Journal of Affective Disorders 338 (2023) 482–486

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Journal of Affective Disorders

journal homepage: www.elsevier.com/locate/jad

Research paper

Study on relationship between self-recognition of voice disorder and mental

health status: Korea National Health and Nutrition Examination Survey
Hyun-Bum Kim a, Youn-Sun Park a, Ju-Eun Lee a, Kyung-Do Han b, Young-Hak Park a, *
a
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
b
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea

A R T I C L E I N F O A B S T R A C T

Keywords: Background: The voice has been thought to be associated with emotions, but conducting large-scale research on
Voice disorders this relationship has some limitations. To overcome these limitations, questionnaires have been utilized as a
Mental health research tool.
Stress
Methods: A population-based cross-sectional study was done. A total of 15,977 participants completed ques­
Psychological
tionnaires regarding self-recognition of voice disorder (SRVD), and mental health status.
Depression
Suicide Results: 1053(6.6 %) participants answered that they had SRVD. In the multivariate Cox proportional hazard
model, psychological stress (Hazard ratio (HR) = 1.371, 95 % confidence interval (CI) = 1.154–1.629),
depressive symptoms (HR = 1.626, 95 % CI = 1.323–1.997), suicidal ideation (HR = 1.739, 95 % CI =
1.418–2.133), and suicide attempt (HR =2.206, 95 % CI = 1.067–4.56) were all associated with SRVD. In SRVD
lasting over three weeks, psychological stress (HR = 1.604, 95 % CI = 1.278–2.014), depressive symptoms (HR
= 1.807, 95 % CI = 1.384–2.36), and suicidal ideation (HR = 2.073, 95 % CI = 1.587–2.709) were also sig­
nificant factors. As the number of mental health problems increased, the odds ratio of both SRVD (OR = 2.49, 95
% CI = 1.839–3.37) and SRVD lasting over three weeks (OR = 3.254, 95 % CI = 2.242–4.725) increased,
respectively.
Limitations: SRVD and mental health status were judged only by simple questionnaires. Cross-sectional design
and retrospective data could not draw causal relationships.
Conclusions: SRVD and SRVD lasting over three weeks had a significant relationship with mental health status,
including psychological stress, depressive symptoms, and suicidal ideation. There is a need to consider psychi­
atric treatment for individuals who visit hospitals with voice disorders.

1. Introduction questionnaires written by patients have been used. Specifically, surveys

Voice has been thought to be associated with emotion. For this
reason, many studies have been conducted on the relationship between
voice and mental health status. Mundt et al. (Mundt et al., 2007) re­
ported that depression affected speech, and several voice acoustic
measures were significantly correlated with depression severity.
Recently, vocal biomarkers, including jitters and cepstral peak
prominence-smoothed, used widely for voice analysis, were tried for
diagnosing depression (Ozkanca et al., 2019; Silva et al., 2021). How­
ever, voice analysis is not easy because there are many restrictions, such
as an insufficient number of medical staff, measuring instruments, and
budget. Therefore, instead of performing voice analysis directly,
conducted at the national level using big data have made it possible to
study the relationship between voice and health or disease. Marmor
et al. (Marmor et al., 2016) reported that the presence of depressive
symptoms was associated with a nearly two-fold increase in the likeli­
hood of voice problems and that there was a significant relationship
between depressive symptoms and the reception and effectiveness of
voice therapy, using big data from the United States. Korea has one of
the best health insurance systems, and the Korea Centers for Disease
Control and Prevention (KCDC) conducts the Korea National Health and
Nutrition Examination Survey (KNHANES) every year and discloses the
results. These data have been used across many fields of medicine.
Byeon et al. (Byeon, 2015) reported that smoking was independently

* Corresponding author at: Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 10, 63-ro,
Yeongdeungpo-gu, Seoul 07345, Republic of Korea.
E-mail address: yhpark7@catholic.ac.kr (Y.-H. Park).

