Vincent Chin-Hung Chen

Asthma and Suicide Mortality in Young People: A 12-Year Follow-Up Study

OBJECTIVE Mortality risk is relatively high in young people with asthma, and the risk may include causes of death other than those directly linked to respiratory disease. The authors investigated the association between asthma and suicide mortality in a large population-based cohort of young people. METHOD A total of 162,766 high school students 11 to 16 years of age living in a catchment area in Taiwan from October 1995 to June 1996 were enrolled in a study of asthma and allergy. Each student and his or her parents completed structured questionnaires. Participants were classified into three groups at baseline: current asthma (symptoms present in the past year), previous asthma (history of asthma but no symptoms in the past year), and no asthma. Participants were followed to December 2007 by record linkage to the national Death Certification System. Cox proportional hazards models were used to study the association between asthma and cause of death. RESULTS The incidence rate of suicide mortality in participants with current asthma at baseline was more than twice that of those without asthma (11.0 compared with 4.3 per 100,000 person-years), but there was no significant difference in the incidence of natural deaths. The adjusted hazard ratio for suicide was 2.26 (95% CI=1.43-3.58) in the current asthma group and 1.76 (95% CI=0.90-3.43) in the previous asthma group. Having a greater number of asthma symptoms at baseline was associated with a higher risk of subsequent suicide. The population attributable fraction was 7.0%. CONCLUSIONS These results highlight evidence of excess suicide mortality in young people with asthma. There is a need to improve mental health care for young people, particularly those with more severe and persistent asthma symptoms.

A meta-analysis of behavioral parent training for children with attention deficit hyperactivity disorder

This meta-analysis examined the effect of behavioral parent training on child and parental outcomes for children with attention deficit hyperactivity disorder. Meta-analytic procedures were used to estimate the effect of behavioral parent training on children with attention deficit hyperactivity disorder. Variables moderating the intervention effect were examined. Forty studies were included and generated an overall moderate effect size at post-treatment and a small effect size at follow-up. The majority of outcome categories were associated with a moderate effect size at post-treatment that decreased to a small effect size at follow-up. Parenting competence was the only outcome that had a large effect, which decreased to moderate at follow-up. The strength of the effect differed between questionnaire and observation measures. Behavioral parent training is an effective intervention for children with attention deficit hyperactivity disorder. Sustainability of the effects over time is a problem that awaits further scrutiny. Recommendations for further research and clinical practices are provided.

Mortality and suicide after self-harm: community cohort study in Taiwan

BACKGROUND Little is known about outcomes after self-harm in East Asia. AIMS To investigate mortality after self-harm in a Taiwanese population. METHOD Between 2000 and 2003, 1083 individuals who self-harmed were identified through a population self-harm register in Nantou County, Taiwan, and followed until 2007 for date and cause of death on a national mortality database. RESULTS In total, 145 individuals died, 48 through suicide. The risks of all-cause and suicide mortality in the first year were 4.7% and 2.1% respectively, representing 8- and 131-fold age- and gender-standardised increases. Male gender and older age were independent risk factors for both suicide and non-suicide mortality. Use of more lethal methods in the index episode was associated with higher mortality but this was accounted for by gender. CONCLUSIONS Results in this sample support the recommendation that people with a history of recent self-harm should be a major target for suicide prevention programmes.

Leisure activity, mobility limitation and stress as modifiable risk factors for depressive symptoms in the elderly: results of a national longitudinal study.

Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at follow-up in 2007. The independent variables included demographics, chronic medical diseases and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms assessed at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR=0.56, 95% confidence interval, CI=0.38-0.83, p=0.0034), more mobility limitations (OR=1.93, 95% CI=1.30-2.86, p=0.0011) and higher stress levels (OR=2.43, 95% CI=1.68-3.50, p<0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors.

Severity of heroin dependence in Taiwan: Reliability and validity of the Chinese version of the Severity of Dependence Scale (SDS[Ch])

The development of instruments to assess substance use that are easy to use, valid and reliable across cultures is an important task. The present study investigates the reliability and validity of the Chinese language version of the SDS (SDS([Ch])) when used to measure severity of dependence among heroin users in Taiwan (n=522). Data were collected on demographic data, heroin use behaviours, and criminal convictions. Taiwanese heroin users recorded high SDS([Ch]) scores and the results support the validity and reliability of the Chinese version of the SDS. A positive correlation was found between SDS([Ch]) scores and DSM-IV criteria for heroin dependence. SDS([Ch]) scores were positively related to heroin injection, frequency of heroin injection, spending on heroin, earlier age of onset of heroin use and more drug-related criminal convictions. The findings support the suggestion that the concept of dependence as assessed by the SDS has cross-cultural validity.

Non-fatal repetition of self-harm: population-based prospective cohort study in Taiwan

BACKGROUND Repeated self-harm is relatively common and is linked with an elevated risk of eventual suicide. There has been no study of this involving a large sample from the Far East. AIMS To estimate the risk over the medium term of non-fatal repetition of self-harm and identify predictive factors in those carrying out self-harm. METHOD A total of 970 individuals who had self-harmed were recruited from a community-based suicide behaviour register system in Nantou, Taiwan from July 2000 to February 2003. Information regarding demography and suicide methods was collected. Individuals were followed-up until December 2005 to examine the risk of repeated self-harm and independent predictive factors. RESULTS Ninety cohort members had repeated self-harm during the follow-up period (accounting for 131 repeated self-harm episodes in all). The cumulative risks were 5.7% for the first year, 7.8% for the second year and 9.5% for the fourth year. The risk was highest within the first year after the self-harm event. Independent risk factors included female gender and self-cutting as well as self-poisoning with drugs. Effect of younger age was mediated through the choice of methods. CONCLUSIONS Individuals with self-harm have a high risk of repetition, especially within the first year. Suicide prevention strategies need to focus on intervening with this population to reduce their repetition.

