Early palliative care: the surprise question and the palliative care screening tool-better together.

OBJECTIVE: The 'surprise question' (SQ) and the palliative care screening tool (PCST) are the common assessment tools in the early identification of patients requiring palliative care. However, the comparison of their prognostic accuracies has not been extensively studied. This study aimed to compare the prognostic accuracy of SQ and PCST in terms of recognising patients nearing end of life (EOL) and those appropriate for palliative care. METHODS: This prospective study used both the SQ and PCST to predict patients' 12-month mortality and identified those appropriate for palliative care. All adult patients admitted to Taipei City Hospital in 2015 were included in this cohort study. The c-statistic value was calculated to indicate the predictive accuracies of the SQ and PCST. RESULTS: Out of 21 109 patients, with a mean age of 62.8 years, 12.4% and 11.1% had a SQ response of 'no' and a PCST score of ≥4, respectively. After controlling for other covariates, an SQ response of 'no' and a PCST score of ≥4 were the independent predictors of 12-month mortality. The c-statistic values of the SQ and PCST at recognising patients in their last year of life were 0.680 and 0.689, respectively. When using a combination of both SQ and PCST in predicting patients' 12-month mortality risk, the predictive value of the c-statistic increased to 0.739 and was significantly higher than either one in isolation (p<0.001). CONCLUSION: A combination of the SQ with PCST has better prognostic accuracy than either one in isolation.

Association of advance care planning with place of death and utilisation of life-sustaining treatments in deceased patients at Taipei City Hospital in Taiwan.

OBJECTIVE: Evidence is mixed regarding the impact of advance care planning (ACP) on place of death. This cohort study investigated the effect of ACP programmes on place of death and utilisation of life-sustaining treatments for patients during end-of-life (EOL) care. METHODS: This prospective cohort study identified deceased patients between 2015 and 2016 at Taipei City Hospital. ACP was determined by patients' medical records and defined as a process to discuss patients' preferences with respect to EOL treatments and place of death. Place of death included hospital or home death. Stepwise logistic regression determined the association of ACP with place of death and utilisation of life-sustaining treatments during EOL care. RESULTS: Of the 3196 deceased patients, the overall mean age was 78.6 years, and 46.5% of the subjects had an ACP communication with healthcare providers before death. During the study follow-up period, 166 individuals died at home, including 98 (6.59%) patients with ACP and 68 (3.98%) patients without ACP. After adjusting for sociodemographic factors and comorbidities, patients with ACP were more likely to die at home during EOL care (adjusted OR (AOR)=1.71, 95% CI 1.24 to 2.35). Moreover, patients with ACP were less likely to receive cardiopulmonary resuscitation (AOR 0.36, 95% CI 0.25 to 0.51) as well as intubation and mechanical ventilation support (AOR 0.54, 95% CI 0.44 to 0.67) during the last 3 months of life. CONCLUSION: Patients with ACP were more likely to die at home and less likely to receive life-sustaining treatments during EOL care.

An Interventional Study for the Early Identification of Patients With Palliative Care Needs and the Promotion of Advance Care Planning and Advance Directives.

CONTEXT: Programs identifying patients needing palliative care and promoting advance care planning (ACP) are rare in Asia. OBJECTIVES: This interventional cohort study aimed to identify hospitalized patients with palliative care needs using a validated palliative care screening tool (PCST), examine the ability of the PCST to predict mortality, and explore effects of a pragmatic ACP program targeted by PCST on the utilization of life-sustaining treatment during the last three months of life. METHODS: In this prospective study, we used PCST to evaluate patients' palliative care needs between 2015 and 2016 and followed patients for three months. ACP with advance directives (ADs) was systematically offered to all patients with PCST score ≥4. RESULTS: Of 47,153 hospitalized patients, 10.4% had PCST score ≥4. During follow-up, 2121 individuals died within three months of palliative care screening: 1225 (25.0%) with PCST score ≥4 and 896 (2.1%) with PCST score <4. After controlling for covariates, PCST score ≥4 was significantly associated with a higher mortality within three months of screening (adjusted odds ratio [AOR] 6.86; 95% CI 6.16-7.63). Moreover, ACP consultation (AOR 0.78; 95% CI 0.66-0.92) and AD completion (AOR 0.49; 95% CI 0.36-0.65) were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life. CONCLUSION: We demonstrated the feasibility of implementing a comprehensive palliative care program to identify patients with palliative care needs and promote ACP and AD in Eastern Asia. ACP consultation and AD completion were associated with reduced utilization of life-sustaining treatments during the last three months of life.

