New methods in cross-cultural psychiatry: psychiatric illness in Taiwan and the United States

An Exploratory Study of the Association between Housing Price Trends and Antidepressant Use in Taiwan: A 10-Year Population-Based Study

This study examined the relationship between various economic indexes and incidences of antidepressant prescriptions during 2001-2011 using the National Health Insurance Research Database (NHIRD). As of 2007, approximately 98.4% of Taiwanese people were enrolled in the NHIRD. In total, 531,281 records identified as antidepressant prescriptions were collected. Furthermore, 2556 quarterly observations from the Taiwan Housing Index (THI) and Executive Yuan were retrieved. We examined the association between the housing index and antidepressant prescription incidence. During the 10-year follow-up period, a higher incidence of antidepressant prescriptions was associated with the local maximum housing index. The relative risk of being prescribed antidepressant increased by 13.3% (95% confidence interval (CI): 1.01~1.27) when the THI reached a peak. For the low-income subgroup, the relative risk of being prescribed antidepressants increased by 28% during the high season of the THI. We also stratified the study sample on the basis of their sex, age, and urbanization levels. Both sexes followed similar patterns. During 2001-2011, although rising economic indexes may have increased incomes and stimulated the housing market, the compromise of public mental health could be a cost people have to pay additional attention to.

Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis

Attention-deficit / hyperactivity disorder (ADHD) and Bipolar Disorder (BD) are common mental disorders with a high degree of comorbidity. However, no systematic review with meta-analysis has aimed to quantify the degree of comorbidity between both disorders. To this end we performed a systematic search of the literature in October 2020. In a meta-analysis of 71 studies with 646,766 participants from 18 countries, it was found that about one in thirteen adults with ADHD was also diagnosed with BD (7.95 %; 95 % CI: 5.31-11.06), and nearly one in six adults with BD had ADHD (17.11 %; 95 % CI: 13.05-21.59 %). Substantial heterogeneity of comorbidity rates was present, highlighting the importance of contextual factors: Heterogeneity could partially be explained by diagnostic system, sample size and geographical location. Age of BD onset occurred earlier in patients with comorbid ADHD (3.96 years; 95 % CI: 2.65-5.26, p < 0.001). Cultural and methodological differences deserve attention for evaluating diagnostic criteria and clinicians should be aware of the high comorbidity rates to prevent misdiagnosis and provide optimal care for both disorders.

Serum Progesterone and Testosterone Levels in Schizophrenia Patients at Different Stages of Treatment

It has been suggested that dysregulation of hormones is associated with schizophrenia (SCZ). This study aimed to measure the serum levels of progesterone and testosterone in 125 SCZ patients at different stages of treatment and 96 healthy control (HC) subjects. Our results showed that first-episode drug-free SCZ patients had significantly increased testosterone levels when compared with HC subjects, and chronic medication, but not short-term medication, further increased the serum testosterone levels in the patients. Further analysis suggested that the sex of the patients did not affect testosterone levels. In contrast, serum progesterone levels did not show significant differences between first-episode, drug-free SCZ patients and controls, and the antipsychotics increased progesterone levels in the male SCZ patients, but not female patients. Interestingly, our analyses demonstrated that the serum progesterone levels were negatively correlated with PANSS total score and PNASS positive score, suggesting a correlation between blood hormone levels and disease severity in SCZ patients. Taken together, our data showed differential changes in serum testosterone and progesterone levels in SCZ patients with or without antipsychotics, and our results suggest that increased sex hormone levels may be a defensive response to protect the human body under stress.

Dimensionality of DSM-5 PTSD symptoms: Validation of the Chinese version of the posttraumatic diagnostic scale for DSM-5 across multiple trauma samples

The Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) is an updated DSM-5 version of the PDS, a widely used measure for PTSD. The PDS-5 has recently been shown to possess sound psychometric properties and awaits cross-cultural validation. The present study aimed first, to evaluate the psychometric properties of the Chinese version of the PDS-5; second, to evaluate alternative factor models of DSM-5 PTSD symptoms with multiple trauma samples. Data were collected from five samples of Taiwanese trauma-exposed individuals (total N = 903): 138 burn injury survivors, 403 earthquake survivors, 181 trauma-exposed young adults, 91 trauma-exposed undergraduates, and 90 female domestic violence survivors. The Chinese PDS-5 possessed excellent internal consistency (α s = .94-.95) and satisfactory five-week (r = .80) and one-year temporal stability (r = 0.76). Convergent, concurrent, and discriminant validity were also established. Consistent with recent studies, confirmatory factor analyses demonstrated the best fit of a seven-factor Hybrid model, followed by a six-factor Anhedonia model across multiple trauma samples.

Optimization of Processing Parameters of Nanoemulsion Containing Aripiprazole Using Response Surface Methodology

BACKGROUND

Aripiprazole, which is a quinolinone derivative, has been widely used to treat schizophrenia, major depressive disorder, and bipolar disorder.

PURPOSE

A Central Composite Rotatable Design (CCRD) of Response Surface Methodology (RSM) was used purposely to optimize process parameters conditions for formulating nanoemulsion containing aripiprazole using high emulsification methods.

METHODS

This design is used to investigate the influences of four independent variables (overhead stirring time (A), shear rate (B), shear time (C), and the cycle of high-pressure homogenizer (D)) on the response variable namely, a droplet size (Y) of nanoemulsion containing aripiprazole.

RESULTS

The optimum conditions suggested by the predicted model were: 120 min of overhead stirring time, 15 min of high shear homogenizer time, 4400 rpm of high shear homogenizer rate and 11 cycles of high-pressure homogenizer, giving a desirable droplet size of nanoemulsion containing aripiprazole of 64.52 nm for experimental value and 62.59 nm for predicted value. The analysis of variance (ANOVA) showed the quadratic polynomial fitted the experimental values with F-value (9.53), a low p-value (0.0003) and a non-significant lack of-fit. It proved that the models were adequate to predict the relevance response. The optimized formulation with a viscosity value of 3.72 mPa.s and pH value of 7.4 showed good osmolality value (297 mOsm/kg) and remained stable for three months in three different temperatures (4°C, 25°C, and 45°C).

CONCLUSION

This proven that response surface methodology is an efficient tool to produce desirable droplet size of nanoemulsion containing aripiprazole for parenteral delivery application.

