Long-Term Trends in Counseling for Stress and Depression Among Adults, 2009-2024, Considering the Impact of COVID-19 Pandemic: A Nationwide Representative Study in South Korea.

Long-Term Trends in Counseling for Stress and Depression Among Adults, 2009–2024, Considering the Impact of COVID-19 Pandemic: A Nationwide Representative Study in South Korea - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. 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Learn more: PMC Disclaimer | PMC Copyright Notice Psychiatry Investig . 2026 Apr 6;23(4):556–575. doi: 10.30773/pi.2025.0463 Search in PMC Search in PubMed View in NLM Catalog Add to search Long-Term Trends in Counseling for Stress and Depression Among Adults, 2009–2024, Considering the Impact of COVID-19 Pandemic: A Nationwide Representative Study in South Korea Seungjae Byun Seungjae Byun 1 Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea 2 Department of Biotechnology, Korea University College of Life Science and Biotechnology, Seoul, Republic of Korea Find articles by Seungjae Byun 1, 2, * , Kyeongeun Kim Kyeongeun Kim 1 Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea 3 Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea Find articles by Kyeongeun Kim 1, 3, * , Hyesu Jo Hyesu Jo 1 Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea 4 Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea Find articles by Hyesu Jo 1, 4 , Christa J Nehs Christa J Nehs 5 Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA 6 Mass General Brigham Department of Anesthesiology, Massachusetts General Hospital, Boston, MA, USA Find articles by Christa J Nehs 5, 6 , Damiano Pizzol Damiano Pizzol 7 Health Unit, Eni, Maputo, Mozambique 8 Health Unit, Eni, San Donato Milanese, Italy Find articles by Damiano Pizzol 7, 8 , Dong Keon Yon Dong Keon Yon 1 Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea 3 Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea 4 Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea 9 Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea Find articles by Dong Keon Yon 1, 3, 4, 9, ✉ , Jiseung Kang Jiseung Kang 10 School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea 11 Department of Health and Safety Convergence Science, Graduate School, Korea University, Seoul, Republic of Korea Find articles by Jiseung Kang 10, 11, ✉ Author information Article notes Copyright and License information 1 Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea 2 Department of Biotechnology, Korea University College of Life Science and Biotechnology, Seoul, Republic of Korea 3 Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea 4 Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea 5 Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA 6 Mass General Brigham Department of Anesthesiology, Massachusetts General Hospital, Boston, MA, USA 7 Health Unit, Eni, Maputo, Mozambique 8 Health Unit, Eni, San Donato Milanese, Italy 9 Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea 10 School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea 11 Department of Health and Safety Convergence Science, Graduate School, Korea University, Seoul, Republic of Korea ✉ Correspondence: Dong Keon Yon, MD, PhD Department of Pediatrics, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea Tel: +82-2-961-0680, E-mail: [email protected] ✉ Correspondence: Jiseung Kang, PhD School of Health and Environmental Science, Korea University College of Health Science, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea Tel: +82-2-3290-5682, E-mail: [email protected] * These authors contributed equally to this work. Received 2025 Dec 17; Revised 2026 Jan 14; Accepted 2026 Jan 27; Issue date 2026 Apr. Copyright © 2026 Korean Neuropsychiatric Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/ ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. PMC Copyright notice PMCID: PMC13084277  PMID: 41987614 Abstract Objective Despite the impact of the COVID-19 pandemic on global mental health, few studies have examined changes in the demand for mental health counseling over time. This study investigated 16-year national trends in counseling for stress and depression in South Korea, with a focus on the pandemic’s impact and evolving population-level risk factors. Methods This study analyzed trends in stress and depression counseling using data from 3,195,912 Korean adults in the Korea Community Health Survey (2009–2024). Counseling was defined by self-reported responses. The period was categorized as pre-pandemic (2009–2019), intra-pandemic (2020–2022), and post-pandemic (2023–2024). Weighted logistic regression was used to assess prevalence trends, high-risk groups, and changes in risk patterns over time. Results The prevalence of counseling for stress steadily increased from 1.54% (2009–2010) to 2.16% (2017–2019), peaked at 3.06% in 2022 during the pandemic, and remained elevated at 2.97% in 2023–2024. Depression counseling showed a similar pattern. Higher rates were consistently observed among young adults, women, those with poor self-rated health, and individuals with sleep <6 or ≥8 hours. Notably, while low education was a key pre-pandemic risk factor, counseling increased more among highly educated individuals during the pandemic. Conclusion The COVID-19 pandemic affected mental health counseling in South Korea and led to the emergence of new at-risk groups. Sustained high counseling rates among young adults and the highly educated highlight the need for targeted, population-specific interventions. Keywords: Depression, Stress, COVID-19 pandemic, South Korea, Epidemiology INTRODUCTION Mental disorders are one of the top ten leading causes of disease burden [ 1 ]. According to the Global Burden of Disease Study 2021, the age-standardized incidence rate of mental disorders has increased by 15.23% between 1990 and 2021 [ 2 ]. In South Korea, the burden of mental health conditions has also grown steadily, with increasing rates of stress, depression, and suicide representing critical public health concerns [ 3 ]. Notably, South Korea has the highest rate among Organization for Economic Co-operation and Development (OECD) countries, about 2.4 times higher than the average suicide rate of other OECD countries [ 4 ]. The COVID-19 pandemic caused significant disruptions in daily life, adversely affecting socioeconomic stability, education, employment, and interpersonal relationships [ 5 , 6 ]. These changes intensified psychological distress across various segments of the population, underscoring the urgent need to address mental health [ 7 ]. Although numerous global studies have examined the acute psychological impacts of the pandemic, few have assessed how these patterns have evolved across the distinct phases of the pandemic and into the post-pandemic. In South Korea, our prior study also aimed to investigate the impact of COVID on the trends in prevalence of counseling of depression and stress, but included data only up to 2021, thus capturing only the early phase of the pandemic [ 8 ]. Herein, we investigated trends in mental health counseling for stress and depression in South Korea from 2009 to 2024. By dividing the study period into pre-pandemic (2009–2019), intra-pandemic (2020–2022), and post-pandemic (2023–2024), we examined temporal changes in counseling utilization and assessed associated demographic, socioeconomic, behavioral, and health-related factors. The findings of this study are anticipated to provide critical evidence to inform targeted public health interventions and guide future mental health policy development. METHODS Study design In this study, data were obtained from the Korea Community Health Survey (KCHS) [ 9 ]. The Korea Disease Control and Prevention Agency (KDCA) has conducted an anonymous, computer-assisted personal interview survey every year since 2008, targeting individuals aged 19 years and older, to assess their health status and behaviors. After excluding participants with missing data on key covariates, a total of 3,195,912 participants were included in the final analysis ( Supplementary Table 1 and Supplementary Figure 1 ). To assess trends in stress and depression from 2009 to 2024 and evaluate the impact of COVID-19, the study period was divided into three phases: pre-pandemic (2009–2019), intra-pandemic (2020–2022), and post-pandemic (2023–2024), based on the timeline of the first confirmed case in January 2020 and