https://doi.org/10.1016/j.jad.2023.05.082
Received 5 October 2022; Received in revised form 21 May 2023; Accepted 22 May 2023
Available online 27 May 2023
0165-0327/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
H.-B. Kim et al. Journal of Affective Disorders 338 (2023) 482–486

associated with voice disorders using the results of the survey. Park et al. Institute, Cary, NC) and SUDAAN, release 10.1 (Research Triangle
(Park and Choi, 2016) reported that asthma was associated with sub­ Institute, Research Triangle Park, NC, USA), a software package that
jective dysphonia but not associated with organic laryngeal lesions. incorporates sample weights and adjusts analyses for the complex
We hypothesized that there was a more significant relationship be­ sample design of the survey. Survey sample weights were used in all
tween voice disorders and mental health status in the general popula­ analyses to produce estimates that were representative of the non-
tion. We also planned to analyze whether there were differences institutionalized civilian Korean population.
between American society and East Asian society.
3. Results
2. Methods
Between 2010 and 2012, 15,977 people participated in the 5th
2.1. Data source KNHANES. Of them, 1053 (6.6 %) participants answered that they had
SRVD. The mean age of the SRVD group was significantly higher than
We obtained data from the 5th KNHANES between 2010 and 2012 by the normal group (*P < 0.001). Men were dominant in the total par­
the Division of Chronic Disease Surveillance under KCDC, and the ticipants, but women were dominant in the SRVD group (*P < 0.001).
Korean Ministry of Health and Welfare. The survey has been conducted The SRVD group had a higher proportion of the lowest quartile by in­
annually since 1998 and contains questionnaires about the health and come (*P < 0.001), while a lower proportion of high education level
nutritional status of common civilians in the Republic of Korea. The (over 13 years) (*P < 0.001). The SRVD group had a higher proportion
sampling units were defined based on household unit data, including of non-smokers, and a lower proportion of current smokers, however,
geographic area, sex, and age, obtained from the 2010 National Census there was no difference in smoking status between the SRVD group and
Registry in Korea. The survey used a stratified multistage probability the normal group (P = 0.084). The percentage of mild drinkers among
sampling method with a rolling sampling model so that a representative drinking status was the highest in both groups, but the percentage of
sample of the civilian, non-institutionalized population was obtained. non-drinkers was higher in the SRVD group than in the normal group
Data from KCDC may be sued by the public. significantly (*P < 0.001). Asthma (*P = 0.004) and hypertension (*P =
0.005) were significantly higher in the SRVD group compared to the
2.2. Measurement normal group, but there was no difference in allergic rhinitis (P =
0.065), diabetes (P = 0.810), or hyperlipidemia (P = 0.294) between the
The questionnaires are divided into three categories: health inter­ groups. Also, there was no difference in employment status (P = 0.197),
view survey, health examination survey, and nutritional survey. The presence of physical activity (P = 0.439), body mass index (P = 0.428),
data on voice disorders were obtained from a health examination sur­ or waist circumference (P = 0.712) (Table 1).
vey, composed of two-stage questions. First, all participants answered In the multivariate Cox proportional hazard model, psychological
the following question: “Do you think there is something wrong with stress (hazard ratio (HR) = 1.371, 95 % confidence interval (CI) =
