Clinical outcomes, medical costs, and medication usage patterns of different somatic symptom disorders and functional somatic syndromes: a population-based study in Taiwan.

BACKGROUND: Somatic symptom disorders (SSD) and functional somatic syndromes (FSS) are often regarded as similar diagnostic constructs; however, whether they exhibit similar clinical outcomes, medical costs, and medication usage patterns has not been examined in nationwide data. Therefore, this study focused on analyzing SSD and four types of FSS (fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, functional dyspepsia). METHODS: This population-based matched cohort study utilized Taiwan's National Health Insurance (NHI) claims database to investigate the impact of SSD/FSS. The study included 2 615 477 newly diagnosed patients with SSD/FSS and matched comparisons from the NHI beneficiary registry. Healthcare utilization, mortality, medical expenditure, and medication usage were assessed as outcome measures. Statistical analysis involved Cox regression models for hazard ratios, generalized linear models for comparing differences, and adjustment for covariates. RESULTS: All SSD/FSS showed significantly higher adjusted hazard ratios for psychiatric hospitalization and all-cause hospitalization compared to the control group. All SSD/FSS exhibited significantly higher adjusted hazard ratios for suicide, and SSD was particularly high. All-cause mortality was significantly higher in all SSD/FSS. Medical costs were significantly higher for all SSD/FSS compared to controls. The usage duration of all psychiatric medications and analgesics was significantly higher in SSD/FSS compared to the control group. CONCLUSION: All SSD/FSS shared similar clinical outcomes and medical costs. The high hazard ratio for suicide in SSD deserves clinical attention.

Psychiatrist density and risk of suicide: a multilevel case-control study based on a national sample in Taiwan.

AIM: No previous studies, to our knowledge, have investigated the association between psychiatrist density and suicide, accounting for individual- and area-level characteristics. METHODS: We investigated all suicide cases in 2007-2017 identified from the national cause-of-death data files, with each suicide case matched to 10 controls by age and sex and each suicide case/control assigned to one of the 355 townships across Taiwan. Our primary outcome was the odds ratio (OR) of suicide and its 95% confidence interval (CI) estimated via multilevel models, which included both individual- and area-level characteristics. Townships with no psychiatrists were compared with the quartiles of townships with psychiatrists (density per 100,000 population): quartile 1 (Q1) (0.01-3.02); quartile 2 (Q2) (3.02-7.20); quartile 3 (Q3) (7.20-13.82); and quartile 4 (Q4) (>13.82). RESULTS: A total of 40,930 suicide cases and 409,300 age- and sex-matched controls were included. We found that increased psychiatrist density was associated with decreased suicide risk (Q1: adjusted OR [aOR], 0.95 [95% CI, 0.90-1.01]; Q2: aOR, 0.90 [95% CI, 0.85-0.96]; Q3: aOR, 0.89 [95% CI, 0.83-0.94]; Q4: aOR, 0.89 [95% CI, 0.83-0.95]) after adjusting for individual-level characteristics (employment state, monthly income, physical comorbidities, and the diagnosis of psychiatric disorders) and area socioeconomic characteristics. CONCLUSIONS: The psychiatrist density-suicide association suggests an effect of increased availability of psychiatric services on preventing suicide. Suicide prevention strategies could usefully focus on enhancing local access to psychiatric services.

Population-attributable risk of psychiatric disorders for suicide among adolescents and young adults in Taiwan.

BACKGROUND: Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10-24 years. METHODS: Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder. RESULTS: A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20-24 years (57.0%) was higher than among adolescents aged 10-19 years (48.0%). CONCLUSIONS: Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.

Societal factors and psychological distress indicators associated with the recent rise in youth suicide in Taiwan: A time trend analysis.