the easing of restrictions by the end of 2022 [ 10 , 11 ]. The study protocol was approved by the Institutional Review Board of the KDCA (2010-02CON-22-P, 2011-05CON04-C, 2012-07CON-01-2C, 2013-06EXP-01-3C, 2014-08EXP-09-4CA, and 2016-10-01-TA) for primary data collection and Kyung Hee University (KHSIRB-25-125) for secondary analysis. The KCHS data for the years covered by this study were anonymized, and written informed consent was obtained from all participants before they participated in the study. Ethical considerations were upheld, adhering to the Declaration of Helsinki. Furthermore, the KCHS provides public access to its data, which can be utilized as a valuable resource for diverse epidemiological investigations. Outcome measures We used counseling experience related to depression or stress as an indicator to assess mental health status. This was measured using the following questions: “Have you received professional counseling due to stress experienced in your usual daily life?” and “In the past year, have you received professional counseling due to feeling sadness or hopelessness for two consecutive weeks or more, to the extent that it interfered with your daily life?” Covariates The covariates included age (19–30, 31–40, 41–50, 51–60, 61–70, and ≥71 years), sex (male and female), region of residence (urban and rural) [ 12 ], level of education (elementary school or lower, middle school, high school, and college of higher education), household income (lowest, second, third, and highest quartile), smoking status (smoker, ex-smoker, and nonsmoker), alcohol consumption (<2, 2–12, and ≥13 days/month), self-rated-health (SRH; high, middle, and low), average sleep duration per day (<6, 6–6.9, 7–7.9, and ≥8 hours/day) and body mass index (BMI: underweight [<18.5 kg/m 2 ], normal weight [18.5–22.9 kg/m 2 ], overweight [23.0–24.9 kg/m 2 ], and obese [≥25 kg/m 2 ]) [ 13 ]. BMI categories were defined according to the WHO-Asia and Korean Society for the Study of Obesity criteria [ 14 ]. In addition, SRH is a subjective assessment that divides the perception of personal health into three levels: high, middle, and low [ 15 ]. Data analyses This study utilized data from the KCHS spanning 2009 to 2024. The prevalence of counseling for stress and depression was estimated annually as the weighted proportion of respondents reporting such services, accounting for the complex survey design. Weighted multivariate logistic regression models were used to estimate weighted odds ratios (wORs) and their corresponding 95% confidence intervals (CIs), in order evaluate factors associated with the prevalence of counseling for stress and depression [ 16 ]. To assess temporal trends, linear regression models were applied to estimate absolute differences in β coefficients across predefined time periods. Analyses were conducted for the overall study population and stratified subgroups based on relevant risk factors. Additionally, wORs were examined across the pre-pandemic, intra-pandemic, and postpandemic periods, and comparisons were made to identify period-specific patterns and disparities in counseling utilization [ 17 ]. All statistical analyses were performed using SAS software (version 9.4; SAS Institute). A p-value of <0.05 (two-sided) was considered statistically significant. RESULTS Table 1 presents the basic characteristics of the study population participating in the KCHS from 2009 to 2024. We conducted an in-depth analysis of a nationally representative sample comprising 3,195,912 South Korean adults who provided complete responses to the questionnaire. Females accounted for the larger proportion of participants, comprising 53.61% of the total sample (n=1,713,173). Table 1. General characteristics of Korean based on data obtained from the KCHS, 2009 to 2024 (N=3,195,912) Variables Total 2009–2010 2011–2013 2014–2016 2017–2019 2020 2021 2022 2023–2024 Overall, N 3,195,912 412,288 612,113 645,296 634,822 218,402 222,275 225,539 225,177 Weighted rate (95% CI) Age (yr) 19–30 18.73 (18.65 to 18.81) 21.81 (21.61 to 22.02) 20.35 (20.19 to 20.51) 19.27 (19.12 to 19.43) 18.78 (18.62 to 18.94) 18.36 (18.10 to 18.63) 17.99 (17.73 to 18.26) 17.64 (17.37 to 17.91) 16.44 (16.17 to 16.72) 31–40 17.88 (17.79 to 17.97) 22.54 (22.29 to 22.78) 21.30 (21.11 to 21.49) 19.32 (19.15 to 19.50) 17.60 (17.42 to 17.77) 16.66 (16.37 to 16.96) 16.23 (15.93 to 16.53) 15.59 (15.31 to 15.87) 15.17 (14.89 to 15.45) 41–50 20.22 (20.13 to 20.30) 22.61 (22.40 to 22.82) 22.33 (22.16 to 22.49) 21.64 (21.47 to 21.80) 20.49 (20.32 to 20.66) 19.45 (19.17 to 19.74) 19.07 (18.78 to 19.36) 18.70 (18.42 to 18.98) 18.27 (17.98 to 18.56) 51–60 19.06 (18.98 to 19.13) 15.91 (15.74 to 16.07) 18.18 (18.04 to 18.32) 19.55 (19.41 to 19.69) 19.83 (19.69 to 19.98) 19.77 (19.52 to 20.02) 19.59 (19.35 to 19.83) 19.51 (19.27 to 19.75) 19.50 (19.25 to 19.75) 61–70 13.23 (13.17 to 13.30) 10.12 (9.99 to 10.26) 10.38 (10.27 to 10.49) 11.10 (10.99 to 11.22) 12.57 (12.45 to 12.69) 13.79 (13.57 to 14.01) 14.47 (14.24 to 14.70) 15.59 (15.37 to 15.82) 16.71 (16.48 to 16.95) ≥71 10.89 (10.82 to 10.95) 7.01 (6.90 to 7.13) 7.47 (7.37 to 7.56) 9.11 (9.01 to 9.22) 10.74 (10.62 to 10.85) 11.96 (11.75 to 12.18) 12.65 (12.42 to 12.88) 12.97 (12.75 to 13.20) 13.91 (13.67 to 14.14) Sex Male 50.00 (49.94 to 50.07) 50.03 (49.88 to 50.18) 50.47 (50.34 to 50.60) 50.29 (50.17 to 50.41) 50.22 (50.09 to 50.35) 49.90 (49.68 to 50.12) 49.80 (49.58 to 50.02) 49.73 (49.51 to 49.95) 49.67 (49.44 to 49.89) Female 50.00 (49.93 to 50.06) 49.97 (49.82 to 50.12) 49.53 (49.40 to 49.66) 49.71 (49.59 to 49.83) 49.78 (49.65 to 49.91) 50.10 (49.88 to 50.32) 50.20 (49.98 to 50.42) 50.27 (50.05 to 50.49) 50.33 (50.11 to 50.56) Region of residence Urban 45.19 (44.99 to 45.39) 47.40 (46.65 to 48.14) 47.15 (46.64 to 47.66) 46.15 (45.65 to 46.65) 45.19 (44.69 to 45.70) 44.23 (43.31 to 45.15) 44.20 (43.29 to 45.11) 44.17 (43.28 to 45.05) 43.76 (42.89 to 44.62) Rural 54.81 (54.61 to 55.01) 52.60 (51.86 to 53.35) 52.85 (52.34 to 53.36) 53.85 (53.35 to 54.35) 54.81 (54.30 to 55.31) 55.77 (54.85 to 56.69) 55.80 (54.89 to 56.71) 55.83 (54.95 to 56.72) 56.24 (55.38 to 57.11) BMI group * Underweight 4.75 (4.71 to 4.79) 5.75 (5.65 to 5.85) 5.56 (5.48 to 5.64) 5.16 (5.09 to 5.24) 4.54 (4.47 to 4.61) 4.13 (4.02 to 4.24) 4.38 (4.26 to 4.50) 4.57 (4.45 to 4.69) 4.20 (4.09 to 4.32) Normal 42.66 (42.57 to 42.74) 48.04 (47.82 to 48.25) 46.77 (46.60 to 46.95) 44.94 (44.77 to 45.11) 40.87 (40.70 to 41.05) 40.79 (40.50 to 41.08) 40.78 (40.49 to 41.07) 40.68 (40.40 to 40.96) 39.95 (39.67 to 40.24) Overweight 23.76 (23.69 to 23.84) 23.68 (23.50 to 23.86) 23.64 (23.49 to 23.78) 23.74 (23.60 to 23.88) 23.67 (23.53 to 23.82) 24.05 (23.81 to 24.29) 24.08 (23.84 to 24.33) 23.60 (23.37 to 23.84) 23.61 (23.37 to 23.85) Obese 28.83 (28.75 to 28.92) 22.54 (22.35 to 22.72) 24.02 (23.88 to 24.17) 26.16 (26.01 to 26.31) 30.92 (30.75 to 31.08) 31.03 (30.74 to 31.31) 30.76 (30.49 to 31.04) 31.15 (30.88 to 31.42) 32.24 (31.96 to 32.52) Education Elementary school or lower education 11.39 (11.33 to 11.46) 14.66 (14.47 to 14.85) 12.56 (12.42 to 12.69) 11.72 (11.59 to 11.85) 11.11 (10.99 to 11.24) 11.06 (10.85 to 11.28) 10.58 (10.37 to 10.79) 10.32 (10.12 to 10.52) 9.90 (9.71 to 10.10) Middle school 8.37 (8.32 to 8.42) 9.79 (9.66 to 9.93) 9.16 (9.06 to 9.27) 8.61 (8.51 to 8.71) 8.34 (8.24 to 8.43) 8.10 (7.93 to 8.27) 7.67 (7.51 to 7.83) 8.00 (7.84 to 8.16) 7.68 (7.52 to 7.83) High school 29.99 (29.89 to 30.08) 32.17 (31.93 to 32.41) 31.33 (31.14 to 31.52) 30.35 (30.17 to 30.54) 29.92 (29.74 to 30.11) 29.88 (29.56 to 30.20) 29.20 (28.88 to 29.52) 29.14 (28.83 to 29.45) 28.50 (28.19 to 28.81) College or higher education 50.25 (50.12 to 50.38) 43.38 (43.05 to 43.70) 46.95 (46.70 to 47.20) 49.32 (49.06 to 49.57) 50.63 (50.37 to 50.88) 50.96 (50.51 to 51.40) 52.54 (52.08 to 53.00) 52.54 (52.10 to 52.98) 53.92 (53.48 to 54.36) Household income Lowest quartile 8.94 (8.88 to 9.01) 11.00 (10.81 to 11.19) 9.40 (9.27 to 9.54) 11.28 (11.13 to 11.43) 8.54 (8.42 to 8.67) 8.98 (8.75 to 9.20) 8.79 (8.57 to 9.02) 7.82 (7.62 to 8.02) 6.29 (6.12 to 6.46) Second quartile 28.34 (28.22 to 28.47) 40.09 (39.73 to 40.46) 33.16 (32.89 to 33.42) 32.93 (32.68 to 33.19) 26.46 (26.23 to 26.70) 26.33 (25.93 to 26.74) 25.39 (24.99 to 25.78) 23.70 (23.33 to 24.06) 21.66 (21.31 to 22.01) Third quartile 28.69 (28.57 to 28.81) 30.68 (30.36 to 31.01) 31.93 (31.68 to 32.17) 33.09 (32.83 to 33.35) 