your voice right now?” Subjects who answered “yes” to the preceding 1.154–1.629), depressive symptoms (HR = 1.626, 95 % CI =
question were classified as having self-recognition of voice disorder 1.323–1.997), suicidal ideation (HR = 1.739, 95 % CI = 1.418–2.133),
(SRVD) and had to answer the following question: “How long has it been and suicide attempt (HR = 2.206, 95 % CI = 1.067–4.56) were all
since you thought there was something wrong with your voice?” Sub­
jects had to choose between “less than 3 weeks” and “3 weeks or more”.
The data on mental health problems were obtained from a health Table 1
interview survey. The mental health status was assessed by three ques­ Socio-demographic and clinical characteristics of the fifth Korea National Health
tions: psychological stress, depressive symptoms, and suicidal ideation. and Nutrition Examination Survey between 2010 and 2012 (N = 15,977).
Psychological stress was assessed based on responses to the following Parameter Self-recognition of voice disorder P-value
question: “Do you experience psychological stress in your daily life?” No (n = 14,924) Yes (n = 1053)
Then, the subjects' psychological stress levels were reported through a
Age (years) 44.69 ± 0.24 48.49 ± 0.66 <0.001*
four-point Likert scale as “severe” “much” “mild” or “rare”. As the Sex (Men), % 50.28 (0.42) 39.27 (1.98) <0.001*
purpose of this study was only to analyze the relationship between voice Income (lowest quartile 1), % 14.68 (0.53) 21.19 (1.69) <0.001*
disorder and mental health status, we classified only those reporting Education (≥13 years), % 72.5 (0.68) 65.54 (2.01) <0.001*
“severe” as having psychological stress. Depressive symptoms were Occupation (Yes), % 65.61 (0.58) 63.2 (1.86) 0.197
Smoking status 0.084
assessed based on responses to the following question: “Has your daily Non-smoker, % 56.71 (0.49) 61.01 (1.82)
life been burdened by feelings of sadness or hopelessness for two or more Ex-smoker, % 17.4 (0.38) 16.1 (1.29)
continuous weeks during the past year?” The subjects were classified as Current smoker, % 25.89 (0.51) 22.89 (1.73)
having depressive symptoms if they answered, “yes”. Suicidal ideation Drinking status <0.001*
Non-drinker, % 22.32 (0.48) 29.01 (1.67)
was assessed based on responses to the following question: “Have you
Mild-drinker, % 67.41 (0.53) 62.15 (1.77)
ever thought about committing suicide during the past year?” If the Heavy drinker, % 10.27 (0.33) 8.84 (1.21)
subjects answered “yes” they were classified as having suicidal ideation Asthma, % 2.72 (0.17) 4.52 (0.77) 0.004*
and had to answer the next question: “Have you ever attempted suicide Allergic rhinitis, % 14.93 (0.44) 17.8 (1.67) 0.065
during the past year?” The subjects were classified as having a suicide Hypertension, % 26.5 (0.53) 31.32 (1.83) 0.005*
Diabetes, % 8.31 (0.29) 8.53 (0.9) 0.810
attempt if they answered, “yes”. Therefore, a total of 4 questions were
Hyperlipidemia, % 12.35 (0.33) 13.55 (1.16) 0.294
used to analyze mental health status. Physical activity (Yes), % 19.81 (0.51) 21.14 (1.67) 0.439
Other factors, including income, education, and occupation, were Body mass index (kg/m2) 23.69 ± 0.04 23.81 ± 0.15 0.428
also obtained by the questionnaires. Drinking status was classified based Body mass index (kg/m2) detail 0.749
<18.5, % 4.95 (0.24) 4.97 (0.9)
on frequency in one week and the amount on one occasion. Physical
<23, % 40.32 (0.54) 38.27 (2.03)
activity level was assessed by the International Physical Activity Ques­ <25, % 22.68 (0.43) 24.02 (1.68)
tionnaire. Data on past disease history were obtained in the responses. <30, % 27.76 (0.48) 27.64 (1.64)
≥30, % 4.29 (0.24) 5.1 (0.95)
2.3. Statistical analysis Waist circumference (cm) 81.02 ± 0.14 81.17 ± 0.4 0.712