OBJECTIVE: We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan. METHODS: Suicide data (1971-2019) for 10-24 year olds were extracted from Taiwan's national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (gross domestic product per capita, Gini index, overall and youth unemployment rates, divorce rates in people aged 40-59 years [i.e. the age of most 15-24 year olds' parents] and Internet use rates) and psychological distress indicators (youth self-harm rates and the prevalence of worry-related insomnia, and suicide ideation, plan and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais-Winsten regression. RESULTS: Suicide rates in Taiwan's 10-24 year olds changed from a downward trend (2005-2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval = [5.2%, 18.1%]) annually between 2014 and 2019. There was also an upturn in divorce rates among females aged 40-59 years in 2014 and self-harm rates among 15- to 24-year-old youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan and attempt in youth started to increase from 2013 to 2016. In the regression analysis, Internet use, female divorce rates and youth self-harm rates were positively associated with youth suicide rates. CONCLUSION: Suicide rates and the prevalence of suicidal behaviors began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, Internet use and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk.

Predicting hospital mortality and length of stay: A prospective cohort study comparing the Intensive Care Delirium Screening Checklist versus Confusion Assessment Method for the Intensive Care Unit.

OBJECTIVE: The objective of this study was to compare two tools, the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the intensive care unit (ICU) (CAM-ICU), for their predictive validity for outcomes related to delirium, hospital mortality, and length of stay (LOS). METHODS: The prospective study conducted in six medical ICUs at a tertiary care hospital in Taiwan enrolled consecutive patients (≥20 years) without delirium at ICU admission. Delirium was screened daily using the ICDSC and CAM-ICU in random order. Arousal was assessed by the Richmond Agitation-Sedation Scale (RASS). Participants with any one positive result were classified as ICDSC- or CAM-ICU-delirium groups. RESULTS: Delirium incidence evaluated by the ICDSC and CAM-ICU were 69.1% (67/97) and 50.5% (49/97), respectively. Although the ICDSC identified 18 more cases as delirious, substantial concordance (κ = 0.63; p < 0.001) was found between tools. Independent of age, Acute Physiology and Chronic Health Evaluation II score, and Charlson Comorbidity Index, both ICDSC- and CAM-ICU-rated delirium significantly predicted hospital mortality (adjusted odds ratio: 4.93; 95% confidence interval [CI]:1.56 to 15.63 vs. 2.79; 95% CI: 1.12 to 6.97, respectively), and only the ICDSC significantly predicted hospital LOS with a mean of 17.59 additional days compared with the no-delirium group. Irrespective of delirium status, a sensitivity analysis of normal-to-increased arousal (RASS≥0) test results did not alter the predictive ability of ICDSC- or CAM-ICU-delirium for hospital mortality (adjusted odds ratio: 2.97; 95% CI: 1.06 to 8.37 vs. 3.82; 95% CI: 1.35 to 10.82, respectively). With reduced arousal (RASS<0), neither tool significantly predicted mortality or LOS. CONCLUSIONS: The ICDSC identified more delirium cases and may have higher predictive validity for mortality and LOS than the CAM-ICU. However, arousal substantially affected performance. Future studies may want to consider patients' arousal when deciding which tool to use to maximise the effects of delirium identification on patient mortality.

Occupational and Non-occupational Injuries Can Result in Prolonged Augmentation of Psychiatric Disorders.

BACKGROUND: The long-term effects of occupational injury (OI) on psychiatric diseases are unclear. This study assessed and compared the effects of OI, no injury (control), and non-OI (NOI) on the development of psychiatric diseases. METHODS: We used Taiwan's National Health Insurance Research Database to investigate the incidence of psychiatric disorders in OI, NOI, and control groups. The subjects were aged 20-50 years, actively employed in 2000, and did not have history of injury or psychiatric disorders. All subjects were followed from 2000 and were classified into OI, NOI, and control groups according to occurrence of target injury later on. Individuals in each group were matched by age, sex, insurance premium before the index date, and year of the index date. Psychiatric disease-free days were compared among the groups using survival analysis and Cox regression. RESULTS: We included a total of 12,528 patients for final analysis, with 4,176 in each group. Compared with the control group, the OI group had an increased occurrence of trauma and stress-related disorder, depressive disorders, anxiety disorders, and alcohol and other substance dependence. These increases were similar to those in the NOI group. Elevated cumulative incidence rate of any psychiatric disorders was observed among those with OI or NOI up to 10 years after injury. CONCLUSION: We confirmed that OI and NOI induced psychiatric disorders. These findings highlight the need for workers' compensation mechanisms to consider long-term psychological care among injured workers.

Associations between lifetime mental disorders and suicidal behaviors: findings from the Taiwan psychiatry morbidity survey.

