alcohol use. The variables that had the most significant impact on overall fatigue were alcohol consumption, the number of chronic illnesses, depression, and GHQ-12, in that order. This emphasizes the importance of lifestyle improvement and dietary management in adults for preventing chronic diseases and managing mental health. The results of this study should be considered when planning health services to provide fatigue interventions for Korean adults.

Cardiovascular disease is the leading cause of non-noncommunicable disease mortality worldwide. Therefore, this study analyzes the mediating effect of dizziness and fatigue in the relationship between stress and sleep quality in patients with heart disease. This study was conducted on patients with heart disease diagnosed by a cardiologist from December 7, 2021 to August 30, 2022 at the Outpatient Department of Cardiology at Hanyang University Hospital in Guri-si, Gyeonggi-do. To verify the serial multiple mediation effect, serial multiple mediation analysis was performed using SPSS Macro Process Model 6 as the most appropriate verification method for this study. The analysis indicated that the more dizziness a participant experienced, the more severe their physical and psychological fatigue and the poorer their quality of sleep. Also, the more severe the physical fatigue, the worse the psychological fatigue and the worse the quality of sleep. In other words, the more severe the psychological fatigue, the poorer the quality of sleep. In summary, in the relationship in which stress in patients with heart disease affects sleep quality, stress is a variable that directly affects sleep quality, and this means that the stress of patients with heart disease can affect the quality of sleep through the parameters, dizziness and fatigue, sequentially; this research model can thus be considered a partial mediator model. Fatigue in patients with cardiovascular disease had a direct effect on sleep quality, and there was a mediating effect through dizziness and fatigue in the relationship between stress and sleep quality. Therefore, it is necessary to develop a sleep management program that can improve the quality of sleep in patients with cardiovascular disease as well as a nursing intervention plan that can alleviate fatigue and control stress in such patients.

Background: This study aimed to examine the effects of psychological distress, depressive symptoms, and emotional eating behaviors on the health-related quality of life of middle-aged Korean females. This study provides primary data for developing an intervention program to improve the health-related quality of life of middle-aged females. Methods: Middle-aged females between 35 and 64 years old, from July 22 to August 10, 2021, were included in this study. The mediating effects of depressive symptoms and emotional eating behaviors on the relationship between psychological distress and health-related quality of life were investigated. A cross-sectional survey was conducted on 325 subjects. Researchers conducted questionnaires measuring psychological distress, depressive symptoms, emotional eating behavior, and health-related quality of life. Results: The findings of this study demonstrated a correlation between the severity of a female’s depressive symptoms and the degree of their psychological distress, indicating that severe depressive symptoms were associated with negative emotions, which increased emotional eating behaviors. Additionally, more severe depressive symptoms indicated a lower health-related quality of life. Higher psychological distress was associated with increased emotional eating behaviors and lower health-related quality of life. The total and direct effects of psychological distress on the health-related quality of life were statistically significant. Conclusions: In this study, psychological distress, depressive symptoms, and emotional eating behaviors affected the health-related quality of life of middle-aged Korean females. This study also confirmed that psychological distress had a direct effect on health-related quality of life. These findings serve as primary data for evidence-based intervention programs that alleviate emotional health problems, such as psychological distress and depressive symptoms in middle-aged females. Moreover, nurses can help develop effective treatment strategies to improve health-related quality of life by identifying and assessing potential symptoms of psychological distress, depressive symptoms, and emotional eating behaviors.

Background: During clinical placement, nursing students may experience unease and moral distress, negatively impacting their professional values and vocational choices.This study explored factors affecting nursing students’ vocational choices. Methods: This cross-sectional study recruited the participants from three universities in South Korea Between September and October 2021. This study was adopted with a convenience sample of 270 Korean fourth-year nursing students who completed their clinical practice at tertiary general hospitals in three provinces in the North, Middle, and South areas of South Korea. Data were collected through a self-administered structured questionnaire. Results: The factors affecting higher vocational choice were higher professional values, intention not to choose nursing as a future career, having no vision for choosing nursing, democratic family climate, and having at least one parent who was a medical professional. Conclusion: Fostering students’ nursing professionalism and professional values through university education curricula may help maintain nursing students’ professional identity.