30.67 (30.42 to 30.91) 27.81 (27.40 to 28.21) 26.56 (26.17 to 26.95) 26.13 (25.76 to 26.50) 23.86 (23.51 to 24.21) Highest quartile 34.02 (33.85 to 34.20) 18.23 (17.88 to 18.57) 25.52 (25.22 to 25.81) 22.70 (22.40 to 22.99) 34.33 (34.01 to 34.65) 36.88 (36.32 to 37.44) 39.26 (38.70 to 39.81) 42.36 (41.82 to 42.90) 48.19 (47.65 to 48.72) Smoking status Smoker 20.18 (20.11 to 20.26) 25.43 (25.24 to 25.62) 23.96 (23.81 to 24.11) 21.80 (21.65 to 21.95) 20.02 (19.87 to 20.17) 18.32 (18.07 to 18.56) 17.69 (17.44 to 17.93) 18.19 (17.95 to 18.44) 17.60 (17.37 to 17.84) Ex-smoker 18.60 (18.53 to 18.67) 13.74 (13.60 to 13.88) 15.96 (15.84 to 16.08) 17.21 (17.09 to 17.33) 18.38 (18.25 to 18.51) 18.69 (18.46 to 18.92) 18.99 (18.76 to 19.22) 21.60 (21.37 to 21.83) 22.83 (22.60 to 23.06) Non-smoker 61.22 (61.14 to 61.31) 60.83 (60.64 to 61.02) 60.08 (59.92 to 60.23) 60.99 (60.84 to 61.14) 61.60 (61.44 to 61.76) 62.99 (62.71 to 63.28) 63.32 (63.03 to 63.61) 60.21 (59.93 to 60.48) 59.57 (59.30 to 59.84) Alcohol consumption (day/mon) <2 55.65 (55.56 to 55.75) 54.31 (54.07 to 54.54) 51.54 (51.35 to 51.72) 50.43 (50.24 to 50.61) 51.88 (51.68 to 52.07) 59.05 (58.72 to 59.37) 61.02 (60.70 to 61.34) 57.98 (57.67 to 58.29) 57.75 (57.44 to 58.06) 2–12 38.35 (38.25 to 38.44) 39.39 (39.16 to 39.63) 41.61 (41.43 to 41.79) 42.40 (42.22 to 42.58) 41.10 (40.91 to 41.28) 35.80 (35.48 to 36.12) 34.03 (33.72 to 34.34) 36.67 (36.36 to 36.98) 36.77 (36.46 to 37.08) ≥13 6.00 (5.96 to 6.04) 6.30 (6.19 to 6.40) 6.85 (6.77 to 6.94) 7.17 (7.09 to 7.26) 7.03 (6.94 to 7.12) 5.16 (5.03 to 5.29) 4.95 (4.82 to 5.08) 5.35 (5.22 to 5.48) 5.48 (5.35 to 5.61) Hypertension Yes 20.30 (20.22 to 20.37) 15.43 (15.27 to 15.59) 16.90 (16.77 to 17.03) 18.66 (18.52 to 18.79) 20.14 (20.00 to 20.29) 20.87 (20.62 to 21.12) 21.75 (21.49 to 22.01) 22.80 (22.54 to 23.06) 24.35 (24.08 to 24.61) No 79.70 (79.63 to 79.78) 84.57 (84.41 to 84.73) 83.10 (82.97 to 83.23) 81.34 (81.21 to 81.48) 79.86 (79.71 to 80.00) 79.13 (78.88 to 79.38) 78.25 (77.99 to 78.51) 77.20 (76.94 to 77.46) 75.65 (75.39 to 75.92) Diabetes Yes 8.50 (8.45 to 8.55) 5.81 (5.71 to 5.90) 6.42 (6.34 to 6.50) 7.48 (7.39 to 7.56) 8.22 (8.13 to 8.32) 8.96 (8.79 to 9.12) 9.47 (9.30 to 9.64) 10.16 (9.99 to 10.33) 10.64 (10.46 to 10.82) No 91.50 (91.45 to 91.55) 94.19 (94.10 to 94.29) 93.58 (93.50 to 93.66) 92.52 (92.44 to 92.61) 91.78 (91.68 to 91.87) 91.04 (90.88 to 91.21) 90.53 (90.36 to 90.70) 89.84 (89.67 to 90.01) 89.36 (89.18 to 89.54) SRH High 45.29 (45.18 to 45.40) 46.72 (46.45 to 46.99) 44.37 (44.16 to 44.57) 42.29 (42.10 to 42.49) 40.26 (40.05 to 40.46) 52.84 (52.50 to 53.19) 45.55 (45.21 to 45.89) 45.89 (45.55 to 46.23) 44.23 (43.88 to 44.57) Middle 41.64 (41.54 to 41.73) 39.21 (38.96 to 39.46) 41.63 (41.43 to 41.82) 43.59 (43.41 to 43.77) 45.43 (45.24 to 45.63) 37.84 (37.53 to 38.16) 42.39 (42.09 to 42.70) 41.22 (40.91 to 41.52) 41.57 (41.25 to 41.88) Low 13.07 (13.01 to 13.14) 14.07 (13.91 to 14.23) 14.01 (13.88 to 14.13) 14.11 (13.99 to 14.24) 14.31 (14.18 to 14.44) 9.31 (9.13 to 9.49) 12.06 (11.86 to 12.26) 12.89 (12.68 to 13.10) 14.21 (13.99 to 14.43) Average sleep duration (hr/day) <6 14.21 (14.15 to 14.27) 13.75 (13.59 to 13.91) 15.20 (15.07 to 15.33) 16.74 (16.61 to 16.87) 16.07 (15.94 to 16.20) 11.62 (11.43 to 11.80) 13.23 (13.03 to 13.43) 13.81 (13.60 to 14.01) 13.51 (13.30 to 13.71) 6–6.9 27.49 (27.41 to 27.57) 29.29 (29.08 to 29.50) 31.11 (30.95 to 31.28) 31.84 (31.68 to 32.01) 30.44 (30.28 to 30.61) 23.54 (23.29 to 23.79) 24.82 (24.56 to 25.07) 25.03 (24.78 to 25.28) 25.06 (24.81 to 25.31) 7–7.9 33.47 (33.38 to 33.56) 32.72 (32.50 to 32.93) 32.63 (32.46 to 32.80) 32.00 (31.84 to 32.16) 32.95 (32.78 to 33.12) 34.53 (34.24 to 34.81) 34.06 (33.77 to 34.35) 33.84 (33.56 to 34.13) 34.68 (34.39 to 34.97) ≥8 24.83 (24.75 to 24.91) 24.24 (24.04 to 24.45) 21.06 (20.91 to 21.20) 19.42 (19.28 to 19.56) 20.54 (20.39 to 20.69) 30.32 (30.03 to 30.61) 27.89 (27.61 to 28.17) 27.32 (27.05 to 27.59) 26.76 (26.49 to 27.02) Stress counseling Yes 2.41 (2.38 to 2.44) 1.54 (1.49 to 1.59) 1.66 (1.62 to 1.71) 1.99 (1.95 to 2.04) 2.16 (2.10 to 2.21) 2.67 (2.57 to 2.77) 2.94 (2.84 to 3.04) 3.06 (2.96 to 3.17) 2.97 (2.87 to 3.08) No 97.59 (97.56 to 97.62) 98.46 (98.41 to 98.51) 98.34 (98.29 to 98.38) 98.01 (97.96 to 98.05) 97.84 (97.79 to 97.90) 97.33 (97.23 to 97.43) 97.06 (96.96 to 97.16) 96.94 (96.83 to 97.04) 97.03 (96.92 to 97.13) Depression counseling Yes 1.41 (1.39 to 1.43) 0.94 (0.90 to 0.98) 0.92 (0.88 to 0.95) 1.11 (1.08 to 1.14) 1.28 (1.24 to 1.32) 1.48 (1.40 to 1.55) 1.72 (1.65 to 1.80) 1.88 (1.80 to 1.96) 1.80 (1.72 to 1.88) No 98.59 (98.57 to 98.61) 99.06 (99.02 to 99.11) 99.08 (99.05 to 99.12) 98.89 (98.86 to 98.92) 98.72 (98.68 to 98.76) 98.52 (98.45 to 98.60) 98.28 (98.20 to 98.35) 98.12 (98.05 to 98.20) 98.20 (98.12 to 98.28) Open in a new tab * according to Asia-Pacific guidelines, BMI is divided into 4 groups: underweight (<18.5 kg/m 2 ), normal (18.5–22.9 kg/m 2 ), overweight (23.0–24.9 kg/m 2 ), and obese (≥25 kg/m 2 ). KCHS, Korea Community Health Survey; CI, confidence interval; BMI, body mass index; SRH, self-rated health. Table 2 and Figure 1 present trends in the prevalence of counseling for stress across the pre-, intra-, and post-pandemic. Overall, the prevalence increased during pre- and intra-pandemic and remained elevated in the post-pandemic. A particularly notable increase was observed among individuals aged 19–30 years at the onset of the pandemic, with the prevalence rising from 2.51% (95% CI, 2.37 to 2.65) in 2017– 2019 to 3.31% (3.06 to 3.57) in 2020. In addition, the prevalence of counseling for stress was consistently higher among females compared to males. At the beginning of the intra-pandemic, individuals with low SRH exhibited a marked increase in the prevalence of counseling for stress. Notably, the gap in stress counseling prevalence between individuals with and without diabetes narrowed during the pandemic and reversed in the post-pandemic. In 2017–2019, individuals with diabetes had a higher prevalence (2.50% [95% CI, 2.32 to 2.67]) than those without diabetes (2.13% [2.07 to 2.18]). By 2022, the rates converged at 3.06% in both groups. In 2023–2024, the trend reversed, with a slightly higher prevalence observed among individuals without diabetes (2.98% [95% CI, 2.88 to 3.08]) than among those with diabetes (2.90% [2.64 to 3.15]). Lastly, a higher prevalence of counseling for stress was generally observed among individuals reporting an average sleep duration of less than 6 hours ( Supplementary Table 2 ). Table 2. Trends in the prevalence of counseling for stress throughout pre-, intra-, and post-pandemic (weighted % [95% CI]), based on data obtained from the KCHS Pre-pandemic Intra-pandemic Post-pandemic 2009–2010 2011–2013 2014–2016 2017–2019 2020 2021 2022 2023–2024 Overall 1.54 (1.49 to 1.59) 1.66 (1.62 to 1.71) 1.99 (1.95 to 2.04) 2.16 (2.10 to 2.21) 2.67 (2.58 to 2.77) 2.94 (2.84 to 3.03) 3.06 (2.97 to 3.16) 2.97 (2.88 to 3.07) Age (yr) 19–30 1.24 (1.13 to 1.35) 1.60 (1.49 to 1.71) 2.08 (1.96 to 2.19) 2.51 (2.37 to 2.65) 3.31 (3.06 to 3.57) 3.95 (3.67 to 4.22) 4.03 (3.75 to 4.31) 3.99 (3.70 to 4.28) 31–40 1.49 (1.38 to 1.60) 1.72 (1.62 to 1.82) 2.33 (2.21 to 2.44) 2.72 (2.58 to 2.85) 3.68 (3.40 to 3.96) 3.93 (3.66 to 4.19) 4.35 (4.06 to 4.64) 4.51 (4.21 to 4.80) 41–50 1.63 (1.52 to 1.75) 1.52 (1.43 to 1.61) 1.84 (1.74 to 1.93) 2.16 (2.05 to 2.27) 2.84 (2.63 to 3.05) 3.22 (3.00 to 3.44) 3.40 (3.16 to 3.63) 3.43 (3.19 to 3.66) 51–60 1.73 (1.59 to 1.86) 1.72 (1.62 to 1.82) 1.82 (1.72 to 1.91) 1.80 (1.70 to 1.90) 2.19 (2.01 to 2.37) 2.36 (2.17 to 2.56) 2.44 (2.25 to 2.63) 2.27 (2.10 to 2.45) 61–70 1.87 (1.72 to 2.02) 1.92 (1.79 to 2.05) 1.99 (1.87 to 2.11) 1.85 (1.74 to 1.96) 2.05 (1.87 to 2.24) 2.10 (1.93 to 2.28) 2.09 (1.93 to 2.25) 1.96 (1.81 to 2.11) ≥71 1.43 (1.28 to 1.59) 1.61 (1.48 to 1.74) 1.85 (1.72 to 1.97) 1.63 (1.52 to 1.74) 1.53 (1.36 to 1.69) 1.65 (1.49 to 1.81) 1.84 (1.68 to 1.99) 1.71 (1.56 to 1.87) Sex Male 0.96 (0.90 to 1.03) 1.10 (1.04 to 1.15) 1.40 (1.34 to 1.45) 1.56 (1.50 to 1.63) 2.06 (1.95 to 2.18) 2.14 (2.03 to 2.26) 2.24 (2.12 to 2.35) 2.15 (2.03 to 2.26) Female 2.12 (2.03 to 2.20) 2.24 (2.17 to 2.31) 2.60 (2.52 to 2.67) 2.75 (2.68 to 2.83) 3.28 (3.14 to 3.42) 3.73 (3.58 to 3.87) 3.88 (3.74 to 4.03) 3.79 (3.65 to 3.94) Region of residence Urban 1.65 (1.56 to 1.74) 1.78 (1.71 to 1.85) 2.07 (1.99 to 2.14) 2.28 (2.20 to 2.36) 2.83 (2.68 to 2.98) 3.17 (3.02 to 3.33) 3.29 (3.13 to 3.45) 3.20 (3.04 to 3.36) Rural 1.44 (1.38 to 1.50) 1.56 (1.51 to 1.61) 1.93 (1.87 to 1.98) 2.05 (1.99 to 2.12) 2.55 (2.43 to 2.66) 2.75 (2.64 to 2.86) 2.89 (2.77 to 3.00) 2.80 (2.69 to 2.91) BMI group * Underweight 1.98 (1.74 to 2.22) 2.18 (1.98 to 2.39) 3.03 (2.78 to 3.27) 3.30 (3.00 to 3.59) 3.74 (3.19 to 4.29) 4.52 (3.99 to 5.04) 4.97 (4.40 to 5.55) 5.08 (4.48 to 5.69) Normal 1.47 (1.40 to 1.54) 1.62 (1.56 to 1.69) 1.94 (1.88 to 2.01) 2.08 (2.01 to 2.16) 2.57 (2.43 to 2.71) 2.87 (2.73 to 3.02) 2.94 (2.79 to 3.08) 2.79 (2.65 to 2.93) Overweight 1.44 (1.34 to 1.54) 1.46 (1.37 to 1.54) 1.68 (1.60 to 1.77) 1.92 (1.82 to 2.02) 2.20 (2.03 to 2.37) 2.43 (2.25 to 2.60) 2.61 (2.43 to 2.79) 2.43 (2.26 to 2.60) Obese 1.68 (1.57 to 1.80) 1.82 (1.73 to 1.92) 2.15 (2.06 to 2.24) 2.26 (2.17 to 2.36) 3.04 (2.86 to 3.21) 3.20 (3.03 to 3.37) 3.30 (3.12 to 3.47) 3.33 (3.16 to 3.50) Education Elementary school or lower education 2.06 (1.92 to 2.19) 2.14 (2.03 to 2.26) 2.43 (2.31 to 2.55) 2.15 (2.04 to 2.27) 2.11 (1.92 to 2.29) 2.34 (2.14 to 2.55) 2.44 (2.23 to 2.64) 2.15 (1.95 to 2.35) Middle school 2.00 (1.81 to 2.18) 1.84 (1.70 to 1.98) 2.21 (2.05 to 2.36) 2.09 (1.94 to 2.24) 2.35 (2.09 to 2.61) 2.29 (2.04 to 2.54) 2.44 (2.19 to 2.69) 2.54 (2.27 to 2.81) High school 1.54 (1.45 to 1.63) 1.66 (1.58 to 1.74) 2.01 (1.93 to 2.10) 2.10 (2.01 to 2.19) 2.52 (2.36 to 2.69) 2.79 (2.63 to 2.95) 2.93 (2.77 to 3.10) 2.67 (2.51 to 2.83) College or higher education 1.26 (1.18 to 1.34) 1.51 (1.44 to 1.57) 1.84 (1.77 to 1.90) 2.20 (2.12 to 2.28) 2.94 (2.80 to 3.08) 3.23 (3.10 to 3.37) 3.36 (3.21 to 3.50) 3.35 (3.21 to 3.49) Household income Lowest quartile 2.79 (2.60 to 2.98) 2.91 (2.74 to 3.08) 3.43 (3.27 to 3.59) 3.69 (3.50 to 3.89) 3.81 (3.49 to 4.13) 4.06 (3.74 to 4.38) 4.40 (4.06 to 4.74) 4.54 (4.14 to 4.94) Second quartile 1.54 (1.46 to 1.62) 1.81 (1.74 to 1.89) 2.09 (2.01 to 2.17) 2.40 (2.30 to 2.50) 2.83 (2.66 to 3.00) 3.04 (2.86 to 3.22) 3.41 (3.21 to 3.60) 3.43 (3.23 to 3.64) Third quartile 1.22 (1.13 to 1.31) 1.36 (1.29 to 1.44) 1.62 (1.55 to 1.70) 1.78 (1.69 to 1.87) 2.54 (2.37 to 2.72) 2.79 (2.62 to 2.97) 2.83 (2.65 to 3.02) 2.71 (2.53 to 2.89) Highest quartile 1.33 (1.20 to 1.45) 1.39 (1.30 to 1.47) 1.68 (1.58 to 1.77) 1.92 (1.83 to 2.01) 2.38 (2.23 to 2.53) 2.72 (2.56 to 2.87) 2.77 (2.62 to 2.92) 2.70 (2.56 to 2.83) Smoking status Smoker 1.37 (1.26 to 1.47) 1.58 (1.49 to 1.67) 2.06 (1.96 to 2.16) 2.35 (2.23 to 2.47) 3.17 (2.94 to 3.41) 3.39 (3.15 to 3.63) 3.63 (3.39 to 3.86) 3.56 (3.32 to 3.79) Ex-smoker 1.11 (0.99 to 1.23) 1.30 (1.20 to 1.39) 1.53 (1.43 to 1.63) 1.79 (1.68 to 1.90) 2.48 (2.27 to 2.69) 2.70 (2.50 to 2.90) 2.77 (2.58 to 2.96) 2.72 (2.53 to 2.91) Non-smoker 1.71 (1.64 to 1.78) 1.79 (1.74 to 1.85) 2.10 (2.04 to 2.16) 2.20 (2.14 to 2.27) 2.59 (2.47 to 2.70) 2.88 (2.77 to 3.00) 3.00 (2.88 to 3.12) 2.90 (2.78 to 3.02) Alcohol consumption (day/mon) <2 1.80 (1.73 to 1.88) 1.93 (1.87 to 2.00) 2.29 (2.22 to 2.36) 2.37 (2.30 to 2.44) 2.79 (2.67 to 2.91) 2.95 (2.84 to 3.07) 3.19 (3.07 to 3.31) 3.14 (3.02 to 3.27) 2–12 1.20 (1.12 to 1.28) 1.36 (1.29 to 1.42) 1.65 (1.58 to 1.72) 1.88 (1.81 to 1.96) 2.40 (2.26 to 2.55) 2.88 (2.72 to 3.05) 2.82 (2.66 to 2.97) 2.65 (2.50 to 2.79) ≥13 1.42 (1.22 to 1.61) 1.50 (1.33 to 1.66) 1.91 (1.74 to 2.08) 2.15 (1.97 to 2.34) 3.20 (2.76 to 3.64) 3.13 (2.72 to 3.55) 3.39 (2.98 to 3.81) 3.38 (2.97 to 3.78) Hypertension Yes 1.42 (1.36 to 1.48) 2.15 (2.03 to 2.26) 2.43 (2.32 to 2.54) 2.25 (2.14 to 2.35) 2.57 (2.38 to 2.76) 2.77 (2.59 to 2.95) 2.75 (2.58 to 2.92) 2.56 (2.40 to 2.71) No 2.16 (1.93 to 2.38) 1.57 (1.52 to 1.61) 1.89 (1.84 to 1.94) 2.13 (2.07 to 2.19) 2.70 (2.59 to 2.81) 2.98 (2.88 to 3.09) 3.16 (3.05 to 3.27) 3.11 (3.00 to 3.22) Diabetes Yes 1.50 (1.45 to 1.56) 2.48 (2.28 to 2.68) 2.64 (2.46 to 2.82) 2.50 (2.32 to 2.67) 2.94 (2.64 to 3.24) 2.92 (2.63 to 3.22) 3.06 (2.80 to 3.33) 2.90 (2.64 to 3.15) No 3.02 (2.83 to 3.21) 1.61 (1.56 to 1.65) 1.94 (1.89 to 1.99) 2.13 (2.07 to 2.18) 2.65 (2.55 to 2.74) 2.94 (2.84 to 3.04) 3.06 (2.96 to 3.17) 2.98 (2.88 to 3.08) SRH High 0.61 (0.57 to 0.66) 0.67 (0.63 to 0.72) 0.85 (0.80 to 0.90) 0.94 (0.89 to 0.99) 1.44 (1.34 to 1.53) 1.49 (1.39 to 1.60) 1.49 (1.39 to 1.59) 1.50 (1.40 to 1.60) Middle 1.57 (1.48 to 1.65) 1.63 (1.56 to 1.70) 1.95 (1.88 to 2.02) 2.13 (2.05 to 2.20) 3.14 (2.98 to 3.30) 3.06 (2.91 to 3.20) 3.38 (3.23 to 3.54) 3.08 (2.93 to 3.22) Low 4.54 (4.32 to 4.76) 4.91 (4.72 to 5.10) 5.54 (5.34 to 5.73) 5.67 (5.47 to 5.87) 7.76 (7.29 to 8.24) 7.97 (7.55 to 8.38) 7.66 (7.28 to 8.04) 7.28 (6.92 to 7.63) Average sleep duration (hr/day) <6 1.41 (1.32 to 1.51) 3.20 (3.04 to 3.35) 3.60 (3.46 to 3.75) 4.07 (3.90 to 4.23) 5.13 (4.78 to 5.47) 5.31 (4.99 to 5.63) 5.45 (5.13 to 5.76) 5.26 (4.95 to 5.58) 6–6.9 1.12 (1.04 to 1.19) 1.43 (1.35 to 1.50) 1.66 (1.59 to 1.74) 1.87 (1.78 to 1.95) 2.53 (2.34 to 2.72) 2.61 (2.43 to 2.78) 2.85 (2.67 to 3.03) 2.73 (2.55 to 2.90) 7–7.9 1.42 (1.32 to 1.53) 1.20 (1.14 to 1.27) 1.42 (1.35 to 1.49) 1.57 (1.50 to 1.65) 2.09 (1.95 to 2.23) 2.30 (2.16 to 2.44) 2.29 (2.15 to 2.43) 2.25 (2.11 to 2.39) ≥8 1.66 (1.62 to 1.71) 1.62 (1.52 to 1.71) 2.09 (1.99 to 2.20) 2.02 (1.92 to 2.13) 2.51 (2.35 to 2.67) 2.88 (2.71 to 3.06) 3.01 (2.83 to 3.20) 2.99 (2.81 to 3.17) Open in a new tab * according to Asia-Pacific guidelines, BMI is divided into 4 groups: underweight (<18.5 kg/m 2 ), normal (18.5–22.9 kg/m 2 ), overweight (23.0–24.9 kg/m 2 ), and obese (≥25 kg/m 2 ). CI, confidence interval; KCHS, Korea Community Health Survey; BMI, body mass index; SRH, self-rated health. Figure 1. Open in a new tab Nationwide trends in the prevalence of counseling for stress (A and B) and depression (A and C) in pre-, intra-, and post-pandemic. SRH, self-rated health. Nationwide trends in the prevalence of counseling for stress (A and B) and depression (A and C) in pre-, intra-, and post-pandemic. SRH, self-rated health. Table 3 and Figure 1 present trends in the prevalence of counseling for depression during pre-, intra-, and post-pandemic. Overall, the prevalence exhibited an upward trend during the pre- and intra-pandemic and sustained high levels in the post-pandemic. At the onset of the intra-pandemic, the prevalence of counseling for depression also increased, particularly among individuals aged 19–30 years. In this group, the prevalence rose from 1.36% (95% CI, 1.26 to 1.46) in 2017– 2019 to 1.83% (1.64 to 2.02) in 2020. Consistent with the pattern observed for stress, females showed a consistently higher prevalence of counseling for depression compared to males throughout the study period. Additionally, underweight individuals reported a higher prevalence of counseling for stress relative to other BMI categories. Among underweight individuals, while the prevalence of counseling for stress continued to increase after the pandemic, the prevalence of counseling for depression declined from 3.26% (95% CI, 2.80 to 3.72) in 2022 to 2.67% (2.26 to 3.07) in 2023–2024. The βdiff between intra- and post-pandemic was significant at -1.10% (95% CI, -1.81 to -0.39) ( Supplementary Table 3 ). Individuals in the lowest household income group reported a higher prevalence of counseling for depression compared to those in higher income groups. Moreover, at the beginning of the pandemic in 2020, individuals with low SRH exhibited a notable increase in the prevalence of counseling for depression, rising from 4.10% (95% CI, 3.93 to 4.27) in 2017–2019 to 5.53% (5.12 to 5.95) in 2020. In addition, a higher prevalence of counseling for depression was generally observed among individuals who reported an average sleep duration of less than 6 hours. Table 3. Trends in the prevalence of counseling for depression throughout pre-, intra-, and post-pandemic (weighted % [95% CI]), based on data obtained from the KCHS Pre-pandemic Intra-pandemic Post-pandemic 2009–2010 2011–2013 2014–2016 2017–2019 2020 2021 2022 2023–2024 Overall 0.94 (0.90 to 0.98) 0.92 (0.88 to 0.95) 1.11 (1.08 to 1.14) 1.28 (1.24 to 1.32) 1.48 (1.41 to 1.55) 1.72 (1.65 to 1.79) 1.88 (1.80 to 1.95) 1.80 (1.73 to 1.87) Age (yr) 19–30 0.65 (0.57 to 0.74) 0.79 (0.71 to 0.87) 0.92 (0.84 to 1.00) 1.36 (1.26 to 1.46) 1.83 (1.64 to 2.02) 2.09 (1.89 to 2.28) 2.24 (2.03 to 2.45) 2.20 (1.98 to 2.43) 31–40 0.75 (0.67 to 0.82) 0.78 (0.71 to 0.84) 1.05 (0.97 to 1.13) 1.26 (1.17 to 1.35) 1.59 (1.42 to 1.77) 1.71 (1.53 to 1.88) 2.11 (1.91 to 2.32) 2.16 (1.95 to 2.36) 41–50 0.97 (0.88 