PURPOSE To analyze regional disparities in depression defined by the Patient Health Questionnaire-9 (PHQ-9) among Korean adults using spatial statistics and survey-weighted prediction models based on the 2024 Korea Community Health Survey (KCHS), and to visualize region-specific contributing factors using SHapley Additive exPlanations (SHAP) METHODS: This cross-sectional secondary analysis evaluated 231,469 respondents. Survey weights were applied to logistic regression, XGBoost, and LightGBM models to classify concurrent depression status, operationally defined as a PHQ-9 score of 10 or higher. Spatial autocorrelation was assessed using global Moran's I and Local Indicators of Spatial Association. SHAP values quantified global feature importance and the spatial heterogeneity of dominant positive mean contributors across 250 harmonized municipal units RESULTS: The national weighted prevalence of PHQ-9-defined depression was 4.1 percent, with weak positive global spatial autocorrelation and regional variation ranging from 0.9 percent to 8.2 percent. In the independent test set, LightGBM achieved an area under the receiver operating characteristic curve of 0.92, an area under the precision-recall curve of 0.43, and a Brier score of 0.03. No local association remained significant after false discovery rate correction. SHAP analysis identified perceived stress, subjective happiness, and subjective health status as the most influential global predictors. Mapping revealed spatial heterogeneity: perceived stress was the most frequent dominant positive mean contributor, whereas other municipal units showed subjective health status, subjective happiness, smoking status, sleep duration, income, and other contributors. Regional contributor rank retention varied across bootstrap samples (median, 72.5%). CONCLUSION Psychosocial and structural characteristics contributed to concurrent classification of PHQ-9-defined depression, with exploratory geographic variation in aggregated SHAP contributions. Combining explainable machine learning with spatial statistics may inform further local assessment. IRB APPROVAL/EXEMPTION This study was exempted from review by the Institutional Review Board of Kangbuk Samsung Hospital (KBSMC IRB No. 2026-02-008).
PURPOSE This study aimed to examine the associations of patient safety speaking-up climate and managerial support for patient safety with patient safety nursing activities among military nurse officers, and to determine whether patient safety competency mediated these associations. METHODS A cross-sectional online survey was conducted among 170 military nurse officers at 12 military hospitals in the Republic of Korea from June to August 2025. Validated instruments were used to assess speaking-up climate and managerial support for patient safety as predictors, patient safety competency as the mediator, and patient safety nursing activities as the outcome. A mediation analysis with multiple X variables was conducted using the PROCESS macro (Model 4) with 5,000 bootstrap samples, with both predictors considered simultaneously and each association estimated while controlling for the other predictor. RESULTS Patient safety nursing activities were positively correlated with patient safety competency (r = .55, p < .001), patient safety speaking-up climate (r = .53, p < .001), and managerial support for patient safety (r = .41, p < .001). In the mutually adjusted model, patient safety speaking-up climate showed significant total (β = .45, p < .001), direct (β = .29, p = .001), and indirect effects through patient safety competency (β = .16, 95% CI [0.08, 0.27]). In contrast, managerial support for patient safety showed no significant total (β = .12, p = .188), direct (β = .08, p = .310), or indirect effects (β = .03, 95% CI [-0.04, 0.11]). CONCLUSION Patient safety speaking-up climate was associated with patient safety nursing activities both directly and indirectly through patient safety competency, whereas managerial support for patient safety showed no unique association with patient safety nursing activities after accounting for speaking-up climate. These findings highlight the importance of considering workplace conditions alongside individual competency in promoting patient safety nursing activities.
PURPOSE Self-esteem plays a crucial role in the healthy adjustment of adolescents. This study examined longitudinal trajectories of self-esteem and identified factors associated with self-esteem among South Korean adolescents. METHODS Data from the Korean Children and Youth Panel Survey 2018 (2018-2022), which included 2,457 adolescents who were in the 4th grade in 2018, were analyzed. Generalized estimating equation analysis was used to evaluate the associations of parenting attitudes, grit, happiness, and depression with self-esteem. RESULTS Self-esteem declined from 32.18 (±4.72) in 2018 to 29.03 (±4.31) in 2022, with concurrent declines in happiness, grit, and positive parenting attitudes. Happiness showed the strongest association with self-esteem (Estimate = 0.37), followed by depression (Estimate = -0.27), grit (Estimate = 0.13), and positive parenting attitudes (Estimate = 0.12). CONCLUSION The concurrent decline in self-esteem and multiple protective factors suggests a need for comprehensive interventions addressing family, emotional, and individual dispositional domains. Nurses in pediatric, mental health, and school or community settings should attend to parenting attitudes, grit, happiness, and depression in combination. Future research should evaluate the effectiveness of such interventions and the long-term consequences of declining adolescent self-esteem for adult mental health.
