Wen-Jung Sun

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.

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.

Prospective Associations Between Household-, Work-, and Leisure-Based Physical Activity and All-Cause Mortality Among Older Taiwanese Adults

Most studies on the health effects of leisure time physical activity have focused on mortality. There has been limited research regarding physical activity undertaken at work or around the home and mortality. This study assessed the associations between leisure, work, and household physical activity and subsequent all-cause mortality among older adults aged 65 years and older (n = 2133) in Taiwan, over 8 years. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Cox proportional hazard models were used to estimate the association of physical activity with the risk of mortality. This study demonstrated that a low level of total physical activity is predictive of increased all-cause mortality in both men and women in an East Asian population. It also indicates that leisure- and household-related but not work-related activity are significant contributors to this relationship.

Assessment of Changes in Knowledge and Stigmatization Following Tuberculosis Training Workshops in Taiwan

BACKGROUND/PURPOSE There is little understanding of the depth of knowledge of health workers involved in tuberculosis (TB) control programs, and even less is known about health workers attaching stigma to TB patients. This study surveyed health workers enrolled in TB training workshops prior to the execution of the directly observed treatment, short course (DOTS) program. METHODS All participants attended the training course and completed structured questionnaires before (pre-test) and after training (post-test). The questionnaires were collected immediately following completion and the scores were analyzed. RESULTS Pair comparison of knowledge scores revealed that all participants made statistically significant improvements in level of TB knowledge, except those who had a history of TB (p = 0.331). Pair comparison of stigmatization scores revealed a reduction in stigmatization, with the DOTS workers attaching less stigma to TB patients. After training, caregivers, including women (p = 0.012), public health workers (p = 0.028), 40-49-year-old subjects (p = 0.035), those with an education of < 12 years (p = 0.024), those who had been a volunteer (p = 0.018), and those who had a history of TB and those who did not (p = 0.034, p = 0.036), were significantly less likely to stigmatize patients. TB knowledge was not found to be significantly correlated with stigmatization (pre-test, p = 0.298; post-test, p = 0.821). CONCLUSION Training workshops in TB control were effective for promotion of knowledge and elimination of stigmatization in first-line caregivers. DOTS workers attached less stigma to TB patients than public health workers, and older workers who had been volunteers attached the least stigma.

Accelerometer-assessed light physical activity is protective of future cognitive ability: A longitudinal study among community dwelling older adults

Objective: Physical activity (PA), especially moderate‐to‐vigorous intensity, could protect older adults from cognitive impairment. However, most literature is based on self‐reported PA which is limited by recall bias. Light PA is popular among older adults, but a paucity of objective longitudinal data has considered the relationship between light PA and cognitive ability. We examined if a higher level of objectively measured light PA, independent of moderate‐to‐vigorous physical activity (MVPA), was prospectively associated with better cognitive ability in older adults. Methods: A longitudinal study over 22.12 (± 1.46) months including 274 community‐dwelling older adults across 14 regions in Taiwan was undertaken. Cognitive ability was obtained using a Chinese version of the Ascertain Dementia 8‐item Questionnaire (AD8) and light PA and MVPA captured by 7 days accelerometer positioned on waist. Multivariable negative binomial regression adjusted for confounders were undertaken. Results: 274 participants (74.52 years, 45.6% male) attended the follow‐up (96.1%). Higher light PA, independent from MVPA, was associated with a reduced rate of decline in cognitive ability (rate ratio 0.75 [0.60–0.92]). MVPA, was also associated with a reduced decline in cognitive ability (rate ratio 0.85 [0.75–0.95]). Light PA was protective of cognitive ability in sensitivity analyses removing participants with activities of daily living difficulties, depressive symptoms and cognitive impairment at baseline. Conclusion: Our data suggest that light PA may offer a protective influence of future cognitive ability in community dwelling older adults. The promotion of light PA may be a valuable means to maintain cognitive ability in older age. HighlightA paucity of studies have considered objective longitudinal PA and future cognitive ability decline in older adults.Our data suggests that higher LPA, independent of MVPA, is associated with a reduced risk of future cognitive decline.This is the first longitudinal paper to investigate light intensity PA and cognitive decline in older adults.This extends the existing evidence for the benefits of PA for preventing cognitive deterioration in later life.

