https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/467 2026-07-24T16:44:26Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/218203 Title: How do network structures of depressive symptoms differ between asian patients with bipolar depression and those with unipolar depression? Authors: Yoon, Heenchan; Kim, Han Seul; Lee, Seonjae; Choi, Tae Young; Jung, Sung-Won; Yoon, Hyung-Jun; Kim, Hyun Soo; Yang, Hyun-Ju; Jeong, Narae; Moon, Eunsoo; Baek, Ji Hyun; Si, Tian-Mei; Kallivayalil, Roy Abraham; Tanra, Andi J.; Nadoushan, Amir Hossein Jalali; Chee, Kok Yoon; Javed, Afzal; Sim, Kang; Pariwatcharakul, Pornjira; Lin, Shih-Ku; Sartorius, Norman; Shinfuku, Naotaka; Kato, Takahiro A.; Kamali, Masoud; Nierenberg, Andrew A.; Park, Seon-Cheol Abstract: Objective: The investigation focused on differences in the overall network structures of depressive symptoms between patients with bipolar depression (BD) and those with unipolar depression (UD), emphasizing their unique symptom dynamics and centralities. Methods: Data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 (REAP-AD3), were used to estimate depressive symptom networks for 240 patients with BD and 2905 patients with UD. A Network Comparison Test (NCT) was conducted to evaluate differences in global strength, edge weights, and node centralities between the two networks. An additional NCT was performed using the same sample size in both groups. Results: Anhedonia emerged as the most central symptom in BD, while persistent sadness was the most central symptom in UD. Global strength was higher in the BD network in the full-sample NCT (p = 0.04), but not in the equal sample-size analysis (p = 0.20). However, no significant differences were identified in overall network structure invariance. Conclusions: These findings underscore distinct depressive symptom networks in BD and UD. Anhedonia and energy dysregulation were prominent in BD, whereas persistent sadness and self-rumination were more pronounced in UD. Despite the non-significance of other NCT results, the full-sample pairwise network comparison suggested that BD patients exhibit a more integrated symptom structure than UD patients, with stronger overall connectivity between symptoms, which may be linked to neurobiological distinctions such as widespread abnormalities in white matter connectivity and increased within-network connectivity in BD. 2026-08-01T00:00:00Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/219348 Title: Prevalence and clinical correlates of lifetime suicide attempts in 2114 patients with bipolar disorder: Findings from a multi-center Asian consortium study Authors: Loh, Jie Xuan; Chew, Qian Hui; Lin, Shih-Ku; Ouyang, Wen-Chen; Chen, Chih-Ken; Park, Seon-Cheol; Jang, Ok-Jin; Park, Jun Hyuk; Chee, Kok Yoon; Zhang, Ling; Zhu, Xiaomin; Jatchavala, Chonnakarn; Pariwatcharakul, Pornjira; Kallivayalil, Roy Abraham; Grover, Sandeep; Maramis, Margarita M.; Xiang, Yu-Tao; Chong, Mian-Yoon; Park, Yong Chon; Kato, Takahiro A.; Shinfuku, Naotaka; Sim, Kang Abstract: Background Bipolar disorder (BD), a psychiatric condition with significant illness burden, is associated with high suicide risk. To date, there are relatively fewer studies examining clinical factors including psychotropic drug use and dosing associated with suicide attempts in patients with BD, especially within Asia. Methods We conducted a cross-sectional survey across 13 Asian sites on both outpatients and inpatients with BD to examine the prevalence of lifetime suicide attempts and clinical correlates, such as demographic features, treatment setting, and illness characteristics (including illness course, psychotropic drug use and dose). Univariate analysis was performed to identify factors associated with lifetime suicide attempts, and multivariable logistic regression analysis was performed to control for confounders. Results A total of 2114 patients with BD (47.7% male, mean age 42.4 ± 15.2 years) were surveyed, with lifetime suicide attempt rate of 17.2%. Univariate analysis found that lifetime suicide attempts were associated with demographic (younger age, females), illness features (depressed and mixed illness phases, recurrent illness course, depression at illness onset, lifetime rapid cycling), and treatment factors (ECT in past year, antidepressant prescription). Multivariable logistic regression showed that factors associated with lifetime suicide attempt included inpatient status, depressive and mixed phases of BD, presence of rapid cycling in the past year and depression at illness onset. Conclusions Our study noted a significant lifetime suicide attempt rate in BD patients across Asian sites and identified germane clinical factors. This allows for better identification and monitoring of relevant BD patients, allowing for optimisation of care for these individuals. 