Objectives This study investigated the association between employment status and depression. Methods Data from the Korea Welfare Panel Study (KOWEPS) collected from 2008 to 2011 were used. A total of 7368 subjects were included in this study after exclusion of subjects with missing data and those who were self-employed or could not work. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Employment status, age, sex, region, education, marital status, income, head of household, self-rated health, smoking status, drinking habits, and the current year's and the previous year's CES-D scores were included in the model as independent variables. A generalised linear mixed-effects model for longitudinal binary data was used. Results Compared with those who were permanently employed, individuals who moved from permanent to precarious employment (OR 1.45, 95% CI 1.23 to 1.70) or to unemployment (OR 1.78, 95% CI 1.30 to 2.43) and from precarious employment to unemployment (OR 1.65, 95% CI 1.32 to 2.06) showed a significantly increased the odds of having depression. Continuing precarious employment (OR 1.54, 95% CI 1.30 to 1.83) or unemployment (OR 1.45, 95% CI 1.23 to 1.70) also significantly increased the odds of having depression. These results were particularly identified in men and head of household women. The effects were not significant among non-head of household women. Conclusions Precarious employment and unemployment were clearly associated with having depression. In addition, in view of our findings, policy makers should consider sex and head of household status when developing welfare policies. The inequity between precarious jobs and permanent jobs should be tackled.

Objective: Untimely vaccination refers to receiving the given dose before (early) or after (delayed) the recommended time window. The purpose of this study was to assess the extent of timeliness of childhood vaccinations and examine the determinants of vaccination timeliness in Sindh province, Pakistan.Design: Cross-sectional analysis of data from the 2013 and 2014 Maternal and Child Health Program Indicator Surveys.Setting: Community-based maternal and child health surveys.Participants: Among 10 200 respondents of Maternal and Child Health Program Indicator Surveys, 1143 women who had a live birth in the 2 years preceding the survey were included.Outcomes: At the participants’ home, an interviewer asked mothers to show their children’s vaccination cards, which contained information regarding vaccinations. Children’s vaccination status was categorised into timely or early/delayed compared with vaccination schedule. A logistic regression analysis using Firth’s penalised likelihood was performed to identify factors associated with timeliness of vaccinations.Results: 238 children (20.8% of children who received a full set of basic vaccinations) received all vaccinations on schedule among children who received a full set of basic vaccinations. The percentages of timely vaccinations ranged from 2.3% for second measles vaccination to 89.3% for bacillus Calmette-Guérin. Child’s age and place of delivery were associated with timely vaccinations. Older child age and institutional delivery were associated with decreased timely vaccination rate.Conclusions: Home-based vaccination record is a key tool to improve the timeliness of vaccinations. The redesigned vaccination cards, the new electronic registries for vaccination card information and the vaccination tracking system to remind the second/third vaccination visits may be helpful to improve timely vaccinations for children under 2 years old.

Objectives To examine the hypothesis that respondents with any of three specific sleep patterns would have a higher likelihood of suicidality than those without reports of these patterns in Korean adolescents. Setting Data from the 2011–2013 Korea Youth Risk Behavior Web-based Survey were used. Participants 191 642 subjects were included. The survey's target population was students in grades 7 through 12 in South Korea. Independent variable Sleep time. Primary and secondary outcome measures Suicidal thoughts, plans and attempts. Results The odds of suicidal thoughts in subjects with very short or long time in bed were 1.487-fold higher (95% CI 1.219 to 1.815) or 0.611-fold lower (95% CI 0.460 to 0.811), respectively, than for subjects with 7 h/day in bed; the odds were similar for suicidal plans. The odds of suicidal thoughts in subjects with early or late awakening times were 1.231-fold higher (95% CI 1.050 to 1.442) or 1.528-fold lower (95% CI 1.000 to 2.334), respectively, than for subjects with 7 h/day in bed; these odds were lower for suicidal plans and attempts. The odds of suicidal thoughts in subjects with early bedtime were 1.748-fold higher (95% CI 1.302 to 2.346), the odds of suicidal plans in people with an early bedtime were 2.494-fold higher (95% CI 1.671 to 3.722) and the odds of suicide attempts in subjects with late bedtime were 1.313-fold higher (95% CI 1.005 to 1.716) than for subjects with a bedtime of 23:00. Conclusions The sleep-related time is associated with suicide-related behaviours in Korean adolescents. Multilateral approaches are needed to identify the greatest risk factors for suicidal behaviours.

Background: Migraines gradually increase year by year, as does its burden. Management and prevention are needed to reduce such burdens. Previous studies have suggested that daily health behaviors can cause migraines. Sleep is a substantial part of daily life, and in South Korea, the average sleep duration is shorter than in other countries. Thus, this study focused on the increase of both diseases, and analyzed sleep disorders as a risk factor for migraines. Methods: The data used in this study was that of the national health insurance service (NHIS) national sample cohort. We used a matched cohort study design that matched non-patients based on patients with sleep disorders, and included 133,262 patients during 2012–2015. We carried out a survival analysis using a Cox proportional hazard model with time-dependent covariates to identify the association between migraines and sleep disorders. Results: Approximately 11.72% of patients were diagnosed with migraines. Sleep disorders were positively correlated with the diagnosis of migraine (Hazard Ratio, 1.591; p < 0.0001). By the types of sleep disorder, patients who were diagnosed as having insomnia, rather than other types of sleep disorder, had the greatest associations with migraine. The associations were greater for males, people with lower income, the elderly population, and patients with mild comorbid conditions. Conclusion: This study provides evidence that migraine is associated with sleep disorders, especially insomnia. Based on these findings, healthcare professionals and policy makers have to reconsider the present level of insurance coverage for sleep medicine, recognize the risk of sleep-related diseases and educate patients about the need for appropriate care.

Private health insurance in South Korea mainly functions as supplementary and complementary health insurance that compensates for insufficient coverage by National Health Insurance. However, full private coverage of public sector cost-sharing led to the problem of encouraging moral hazard–induced utilization, resulting in a policy change that occurred in October 2009. At that time, the Korean government introduced a minimum cost-sharing policy for indemnity health insurance. The purpose of this study was to analyze the effect of cost-sharing in private health insurance on health care utilization. We analyzed data collected from the Korean Health Panel Survey from October 2008 to December 2011. We restricted the two groups to 803 purchasers with indemnity health insurance and 7023 non-purchasers who did not obtain any private health insurance. A difference-in-difference analysis was used to evaluate the effect of the 2009 policy. After the policy change, the utilization of outpatient visits by purchasers gradually decreased more than non-purchasers (0.015 in 2009 [p = 0.758], −0.117 in 2010 [p < 0.016], and −0.140 in 2011 [p = 0.004]). However, utilization of inpatient services was not statistically significant. Notably, the magnitude of the cost-sharing effect in indemnity health insurance was stronger for those receiving medical aid. Among this group, utilization of outpatient services (after the policy change in 2009) decreased more so than non-purchasers. Patients with three or more chronic diseases have not changed their health care utilization. Our results implied meaningful lessons for decision-makers and future health insurance policies in Korea and other countries in terms of cost-sharing in medical care. When policy makers intend to implement the cost-sharing, a different copayment scheme is needed according to the socioeconomic status or disease severity.