KIHASA has published the KCI-listed Health and Social Welfare Review, Vol. 45, No. 3. This issue features 23 peer-reviewed articles.

EDITORIAL: Who Cares? Choi Young Jun, Yonsei University

Article I: Regional Health Care Workforce Challenges in the Era of Population Decline Yoon Taeho, Pusan National University

According to population projections by Statistics Korea, Korea is expected to undergo a rapid population decline, and population in most regions is likewise projected to decline. However, the health-care needs？weighted population is projected to increase at least until 2050. Therefore, the supply of the regional health care workforce should be adjusted to meet the increase in this needs-weighted population. Relative to other OECD countries, Korea ranks low in the number of practicing physicians and nurses per 1,000 population. In particular, the number of practicing physicians per 1,000 population was below the OECD average in all regions except Seoul. Moreover, there were substantial regional disparities in the total number of physicians, hospital-based physicians, and essential medical specialists. Policies to resolve the regional imbalance of the physician workforce, which plays the most important role in the health workforce market, have been either abandoned or implemented only in a limited form. Amid the continuing and worsening regional health workforce imbalance, past workforce policies have relied on a centralized approach. In addition, in the absence of regional health systems, both financial and management mechanisms have been fragmented. To address health care workforce challenges in the era of regional population decline, a regional health system must first be properly established. For this purpose, decentralization of health care, based on the integration of management and financing mechanisms, should be implemented. Local problems are best known and solved by local communities themselves.

Article II: Wage Differentials across Social Service Industries: A Comparison between Social Welfare Services and the Health, Education, and Public Administration Sectors Um Dawon, KIHASA; Jang Yunseon, Sungkyunkwan University

This study empirically examines wage differentials between the social welfare services sector―a core segment within the social service industry―and other sectors including health, education, and public administration. Although persistent concerns have been raised regarding low wages and poor working conditions in the social welfare services sector, prior studies have predominantly relied on occupational classifications rather than industry-level comparisons, resulting in largely descriptive analyses and limited empirical investigations into wage disparities. Using the Local Area Labour Force Survey conducted by Statistics Korea between 2013 and 2023, we longitudinally analyse trends of wage differentials between the core and other sectors in the social service industry. The Oaxaca-Blinder decomposition was applied to analyse mean wage differentials, while distributional differences were examined through an integrated approach combining the Recentered Influence Function (RIF) and the Oaxaca-Blinder method. The findings reveal that the hourly wage gap has gradually narrowed over the past decade, while the gap in monthly earnings has widened. Moreover, changes in the magnitude and structure of wage differentials varied across the wage distribution, with shifts in the workforce composition within the social welfare services sector significantly contributing to these changes. Based on these results, the study discusses the necessity of policy interventions aimed at improving the compensation structures and enhancing the quality of employment for workers in the social service industry.

Article III: Ethical Issues and Social Acceptance of AI-Based Health Risk Prediction Tools Lim Jae Kang, Former Professor of Kyungwoon University

This study conducts a comparative analysis of the ethical issues and social acceptance of artificial intelligence (AI)-based health risk prediction tools in the United States, the European Union (EU), South Korea, and China. While such tools offer transformative potential for early disease detection, personalized treatment, and healthcare resource optimization, they also pose significant ethical challenges, including concerns over data governance (privacy, security, consent), algorithmic integrity (bias, fairness), transparency and explainability, accountability, and the risk of discrimination. The findings indicate that while these regions share common concerns, they differ in their normative priorities: the EU emphasizes fundamental rights protection, the US focuses on health equity, China prioritizes social stability, and South Korea seeks a balance between innovation and regulation. Social acceptance also varies widely: China shows high optimism for medical AI, while the West expresses concerns, and South Korea remains cautious. Regulatory approaches reflect these differences, with the EU adopting comprehensive ex-ante regulation, the US favoring a sector-specific approach, China pursuing goal-oriented control, and South Korea implementing a risk-based framework. These variations are shaped by cultural norms, political structures, economic priorities, and technological readiness, offering key insights for global AI governance, international cooperation, and cross-border policy alignment.