Prevalence of Total Physical Activity, Muscle-Strengthening Activities, and Excessive TV Viewing among Older Adults; and Their Association with Sociodemographic Factors.

The study aimed to describe the prevalence of meeting moderate-to-vigorous-intensity physical activity (MVPA), muscle-strengthening (MS) activities, and television (TV) viewing guidelines, and their association with sociodemographic factors. Data from older adults aged 65 or above were sampled by age and sex to the population aged 65+ years for each area in Taiwan and collected through telephone interviews. The prevalence of meeting MVPA and MS activities, MVPA and MS activities guidelines, and excessive TV viewing were calculated. We also investigated their associations with sociodemographic variables using logistic regression analyses. A total of 1068 older adults (response rate: 32.5%) participated in the present study. 79.4% met the MVPA guidelines (150 min weekly), 25.3% met the MS guidelines (twice a week), 22.4% met both MVPA and MS guidelines, and 53.1% engaged in excessive TV viewing (more than or equal to two hours per day). Overall, in old age, low educational level was associated with lower odds of meeting MVPA and MS activities, and both the MVPA and MS activity guidelines; while living alone and having no full-time job had higher odds of excessive TV viewing. A large number of older adults do not meet the MS recommendations, but are engaged in excessive TV viewing. Our findings may be important for public health interventions to promote MS and avoid excessive TV viewing, especially for at-risk subgroups.

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.

Factors associated with advance directives completion among patients with advance care planning communication in Taipei, Taiwan.

BACKGROUND: Although advance directives (AD) have been implemented for years in western countries, the concept of AD is not promoted extensively in eastern countries. In this study we evaluate a program to systematically conduct advance care planning (ACP) communication for hospitalized patients in Taiwan and identify the factors associated with AD completion. METHODS: In this retrospective evaluation of a clinical ACP program, we identified adult patients with chronic life-limiting illness admitted to Taipei City Hospital between April 2015 and January 2016. Trained healthcare providers held an ACP meeting to discuss patients' preference regarding end-of-life care and AD completion. A multiple logistic regression was performed to determine the factors associated with the AD completion. RESULTS: A total of 2878 patients were determined to be eligible for ACP during the study, among which 1798 (62.5%) completed ACP and data was available for 1411 patients (49.1%). Of the 1411 patients who received ACP communication with complete data, the rate of AD completion was 82.6%. The overall mean (SD) age was 78.2 (14.4) years. Adjusting for other variables, AD completion was associated with patients aged ≥ 85 years [adjusted odds ratio (AOR) = 1.80, 95% CI 1.21-2.67], critical illness (AOR = 1.17, 95% CI 1.06-1.30), and social workers participating in ACP meetings (AOR = 1.74, 95% CI 1.24-2.45). CONCLUSION: The majority of inpatients with chronic life-limiting illness had ACP communication as part of this ACP program and over 80% completed an AD. Our study demonstrates the feasibility of implementing ACP discussion in East Asia and suggests that social workers may be an important component of ACP communication with patients.

[The Promotion of Resources Integration in Long-Term Care Service: The Experience of Taipei City Hospital].

The home-based medical care integrated plan under Taiwan National Health Insurance has changed from paying for home-based medical care, home-based nursing, home-based respiratory treatment, and palliative care to paying for a single, continuous home-based care service package. Formerly, physician-visit regulations limited home visits for home-based nursing to providing medical related assessments only. This limitation not only did not provide practical assistance to the public but also caused additional problems for those with mobility problems or who faced difficulties in making visits hospital. This 2016 change in regulations opens the door for doctors to step out their 'ivory tower', while offering the public more options to seek medical assistance in the hope that patients may change their health-seeking behavior. The home-based concept that underlies the medical service system is rooted deeply in the community in order to set up a sound, integrated model of community medical care. It is a critical issue to proceed with timely job handover confirmation with the connecting team and to provide patients with continuous-care services prior to discharge through the discharge-planning service and the connection with the connecting team. This is currently believed to be the only continuous home-based medical care integrated service model in the world. This model not only connects services such as health literacy, rehabilitation, home-based medical care, home-based nursing, community palliative care, and death but also integrates community resources, builds community resources networks, and provides high quality community care services.

