{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T20:09:16Z","timestamp":1784232556970,"version":"3.55.0"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Adverse childhood experiences (ACEs) are fundamental factors in developing depression with increased suicide risk. Resilience is considered an important protective factor that can prevent trauma survivors from developing depression. We developed a home evaluation kit for a comprehensive assessment of bio-psycho-social factors related to depression and suicide. This kit contained a psycho-social evaluation battery, named the Protective and Vulnerable factors battery questionnaire (PROVE) comprising depressive symptoms and suicide risk, as well as various depression-related psychosocial factors, such as ACE, resilience, mentalization capacity, and attachment, <jats:italic>via<\/jats:italic> online survey tools. Furthermore, salivary cortisol levels were used as biological indicators to assess the hypothalamus-pituitary-adrenal axis function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Real-world data analysis was made out of data collected from participants who visited CHEEU Counseling center or Gangnam Severance hospital for mental health check-ups. The participants were put into three mental state groups (green-normal, yellow-borderline, and red-risk) depending on the result of PROVE battery. The difference between psychosocial factors and salivary cortisol indicators by the group was identified by analysis of covariance with sex and age as covariates. Linear regression analysis was conducted to find a significant association of resilience score with other bio-psycho-social variables, such as ACE, attachment, mentalization, or post-awakening cortisol concentrations (area under the curve with respect to ground, AUCg). A partial correlation analysis was performed to evaluate the relationship of AUCg with psychosocial factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Depression-related psycho-social indicators were significantly different among groups. Insecure attachment and the mentalization problem are negatively influencing factors to resilience. Furthermore, the severity of depression in participants with ACE was also influenced by mentalization problems. AUCg was different according to the PROVE group, presence of ACE, or resilience level. In addition, AUCg showed a positive correlation with resilience score but negative correlations with depressive symptoms, ACE, mentalization problems, and anxiety or avoidance attachment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests that there are some key factors negatively affecting resilience: insecure attachment and mentalization problems. In groups with ACE, a mentalization problem was suggested as a factor that can increase depressive symptoms. AUCg was associated with resilience as well as several other vulnerable factors of depression, showing its potential as a promising biomarker.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2022.847498","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T06:48:51Z","timestamp":1654066131000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Relationship of Resilience Factors With Biopsychosocial Markers Using a Comprehensive Home Evaluation Kit for Depression and Suicide Risk: A Real-World Data Analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Sooah","family":"Jang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun-Woo","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryunsup","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Yeal","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joohan","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Ho","family":"Seok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"341","DOI":"10.31887\/DCNS.2019.21.4\/enestler","article-title":"Unraveling the epigenetic landscape of depression: focus on early life stress","volume":"21","author":"Torres-Berr\u00edo","year":"2019","journal-title":"Dialogues Clin Neurosci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/j.jaac.2019.10.011","article-title":"Meta-analysis: exposure to early life stress and risk for depression in childhood and adolescence","volume":"59","author":"LeMoult","year":"2020","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"key":"B3","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1192\/bjp.bp.115.180752","article-title":"Childhood maltreatment and characteristics of adult depression: meta-analysis","volume":"210","author":"Nelson","year":"2017","journal-title":"Br J Psychiatry."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1097\/NMD.0000000000000049","article-title":"The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes","volume":"201","author":"Carr","year":"2013","journal-title":"J Nerv Ment Dis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3389\/fnbeh.2019.00156","article-title":"early life exposure to violence: developmental consequences on brain and behavior","volume":"13","author":"Mueller","year":"2019","journal-title":"Front Behav Neurosci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2706","DOI":"10.3389\/fpsyg.2018.02706","article-title":"Bullying the brain? longitudinal links between childhood peer victimization, cortisol, and adolescent brain structure","volume":"9","author":"du Plessis","year":"2019","journal-title":"Front Psychol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.avb.2010.12.007","article-title":"The traumatic stress response in child maltreatment and resultant neuropsychological effects","volume":"16","author":"Wilson","year":"2011","journal-title":"Aggress Violent Behav."},{"key":"B8","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.avb.2009.08.003","article-title":"behavior v. 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