Article IV: Barriers Influencing Human Papillomavirus (HPV) Vaccination Intentions among Men Who Have Sex with Men (MSM): A Scoping Review Kim Hye-Min, Ewha Womans University; Chae Won-Jeong, Kongju National University

This scoping review aimed to identify and synthesize the barriers that influence human papillomavirus (HPV) vaccination intention among unvaccinated men who have sex with men (MSM). A comprehensive literature search was conducted using major domestic and international academic databases from 2015 to 2024. Ten peer-reviewed studies met the inclusion criteria and were analyzed. The findings revealed four overarching thematic categories with twelve corresponding subthemes: financial barriers, such as high vaccination cost; healthcare provider-related factors, including lack of proactive recommendation; cognitive factors, including limited knowledge or awareness of HPV risks and vaccine benefits; and psychological factors, such as internalized stigma and uncertainty about sexual identity. This review highlights the multifaceted and intersecting nature of the barriers that MSM face in forming vaccination intentions, moving beyond a simple listing of individual factors. It emphasizes the need for multi-layered, culturally responsive public health interventions that address both structural and psychosocial determinants. Notably, the review identifies a significant research gap within the Korean context, where no relevant empirical studies were found. Therefore, it calls for the urgent development of localized research and evidence-based policies. Recommendations include providing inclusive and accessible health information, implementing LGBTQ+-sensitive provider training, and establishing financial support mechanisms to reduce cost-related barriers. These strategies may contribute to improving vaccine uptake and advancing health equity among sexual minority populations, thereby informing future national public health agendas.

Article V: Effect of Digital Health Literacy on Subjective Health Status: The Mediating Role of Health Management Confidence Shin Chaeeun; Kim Kyoung-Hoon; Song Inmyung, Kongju National University

Background: Digital health literacy refers to the ability to understand and utilize health information through digital media. This study analyzes whether the ability to understand and utilize digital health information affects health status and whether this relationship is mediated by self-efficacy in health management. Methods: The study used microdata from the 2021 Korea Institute for Health and Social Affairs survey on "Digital Health Accessibility and Personal Competency Factors." A total of 936 participants aged 20 to 69 were analyzed through multiple regression analysis and mediation analysis. The independent variable was digital health literacy, the mediator was self-efficacy in health management, and the dependent variable was subjective health status. Results: For every 1-point increase in digital health literacy, subjective health status increased by 0.022 points and self-efficacy in health management increased by 0.108 points (p<0.0001). The indirect effect of digital health literacy on subjective health status through self-efficacy in health management was 0.019 points, with 48.62% of the total effect explained by the mediation effect. Conclusion: Digital health literacy can directly or indirectly affect subjective health status through self-efficacy in health management. This study provides the first domestic evidence that digital health literacy can influence subjective health status through self-efficacy in health management.

Article VI: The Health Recovery Effects of Non-Return to Work as a Form of Involuntary Unemployment: Focusing on Older Industrial Accident Workers Choi Seoyoung, Sogang University

The purpose of this study is to analyze the effect of return to work on the health recovery of workers who have experienced industrial accidents. While previous research has primarily focused on the impact of health status on the return-to-work outcomes of injured workers, relatively little attention has been paid to the reverse relationship―that is, how return-to-work outcomes affect health recovery. However, labor market participation is not only a means of livelihood but also an opportunity to access a variety of social resources. From this perspective, failure to return to work can serve as a trigger for resource deprivation. In particular, this study examines how non-return to work influences health outcomes among older injured workers, a group that is both more vulnerable in terms of health and faces greater barriers to reemployment. To this end, we conducted multiple regression analyses using difference-in-differences(DID) and difference in difference in differences(DDD) designs with propensity score-based weighting. The results show that the effect of return to work on health recovery is more pronounced among workers aged 60 and above. Moreover, even when these workers returned to jobs with less stable employment conditions compared to their pre-injury positions, return to work still had a more positive effect on health recovery than non-return. These findings suggest that sudden labor market exit due to work-related health problems is particularly detrimental to the health of older workers. Therefore, it is necessary to strengthen return-to-work support policies for older injured workers, and when return is not feasible, to provide programs that help maintain livelihood, social relationships, and physical activity so as to prevent the negative health consequences of labor market exit.

