Chao-Yueh Su

Survey of quality of life and related risk factors for a Taiwanese village population 3 years post-earthquake

OBJECTIVE To investigate quality of life (QOL) and related risk factors in Taiwanese earthquake survivors diagnosed with different psychiatric disorders 3 years after the 1999 Chi-Chi earthquake. METHOD This study was a population survey. Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and questionnaires to interview 405 respondents (189 men and 216 women) aged 16 years or older, who had been exposed to the earthquake. Psychiatrists interviewed the same respondents using the Mini-International Neuropsychiatric Interview, with an adjusted response rate of 70.2%. RESULTS The prevalence range for psychiatric disorders in the earthquake survivors was 0.2-7.2% 3 years after the Chi-Chi earthquake, with rates for major depression (MD) and posttraumatic stress disorder (PTSD) of 6.4% and 4.4%, respectively. The QOL scores for the PTSD/MD group were lower than for the other two diagnostic groups, as determined by assessment of physical and mental aspects of functional integrity from MOS SF-36 scores. The predictors for poor QOL were age, female gender, economic problems, physical illness, subjective assessment of memory and social-activity decline and diagnosis of PTSD or MD. CONCLUSION The QOL for earthquake survivors with psychiatric disorders, especially PTSD or MD, was inferior compared with the mentally healthy analogues, with contemporaneous decreases in mental and physical function scores across the QOL subscales. The persistence of long-term economic problems was one of many important factors affecting QOL.

The incidence and relative risk factors for developing cancer among patients with schizophrenia: A nine-year follow-up study

OBJECTIVE To estimate the incidence and relative risk of developing cancer as well as the mortality rate after cancer diagnosis for patients with schizophrenia compared with the general population. METHODS Our population for this study was identified before the end of 1999. The study included 59,257 patients with schizophrenia and 178,156 age- and gender-matched individuals without schizophrenia as controls, who were selected from the 23,981,020 subjects in the National Health Insurance Research Database (NHIRD), which consists of 96% of the entire Taiwanese population. From the 2000 to 2008 NHIRD, we calculated the cancer incidence and survival time after cancer diagnosis in each of the two groups. Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), the cancers were divided into nine groups. RESULTS During the nine-year follow-up period, 1145 (1.93%) of the patients with schizophrenia and 5294 (2.97%) of the control group developed cancer. The patients with schizophrenia had a significantly lower cancer incidence than those in the control group in both the male (OR=0.50, 95% CI, 0.46-0.55) and female (OR=0.81, 95% CI, 0.74-0.88) populations. Patients with schizophrenia were less likely to develop cancer than individuals in the control group for every cancer type except breast and cervical/uterine cancer. After adjustment using the Cox regression model, patients with schizophrenia had an overall decreased cancer risk (adjusted hazard ratio 0.71, 95% CI, 0.66-0.76) compared to the control population. For all cancer patients, the mortality adjusted hazard ratio for patients with schizophrenia versus the control group was 1.36 (95% CI, 1.24-1.50) after adjusting for other variables. CONCLUSIONS Although the likelihood of developing cancer among patients with schizophrenia (0.64) was less than that of the non-schizophrenia group, the mortality rate among patients with schizophrenia was higher than that of the control group.

Epidemiologic psychiatric studies on post-disaster impact among Chi-Chi earthquake survivors in Yu-Chi, Taiwan.

Abstract  The aim of the present study was to survey a cohort population for the risk factors of post‐traumatic stress disorder (PTSD) and major depression, and the prevalence of different psychiatric disorders at 6 months and 2 and 3 years after a major earthquake. The Disaster‐Related Psychological Screening Test (DRPST), part I, and the Mini‐International Neuropsychiatric Interview (MINI) were, respectively, administered by trained interviewers and psychiatrists in this community‐interview program. The prevalence of PTSD decreased from 8.3% at 6 months to 4.2% at 3 years after the earthquake. Suicidality increased from 4.2% at 6 months and 5.6% at 2 years to 6.0% at 3 years after the earthquake; drug abuse/dependence increased from 2.3% at 6 months to 5.1% at 3 years after the disaster. The risk factors for PTSD and major depression in various post‐disaster stages were determined. Earthquake survivors had a high percentage of psychiatric disorders in the first 2 years, and then the prevalence declined. Following the devastation caused by the Chi‐Chi earthquake, it is important to focus on treating symptoms of major depression and PTSD and eliminating the risk factors for both of these disorders in survivors to avoid the increase in suicidality.

The relationship between quality of life and psychiatric impairment for a Taiwanese community post-earthquake

This purpose of this study was to investigate the relationship between quality of life and psychiatric impairment in a Taiwanese community located near the epicenter of the 1999 earthquake, as assessed four to six months after the natural catastrophe. Trained assistants interviewed the 4223 respondents using the disaster-related psychological screening test (DRPST), an instrument specifically designed and validated by senior psychiatrists for assessment of psychiatric impairment after natural catastrophe. Additionally, the 36-Item Short-Form Health Survey (SF-36) was used to evaluate quality of life. The collected results were analyzed using Windows SPSS 10.0 software. Psychiatric impairment rated moderate to severe was assessed for 1448 (34.3%) of the responding residents. The 4223 respondents were divided into 4 psychiatric-impairment groups based on DPRST score: healthy (n = 952); mild impairment (n = 1823); moderate impairment (n = 1126); and, severe impairment (n = 322). The four groups were compared for a number of salient factors, including gender, age, current marital status and psychiatric-impairment score, to determine impact on quality of life. Respondents assessed as psychiatrically impaired tended to be older, female, divorced/widowed, and less educated, and they were more likely to have experienced major familial financial loss as an immediate consequence of the earthquake. Further, the greater the severity of the psychiatric impairment, the lower the scores for quality of life, for both the physical and mental aspects of this important general indicator.

