Segmentation of Shallow Slow Slip Events at the Hikurangi Subduction Zone Explained by Along-Strike Changes in Fault Geometry and Plate Convergence Rates.

Over the last two decades, geodetic and seismic observations have revealed a spectrum of slow earthquakes along the Hikurangi subduction zone in New Zealand. Of those, shallow slow slip events (SSEs) that occur at depths of less than 15 km along the plate interface show a strong along-strike segmentation in their recurrence intervals, which vary from ∼1 yr from offshore Tolaga Bay in the northeast to ∼5 yr offshore Cape Turnagain ∼300 km to the southwest. To understand the factors that control this segmentation, we conduct numerical simulations of SSEs incorporating laboratory-derived rate-and-state friction laws with both planar and non-planar fault geometries. We find that a relatively simple model assuming a realistic non-planar fault geometry reproduces the characteristics of shallow SSEs as constrained by geodetic observations. Our preferred model captures the magnitudes and durations of SSEs, as well as the northward decrease of their recurrence intervals. Our results indicate that the segmentation of SSE recurrence intervals is favored by along-strike changes in both the plate convergence rate and the downdip width of the SSE source region. Modeled SSEs with longer recurrence intervals concentrate in the southern part of the fault (offshore Cape Turnagain), where the plate convergence rate is lowest and the source region of SSEs is widest due to the shallower slab dip angle. Notably, the observed segmentation of shallow SSEs cannot be reproduced with a simple planar fault model, which indicates that a realistic plate interface is an important factor to account for in modeling SSEs.

Reactogenicity and immunogenicity of BNT162b2 or mRNA-1273 COVID-19 booster vaccinations after two doses of BNT162b2 among healthcare workers in Japan: a prospective observational study.

BACKGROUND: This study evaluates the immunogenicity and reactogenicity of BNT162b2 and mRNA-1273 booster doses after the primary two-dose BNT162b2 series in Japan and is the first report from Western Pacific region. RESEARCH DESIGN AND METHODS: Healthcare workers receiving the two-dose BNT162b2 series and eligible for booster vaccination were enrolled. Self-reported adverse reactions were recorded for 8 days. Antibody titer was measured at baseline and on day 28. RESULTS: A total of 2,931 and 890 subjects received BNT162b2 (homologous) and mRNA-1273 (heterologous) booster vaccinations, respectively. The anti-SARS-CoV-2 spike protein IgG titer increased by 50.9- and 64.3-fold in the homologous and heterologous groups, respectively. Immunogenicity was greater with increasing age, regardless of sex. Adverse reactions were mild to moderate and decreased with age. The most common adverse reactions were injection-site pain (92.2%), fatigue (71.8%), headache (58.3%), and fever ≥37.5°C (46.5%). Two cases of non-severe myocarditis occurred in the heterologous group and resolved without clinical sequelae. CONCLUSION: Homologous booster schedules had fewer reported adverse reactions; heterologous boosters elicited greater immunogenicity. Among different age groups, subjects aged 60 or over had the lowest immunogenicity before the booster, and both homologous and heterologous boosters restored vaccine immunogenicity level comparable to those of younger age groups.

Case report: Vascular graft infection due to Aspergillus species presenting with recurrent vascular occlusion.

BACKGROUND: An aortic graft implantation is an effective therapeutic method for various aortic diseases. However, it is known that sometimes these implanted grafts can be the foci of infections. Here we report a rare case of graft infection that presented multiple embolisms of aortic branches and peripheral organs. CASE PRESENTATION: A 63-year-old Japanese woman with a history of aortic graft implantation presented with occlusions of large arteries in different loci and time points, with elevation of non-specific inflammatory markers. Thoracic contrast-computed tomography (CT) captured vegetation in the descending aortic graft and the [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) showed accumulation of FDG in the same site, suggesting a graft infection. Despite all these suspicious findings, repeated blood culture examinations never detected any microorganisms. A diagnosis of Aspergillus graft infection was made based on an elevated serum ß-D glucan (ßDG) and a positive Aspergillus galactomannan (GM) antigen test. The patient subsequently had surgery with replacement of the descending aortic graft and anti-fungal drugs were instituted with significant improvement noted. CONCLUSION: In the present case, the patient's specific feature in the anatomical vascular construction, past operation, and basal fundamental diseases collaboratively contributed to the pathogenesis of the present infection. It is important to recognize the risk of graft infection and conduct imaging studies when indicative symptoms emerge. The negativity in blood culture studies often makes detection of pathogenic microbes extremely difficult. This case suggests that non-cultural tests such as bDG and GM can be useful for diagnosis and starting appropriate anti-fungal drugs in the early stages.

