OBJECTIVES:The demographic trend towards an ageing society is accompanied by an increase in age-related illnesses, with late-life depression (LLD) being one of the most common mental illnesses in the oldest-old (≥ 80 years). As activity participation potentially prevents LLD, this study examines sex-specific differences in the relationship between activity participation and LLD risk. METHOD:Data were derived from the prospective multicenter cohort study AgeCoDe/AgeQualiDe with 9 follow-ups (FU). LLD was assessed using the 15-item Geriatric Depression Scale (GDS-15, cut-off score 6). Activity participation was first assessed at FU1 based on 14 physical, social and cognitive activities (5-point ordinal scale). Statistical analyses included descriptive statistics, Mann-Whitney U-tests and Cox regressions estimating incident LLD from FU2 to FU9. Time at risk began at FU1, where activity participation was first assessed. RESULTS:Analyses included n = 2,305 at FU1; mean age 81.0; 64% women. Men reported significantly more physical activity (U = 569,468, p = 0.010), women more cognitive activity (U = 658,426, p = 0.002). A higher activity participation at FU1 was associated with a lower risk of LLD with HR = 0.97, 95% CI [0.95, 0.98]. Particularly, participation in physical activities reduced LLD risk with HR = 0.96, 95% CI [0.93, 0.98], which could not be shown for social and cognitive activities. Analyses could not confirm a sex-dependent association. CONCLUSION:Activity participation, especially in physical activities, appears preventive for LLD in the oldest-old. Contrary to the hypothesis, these associations did not differ between men and women.

OBJECTIVE:This study examines how multiple dimensions of socio-emotional well-being relate to cognitive functioning in older adults, and whether the associations vary by cognitive status, depression, and socio-demographic factors. METHODS:Data from the Harmonized Cognitive Assessment Protocol of the Survey of Health, Ageing and Retirement in Europe (n = 2,650; mean age = 76; 54.5% females) were used to test associations between life satisfaction, meaning in life, social connectedness, and loneliness with global, domain-specific cognitive performance, and informant-rated cognitive decline. RESULTS:Linear mixed models, with individuals nested within five countries, found that higher life satisfaction, meaning in life, and social connectedness were associated with better cognitive outcomes, whereas greater loneliness was associated with worse performance and greater informant-rated decline. The largest effect sizes were observed for meaning in life (median β = .10) and loneliness (median β = -.09) across cognitive measures. The associations generally remained significant adjusting for well-known clinical (e.g., diabetes), behavioral (e.g., physical inactivity), and psychological (depressive symptomatology) risk factors for dementia. Moderation and sensitivity analyses suggested that associations with global cognition hinged on the inclusion of participants classified with cognitive impairment, while some domain-specific associations (e.g., loneliness and episodic memory) were observed only in individuals without cognitive impairment. Overall, evidence for moderation by cognitive status, depression and age was limited, and no moderation was observed for sex or education. CONCLUSIONS:The results underscore the importance of socio-emotional well-being in cognitive aging and highlight the need for longitudinal research to clarify mechanistic pathways and inform targeted interventions.

OBJECTIVE:Diagnosis rates of depression and demand for psychotherapy are increasing, posing significant challenges to the mental health care system. Availability of different treatments enables patients to express their preferences. Understanding these preferences can inform policy makers and clinicians and holds the potential to increase treatment adherence and improve clinical outcomes. METHOD:A web survey was carried out among German adults (18-74) with psychotherapy experience, using quota sampling to reflect the gender distribution of psychotherapy-seeking adults. We conducted a discrete choice experiment to measure factors influencing the choice of psychotherapy. Included attributes were setting, delivery mode, waiting time, gender and professional experience of psychotherapist. Latent class analysis (LCA) was applied to identify preference patterns. RESULTS:Respondents (n = 1575, 70.5% female, Mage = 47) preferred individual, face-to-face, shorter waiting times, female and more experienced therapists. Setting was most influential, followed by professional experience, waiting time, delivery mode and gender. LCA revealed five distinct classes that showed varying valuations of the attributes and their relative importance. CONCLUSION:Results showed that respondents mainly homogeneously preferred specific treatment characteristics. These preferences should be considered when planning mental health services. Identification of distinct preference types suggests tailored provision of mental health care.