Psychological Distress Among Methadone Maintenance Patients in Vietnamese Mountainous Areas

We conducted a cross-sectional study in Tuyen Quang Province, a mountainous province in northern Vietnam, to examine rates of psychological distress among 241 patients receiving methadone maintenance treatment (MMT). Using the Kessler psychological distress Scale, we found that approximately one-fourth (26.8%) of respondents suffered from mental health pathologies. Physical health problems, current drug use, and alcohol abuse were found to be associated with mental health problems among the participants. Our findings highlight the high prevalence of psychological distress among MMT patients in northern Vietnam, and the need to integrate mental and physical health care services, as well as behavioral health counseling, into currently existing MMT clinics in this region.

Exploring the East-West Divide in Prevalence of Affective Disorder: A Case for Cultural Differences in Coping With Negative Emotion

Lifetime rates of clinical depression and anxiety in the West tend to be approximately 4 to 10 times greater than rates in Asia. In this review, we explore one possible reason for this cross-cultural difference, that Asian cultures think differently about emotion than do Western cultures and that these different systems of thought help explain why negative affect does not escalate into clinical disorder at the same rate. We review research from multiple disciplines-including cross-cultural psychology, social cognition, clinical psychology, and psychiatry-to make the case that the Eastern holistic principles of contradiction (each experience is associated with its opposite), change (the world exists in a state of constant flux), and context (the interconnectedness of all things) fundamentally shape people's experience of emotions in different cultures. We then review evidence for how these cultural differences influence how successfully people use common emotion regulation strategies such as rumination and suppression.

Association between Emotional Symptoms and Job Demands in an Asian Electronics Factory

Various work-related issues including mental health have been described for the electronic industry. Although East Asian countries play important roles in the electronics industry, the association between job demands and emotional symptoms has been rarely examined. The present study recruited 603 workers from either office or clean room environments in an electronics factory in Taiwan. Their personal factors, work-related factors, and emotional symptoms were assessed by a self-administered questionnaire. The symptoms of depression and hostility were reported in 24.88% and 24.38% of the subjects, respectively, while 14.93% reported both. A multivariate analysis showed that, overall, women workers were more likely to have emotional symptoms than male workers (odds ration (OR) = 1.50, 95% CI = 1.02-2.18). Among clean room workers, working under high pressure (OR = 1.84, 95% CI = 1.05-3.21), conflicting demands (OR = 2.15, 95% CI = 1.30-3.57), and social isolation at work (OR = 2.99, 95% CI = 1.23-7.30) were associated with emotional symptoms. The findings suggest that in the Asian electronics industry, for women, working under high pressure, conflicting demands, and social isolation at work are risk factors for emotional symptoms, especially for clean room workers. Further large-scale, longitudinal studies are necessary to confirm and prevent the mental health problems in this fast-evolving, highly competitive industry.

Prevalence of and risk factors for minor and major depression among community-dwelling older adults in Taiwan

BACKGROUND

This study was conducted to estimate prevalence rates and risk factors for late-life depression in a large nationwide representative sample from Taiwan.

METHODS

A total of 5,664, randomly sampled individuals aged ≥55 years were enrolled. Clinically, relevant depressive symptoms were classified using the Center for Epidemiological Studies Depression Scale (CES-D score ≥16), and major depression was confirmed using the Primary Care Evaluation of Mental Disorders. Individuals with clinically relevant depressive symptoms, who did not meet the strict diagnostic criteria for major depression, were considered to have minor depression. Multinomial logistic regression analyses were conducted to identify risk factors for major and minor depression, including socio-demographic characteristics, medical conditions, lifestyle behaviors, social support network, and life events.

RESULTS

The prevalence rates of minor and major depression were 3.7% and 1.5%, respectively. Major depression was associated with personal vulnerability factors, such as poor social support, cognitive impairment, comorbid pain conditions, and sleep disturbance. However, minor depression was more likely to be related to adverse life events, including increased burden on families, changes in health status, or relationship problem. Approximately, 20.0% of individuals with major depression received antidepressant treatment.

CONCLUSIONS

Late-life depression was less prevalent among community-dwelling older adults in Taiwan than among populations in other countries. Our findings may aid the early detection and treatment of late-life depression and provide a basis for future investigations.

Obsessive-Compulsive Disorder: A Review of the Cross-Cultural Epidemiological Literature

Early clinical studies suggested that obsessive-compulsive disorder (OCD) was a rare disorder, but recent large-scale epidemiological research conducted in North America using standardized diagnostic criteria (DSM-III) report prevalence rates between 1 to 3%. A review of clinical and case reports of OCD among psychiatric population in non-Western countries reveals similar sociodemographic and clinical correlates for the disorder compared to Western findings. Epidemiological studies using translated versions of standardized diagnostic instruments and conducted in non-Western countries, report similar prevalence rates and clinical phenomenology for O CD as that found in Western settings. Methodological and measurement issues relevant to conducting valid cross- cultural psychiatric research are discussed in relationship to the diagnosis of OCD. The review concludes that OCD is generally similar in prevalence, sociodemographic characteristics and clinical features in both Western and non-Western countries for adult populations.

Prevalence of Depression among Older Adults—Results from the Well-being of the Singapore Elderly Study

Introduction: Depression is a significant public health issue across all sociodemographic groups and is identified as a common and serious mental health problem particularly among the older adult population. The aims of the current study were to determine the prevalence of depression and subsyndromal depression among older adults in Singapore. Materials and Methods: The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. Stage 1 Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) depression syndrome was used for this analysis. Association of depression and subsyndromal depression with sociodemographic characteristics, social support as well as comorbidity with chronic physical illnesses and quality of life was assessed. Results: The prevalence of GMS-AGECAT depression and subsyndromal depression was 3.7% and 13.4%, respectively. The odds of depression were significantly higher among those aged 75 to 84 (2.1) as compared to those aged 60 to 74 years and in those who had a history of depression diagnosis by a doctor (4.1). The odds of depression were higher among those of Indian and Malay ethnicities (5.2 and 3.2 times, respectively) as compared to those of Chinese ethnicity. Those with depression and subsyndromal depression were associated with more disability, poorer life satisfaction, and medical comorbidities. Conclusion: Our study suggests that the prevalence of depression seems to have decreased as compared to a decade ago wherein the prevalence of depression was estimated to be 5.5%. This positive trend can be ascribed to concerted efforts across various disciplines and sectors, which need to be continually strengthened, monitored and evaluated. Key words: Comorbidity, GMS-AGECAT, Social support, Subsyndromal depression

The prediction of the optimum compositions of a parenteral nanoemulsion system loaded with a low water solubility drug for the treatment of schizophrenia by artificial neural networks

Aripiprazole was encapsulated in a palm kernel oil esters nanoemulsion for the purpose of brain deliveryviaintravenous administration.