Extreme Accelerations During Earthquakes Caused by Elastic Flapping Effect.

Accurate recording of large, earthquake-induced ground shaking is critical for our understanding of earthquake physics as well as seismic hazard assessment. Extremely large accelerations with the peak value of 3.2 times the gravity acceleration were recorded at seismic station WTMC located in northern South Island of New Zealand during the recent magnitude 7.8 Kaikoura earthquake. However, the mechanisms responsible for the generation of such large accelerations are not well understood. Here we use numerical simulations to examine a range of physical models that can reproduce the observed characteristics of the acceleration record. We find that the record of the asymmetric, vertical accelerations, also observed during a magnitude 6.3 earthquake, can be explained by a flapping effect, that is, the local, elastic bouncing of a foundation slab on which the sensor is installed. Our results suggest that the extremely large accelerations recorded at seismic station WTMC do not reflect the actual ground shaking, but were caused by a local, system response around the sensor. Our finding has important implications for both the evaluation of future seismic hazard based on the waveform records of the Kaikoura earthquake and the installation methodology of strong-motion seismometers in all earthquake prone countries.

Leisure-time activities and psychological distress in a suburban community in Japan.

OBJECTIVE: There is a wide range of leisure-time activities and previous research indicates that some of these are associated with lower psychological distress. The aim of this study was to assess whether leisure-time activities were associated with psychological distress. METHODS: A population-based questionnaire survey was conducted in 2009 in a suburban area of northern Japan using complete enumeration. Of 16,996 residents aged 30-79 years who received the questionnaire, 14,261 (83.9%) responded and 9908 (58.3%) responses were eligible for analysis. The relationship between psychological distress and physical, artistic, outdoor, and volunteer leisure-time activities was assessed separately and simultaneously by sex. RESULTS: The percentage of reported psychological distress was 2.8% for men and 3.9% for women. Each category of leisure-time activity was related to psychological distress separately. The simultaneous analyses revealed that engaging in regular outdoor leisure activity was associated with less psychological distress in both men (odds ratio [OR] = 0.38; 95% confidence intervals [CI]: 0.23, 0.63, p < 0.001) and women (OR = 0.39; 95% CI: 0.25, 0.59, p < 0.001). Engaging in regular physical activity was associated with less psychological distress in women (OR = 0.09; 95% CI: 0.01, 0.68, p = 0.019). Volunteer work and art activities were not associated with psychological distress in either men or women. CONCLUSION: Greater engagement in outdoor leisure activity and physical activity was significantly associated with a lower likelihood of psychological distress. The results from the present study indicate that engaging in leisure-time activities, especially in outdoor leisure and physical activities, may be an effective means of promoting public health.

Individually wide range of renal motion evaluated by four-dimensional computed tomography.

OBJECTIVES: Assessment of physiologic renal motion in order to optimize abdominal intensity-modulated radiation therapy and stereotactic body radiation therapy. METHODS AND MATERIALS: Twenty patients with a median age of 47 years underwent computed tomography simulation and four-dimensional computed tomography acquisition. Thirty-nine kidneys were contoured during ten phases of respiration to estimate renal motion. RESULTS: Kidney motion was not related to age (p = 0.42), sex (p = 0.28), height (p = 0.75), or body weight (p = 0.63). The average +/- standard deviation (SD) of movement of the center of gravity for all subjects was 11.1 +/- 4.8 mm in the cranio-caudal (CC) direction (range, 2.5-20.5 mm), 3.6 +/- 2.1 mm in the anterior-posterior (AP) direction (range, 0.6-8.0 mm), and 1.7 +/- 1.4 mm in the right-left (RL) direction (range, 0.4-5.9 mm). Renal motion strongly correlated with the respiratory phases (r > 0.97 and p < 0.01 in all three directions). CONCLUSIONS: Renal motion was independent of age, sex, height, or body weight. Renal motion in all directions was strongly respiration dependent, but motion in the cranio-caudal direction showed wide individual variation. In a clinical setting, it will be necessary to evaluate renal respiratory motion separately in each individual.