Article VII: Perceived Social Capital and Multicultural Acceptance in South Korea: A Comparative Study of Migrant Workers, Refugees and Overseas Koreans Kwak YoonKyung, KIHASA; Yang Youngmi, Korea Social Convergence Institute

This study aims to examine the impact of perceived social capital among Korean adults on their multicultural acceptance of three distinct migrant groups: migrant workers, refugees, and overseas Koreans. Specifically, it seeks to examine how multicultural acceptance is shaped differently across these migrant categories by focusing on the sub-components of social capital. The study utilizes the raw data from the 2024 National Survey on Social Cohesion and conducts multiple regression analyses based on a sample of 3,011 Korean adults. The results reveal that both social trust and institutional trust exert a significant positive effect on multicultural acceptance toward refugees, whereas no statistically significant relationships were found for migrant workers and overseas Koreans. Furthermore, socio-demographic factors, including gender, generation, educational attainment, subjective income level, and frequency of contact with foreigners, were found to have varying influences on multicultural acceptance depending on the type of migrant group. These findings highlight the heterogeneous nature of multicultural attitudes within Korean society and underscore the importance of incorporating the role of social capital into the development of targeted social integration policies for different migrant populations.

Article VIII: A Study on the Factors Influencing Older Adults' Participation in and Frequency of Volunteering: An Analysis Using the Zero-inflated Negative Binomial Regression Kang Chulhee & Choi Seong Eon, Yonsei University

Volunteer activities among older adults play a crucial role not only in contributing to the public good but also in enhancing their physical and mental health and fostering social relationships. However, the volunteer participation rate of older adults in South Korea remains at a relatively low level. To promote wider participation, it is essential to build a deeper understanding of the phenomenon. This study examines the frequency of volunteer activity among older adults as the dependent variable and compares the results of the Negative Binomial Regression model with those of the Zero-Inflated Negative Binomial Regression model, in order to highlight the importance of applying an analytical method that reflects the data structure. The results show that the standard Negative Binomial model fails to adequately account for the excess zero values― representing non-participation―which may lead to inaccurate estimation of explanatory variables. In contrast, the Zero-Inflated Negative Binomial model, which is better suited to data with an excessive number of zeros, yields significantly different results. Specifically, only educational attainment (positive), housing status (renter), depressive symptoms (negative), and institutional trust (negative) were found to significantly influence the intensity of volunteering among older adults in the zero-inflated model. These findings suggest that, in order to achieve an accurate understanding of older adults’ volunteer behavior, it is crucial to apply analytical approaches that align with the characteristics of the data. This study underscores that the appropriate choice and application of statistical models are essential tasks in the knowledge-building process.

Article IX: A Study on the Determinants of Social Exclusion Types among Young Adult Single-Person Households Song Dohun; Jeong Kyu-Hyung; Kim Yiseul - Jeonbuk National University

This study aims to identify potential types of social exclusion experienced by young adults living alone and the factors that determine them. We analyzed data from 5,355 young adults aged 19-34 living alone, using the 2022 Youth Life Survey. Employing latent class analysis (LCA), we categorized social exclusion among these young adult households into three types: (1) employment, housing, and economic exclusion, (2) multiple exclusion, and (3) partial health and housing exclusion. For each type, the key determinants identified were gender, education level, region of residence, disposable income, and personal debt. These findings suggest that the social exclusion among young adults living alone is multidimensional, with interrelated effects including employment and economic insecurity, housing vulnerability, poor health, and social isolation. This study aims to provide policy and practical implications for addressing the multidimensional nature of social exclusion among young adults living alone.

Article X: Study the Experience of Public and Private Experts in Identifying and Supporting Solitary Death Risk Groups Ryu Ju Yeon, Daejeon Public Agency for Social Service; Joo Yeon Sun, Pai Chai University

The purpose of this study is to examine how public and private professionals identify and support individuals at risk of solitary death, in order to draw practical and policy implications for prevention. To this end, data were collected through focus group interviews with 10 public officials and 7 social workers involved in solitary death-related work, recruited via community referrals. The data were analyzed using content analysis. The analysis yielded 4 major themes and 15 subcategories. Focusing on the major themes, we found that recognizing the widening gaps in services is critical. However, difficulties in identifying those at risk are increasing, and even when they are identified, providing adequate support remains difficult. Furthermore, this study emphasized the need for a human safety net involving neighbors, along with a systematic and collaborative service delivery system, to better identify and support those at risk. Based on these findings, this study recommends continued attention to the characteristics of solitary death risk groups, expanding resources to address service gaps, and strengthening local community participation to prevent solitary deaths.