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.

Enhancement of encapsulation efficiency of nanoemulsion-containing aripiprazole for the treatment of schizophrenia using mixture experimental design

Aripiprazole is considered as a third-generation antipsychotic drug with excellent therapeutic efficacy in controlling schizophrenia symptoms and was the first atypical anti-psychotic agent to be approved by the US Food and Drug Administration. Formulation of nanoemulsion-containing aripiprazole was carried out using high shear and high pressure homogenizers. Mixture experimental design was selected to optimize the composition of nanoemulsion. A very small droplet size of emulsion can provide an effective encapsulation for delivery system in the body. The effects of palm kernel oil ester (3–6 wt%), lecithin (2–3 wt%), Tween 80 (0.5–1 wt%), glycerol (1.5–3 wt%), and water (87–93 wt%) on the droplet size of aripiprazole nanoemulsions were investigated. The mathematical model showed that the optimum formulation for preparation of aripiprazole nanoemulsion having the desirable criteria was 3.00% of palm kernel oil ester, 2.00% of lecithin, 1.00% of Tween 80, 2.25% of glycerol, and 91.75% of water. Under optimum formulation, the corresponding predicted response value for droplet size was 64.24 nm, which showed an excellent agreement with the actual value (62.23 nm) with residual standard error <3.2%.

The efficacy and safety of once-daily quetiapine extended release in patients with schizophrenia switched from other antipsychotics: an open-label study in Chinese population

BACKGROUND

Non-adherence to antipsychotic medication in schizophrenic patients is common and associated with symptom relapse and poorer long-term outcomes. The risk factors for treatment non-adherence include dosing frequency and complexity. Besides, slower dose titration in an acute schizophrenic episode may lead to attenuated efficacy. Therefore, the convenient dosage regimen and rapid initiation scheme of quetiapine extended release (XR) were expected to provide better effectiveness and promote adherence in patients with schizophrenia. This study was implemented to assess the efficacy and safety of once-daily quetiapine XR in schizophrenic patients with switched from other antipsychotics which were suboptimal due to insufficient efficacy or tolerability.

METHODS

This was a 12-week, open-label study conducted in the Chinese population in Taiwan. Patients who had a score of 4 (moderate) or greater on any of the 7 items of the Positive and Negative Syndrome Scale (PANSS) Positive Symptom Subscale and needed to switch from previous antipsychotics were recruited. Quetiapine XR was administered at 300 mg on day 1, 600 mg on day 2 and up to 800 mg after day 2. From day 8 until the end of the study, the dose of quetiapine XR was adjusted within 400-800 mg per day, depending on the clinical response and tolerance of the patients. The variable of the primary outcome was the change from baseline to Week 12 in PANSS total and subscale scores. Secondary outcome was the baseline-to-endpoint difference in the Clinical Global Impression-Severity (CGI-S) scores of the participants.

RESULTS

Sixty-one patients were recruited and 55.7% of them completed the study. The mean changes in the PANSS total score and CGI-S score showed significant improvement (-18.4, p < .001 and -1.0, p < .001, respectively). Four patients (6.7%) experienced adverse events including headache, exacerbation of psychosis and dysuria. The use of concomitant anticholinergics decreased from 15.0% to 8.3%.

CONCLUSIONS

The results of our investigation implicated that quetiapine XR was an effective and well tolerated alternative for Chinese schizophrenic patients with previous suboptimal treatment. Future large-scale studies are warranted to validate our results.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT02142556 . Registered 15 May 2014.

Psychiatric disorders after occupational injury among National Health Insurance enrollees in Taiwan

This study aimed to determine the incidence rates of psychiatric disorders within 1 year after occupational injury and to examine the association between occupational injury and the incidence of psychiatric disorders using National Health Insurance Research Database (NHIRD). We used cohort approach in this investigation. All eligible subjects were from the NHIRD, and aged 18-65 years old. A total of 542,208 patients were enrolled in this study. Among them, 1038 patients sustained occupational injury, 6891 patients sustained non-occupational injury. The reference group in this study was 534,279 patients who ever used the NHI for any medical condition in 2001. The incidence rates of any psychiatric disorders within 1 year after occupational injury (inpatient), occupational injury (outpatient), non-occupational injury (inpatient), non-occupational injury (outpatient), and any disease were 9.5%, 2.5%, 7.4%, 1.5%, and 1.1%, respectively. Occupational injury was found as a significant factor for developing psychiatric disorders within 1 year after the target injury. The incidence rate of any psychiatric disorders was higher in patients after occupational injury than those after non-occupational injury and any medical condition.

Efficacy and safety of aripiprazole in Chinese Han schizophrenia subjects: a randomized, double-blind, active parallel-controlled, multicenter clinical trial

OBJECTIVE

Antipsychotics, such as aripiprazole and risperidone, are often used to treat individuals with schizophrenia. The efficacy as well as safety of aripiprazole in Western populations has been described. The objective of this study is to investigate the efficacy, safety, and tolerability of aripiprazole and risperidone in Chinese Han schizophrenia subjects in mainland China.

METHOD

The 6-week, double-blind, randomized, parallel study was conducted in 5 medical centers in mainland China from November 2007 to March 2011. A total of 279 subjects with a primary DSM-IV diagnosis of schizophrenia were randomly assigned (with a randomization ratio of 1:1) to aripiprazole (n=139) or risperidone (n=140). Efficacy measurements included the Positive and Negative Syndrome Scale (PANSS) total, positive, negative and general psychopathology subscale scores, and Clinical Global Impressions-Severity of Illness (CGI-S), and Improvement scale scores. Extrapyramidal symptoms (EPS), weight gain, serum prolactin level, QTc interval, and self-reported adverse events were also assessed as measures of safety and tolerability.

RESULTS

Both the aripiprazole and risperidone groups showed statistically significant improvement of PANSS total, positive, negative, general psychopathology subscale scores, and CGI-S scores from baseline to the endpoint (all p<0.01). Significant improvement was noted in the first week for both treatment groups. There were no significant differences in efficacy measurements between the two treatment groups. Mean change of PANSS total scores from baseline to the endpoint was -26.8±18.1 for aripiprazole and -30.0±17.7 for risperidone, (p=0.1475). The responder rate was 71% (n=99) and 76% (n=107) for aripiprazole and risperidone, respectively, (p=0.323). The incidences of EPS were similar in the aripiprazole (25%, n=35) and risperidone groups (24%, n=34), respectively (p=0.757). No clinically meaningful effects on QTc interval, QRS duration, or PR interval were observed in either treatment groups. However, the incidence of clinically significant weight gain (p=0.0118) and hyperprolactinemia (p<0.001) in the aripiprazole group was significantly lower than in the risperidone group.