Objectives In light of the very restricted knowledge, we aimed to examine future nursing home (NH) preferences regarding LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other sexual and gender minority) issues among heterosexuals and sexual minorities in Germany. Design Representative sample of the German general adult population. Setting and Participants Individuals residing in Germany aged 18 to 74 years (n = 2518; average age was 47 years). Methods Regarding future NH preferences, outcomes focused on the importance of tolerance toward LGBTQIA+ individuals, offering LGBTQIA+ friendly services and treatments, and openness to the concerns of LGBTQIA+ individuals. The main independent variable was sexual orientation (heterosexual; sexual minorities encompassing homosexual, bisexual, or other). Several sociodemographic and health-related covariates were incorporated in the regression model. Results Overall, 8.7% of the respondents belonged to the group of sexual minorities. Regarding future NH preferences, unadjusted and adjusted regressions showed that sexual minorities had a higher importance of tolerance toward LGBTQIA+ individuals (β = 1.44; P < .001), offering LGBTQIA+ friendly services and treatments (β = 1.15; P < .001), and openness to the concerns of LGBTQIA+ individuals (β = 1.29; P < .001). Our results were mainly driven by differences between heterosexuals and homosexuals. Conclusions and Implications The identified differences in the preferences regarding LGBTQIA+ issues between heterosexual and sexual minority people showed the particular significance of these factors for the group of sexual minorities (and homosexuals in particular). Taking such factors into account might probably contribute to the satisfaction of sexual minorities in NHs. Moreover, our results are important for NH operators and health policymakers.

BACKGROUND:To date, there is restricted knowledge with regard to the association of relationship quality with family and friends and depressive symptoms and loneliness among the oldest old. Thus, we aimed to address this knowledge gap. METHODS:Data were taken from wave 8 of the German Ageing Survey (December 2022 to June 2023), a nationally representative sample of community-dwelling individuals in their second half of life. We restricted our analytical sample (n = 810 respondents) to individuals aged 80 years and over (i.e., oldest old). Loneliness was measured using the De Jong Gierveld tool. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms. Multiple linear regression models were estimated. Both the quality of relationships with family and friends was measured via single-item tools. Multiple linear regression models were used. RESULTS:A high quality of relationship with family (compared to a low-quality relationship) was neither statistically significantly associated with depressive symptoms nor with loneliness. Contrary, a high quality of relationship with friends (compared to a low-quality relationship) was significantly associated with fewer depressive symptoms (β = -3.71, p < 0.01) and lower loneliness levels (β = -0.28, p < 0.01). CONCLUSIONS:Our findings revealed an association of a high quality of relationship with friends and fewer depressive symptoms and lower loneliness scores among the oldest old in Germany. Upcoming research should elucidate the underlying mechanisms of the identified associations.

BackgroundA conscious use of wearables may be beneficial for health in general. Therefore, we aimed to investigate the current use of specific wearables and factors that would motivate future use of wearables in the German general adult population.Methodology/principal findingsData were taken from a quota-based online survey which took place in January 2026 (German general adult population, mean age of 47.3 years, 18-74 years, n = 2,591). Individuals were asked about their current use of specific wearables, and non-users were also asked about the factors that would motivate future use of wearables. Slightly more than one in three (34.8%) used one or more wearables. Based on the users, 80.8% used a smartwatch, and 24.3% used a fitness tracker, whereas only a small minority used other wearables (smart ring: 5.4%; smart clothing: 4.1%; smart glasses: 2.0%; hearables: 2.9%). Key factors that would motivate future use of wearables were (in descending order of frequency): need for medical monitoring (e.g., due to future chronic illnesses) (42.0%), lower prices (33.3%), interest in monitoring health (32.9%), health data as an incentive to lead a healthy lifestyle (27.2%), experience technological advances (18.2%), and greater user-friendliness (13.5%). Regressions showed that higher odds of currently using at least one wearable were associated with, among others, being married, living with a dog, leading a healthier lifestyle, and having more chronic conditions.Conclusions/significanceApart from smartwatches, there is still a lot of potential for growth in user numbers for other wearables. We recommend research in other countries and based on longitudinal data.