BACKGROUND: East Asia has high suicide rates but low prevalence of mental disorders. We examined the associations between prior lifetime mental disorders (mood disorders, anxiety disorders, substance use disorders, and impulse control disorders) and subsequent suicidal behaviors (suicidal ideation and attempts in the general population and suicide plans, planned attempts, and unplanned attempts in suicidal ideators) in Taiwan. METHODS: This survey applied the World Mental Health Survey Composite International Diagnostic Interview to a population representative sample of noninstitutionalized adults between 2003 and 2005. Odds ratios (ORs) obtained using discrete-time survival analysis were used to estimate population attributable fractions (PAFs) of suicidal behaviors due to lifetime mental disorders. RESULTS: Lifetime mental illness was a significant risk factor for subsequent suicidal behaviors (except unplanned attempts among ideators) despite the relatively low prevalence of mental disorders in people with suicidality (16.1%-35.0%). Each diagnosis increased the odds of suicidal ideation. In terms of acting on suicidal ideation, mood disorders were most strongly associated with having plans (OR = 10.0; 95% confidence interval, CI 4.3-21.1), whereas substance use disorders most strongly with either planned (OR = 27.3; 95% CI 6.3-118.5) or unplanned attempts (OR = 14.5; 95% CI 1.7-121.5). PAFs of all mental disorders on suicidality lay between 20 and 30% (except 11% of unplanned attempts among ideators). Mood, anxiety, and substance use disorders had higher PAFs than impulse control disorders. CONCLUSIONS: In addition to mood disorders, considering anxiety and substance use disorders is essential in devising population-based suicide prevention strategies.

The psychological features of distinct somatic syndromes: A cluster analysis according to population-based somatic symptom profiles in Taiwan.

BACKGROUND: Functional somatic syndromes (such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome) are often comorbid. Whether these syndromes are distinct constructs and whether they have different psychological features are interesting questions. We perform a cluster analysis based on a nationwide survey in Taiwan to answer these questions. METHODS: A score of at least 5 on the Patient Health Questionnaire-15 (PHQ-15, measuring somatic symptoms) indicated somatic syndromes and the data of 550 subjects were included. According to the gastrointestinal, pain-fatigue and cardiovascular subdimension scores of the PHQ-15, we performed a two-step cluster analysis. The demographic data and the cluster scores of the Health Anxiety Questionnaire and the Patient Health Questionnaire-4 (measuring depression and anxiety) were compared. Multinomial logistic and multiple linear regression analyses were used to clarify the associations between clusters/somatic symptoms and demographics/psychological features. RESULTS: Four clusters were generated and named according to their somatic features: "high gastrointestinal symptoms", "high pain-fatigue and comorbid somatic symptoms", "middle to high pain-fatigue symptoms" and "high cardiovascular symptoms". The high pain-fatigue and comorbid somatic symptom cluster had the highest levels of extent to which symptoms interfere with a person's life, depression and anxiety. The high cardiovascular symptom cluster was featured by high excessive worry over health and illness and low educational level. The high gastrointestinal symptom cluster had relatively low psychopathologies. CONCLUSION: The results of this population-based analysis supported the existence of distinct somatic syndromes that are not parts of a single whole somatic syndrome and have different psychological features.

Ten-year trends in depression care in Taiwan.

BACKGROUND/PURPOSE: The number of psychiatrists working in community clinics in Taiwan has increased dramatically in the recent decade. This study aimed to investigate the trend of prevalence and incidence of depressive disorders and assess the quality of depression care between 2007 and 2016 in Taiwan. METHODS: We used the claims database derived from Taiwan's National Health Insurance (NHI) program, in which approximately 23.0 million individuals were enrolled, translating to a coverage rate of 99%. Patients with depressive disorders were identified based on International Classification of Diseases codes. The process indicators of depression care quality included visit, duration, and dose adequacy. The outcome indicators included the rate of psychiatric hospitalisation, emergency visit, self-harm hospitalisation, and suicide. RESULTS: The prevalence of treated depressive disorders increased from 1.61% in 2007 to 1.92% in 2016, i.e., a 25% increase, whereas the incidence of first-ever or recurrent depressive disorder did not change significantly. The number of patients treated by psychiatrists and in community clinics also increased. The quality of depression care improved, the proportion of patients receiving minimum psychiatric clinic follow-up and adequate medication increased, and the rate of emergency visits, psychiatric hospitalisation, and self-harm hospitalisation declined. CONCLUSION: The community-based psychiatric services increased and the quality indicators of depression care in Taiwan improved during 2007-2016. The causality warrants further investigations.