Association of Advance Directives Completion With the Utilization of Life-Sustaining Treatments During the End-of-Life Care in Older Patients.

CONTEXT: Evidence is mixed regarding the impact of advance directives (ADs) on the utilization of end-of-life treatments. OBJECTIVES: This study evaluated the effect of AD on the utilization of end-of-life treatments during the last month of life in older patients. METHODS: Taipei City Hospital initiated an advance care planning program to promote AD for admitted patients in 2015. This prospective study recruited deceased older patients who completed advance care planning communication between 2015 and 2016. Multiple logistic regression was used to determine the association of AD completion with utilization of life-sustaining treatments. RESULTS: Of 1307 deceased older patients, overall mean age was 84.1 years and 78.7% of the subjects had AD completion. During the study follow-up period, 31 older patients received life-sustaining treatments during the last month of life, including 17 patients (1.7%) with AD completion and 14 patients (5.0%) without AD completion. After adjusting for the sociodemographic factors and co-morbidities, older patients with AD completion were less likely to receive life-sustaining treatments during the last month of life (adjusted odds ratio [AOR] = 0.32, 95% confidence interval [CI]: 0.16-0.67). Considering type of life-sustaining treatments, AD completion was associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.21, 95% CI: 0.06-0.70) as well as intubation and mechanical ventilation support (AOR = 0.32, 95% CI: 0.14-0.70) during the last month of life in older patients. CONCLUSION: AD completion was associated with a lower likelihood of receiving life-sustaining treatments during the last month of life in older patients. These findings support the continued use of AD in older population.

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

BACKGROUND: 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. OBJECTIVE: This study aimed to explore whether objectively measured light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in older adults. METHODS: This was a 2-year prospective cohort study. A total of 285 community-dwelling older adults aged 65 years or older were interviewed in 2012. A second wave of assessment was carried out in 2014 involving 274 (96.1%) participants. Time spent in physical activity at different intensities was assessed using triaxial accelerometers. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. Negative binomial regression models with adjustment for baseline depressive symptoms, accelerometer wear time, socio-demographic variables, lifestyle behaviors, and chronic disease conditions were conducted. RESULTS: Time spent in moderate-to-vigorous and light physical activities were both inversely related to depressive symptoms at follow-up. Sedentary time was associated with an increased risk of subsequent depressive symptoms. When sedentary or moderate-to-vigorous activity were included in the multivariable-adjusted regression models with light physical activity simultaneously, only light physical activity remained significant. Sensitivity analyses for assessing confounding and reverse causation provided further support for the stability of these findings. CONCLUSION: Light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in later life. Copyright © 2017 John Wiley & Sons, Ltd.

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 7days accelerometer positioned on waist. Multivariable negative binomial regression adjusted for confounders were undertaken. RESULTS: 274 participants (74.52years, 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.

Prospective associations of objectively assessed physical activity at different intensities with subjective well-being in older adults.

PURPOSE: This study aimed to examine the longitudinal independent associations of objectively assessed physical activity at different intensities, including moderate-to-vigorous physical activity, light physical activity, and sedentary behaviors, with dimensions of subjective well-being in older adults. METHODS: A total of 307 community-dwelling older adults aged 65 or older in Taiwan were interviewed in 2012. Physical activity was assessed using triaxial accelerometry. Subjective well-being was measured using the Chinese Aging Well Profile. Among them, 295 attended an 18-month follow-up study in 2013. Hierarchical linear regression models with adjustment for socio-demographic variables, lifestyle behaviors, health status, accelerometer wear time, and state of well-being at baseline were performed. RESULTS: The hierarchical regression models (step one) demonstrated that moderate-to-vigorous physical activity was associated with higher levels of follow-up general and specific dimensions of well-being (ß = 0.19-0.24) with the exception of material and environmental well-being. After light physical activity was further included in the models (step two), the associations of moderate-to-vigorous physical activity with general, physical, and independence well-being remained, while the contribution of light physical activity was not significant. In contrast, light physical activity was a significant predictor of psychological, learning and growth, and social well-being in these models (ß = 0.20-0.24), while these associations with moderate-to-vigorous physical activity were attenuated or not significant. Sedentary time was not related to any dimension of well-being. DISCUSSION: The findings indicate that moderate-to-vigorous physical activity and light physical activity are associated with different dimensions of well-being, suggesting that different intensities of late-life physical activity make distinct contributions to well-being.

