Jung-Chen Chang

Mental health aspects of culture and migration

The process of migration, with cultural adaptation and potential exposure to traumatic experiences, has been a challenge to mental health. Recent studies suggest that social support and cultural integration, rather than acculturation, are protective factors for immigrants. Advances in research metho

Survival of bipolar depression, other type of depression and comorbid ailments: ten-year longitudinal follow-up of 10,922 Taiwanese patients with depressive disorders (KCIS no. PSY1).

OBJECTIVE The effect of type of depressive disorder on mortality has been rarely addressed in the relevant literature. It is especially true in considering comorbid disorders and by population-based longitudinal cohort sample. The aims of this study are to compare all-cause and unnatural (suicides and accidents) mortality rates between subjects with bipolar depression (BD) and those with other types of depression (OTD). METHOD A cohort of patients diagnosed as clinically depressed between 1999 and 2004 according to the National Health Insurance Dataset (NHID) were followed until the end of 2008. The occurrence of death was identified by the National Mortality Registry (NMR) in Taiwan. Patients in this cohort were further classified into BD and OTD groups. Proportional hazards regression model were used to evaluate the different mortality risks between two groups. RESULTS BD (n = 1542) was associated with a significantly greater risk in all-cause mortality (adjusted hazard ratio = 1.3, 95% CI: 1.1, 1.5) than was OTD (n = 17,480), even after controlling for demographic features and comorbid disorders. BD was associated with approximately twice the risk for suicide and accidental death compared with OTD after other variables were held constant. Bipolar depression (v.s. OTD) exerted adjusted hazard ratio 3.76 (95% CI: 2.17, 6.51) in depressed patients with CVD but only aHR 1.43 (95% CI: 0.79, 2.58) in those without CVD. CONCLUSIONS Compared with OTD, BD was related to a significantly increased risk for all-cause mortality, suicide, and accidental death. Under the comorbidity with CVD, the risk of suicide was 4-fold times more likely in BD than in OTD. This magnitude of suicide risk among BD patients comorbid with CVD was also higher than those BD without CVD. Thus, patients with both BD and CVD may constitute one of groups at highest risk for suicide and accidental death.

Ultimedia Manager: Query By Image Content and its applications

IBM Almaden Research Centers project on Query By Image Content (QBIC) is studying means to retrieve images from large image databases using image contents such as color, texture, shape and layout. In this paper, we describe the beta version of the PC-based Ultimedia Manager product, which is based on QBIC technology. We outline the product philosophy and give a demonstration of the current version. The product is expected to be announced soon, together with an OEM offering of the QBIC search and query engine.<<ETX>>

Development of a Chinese Version of the Suicide Intent Scale

This study established the psychometric properties of the Chinese version of the Suicide Intent Scale (SIS) in a clinic- and community-based sample of 36 patients and 592 respondents, respectively. Results showed that the Chinese SIS demonstrated good inter-rater and test-retest reliability. Factor analysis generated three factors (Precautions, Planning, and Seriousness) explaining 92.9% of the total variance with high internal consistency. It was moderately correlated with depressive symptoms. Results suggest that the Chinese SIS is a reliable and valid instrument for use in assessing the extent of suicidal intention among subjects with deliberate self-harm in ethnic Chinese populations.

Development of a chinese version of the Yale-Brown obsessive compulsive scale for heavy drinking.

BACKGROUND Measurement of craving is an important component in the investigation of the etiology and clinical pictures of alcoholism and dependence of other substances in different cultures. The aim of this study was to develop a Chinese version of the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd-C), the instrument most frequently used in assessing the severity of alcohol craving in Taiwan. METHODS Four hundred twenty Han Chinese (220 with alcohol use disorders) and 218 Bunun aborigines (150 with alcohol use disorders) in Taiwan were interviewed by mental health professionals with the YBOCS-hd-C and a Chinese version of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry to establish the psychiatric diagnosis. Validity and reliability of the YBOCS-hd-C were examined. RESULTS The YBOCS-hd-C was found to have acceptable interrater reliability (intraclass correlation, 0.89-0.96), internal consistency (Cronbachs alpha = 0.99), construct validity, concurrent validity, and cross-cultural validity. The correlations between 10 items of the YBOCS-hd-C and 11 items of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry adjusted for age, gender, and ethnicity ranged from 0.39 to 1.00. The YBOCS-hd-C also discriminated effectively among individuals with alcohol dependence, alcohol abusers, and normal drinkers. CONCLUSIONS This study demonstrated that the YBOCS-hd-C is a reliable and valid instrument for assessing the extent of craving for alcohol in Taiwanese Han and Bunun individuals.

Metabolic syndrome and the risk of suicide: a community-based integrated screening samples cohort study.

Objective Metabolic syndrome (MetS) is reportedly associated with mental disorders that are known to increase the risk of suicide. However, it is not known whether this association is independent of other risk indicators of suicide. This study therefore investigated whether metabolic abnormalities increase the risk of suicide during a 10-year follow-up period. Methods This prospective study enrolled participants from a community-based integrated screening samples cohort in Taiwan. Of the 76,297 people recruited for this study, 12,094 had MetS at baseline. The independent variables were MetS and its components such as high blood pressure and high blood lipid levels. The outcome was death from suicide (n = 146). Results MetS was associated with an increased risk of suicide risk by 16% per MetS component (95% confidence interval [CI] = 1%–33%), adjusting for demographics, life-style factors, and clinical correlates. Of the five MetS components, elevated blood pressure was independently associated with suicide-related mortality (adjusted hazard ratio [aHR] = 1.49, 95% CI = 1.03–2.15). Conclusions This analysis of community-based longitudinal data showed that MetS and its components, particularly elevated blood pressure, correlated positively with suicide risk after controlling other factors. Therefore, public mental health interventions targeting suicide reduction may need to specifically focus on individuals with hypertension and other components of the MetS.