CONCLUSION

The study demonstrated that aripiprazole, as well as risperidone, had rapid and persistent efficacy for psychotic symptoms from the first week of therapy. There may be poor efficacy for aripiprazole compared with risperidone for overall improvement, but there were no significant differences in this study. Aripiprazole showed good tolerability with less weight gain and hyperprolactinemia compared with risperidone. The overall efficacy and safety of aripiprazole in Chinese Han schizophrenia subjects were similar to that reported in Western populations.

Long-term psychological outcome of workers after occupational injury: prevalence and risk factors

INTRODUCTION

This study aimed to examine the prevalence rates of both post-traumatic stress disorder (PTSD) and major depression at 12 months in workers experiencing different types of occupational injury in Taiwan. Demographic and injury-related risk factors for psychological symptoms were also evaluated.

METHODS

Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale and Post-traumatic Symptom Checklist was sent to workers at 12 months after injury. Those who met the criteria were recruited for the second-stage phone interview with a psychiatrist using the Mini-international Neuropsychiatric Interview (MINI).

RESULTS

A total of 1,233 workers completed the questionnaire (response rate 28.0 %). Among them, 167 (13.5 %) fulfilled the criteria for the MINI interview and were invited. A total of 106 (63.5 %) completed the phone interview. The estimated rate of either PTSD/PPTSD or major depression was 5.2 %. The risk factors for psychological symptoms were female gender, lower education level, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family.

CONCLUSIONS

These results showed that occupational injury can cause long-term psychological impact in workers. Key demographic and injury characteristics may enhance the identification of at-risk occupational injured workers who would benefit from targeted screening and early intervention efforts.

Birth seasonality in schizophrenia: effects of gender and income status

AIMS

The aim of this study was to examine the correlations of birth seasonality in schizophrenia, considering influences of gender and income status.

METHODS

The sample consisted of 1 000 000 people in the general population randomly selected from the Taiwan National Health Insurance Research Database. Data for the birth-year period 1950-1989 were extracted for analysis (n = 631 911; 306 194 male, 325 717 female). Subjects with schizophrenia (2796 male, 2251 female) were compared with the general population. Subgroups divided by birth-year periods (10-year interval), gender, and income status (low, medium, high) were analyzed using both the Walter and Elwood seasonality and chi-squared tests.

RESULTS

The winter/spring birth excess in schizophrenia was 5.3% when compared with the general population. There was a statistically significant excess in winter/spring births than summer/autumn births inschizophrenia patients (relative risk [RR], 1.12; 95% confidence interval [CI]: 1.06-1.18). This winter/spring birth excess in schizophrenia was observed only in female subjects (RR, 1.20; 95%CI: 1.10-1.30), not in male subjects (RR, 1.03; 95%CI: 0.98-1.14), in all subgroups of income status, but was most pronounced in the low income subgroup (RR, 1.20, 1.09, 1.13; 95% CI: 1.05-1.37, 1.01-1.17, 1.02-1.25 for low, medium, and high income status, respectively).

CONCLUSION

A gender difference with female predominance of the effect of birth seasonality in schizophrenia, and a more pronounced effect in low income status were noted.

A positive relationship between ambient temperature and bipolar disorder identified using a national cohort of psychiatric inpatients

OBJECTIVE

This study characterizes the positive relationship between daily temperature and bipolar disorder in a cohort of Taiwanese psychiatric inpatients.

METHODS

Meteorological data, provided by the Central Weather Bureau (CWB) of Taiwan, were interpolated to create representative estimates of mean diurnal temperatures for 352 townships. Psychiatric inpatient admissions enrolled in the national health-care insurance system were retrieved from the 1996-2007 Psychiatric Inpatient Medical Claim (PIMC) dataset. The generalized linear mixed models with Poisson distribution were used to evaluate the relative risks of mean diurnal temperature with respect to increased admissions for bipolar disorder, while adjusting for internal correlations and demographic covariates.

RESULTS

Increased relative risks of bipolar disorder admissions were associated with the increasing trends of temperature over 24.0 °C (50th ‰), especially for adults and females. The highest daily diurnal temperatures above 30.7 °C (99th ‰) had the greatest risks of bipolar hospitalizations.

CONCLUSION

Understanding the increase of bipolar disorder admissions occurring in extreme heat is important in the preparation and prevention of massive recurrences of bipolar episodes.

Low prevalence of major depressive disorder in Taiwanese adults: possible explanations and implications

BACKGROUND

This study examined the prevalence of major depressive disorder (MDD), and the correlations and co-morbid conditions associated with MDD, in the adult Taiwanese population, which a previous estimate in the 1980s had found to be at the lower end of the spectrum worldwide. Possible explanations for the reported low prevalence of MDD were evaluated.

METHOD

As part of a survey of common psychiatric disorders in a nationally representative sample of individuals aged ≥ 18 years who were non-institutionalized civilians in Taiwan, a face-to-face interview using the paper version of the World Mental Health Survey of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI) was conducted between 2003 and 2005. Functional impairment and help-seeking behaviors were compared between Taiwanese subjects with MDD and their counterparts in the USA.

RESULTS

Among the 10 135 respondents, the lifetime prevalence of MDD was 1.20% [standard error (S.E.)=0.2%]. Individuals who were divorced or widowed, aged ≤ 40 years, and female were at increased risk, whereas rural residents were at lower risk for MDD. The proportion of MDD cases co-morbid with other psychiatric disorders in this study was much lower than in the US study. Only one-third of Taiwanese individuals with MDD sought help despite having twice the number of lost workdays compared with the US sample.

CONCLUSIONS

Despite the low prevalence of MDD in Taiwanese adults, the pattern of low help-seeking behavior and profound functional impairment indicates much room for improvement in the early detection of and intervention in major depression in this population.

Relationship of cognitions and symptoms of agoraphobia in Hong Kong Chinese: a combined quantitative and qualitative study

OBJECTIVES

The aim of this study was to explore and describe the subjective experiences of agoraphobia in Hong Kong Chinese.

METHOD

This was a cross-sectional descriptive study, using a combined qualitative-quantitative approach. In the qualitative part, two focus groups were held with nine participants suffering from DSM-IV panic disorder with agoraphobia, followed up in a regional hospital in Hong Kong. The audiotaped

MATERIAL

was transcribed and analysed into four main categories and 13 subcategories based on a grounded theory approach. One subcategory ('Fear of making others worried and being a burden to others') was identified as a novel, culture-specific concept in agoraphobia that was not reported in Western literature. In the quantitative part, this subcategory was redefined and measured by a two-item, self-rated questionnaire survey in another 35 participants suffering from DSM-IV defined panic disorder with agoraphobia.

