Eng-Kung Yeh

Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule

ABSTRACT The Taiwan Psychiatric Epidemiological Project, conducted from 1982 to 1986, used the multistage random sampling method with 5005, 3004 and 2995 subjects selected respectively from metropolitan Taipei (MT), 2 small towns (ST) and 6 rural villages (RV). The case identification tool was the Chinese modified Diagnostic Interview Schedule (DIS‐CM). This study presents the lifetime and one‐year prevalence of 27 and of 17 specific psychiatric disorders respectively. The lifetime prevalence of any disorder defined by the DIS‐CM—excluding tobacco dependence—was 16.3%, 28.0% and 21.5% in the MT, ST and RV samples respectively. The differences in lifetime prevalence between the sexes and between the 3 sampling areas were significant for 15 and 8 disorders respectively. The ST sample seemed to have the most disorders, with the highest prevalence among 3 sampling areas. The mean ratio of one‐year to lifetime prevalence was 0.67. The differences in prevalence rates between the 3 sampling areas and between the international studies are discussed from methodological, social and cultural points of view.

Major depressive disorder in Taiwan defined by the Chinese Diagnostic Interview Schedule

The lifetime prevalence rate of major depressive disorder (MDD), as defined by the Chinese Diagnostic Interview Schedule, is 1.14% in Taiwan. This is significantly lower than the lifetime prevalence rates reported in Western studies and similar to other studies in the Chinese population using similar methods for assessing cases of MDD. Epidemiological data from 136 MDD cases were analyzed to provide possible explanations for this difference in lifetime prevalence rates. The low rate of broken families in Chinese culture, low comorbidity rate, and older age of onset of MDD may suggest a reality of low lifetime prevalence rates of MDD in Taiwan.

Alcoholism among Taiwan aborigines defined by the Chinese Diagnostic Interview Schedule: a comparison with alcoholism among Chinese

The prevalence of alcoholism was reported to be 0.1 % in an aboriginal study on Taiwan using the census survey method in the 1950s. This study adopted a modified Chinese Diagnostic Interview Schedule to determine the prevalence of DSM‐III‐defined alcohol abuse (AA) and alcohol dependence (AD) in the Atayal, Paiwan and Yami ethnic groups of Taiwan aborigines. Stratified random sampling was used. The sample sizes of Atayal, Paiwan and Yami were 793, 656 and 106 respectively. The prevalence rates of DSM‐III‐defined AA and AD were 11.6%, 11.4% and 14.2%; and 9.0%, 8.1% and 6.4% respectively. No significant difference was found between the 3 ethnic groups. These prevalence figures are significantly higher than those for Chinese. In this comparative analysis, 2 distinct etiological hypotheses are proposed for the AA and the AD.

Alcoholism by Chinese Diagnostic Interview Schedule:A Prevalence and Validity Study

ABSTRACT— A community survey in metropolitan Taipei (MT) and two small towns (ST) by using the Chinese modified diagnostic interview schedule (DIS‐CM) revealed a significant difference in the prevalence of alcohol abuse (AA) defined by DSM‐III between two study samples (MT 3.4%; ST 8.0%), but the prevalence of alcohol dependence (AD) was not different (MT 1.5%; ST 1.8%). These figures are significantly higher than that of an earlier Formosan study. Demographic data, psychiatric symptoms, medical complications and impairment of social functions were adopted as the variables to validate the nosological status of AA and AD. The results of this study substantiated that AA and AD identified by the DISCM were nosologically different from a non‐alcoholic group. The possible reasons for an increasing prevalence of alcoholism in Taiwan Chinese were discussed. An etiological hypothesis was proposed for AA and AD on account of their differential prevalences.

Chinese diagnostic interview schedule. I: Agreement with psychiatrist's diagnosis

ABSTRACT NIMH‐DIS was translated into Chinese and modified to the Chinese version of DIS (DIS‐CM). One hundred clinical patients and 187 community subjects were studied for diagnostic agreement between the DIS‐CM and the psychiatrists clinical diagnosis. In the community sample, DIS‐CM overdiagnosed the cases of manic episode, phobic disorder, obsessive‐compulsive disorder and alcoholic problem, while it underdiagnosed the cases of tobacco dependence in the community sample and manic episode in the clinical cases. Standard diagnostic criteria, method of symptom detection, and social desirability, were identified as the major factors contributing to the diagnostic disparity. Variables related to life situations, language habit and medical histories were also analysed to test the external validity of the DIS‐CM in case identification. The results affirm that the DIS‐CM is reliable as a psychiatric epidemiological tool.