An Investigation into Reliability of Knee Extension Muscle Strength Measurements, and into the Relationship between Muscle Strength and Means of Independent Mobility in the Ward: Examinations of Patients Who Underwent Femoral Neck Fracture Surgery.

[Purpose] The purpose of the present study was to investigate the reliability of isometric knee extension muscle strength measurement of patients who underwent femoral neck fracture surgery, as well as the relationship between independent mobility in the ward and knee muscle strength. [Subjects] The subjects were 75 patients who underwent femoral neck fracture surgery. [Methods] We used a hand-held dynamometer and a belt to measure isometric knee extension muscle strength three times, and used intraclass correlation coefficients (ICCs) to investigate the reliability of the measurements. We used a receiver operating characteristic curve to investigate the cutoff values for independent walking with walking sticks and non-independent mobility. [Results] ICCs (1, 1) were 0.9 or higher. The cutoff value for independent walking with walking sticks was 0.289 kgf/kg on the non-fractured side, 0.193 kgf/kg on the fractured side, and the average of both limbs was 0.238 kgf/kg. [Conclusion] We consider that the test-retest reliability of isometric knee extension muscle strength measurement of patients who have undergone femoral neck fracture surgery is high. We also consider that isometric knee extension muscle strength is useful for investigating means of independent mobility in the ward.

Interest in dietary pattern, social capital, and psychological distress: a cross-sectional study in a rural Japanese community.

BACKGROUND: Among life-style factors affecting mental health, dietary habits are becoming a public health concern in their relation to psychological distress and social capital. We examined associations between interest in dietary pattern, social capital, and psychological distress with a population-based cross-sectional study in rural Japan. METHODS: A total of 16,996 residents of a rural town in northern Japan aged 30-79 years participated in this questionnaire survey. The questionnaire gathered data about socio-demographic variables, psychological distress, issues related to dietary habits, including interest in dietary pattern, and the social capital factors of reciprocity and sense of community belonging. Factors related to psychological distress were analyzed by using multiple logistic regression analysis. RESULTS: A high interest in dietary pattern was significantly associated with a high level of social capital. In addition, an association between interest in dietary pattern and frequencies of intake of vegetables and fruits was confirmed. The multiple logistic regression analyses showed significant associations between interest in dietary pattern, social capital, frequency of intake of vegetables, and psychological distress after adjusting for socio-demographic variables. Low interest in dietary pattern was positively associated with psychological distress after adjusting for socio-demographic variables (OR = 2.18; 95%CI: 1.69-2.81). Low levels of both reciprocity and sense of community belonging were associated with psychological distress after adjusting for socio-demographic variables (OR = 3.46 with 95%CI of 2.10-5.71 for reciprocity, and OR = 7.42 with 95%CI of 4.64-11.87 for sense of community belonging). CONCLUSION: Low interest in dietary pattern, low frequency of intake of vegetables, and low levels of social capital were significantly associated with psychological distress after adjusting for socio-demographic variables.

Physician's Perceptions of Interprofessional Collaboration in Clinical Training Hospitals in Northeastern Japan.

BACKGROUND: Effective and efficient interprofessional collaboration (IPC) is needed between departments in a healthcare setting. Although Japanese physicians are expected to provide leadership in IPC, it has been suggested that their perception of IPC is more negative than among other healthcare professionals. The purpose of this study was to clarify Japanese physician's perceptions of IPC and what factors influenced their views. METHODS: This cross-sectional study surveyed 732 medical doctors at a university hospital and six foundation hospitals in a prefecture located in Tohoku district, northeastern Japan. Those hospitals were approved for delivery of postgraduate clinical training. Physician's perceptions of IPC were investigated for three items, namely providing patient-centered care, preventing medical accidents, and improving the quality of medical care. A total of 409 doctors who were engaged in clinical practice, responded adequately to the survey. Factors associated with negative perceptions towards IPC among physicians were analyzed using a logistic regression model. RESULTS: The proportion of negative perceptions of IPC for providing patient-centered care, preventing medical accidents, and improving the quality of medical care were 41.1%, 34.0% and 33.7%, respectively. Negative perceptions of IPC for providing patient-centered care were associated with older age (50 + years; odds ratio (OR): 2.73; 95% confidence interval (CI): 1.11 - 6.68) and a lower frequency of interprofessional meetings (no meetings; OR: 2.95; 95%CI: 1.43 - 6.08). Negative perceptions of IPC for preventing medical accidents were associated with a lower frequency of interprofessional meetings (no meetings, OR: 3.23; 95%CI: 1.58 - 6.62). Negative perceptions of IPC for improving the quality of medical care were associated with middle age (40 - 49 years, OR: 2.93; 95%CI: 1.20 - 7.12) and a lower frequency of interprofessional meetings (no meetings; OR: 2.75; 95%CI: 1.34 - 5.66). CONCLUSIONS: Physician's negative perceptions of IPC in our study were associated with age and a lower frequency of interprofessional meetings. Our findings suggest that effective regular interprofessional meetings serve to share information about patients, and to allow physicians to understand each other better, which should have a positive impact on the quality of patient-centered care.

