I-Chia Chien

Quality of life and related risk factors in a Taiwanese Village population 21 months after an earthquake

OBJECTIVE To investigate quality of life and related risk factors of Taiwanese earthquake survivors with different psychiatric disorders 21 months after the earthquake. METHOD This was a population survey. Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and questionnaires to interview 461 respondents (209 males and 252 females) 16 years or older who were equally exposed to the earthquake. Psychiatrists interviewed the same respondents using the Mini-International Neuropsychiatric Interview (MINI), with an adjusted response rate of 79.9%. RESULTS The prevalence of varied psychiatric disorders in earthquake survivors ranged from 3.3% to 18%. However, there was almost a positive trend in quality of life in survivors among the following groups: posttraumatic stress disorder combined with major depressive episode; major depressive episode; posttraumatic stress disorder; other psychiatric diseases; and healthy mentality groups on the physical aspect or mental aspect of the MOS SF-36. When survivors were elderly or female and had experienced prominent financial loss immediately after the earthquake, social network change, and mental impairment, their quality of life tended to be worse. CONCLUSION The earthquake survivors had a higher percentage of psychiatric disorders. The risk factors that affected quality of life in survivors were age, female sex, financial loss, social network change, and mental impairment.

Prevalence and incidence of schizophrenia among national health insurance enrollees in Taiwan, 1996–2001

Abstract  As many as 96% of all residents of Taiwan have been enrolled in the National Health Insurance (NHI) program since 1996. The NHI database was used to examine the prevalence and incidence of schizoprenia. The National Health Research Institute provided a database of 200 432 random subjects, about 1% of the population, for study. By means of exclusion criteria, a random sample of 136 045 subjects as a fixed cohort dated from 1996–2001 was obtained. Those study subjects who had at least one service claim during these years for either ambulatory or inpatient care, with a principal diagnosis of schizophrenia, were identified. The cumulative prevalence increased from 3.34 per 1000 to 6.42 per 1000 from 1996 to 2001. The annual incidence density decreased from 0.95 per 1000/year to 0.45 per 1000/year from 1997 to 2001. Male subjects had higher treated prevalence in younger age groups than did female subjects. Higher prevalence was associated with the 25–44 and 45–64 age groups, insurance amount less than US

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

640, the eastern region, and suburban areas. Lower incidence was associated with the 45–64 age group. Higher incidence was associated with insurance amount less than US

Prevalence of diabetes in patients with schizophrenia in Taiwan: A population-based National Health Insurance study

640, and the eastern region. According to the trends of cumulative prevalence and incidence density, the treated prevalence and incidence rate will be approximate to community rates gradually. Most persons with schizophrenia had received treatment in Taiwan after the NHI program was implemented. Future studies should focus on outcome and cost evaluation.

Establishment of a disaster-related psychological screening test

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 Prevalence and Incidence of Treated Major Depressive Disorder among National Health Insurance Enrollees in Taiwan, 1996 to 2003

OBJECTIVE We conducted this study to investigate the prevalence and correlates of diabetes in patients with schizophrenia in Taiwan. METHODS The National Health Research Institute provided a database of 1,000,000 random subjects for study. We obtained a random sample aged 18 years and over of 766,427 subjects in 2005. Those study subjects who had at least one service claim during this year for either ambulatory or inpatient care, with a primary diagnosis of schizophrenia or with a prescription for treatment of diabetes, were identified. RESULTS The prevalence of diabetes in patients with schizophrenia was higher than in the general population (7.90% vs. 5.57%, odds ratio [OR], 1.81; 95% confidence interval [CI], 1.61-2.03). Compared with the general population, patients with schizophrenia revealed a higher prevalence of diabetes in all age groups, except age 70 or more years; among females (10.30% vs. 5.42%, p<0.001), and males (5.93% vs. 5.73%, p<0.001); among all insurance amount groups; among those living in the northern (7.56% vs. 4.89%, p<0.001), central (8.26% vs. 5.61%, p<0.001), southern regions (8.45% vs. 6.62%, p<0.001); and among residents living in urban (8.18% vs. 5.19%, p<0.001) and rural areas (7.99% vs. 6.15%, p<0.001). CONCLUSIONS Patients with schizophrenia had a much higher prevalence of diabetes in younger adult age groups and in females than in the general population, a finding that deserves further biological and psychosocial study in the future.