The incidence and relative risk of stroke in patients with schizophrenia: A five-year follow-up study

OBJECTIVE This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality in patients with schizophrenia. METHODS This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 80,569 patients with schizophrenia and 241,707 age- and sex-matched control participants without schizophrenia. The participants were randomly selected from the 23,981,020-participant NHIRD, which consists of 96% Taiwanese participants. Participants who had experienced a stroke between 1999 and 2003 were excluded. Using data from the NHIRD between 2004 and 2008, the incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups. After adjusting for confounding risk factors, a Cox proportional-hazards model was used to compare the five-year stroke-free survival rate to the all-cause mortality rate across the two cohorts. RESULTS Over five years, 1380 (1.71%) patients with schizophrenia and 2954 (1.22%) controls suffered from strokes. After adjusting for demographic characteristics and comorbid medical conditions, patients with schizophrenia were 1.13 times more likely to have a stroke (95% CI=1.05-1.22; P=0.0006). In addition, 1039 (24%) patients who had a stroke died during the follow-up period. After adjusting for patient, physician and hospital variables, the all-cause mortality hazard ratio for patients with schizophrenia was 1.23 (95% CI=1.06-1.41; P=0.0052). CONCLUSIONS During a five-year follow-up, the likelihood of developing a stroke and the all-cause mortality rate were greater among patients with schizophrenia as compared with the control group.

A three-year follow-up study of the psychosocial predictors of delayed and unresolved post-traumatic stress disorder in Taiwan Chi-Chi earthquake survivors

Aims:  To predict the longitudinal course of post‐traumatic stress disorder (PTSD) in survivors three years following a catastrophic earthquake using multivariate data presented six months after the earthquake.

The risks of major osteoporotic fractures in patients with schizophrenia: a population-based 10-year follow-up study.

OBJECTIVE The aim of the study is to explore the incidence and the risks associated with major osteoporotic fractures, all-cause mortality with osteoporotic fractures and the effect of the psychiatric drug exposure in patients with schizophrenia during a 10-year follow-up period. METHODS Two nationwide cohorts were selected from the Taiwan National Health Insurance Research Database (NHIRD) consisting of 30,335 patients with schizophrenia (age ≥ 40 years) and 121,340 age- and sex-matched control participants without schizophrenia. The psychiatric proportion of days covered (PDC) is an indicator of the intensity of drug exposure in patients with schizophrenia. The incidence and risk factors of major osteoporotic fractures were calculated for both cohorts. Additionally, the patient survival rate after major osteoporotic fractures was also calculated. RESULTS During a 10-year follow-up period, 1677 (5.53%) schizophrenia and 4257 (3.51%) control subjects had major osteoporotic fractures (P < 0.001). The schizophrenia patients with a PDC > 0.1 showed a significantly higher incidence of major osteoporotic fractures than did the non-schizophrenia controls; however, those with a psychiatric PDC ≤ 0.1 did not. After adjustment, the psychiatric PDC was significantly and independently associated with the risk of major osteoporotic fractures except some medical morbidities but the schizophrenia diagnosis was not. In addition, among all 5934 patients with major osteoporotic fracture, the adjusted mortality hazard ratio for psychiatric PDC was 1.92 (95% CI = 1.63-2.26). CONCLUSIONS Patients with schizophrenia are at a higher risk for major osteoporotic fractures than the general population and also have a higher mortality rate due to major osteoporotic fractures. These findings may be caused by psychiatric drug use rather than schizophrenia, which suggests that directions can be taken in future studies.

The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study.

Objective This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder. Methods This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430–438) and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors. Results A total of 472 (2.81%) patients with bipolar disorder and 1,443 (2.14%) controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12–1.38; p<0.0001) after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8%) patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06–1.55; p = 0.012) after adjusting for patient, physician and hospital variables. Conclusions The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period.

The establishment of a standard operation procedure for psychiatric service after an earthquake

This study presents information on the design and creation of a standard operation procedure (SOP) for psychiatric service after an earthquake. The strategies employed focused on the detection of survivors who developed persistent psychiatric illness, particularly post-traumatic stress and major depressive disorders. In addition, the study attempted to detect the risk factors for psychiatric illness. A Disaster-Related Psychological Screening Test (DRPST) was designed by five psychiatrists and two public health professionals for rapidly and simply interviewing 4,223 respondents within six months of the September 1999 Chi-Chi earthquake. A SOP was established through a systemic literature review, action research, and two years of data collection. Despite the limited time and resources inherent to a disaster situation, it is necessary to develop an SOP for psychiatric service after an earthquake in order to assist the high number of survivors suffering from subsequent psychiatric impairment.

The characteristics of and risk factors associated with incarcerated sex offenders in Taiwan

This article presents the demographic characteristics of a sample of Taiwanese sex offenders, examines the rate of sexual recidivism in Taiwan, and describes which factors distinguish recidivists from non-recidivists. This article assesses the recidivism rate of a sample of 503 male sex offenders incarcerated from 1999 to 2004. The sample is divided into two groups: non-recidivists (88.7%) and recidivists (11.3%). The variables are categorized into demographic characteristics, criminal history, interpersonal relationships, and offending behaviors. Multivariate logistic regression analysis suggests that recidivism is significantly related to male victims, poor interactions with employers, verbal control (i.e., threats to or verbal control of victims), weapon control (threatening or controlling victims with weapons), and familiarity with victims. Furthermore, this article will establish a database for demographic characteristics and associated risk factors related to recidivism in incarcerated sex offenders in Taiwan. These data will be useful for preventing future sex crimes.