Values are the mean ± SE or % (SE).

Statistical analyses were performed using SAS, version 9.2 (SAS *
Significant at P < 0.05.

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significantly associated with SRVD when adjusted for age, gender,
smoking, drinking, physical activity, income, education, hypertension,
diabetes, asthma, and allergic rhinitis (Table 2). In SRVD lasting over
three weeks, psychological stress (HR = 1.604, 95 % CI = 1.278–2.014),
depressive symptoms (HR = 1.807, 95 % CI = 1.384–2.36), and suicidal
ideation (HR = 2.073, 95 % CI = 1.587–2.709) were significant factors.
However, suicide attempt (HR = 2.197, 95 % CI = 0.785–6.151) was not
a significant factor (Table 3). We also investigated the correlation be­
tween the number of mental health problems and SRVD, and SRVD
lasting over three weeks. The suicide attempt was excluded from the
number of mental health problems because that question was only for
those who answered that they had suicidal ideation. As we analyzed a
total of three questions, the greater the number of mental health prob­
lems, the higher the odds ratio of both SRVD and SRVD lasting over
three weeks. When there were all three mental health problems, the
odds ratio of SRVD and SRVD lasting over three weeks were the highest
at 2.49 (95 % CI = 1.839–3.37) and 3.254 (95 % CI = 2.242–4.725),
respectively (Tables 4, 5).
4. Discussion
Voice is one of the difficult physical symptoms to study. First, too
many factors influence the voice: sex, age, height, weight, pharynx and
larynx structure, pulmonary function, hormonal change, even emotional
problems, and phonation habits (McAllister and Sjolander, 2013). Sec­
ond, the range of the initial normal voice is too diverse, and the criteria
for abnormality are different. For example, professional voice users such
as vocalists and singers often come to the clinic due to functional voice
deterioration even if they have a normal voice without any pathophys­
iologic changes. On the other hand, some people, including those with
muscle tension dysphonia, do not seek medical attention because they
are unaware of their voice problems. There are even cases in which
having a rough voice or nasal voice can be beneficial for one's career. For
these reasons, researching the voice itself is important, but it is also
crucial to study the past and present voice changes for each individual.
One research method for this is conducting questionnaires. In Korea,
there are highly developed health insurance systems and national-level
health checkups that are conducted, leading to a high percentage of the
population receiving them. The collected data is disclosed after being
anonymized. In health checkups, many kinds of questionnaires are
included.
In this study, mental health problems were estimated by four
questions covering psychological stress, depressive symptoms, suicidal
ideation, and suicide attempt. Because mental health problems are so
difficult to quantify, these four questions cannot represent the severity of
those. However, it can be said that mental health status generally gets
worse when it progresses from psychological stress to suicide attempts.
Conejero et al. (Conejero et al., 2018) utilized the term “psychological
pain” to describe a symptom present in depression. They reported that
the higher levels of psychological pain, the greater the severity of
depression and suicidal ideation. O'Neill et al. (O'Neill et al., 2021) re­
ported that people who have suicide attempts tended to be more self-
criticism. Self-criticism had been described as behavior including own
self-evaluation and critical, hostile, and persecuting sense (O'Neill et al.,
2021). Self-criticism had been associated with self-harm, depression,
and several psychopathologic diseases (Gilbert et al., 2004; Gilbert et al.,
2010; Irons et al., 2006). Considering SRVD as one kind of self-criticism,
the high correlation between SRVD and four mental health problems is
consistent with previous studies. Especially, the increasing percentage of
SRVD from psychological stress to suicide attempts is quantitatively
meaningful. It is worth further study of the relationship between SRVD
and psychological pain.
As the number of mental health problems has increased, SRVD and
SRVD lasting over three weeks also increased (Tables 4 and, 5). This
result correlated with patients with more mental health problems being
more likely to have suicidal ideation or suicide attempt. In conclusion,
the more mental health problems, the higher the incidence of SRVD.
Although the percentage of SRVD lasting over three weeks was the
highest in the group with suicide attempts among four mental health
problems, this result was not significantly different from that in the
group without suicide attempts. Caceda et al. (Caceda et al., 2017) re­
ported that increased pressure pain thresholds in suicide attempters
were reduced to the levels in patients with suicidal ideation within five
days. Referring to this study, if suicide attempters endure more than five
days, they tend to be more stable than they were in the past. For these
reasons, although the percentage of SRVD and SRVD lasting over three
weeks in participants with suicide attempts was higher than any other
mental health problems, no significant difference was found between
the group with and without suicide attempts if SRVD lasted over three
weeks. Of course, this needs more studies to find more accurate reasons.
The previous study (Marmor et al., 2016) reported that voice prob­
lem was nearly twice in the depression group, and there was a significant
relationship between depressive symptoms and the reception and
effectiveness of voice therapy. However, the duration and severity of

Table 2
Multivariate Cox proportional hazard model for self-recognition of voice disorder according to mental health problems.
Self-recognition of Self-recognition of Hazard Ratio (95 % confidence interval)
voice disorder voice disorder
% (SE) Model 1 P-value Model 2 P-value Model 3 P-value

<0.001* <0.001* <0.001*

Psychological stress No 5.51 (0.29) 1 (reference) 1 (reference) 1 (reference)
(high) 1.412 1.384 1.371
Yes 7.45 (0.53)
(1.192− 1.674) (1.164− 1.646) (1.154− 1.629)
<0.001* <0.001* <0.001*
Depressive No 5.52 (0.27) 1 (reference) 1 (reference) 1 (reference)
symptoms 1.654 1.627 1.626
Yes 9.63 (0.83)
(1.35− 2.027) (1.324− 1.999) (1.323− 1.997)
<0.001* <0.001* <0.001*
No 5.4 (0.27) 1 (reference) 1 (reference) 1 (reference)
Suicidal ideation
1.788 1.75 1.739
Yes 10.2 (0.85)
(1.464− 2.184) (1.429− 2.144) (1.418− 2.133)
0.028* 0.038* 0.033*
No 5.99 (0.28) 1 (reference) 1 (reference) 1 (reference)
Suicide attempt
2.255 2.154 2.206
Yes 13.03 (4.11)
(1.095− 4.644) (1.043− 4.448) (1.067− 4.56)

Model 1: Adjusted for age, and gender.

