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Peng F, Chung CH, Koh WY, Chien WC, Lin CE. Risks of mental disorders among inpatients with burn injury: A nationwide cohort study. Burns 2024; 50:1315-1329. [PMID: 38519375 DOI: 10.1016/j.burns.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This investigation identified the association between burn injuries and the risk of mental disorders in patients with no documented pre-existing psychiatric comorbidities. We also examined the relationship of injury severity and the types of injury with the likelihood of receiving new diagnoses of mental disorders. METHODS This population-based retrospective cohort study used administrative data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) between 2000 and 2013. In total, 10,045 burn survivors were matched with a reference cohort of 40,180 patients without burn injuries and were followed to determine if any mental disorder was diagnosed. Patients diagnosed with mental disorders in the five years before study initiation were excluded to ensure incident diagnoses throughout the research duration. Generalized estimating equations in Cox proportional hazard regression models were used for data analysis. RESULTS In general, burn injury survivors have a 1.21-fold risk of being diagnosed with new mental disorders relative to patients without burn injuries. Total body surface area (TBSA) of ≧ 30% (aHR: 1.49, 95% CI: 1.36-1.63) and third- or fourth-degree burns (aHR: 1.49, 95% CI: 1.37-1.63) had a significantly greater risk of being diagnosed with mental disorders in comparison to the reference cohort. Patients TBSA 10-29% (aHR: 0.85, 95% CI: 0.77-0.93) and first- or second-degree burn victims (aHR: 0.89, 95% CI: 0.81-0.97) had relatively lower risk of mental disorders than the reference cohort. CONCLUSION Burn injuries were associated with an increased risk of mental disorders. Additional research in this field could elucidate this observation, especially if the inherent limitations of the NHIRD can be overcome.
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Affiliation(s)
- Fan Peng
- Department of Psychiatry, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC; School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wan-Ying Koh
- School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of General Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Life Science, National Defense Medical Center, Taiwan, ROC.
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
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Li ST, Chien WC, Chung CH, Tzeng NS. Increased risk of acute stress disorder and post-traumatic stress disorder in children and adolescents with autism spectrum disorder: a nation-wide cohort study in Taiwan. Front Psychiatry 2024; 15:1329836. [PMID: 38356908 PMCID: PMC10864464 DOI: 10.3389/fpsyt.2024.1329836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Children and adolescents with autism spectrum disorder (ASD) may be particularly vulnerable to the impact of traumatic events, yet the association between ASD and the risk of developing acute stress disorder and post-traumatic stress disorder (PTSD) remains uncertain. This study aims to investigate this association, addressing the gap in large-scale evidence on the subject. Methods Conducted as a retrospective and matched cohort study, data was sourced from the National Health Insurance Research Database (NHIRD) in Taiwan, spanning from January 1, 2000, to December 31, 2015. The study included patients aged 18 years or under newly diagnosed with ASD (n=15,200) and compared them with a matched control group (n=45,600). The Cox proportional regression model was employed to assess the risk of acute stress disorder and PTSD. Results Over the 15-year follow-up period, a total of 132 participants developed either acute stress disorder or PTSD. Among them, 105 cases (0.691% or 64.90 per 100,000 person-years) were in the ASD group, while 27 cases (0.059% or 5.38 per 100,000 person-years) were in the control group. The adjusted hazard ratio for the ASD group was significantly higher compared to the control group (25.661 with 95% CI = 15.913-41.232; P < .001). Discussion This study provides compelling evidence that individuals with ASD face an elevated risk of developing acute stress disorder and PTSD. The findings underscore the importance of clinicians recognizing and addressing this vulnerability in ASD individuals exposed to traumatic events. This emphasizes the need for heightened attention to the risk of PTSD and acute stress disorder in the ASD population.