RESULTS

Qualitative data showed that the clinical manifestations of agoraphobia were specifically related to the underlying corresponding catastrophic cognitions. An individual's agoraphobic cognitions and symptoms were highly related to the identity of the surrounding people during panic attacks in agoraphobic situations, which reflected the characteristic structure of the Chinese interpersonal network. Participants preferred reliance on self to cope with the anxiety first, then turned to their family members for help due to higher interpersonal trust. Participants also expressed fear of affecting others due to their illness. A new sub-theme of agoraphobia ('Fear of making others worried and being a burden to others') was extracted from the qualitative data. Its validity was confirmed by the quantitative description of this new theme using a self-rated questionnaire as a methodological triangulation.

CONCLUSIONS

The central theme to emerge from the qualitative data was that agoraphobia is a clinical condition that has a close relationship to Chinese cultural factors. 'Fear of making others worried and being a burden to others' is a new concept in agoraphobia worthy of further study.

Alcohol use disorders, nicotine dependence, and co-occurring mood and anxiety disorders in the United States and South Korea-a cross-national comparison

BACKGROUND

The strong comorbidity between substance use disorders (SUDs) and mood and anxiety disorders has been well documented. In view of lack of research findings addressing the co-occurrence of SUDs and mood and anxiety disorders, this study examined the pattern of comorbidity of alcohol use disorders (AUDs) and nicotine dependence (ND) between 2 culturally diverse countries, the United States and South Korea.

METHODS

Using the nationally representative samples of the U.S. and Korean general populations, we directly compared rates and comorbidity patterns of AUDs, ND, and mood and anxiety disorders between the 2 countries. We further examined the rates and the comorbidity pattern among individuals with AUDs who sought treatment in the last 12 months. Twelve-month prevalence rates were derived to estimate country differentials, and odds ratios (ORs) and 95% confidence intervals were estimated to measure the strength of comorbid associations while adjusting for all sociodemographic characteristics in multivariate logistic models specific to each country.

RESULTS

The 12-month prevalence rates of AUDs, ND, and any mood disorder and any anxiety disorder were 9.7, 14.4, 9.5, and 11.9% among Americans, whereas the corresponding rates were 7.1, 6.6, 2.0, and 5.2% among Koreans. These rates were significantly greater (except for any AUD) among Americans than among their Korean counterparts. With respect to comorbidity, both countries showed comparable patterns that the prevalence rates of mood and anxiety disorders were consistently the highest among persons with alcohol dependence (AD). Also, a disparate pattern was observed in Korea that the prevalence rates of mood and anxiety disorders were generally lower among individuals with ND than among those with alcohol abuse and AD. Furthermore, despite significantly greater prevalence of AD in Korea (5.1%) than in the United States (4.4%), alcohol-dependent Americans were 4 times (OR = 3.93) more likely to seek treatment compared to their Korean counterparts.

CONCLUSIONS

Our results indicated that the prevalence of AD in Korea was substantially greater than that in both Western and other Asian countries, suggesting a maladaptive pattern of alcohol use in Korea, which is different from the general use pattern of other East Asian countries. The low rate of treatment utilization among Koreans might be attributable to perceived social stigma toward SUDs or mental health problems despite the fact that the Korean government offers national health insurance.

Prevalence and incidence of mental illness in diabetes: a national population-based cohort study

BACKGROUND

This study aimed to investigate the prevalence and incidence of mental illness among diabetic patients in Taiwan.

METHODS

Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of mental illness, and at least two claims for ambulatory care or one claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004.

RESULTS

The one-year prevalence of mental illness among diabetic patients was 20.6% in 2000, and the cumulative prevalence increased to 42.2% in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age ≥45 and low income, and a lower prevalence with male gender and residing in rural areas. Cox regression analysis revealed that a higher incidence was associated with female gender, age ≥45, and low income.

CONCLUSIONS

The prevalence and annual incidence density of mental illness in diabetic patients were significantly higher than in the general population. Females had higher prevalence and incidence density of mental illness among diabetic patients. Mental illness in diabetic patients was more prevalent in elderly females of low income, and less in rural areas.

The serotonin transporter polymorphism (5-HTTLPR): allelic variation and links with depressive symptoms

BACKGROUND

We compare the genotype distribution for the serotonin transporter polymorphism (5-HTTLPR) in a sample of older Taiwanese adults with samples of various racial and ethnic groups collected in other studies. We also explore interactions among sex, stressors, and 5-HTTLPR genotype on depressive symptoms in our sample.

METHODS

Using a nationally representative sample of 984 Taiwanese aged 53 and older, we model depressive symptoms as a function of 5-HTTLPR genotype and two classes of stressors: lifetime trauma and recent major life events. We test two- and three-way interactions among stressors, 5-HTTLPR, and sex.

RESULTS

This sample exhibits higher frequency of S/S and lower frequency of L/L genotype than Western samples, but the distribution is comparable to those in East Asian populations. Nearly 9% carry an allele (XL) that has rarely been reported in the literature. Although the gene-environment (GxE) interaction with recent major life events is not significant, our results suggest that trauma has a worse effect on depressive symptoms for those with S/S or S/L genotype than for those who do not carry the S allele (P<0.05). We find no evidence that this GxE interaction varies by sex.

CONCLUSIONS

Previous studies of this GxE interaction have been inconclusive, perhaps because interactions between genotype and stressful events are more prominent under extreme stressors. Our findings underscore the need to move beyond a bi-allelic parameterization of the 5-HTTLPR polymorphism and raise questions about why East Asian populations exhibit low rates of depression despite a high frequency of the S allele.

