Kuan-Yi Tsai

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 posttraumatic stress disorder or major depression for firefighters in Kaohsiung, Taiwan

ObjectiveThe work of firefighters involves the risk of exposure to the harmful effects of toxic substances as well as the possibility of enormous emotional shock from disasters, which may result in psychiatric impairments and a lower quality of life. Therefore, we examined quality of life, prevalence of posttraumatic stress disorder (PTSD) and major depression, and the related risk factors for firefighters in Kaohsiung, Taiwan.MethodsThis is a two-stage survey study. During the first stage, we used the 36-item Short-Form Health Survey (SF-36) and the Disaster-Related Psychological Screening Test (DRPST) to assess quality of life, probable PTSD, probable major depression, and the related risk factors for 410 firefighters. During the second stage, psychiatrists categorized these probable cases according to self-reported questionnaires against DSM-IV into PTSD or major depression group, subclinical group, and health group. All the data were analyzed with SPSS 10.0 Chinese version.ResultsThe estimated current prevalence rates for major depression and PTSD were 5.4% (22/410) and 10.5% (43/410), respectively. The firefighters with estimated PTSD or major depression scored significantly lower on quality of life measures than subclinical PTSD/major depression and mentally healthy groups, which was evident in eight concepts and two domains of the SF-36. The major predictors of poor quality of life and PTSD/major depression were mental status, psychosocial stressors, or perceived physical condition.ConclusionFirefighters have a higher estimated rate of PTSD, and the risk factors that affect quality of life and PTSD/major depression should encourage intervention from mental health professionals.

A survey of quality of life and depression for police officers in Kaohsiung, Taiwan

Objective: The enormous job stress of police work may result in depression, which is highly correlated with work disability and poor quality of life. We investigated the quality of life, the probability of depression, and the related risk factors for police officers in Kaohsiung, Taiwan. Methods: We used the 12-item Short-Form Health Survey (SF-12) and the Disaster-Related Psychological Screening Test (DRPST) to assess the quality of life and prevalence of depression for 832 police officers in Kaohsiung. Results: The estimated rate of probable major depression was 21.6% (180/832). Those with an educational level of university or above and nondepressed police officers had higher scores in every subscale for quality of life. Police officers older than 50 had higher scores in the mental aspects of quality of life. Family problems and job stress related to achievement, peer pressure about performance, and heavy workloads were predictive factors for depression. Conclusion: Police officers might have a higher estimated rate of depression than previously thought, and those with depression have a poorer quality of life.

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 comparison of quality of life and depression between female married immigrants and native married women in Taiwan

BackgroundsImmigration to Taiwan is often connected with marriage, resulting in the presence of so-called married immigrants or foreign brides.AimsTo compare the quality of life (QOL) and prevalence of depression between female married immigrants and native married women.MethodsTrained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the disaster-related psychological screening test (DRPST) to interview 1,602 married women who were 16–50 years of age. Half (801) of the participants were female immigrants, whilst the remainder comprised the age-matched control group that consisted of 801 native married women. Participants who scored ≥2 (probable major depressive episode) on the DRPST were assessed according to DSM-IV criteria by a senior psychiatrist. The MOS SF-36 measures QOL and has two dimensions: the physical component summary (PCS) and the mental component summary (MCS).ResultsMarried immigrants had a lower prevalence (3.5%) of major depressive episodes than native women (8.9%) in Taiwan. Variables such as an increased severity of psychosocial impact were the best predictors of a lower PCS and MCS.ConclusionCompared to Taiwanese native married women, fewer married immigrants had stressful life events or depression, and they reported higher QOL. After controlling for putative confounding factors, the married immigrants still had better mental QOL and a lower prevalence rate of depression.

Cancer in patients with schizophrenia: What is the next step?

People with schizophrenia, who constitute approximately 0.3–1% of the general population, have a nearly 20% shorter life expectancy than the general population. The incidence of varied types of cancers in patients with schizophrenia is controversial. The majority of previous research has demonstrated that patients who have schizophrenia and cancer have early mortality compared to the general population with cancer. The causes of early mortality in patients with schizophrenia and cancer might be attributed to a lower cancer screening rate and lack of effective treatment, including: (i) patient factors, such as poor lifestyle, passive attitude toward treatment, or comorbidity; (ii) physician factors, such as physician bias, which may decrease the delivery of care for individuals with mental disorders; and (iii) hospital administration factors, such as stigma and discrimination. Additional studies on patients with schizophrenia and cancer are warranted and should include the following: a comprehensive review of previous studies; a focus on differentiating the specific types of cancer; and methods for improvement. To decrease the early mortality of patients with schizophrenia, the following measures are proposed: (i) enhance early detection and early treatment, such as increasing the cancer screening rate for patients with schizophrenia; (ii) provide effective, timely treatment and rehabilitation; (iii) improve patients’ psychiatric symptoms and cognitive impairment; (iv) promote healthy behavior in the general population and emphasize healthy lifestyles in vulnerable populations; and (v) remove the stigma of schizophrenia. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this group of patients.

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.

Models to Predict Unresolved Post-traumatic Stress Symptoms in Earthquake Survivors: Comparison of Classification and Regression Tree and Logistic Regression

Objective: This study was to evaluate the implementation and performance of a classification and regression tree (CART) and a logistic regression model to predict unresolved post-traumatic stress symptoms (PTSS) in survivors three years after the Taiwan Chi-Chi Earthquake from multivariate data presented at 0.5 year. Methods: We surveyed 4,223 respondents 0.5 year after the earthquake, and 875 (20.7%) of them were found to be positive for PTSS. Three years later, we followed up 418 (47.8%) of the 875 participants, and in 38 (9.1%) of these cases were found to have their symptoms unresolved. Verified values falling outside threshold limits were analyzed according to demographic data, quality of life (QOL), putative risk factors, and post-traumatic stress disorder (PTSD)-related symptoms with the aid of logistic regression. A decision tree was automatically produced from the root nod to target classes (remissive or unresolved PTSS). Result: With CART, we found that the predicted probability for unresolved PTSS was 53.6%, if the respondents had ”prominent financial loss,” ”mental component summary (MCS) score ≦36.0”, and ”reliving the traumatic experience”. These three factors were also included in the six significant independent variables identified in logistic regression. Conclusion: Decision tree analysis confirmed some of the results of logistic regression. This investigation shows there is knowledge to be gained from analyzing observational data with the aid of decision tree analysis.