Article XI: Tasks for Improving the Patient Experience Assessment and Strengthening Patient-Centeredness in the Healthcare System: Results of a Qualitative Study of Patients KYoon Eunsil, Formerly at Seoul National University, Institute of Health Policy and Management; Song Yeongchae, Seoul National University; An Gijong, Korea Alliance of Patient Organizations; Do Young Kyung, Seoul National University

This study aimed to identify the current status and challenges of the selection pathway―a causal mechanism through which patient experience measurement and public reporting promote quality improvement in healthcare systems by influencing patients' choice of healthcare providers―and to identify key areas for improving the patient-centeredness in the healthcare system from the patient's perspective. Data were collected through focus group discussions and one-on-one in-depth interviews with patients, followed by thematic analysis. The analysis yielded twelve subthemes categorized under three main themes: i) perceptions and attitudes toward patient experience assessment, ii) comprehensive improvement for patient experience assessment survey systems, and iii) tasks for improving patient-centeredness in the healthcare system. Patients expressed strong support for the necessity and value of the Patient Experience Assessment, while also identifying areas of improvement to better activate the selection pathway. Furthermore, participants proposed long-term strategies for promoting a more patient-centered healthcare system, including comprehensive healthcare quality improvement, reforms in medical education, and systemic changes in the healthcare system. This study is significant in that it directly involved patients during the early stages of implementing the Patient Experience Assessment and contributed to understanding how effectively the selection pathway operates and identifying areas for improvement.

Article XII: A Study on the Factors Influencing Youth's Mental Health: Focusing on Personal and Social Factors Ko Jinsun, GoodWithUs Corporation; Choi Ahyoung, Korea Human Resource Development Institute for Health and Welfare; Hong Seojoon, Dongseoul University

This study verified how young adults’ mental health is affected by personal and social factors. To this end, data were collected through a structured survey of individuals aged 20 to 39, and hierarchical regression analysis was conducted. The main findings were as follows. Among personal factors, economic level, life satisfaction, positive emotions, and negative emotions had significant effects on mental health. Among social factors, social participation, social isolation, and social deprivation had significant effects. These results suggest that economic status is an important external factor, life satisfaction and positive/negative emotions are key internal factors, and social participation and social isolation are critical social factors affecting young adults’ mental health. Based on these findings, practical and policy recommendations were proposed to improve young adults’ mental health.

Article XIII: Development of a Dementia-Focused Advance Care Planning Coaching Program for Korean Older Adults Ha Jung-Hwa, Seoul National University; Lee Changsook, Ewha Institute for Age Integration Research, Ewha Womans University

The purpose of this research was to develop a coaching program to guide advance care planning (ACP) for older adults with dementia and their caregivers in Korea. To this end, we first analyzed five ACP guidance programs developed in other countries specifically for dementia patients and their caregivers. We identified the core components of these programs―including context, conceptual model, intervention, theory, mechanisms of action, and outcomesusing a logic model proposed by Lin et al. (2019). Programs in other countries typically focused on explaining the progression of dementia, assessing the level of understanding of dementia among patients and their caregivers, identifying the values and preferences of individuals with dementia regarding end-of-life care, and clarifying their goals of care in light of their values and preferences. Based on these findings, we developed a Korean ACP coaching program. During this process, we incorporated feedback from professionals working in dementia care settings. The core elements of the program were adapted to fit the Korean cultural context. The detailed program protocol was developed using the same logic model we used in analyzing previous research. The program we developed aims to provide support for not only individuals with dementia and their families, but also the broader older adult population, with opportunities to reflect on their values and preferences regarding end-stage dementia care and to discuss these matters with their families or care providers.