Meta-analysis of the BDNF Val66Met polymorphism in major depressive disorder: effects of gender and ethnicity

Brain-derived neurotrophic factor (BDNF) is a nerve growth factor that has antidepressant-like effects in animals and may be implicated in the etiology of mood-related phenotypes. However, genetic association studies of the BDNF Val66Met polymorphism (single nucleotide polymorphism rs6265) in major depressive disorder (MDD) have produced inconsistent results. We conducted a meta-analysis of studies comparing the frequency of the BDNF Val66Met-coding variant in depressed cases (MDD) and nondepressed controls. A total of 14 studies involving 2812 cases with DSM-III or -IV defined MDD and 10 843 nondepressed controls met the inclusion criteria. Analyses were stratified either by gender or ethnicity (Asian and Caucasian) because MDD is more prevalent in women and in Caucasians and because BDNF allele frequencies differ by ethnicity. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were provided for allelic analyses (Met versus Val), as well as for genotypic analyses (Met/Met and Val/Met versus Val/Val). In the total sample, the BDNF Val66Met polymorphism was not significantly associated with depression. However, the gender stratified analyses revealed significant effects in both the allelic and genotypic analyses in men (OR(MET), 95% CI; 1.27 (1.10-1.47); OR(MET/MET), 95% CI; 1.67 (1.19-2.36)). Stratification according to ethnicity did not show significant effects of the Val66Met polymorphism on MDD. Our results suggest that the BDNF Val66Met polymorphism is of greater importance in the development of MDD in men than in women. Future research into gender issues will be of interest.

The treated prevalence and incidence of bipolar disorder among national health insurance enrollees in Taiwan, 1996-2003

We used the NHI database to estimate the treated prevalence and incidence of bipolar disorder. The national health research institute (NHRI) provided a population based data file of 200,432 random subjects, about 1% of the population, for the study. We obtain a random sample of 136,045 subjects as a fixed cohort from 1996 to 2003. We identified study subjects who had at least one service claim during these years for either ambulatory or inpatient care with a principal diagnosis of bipolar disorder. The cumulative treated prevalence increased from 0.60 per 1,000 to 4.51 per 1,000 from 1996 to 2003. The annual treated incidence was around 0.48 per 1,000 per year to 0.71 per 1,000 per year during 1997-2003. Higher treated incidence was detected in the 45-64 (hazard ratio [HR], 1.63; 95% CI, 1.26-2.12) and 65 years or older age groups (HR, 1.57; 95% CI, 1.14-2.15), female (HR, 1.23; 95% CI, 1.04-1.46), non-aborigine (HR, 3.12; 95% CI, 1.26-7.75), with a fixed premium (HR, 1.60; 95% CI, 1.18-2.17), and those who lived in the eastern region (HR, 3.26; 95% CI, 2.31-4.59). According to the trends from 1996 to 2003, more persons with bipolar disorder had sought treatment in the NHI program in Taiwan. However, the treated prevalence of bipolar disorder in NHI was still lower than those of community studies in Western countries. In the future, we will continue to use NHI data to perform outcome evaluation and follow-up studies of bipolar disorder.

Treated prevalence and incidence of dementia among National Health Insurance enrollees in Taiwan, 1996-2003

The National Health Insurance database to determine the treated prevalence and incidence of dementia in Taiwan was used in this study. A population-based random sample of 22 118 subjects aged 65 or older was obtained as a dynamic cohort. Those study subjects who had filed at least one service claim from 1996 to 2003 for either outpatient care or inpatient care with a principal diagnosis of dementia were identified. The annual treated prevalence increased from 0.71% to 1.92% from 1996 to 2003. The annual treated incidence rates were around 0.76% to 1.04% per year from 1997 to 2003. The annual treated incidence rates for the 5-year age groups, from 65 to 90 years and older, were 0.44%, 0.65%, 0.98%, 1.46%, 1.81%, and 1.80%, respectively. Both the treated prevalence and incidence rates of dementia in National Health Insurance were lower than those of community studies.

Prevalence of heroin and methamphetamine male users in the northern Taiwan, 1999-2002: capture-recapture estimates

Background

Illegal drug use and related problems have been emerging as an important public health issue in Taiwan. Via the capture-recapture approach, the present study aimed to offer insights into the size of heroin and methamphetamine male user population in the northern Taiwan during the period from 1999 to 2002.

Methods

Annual lists of male subjects were collated from both judiciary and medical systems in Taoyuan County, Taiwan. A total of 2809, 2486, 1661, and 1440 local male illegal drug users aged 15 to 54 years were identified in Taoyuan County from 1999 to 2002, respectively.

Results

An estimated number of 16192, 14532, 16844, and 11783 local male methamphetamine or heroin users were found in each of the four consecutive years in the region. From 1999 to 2002, the annual prevalence rate for heroin use was 0.27% (95% CI = 0.20%, 0.38%), 0.33% (95% CI = 0.25%, 0.44%), 0.63% (95% CI = 0.44%, 0.92%), and 0.72% (95% CI = 0.54%, 0.97%), respectively, suggesting a trend of significant increase (chi-square for linear trend = 1677.76, d.f. = 3, p < 0.0001). In contrast, a decreasing trend was found for methamphetamine (2.38%, 1.91%, 2.47%, and 1.24%), with a modest rebound in 2001. The prevalence rates of illegal drug use for male residents in Taoyuan County were approximately 2–3% during this period, and the scale of problem shows no sign of diminution.

Conclusion

By taking advantage of existing datasets that were incomplete by each alone, the approach of capture-recapture model may be ultimately considered as a tool to estimate the scale of illegal drug use problems. The population of heroin-using males apparently is stably expanding in the northern part of Taiwan in the first years of 21^st century.

The prevalence and incidence of treated major depressive disorder among National Health Insurance enrollees in Taiwan, 1996 to 2003

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 $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.

Anxiety, depression and quality of life in colorectal cancer patients

BACKGROUND

Few studies have examined psychological distress and its relationship with quality of life (QL) dimensions in colorectal cancer patients.

METHODS

One hundred and twenty-eight outpatients were given psychological tests for anxiety and depression (Hospital Anxiety and Depression Scale; HADS) and QL The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ-C30) on the same occasion. The association between the patients' emotional function (EF) scoring on EORTC QLQ-C30 and their HADS scores was analyzed by multiple linear regression.

RESULTS

Statistically significant negative relationships were found between EF and HADS-A (anxiety), HADS-D (depression), and HADS-T (total score), respectively, with the highest correlation coefficient being for HADS-A. However, HADS-D was significantly more highly correlated than HADS-A to other QL dimensions, and depression was more highly correlated than anxiety with reduced QL.

CONCLUSION

The EF dimension of the EORTC QLQ-C30 predominantly assesses anxiety. Depression has a stronger impact on the global QL of patients than anxiety; therefore, the use of an additional instrument is recommended for the assessment of depression in outpatients with colorectal cancer.

An epidemiological survey of psychiatric disorders in Iran

BACKGROUND

The nation-wide epidemiological survey of psychiatric disorders in term of lifetime prevalence is not adequately known in Iran. The prevalence of lifetime psychiatric disorders was estimated among the population of aged 18 and over on gender, age group, educational level, occupational status, marital status, and residential area.