BACKGROUND:Overall, there is a lack of studies examining whether providing great-grandchild care is associated with life satisfaction and loneliness, based on nationally representative samples. Thus, we aimed to examine whether providing great-grandchild care is associated with life satisfaction and loneliness (also stratified by sex). METHODS:Data were used from the "Old Age in Germany (D80+)" study-a nationwide representative study encompassing community-dwelling and institutionalised individuals aged 80+ in Germany (n = 995 in the analytic sample). Frequently used tools were used to quantify both loneliness and life satisfaction. Caring for great-grandchildren served as the key independent variable. It was adjusted for several sociodemographic and health-related factors. Linear regression models were estimated. Robustness checks were conducted. RESULTS:Regressions showed that providing great-grandchild care was not significantly associated with higher life satisfaction among the total sample and men, but among women. Moreover, it was not significantly associated with loneliness (neither in the total sample nor in both sexes). CONCLUSION:Providing great-grandchild care is associated with higher life satisfaction among women aged 80 years and over. Future research in other countries and based on longitudinal data is recommended.

OBJECTIVES:The aim of this study was to assess the longitudinal association between transitioning to adult caregiving, grandparent childcare and mental health outcomes (depressive symptoms, life satisfaction and cognitive functioning) and physical health outcomes (pain interference) in South Africa from 2015 to 2022. METHODS:We used information from three waves of the 'Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)'. To evaluate within-person changes over time, symmetric and asymmetric linear fixed-effects (FE) regressions were employed and also stratified by sex. RESULTS:Adjusted FE regression analysis found a positive association between the change in grandchild care and beginning to provide grandchild care and depressive symptoms in the total sample and among women. Onset of adult caregiving, change in grandchild care and beginning to provide grandchild care were negatively associated with life satisfaction and positively associated with pain interference, while ceased grandchild care was positively associated with life satisfaction and negatively associated with pain interference. Onset of adult caregiving was negatively associated with cognitive functioning, and change in grandchild care and beginning to provide grandchild care were positively associated with cognitive functioning. CONCLUSIONS:Transitions into caregiving-both for grandchildren and adults-are associated with poorer well-being, including higher depressive symptoms (especially among women), lower life satisfaction and greater pain interference, supporting a role-strain perspective. However, initiating or changing grandchild care is linked to better cognitive functioning, suggesting potential stimulation benefits. In contrast, ceasing grandchild care is associated with improved life satisfaction and reduced pain.

OBJECTIVE:This study aims to examine the relevance of different hospital quality indicators (QIs) for patients choosing a hospital for inpatient care, and to assess whether their importance varies by risk level and patient characteristics. METHOD:We conducted an online survey with a quota-based sample of 2,894 individuals aged 18-74 years, which reflected the demographic composition of the general adult population in Germany. Participants were asked to imagine needing elective surgery in two scenarios (gallbladder surgery and coronary artery bypass graft [CABG] surgery) and to rate the relevance of 43 QIs on a 6-point Likert scale. We used multiple linear regression to examine the associations between QI relevance ratings and participants sociodemographic, socioeconomic, and health-related characteristics. RESULTS:For both scenarios, the most relevant QIs were physician qualifications, mortality rate and the presence of a robust infection prevention and control program. Outcome indicators were generally rated as more relevant than process or structure indicators. All indicators were rated as more relevant for CABG than for gallbladder surgery, except scar size, proximity to home, and length of stay. Preferences varied by sociodemographic, socioeconomic, and health-related characteristics, including age, gender, presence of chronic disease, and prior hospitalization. All outcome and process indicators were rated as more relevant by women than by men, except for food quality, which was rated as more relevant by men. CONCLUSION:Preferences varied by surgical scenario and patient characteristics. Participants generally assigned higher importance to most indicators for CABG than for gallbladder surgery. The results point to a need for transparent and accessible presentation of hospital quality information that reflects the information needs and values of different patient groups. Improving how such information is presented may help patients make better-informed hospital choices.