Association between psychological distress and a sense of contribution to society in the workplace.

BACKGROUND: Globally, mental health promotion related to psychological distress in the workplace has become a great concern, and a focus of much research attention. However, a sense of contribution to society and sense of bonding with the workplace have not been examined in relation to psychological distress. Thus, the purpose of this study is to examine whether these two factors are associated with psychological distress. METHODS: We conducted a cross-sectional survey of 1137 full-time employees who worked in systems engineering, sales, or administration at a Japanese company. Participant's sense of contribution to society, sense of bonding with the workplace, psychological distress, and qualitative job stress (quantitative and qualitative workloads, job-control latitude, and support from supervisors, co-workers and family) were assessed with a questionnaire. We performed multiple logistic regression analyses to examine associations between psychological distress and sense of contribution to society and of bonding with the workplace. RESULTS: A high sense of contribution to society was significantly associated with a high sense of bonding with the workplace (Spearman's ρ = 0.47, p < 0.01). A sense of contribution to society was negatively associated with psychological distress after adjusting for job stress factors (OR = 2.05, 95% CI 0.99-4.23) or sociodemographic characteristics of participants (OR = 2.92, 1.53-5.59). After adjusting for job stress factors as well as sociodemographic characteristics, the association became weaker. A sense of bonding with the workplace was negatively associated with psychological distress after adjusting for sociodemographic characteristics (OR = 2.49, 1.29-4.79). However, this association was not observed after adjusting for job stress factors. CONCLUSIONS: Psychological distress in the workplace was associated with sense of contribution to society. Therefore, workplace mental health promotion should consider the workers' sense of contribution to society.

Impact of obesity on plasma B-type natriuretic peptide levels in Japanese community-based subjects.

The plasma B-type natriuretic peptide (BNP) concentration was recently shown to be inversely correlated with body mass index (BMI). However, very few attempts have been made to associate abdominal obesity and BNP in the Japanese general population. Here, we conducted a cross-sectional study, and examined 339 male and 429 female residents without heart disease in a rural Japanese community who received an annual health checkup in 2006. BNP was inversely associated with both BMI and abdominal circumference (AC) in the age-adjusted regression analysis (p < 0.05). Following adjustment for traditional risk factors, multiple regression analysis revealed that BNP was negatively correlated with AC (p < 0.05), but not BMI. Although metabolic syndrome was not associated with BNP levels, AC had an influence on low BNP levels in the multiple regression analysis using both AC and BMI concurrently (p < 0.05 for AC and p > 0.60 for BMI). These effects were more prominent in men than in women. Collectively, plasma BNP levels are inversely related with obesity, as measured by AC, in Japanese community-based subjects.

Evaluation of Chinese hamster ovary cell stability during repeated batch culture for large-scale antibody production.

Pharmaceutical manufacturing plants can be operated continuously for several months. It is therefore important to use cells with long-term stability for the production of active ingredients. We investigated the reliability and long-term stability of an antibody-producing cell line. A recombinant Chinese hamster ovary (CHO) cell line was cultivated in spinner flasks and reactors, including a practical production-scale reactor (1600 L), for 109 days to produce monoclonal antibodies against the HM1.24 antigen. During cultivation, the cells remained stable and there was an increase in the rate of cell proliferation, yielding viable cells at high density. A decrease in cell-specific productivity was associated with this increase in the rate of cell proliferation. The cells were genetically stable and other measures of cellular function remained consistent throughout the cultivation period.

