Korean Journal of Family Medicine

Association between mild depressive symptoms and annual changes in bone mineral density among South Korean women: a retrospective study: Jiyoung Baek, Hyemin Kim, Seo Eun Hwang, Kyungha Min; Received October 29, 2025 Accepted February 20, 2026 Published online June 16, 2026; DOI: https://doi.org/10.4082/kjfm.25.0313 [Epub ahead of print]

Background
Depression is associated with various physical conditions, including bone metabolism. Most previous studies were cross-sectional, and longitudinal findings regarding osteoporosis or fracture risk remain inconsistent. This study examined the association between mild depressive symptoms and annual changes in bone mineral density (BMD) among women undergoing repeated dual-energy X-ray absorptiometry (DEXA).
Methods
We retrospectively analyzed 1,629 women aged ≥20 years who completed the Patient Health Questionnaire-9 (PHQ-9) and underwent at least two DEXA scans between 2017 and 2023. Mild depressive symptoms were defined as PHQ-9 scores of 5–9. Annualized BMD changes at the lumbar spine, femoral neck, and total femur were calculated. Multivariable linear regression analyses adjusted for age, body mass index, smoking, alcohol consumption, physical activity, and diabetes. Women with PHQ-9 ≥10, only one DEXA scan, T-score ≤–2.5, or missing PHQ-9 data were excluded.
Results
Mild depressive symptoms were not significantly associated with annualized BMD change in the overall cohort. However, among women aged ≥60 years (n=1,047), PHQ-9 scores of 5–9 were associated with more negative annualized BMD changes at the femoral neck (β=–3.26; 95% confidence interval [CI], –5.92 to –0.61; P=0.016) and total femur (β=–2.24; 95% CI, –4.39 to –0.09; P=0.041), but not at the lumbar spine.
Conclusion
In women aged ≥60 years, mild depressive symptoms were negatively associated with annual BMD change. Given the close relationship between femoral BMD and hip fracture, even modest negative shifts may be clinically meaningful in older women.

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Association between Salivary Mitochondrial DNA Copy Number and Chronic Fatigue according to Combined Symptoms in Korean Adults: Jinyoung Shin, Kyong Chol Kim, Duk Chul Lee, Hye Ree Lee, Jae Yong Shim; Korean J Fam Med 2017;38(4):206-212. Published online July 20, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.4.206

Background

We examined the association between salivary mitochondrial DNA (mtDNA) copy number and chronic fatigue combined with depression and insomnia.

Methods

This cross-sectional study included 58 healthy adults with moderate to severe fatigue (Brief Fatigue Inventory [BFI] ≥4) for longer than 6 months. Subjects were classified as those without combined symptoms, with either depression (Beck Depression Inventory [BDI] ≥13) or insomnia (Pittsburgh Sleep Quality Index [PSQI] ≥5), or with both depression and insomnia. Salivary mtDNA copy number was measured by real-time quantitative polymerase chain reaction. The association was evaluated using a general linear model.

Results

About 76% of participants had either depression or insomnia as additional symptoms. These subjects were predominately female, drank more alcohol, and exercised less than those without combined symptoms (P<0.05). The group with both depression and insomnia exhibited significantly higher BFI and lower mtDNA copy number than those without combined symptoms (P<0.05). After adjusting for confounding factors, significant negative associations between mtDNA copy number and usual fatigue were found in the group without combined symptoms, whereas the negative associations in the group with combined symptoms were attenuated. BDI and PSQI were not associated with mtDNA copy number.

Conclusion

Chronic fatigue is negatively associated with salivary mtDNA copy number. Salivary mtDNA copy number may be a biological marker of fatigue with or without combined symptoms, indicating that a separate approach is necessary.

Citations

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Heart Rate Variability in Major Depressive Disorder.: Jeong A Kim, Youn Seun Choi, Kyung Hwan Cho, Myung Ho Hong; J Korean Acad Fam Med 2003;24(12):1117-1122. Published online December 10, 2003

Abstract
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In foreign country, lots of studies were reported about the relationship between heart rate variability (HRV) and cardiac mortality. Lower HRV has been identified as a independent risk factor for sudden death. By the time, the study of HRV is confined to physically diseased state such as myocardial infarction or diabetic neuropathy. However recently the tendency of HRV has been toward to make clear the relationship of HRV and psychological problem. It is well known that depressed person is affected frequently by cardiovascular disease compared with normal people. However the mechanism that depression increases cardiovascular disease is not definitely found even though the autonomic dysfunction measured in HRV is suggested a factor for this mechanism. Depressed person has decreased HRV, decreased low frequency which reflects sympathetic activity, decreased high frequency which reflects parasympathetic activity. It means they have lower autonomic activity, so they have high cardiac mortality.

Few physician knows about the utility of heart rate variability and in my thought, especially short time analysis and frequency domain method is first introduced in Korea.

So we introduce this case for as many as physician know the utility of HRV.