Prevalence and correlates of suicidal behaviors in the Taiwan Psychiatric Morbidity Survey.

BACKGROUND/PURPOSE: Suicide is a huge global health burden. High suicide rates with a low prevalence of major depressive disorder were reported in East Asia. This study aimed to investigate the prevalence of suicidal behaviors in relation to the demographic characteristics and major depressive disorder in Taiwan. METHODS: This study was based on the Taiwan Psychiatric Morbidity Survey, conducted between 2003 and 2005, a survey of common psychiatric disorders in a nationally representative sample of non-institutionalized civilians aged 18 or above. Demographic data, major depressive disorder, and suicidal behaviors were ascertained by a face-to-face interview using the paper version of the World Mental Health Survey Composite International Diagnostic Interview. RESULTS: According to the total sample of 10,135 participants, the lifetime prevalence of suicidal ideation, plans and attempts was 7.52% (S.E = 0.46%), 1.31% (S.E. = 0.16%) and 1.29% (S.E. = 0.16%), respectively. Among suicide ideators, the conditional probability of making a suicide plan was 17.39% (S.E. = 1.92%), and a suicide attempt 17.16% (S.E. = 2.15%). Age ≤ 40, female sex, and major depressive disorder were related to a higher risk of suicidal behaviors in the general population; the former two were associated with further developing suicide attempts and the latter one developing plans among ideators. CONCLUSION: Despite low prevalence, major depressive disorder remained a significant risk factor for suicidal behaviors in Taiwan.

Adherence to World Health Organization guideline on suicide reporting by media in Taiwan: A surveillance study from 2010 to 2018.

BACKGROUND/PURPOSE: Significant associations between suicide behaviors and inappropriate suicide reports in the media have been reported. The study aimed to examine the quality of long-term suicide reports under surveillance by the Taiwan Suicide Prevention Center (TSPC). METHODS: The TSPC conducted daily surveillance with timely feedback and interactive approaches with the media professionals. To examine the reporting trends under the surveillance, daily adherence to the 12-item World Health Organization (WHO) guidelines was analyzed for print media published between 2010 and 2018, and for online media in 2017 and 2018. The trend analysis using the Cochran-Armitage test was performed to estimate the significance of adherence changes. RESULTS: In total, 5529 print reports and 16,445 person-event items from online media were reviewed. The number of suicide reports in print newspapers markedly decreased while it increased for online media. Surveillance of print media showed statistical significance of the improvement of reporting adherence to all guideline items except one item ("Do not publish photo or suicide notes"). Adherence rates were high (∼90%) for 6 of the 12 items over the study duration. Marked improvement was observed in three items: reporting details, giving simplistic reasons, and providing helpline resources. However, both "Highlight the alternatives to suicide" and "Work closely with health authorities to present the facts" items had the lowest adherence. Online media had similar findings and adherence profile as the print media. CONCLUSION: The quality of suicide reports significantly improved in most WHO guideline items. Development of psychiatric-media liaisons may be beneficial for further improvement.

Psychological distress of suicide attempters predicts one-year suicidal deaths during 2007-2016: A population-based study.