Changes in the quality of antibodies produced by Chinese hamster ovary cells during the death phase of cell culture.

Although overproduction of recombinant proteins by mammalian cells is well established, little attention has been paid to analysis of the quality of the products. We focused on the quality of antibodies produced during the death phase of a recombinant Chinese hamster ovary (CHO) cell line. The quality of the monoclonal antibody against HM1.24 antigen and the post-translational characteristics of the subunits during CHO cell culture in a 160-L bioreactor were investigated. The culture supernatant of a stable cell line was collected and purified by affinity chromatography and then analyzed. There were no significant changes in gel-permeation chromatography variables, carbohydrate structure, or antibody-dependent cellular cytotoxicity activity during the death phase of cell culture. However, ion-exchange chromatography analysis revealed that antibody heterogeneity changed, as indicated by a decrease in cell viability. The results presented here provide useful information that will help in determining the time to end each batch culture.

Association between perceived stress and plasma B-type natriuretic peptide concentrations.

BACKGROUND: Many patients with heart disease continue to have cardiac events despite receiving optimal treatments for traditional risk factors. Consequently, non-traditional risk factors for heart disease, such as perceived stress, have attracted attention. Associations between perceived stress and plasma B-type natriuretic peptide (BNP) were explored, while controlling for traditional heart disease risk factors. METHODS AND RESULTS: This cross-sectional study examined 360 male and 446 female (age, >40 years) residents of a rural Japanese community who received annual health checkups in 2006. A lifestyle questionnaire was used to obtain information regarding perceived stress and medical history, and routine anthropometric and blood pressure measurements and a laboratory assessment of cardiovascular risk factors, including plasma BNP concentrations and an electrocardiogram, were done. After adjusting for traditional heart disease risk factors, multiple regression analysis showed that perceived stress was associated with BNP concentrations, particularly in women (F=6.12, P=0.026). In addition, multiple tests using Bonferroni's procedure showed that BNP concentrations decreased with perceived stress level in men and women. Similar trends were observed in the sub-analyses of subjects with and without known heart disease. CONCLUSIONS: Perceived stress in our study was negatively associated with plasma BNP concentrations, independently of traditional heart disease risk factors.

Attitudes towards those bereaved by a suicide: a population-based, cross-sectional study in rural Japan.

BACKGROUND: Family or friends bereaved by suicide are at risk of experiencing complications because of attitudes regarding suicide. It is important that individuals close to those grieving after a death by suicide demonstrate adequate knowledge and compassionate attitudes. To this end, we examined the factors that contribute to attitudes toward persons bereaved by the suicide of a family member or friend, and perceptions of suicide prevention and the promotion of mental health. METHODS: A total of 5154 residents of a rural town in northern Japan aged 30-69 years completed a cross-sectional questionnaire. The questionnaire gathered data about demographic variables, depressive symptoms, and issues related to suicide including personal experience of an acquaintance's suicide, attitudes towards those bereaved by suicide, and perceptions regarding suicide prevention. Factors related to these attitudes and perceptions were analysed using logistic regression models. RESULTS: Overall, 67.5% of respondents demonstrated appropriate attitudes towards those bereaved by suicide; 30.4% of responses were undetermined, and 2.1% were inappropriate. Undetermined attitudes were associated with male gender (adjusted OR 1.42, 95%CI = 1.26-1.61), younger age (2.64, 2.12-3.29), lower education level (1.32, 1.07-1.62), greater severity of depression (3.81, 2.80-5.20), and lack of personal experience of an acquaintance's suicide (1.39, 1.22-1.57). Inappropriate attitudes were associated with male gender (adjusted OR 1.98, 95%CI = 1.33-2.94), lower education level (2.55 1.34-4.83), and greater severity of depression (6.93, 3.52-13.67). Overall, 16.0% demonstrated passive thoughts regarding suicide prevention and the promotion of mental health in the community, and were associated with male gender (1.22, 1.04-1.42), younger age (2.72, 2.03-3.65), lower education level (1.32, 1.02-1.71), and greater severity of depression (4.94, 3.58-6.82). CONCLUSION: Factors that contributed to undetermined attitudes included male gender, younger age, lower education level, greater severity of depression, and lack of personal experience of an acquaintance's suicide. Passive thoughts regarding suicide prevention and the promotion of mental health were associated with male gender, younger age, lower education level, and greater severity of depression.