Background:Thus far, no studies have focused on hugging and social disconnectedness outcomes comprehensively (loneliness, social isolation, social withdrawal) in the post-pandemic era. Our aim was to examine whether hugging is associated with loneliness, social isolation, and social withdrawal and whether these associations vary by gender. Methods:We used cross-sectional data collected via an online survey conducted in January 2025 (N = 3,270 adults aged 18 to 74 years across Germany). To ensure representativeness, a quota sampling method was employed based on gender, age, and federal state. Participants reported on their loneliness, social isolation, and social withdrawal and how many individuals they hugged each day. Linear regression models with robust standard errors were used. Results:After adjusting for multiple covariates, hugging on average one (or more) individuals per day (compared to lack of hugging) was associated with fewer feelings of loneliness, social isolation, and social withdrawal in the total sample. Among men, hugging was associated with reduced feelings of loneliness and social withdrawal but not social isolation; hugging was related to all three social disconnectedness metrics among women and the associations were stronger than for men, as indicated by corresponding interaction terms (hugging x gender). Conclusion:Our findings suggested an association between hugging frequency and measures of social disconnectedness, particularly among women. Efforts to increase the frequency of hugs, ideally to at least 2-3 individuals on average per day, may be beneficial for social outcomes, pending longitudinal and experimental evidence.

Person-environment (P-E) fit and ageing theories suggest that perceived safety and social inclusion are associated with health outcomes. However, no study has utilised time-separated unique samples to investigate whether age moderates the association of perceived safety with quality of life (QoL) through social inclusion. This study used three distinct, time-separated samples to ascertain whether the indirect association between perceived safety and QoL through social inclusion is moderated by age. This study employed a moderated mediation analysis repeated at three waves [wave 1 (2007/2008); wave 2 (2014/2015), and wave 3 (2018/2019)] from the World Health Organization’s Study on Global AGEing and adult health Ghana (WHO-SAGE Ghana). It included a weighted sample of 14,172 adults aged 50 to 112 years. The unique sample for each wave was 4724 nationally representative adults, and the Hayes’ Process Macros (Model 59) was utilised to assess moderated mediation. Perceived safety was not directly associated with QoL but was indirectly associated with QoL through social inclusion. The association of perceived safety with QoL was fully mediated by social inclusion, and the mediation was stronger in older age. There was a direct positive association of social inclusion with QoL, which was stronger in older age. The foregoing results were consistent across the three time points and samples. Social inclusion may be more strongly associated with QoL in older age. The results support positive ageing theories, including the Socioemotional Selectivity Theory, and reinforce the importance of enhancing neighbourhood safety and social inclusion.

In many countries, the health systems allow patients to have free selection of the hospital where they wish to receive treatment. The market for hospital services is a competitive market, where competition not necessarily happens over costs but over the quality of care. So far, only limited information on patient preferences of hospital choice is available. The aim of this study was to provide a systematic review about the relevance of the quality indicators for patients when making a choice of hospital for inpatient treatment, which we conducted according to the PRISMA guidelines. We retrieved studies from PubMed, Web of Science, and EconLit and assessed them according to predefined criteria. To be eligible for our purposes, studies needed to examine inpatient preferences for hospital choice in North America, Europe, Australia, and New Zealand. The extracted quality indicators were then sorted according to study type (quantitative or qualitative), main indication (cancer, orthopedics, gastrointestinal, cardiology, and other), and structure, process, or outcome quality following Donabedian’s framework. Study quality was assessed with the Mixed-Methods-Appraisal-Tool (MMAT). Fifty-one studies met inclusion criteria. We extracted 24 quality indicators (ten structure, five process, five experiences and recommendations as a sub-category of process indicators, and four outcome). The most frequently examined one was “proximity to hospital/travel distance or time” (n = 38). Structure and process indicators were examined often, as well as experiences and recommendation indicators, while outcome indicators were examined seldom. We found few studies conducting qualitative research and more studies examining stated preferences than revealed preferences. Structure and process quality indicators were examined frequently, while outcome quality indicators were examined seldom, potentially either because patients do not consider them important or because little information on them is available. More qualitative and mixed methods studies are needed, as well as information on additional quality indicators.

We aimed to investigate the association of distractions at work and perceived occupational challenges with psychosocial outcomes among the adult German population. A quota-based online sample of the German adult population (representative in terms of gender, age group, and federal state) was used. We restricted our sample to the working population aged 18 to 64 years (n = 2274 individuals). The mean age was 41.7 years (SD 12.7 years). Widely used and psychometrically sound tools were used to quantify the psychosocial outcomes. Multiple linear regressions were estimated. Overall, 19.5