2026-08-01T00:00:00Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/211859 Title: A decade-long comparison of depressive symptom networks in Asian patients with depressive disorders: Findings from REAP studies in 2023 and 2013 Authors: Lee, Seonjae; Kim, Han Seul; Yoon, Heechan; Kim, Eunkyung; Kim, Kiwon; Kim, Ii Bin; Yang, Hyun-Ju; Yoon, Hyung-Jun; Kim, Hyun Soo; Kim, Gyung-Mee; Si, Tian-Mei; Kallivayalil, Roy Abraham; Tanra, Andi J.; Chee, Kok Yoon; Sim, Kang; Pariwatcharakul, Pornjira; Lin, Shih-Ku; Sartorius, Norman; Shinfuku, Naotaka; Lee, Seonhwa; Toyota, Eric; Lee, Jae-Hon; Kato, Takahiro A.; Park, Seon-Cheol Abstract: Background Network analysis provides a framework for examining interrelationships among symptoms beyond traditional categorical diagnostic models. Objective Data were analyzed from two decade-apart, large-scale, multi-country surveys in Asia. Network structures of depressive symptoms among Asian patients with depressive disorders in 2023 and 2013 were compared. Methods Ten depressive symptom domains, rated by clinicians in accordance with National Institute for Health and Care Excellence (NICE) guidelines, were modeled using the graphical Least Absolute Shrinkage and Selection Operator. Network structures were compared using the Network Comparison Test and evaluated with respect to expected influence centrality, stability, and clustering. Subgroup network structure comparisons were additionally conducted according to gender and geographic region. Results The Network Comparison Test demonstrated significant differences in both network structure and global strength between 2013 and 2023. In 2023, among 2298 patients, depressive symptom networks comprised 38 connections, with the strongest associations observed between low self-confidence and guilt or self-blame and between disturbed sleep and poor or increased appetite; low self-confidence emerged as the most central symptom. In contrast, in 2013, among 1303 patients, 36 connections were identified, with persistent sadness and disturbed sleep forming the strongest association and persistent sadness representing the most central symptom. Substantial subgroup differences in network structure were also observed according to gender and region. Conclusions These differences may reflect contextual influences, including the COVID-19 pandemic and related sociocultural factors. The findings may further identify self-critical symptoms as promising targets for clinical intervention. 2026-07-01T00:00:00Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/211850 Title: Early-life exposure to per- and polyfluoroalkyl substances and heavy metals and lower lung function in school-age children: A prospective cohort study Authors: Shin, Sanghee; Shin, Choong Ho; Lee, Young Ah; Lee, Yun Jeong; Hong, Yun-Chul; Lim, Youn-Hee; Kim, Bung-Nyun; Kim, Johanna Inhyang; Lee, Dong-Wook; Kim, Kyoung-Nam Abstract: Previous studies examining the associations of per- and polyfluoroalkyl substances (PFAS) and heavy metals (HMs) with lung function have yielded inconsistent findings. We investigated the associations of PFAS and HMs with lung function in a Korean birth cohort followed up to 10 years of age. Data from the Environment and Development of Children (EDC) cohort were used (n = 505). Serum PFAS and whole blood HM concentrations were measured at ages 2, 4, and 6 years. Lung function was assessed at ages 8 and 10 years. Linear mixed models were used to evaluate the associations of individual chemicals with repeated lung function measurements. Principal component analysis (PCA) within a doubly robust estimation framework was applied to examine the associations between chemical mixtures and lung function. In analyses for individual chemicals, several PFAS (e.g., perfluorooctanoic acid [PFOA] and linear perfluorooctane sulfonate [L-PFOS]) and HMs (e.g., mercury and cadmium), particularly those measured at age 2, were associated with lower lung function. In mixture analyses, higher age-2 PCA-derived exposure patterns characterized by PFAS-dominant components were associated with lower FEF25-75 [β = 0.04, 95% confidence interval (CI): 0.01, 0.07], whereas higher age-2 HM-dominant components were associated with lower FEV1/FVC (β = 1.33, 95% CI: 0.63, 2.03) at 8–10 years. These findings suggest that early-life exposure to PFAS- and HM-dominant mixtures, particularly around age 2 years, may adversely influence subsequent lung function. Our results highlight the importance of early-life prevention strategies to minimize exposure to these ubiquitous chemicals, particularly around 2 years of age. 2026-06-01T00:00:00Z