Prevalence of diabetes in patients with bipolar disorder in Taiwan: a population-based national health insurance study

Objective: To create a short screening scale for the detection of posttraumatic stress disorder (PTSD) and major depressive disorder (MDE) in earthquake survivors in Taiwan. Method: Trained research assistants used the Disaster-Related Psychological Screening Test (DRPST) to assess 461 residents of a village that had experienced a major earthquake. The participants were also evaluated by psychiatrists using the Mini-International Neuropsychiatric Interview (MINI). Best subset regression analysis and the receiver operating characteristics curve were used to select a subset of items and cut-off points from the DRPST. Results: A seven-symptom scale and a three-symptom analogue were selected for PTSD and MDE screening, respectively. Scores of three or more on the PTSD scale and two or more on the MDE scale were used to define a group of positive cases that provide useful information for the patient cohort and will be valuable in long-term follow-up studies of the prevalence of psychiatric diseases following a natural disaster. However, higher scores could also be used to define positive cases under limited psychiatric care resources. Conclusion: The DRPST, which was administered for phase 1 of this two-phase study, may be used for effective and rapid screening for PTSD and MDE after an earthquake, despite the usual limitations on resources following a disaster.

Prevalence and Incidence of Autism Spectrum Disorders Among National Health Insurance Enrollees in Taiwan from 1996 to 2005

Objective: We used the National Health Insurance (NHI) database to examine the prevalence and incidence of treated major depressive disorder (MDD) and their associated factors. Method: The National Health Research Institute provided a database of 200 432 randomly selected subjects for study. We obtained a population-based random sample aged 15 years or older (n = 136 045) as a fixed cohort dated 1996 to 2003. We identified study subjects with a principal diagnosis of MDD who had at least one service claim during these years for either ambulatory or inpatient care. Results: From 1996 to 2003, the cumulative treated prevalence increased from 1.67 per 1000 to 17.24 per 1000. From 1997 to 2003, the annual treated incidence increased from 1.89 per 1000 to 2.58 per 1000. A higher incidence of treated MDD was detected in the groups aged 25 to 44 years (hazard ratio [HR] 1.28; 95% confidence interval [CI], 1.13 to 1.45), 45 to 64 years (HR 1.90; 95%CI, 1.66 to 2.16), and 65 years or older (HR 1.87; 95%CI, 1.59 to 2.20); in female subjects (HR 1.97; 95%CI, 1.80 to 2.15); in those with with an insurance amount of US

Increased risk of hypertension in patients with major depressive disorder: A population-based study

1281 or more (HR 1.15; 95%CI, 1.01 to 1.31); in those with a fixed premium (HR 1.44; 95%CI, 1.27 to 1.62); and among those who lived in urban areas (HR 1.22; 95%CI, 1.10 to 1.35). Conclusions: For treated MDD, the prevalence and incidence in Taiwan were lower than in community studies in Western countries. Individuals with MDD are underdiagnosed and undertreated in Taiwan.

Prevalence of diabetes in patients with major depressive disorder: a population-based study

OBJECTIVE We investigated the prevalence and correlates of diabetes in patients with bipolar disorder in Taiwan. METHODS The National Health Research Institute provided a database of 1,000,000 random subjects from which we selected a sample of 766,427 subjects aged 18 years and over. We identified study subjects who had at least one service claim during 2005, with a primary diagnosis of bipolar disorder or with a prescription for treatment of diabetes. RESULTS The prevalence of diabetes in patients with bipolar disorder was higher than in the general population (10.77% vs. 5.57%, OR, 2.01; 99% CI, 1.64-2.48). Compared with the general population, patients with bipolar disorder had a higher prevalence of diabetes in all age groups under 60 years; among females and males; among lower insurance amount groups; among those living in the northern, central and southern regions and among residents living in urban and rural areas. Antipsychotic use was associated with a higher prevalence of diabetes in persons with bipolar disorder. CONCLUSIONS Patients with bipolar disorder had a higher prevalence of diabetes than the general population. Prevention, early detection and treatment of diabetes are important issues for patients with bipolar disorder.