BACKGROUND/PURPOSE: Of the risk factors for suicide, prior attempt is regarded as one of the strongest for subsequent attempts or completed suicide. This large-scale cohort study aims to examine whether the distress level of individual mental symptoms and general psychopathology measured at the index attempt can predict subsequent suicide death within one year. METHODS: The participants were 104,441 suicide attempters first reported to the Taiwan National Suicide Surveillance System during 2007-2016, who completed the five-item Brief Symptom Rating Scale (BSRS-5) at the index attempt. Kaplan-Meier survival curve analysis with log-rank test and Cox regression model were used to examine whether the level of psychological distress could predict the cumulative incidence of re-attempted suicidal death in the following year. RESULTS: In total, 1254 (1.2%) participants subsequently killed themselves within one year. Survival curves analysis and Cox regression modelling indicated that levels of distress of individual items (i.e., suicide ideation, depression, inferiority, anxiety, hostility and insomnia) and total BSRS-5 scores were significantly correlated with the incidence of subsequent suicidal death within one year for both genders. CONCLUSION: The study revealed that self-rated psychological distress was a significant and sustained predictor of re-attempted suicide death within one year after the index attempt. These results imply that suicide is not only an issue of acute crisis, but also a prolonged problem of lasting psychological distress. The BSRS-5 assessment could provide a symptom profile on which to develop a pertinent person-centered approach to prevent subsequent suicide attempts.

Functioning and quality of life in patients with somatic symptom disorder: The association with comorbid depression.

OBJECTIVES: Patients with somatic symptoms often have impaired functioning and reduced quality of life (QOL), but the factors identified as responsible for these impairments vary between studies. We examined functioning and QOL in patients with somatic symptom disorder (SSD), exploring their associations with demographic factors, personality traits and psychological features. METHODS: The sample comprised 107 SSD patients and 100 healthy controls. Several types of self-report instrument were administered. Group differences were assessed with independent t-tests. We used multiple linear regression to examine relationships between the independent variables and functioning and QOL. Finally, we used structural equation modeling (SEM) to perform path analysis and examine the fit of a model based on the earlier results. RESULTS: Most function scores were lower in SSD patients than in healthy controls. In SSD patients overall WHO Quality of Life-BREF (WHOQOL-BREF) score was correlated with exercise level and Beck Depression Inventory-II (BDI-II) score. There were also associations between Sheehan Disability Scale (SDS) score and age, novelty seeking, Cognitions About Body and Health Questionnaire (CABAH) score and BDI-II score. Family APGAR score was only related to BDI-II score. Path analysis revealed that BDI-II score was related to all three indices of functioning. CONCLUSIONS: Depression is associated with functioning and QOL in SSD patients. TRIAL REGISTRATION INFORMATION: The Research Ethics Committee of National Taiwan University National Taiwan University Hospital approved this study (approval number: 201507007RINB).

Rates and trends of psychiatric inpatient and postdischarge suicides in Taiwan, 2002-2013: a national register-based study.

PURPOSE: In contrast to the downsizing trend of psychiatric beds in the Western world, the psychiatric bed capacity in Taiwan has steadily increased in recent decades. This study aimed to assess the suicide rates and their variations over time among psychiatric inpatients and recently discharged patients. METHODS: Data on psychiatric inpatients admitted from 2002 to 2013 were extracted from the psychiatric inpatient registry of the National Health Insurance and merged with information from the Cause of Death data by means of unique identified numbers. Suicides occurring during admission and within 90 days after discharge were defined as inpatient and postdischarge suicides, respectively. Calendar year was fitted as a continuous variable in multivariate Poisson regression models to evaluate these rates over time. The analyses were adjusted for sex, age, primary psychiatric diagnosis, and number of admissions in the preceding year. RESULTS: The overall inpatient suicide rate was very low (81 per 100,000 person-years). It decreased significantly from 146 to 74 per 100,000 person-years over the study period. This fall was observed among both genders and across all psychiatric diagnoses. The postdischarge suicide rate was comparatively high (1108 per 100,000 person-years) and did not show statistically significant change over the study period. CONCLUSIONS: Our results suggest that efforts to increase public awareness of mental disorders and efficient utilization of psychiatric inpatient care are essential for suicide prevention despite the comparatively high bed capacity. The discharge plans of inpatients should be bridged with population suicide prevention programs for continuity of care after discharge.

The changes and the predictors of suicide ideation and suicide attempt among HIV-positive patients at 6-12 months post diagnosis: A longitudinal study.