Associations of exercise, sedentary time and insomnia with metabolic syndrome in Taiwanese older adults: A 1-year follow-up study

Abstract Background: Understanding the risk factors of metabolic syndrome (MetS) is important to public health, since individuals with MetS have an increased risk of health problems. This study examined the associations of exercise, sedentary time and insomnia with incident MetS among older adults 1 year later. Method: A total of 1,359 older adults receiving hospital health examinations in 2012 were studied, and 779 subjects had a follow-up after 1 year. The components of MetS (waist, blood pressure, high-density lipoprotein cholesterol, fasting glucose and triglyceride) were defined by the Program’s Adult Treatment Panel III report. Exercise, sedentary time and insomnia data were obtained through self-report questionnaires. Physical fitness (body fatness, balance and hand grip strength) was measured. Two logistic regressions were computed to examine the associations of exercise/physical fitness, sedentary time and insomnia at baseline with incident MetS 1 year later. The first regression included age, sex, smoking and alcohol as covariates. The second regression was further adjusted with the components of MetS. Results: Sex, exercise/balance, sedentary time and insomnia were significant predictors of MetS. The risk of MetS incidence was 3.36 (95% CI 1.96–5.77) for women, 1.92 (95% CI 1.01–3.63) for those who did not exercise, 2.52 (95% CI 1.37–4.63) for those who sat more than 5 h/day, and 2.17 (95% CI 1.13–4.15) for those with insomnia. Poor balance was significantly associated with greater risk of MetS (AOR = 1.07, 95% CI 1.02–1.12). Sex, sedentary time, insomnia and balance remained significant after adjusting with the components of MetS. Conclusions: Cultivating exercise habits, reducing sedentary time and improving sleep quality may be important strategies for MetS prevention among older adults.

Association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent

The aim of this study is to investigate the association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent.

A rapid screening test for depression in junior high school children.

Background: Depression generates a remarkable disease burden. Early onset of depression in young people is associated with a poor prognosis. This has precipitated developing a screening instrument for early detection of depression in Taiwan adolescents. Methods: We recruited 662 junior high school students who completed the Screening Test for Depression (STD) designed using diagnostic and statistical manual‐IV diagnostic criteria of major depressive disorder for assessing depressive symptoms. The students were then interviewed by psychiatrists who used the Mini International Neuropsychiatric Interview‐Kid to verify the validity of the soon‐to‐be‐developed Rapid STD (RSTD). Multiple logistic regression analysis of the STD results was used to extract items for the RSTD. Results: We extracted four items for the RSTD: “insomnia or hypersomnia”, “recurrent thoughts of death or recurrent suicidal ideation”, “feelings of worthlessness or excessive or inappropriate guilt”, and “psychomotor agitation or retardation”. Any two of the first three yielded the best‐balanced algorithm for major depressive disorder, which had a sensitivity of 75.0%, specificity of 92.9%, positive predictive value of 28.6%, and negative predictive value of 99.0%. Any two of the four yielded the best‐balanced algorithm for depressive disorders, which had a sensitivity of 71.4%, specificity of 92.0%, the positive predictive value of 33.3%, and the negative predictive value of 98.3%. Conclusion: The RSTD, a 4‐item tool for junior high school children, can be easily used to assess fluctuating risks of major depressive disorder and depressive disorders at any time.

Prospective relationship between objectively measured light physical activity and depressive symptoms in later life

The use of self‐report measures of physical activity is a serious methodological weakness in many studies of physical activity and depressive symptoms. It is still equivocal whether light physical activity protects older adults from depressive symptoms.

Associations between walking parameters and subsequent sleep difficulty in older adults: a 2-year follow-up study

Purpose This 2-year follow-up study aimed to examine the associations between total volume, frequency, duration, and speed of walking with subsequent sleep difficulty in older adults. Methods A total of 800 older adults aged 65 years and over participated in the first survey in 2012 and 511 of them were followed 2 years later. The 5-item Athens Insomnia Scale (AIS-5) was used to measure sleep difficulty. Frequency, duration, and speed of outdoor walking were self-reported. Walking speed was assigned a metabolic equivalent value (MET) from 2.5 to 4.5. Total walking volume in MET-h/week was calculated as frequency × duration × speed. Negative binomial regressions were performed to examine the associations between volume and components of walking with subsequent sleep difficulty with covariates of age, sex, education, marital status, living arrangement, smoking, alcohol consumption, mental health, Charlson Index, exercise (excluding walking), and sleep difficulty at baseline. Results Participants with low walking volume had a higher level of sleep difficulty 2 years later compared with those with high walking volume (incident rate ratios = 1.61, p = 0.004). When speed, frequency, and duration of walking were simultaneously entered into 1 model, only walking speed was significantly associated with subsequent sleep difficulty (after the model was adjusted for covariates and baseline sleep difficulty). Sensitivity analyses showed that walking duration emerged as a significant predictor among 3 walking parameters, with 2-year changes of sleep scores as dependent variable. Conclusion Total amount of walking (especially faster walking and lasting for more than 20 min) is associated with less subsequent sleep difficulty after 2 years among older adults.