Suicide attempts prior to starting methadone maintenance treatment in Taiwan

This study investigates recent (one-month) and lifetime prevalence of suicide attempts, and factors associated with one-month suicide attempts among heroin users (n=488) seeking treatment at a methadone maintenance programme in Taiwan. Data were collected by structured interview on demographics, use of heroin and other substances, criminal convictions, depression, social networks, and history of suicide attempt (lifetime suicide attempt, and suicide attempt and suicide ideation in the previous month). Prevalence of recent (one-month) suicide attempt was 10.9% and lifetime prevalence was 17.8%. The finding that so many heroin users had made a suicide attempt in the very recent past is both disturbing and little researched. Recent suicidal attempts were associated with severity of heroin dependence, needle sharing, higher educational level, increased levels of depression, and number of stressful life events. It is suggested that methadone maintenance programmes should routinely screen at intake for previous suicidal behaviour and especially for recent suicidal attempts.

Parent-Child Interaction of Mothers with Depression and Their Children with ADHD.

Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder that may have a chronic and pervasive impact on the childs function and cause long-term stress to parents. A higher rate of depression is associated with mothers of children with ADHD. This observational study aimed to investigate the effect of maternal depression and the childs ADHD on the quality of the parent-child interaction in children with ADHD and their mothers with depression. The study participants comprised 39 mother-son dyads including children with ADHD and mothers with depression, children with ADHD and mothers without depression, and children without ADHD and mothers without depression. The Specific Affect Coding System, 20-code version was used to code interactional affect, including positive engagement, negative engagement, negative disengagement, and neural affect. There were no statistically significant group-by-context interaction effects or group effects on all affective variables between the group of children with ADHD and mothers without depression and the group of children without ADHD and mothers without depression. Stimulant medication may account for these nonsignificant findings. No significant difference of positive affect between neutral and conflict-solving contexts was observed in depressed mothers whose children were diagnosed as ADHD. Children with ADHD whose mothers were depressed were less positive in their parent-child interaction compared with children in the other groups. Maternal depression may play an important role in the affective presentation of dyads of children with ADHD and mothers with depression. Implications for clinical practice and future research are provided.

Assessment of abnormal brain structures and networks in major depressive disorder using morphometric and connectome analyses

BACKGROUND It is hypothesized that the phenomenology of major depressive disorder (MDD) is subserved by disturbances in the structure and function of brain circuits; however, findings of structural abnormalities using MRI have been inconsistent. Generalized q-sampling imaging (GQI) methodology provides an opportunity to assess the functional integrity of white matter tracts in implicated circuits. METHODS The study population was comprised of 16 outpatients with MDD (mean age 44.81±2.2 years) and 30 age- and gender-matched healthy controls (mean age 45.03±1.88 years). We excluded participants with any other primary mental disorder, substance use disorder, or any neurological illnesses. We used T1-weighted 3D MRI with voxel-based morphometry (VBM) and vertex-wise shape analysis, and GQI with voxel-based statistical analysis (VBA), graph theoretical analysis (GTA) and network-based statistical (NBS) analysis to evaluate brain structure and connectivity abnormalities in MDD compared to healthy controls correlates with clinical measures of depressive symptom severity, Hamilton Depression Rating Scale 17-item (HAMD) and Hospital Anxiety and Depression Scale (HADS). RESULTS Using VBM and vertex-wise shape analyses, we found significant volumetric decreases in the hippocampus and amygdala among subjects with MDD (p<0.001). Using GQI, we found decreases in diffusion anisotropy in the superior longitudinal fasciculus and increases in diffusion probability distribution in the frontal lobe among subjects with MDD (p<0.01). In GTA and NBS analyses, we found several disruptions in connectivity among subjects with MDD, particularly in the frontal lobes (p<0.05). In addition, structural alterations were correlated with depressive symptom severity (p<0.01). LIMITATIONS Small sample size; the cross-sectional design did not allow us to observe treatment effects in the MDD participants. CONCLUSIONS Our results provide further evidence indicating that MDD may be conceptualized as a brain disorder with abnormal circuit structure and connectivity.

Weight gain and ghrelin level after olanzapine monotherapy

BACKGROUND The present study aimed to explore the association between weight gain and ghrelin among schizophrenic patients under olanzapine treatment. The relationships among weight gain and adiponectin, fasting glucose, and lipid profile were also investigated. METHODS This case-control study recruited 66 schizophrenic patients from the Chung Shan Medical University Hospital in central Taiwan. All of them were undergoing olanzapine monotherapy and were categorized into weight gain (WG) and non-weight gain (NWG) groups. Subjects in the control group (CG) were recruited from a healthy community population based on a health survey (n=119). Multivariate logistic regression was used to explore the association of ghrelin with weight gain. RESULTS The 66 schizophrenic patients had a mean age of 36.3±9.6 years, with 50% females. They received olanzapine treatment for a mean period of 8.3±7.5 years. The control group had a mean age of 38.9±9.3 years and 52.9% were females. Comparing fasting serum ghrelin levels, the WG group had the lowest mean value (822.3±253.1 pg/ml) while the control group had the highest mean value (1261.2±1639.7 pg/ml), with a significant difference between the two (p=0.01). In contrast, there was no difference in adiponectin levels among the three groups. The WG and NWG groups had higher diastolic blood pressure than the control group, but systolic blood pressure was the same in all three groups. There was no difference in the total cholesterol level although the WG and NWG groups had higher triglyceride (TG) and glucose levels than the control group. CONCLUSIONS Weight gain after olanzapine treatment is associated with lower ghrelin level. Olanzapine is linked to elevated diastolic pressure, TG, and glucose, regardless of the weight gain.