There is limited knowledge regarding the association of loneliness or social exclusion with donation behavior. Our aim was to investigate the association of loneliness and perceived social exclusion with donation behavior based on a longitudinal approach. Longitudinal data were taken from wave 5 (year 2014) to wave 8 (year 2023) of the German Ageing Survey encompassing community-dwelling individuals aged 40 years and over. Established tools were used to quantify loneliness and perceived social exclusion. The willingness to donate and the total amount (in euros) of all donations (in the last 12 months) served as outcome measures. Fixed effects (FE) regressions with cluster-robust standard errors were used. FE regressions showed that increases in loneliness were significantly associated with lower odds of donation after adjusting for socioeconomic factors, but became insignificant when accounting for lifestyle and health-related covariates. Conversely, a significant association was found between increases in perceived social exclusion and lower odds of donation across all models. However, neither changes in loneliness nor perceived social exclusion were significantly associated with changes in log amount of donations. Sociodemographic factors (i.e., age, sex, and education) did not moderate the identified associations. Even after adjusting for a wide array of covariates, our longitudinal study showed a significant and robust association between increases in social exclusion and lower odds of donation. Avoiding increases in perceived social exclusion could encourage the decision to donate, an important prosocial behavior, pending further longitudinal evidence. Cross-country comparisons are recommended.

We aimed to investigate the association of perceived orofacial esthetics with loneliness, social isolation, and social withdrawal. Cross-sectional data from an online survey of the adult population in Germany (n = 3270 individuals, 18–74 years; January 2025) was used. A quota-based approach was used (ensuring representativeness in terms of sex, age, and federal state). Outcomes were measured using established tools (German versions of the De Jong Gierveld tool, Bude Lantermann tool, and 25-item Hikikomori Questionnaire). The German version of the Orofacial Esthetic Scale (OES-G) was used to quantify perceived orofacial esthetics. Linear regressions were used. Mean perceived orofacial esthetics score was 22.7 (SD 6.9), varying from 0 to 35. Even after adjusting for various covariates, favorable perceived orofacial esthetics were associated with lower loneliness (β = −.03, p < .001), lower social isolation (β = −.02, p < .001), and lower social withdrawal (β = −.33, p < .001). Sex-stratified regressions yielded similar results. However, it is worth noting that the association of favorable perceived orofacial esthetics with lower loneliness was significantly more pronounced among women (compared to men). As the very first study, we found that favorable perceived orofacial esthetics were associated with lower loneliness, lower social isolation, and lower social withdrawal. The observed sex differences in loneliness underscore the importance of further research to achieve a more detailed understanding of how social norms and psychological factors contribute to this variation.

Introduction: Few studies have longitudinally assessed the prevalence and factors associated with obesity among persons 80 years and older. This study aimed to estimate these based on 4-wave national longitudinal data from Thailand. Methods: Data from the Health, Aging, and Retirement in Thailand study from 2015, 2017, 2020 and 2022 were utilized. The sample was restricted to community-dwelling persons 80 years and older with complete self-reported body weight and height values (analytic sample: n=2986 observations). For the pooled sample, the average age was 85.3 years (range 80-107 years). Thai obesity was defined using Thai criteria (body mass index-BMI ≥25 kg/m2) and World Health Organization (WHO) criteria (BMI ≥30 kg/m2). Random effects (RE) logistic regressions were utilized to estimate the factors associated with Thai and WHO obesity. Results: The average BMI was 21.6 (SD = 4.4), 23.0% were underweight, 17.4% had Thai obesity, and 3.6% had WHO obesity. RE regssions showed that age and male sex were negatively associated with Thai and WHO obesity. Being married or cohabiting and higher subjective economic status were associated with WHO obesity. Having no exercise was associated with WHO obesity. Living alone was negatively associated with Thai obesity, and having a greater number of chronic conditions was associated with both Thai and WHO obesity. Conclusion: This longitudinal study enhances our understanding of the factors associated with obesity among people 80 years of age and older. Strategies to delay or decrease chronic conditions and increase physical activity may help reduce obesity.