to 1.06) 0.82 (0.75 to 0.88) 0.96 (0.89 to 1.03) 1.17 (1.09 to 1.26) 1.44 (1.29 to 1.59) 1.69 (1.52 to 1.85) 1.74 (1.58 to 1.90) 1.81 (1.64 to 1.98) 51–60 1.16 (1.05 to 1.26) 1.04 (0.96 to 1.12) 1.23 (1.15 to 1.31) 1.24 (1.16 to 1.33) 1.30 (1.16 to 1.44) 1.55 (1.40 to 1.70) 1.79 (1.63 to 1.94) 1.58 (1.43 to 1.73) 61–70 1.37 (1.24 to 1.51) 1.33 (1.22 to 1.44) 1.40 (1.30 to 1.50) 1.37 (1.27 to 1.46) 1.36 (1.22 to 1.51) 1.61 (1.45 to 1.76) 1.73 (1.58 to 1.88) 1.50 (1.37 to 1.64) ≥71 1.18 (1.04 to 1.32) 1.07 (0.96 to 1.17) 1.38 (1.28 to 1.49) 1.33 (1.23 to 1.43) 1.26 (1.10 to 1.41) 1.68 (1.51 to 1.85) 1.61 (1.46 to 1.75) 1.60 (1.45 to 1.75) Sex Male 0.52 (0.48 to 0.57) 0.52 (0.49 to 0.56) 0.68 (0.64 to 0.72) 0.86 (0.81 to 0.90) 1.02 (0.94 to 1.10) 1.14 (1.06 to 1.22) 1.20 (1.11 to 1.28) 1.24 (1.15 to 1.33) Female 1.35 (1.29 to 1.42) 1.31 (1.26 to 1.37) 1.54 (1.49 to 1.60) 1.71 (1.65 to 1.77) 1.93 (1.83 to 2.04) 2.30 (2.19 to 2.42) 2.55 (2.43 to 2.66) 2.36 (2.25 to 2.47) Region of residence Urban 0.98 (0.91 to 1.05) 0.96 (0.91 to 1.02) 1.17 (1.11 to 1.23) 1.32 (1.26 to 1.39) 1.61 (1.49 to 1.72) 1.86 (1.75 to 1.98) 2.01 (1.89 to 2.13) 1.95 (1.82 to 2.07) Rural 0.90 (0.85 to 0.94) 0.87 (0.83 to 0.91) 1.06 (1.02 to 1.10) 1.24 (1.19 to 1.29) 1.37 (1.29 to 1.46) 1.61 (1.52 to 1.70) 1.77 (1.68 to 1.86) 1.69 (1.60 to 1.78) BMI group * Underweight 1.30 (1.10 to 1.51) 1.39 (1.22 to 1.55) 1.64 (1.47 to 1.81) 2.02 (1.80 to 2.24) 2.23 (1.81 to 2.65) 3.01 (2.56 to 3.46) 3.26 (2.80 to 3.72) 2.67 (2.26 to 3.07) Normal 0.90 (0.85 to 0.96) 0.89 (0.84 to 0.94) 1.12 (1.06 to 1.17) 1.29 (1.22 to 1.35) 1.46 (1.36 to 1.56) 1.75 (1.64 to 1.86) 1.84 (1.73 to 1.96) 1.71 (1.60 to 1.82) Overweight 0.87 (0.79 to 0.95) 0.81 (0.75 to 0.87) 0.96 (0.90 to 1.02) 1.13 (1.05 to 1.20) 1.24 (1.12 to 1.37) 1.38 (1.25 to 1.50) 1.68 (1.54 to 1.82) 1.55 (1.41 to 1.69) Obese 0.98 (0.90 to 1.06) 0.97 (0.90 to 1.04) 1.13 (1.06 to 1.20) 1.28 (1.21 to 1.35) 1.58 (1.46 to 1.71) 1.78 (1.65 to 1.90) 1.87 (1.74 to 2.00) 1.98 (1.85 to 2.11) Education Elementary school or lower education 1.57 (1.45 to 1.68) 1.44 (1.34 to 1.54) 1.80 (1.69 to 1.91) 1.68 (1.58 to 1.79) 1.55 (1.39 to 1.72) 2.09 (1.90 to 2.29) 2.24 (2.05 to 2.43) 1.94 (1.75 to 2.13) Middle school 1.31 (1.17 to 1.45) 1.25 (1.14 to 1.37) 1.58 (1.45 to 1.71) 1.60 (1.46 to 1.73) 1.80 (1.57 to 2.03) 1.99 (1.75 to 2.22) 2.06 (1.84 to 2.29) 2.06 (1.83 to 2.29) High school 0.94 (0.87 to 1.01) 0.99 (0.93 to 1.05) 1.20 (1.13 to 1.26) 1.37 (1.30 to 1.45) 1.53 (1.40 to 1.65) 1.76 (1.63 to 1.89) 1.92 (1.79 to 2.06) 1.85 (1.72 to 1.98) College or higher education 0.63 (0.58 to 0.69) 0.66 (0.62 to 0.70) 0.81 (0.77 to 0.86) 1.08 (1.03 to 1.14) 1.38 (1.29 to 1.48) 1.59 (1.49 to 1.69) 1.75 (1.65 to 1.85) 1.71 (1.61 to 1.81) Household income Lowest quartile 2.15 (1.99 to 2.32) 2.12 (1.98 to 2.27) 2.65 (2.51 to 2.80) 3.04 (2.86 to 3.22) 3.08 (2.78 to 3.37) 3.86 (3.54 to 4.18) 4.27 (3.94 to 4.60) 4.24 (3.86 to 4.63) Second quartile 0.94 (0.87 to 1.00) 1.05 (0.99 to 1.10) 1.19 (1.13 to 1.25) 1.58 (1.50 to 1.66) 1.83 (1.69 to 1.97) 2.09 (1.94 to 2.24) 2.37 (2.21 to 2.53) 2.59 (2.42 to 2.76) Third quartile 0.65 (0.59 to 0.72) 0.66 (0.61 to 0.71) 0.73 (0.69 to 0.78) 0.98 (0.92 to 1.04) 1.22 (1.10 to 1.34) 1.38 (1.26 to 1.51) 1.59 (1.46 to 1.73) 1.57 (1.43 to 1.71) Highest quartile 0.68 (0.59 to 0.76) 0.62 (0.57 to 0.68) 0.77 (0.70 to 0.83) 0.88 (0.82 to 0.94) 1.03 (0.93 to 1.13) 1.24 (1.13 to 1.34) 1.33 (1.23 to 1.44) 1.24 (1.15 to 1.33) Smoking status Smoker 0.77 (0.70 to 0.85) 0.82 (0.75 to 0.88) 1.12 (1.04 to 1.19) 1.39 (1.30 to 1.49) 1.82 (1.64 to 2.00) 1.90 (1.71 to 2.09) 2.32 (2.13 to 2.51) 2.19 (1.99 to 2.38) Ex-smoker 0.68 (0.59 to 0.77) 0.73 (0.65 to 0.80) 0.81 (0.74 to 0.88) 1.07 (0.99 to 1.15) 1.20 (1.06 to 1.34) 1.51 (1.36 to 1.66) 1.57 (1.42 to 1.72) 1.65 (1.51 to 1.79) Non-smoker 1.06 (1.01 to 1.12) 1.01 (0.96 to 1.05) 1.19 (1.15 to 1.23) 1.31 (1.26 to 1.35) 1.46 (1.38 to 1.54) 1.74 (1.65 to 1.83) 1.85 (1.76 to 1.94) 1.75 (1.66 to 1.84) Alcohol consumption (day/mon) <2 1.17 (1.12 to 1.23) 1.12 (1.07 to 1.17) 1.38 (1.33 to 1.43) 1.50 (1.45 to 1.56) 1.65 (1.55 to 1.74) 1.92 (1.83 to 2.02) 2.06 (1.97 to 2.16) 2.02 (1.92 to 2.11) 2–12 0.62 (0.56 to 0.67) 0.67 (0.62 to 0.71) 0.81 (0.76 to 0.86) 0.99 (0.93 to 1.04) 1.19 (1.08 to 1.29) 1.36 (1.25 to 1.47) 1.56 (1.45 to 1.67) 1.44 (1.32 to 1.55) ≥13 0.87 (0.72 to 1.02) 0.86 (0.73 to 0.99) 0.97 (0.86 to 1.09) 1.35 (1.20 to 1.50) 1.58 (1.28 to 1.88) 1.78 (1.47 to 2.10) 2.01 (1.66 to 2.35) 1.98 (1.67 to 2.30) Hypertension Yes 1.41 (1.30 to 1.53) 1.31 (1.22 to 1.40) 1.58 (1.49 to 1.66) 1.54 (1.45 to 1.62) 1.68 (1.53 to 1.83) 1.86 (1.72 to 1.99) 2.13 (1.98 to 2.28) 1.83 (1.70 to 1.96) No 0.85 (0.81 to 0.89) 0.83 (0.80 to 0.87) 1.00 (0.97 to 1.04) 1.21 (1.17 to 1.26) 1.42 (1.35 to 1.50) 1.69 (1.60 to 1.77) 1.80 (1.72 to 1.89) 1.79 (1.71 to 1.88) Diabetes Yes 1.63 (1.43 to 1.83) 1.61 (1.45 to 1.77) 1.88 (1.73 to 2.03) 1.79 (1.64 to 1.94) 1.84 (1.60 to 2.07) 2.06 (1.84 to 2.28) 2.48 (2.24 to 2.72) 2.07 (1.86 to 2.29) No 0.89 (0.85 to 0.93) 0.87 (0.83 to 0.90) 1.05 (1.01 to 1.08) 1.23 (1.19 to 1.27) 1.44 (1.37 to 1.51) 1.69 (1.61 to 1.76) 1.81 (1.73 to 1.89) 1.77 (1.69 to 1.85) SRH High 0.32 (0.28 to 0.35) 0.30 (0.27 to 0.33) 0.40 (0.37 to 0.44) 0.47 (0.43 to 0.51) 0.71 (0.65 to 0.78) 0.74 (0.67 to 0.81) 0.81 (0.74 to 0.89) 0.80 (0.72 to 0.87) Middle 0.82 (0.76 to 0.88) 0.79 (0.75 to 0.84) 0.93 (0.89 to 0.98) 1.11 (1.05 to 1.16) 1.55 (1.43 to 1.66) 1.61 (1.51 to 1.72) 1.81 (1.70 to 1.92) 1.66 (1.55 to 1.77) Low 3.32 (3.13 to 3.51) 3.22 (3.06 to 3.37) 3.77 (3.61 to 3.92) 4.10 (3.93 to 4.27) 5.53 (5.12 to 5.95) 5.82 (5.48 to 6.17) 5.88 (5.56 to 6.21) 5.32 (5.02 to 5.63) Average sleep duration (hr/day) <6 1.81 (1.67 to 1.95) 1.82 (1.71 to 1.94) 2.07 (1.96 to 2.18) 2.40 (2.28 to 2.53) 3.04 (2.78 to 3.30) 3.39 (3.13 to 3.64) 3.64 (3.38 to 3.91) 3.54 (3.28 to 3.80) 6–6.9 0.76 (0.69 to 0.82) 0.74 (0.68 to 0.79) 0.87 (0.81 to 0.92) 0.98 (0.92 to 1.05) 1.28 (1.15 to 1.41) 1.44 (1.31 to 1.57) 1.61 (1.47 to 1.74) 1.50 (1.37 to 1.63) 7–7.9 0.62 (0.57 to 0.68) 0.58 (0.53 to 0.62) 0.72 (0.67 to 0.77) 0.89 (0.84 to 0.95) 1.04 (0.94 to 1.13) 1.19 (1.09 to 1.30) 1.32 (1.22 to 1.43) 1.25 (1.14 to 1.35) ≥8 1.08 (0.99 to 1.17) 1.05 (0.97 to 1.13) 1.31 (1.23 to 1.39) 1.46 (1.37 to 1.55) 1.54 (1.41 to 1.66) 1.83 (1.69 to 1.97) 1.92 (1.77 to 2.06) 1.92 (1.78 to 2.06) Open in a new tab * according to Asia-Pacific guidelines, BMI is divided into 4 groups: underweight (<18.5 kg/m 2 ), normal (18.5–22.9 kg/m 2 ), overweight (23.0–24.9 kg/m 2 ), and obese (≥25 kg/m 2 ). CI, confidence interval; KCHS, Korea Community Health Survey; BMI, body mass index; SRH, self-rated health. Table 4 shows the wORs from an analysis conducted to investigate trends in counseling for stress and depression. Counseling rates increased significantly during the pandemic compared to the pre-pandemic. In contrast, no significant differences were observed between the intra-pandemic and postpandemic. When compared to the pre-pandemic, the rates of counseling for both stress and depression increased significantly during the pandemic among individuals aged 19–30 years, those classified as underweight and current smokers. Specifically, among individuals aged 19–30 years, the wORs were 2.07 (95% CI, 1.95 to 2.19) for stress and 2.23 (2.07 to 2.41) for depression. In the underweight group, the wORs were 1.73 (95% CI, 1.58 to 1.90) for stress and 1.83 (1.63 to 2.06) for depression. Among smokers, the wORs were 1.89 (95% CI, 1.79 to 1.99) for stress and 2.00 (1.87 to 2.15) for depression. Table 4. Weighted ORs as a trend of counseling for stress and counseling for depression rates, based on data obtained from the KCHS Counseling for stress Counseling for depression Pre-pandemic (reference) vs. intra-pandemic Intra-pandemic (reference) vs. post-pandemic Pre-pandemic (reference) vs. intra-pandemic Intra-pandemic (reference) vs. post-pandemic Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Overall 1.58 (1.54 to 1.62) * 1.03 (0.99 to 1.07) 1.60 (1.55 to 1.65) * 1.06 (1.01 to 1.12) * Age (yr) 19–30 2.07 (1.95 to 2.19) * 1.06 (0.97 to 1.17) 2.23 (2.07 to 2.41) * 1.08 (0.95 to 1.22) 31–40 1.98 (1.88 to 2.09) * 1.14 (1.05 to 1.24) * 1.91 (1.77 to 2.06) * 1.20 (1.06 to 1.36) * 41–50 1.79 (1.69 to 1.88) * 1.09 (1.00 to 1.19) * 1.67 (1.55 to 1.79) * 1.12 (0.99 to 1.25) 51–60 1.32 (1.25 to 1.40) * 0.97 (0.88 to 1.07) 1.32 (1.23 to 1.42) * 1.02 (0.90 to 