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Affiliation(s)
- Sung-Tao Li
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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Chou PH, Wang SC, Wu CS, Ito M. Trauma-related guilt as a mediator between post-traumatic stress disorder and suicidal ideation. Front Psychiatry 2023; 14:1131733. [PMID: 37056401 PMCID: PMC10086326 DOI: 10.3389/fpsyt.2023.1131733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/13/2023] [Indexed: 04/15/2023] Open
Abstract
Background As a mental health issue, suicide is a growing global concern, with patients who have post-traumatic stress disorder (PTSD) being at particularly high risk. This study aimed to investigate whether the link between PTSD and suicidal ideation is mediated by trauma-related guilt. Methods Data were obtained from Wave 1, Time 1 (November 2016), and Time 2 (March 2017) of the National Survey for Stress and Health (NSSH) in Japan. The NSSH is an online longitudinal survey conducted on Japan's national population aged 18 years and older. The cumulative response rate of the survey was 66.7% at Time 2. A total of 1,005 patients with PTSD were included for analyses. The severity of PTSD symptoms was assessed with PTSD DSM-5 Checklist, and the trauma-related guilt were assessed using the two subscales (hindsight-bias/responsibility and global guilt scale) of the trauma-related guilt inventory (TRGI). Suicidal ideation was evaluated using the suicidal ideation attributes scale (SIDAS). Pearson's correlation was used to investigate the associations among PTSD symptoms, TRGI scores, and SIDAS scores. Causal mediation analysis was applied to evaluate the causal relationship between PTSD, trauma-related guilt, and suicidal ideation. Results Pearson's correlation did not show patients' age, gender, and household income significantly associated with SIDAS scores. On the other hand, severities of PTSD symptoms (r = 0.361, p < 0.001) and trauma-related guilt (r = 0.235, p < 0.001) were positively associated with SIDAS scores. After adjusting for age, gender, and household income, the mediation analysis revealed that trauma-related guilt significantly mediates the effects of PTSD symptoms on suicidal ideation. Conclusion Our results implied that trauma-related guilt may represent a critical link between PTSD and suicidal ideation, which may be a noteworthy target for therapeutic intervention.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan
- *Correspondence: Po-Han Chou, ;
| | - Shao-Cheng Wang
- Department of Psychiatry, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Chi-Shin Wu,
| | - Masaya Ito
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Hsinchu, Miaoli, Taiwan
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Peng F, Koh WY, Chung CH, Chien WC, Lin CE. Risks of mental disorders among intensive care unit survivors: A nationwide cohort study in Taiwan. Gen Hosp Psychiatry 2022; 77:147-154. [PMID: 35660739 DOI: 10.1016/j.genhosppsych.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk of mental disorders among the intensive care unit (ICU) survivors compared with the hospitalized non-ICU and non-hospitalized patients. METHOD We extracted data from the Taiwanese National Health Insurance Research Database (NHIRD) to conduct a retrospective cohort study. Multivariate Cox proportional hazard regression models were used to analyze the data. Identified from the NHIRD, we matched 15,918 patients with ICU admissions, 63,672 patients without any inpatient admission (non-inpatient department [non-IPD] cohort), and 63,672 patients admitted to a general ward but not the ICU (non-ICU cohort). The patient records were extracted between the periods of 2000-2015 to identify any occurrence of mental disorders. RESULTS During the study period, the overall risk of mental disorder diagnosis was 1.68-fold higher in the ICU cohort than the non-IPD cohort (95% confidence interval (CI): 1.23-1.89, P < 0.001). Alternatively, there were no differences in risks for any mental disorders between the ICU and non-ICU cohorts. CONCLUSION Both admissions to the ICU and the general ward cohorts were associated with a higher risk of any mental disorders compared to the general population. Further clinical studies are warranted to confirm this association due to residual or unmeasured risk factors.
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Affiliation(s)
- Fan Peng
- Department of General Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Wan-Ying Koh
- School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Centre, Taipei, Taiwan, ROC.
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Centre, Taipei, Taiwan, ROC; Graduate Institute of Life Science, National Defense Medical center, Taiwan, ROC.