Effect of having a sense of purpose in life on the risk of death from cardiovascular diseases.

BACKGROUND: Many studies have focused on disease causality, but few of them deal with health-promoting factors. Thus, we examined the effect of having a sense of purpose in life (ikigai) on mortality from cardiovascular disease (CVD). METHODS: In 1988, we conducted a prospective cohort study of 2,959 Japanese subjects, ranging in age from 40 to 74 years, and followed them till the end of 2003. The level of their sense of purpose in life was evaluated by a self-administered questionnaire. After excluding those with a history of heart disease, stroke, or malignant tumor, 1,618 subjects (832 men and 786 women) who had completed the questionnaire were used in the analyses with Cox's proportional hazards model. RESULTS: During the average 13.3 years of follow up, 249 deaths (172 men and 77 women) occurred as a result of all causes: 32 from heart disease, 31 from stroke, 63 from CVD, and 104 from malignant tumors. The adjusted hazard ratios for death in men with a strong sense of purpose in life, as compared with those with a low sense of purpose, were 0.28 (95% confidence interval: 0.10-0.84) for stroke, 0.56 (0.28-1.10) for CVD, and 0.62 (0.45-0.86) as a result of all causes. In women, no significant relationship was found between having a sense of purpose in life and mortality; this was possibly because the smaller number of deaths reduced the statistical significance. CONCLUSION: We found that in men, having a sense of purpose in life affected the risk of death as a result of all causes, stroke, and CVD.

A decrease in suicide rates in Japanese rural towns after community-based intervention by the health promotion approach.

A community-based intervention study for suicide prevention was conducted in six towns (total population 43,964) in Akita Prefecture of Japan according to a quasi-experimental design to reduce suicide rates in rural towns. Public awareness raising activities using a health promotion approach emphasizing the empowerment of residents and civic participation were conducted. The welfare measures of promoting a sense of purpose among senior citizens and creating a community network were also taken. As a result, the suicide rate per 100,000 in the intervention towns decreased from 70.8 before intervention (1999) to 34.1 after intervention (2004). The suicide rate per 100,000 in the control towns was 47.8 before intervention and 49.1 after intervention.

Prevalence of depressive symptoms and related risk factors for depressive symptoms among elderly persons living in a rural Japanese community: a cross-sectional study.

To clarify the prevalence of depression in a rural community in Japan and to evaluate the social and familial risk factors for depression, with the goal of suicide prevention, a questionnaire survey was conducted on a total of 2,763 elderly persons. The determined prevalence of depressive symptoms (Zung's self-rated depression scale score of 50 points or more) was 10.4%. Logistic regression analysis showed associations between depressive symptoms and age, absence of a friendly companion, irritation with one's family, frequent loneliness, the opinion that stress has a large impact on one's life, suicide ideation, and poor subjective physical and mental health.

Male gender and low education with poor mental health literacy: a population-based study.

BACKGROUND: Both male gender and low socioeconomic status have been related to depression and suicide, but their possible relationship to mental health literacy remains uncertain. The objectives of this study were to assess the level of mental health literacy in rural communities in Japan and to examine related factors. METHODS: A population-based cross-sectional study using a questionnaire was conducted. Response rate was 88.2% from 8163 residents aged 30-69 years. The relationships between mental health literacy (including cognition of depression, attitude toward depression, and acceptance of suicide) and demographics, socioeconomic status, and the severity of depression were assessed by logistic regression analysis. RESULTS: Of the respondents, 25.2% showed an inadequate cognition of depression, 12.5% showed an inadequate attitude toward depression, and 13.1% showed an acceptance of suicide. Of the complete respondents (65.5%), an inadequate cognition of depression was associated with being male (adjusted odds ratio=1.93, 95% confidence interval: 1.68-2.22), advanced age (2.18, 1.58-3.00), and a lower level of education (1.95, 1.34-2.86); an inadequate attitude toward depression was associated with being male (2.18, 1.82-2.61), a lower education (2.34, 1.38-3.97), and the severity of depression (2.26, 1.54-3.32); and an acceptance of suicide was associated with being male (1.33, 1.13-1.58) and the severity of depression (5.77, 4.20-7.93). CONCLUSIONS: Poor mental health literacy related strongly to male gender and a low level of education. According to our results, poor mental health literacy may possibly be a factor contributing to male vulnerability to suicide.