A 10-year follow-up study on suicidal mortality after 1999 Taiwan earthquake

OBJECTIVE The long-term impact of natural disasters on suicide in general population and survivors remains uncertain. The present report examined the direction and the length of the influence of an earthquake over suicide across age groups. METHOD We used an interrupted time-series design with non-equivalent no-treatment group to evaluate post-earthquake changes in suicide rates by the standardized mortality ratio. RESULTS The time trend changes in suicide rates before and after the earthquake were similar for males and females but different between senior and junior age groups. Gender-specific relative ratios were 0.85 (95%CI: 0.81-0.90) for males and 0.79 (95% CI: 0.72-0.86) for females. Age-gender-stratified relative ratios were 0.61 (95% CI: 0.53-0.70) and 0.69 (95% CI: 0.64-0.75) for males and females aged less than 45 years, respectively. Although the overall suicide mortality increased after the earthquake, the relative suicide risk ratio decreased 31-39% for those aged less than 45 years, which persisted for nearly 10 years after earthquake. CONCLUSION Our study demonstrated that a severe earthquake resulted in a significant decrease in standardized suicide mortality ratios in exposed areas for 10 years compared to unexposed area, particularly in a younger population.

Risk of suicide within 1 year of cancer diagnosis: Cancer and suicide

The association of the risk of suicide with cancer at different time points after a new cancer diagnosis is unclear. This study explored the suicide hazard at different time points after a first cancer diagnosis during the 1‐year period before suicide. This case–crossover study included 2,907 suicide cases from 2002 to 2012 in Taiwan and compared the odds of suicide risk at different time points during one year after any cancer diagnosis with self‐matched periods. The 13th month preceding the suicide date was used as the control period, and the hazard period was the duration from the 1st to 12th month in the conditional logistic regression for case–crossover comparisons. Among major groups of cancers, group of lip, oral cavity and pharynx cancers tended to have higher risk of suicide than other groups of cancers. The first month of cancer diagnosis was associated with the highest risk of suicide compared with the 13th month before suicide. The odds ratio (OR) of suicide were significantly in the first six months after cancer diagnosis but declined afterwards. For example, the adjusted OR was 3.47 [95% confidence interval (CI) = 2.60–4.62] in the first month and 1.53 (95% CI = 1.11–2.12) in the sixth month following cancer diagnosis. These findings provide clinicians with a vital reference period during which sufficient support and necessary referral to mental health support should be provided to reduce the risk of suicide among patients with newly diagnosed cancer morbidity.

Comorbid diseases as risk factors for incident posttraumatic stress disorder (PTSD) in a large community cohort (KCIS no.PSY4)

Nature disasters and terrorist attacks have occurred globally in recent years. Posttraumatic stress disorder (PTSD) has gained increasing attention, but its incidence and comorbidities in the general population are different from those inside the disaster areas. The present study estimated incident PTSD and comorbid diseases for over a decade in a cohort from a community-based integrated screening program. Factors associated with the incidence of PTSD were analyzed using Cox regression models. PTSD incidence was estimated as 81 per 105 person-years. Incidence was higher in females than in males and one-year increments in age lowered the risk for PTSD by 3%. Adjusting for other factors, cardiovascular heart disease (adjusted hazard ratio (aHR) = 1.45, 95% confidence interval (CI): 1.03–2.04), bipolar disorder (aHR = 1.86, 95% CI: 1.07–3.24) and major depressive disorder (aHR = 7.03, 95% CI: 5.02–9.85) all significantly increased 45%, 86% and 603%, respectively, the risk of developing PTSD. The low rate of people with incident PTSD receiving treatment in this community health screening population implies there is room for improvement in terms of early detection and intervention. Clinical preventive efforts may be made for patients seeking general medical help, especially those with cardiovascular disorders or mood disorders.

GADL1 variant and medication adherence in predicting response to lithium maintenance treatment in bipolar I disorder

Background Genetic variants and medication adherence have been identified to be the main factors contributing to lithium treatment response in bipolar disorders. Aims To simultaneously examine effects of variant glutamate decarboxylase-like protein 1 (GADL1) and medication adherence on response to lithium maintenance treatment in Han Chinese patients with bipolar I (BPI) disorder. Method Frequencies of manic and depressive episodes between carriers and non-carriers of the effective GADL1 rs17026688 T allele during the cumulative periods of off-lithium, poor adherence to lithium treatment and good adherence to lithium treatment were compared in Han Chinese patients with BPI disorder (n=215). Results GADL1 rs17026688 T carriers had significantly lower frequencies of recurrent affective episodes than non-T carriers during the cumulative period of good adherence, but not during those of poor adherence. Conclusions GADL1 rs17026688 and medication adherence jointly predict response to lithium maintenance treatment in Han Chinese BPI patients. Declaration of interest None. Copyright and usage