METHODS

The subjects were 25,180 individuals selected through a clustered random sampling method. The psychiatric disorders were diagnosed on the bases of Diagnostic and Statistical Manual of Mental Disorders-IV criteria. It is the first study in which the structured psychiatric interview administered to a representative sample of the Iranian population age 18 and over by the 250 trained clinical psychologist interviewers. The data was entered through EPI-Info software twice in an attempt to prevent any errors and SPSS-11 statistical software was also used for analyses. The odds ratios and their confidence intervals estimated by using logistic regression.

RESULTS AND DISCUSSION

The prevalence of psychiatric disorders was 10.81%. It was more common among females than males (14.34% vs. 7.34%, P < 0.001). The prevalence of anxiety and mood disorders were 8.35% and 4.29% respectively. The prevalence of psychotic disorders was 0.89%; neuro-cognitive disorders, 2.78% and dissociative disorders, 0.77%. Among mood disorders, major depressive disorder (2.98%) and among anxiety disorders, phobic disorder (2.05%) had the higher prevalence. The prevalence of psychiatric disorders among divorced and separated 22.31%; residents of urban areas 11.77%; illiterates 13.80%; householders 15.48%; unemployed 12.33% that were more than other groups.

CONCLUSION

The mental health pattern in Iran is similar to the western countries, but it seems that the prevalence of psychiatric disorders in Iran may be lower than these countries. It is estimated that at least about 7 millions of Iranian population suffer from one or more of the psychiatric disorders. It shows the importance of the role of the psychiatric disorders in providing preventive and management programs in Iran.

Mental disorders, disability and health service use amongst Vietnamese refugees and the host Australian population

OBJECTIVE

To compare the prevalence of common mental disorders, disability and health service utilization amongst Vietnamese refugees resettled in Australia for 11 years, with data obtained from a national survey of the host population.

METHOD

A stratified multistage probability household survey of 1611 Vietnamese undertaken in the state of New South Wales was compared with data from 7961 Australian-born respondents. Measures included the CIDI 2.1 and the MOS SF-12.

RESULTS

The 12-month prevalence of anxiety, depression and drug and alcohol dependence amongst Vietnamese was 6.1% compared with 16.7% amongst Australians. Vietnamese with a mental illness reported higher disability but exhibited similar levels of mental health consultation. The overall service burden of mental disorders was lower for the Vietnamese.

CONCLUSION

The findings suggest that refugee groups resettled for some time in Western countries may show sound mental health adaptation and do not necessarily impose a burden on general or mental health services.

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

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$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$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.

Mental health in prison populations. A review--with special emphasis on a study of Danish prisoners on remand

OBJECTIVE

To review the literature on mental health and psychiatric morbidity in prison populations and relate findings to a Danish study on remand prisoners.

METHOD

The literature is reviewed and subdivided in the following section: validity of psychometrics in prison populations, prevalence of psychiatric disorders prior to imprisonment, incidence of psychiatric disorders during imprisonment, psychopathy related to psychiatric comorbidity, dependence syndromes with special emphasis on different administrations of heroin use (smoke vs. injection). The results are compared with a longitudinal Danish study on remand prisoners in either solitary confinement (SC) or non-SC.

RESULTS

Many factors must be taken into consideration when dealing with prisoners and mental health, e.g. international differences, the prison setting, demographics and methodological issues. The prison populations in general are increasing worldwide. Psychometrics may perform differently in prison populations compared with general populations with the General Health Questionnaire-28 having a low validity in remand prisoners. Psychiatric morbidity including schizophrenia is higher and perhaps increasing in prison populations compared with general populations with dependence syndromes being the most frequent disorders. The early phase of imprisonment is a vulnerable period with a moderately high incidence of adjustment disorders and twice the incidence in SC compared with non-SC. Prevalence of psychopathy is lower in European than North American prisons. Medium to high scores of psychopathy is related to higher psychiatric comorbidity. Opioid dependence is the most frequent drug disorder with subjects using injection representing a more dysfunctional group than subjects using smoke administration. Many mentally ill prisoners remain undetected and undertreated.

CONCLUSION

There is a growing population of mentally ill prisoners being insufficiently detected and treated.

ALDH2 Status and Conduct Disorder Mediate the Relationship Between Ethnicity and Alcohol Dependence in Chinese, Korean, and White American College Students

This study examined aldehyde dehydrogense (ALDH2) gene status, alcohol dehydrogense (ADH2) gene status, conduct disorder, and alcohol dependence in Chinese, Korean, and White American college students. Chinese had a lower rate of alcohol dependence (5%) than Koreans (13%) and Whites (17%). Koreans had a higher rate of conduct disorder (15%) than Whites (9%) and Chinese (6%). The relationship of ethnicity to alcohol dependence was mediated by ALDH2 status and conduct disorder, although Chinese ethnicity remained significant. ADH2 status was not related to alcohol dependence with ALDH2 included, and no interactions were significant. Results suggest that different rates of risk (e.g., conduct disorder) and protective (e.g., ALDH2 status) factors partially account for ethnic differences in rates of alcohol dependence.

International differences in major depression prevalence: what do they mean?

The international literature concerned with major depression prevalence has been growing rapidly, providing a wealth of new information about prevalence in different countries. In understanding and using these rates, analytically oriented epidemiologists, decision makers, and administrators, however, need to be aware of a set of interpretive difficulties. Experience suggests that international major depression prevalence comparisons should be treated with caution. The portability of major depression diagnostic criteria across countries requires further confirmation, and existing diagnostic interviews have technical vulnerabilities that may render international comparisons vulnerable to measurement bias.

Depression and psychological distress in patients during the year after curative resection of non-small-cell lung cancer

PURPOSE

There have been few psychosocial studies of patients after curative resection of non-small-cell lung cancer (NSCLC). The purpose of this study was to clarify the clinical course of depression and psychological distress of such patients during the year after surgery and to identify predictors of their long-term outcome.

PATIENTS AND METHODS

A total of 212 patients completed assessments during a 12-month follow-up period after curative resection of NSCLC. Psychological measurements at 1, 3, and 12 months after surgery were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (ed 3), Revised, and the Profiles of Mood States (POMS) scale. Univariate and multivariate analyses were used to identify predictors of psychological outcome according to these two methods of assessment.

RESULTS

The prevalence of depression did not change during the year after curative resection (range, 4.7% to 8.0%). The total POMS score was also unaltered during the year after surgery: the anger-hostility (P <.001) and tension-anxiety subscale scores (P <.026) had increased at 12 months, but the vigor-activity subscale score had also increased (P <.001). All predictors of psychological outcome at 12 months included a depression episode after the diagnosis of lung cancer or at 1 month after surgery. Less-educated status was also a significant predictor of depression at 12 months.