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

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.

INTRODUCTION: The aim of this study is to investigate the association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent. METHODS: We recruited 607 students (grades 5-9) to fill out the investigation of basic data and sleep disturbance. Psychiatrists then used the Mini International Neuropsychiatric Interview-Kid to interview these students to assess their suicidal ideation and psychiatric diagnosis. Multiple logistic regression with forward conditionals was used to find the risk factors for multivariate analysis. RESULTS: Female, age, depressive disorder, adjustment disorder, and poor sleep all contributed to adolescent suicidal ideation in univariate analysis. However, poor sleep became non-significant under the control of depressive disorder and adjustment disorder. DISCUSSION: We found that both depressive disorder and adjustment disorder play important roles in sleep and adolescent suicidal ideation. After controlling both depressive disorder and adjustment disorder, sleep disturbance was no longer a risk of adolescent suicidal ideation. We also confirm the indirect influence of sleep on suicidal ideation in adolescent.

Evaluating the satisfaction of immigrant women from a rural community regarding family functioning and health-related quality of life.

Transnational marriages in Taiwan are largely mediated by marriage brokers. The present study was conducted to evaluate the satisfaction of immigrant women with their family function and health-related quality of life in a rural township in southern Taiwan. Data were collected from January 1, 2006 to November 31, 2006, and 157 immigrants agreed to participate in the study, with a 79.3% response rate. A structured questionnaire was used for data collection. The interviewers also collected information on the immigrants' and husbands' demographics, self-reported mental conditions, family function using a Family APGAR questionnaire (Adaptability, Partnership, Growth, Affection, and Resolve), and health-related quality of life. Marriage arranged through a marriage broker and having emotional distress were factors that were strongly associated with lower Family APGAR scores. Based on multiple regression models, higher Family APGAR scores were more positively related to vitality and mental health scales. Self-reported mental conditions, including feeling economic distress, emotional distress, loneliness, and having sleep problems, were negatively associated with most scales of the health-related quality of life. Female migrants' mental health was significantly related to their health-related quality of life. These findings suggest that migrant women must be educated regarding the importance of mental health by physicians and hygiene authorities in Taiwan.

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.

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.

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.

Epidemiologic psychiatric studies on post-disaster impact among Chi-Chi earthquake survivors in Yu-Chi, Taiwan.

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.

Three-year follow-up study of the relationship between posttraumatic stress symptoms and quality of life among earthquake survivors in Yu-Chi, Taiwan.

OBJECTIVE: To prospectively evaluate the relationship between the clinical course of posttraumatic stress symptoms (PTSS) and quality of life (QOL) among Taiwan earthquake survivors for 3 years. METHODS: A population survey was done in a Taiwan township near the epicenter of a severe earthquake (7.3 on the Richter scale). Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the Disaster-Related Psychological Screening Test to interview earthquake survivors 16 and older. A total of 1756 respondents were surveyed during the 3-year follow-up period. RESULTS: At 0.5 and 3 years after the earthquake, the estimated rate of PTSS (cutoff point, 3/4) was 23.8% and 4.4%, respectively. The survivors with PTSS scored lower for each concept of the MOS SF-36 at these two intervals. Three years after the earthquake, the survivors in the persistently healthy group showed the highest scores in all subscales and domains of the MOS SF-36; second-highest was the recovering group; third-highest was the delayed PTSS group; and the persistent PTSS group showed the lowest scores in all concepts and domains. Notably, survivors with delayed onset PTSS exhibited a lower QOL when PTSS occurred. CONCLUSIONS: Three years after the earthquake, the estimated rate of PTSS had declined, and the QOL of the survivors varied according to how their PTSS had progressed.

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.