Hardly any evidence exists on fears regarding the future development of AI in medicine. Thus, we investigated the factors associated with such fears regarding the future development of AI in medicine. Data were used from a representative sample of German adults (sample consisted of 2591 individuals, averaging around 47 years). We developed a scale to quantify fears regarding the future development of AI in medicine (called FFDAIM-G). Norm values were presented, and multiple linear regressions were performed. On a scale from 1 to 7, the mean level of fear regarding the future development of AI in medicine (i.e., FFDAIM-G) was 4.3 (SD 1.5). The reference values significantly differed between certain sociodemographic groups (e.g., depending on age group). The FFDAIM-G had favorable psychometric properties. Regressions showed that higher fear levels regarding the future development of AI in medicine were significantly associated with being female (compared to being male, β = .20, p < .01), a higher number of chronic conditions (β = .10, p < .001), and poorer self-rated health (β = −.12, p < .01). Overall, some fears already exist regarding the future development of AI in medicine, depending on the sociodemographic group. Women and individuals with poor health are susceptible to such fears. This study can be seen as a basis for researching fears regarding the future development of AI in medicine and may thus guide upcoming studies.

AimTo describe oral hygiene behavior and oral health literacy in the general adult German population (also stratified by migration background) and to identify the association of migration background with such outcomes.MethodsData from the general adult German population aged 18–74 years was used (quota-based sample representative in terms of age, gender, and federal state). The analytic sample equaled 5,000 individuals, with mean age of 47 years, 51% being female, and 11% had a migration background. Common questions were employed to measure oral hygiene behavior, oral health literacy and migration background. Multiple logistic regressions were used to explore the association of migration background with oral hygiene behavior and oral health literacy.ResultsA significant proportion reported not using oral hygiene products, with 35.5% not using an electric toothbrush (not using manual toothbrush: 28.1%), 59.4% not using fluoride gel, and 27.7% not using interdental cleaning aids. Additionally, 14.1% brushed their teeth for less than two minutes and 76.4% reported having at least good oral health literacy. Depending on migration background, some outcomes significantly varied. Adjusted multiple logistic regressions showed that having a migration background (compared to not having a migration background) was significantly associated with lower odds of using an electric toothbrush (OR = 0.79, 95% CI:0.66–0.95) and duration of tooth brushing (OR = 0.54, 95% CI:0.43–0.69).ConclusionData on oral health, use of different oral hygiene products, and oral health literacy among adults with migration background is limited. Our analysis adds to this knowledge and helps identify gaps and needs in this population to improve preventive measures.

AIM:To identify the prevalence of gaming disorder and its association with psychosocial outcomes (including mental health, subjective well-being and social disconnectedness) in the general adult population in Germany and whether these associations differ by gender and/or age. METHODS:Individuals aged 18 to 74 years (mean age: 47 years, SD: 15 years) were surveyed (quota sample of the general adult German population in January 2025, n = 3,270). Psychometrically validated tools were used to quantify the outcomes. The Internet Gaming Disorder Scale was used to quantify the problematic use of computer games (cut-off of 5 or higher to indicate probable gaming disorder). RESULTS:Overall, 59.2% of the individuals in the sample played computer games (offline or online). Among these, 11.9% had a probable gaming disorder, equaling a prevalence of 7% in the entire sample. In adjusted regression analyses, individuals playing computer games, but without a probable gaming disorder, had significantly poorer psychosocial outcomes in terms of depressive symptoms, anxiety symptoms, social isolation, social withdrawal and poor life satisfaction compared to those not playing computer games. Individuals with a probable gaming disorder had markedly poorer psychosocial outcomes compared to their counterparts who did not play computer games. Comparable findings were observed in gender- and age-stratified analyses. CONCLUSIONS:In this study, 7% of the sample had a probable gaming disorder. Analyses indicated that such individuals are at high risk of poorer psychosocial outcomes and that these associations are observed across gender and age groups. Future longitudinal studies are recommended to further elucidate these associations.

There are relatively few studies on ikigai that go beyond older adults in Japan, and there is a lack of research focusing on the link between ikigai and hikikomori. Thus, we aimed to examine the association between ikigai (having purpose and meaning in life) and hikikomori (experiencing extreme social withdrawal) in the German adult population. Data came from an online quota survey of the German general adult population (n = 3270 individuals; 18 to 74 years, average age 47 years). Data collection took place in January 2025. The validated German versions of the 25-item Hikikomori Questionnaire and Ikigai-9 scale were used to quantify key variables. Unadjusted and adjusted logistic regression analyses were performed among the total sample and additionally stratified by gender and age group. Higher ikigai levels were associated with significantly lower odds of being a hikikomori (e.g., in the fully adjusted model OR 0.91, 95