Article XIV: Longitudinal Study on the Effects of Social Cognitive Factors on Changes in Life Satisfaction among Persons with Disabilities Yu Seunghee, Kookmin University

This study investigated changes in life satisfaction among persons with disabilities and the influence of social cognitive factors on these changes, using a latent growth model. The analysis was based on data from the Disability and Life Dynamics Panel, focusing on 3,962 adults with disabilities. The results revealed that life satisfaction among persons with disabilities steadily increased over time. The rate of increase in life satisfaction was higher among men than women. Individuals with severe disabilities had lower initial life satisfaction than those with mild disabilities. Higher levels of disability perception and acceptance were associated with higher initial life satisfaction, but the rate of increase was attenuated. Greater suppression of emotional expression was linked to lower initial life satisfaction, whereas effort due to disability was associated with higher initial levels. Household income, emotional support from family, convenience of residential area, and emotional support from others all contributed to higher initial life satisfaction. However, emotional support from others was also found to moderate the rate of increase in life satisfaction. Greater social isolation was associated with lower initial life satisfaction. Based on these findings, this study proposes strategies to enhance the life satisfaction of persons with disabilities through improvements in education and the environment.

Article XV: A Study on the Health Literacy of Medical Aid Recipients: Based on Data from the Korean Health Panel (KHP) Rhee YungSeon, Chosun University

Background: Health literacy is a key factor in achieving health equity, and its importance is particularly emphasized among vulnerable populations such as Medical Aid recipients. Methods: This study used data from the 2021 supplementary survey of the Korean Health Panel (KHP) to examine the level of health literacy among Medical Aid recipients and identify related factors. Results: Health literacy among Medical Aid recipients was significantly lower than that of National Health Insurance members, especially in areas requiring complex understanding such as disease-related information search, determining the need for further treatment, and managing mental health. Multiple regression analysis identified education level, anxiety, subjective health status, chronic disease, and access to a regular healthcare provider as significant factors. Conclusion: This study empirically demonstrates the vulnerability of Medical Aid recipients in health literacy and emphasizes the need for policy interventions to improve their access to and understanding of health information.

Article XVI: Predictors of Emotions in Staff Supporting Challenging Behaviors of People with Developmental Disabilities: A Decision Tree Analysis Kim, Miok, Junbuk National University; Kim Goeun, Kwangwoon University; Jung Eunhye, Korea Nazarene University

This study aimed to explore the predictors of negative emotions among staff members at day service centers for people with developmental disabilities who support challenging behaviors. Data from 305 respondents were analyzed using decision tree analysis, which is well-suited for intuitive exploration. The analysis revealed that higher levels of negative emotions were found among staff working in environments with a high proportion of users exhibiting challenging behaviors, frequent daily challenging behaviors, and limited training. Even when ample training was provided, staff members who had frequent experiences of injury reported higher levels of negative emotions. Additionally, staff in institutions with lower proportions of users showing challenging behaviors but with frequent physical interventions, frequent injury experiences, and a lack of individualized behavior support plans also reported higher negative emotions. These findings identify key predictors of negative emotions among staff supporting challenging behaviors and suggest implications for effective support strategies.

Article XVII: A Scoping Review of Health Research on Female Marriage Migrants Choi Jihee, KIHASA; Park Eunja, KIHASA; Jun Jina, KIHASA; Lee Eunie Hong Lim, KIHASA; Kwak YoonKyung, KIHASA; Chun Heeran, Jungwon University; Lee Nagyeong, KIHASA

South Korea, which had previously discussed its transition to a multicultural society, has now become one. Since the mid-2000s, international marriages have consistently accounted for around 10% of all marriages annually, and female marriage migrants have become a significant demographic group within Korean society. However, academic and policy interest in these women has not adequately reflected this societal shift. This study conducted a scoping review of academic research on the health of female marriage migrants in South Korea over the past 20 years, starting from 2004. Based on an in-depth analysis of research topics and methodologies, this study examined the trends and characteristics of health research on marriage migrant women in Korea, aiming to contribute to the expansion of relevant studies and the development of evidence-based policies for women. The analysis revealed a concentration of published studies during the early phases of the Multicultural Family Policy Basic Plan (1st and 2nd phases). There was an imbalance between studies assessing basic health status and those exploring health determinants. Moreover, there was a lack of intervention studies and nationwide surveys that could serve as evidence for health policy. To identify the wide range of health issues facing female marriage migrants and to accumulate reliable research findings, it is necessary not only to expand the quantity of related studies but also to enhance their quality.