1.15) 61–70 1.09 (1.03 to 1.17) * 0.94 (0.85 to 1.04) 1.15 (1.07 to 1.24) * 0.95 (0.85 to 1.07) ≥71 1.02 (0.95 to 1.09) 1.02 (0.91 to 1.15) 1.21 (1.12 to 1.31) * 1.05 (0.93 to 1.19) Sex Male 1.71 (1.64 to 1.78) * 1.00 (0.93 to 1.07) 1.73 (1.63 to 1.83) * 1.11 (1.01 to 1.21) * Female 1.51 (1.46 to 1.55) * 1.05 (1.01 to 1.10) 1.53 (1.48 to 1.59) * 1.04 (0.98 to 1.11) Region of residence Urban 1.60 (1.54 to 1.67) * 1.03 (0.97 to 1.10) 1.65 (1.58 to 1.74) * 1.07 (0.98 to 1.15) Rural 1.56 (1.51 to 1.61) * 1.03 (0.98 to 1.08) 1.55 (1.49 to 1.62) * 1.07 (1.01 to 1.14) BMI group† Underweight 1.73 (1.58 to 1.90) * 1.15 (0.99 to 1.35) 1.83 (1.63 to 2.06) * 0.93 (0.77 to 1.12) Normal 1.58 (1.53 to 1.65) * 1.00 (0.94 to 1.06) 1.62 (1.54 to 1.70) * 1.02 (0.94 to 1.10) Overweight 1.49 (1.41 to 1.57) * 1.01 (0.92 to 1.10) 1.52 (1.42 to 1.63) * 1.08 (0.97 to 1.21) Obese 1.59 (1.53 to 1.66) * 1.05 (0.98 to 1.12) 1.58 (1.49 to 1.67) * 1.14 (1.05 to 1.24) * Education Elementary school or lower education 1.05 (0.98 to 1.11) 0.94 (0.84 to 1.05) 1.21 (1.13 to 1.30) * 0.99 (0.88 to 1.12) Middle school 1.16 (1.08 to 1.26) * 1.08 (0.94 to 1.24) 1.37 (1.25 to 1.49) * 1.06 (0.91 to 1.22) High school 1.51 (1.44 to 1.58) * 0.97 (0.90 to 1.05) 1.55 (1.46 to 1.64) * 1.07 (0.97 to 1.17) College or higher education 1.85 (1.79 to 1.92) * 1.06 (0.99 to 1.11) 1.95 (1.86 to 2.05) * 1.09 (1.01 to 1.17) * Household income Lowest quartile 1.28 (1.21 to 1.36) * 1.12 (1.01 to 1.25) * 1.51 (1.42 to 1.61) * 1.15 (1.02 to 1.29) * Second quartile 1.61 (1.55 to 1.69) * 1.12 (1.04 to 1.21) * 1.81 (1.71 to 1.90) * 1.25 (1.14 to 1.36) * Third quartile 1.82 (1.73 to 1.92) * 0.99 (0.91 to 1.08) 1.85 (1.73 to 1.98) * 1.13 (1.01 to 1.26) * Highest quartile 1.63 (1.55 to 1.70) * 1.03 (0.96 to 1.09) 1.60 (1.50 to 1.72) * 1.03 (0.93 to 1.13) Smoking status Smoker 1.89 (1.79 to 1.99) * 1.05 (0.96 to 1.15) 2.00 (1.87 to 2.15) * 1.09 (0.97 to 1.22) Ex-smoker 1.83 (1.72 to 1.94) * 1.02 (0.94 to 1.12) 1.71 (1.58 to 1.86) * 1.15 (1.03 to 1.29) * Non-smoker 1.45 (1.41 to 1.49) * 1.03 (0.98 to 1.08) 1.48 (1.42 to 1.53) * 1.04 (0.97 to 1.11) Alcohol consumption (day/mon) <2 1.42 (1.38 to 1.47) * 1.06 (1.01 to 1.11) * 1.45 (1.40 to 1.51) * 1.08 (1.01 to 1.14) * 2–12 1.77 (1.70 to 1.85) * 0.98 (0.91 to 1.05) 1.77 (1.67 to 1.88) * 1.05 (0.95 to 1.16) ≥13 1.86 (1.69 to 2.05) * 1.04 (0.89 to 1.22) 1.77 (1.55 to 2.01) * 1.11 (0.90 to 1.36) Hypertension Yes 1.20 (1.14 to 1.26) * 0.95 (0.87 to 1.02) 1.29 (1.22 to 1.37) * 0.97 (0.88 to 1.06) No 1.69 (1.65 to 1.74) * 1.06 (1.01 to 1.11) * 1.68 (1.62 to 1.75) * 1.10 (1.03 to 1.16) * Diabetes Yes 1.21 (1.13 to 1.30) * 0.97 (0.87 to 1.09) 1.23 (1.13 to 1.34) * 0.97 (0.85 to 1.10) No 1.62 (1.57 to 1.66) * 1.04 (0.99 to 1.08) 1.63 (1.58 to 1.69) * 1.08 (1.02 to 1.14) * SRH High 1.93 (1.83 to 2.03) * 1.02 (0.94 to 1.11) 2.02 (1.88 to 2.18) * 1.06 (0.94 to 1.19) Middle 1.76 (1.69 to 1.82) * 0.96 (0.91 to 1.02) 1.81 (1.72 to 1.90) * 1.00 (0.92 to 1.09) Low 1.54 (1.48 to 1.61) * 0.93 (0.87 to 0.99) * 1.63 (1.55 to 1.71) * 0.92 (0.85 to 0.99) Average sleep duration (hr/day) <6 1.54 (1.47 to 1.61) * 0.99 (0.92 to 1.07) 1.67 (1.58 to 1.77) * 1.05 (0.96 to 1.16) 6–6.9 1.68 (1.60 to 1.77) * 1.02 (0.94 to 1.11) 1.73 (1.62 to 1.85) * 1.04 (0.93 to 1.16) 7–7.9 1.68 (1.60 to 1.76) * 1.01 (0.94 to 1.09) 1.68 (1.57 to 1.79) * 1.05 (0.95 to 1.17) ≥8 1.58 (1.51 to 1.66) * 1.07 (0.99 to 1.16) 1.44 (1.36 to 1.53) * 1.10 (1.01 to 1.21) Open in a new tab * p<0.05; †according to Asia-Pacific guidelines, BMI is divided into 4 groups: underweight (<18.5 kg/m 2 ), normal (18.5–22.9 kg/m 2 ), overweight (23.0–24.9 kg/m 2 ), and obese (≥25 kg/m 2 ). OR, odds ratio; KCHS, Korea Community Health Survey; CI, confidence interval; BMI, body mass index; SRH, self-rated health. Table 5 and Figure 2 show the risk factors associated with vulnerability to counseling for stress and depression, expressed as the wOR. Female, urban residents, and individuals with low household income were identified as key vulnerable groups. During the pre-pandemic period, individuals with the lowest level of education (elementary school or below) were the most vulnerable compared to those with a college education or higher (1.27 [95% CI, 1.22 to 1.31]). However, since the onset of the intra-pandemic, this trend reversed, and the group with a college or higher education has become the most vulnerable to stress. Age-related shifts were also notable. Prior to the pandemic, individuals aged 19–30 were not considered a high-risk group for depression. However, they became significantly more vulnerable during the intra-pandemic (95% CI, 1.36 [1.24 to 1.48]) and post-pandemic (1.39 [1.20 to 1.59]) compared to those aged ≥71 years. Across all time periods, individuals with low SRH and those with average sleep durations of fewer than 6 hours or more than 8 hours per day remained the most vulnerable groups. Table 5. Ratio of weighted ORs for risk factors for the vulnerable group of counseling for stress and depression pre-, intra-, and post-pandemic, based on data obtained from the KCHS Variables Counseling for stress Counseling for depression Overallv Pre-pandemic Intra-pandemic Post-pandemic Overall Pre-pandemic Intra-pandemic Post-pandemic Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Weighted OR (95% CI) Age (yr) ≥71 (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 19–30 1.71 (1.64 to 1.79) * 1.13 (1.07 to 1.19) * 2.29 (2.13 to 2.47) * 2.39 (2.12 to 2.69) * 1.05 (0.99 to 1.11) 0.73 (0.69 to 0.78) * 1.36 (1.24 to 1.48) * 1.39 (1.20 to 1.59) * 31–40 1.83 (1.75 to 1.91) * 1.25 (1.19 to 1.31) * 2.43 (2.26 to 2.62) * 2.71 (2.41 to 3.04) * 0.97 (0.92 to 1.02) 0.75 (0.71 to 0.80) * 1.19 (1.08 to 1.30) * 1.36 (1.18 to 1.55) * 41–50 1.50 (1.44 to 1.57) * 1.09 (1.04 to 1.14) * 1.91 (1.77 to 2.06) * 2.04 (1.82 to 2.28) * 0.92 (0.87 to 0.97) * 0.77 (0.73 to 0.82) * 1.07 (0.98 to 1.17) 1.13 (0.99 to 1.29) 51–60 1.24 (1.19 to 1.30) * 1.08 (1.02 to 1.13) * 1.40 (1.30 to 1.51) * 1.33 (1.18 to 1.51) * 0.96 (0.91 to 1.01) 0.93 (0.88 to 0.98) * 1.02 (0.93 to 1.11) 0.99 (0.86 to 1.13) 61–70 1.20 (1.14 to 1.25) * 1.16 (1.10 to 1.22) * 1.25 (1.15 to 1.35) * 1.15 (1.02 to 1.29) * 1.03 (0.98 to 1.09) 1.09 (1.02 to 1.15) * 1.04 (0.95 to 1.13) 0.94 (0.82 to 1.07) Sex Male (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Female 1.81 (1.77 to 1.86) * 1.95 (1.89 to 2.00) * 1.72 (1.65 to 1.79) * 1.80 (1.68 to 1.92) * 2.11 (2.05 to 2.18) * 2.30 (2.21 to 2.39) * 2.05 (1.94 to 2.16) * 1.93 (1.77 to 2.10) * Region of residence Rural (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Urban 1.12 (1.09 to 1.15) * 1.11 (1.08 to 1.14) * 1.14 (1.09 to 1.19) * 1.15 (1.08 to 1.23) * 1.12 (1.08 to 1.15) * 1.09 (1.05 to 1.12) * 1.16 (1.10 to 1.22) * 1.16 (1.06 to 1.26) * BMI group† Underweight (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Normal 0.63 (0.60 to 0.67) * 0.68 (0.64 to 0.71) * 0.62 (0.57 to 0.67) * 0.54 (0.47 to 0.61) * 0.63 (0.59 to 0.67) * 0.66 (0.62 to 0.71) * 0.58 (0.53 to 0.65) * 0.64 (0.54 to 0.75) * Overweight 0.57 (0.54 to 0.60) * 0.62 (0.59 to 0.66) * 0.53 (0.49 to 0.58) * 0.47 (0.40 to 0.54) * 0.56 (0.52 to 0.60) * 0.60 (0.56 to 0.64) * 0.50 (0.44 to 0.55) * 0.58 (0.48 to 0.69) * Obese 0.75 (0.72 to 0.79) * 0.77 (0.73 to 0.81) * 0.71 (0.65 to 0.77) * 0.64 (0.56 to 0.74) * 0.69 (0.65 to 0.74) * 0.70 (0.65 to 0.75) * 0.60 (0.54 to 0.67) * 0.74 (0.62 to 0.88) * Education College or higher education (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Elementary school or lower education 0.87 (0.84 to 0.90) * 1.27 (1.22 to 1.31) * 0.72 (0.67 to 0.76) * 0.64 (0.57 to 0.70) * 1.43 (1.37 to 1.49) * 2.01 (1.92 to 2.10) * 1.25 (1.16 to 1.34) * 1.14 (1.01 to 1.28) * Middle school 0.86 (0.83 to 0.90) * 1.17 (1.12 to 1.23) * 0.74 (0.69 to 0.79) * 0.75 (0.67 to 0.85) * 1.36 (1.30 to 1.43) * 1.77 (1.68 to 1.87) * 1.24 (1.14 to 1.35) * 1.21 (1.06 to 1.37) * High school 0.90 (0.87 to 0.92) * 1.06 (1.02 to 1.09) * 0.86 (0.82 to 0.90) * 0.79 (0.74 to 0.85) * 1.16 (1.12 to 1.21) * 1.39 (1.33 to 1.45) * 1.10 (1.04 to 1.17) * 1.08 (0.98 to 1.19) Household income Highest quartile (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Lowest quartile 1.62 (1.56 to 1.68) * 2.00 (1.91 to 2.08) * 1.57 (1.48 to 1.68) * 1.72 (1.55 to 1.91) * 3.02 (2.88 to 3.16) * 3.36 (3.18 to 3.55) * 3.16 (2.93 to 3.41) * 3.53 (3.13 to 3.98) * Second quartile 1.09 (1.06 to 1.12) * 1.19 (1.14 to 1.23) * 1.18 (1.12 to 1.24) * 1.28 (1.19 to 