CONCLUSION

These results suggest the need for psychosocial support even after curative resection of NSCLC and indicate that an approach that includes repetitive perioperative assessment of depression and careful attention to less-educated patients might be of benefit to patients in ameliorating depression and psychological distress during the year after curative resection.

Comorbid depressive symptomatology: isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults

Advances in medical technology and surgical knowledge have greatly extended the life expectancy of older individuals with chronic disabilities. Among the older adult population the prevalence of comorbid chronic illness and depressive symptoms has often been investigated. Yet there continues to be a lack of understanding about the consequences of specific chronic illnesses on depressive symptoms. Using cross-sectional data while simultaneously controlling the effects of various socioenvironmental, demographic, and other factors, this study analyzed the prevalence of self-reported depressive symptoms in relation to chronic illness. The cumulative effect of medical comorbidity and the specific effect of individual chronic illnesses were examined. The sample consisted of 359 older white Americans aged 55-93. Overall, the findings show that self-reports of depressive symptoms were greater among those individuals who also reported digestive disorders, respiratory ailments, and heart problems. These results suggest that for older white Americans these three chronic conditions may present a greater mental health burden than other chronic illnesses.

Cross-cultural implementation of a Chinese version of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in Taiwan

BACKGROUND

There are no published reports of cross-cultural equivalence and interrater reliability at the level of individual symptom items assessed by a semi-structured clinical interview employing operationalised clinician ratings.

AIMS

To assess the cross-cultural clinical equivalence and reliability of a Chinese version of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry (SCAN).

METHOD

UK-US and Taiwanese groups of psychiatrists used Chinese and English transcripts of videotape interviews of Taiwanese patients to discuss cross-cultural issues and ratings of SCAN items. Item ratings were compared quantitatively individually and pooled by SCAN section.

RESULTS

Chinese equivalents were found for all SCAN items. No between-group differences were found for most individual items, but there were differences for some scaled items. Average agreement between the two groups was 69-100%.

CONCLUSIONS

Cross-cultural implementation based on SCAN in Taiwan appears valid.

Clinical relevance of contemporary cultural psychiatry

In recent years, the field of cultural psychiatry has gained recognition and accumulated evidence of its clinical relevance. This article examines the intersections of culture and psychopathology and describes five independent but interrelated clinical dimensions that identify and define culture as: a) an interpretive/explanatory tool, b) a pathogenic/pathoplastic agent, c) a diagnostic/nosological factor, d) a therapeutic/protective element, and e) a service/management instrument. Along these lines, conceptual boundaries, clinical findings, specific applications, and research implications for each of the five dimensions are systematically reviewed. Cultural psychiatry adds significantly to the comprehensiveness of psychiatric evaluation and management and addresses prominent issues regarding understanding, classification, diagnosis, and competent treatment of most psychiatric disorders in every society and region of the world. Based on the strength of these clinical dimensions, and on the related educational and research efforts, cultural psychiatry can also contribute decisively to the design of comprehensive mental health policies.

One-year prevalence of long-term functional psychosis in three different areas of Uppsala

The 1-year prevalence of long term functional psychoses (LFP) in Uppsala was found to be 0.73%, with a clear gradient from the central city area (0.87%) to the rural area (0.60%). The highest prevalence was found in the 35-54 years age group (1.01%), and the lowest prevalence in the 18-34 years age group (0.45%). There were no pronounced sex differences. The majority of the LFP patients were diagnosed as having schizophrenia. The 1-year prevalence of schizophrenia was 0.42%, with a clear gradient from the central city area to the rural area (0.53%, 0.44% and 0.30%, respectively). The same gradient was not observed with regard to the other diagnostic subgroups relating to LFP.

Major depressive disorder in Taiwan defined by the Chinese diagnostic Interview Schedule

The lifetime prevalence rate of major depressive disorder (MDD), as defined by the Chinese Diagnostic Interview Schedule, is 1.14% in Taiwan. This is significantly lower than the lifetime prevalence rates reported in Western studies and similar to other studies in the Chinese population using similar methods for assessing cases of MDD. Epidemiological data from 136 MDD cases were analyzed to provide possible explanations for this difference in lifetime prevalence rates. The low rate of broken families in Chinese culture, low comorbidity rate, and older age of onset of MDD may suggest a reality of low lifetime prevalence rates of MDD in Taiwan.

Antisocial personality disorder: a biopsychosocial model

OBJECTIVE

To propose an etiological model of antisocial personality disorder that is grounded in empirical data.

METHOD

Recent research findings are reviewed that clarify our understanding of the etiology and course of antisocial pathology.

RESULTS

Neither biological nor psychological factors fully account for the development of this disorder. Epidemiological studies show that there are strong cross-cultural differences in its prevalence, pointing to the importance of social factors in its etiology. Outcome research shows that antisocial personality only partially remits with time, and that most patients continue to be dysfunctional in later life. No treatment modality has been shown to be effective.

CONCLUSIONS

All these empirical findings can be accounted for by a biopsychosocial model of antisocial personality disorder.

Anthropology and psychiatric epidemiology

Psychiatric epidemiologic research has been criticized by anthropologists for ignoring cultural variation in the definitions of psychiatric disorders. While recognizing the importance of this issue, it is suggested here that a considerable amount of ethnographic evidence indicates that many types of comparative effort can be carried out without cultural injustice. It is also urged that anthropologists provide a system for classifying cultures so as to foster an understanding of the ways in which shared beliefs and meanings can influence psychiatric illness. Categorizing populations as Western versus Non-Western or Developed versus Developing is inadequate as a basis for studying the cultural context of psychiatric illness in different parts of the world.

Culture and schizophrenia: the DOSMD challenge

The World Health Organization's International Pilot Study on Schizophrenia (IPSS) and subsequent Determinants of Outcomes of Severe Mental Disorder (DOSMD) studies have reported that the course of schizophrenia is more favourable in 'developing' than 'developed' societies. The 1992 DOSMD study attributes this difference to culture. We review studies concerning the course of schizophrenia and conclude that the evidence for a more favourable course in developing societies is not conclusive. Indeed, a favourable course has also been reported in various industrialised societies. We also raise questions about the findings reported in the recent DOSMD study, including the conclusion that the putatively more favourable course is a product of culture. Finally, we argue that longitudinal, direct observation of patients in their natural environments must be carried out before variations in the course of schizophrenia can be adequately understood.