Article XVIII: Types of Adverse Life Experiences in Adulthood for Isolated and Reclusive Young Adults Ahn Seon-Kyeong, Ewha Womans University; Kim Soyoun, Ewha Womans University; Chung Ick-Joong, Ewha Womans University

This study utilized Latent Class Analysis (LCA) to classify types of adverse experiences in adulthood among socially isolated and reclusive young adults and to examine differences in characteristics and mental health across these groups. Using data from the 2022 Seoul Metropolitan City Isolated and Reclusive Young Adults Survey, 447 participants were selected as the study sample. The findings are as follows: First, the adverse life experiences in adulthood among isolated and reclusive young adults were classified into four types: Complex Adversity Type (n=131, 29.3%), Employment Frustration Type (n=143, 32.0%), Relationship Conflict Type (n=75, 16.8%), and Low-Risk Type (n=98, 21.9%). Second, the analysis revealed significant differences among the types in age, education level, subjective health, use of mental health medication, and subjective household economic status among the individual and household factors. Additionally, concerning factors related to isolation and reclusion, pre-adult negative life experiences showed significant group differences; however, the period of isolation and reclusive life was not significant. Third, significant differences in depression and loneliness were identified across the types of adverse life experiences in adulthood. This study empirically demonstrated that even among young adults who share the common experience of social isolation and reclusion, heterogeneity may exist depending on their experiential characteristics and that the patterns and mechanisms of isolation and reclusion are diverse.

Article XIX: Suicidal Ideation and Its Influencing Factors between Individuals with and without Disabilities Koh Seongjo, Catholic University of Korea; Im Youngjae, Mokwon University; Kwon Hey-young, Mokwon University

This study aims to compare the prevalence of suicidal ideation between individuals with and without disabilities and to explore how factors influencing suicidal ideation differ between the two groups. For this, two secondary datasets―the 2023 National Survey on the Disabled (NSD) and the Korea National Health and Nutrition Examination Survey (KNHANES)―were integrated using a propensity score matching technique. A 1:1 matched dataset was established, comprising 4,149 people with disabilities and 4,149 people without disabilities, matched based on gender and age. Stepwise logistic regression analysis was conducted to examine the factors associated with suicidal ideation. The results indicated that individuals with disabilities were 1.746 times more likely to experience suicidal ideation than those without disabilities. The most significant predictor of suicidal ideation across both groups was depressive mood (OR=11.639). High stress (OR=2.405) increased, whereas high self-rated health (OR=0.409) decreased the likelihood of suicidal ideation. Subgroup analysis showed that among individuals with disabilities, suicidal ideation was significantly associated with depressive mood (OR=12.221), stress (OR=2.295), high self-rated health (OR=0.413), being married (OR=0.704), being employed (OR=0.546), and drinking (OR=1.542). In contrast, among individuals without disabilities, suicidal ideation was significantly associated with depressive mood (OR=10.672), stress (OR=2.755), high self-rated health (OR=0.404), and equivalized income (OR=0.998). The findings underscore the need for disability-tailored mental health interventions and suicide prevention strategies, particularly emphasizing employment support and initiatives to improve self-rated health.

Article XX: The Impact of Having a Usual Source of Care on Healthcare Expenditure among Patients with Chronic Musculoskeletal Disorders Park Jeonghee, National Cancer Center; Lim Youna, KIHASA

This study investigates the impact of having a Usual Source of Care (USC) on medical expenditures among patients with chronic musculoskeletal disorders, with a focus on strengthening primary care. Using data from the Korea Health Panel (2019？2021), we applied a linear mixed model with fixed effects to analyze adult patients diagnosed with chronic musculoskeletal conditions. The analysis revealed that individuals who had both a usual care institution and physician incurred higher annual medical expenditures compared to those without a USC. However, those who had both an institution and a physician showed lower per-visit outpatient costs than those with only an institution. Notably, the cost-reducing effect on outpatient visits was most pronounced among patients in poor self-rated health with multiple chronic conditions. Conversely, among Medicaid beneficiaries, annual medical expenditures increased more substantially with USC, suggesting improved access to care for medically underserved populations. These findings indicate that having a USC can play a crucial role in enhancing the function of primary care. A USC may enable patients to receive continuous and comprehensive care, maintain their health more effectively, and reduce unnecessary or emergency service utilization, thereby contributing to more efficient healthcare spending. By focusing on chronic musculoskeletal disorders, this study provides empirical evidence on the effectiveness of USC and offers policy implications for developing primary care-based chronic disease management systems in Korea.