1.39) * 1.56 (1.49 to 1.63) * 1.55 (1.47 to 1.63) * 1.74 (1.63 to 1.87) * 2.12 (1.91 to 2.35) * Third quartile 0.91 (0.88 to 0.94) * 0.92 (0.89 to 0.96) * 1.04 (0.98 to 1.09) 1.01 (0.92 to 1.09) 1.03 (0.98 to 1.08) 1.01 (0.95 to 1.07) 1.16 (1.07 to 1.25) * 1.27 (1.13 to 1.43) * Smoking status Ex-smoker (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Smoker 1.19 (1.15 to 1.24) * 1.25 (1.19 to 1.31) * 1.29 (1.21 to 1.37) * 1.32 (1.19 to 1.46) * 1.23 (1.17 to 1.30) * 1.21 (1.14 to 1.28) * 1.41 (1.30 to 1.54) * 1.34 (1.18 to 1.51) * Non-smoker 1.12 (1.08 to 1.16) * 1.34 (1.29 to 1.40) * 1.06 (1.01 to 1.12) * 1.07 (0.99 to 1.16) 1.18 (1.13 to 1.23) * 1.37 (1.30 to 1.44) * 1.18 (1.10 to 1.26) * 1.06 (0.96 to 1.17) Alcohol consumption (day/mon) <2 (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 2–12 1.25 (1.22 to 1.28) * 1.38 (1.34 to 1.42) * 1.11 (1.06 to 1.16) * 1.19 (1.11 to 1.28) * 1.53 (1.48 to 1.59) * 1.68 (1.61 to 1.74) * 1.38 (1.30 to 1.46) * 1.41 (1.29 to 1.55) * ≥13 1.18 (1.12 to 1.24) * 1.15 (1.09 to 1.22) * 1.21 (1.11 to 1.32) * 1.29 (1.12 to 1.47) * 1.30 (1.22 to 1.40) * 1.32 (1.22 to 1.42) * 1.32 (1.17 to 1.48) * 1.39 (1.16 to 1.66) * SRH High (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Middle 2.24 (2.14 to 2.34) * 2.42 (2.33 to 2.52) * 2.21 (2.10 to 2.32) * 2.09 (1.92 to 2.27) * 2.24 (2.14 to 2.34) * 2.49 (2.36 to 2.63) * 2.22 (2.07 to 2.38) * 2.10 (1.87 to 2.36) * Low 8.17 (7.82 to 8.53) * 7.06 (6.79 to 7.33) * 5.66 (5.36 to 5.97) * 5.17 (4.74 to 5.63) * 8.17 (7.82 to 8.53) * 10.01 (9.50 to 10.54) * 8.07 (7.52 to 8.66) * 6.99 (6.28 to 7.78) * Average sleep duration (hr/day) <6 (ref) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 6–6.9 2.47 (2.39 to 2.55) * 2.69 (2.59 to 2.79) * 2.46 (2.33 to 2.60) * 2.41 (2.21 to 2.64) * 2.83 (2.71 to 2.95) * 2.92 (2.78 to 3.06) * 2.91 (2.71 to 3.13) * 2.90 (2.59 to 3.25) * 7–7.9 1.16 (1.13 to 1.20) * 1.20 (1.16 to 1.25) * 1.20 (1.14 to 1.28) * 1.22 (1.11 to 1.34) * 1.16 (1.11 to 1.22) * 1.19 (1.13 to 1.25) * 1.22 (1.13 to 1.32) * 1.20 (1.07 to 1.36) * ≥8 1.33 (1.29 to 1.38) * 1.34 (1.29 to 1.40) * 1.26 (1.20 to 1.33) * 1.34 (1.22 to 1.46) * 1.61 (1.54 to 1.69) * 1.73 (1.65 to 1.82) * 1.49 (1.39 to 1.60) * 1.55 (1.38 to 1.73) * Open in a new tab * p<0.05; †according to Asia-Pacific guidelines, BMI is divided into 4 groups: underweight (<18.5 kg/m 2 ), normal (18.5–22.9 kg/m 2 ), overweight (23.0–24.9 kg/m 2 ), and obese (≥25 kg/m 2 ). OR, odds ratio; KCHS, Korea Community Health Survey; CI, confidence interval; BMI, body mass index; SRH, self-rated health. Figure 2. Open in a new tab Ratio of weighted ORs for risk factors for the vulnerable group of counseling for depression pre-, intra-, and post-pandemic, based on data obtained from the KCHS. BMI, body mass index; SRH, self-rated health; OR, odds ratio; CI, confidence interval; ref, reference; KCHS, Korea Community Health Survey. DISCUSSION Key finding This study analyzed trends in counseling for stress and depression in South Korea from 2009 to 2024. The overall prevalence of counseling for stress and depression had been steadily increasing even before the pandemic and has not returned to pre-pandemic levels after its end. In other words, while the overall trend was not significantly affected by the pandemic, certain subgroups were notably impacted by it. Both types of counseling showed a sharp increase among young adults (aged 19–30) during the intra-pandemic. In addition, individuals with low SRH and abnormal sleep duration were identified as a risk factor for both stress and depression across all periods. Notably, a reversal in the trend of counseling for stress was observed based on diabetes status. Also, prior to the pandemic, those with an elementary school education or lower were the most vulnerable group to stress, but after the pandemic, the most vulnerable group shifted to those with a college education or higher. Comparison of previous studies Other studies to date have shown mixed findings regarding the mental health impact of the COVID-19 pandemic [ 18 , 19 ]. Among U.S. adults, the prevalence of depression was 25.2% before the COVID-19 pandemic, rose to 37.6% during the pandemic, and subsequently declined to 29.5% in the postpandemic [ 18 , 19 ]. Nevertheless, it remains elevated compared to the pre-pandemic level [ 18 , 19 ]. In addition, a survey conducted in the U.S reported that 71.2% of participants experienced increased stress levels during the pandemic [ 20 ]. However, in the Netherlands, the prevalence of depression symptoms was 16.8% in 2019 and 17.0% in 2020, indicating that the pandemic did not lead to a short-term increase in depression [ 21 ]. According to a study that examined changes in depressive symptoms in China between 2019 and 2020, approximately 70% of participants experienced no change in their symptoms, while around 15% reported either worsening or improvement. Subgroup analysis further revealed that, except for the male group, the number of individuals whose depressive symptoms improved exceeded those whose symptoms worsened [ 22 ]. In a study con-ducted in China, 82.9% participants reported low to mild stress in 2020 [ 23 ]. These findings likely reflect not only differences in underlying levels of psychological distress across countries but also variation in health system organization, access pathways to mental health services, and cultural norms surrounding helpseeking [ 24 ]. In this context, South Korea represents a distinct setting characterized by relatively strong stigma toward mental illness and rapid expansion of mental health support and remote counseling during the pandemic [ 25 , 26 ]. Most previous studies focused primarily on trends during the pandemic (2020– 2022), with depression, a representative mental illness, as the main outcome. In contrast, this study examined the relationship between COVID-19 pandemic and mental health in South Korea, not only intra-but also post-pandemic, incorporating both depression and stress as key outcomes, allowing a more comprehensive assessment of how beyond the acute phase of the pandemic. Plausible underlying mechanisms The overall prevalence of counseling for stress and depression had been steadily increasing even before the pandemic and has not returned to pre-pandemic levels since its end. Counseling utilization reflects not only underlying mental health needs but also access to care, mental health awareness, stigma, service availability, and help-seeking behavior, all of which plausibly changed during and after the pandemic [ 27 ]. Consequently, increases in counseling utilization should not be interpreted solely as indicators of worsening psychological distress; they may also reflect improved access to services or reduced stigma surrounding mental health care. In South Korea, the pandemic period was accompanied by changes in mental health service delivery, including expanded use of remote and tele-counseling and national efforts to strengthen psychological support, which may have influenced the observed utilization patterns [ 25 , 28 ]. Regardless of periods, low SRH and abnormal sleep duration were the key risk factors. Previous studies have shown that individuals with low SRH experience poorer physical and mental quality of life and are more prone to negative thinking, which increases life dissatisfaction, a factor closely linked to depressive symptoms [ 29 , 30 ]. In addition, those who do not get sufficient sleep are nearly three times more likely to experience frequent psychological distress compared to those who sleep adequately [ 31 ]. In our study, individuals with an average sleep duration of eight hours or more also emerged as a vulnerable group for counseling for depression. This may be attributed to lower levels of physical activity during prolonged sleep durations. Increased levels of neurotransmitters such as dopamine and serotonin, enhanced endorphin release, and the facilita-tion of brain aminergic synaptic transmission are known to reduce the risk of depression [ 32 ]. Therefore, long sleepers who spend less time engaging in physical activity may be more likely to experience depressive symptoms [ 32 ]. Notably, a prominent change was observed in counselling utilization patterns across educational groups following the onset of the COVID-19 pandemic. After the pandemic, the prevalence of counseling for stress significantly increased among highly educated individuals. This may be