Chinese diagnostic interview schedule II. A validity study on estimation of lifetime prevalence

ABSTRACT The validity of DIS‐CM (Chinese modified version of Diagnostic Interview Schedule) was examined by analyzing lifetime prevalence of each age group, age at onset, and recency of illness. The magnitude of the discrepancy between the empirical and the estimated data was adopted as the criterion of the degree of deviation. Manic and depressive episodes were found to be seriously underestimated. Schizophrenic, panic, phobic and antisocial personality disorders were probably underestimated. The observed lifetime prevalence figures with DIS‐CM are rather conservative for these disorders. The prevalence data of a recent 1‐year period are less biased and more reliable. The nature of the disease, recall effect, active or passive psychological resistance, mortality, and uncooperative attitude are considered factors that induce an underestimate of lifetime prevalence.

Self-destructive acts occurring during medical general hospitalization

Although several articles about suicide in general hospitals have been published, the rates of self-destructive individuals among various diseases and departments have not been reported previously. Moreover, self-destructive acts in Chinese general hospital inpatients have been neglected. We retrospectively investigated self-destructive incidents among medical general inpatients. A total of 75 self-destructive incidents, including 15 fatalities, were identified during the 10-year study period. The self-destructive rate was 8.7 per 100,000, and the fatality rate was 1.8 per 100,000 admissions. The highest self-destructive rate occurred in patients admitted to the rehabilitation ward (33.4 per 100,000) followed by the neurology ward (29.9 per 100,000). The highest fatality rate occurred among patients in the neurology ward (6.7 per 100,000). The majority of self-destructive patients suffered from a chronic or terminal illness with the most frequent types of illnesses being malignant neoplasm (31.1%), neurological disease (20.3%), and chronic obstructive pulmonary disease (COPD, 10.8%). COPD patients had the highest rate of self-destructive behavior (64.0 per 100,000) and the highest fatality rate (16.0 per 100,000) due to these incidents. The most common self-destructive incident was knife-cutting. More than one-half (53.4%) of the self-destructive incidents occurred within the first 2 weeks of admission, and nearly one-half (46.7%) occurred during the night shift. Moreover, the majority of severe or fatal incidents also occurred during the night shift. The results suggest that close supervision of high-risk patients should be mandatory within the first 2 weeks following admission, especially during the night shift.

What Happens to Depressed Men? Application of the Stirling County Criteria

&NA; In a recent issue of the Harvard Review of Psychiatry,1 results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when “gender‐fair” criteria were used and help‐seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross‐nationally, except in Puerto Rico. Excluding help‐seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using “gender‐fair” criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.

Aldehyde dehydrogenase deficiency, flush patterns and prevalence of alcoholism: an interethnic comparison.

A study was performed to verify that the prevalence of alcohol abuse and dependence in Formosan aborigines differs from that of Taiwanese (Chinese Han people), using analysis of aldehyde dehydrogenase (ALDH) isozymes and flush patterns on randomly sampled 70 Atayal, 66 Paiwan, 61 Yami and 94 Taiwanese subjects were studied. The activity of an isomer of ALDH having a low Km (ALDH-I) in hair roots was analysed by isoelectric focusing assay. The subjective experience of flushing response after alcohol ingestion was assessed. Results showed that the rate of ALDH-I deficiency in Taiwanese (51.1%) was significantly higher than in aborigines, i.e., 6.4%, 3.9%, and 0% in Atayal, Paiwan, and Yami subjects, respectively. The percentage occurrence of ALDH-I deficiency and prevalence of alcohol dependence in Taiwanese and aborigines were negatively correlated. The predominant pattern of self-reported flush response after alcohol use among aborigines was of slow onset. The flush response to alcohol ingestion was examined in relation to aldehyde metabolizing enzyme. Since alcohol sensitivity is an important factor in the development and maintenance of the alcohol ingestion habit in humans, our results support the hypothesis that there is a biological basis in the different rates of alcohol abuse and dependence among different ethnic groups.

Risk factors of alcoholism in Taiwan Chinese: an epidemiological approach

This study investigated the risk factors of alcohol abuse and alcohol dependence, as defined by DSM‐III criteria, in 11,004 Chinese subjects in the Taiwan community. Risk factors were analyzed using chi‐square and multivariate logistic regression statistics. The logistic regression shows that the risk factors of alcohol dependence include male, having had childhood or adulthood behavior problems; of alcohol abuse include male, having had childhood or adulthood behavior problems, non‐metropolitan community, age cohort, job‐holder. The etiological models proposed are biological for Chinese alcohol dependence and interactional for Chinese alcohol abuse.