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
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Wang SC, Chien WC, Chung CH, Tzeng NS, Liu YP. Posttraumatic stress disorder and the risk of erectile dysfunction: a nationwide cohort study in Taiwan : PTSD and erectile dysfunction. Ann Gen Psychiatry 2021; 20:48. [PMID: 34583712 PMCID: PMC8480081 DOI: 10.1186/s12991-021-00368-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the association between posttraumatic stress disorder and the risk of developing erectile dysfunction. METHODS In this population-based retrospective cohort study, we used Taiwan's National Health Insurance Research Database to analyze patients who were newly diagnosed with posttraumatic stress disorder (PTSD) between 2000 and 2013, with a 1:3 ratio by age and index year matched with patients in a non-PTSD comparison group, for the risk of erectile dysfunction. RESULTS In total, 5 out of 1079 patients in the PTSD group developed erectile dysfunction, and 3 out of 3237 patients in the non-PTSD group (47.58 vs. 9.03 per 100,000 per person-year) developed erectile dysfunction. The Kaplan-Meier analysis showed that the PTSD cohort had a significantly higher risk of erectile dysfunction (log-rank, p < 0.001). The Cox regression analysis revealed that the study subjects were more likely to develop an injury (hazard ratio: 12.898, 95% confidence intervals = 2.453-67.811, p = 0.003) after adjusting for age, monthly income, urbanization level, geographic region, and comorbidities. Psychotropic medications used by the patients with PTSD were not associated with the risk of erectile dysfunction. CONCLUSIONS Patients who suffered from PTSD had a higher risk of developing erectile dysfunction.
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Affiliation(s)
- Sheng-Chiang Wang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Songshan Branch, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan.,Laboratory of Cognitive Neuroscience, Departments of Physiology and Biophysics, National Defense Medical Center, 161, Minquan East Road, Neihu District, Taipei, 11490, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan. .,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
| | - Yia-Ping Liu
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan. .,Laboratory of Cognitive Neuroscience, Departments of Physiology and Biophysics, National Defense Medical Center, 161, Minquan East Road, Neihu District, Taipei, 11490, Taiwan. .,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan. .,Department of Psychiatry, Chen Hsin General Hospital, Taipei, Taiwan.
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Kim JI, Park H, Min B, Oh S, Lee JH, Kim JH. The mediation effect of depression and alcohol use disorders on the association between post-traumatic stress disorder and obstructive sleep apnea risk in 51,149 Korean firefighters: PTSD and OSA in Korean firefighters. J Affect Disord 2021; 292:189-196. [PMID: 34126310 DOI: 10.1016/j.jad.2021.05.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/19/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is shown to be linked to a higher risk of obstructive sleep apnea (OSA). Firefighters are at high risk for PTSD given the increased exposure to trauma. However, the relationship between PTSD and OSA remains unclear in firefighters. Moreover, alcohol use disorders (AUDs) and depression - also common in firefighters - show a high comorbidity rate with both PTSD and OSA. The purpose of this study was to investigate the association of PTSD, depression, and AUDs with OSA in a national sample of Korean firefighters. METHODS A total of 51,149 Korean firefighters completed self-reported questionnaires, assessing the severity of PTSD, OSA, depression, and alcohol misuse. Multivariable logistic regression and mediation analyses were performed. RESULTS PTSD, depression, and AUDs were significantly associated with OSA. In the mediation analyses, PTSD had both direct and indirect effects mediated by depression and AUDs on OSA. Depression had both direct and indirect effects on OSA, with the latter mediated by AUDs. LIMITATIONS First, high-risk of OSA was measured using the Berlin Questionnaire. Second, other medical comorbidities or mediation use were not considered. Third, self-report questionnaires were used for assessment, which are prone to subjectivity and recollection bias. Finally, the majority of the study population were male and all Korean, limiting generalizability. CONCLUSIONS PTSD had both direct and indirect effects on OSA, mediated by depression and AUDs. In patients with both PTSD and OSA, depression and AUD symptoms should be screened routinely.
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Affiliation(s)
- Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Heyeon Park
- Division of General Studies & Teaching Profession, Dongduk Women's University, 60, Hwarang-ro 13-gil, Seongbuk-gu, Seoul 02748, Republic of Korea
| | - Beomjun Min
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 5 gil, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea
| | - Ji-Hye Lee
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Psychiatry, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
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