attributed not only to shifts in underlying vulnerability but also to differences in help-seeking behavior, access to counselling services, and mental health awareness across socioeconomic strata [ 33 ]. Highly educated individuals are more likely to be employed in whitecolor professionals and may have experienced substantial changes in work during the pandemic, including a rapid transition to remote work [ 34 ]. From the perspective of the Job Demand-Resources model, the sudden shift to remote work and the accompanying increase in job demands during the pandemic may have heightened the risk of burnout among highly educated individuals and improved access to counselling. At the same time, reduced organizational peer support due to prolonged remote work may have further intensified their stress [ 35 ]. Strengths and limitations This study has several limitations. First, as a cross-sectional study, this research could not account for the temporal order of events, limiting the ability to infer causality. However, our dataset from 2009 to 2024, which includes about 3 million individuals, is nationally representative. Second, mental health status related to stress and depression was assessed using selfreported counseling experience rather than standardized clinical diagnostic tools. Although self-reported stress is widely used as a subjective measure, prior studies have suggested that counseling experience may serve as a more objective proxy for clinically significant psychological distress, particularly in population-based health surveys [ 36 ]. Third, this study classified insufficient and excessive sleep as less than 6 hours and more than 8 hours per day, respectively. This approach may not have adequately reflected differences in optimal sleep duration by age group. Given that organizations such as the National Sleep Foundation have established age-specific sleep guidelines, future research should adopt more refined sleep classifications that incorporate age-based recommendations. Lastly, due to the absence of data from 2023, the post-pandemic in this analysis was limited to the year 2024, restricting the ability to evaluate long-term trends following the COVID-19 pandemic. Despite these limitations, this study has considerable strengths. This study utilized data from 2009 to 2024, allowing for a comprehensive assessment of the impact of the COVID-19 pandemic on mental health trends. By incorporating key factors critically affected during the pandemic, this study provides valuable insights into the evolving patterns and determinants of mental health counseling both during and after the pandemic, over a span of more than a decade. Clinical and policy implications Even before the COVID-19 pandemic, certain population groups already exhibited relatively high vulnerability in terms of mental health counseling. In the current post-pandemic context, the demand for mental health support remains high, highlighting the need for responsive policy interventions. The World Health Organization launched the global campaign “Depression: Let’s Talk” in 2017 to raise awareness about depression and encourage help-seeking behaviors. However, media-based awareness efforts have shown limited long-term impact on behavioral change compared to contact-based interventions [ 37 ]. In South Korea, stigma-related help avoidance remains a significant barrier to mental health service utilization [ 38 ]. Accordingly, rather than relying solely on media campaigns, there is a growing need to expand community-based and participatory anti-stigma programs. In parallel, the widespread shift to remote work highlights the urgency of implementing workplace-based mental health initiatives to address the psychological burdens associated with changing work environments. Moreover, given that low SRH and abnormal sleep durations (<6 or ≥8 hours) were consistently associated with mental health problems across all periods, it is essential to incorporate routine assessments of SRH and sleep patterns into primary care. Establishing a systematic referral pathway to mental health counseling services would facilitate early detection and timely intervention for at-risk individuals. Conclusion This study examined the impact of the COVID-19 pandemic on counseling trends for stress and depression in South Korea, and despite the significant expansion of national-level mental health infrastructure during the pandemic, the counseling rates for stress and depression have remained largely unchanged even after the pandemic officially ended. In particular, young adults, low SRH, highly educated individuals, and those with extreme sleep durations constituted vulnerable groups. Enhancing the capacity of primary care to identify individuals in need and ensure timely access to mental health counseling will be critical to establishing a more responsive and forwardlooking mental health care system. Footnotes Availability of Data and Material The data are available on reasonable request. Study protocol, statistical code: available from DKY (email: [email protected] ). Data set: available from the Korea Disease Control and Prevention Agency (KDCA) and the Ministry of Education through a data use agreement. Conflicts of Interest The authors have no potential conflicts of interest to disclose. Author Contributions Conceptualization: Seungjae Byun, Kyeongeun Kim, Dong Keon Yon, Jiseung Kang. Data curation: Seungjae Byun, Kyeongeun Kim, Dong Keon Yon, Jiseung Kang. Formal analysis: Seungjae Byun, Kyeongeun Kim, Dong Keon Yon, Jiseung Kang. Funding acquisition: Dong Keon Yon. Investigation: Seungjae Byun, Kyeongeun Kim, Dong Keon Yon, Jiseung Kang. Methodology: Seungjae Byun, Kyeongeun Kim, Dong Keon Yon, Jiseung Kang. Project administration: Dong Keon Yon, Jiseung Kang. Resources: Dong Keon Yon. Software: Dong Keon Yon. Supervision: Dong Keon Yon, Jiseung Kang. Visualization: Seungjae Byun, Kyeongeun Kim, Dong Keon Yon, Jiseung Kang. Writing—original draft: Seungjae Byun, Kyeongeun Kim, Dong Keon Yon, Jiseung Kang. Writing—review & editing: Hyesu Jo, Christa J Nehs, Damiano Pizzol, Dong Keon Yon, Jiseung Kang. Funding Statement This research was supported by the Ministry of Science and ICT (RS-2024-00509257 and IITP-2024-RS-2024-00438239) and the Ministry of Health & Welfare (RS-2025-02220492), Republic of Korea. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Acknowledgments None Supplementary Materials The Supplement is available with this article at https://doi.org/10.30773/pi.2025.0463 . Supplementary Table 1. General characteristics of Korean based on data obtained from the KCHS, 2009 to 2024 (N=3,195,912) pi-2025-0463-Supplementary-Table-1.pdf (90.9KB, pdf) Supplementary Table 2. β-coefficients and β-differences in counseling for stress trends across pre-, intra-, and post-pandemic periods (weighted % [95% CI]) pi-2025-0463-Supplementary-Table-2.pdf (124KB, pdf) Supplementary Table 3. β-coefficients and β-differences in counseling for depression trends across pre-, intra-, and post-pandemic periods (weighted % [95% CI]) pi-2025-0463-Supplementary-Table-3.pdf (124.1KB, pdf) Supplementary Figure 1. Study population flowchart. SRH, self-rated health; BMI, body mass index. pi-2025-0463-Supplementary-Fig-1.pdf (67.7KB, pdf) REFERENCES 1. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and metaanalysis. JAMA Psychiatry. 2015;72:334–341. doi: 10.1001/jamapsychiatry.2014.2502. 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Supplementary Materials Supplementary Table 1. General characteristics of Korean based on data obtained from the KCHS, 2009 to 2024 (N=3,195,912) pi-2025-0463-Supplementary-Table-1.pdf (90.9KB, pdf) Supplementary Table 2. β-coefficients and β-differences in counseling for stress trends across pre-, intra-, and post-pandemic periods (weighted % [95% CI]) pi-2025-0463-Supplementary-Table-2.pdf (124KB, pdf) Supplementary Table 3. β-coefficients and β-differences in counseling for depression trends across pre-, intra-, and post-pandemic periods (weighted % [95% CI]) pi-2025-0463-Supplementary-Table-3.pdf (124.1KB, pdf) Supplementary Figure 1. Study population flowchart. SRH, self-rated health; BMI, body mass index. pi-2025-0463-Supplementary-Fig-1.pdf (67.7KB, pdf) Articles from Psychiatry Investigation are provided here courtesy of Korean Neuropsychiatric Association ACTIONS View on publisher site PDF (3.3 MB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top