Model 2: Adjusted for age, gender, smoking, drinking, physical activity, income, and education.
Model 3: Adjusted for age, gender, smoking, drinking, physical activity, income, education, hypertension, diabetes, asthma, and allergic rhinitis.
*
Significant at P < 0.05.

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H.-B. Kim et al. Journal of Affective Disorders 338 (2023) 482–486

Table 3
Multivariate Cox proportional hazard model for self-recognition of voice disorder lasting over three weeks according to mental health problems.
Self-recognition of voice Self-recognition of Hazard Ratio (95 % confidence interval)
disorder (>3wks) voice disorder
(>3wks), % (SE) Model 1 P-value Model 2 P-value Model 3 P-value

<0.001* <0.001* <0.001*

Psychological stress No 2.94 (0.19) 1 (reference) 1 (reference) 1 (reference)
(high) 1.649 1.62 1.604
Yes 4.49 (0.43)
(1.315− 2.069) (1.291− 2.033) (1.278− 2.014)
<0.001* <0.001* <0.001*
Depressive No 3 (0.19) 1 (reference) 1 (reference) 1 (reference)
symptoms 1.835 1.819 1.807
Yes 5.92 (0.64)
(1.417− 2.376) (1.395− 2.371) (1.384− 2.36)
<0.001* <0.001* <0.001*
No 2.87 (0.18) 1 (reference) 1 (reference) 1 (reference)
Suicidal ideation
2.09 2.086 2.073
Yes 6.57 (0.71)
(1.602− 2.727) (1.601− 2.718) (1.587− 2.709)
0.132 0.1488 0.1337
No 3.34 (0.19) 1 (reference) 1 (reference) 1 (reference)
Suicide attempt
2.173 2.129 2.197
Yes 7.23 (3.38)
(0.79− 5.974) (0.763− 5.946) (0.785− 6.151)

Model 1: Adjusted for age, and gender.

Model 2: Adjusted for age, gender, smoking, drinking, physical activity, income, and education.
Model 3: Adjusted for age, gender, smoking, drinking, physical activity, income, education, hypertension, diabetes, asthma, and allergic rhinitis.
*
Significant at P < 0.05.

Table 4
Segmental linear regression model for the risk of self-recognition of voice disorder according to the number of the mental health problems.
Number of the mental health Self-recognition of voice disorder, Odds Ratio (95 % confidence interval)
% (SE)
problems
Model 1 P-value Model 2 P-value Model 3 P-value

0 5.29 (0.3) 1 (reference) <0.001* 1 (reference) <0.001* 1 (reference) <0.001*

1.081
1 5.76 (0.48) 1.099 (0.902− 1.34) 1.09 (0.893− 1.332)
(0.887− 1.318)
1.506 1.483 1.485
2 8.23 (0.92)
(1.168− 1.942) (1.146− 1.919) (1.148− 1.923)
3 13.83 (1.67) 2.605 (1.94− 3.497) 2.528 (1.87− 3.417) 2.49 (1.839− 3.37)

Model 1: Adjusted for age, and gender.

Model 2: Adjusted for age, gender, smoking, drinking, physical activity, income, and education.
Model 3: Adjusted for age, gender, smoking, drinking, physical activity, income, education, hypertension, diabetes, asthma, and allergic rhinitis.
*
Significant at P < 0.05.

Table 5
Segmental linear regression model for the risk of self-recognition of voice disorder lasting over three weeks according to the number of the mental health problems.
Number of the mental health Self-recognition of voice disorder, Odds Ratio (95 % confidence interval)
% (SE)
problems
Model 1 P-value Model 2 P-value Model 3 P-value

0 2.77 (0.19) 1 (reference) <0.001* 1 (reference) <0.001* 1 (reference) <0.001*

1.239 1.221
1 3.33 (0.39) 1.23 (0.946− 1.601)
(0.954− 1.609) (0.939− 1.586)
1.634 1.621 1.617
2 4.68 (0.7)
(1.165− 2.291) (1.153− 2.278) (1.148− 2.277)
3.345 3.254
3 9.43 (1.4) 3.31 (2.287− 4.791)
(2.332− 4.499) (2.242− 4.725)

Model 1: Adjusted for age, and gender.