Article XXI: Future Realization Gaps and Depression among Young Adults: Regional Differences in the Moderating Role of Social Networks Choi Yoon Hee, Yonsei University; Kim Seon Mi, Yonsei University; Lim Eun Hyo, Yonsei University

This study explores depression among young adults by investigating the relationship between future realization gaps and social networks. We define the future realization gap as the perceived discrepancy between one’s current status and desired future aspirations. Using data from 14,966 participants aged 19 to 34 from the 2022 Youth Life Survey, we employed generalized linear models (GLM) to analyze how this gap affects depression and whether social networks moderate this relationship. Analyses were conducted separately for metropolitan and non-metropolitan residents. Results demonstrate that larger future realization gaps are significantly associated with higher depression levels in both regions. Although social networks did not show a direct effect on depression, significant interaction effects emerged. In metropolitan areas, social networks moderated the relationship between parental educational achievement gaps and depression. In non-metropolitan areas, social networks buffered the effects of both parental economic status gaps and individual’s educational achievement gaps on depression. These findings suggest that social networks serve as protective factors that mitigate the adverse mental health consequences of perceived resource deficits. However, the mechanisms vary by regions, highlighting the need for location-specific interventions to support young adults’ mental health.

Article XXII: A Study of Precarious Labor and Its Determinants of Precarious Labor in New Middle-Aged Adults: Using Group Based Trajectory Analysis Lee Sungwoo, Seoul National University; Choi Haebin, Seoul National University

This study examines perceived labor market instability among middle-aged individuals, categorizing it by employment status, income level, and social insurance expectations, and analyzing the factors that influence precarious labor experiences of new middle-aged adults. Utilizing data from the 5th to 9th waves (2014-2022) of the Korean Longitudinal Study of Aging (KLoSA), managed by the Korea Employment Information Service, this research employs group-based trajectory modeling to categorize labor market trajectories. The analysis identifies five distinct precarious labor archetypes: (1) Low-income Non-wage Workers, (2) Low-income Self-employment-oriented Workers, (3) Middle-income Self-employed Workers, (4) Low-to-middle-income Unskilled Workers, and (5) High-income Full-time Workers. Key determinants influencing these trajectories include gender, age, educational attainment, quality of life, and employment stability. The findings elucidate the dynamic labor market transitions experienced by new middle-aged individuals and offer significant implications for policy development and scholarly research, emphasizing the need to address the specific vulnerabilities and roles of this population.

Article XXIII: Factors Influencing the Intention to Use Primary Care Physicians among People with Disabilities: Focusing on People with Severe Disabilities Jang Hyekyong, Chung Ang University; Lee Weonyoung, Chung Ang University

This study aimed to identify the factors influencing the intention to use primary care physicians (PCPs) among people with severe disabilities (hereafter "severe disabilities") and to provide evidence for strengthening the PCP program for people with disabilities. Data were drawn from the 2020 National Survey on Persons with Disabilities, and a total of 3,157 individuals with severe disabilities were analyzed. Andersen’s Behavioral Model was used as the theoretical framework. Chi-square tests were performed to assess associations between predisposing, enabling, and need factors and the intention to use a PCP. Multiple logistic regression analysis was conducted to identify significant predictors. The proportion of those intending to use a PCP was 49.6%. Significant predictors included age (predisposing factor); region, healthcare service use, sources of welfare information, experiences of difficulties due to COVID-19, health check-ups, and awareness of the PCP system (enabling factors); and self-rated health status, chronic disease, type of disability, need for assistance in daily living, and depressive symptoms (need factors). Notably, sources of welfare information and awareness of the PCP system emerged as key factors. Direct information from welfare, administrative, or religious organizations was more effective than mass media in promoting intention to use the service. These findings highlight the need for targeted outreach and awareness strategies to reduce regional disparities and enhance the nationwide implementation of the PCP system for people with disabilities.