AIMS: This study examined the changes and the predictors of suicide ideation/suicide attempt and the moderating effects of psychosocial factors on the suicide ideation/suicide attempts among human immunodeficiency virus (HIV)-positive patients at 6-12 months post-diagnosis. BACKGROUND: Suicide behaviours are prevalent among newly diagnosed HIV-positive patients, but the changes in suicide behaviours after diagnosis and the role of psychosocial factors in these behaviours are not well studied. DESIGN: This study used a prospective longitudinal design. METHODS: A total of 113 participants diagnosed as HIV-positive for 6-12 months were recruited from the outpatient department. Data were collected from June 2015 - October 2016. They were asked to complete Beck's Scale for Suicide Ideation, the Beck Depression Inventory-II, the Body Image Scale, the Meaning in Life Questionnaire and the Multidimensional Scale of Perceived Social Support at baseline, the third month and the sixth month. RESULTS: The results showed the high occurrence rates for suicide ideation ranging from 27.2%, 21.6%, and 25.8% and suicide attempt ranging from 14.7%, 8.6%, and 13.3% at the baseline, the third month and the sixth month, respectively. The education level, social support from family and depressive symptoms were the predictors of suicide ideation. The history of depression disorders, depressive symptoms and social support from friends significantly predicted suicide attempt. Meaning in life-presence moderated the relationship between depressive symptoms and suicide ideation. CONCLUSIONS: After diagnosed for 6-12 months, HIV-positive patients remain the high-risk group for suicide ideation and attempt. Suicide intervention targeting the risk and protective factors are required for HIV-positive patients.

A nationwide survey of the prevalence and psychosocial correlates of internet addictive disorders in Taiwan.

BACKGROUND AND PURPOSE: The American Psychiatric Association has published the diagnostic criteria of Internet Gaming Disorder (IGD) in the 5th Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for further studies to clarify IGD and related concepts of internet addiction. The study aims to investigate the prevalence and psychosocial correlates of internet addictive disorder (IAD) in the general population using the framework of IGD criteria. METHODS: A nationwide survey was conducted using a computer-assisted telephone interview of residents aged 15 and older selected by a stratified proportional randomizing method. The questionnaire comprised socio-demographic information, 9-items IAD (IAD-9) for identification of IGD and non-gaming IAD, the 5-item Brief Symptom Rating Scale, and questions about internet use and suicidal ideation. RESULTS: Among 2147 respondents (50.4% females), the one-year prevalence of IAD was 1.9% (1.2% for IGD and 0.7% for non-gaming IAD). People with IAD were characterized as: younger, unemployed or students, under recent psychological distress, with recent and lifetime suicidal ideation, and engaging in regular multiple online activities including gaming, shopping or video-watching. Logistic regression revealed that age and psychopathology including insomnia, depression and inferiority were significant predictors of IAD. High prevalence of psychiatric morbidity (27.5%) and lifetime suicidal ideation (34.2%) accompanied with very low psychiatric treatment rate were also identified. CONCLUSION: Age and psychopathology were identified as major determinants of IAD. The IGD criteria in DMS-5 is applicable to identify the internet addictive problems that enhances early engagement for high-risk populations across the ages.

Development and validation of the 9-item Concise Mental Health Checklist (CMHC-9) for suicide risk assessment.

BACKGROUND/PURPOSE: Early detection of suicide risk is a challenge in suicide prevention. A comprehensive yet efficient tool providing timely identification of key risk factors allows healthcare providers to initiate interventions. The study aims to validate the 9-item Concise Mental Health Checklist (CMHC-9). METHODS: A series of cross-sectional surveys were conducted in 3982 participants from psychiatric outpatient (n = 931), medical outpatient (n = 931) and community (n = 2120) populations. The factor analysis with internal consistency coefficients (Cronbach's α) and receiver operating characteristic (ROC) analysis were performed to evaluate the scale's reliability and validity. RESULTS: The internal consistency of the CMHC-9 was satisfactory based on Cronbach's α values for the total sample (α = 0.79) and the three sub-samples (i.e., α = 0.76 for psychiatric subjects; 0.67 for community subjects; and 0.69 for medical outpatient subjects). Hierarchical exploratory factor analysis revealed that the CMHC-9 was a single-dimensional scale with two-factor structure of psychopathology and suicidality. The two-factor solution was confirmed by confirmatory factor analysis. The optimal cut-off of 3/4 obtained from the ROC analysis represented a satisfactory sensitivity (92%) and specificity (82%) in identifying recent suicide ideation. CONCLUSION: This large-scale study confirmed the CMHC-9 as a brief and effective tool for suicide risk detection. It is recommended that CMHC-9 can be used for care engagement and risk identification in both medical and community settings among people at risk for suicide.