Model 2: Adjusted for age, gender, smoking, drinking, physical activity, income, and education.
Model 3: Adjusted for age, gender, smoking, drinking, physical activity, income, education, hypertension, diabetes, asthma, and allergic rhinitis.
*
Significant at P < 0.05.

voice problems were not associated with depression status. Our study
also showed a significant relationship between voice disorders and
mental health status, including depressive symptoms. But our study
included a significant relationship between voice disorder and the
severity of mental health, which showed tending to increase as pro­
cessing to suicidal ideation. However, questions about voice therapy
were not included in this study. There were also some differences in
question contents. The previous study investigated the presence of voice
disorders over the past 12 months, whereas this study evaluated voice
disorder at the time of the study and distinguished whether the voice
disorder was more than three weeks or not. The questions regarding
depression and inclusion criteria for depression were also very
comprehensive, asking participants how often they felt depressed in the
past 12 months and including all participants who answered feeling
depressed at least once. In contrast, this study distinguished psycho­
logical stress, depressive symptoms, and suicide. Furthermore, this study
utilized specific words such as sadness and hopelessness, and a clear
time limitation such as two or more continuous weeks to improve the
clarity of the definition of depressive symptoms. Despite some differ­
ences in these two studies, the result that there was a strong relationship

485
H.-B. Kim et al.
between voice and depressive symptoms was in agreement.
Alcohol drinking and smoking have a significant impact on the vocal
cords. According to Nam et al. (Nam et al., 2022), smoking is one of the
strongest factors for larynx cancer and Reinke's edema, a condition that
leads to polypoid degeneration of connective tissue in the lamina
propria of the vocal cords (Tavaluc and Tan-Geller, 2019). Smoking can
induce chronic microvascular damage or immune cell infiltration into
the vocal cords, resulting in vocal cord edema and ultimately larynx
cancer (Gugatschka et al., 2019). Pinar et al. (Pinar et al., 2016) reported
that the voice handicap index, a subjective index of voice, was lower in
the smoking group than in the non-smoking group. Alcohol drinking is
also a risk factor for larynx cancer (La Vecchia et al., 2008) and lar­
yngopharyngeal reflux, a condition that causes voice change (Spantideas
et al., 2015). However, the percentage of current smokers and heavy
drinkers was lower in the SRVD group. Furthermore, the proportion of
non-smokers and non-drinkers was higher in the SRVD group. This result
could be due to the higher number of women in the SRVD group, and
alcohol drinking and smoking have a gradual rather than an immediate
impact on the voice, so the participants might not have recognized it.
This study has several limitations. First, as this study is a population-
based study, the data were cross-sectional and retrospective. Therefore,
causality between SRVD and mental health status could not be inferred.
Second, SRVD and mental health status were judged only by simple
questionnaires. SRVD was not differentiated by clinicians, so many
pathological diseases, including benign laryngeal mucosa disease, vocal
fold paralysis, sulcus vocalis, and larynx cancer might be involved. And
mental status was assessed by four questions, not by a formal Diagnostic
and Statistical Manual of Mental Disorder (DSM)-IV diagnosis. Because
the cause of voice disorder had not been identified and mental status had
not been diagnosed by a psychiatrist, further consideration is needed to
interpret the relationship between purely psychological voice change
and depression. Third, there was no information on treatment. A survey
with questions on treatments could be more useful. Unfortunately, there
was no question about voice therapy or treatment of mental problems in
the survey.
Despite these limitations, our study found a positive correlation be­
tween SRVD and mental health status. This study is the first investiga­
tion conducted in Asia and is the largest study in terms of scale.
Furthermore, we confirmed the possibility of developing a tool using
voice to quickly detect and prevent mental health problems, especially
suicide attempts.
Funding
This research was supported by grant from the Institute of Clinical
Medicine Research in the Yeouido St. Mary's Hospital, Catholic Uni­
versity of Korea.
Ethics statement
The present study protocol was reviewed and approved by the
Institutional Review Board (IRB)/Ethics Committee of The Catholic
University of Korea in accordance with the Declaration of Helsinki.
[SC21ZISE0204].
486
Journal of Affective Disorders 338 (2023) 482–486
CRediT authorship contribution statement
Hyun-Bum Kim: Conceptualization, Funding acquisition, Investi­
gation, Methodology, Writing – original draft. Youn-Sun Park: Formal
analysis, Validation, Visualization. Ju-Eun Lee: Formal analysis, Vali­
dation, Visualization. Kyung-Do Han: Investigation, Methodology,
Software. Young-Hak Park: Conceptualization, Writing – original draft.
Declaration of competing interest
The authors have no potential conflicts of interest to disclose.
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