Author(s): KIM, S.Y., CHOI, Y., KIM, Y., Institution: SEOUL NATIONAL UNIVERSITY, Country: KOREA, SOUTH, Abstract-ID: 790

INTRODUCTION:
Emotional distress (ED) is known as a critical risk factor for mortality. The suicide rate in South Korea has been the highest among OECD nations, emphasizing the need for effective interventions to mitigate this risk associated with ED. Current physical activity (PA) guidelines recommend adults to engage in at least 150 min/wk of moderate to vigorous PA (MVPA) to prevent and manage health problems. However, the protective effect of PA against mortality in individuals with ED remains unclear. This study aims to investigate the impact of PA on mortality in individuals with ED.
METHODS:
This study included 35,059 Korean adults from the 2007-2013 Korea National Health and Nutrition Examination Survey, with their all-cause and cardiovascular disease (CVD) mortality data linked up to 2019. ED was assessed using a self-reported questionnaire that evaluated the presence of stress, depressive symptoms (DS), and suicidal thoughts (ST). MVPA levels were also determined by questionnaires and classified as inactive (0 min/week), insufficiently active (<150 min/wk), and active (>=150 min/wk). Cox proportional hazards model was applied to estimate the risks of mortality associated with ED and MVPA levels. The study also assessed the combined effect of emotional status and MVPA on the risk of mortality. In a combined analysis investigating the association between ED and mortality risk across different levels of MVPA, six groups were categorized based on the presence of ED and MVPA levels (inactive, insufficiently active, active).
RESULTS:
Over a mean follow-up of 9.2 years, 2,033 deaths occurred, including 439 from CVD. The hazard ratios (HR) for all-cause mortality due to stress, DS, and ST were 1.13 (95% CI: 1.02-1.26), 1.13 (1.00-1.27), and 1.34 (1.21-1.49), when compared to non-affected individuals. For those with all three ED categories, the HRs for all-cause and CVD mortality were 1.31 (1.10-1.55), and 1.72 (1.24-2.39). Adhering to PA guidelines was significantly associated with lower risk of mortality: 0.76 (0.62-0.94) for stress, 0.71 (0.55-0.92) for DS, and 0.76 (0.62-0.95) for ST. Similarly, CVD mortality risks were reduced to 0.47 (0.29-0.77), 0.43 (0.23-0.79), and 0.65 (0.41-1.02) for stress, DS, and ST, respectively. In the combined analysis, individuals with ED who engage in PA (either insufficiently active (HR =0.75 (0.57-0.98) or active (HR=0.79 (0.67-0.93)) were associated with a lower risk of all-cause mortality compared to those without ED but who were inactive (HR=0.83 (0.74-0.93)). Similar patterns of associations were observed for CVD mortality.
CONCLUSION:
ED and MVPA were both independent predictors for risk of mortality. The higher risk of mortality associated with ED was significantly reduced by adherence to PA guidelines. Combined analysis also indicated that PA is associated with a lower mortality risk in individuals with ED, emphasizing the importance of promoting PA as a key strategy for reducing mortality risk in public health.