Targeted treatment of primary aldosteronism - The consensus of Taiwan Society of Aldosteronism.

BACKGROUND/PURPOSE: Even with the increasing recognition of primary aldosteronism (PA) as a cause of refractory hypertension and an issue of public health, the consensus of its optimal surgical or medical treatment in Taiwan has not been reached. Our objective was to develop a clinical practice guideline that is feasible for real-world management of PA patients in Taiwan. METHODS: The Taiwan Society of Aldosteronism (TSA) Task Force recognized the above-mentioned issues and reached this Taiwan PA consensus at its inaugural meeting, in order to provide updated information of internationally acceptable standards, and also to incorporate our local disease characteristics and constraints into PA management. RESULTS: In patients with lateralized PA, including aldosterone producing adenoma (APA), laparoscopic adrenalectomy is the 'gold standard' of treatment. Mini-laparoscopic and laparoendoscopic single-site approaches are feasible only in highly experienced surgeons. Patients with bilateral adrenal hyperplasia or those not suitable for surgery should be treated by mineralocorticoid receptor antagonists. The outcome data of PA patient management from the literature, especially from PA patients in Taiwan, are reviewed. Mental health screening is helpful in early detection and management of psychopathology among PA patients. CONCLUSION: We hope this consensus will provide a guideline to help medical professionals to manage PA patients in Taiwan to achieve a better quality of care.

Quality of life at 6 years after occupational injury.

PURPOSE: Occupational injuries have considerable impact on workers' lives. However, data regarding workers' health-related quality of life (HRQOL) at several years after the injury are lacking. This study assessed workers' HRQOL at 6 years after occupational injury and determined related factors in each HRQOL domain. METHODS: Workers who sustained an occupational injury in 2009 and who responded to a previous survey at 3 or 12 months after their injury were followed up in 2015. A total of 1715 participants were candidates for this study. The Taiwanese version of the World Health Organization Quality of Life scale-abbreviated version (WHOQOL-BREF) was used to assess their HRQOL. Multiple linear regression analysis identified predictive factors for HRQOL at 6 years after occupational injury. RESULTS: A total of 563 workers completed the questionnaire (response rate, 32.8%). Adverse life events and additional severe occupational injuries that occurred within the follow-up period, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF. In addition, unmarried participants had low scores in the social relationship domain. Workers with family members requiring care scored low in the physical and environment domains. Workers whose injuries had major effects on their physical appearance had low scores in the physical and psychological domains. Workers with unstable employment had low scores in physical, psychological, and environment domains. CONCLUSION: At 6 years after occupational injury, workers' HRQOL was poor among those whose salaries decreased after the injury, after adjustment for other factors.

Prevalence and Predictors of Depression Among People Living With HIV/AIDS: A National Study.

BACKGROUND: Depression is prevalent among people living with HIV/AIDS (PLWHA), but there are few longitudinal studies investigating the prevalence of depression among HIV respondents in Taiwan. OBJECTIVES: This study examined the trend in the prevalence of depression and its main predictors among PLWHA in Taiwan. METHODS: This study analyzed the 2-million random-sample data set of the Taiwanese longitudinal health research database using data from 2000 to 2011and applied the Internal Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes for the detection of HIV infection and depression. Chi-square tests and logistic regression analyses were conducted to determine predictive factors for depression. RESULTS: A total of 769 PLWHA who met the criterion of HIV infection were extracted from the database. Of these respondents, 20.03% had a diagnosis of depression after their HIV-positive diagnosis. The annual prevalence of depression among the study respondents increased significantly from 1.95% in 2000 to 6.93% in 2011 according to time trend analysis (χ = 6.428, df =11, p = .03). Multivariate, logistic regression analysis indicated a history of drug abuse was the main predictor of a diagnosis of depression. DISCUSSION: The increasing trend in the prevalence of depression revealed an urgent need for the development of care programs for PLWHA with depression. Such programs should take into consideration a history of drug abuse as a strong risk factor for the development of depression.