Correction: Dashboard With Bump Charts to Visualize the Changes in the Rankings of Leading Causes of Death According to Two Lists: National Population-Based Time-Series Cross-Sectional Study.

[This corrects the article DOI: 10.2196/42149.].

Dynamic reciprocal relationships between traditional media reports, social media postings, and youth suicide in Taiwan between 2012 and 2021.

Rising social media use over the past decade has been linked with increasing suicide rates among young people. Previous studies that assessed the impact of social media on suicide have typically focused on single social media platforms, such as Twitter, and assumed unidirectional associations, where social media posts leads to suicide. Our study focused on the past decade (2012-2021) which has witnessed a rapid increase of social media platforms and use. Poisson and negative binominal auto-regression models were employed to examine the dynamic reciprocity between social media, traditional media and youth suicides in Taiwan. Increased volume in suicide-related social media posts positively correlated with increased youth suicide rates (ß = 2.53 × 10-5, 95% CI= (0.83 × 10-5, 4.24 × 10-5), P < 0.01), but increased rates of youth suicide was not related to an increase in suicide-related social media posts. Suicide-related posts on social media triggered reporting of suicide-related news on traditional media platforms (ß = 3.35 × 10-2, 95% CI= (2.51 × 10-2, 4.19 × 10-2), P < 0.001), whilst traditional media reports of suicide led to increased suicide-related social media posts (ß = 6.13 × 10-1, 95% CI = (4.58 × 10-1, 7.68 × 10-1); P < 0.001). However, suicide-related reports on traditional media platforms did not directly lead to an increase in youth suicide rates. Our findings highlight challenges for suicide prevention strategies in the 21st Century, in dealing with the increasing prominence of social media over traditional media. As social media is more difficult to regulate than traditional media, suicide prevention efforts must adapt to this new landscape by developing innovative strategies that address the unique risks and opportunities presented by social media.

Intentions to Help People at Risk of Suicide and Associated Factors: A National Telephone Survey in Taiwan.

OBJECTIVE: Many people at risk of suicide do not actively seek help. Suicide prevention efforts need to involve the general public to provide appropriate support to those in need. It is important to investigate the intention to help those at risk of suicide and the factors associated with helping intentions in the general population. We aimed to assess the intention to help people at risk and associated factors using a national representative sample. METHOD: We conducted a national telephone survey of 1,087 Taiwanese adults and collected data regarding participants' socio-demographic characteristics, mental health status, helping intentions, misconceptions about suicide, and attitudes toward suicide and suicide prevention. RESULTS: The prevalence of high intentions to help people at risk of suicide was 56.5%. Helping intentions did not differ by sex, educational level, employment status, marital status, or mental health status. Those with high helping intentions were younger, less likely to have misconceptions about suicide or agree that suicide is a personal choice, and more likely to believe that suicide is preventable and support suicide prevention measures. CONCLUSIONS: Suicide prevention education programs aimed to enhance helping intentions may usefully target debunking misconceptions about suicide and cultivating positive attitudes toward suicide prevention.

The prevalence of high intentions to help people at risk of suicide was 56.5%.Individuals with high intentions to help were less likely to hold misconceptions about suicide.Individuals with high intentions to help were less likely to believe that suicide is a personal choice.

International Variations in Dementia and Alzheimer Disease Diagnosis and Certification Habits and Their Associations With Dementia and Alzheimer Disease Mortality: A Cross-Sectional Study of 38 Countries.

OBJECTIVE: To examine international variations in national diagnosis and certification habits prefer recording dementia (D) versus Alzhiemer disease (AD) as the underlying cause of death (UCOD) and their associations with mortality rates of dementia and AD. METHODS: We calculated proportions of D/D+AD and AD/D+AD deaths as proxies of national diagnosis and certification habits. Pearson correlation coefficients (r) were estimated to assess the associations of proportions with the mortality rates of dementia or AD among adults aged 75 to 84 years across 38 countries. RESULTS: The countries with a high preference for recording dementia as the UCOD were Taiwan and Latvia with proportion of D/D+AD deaths of 92% and 88%, respectively, and those with a high preference for recording AD as the UCOD were Slovenia, Turkey, and Poland with proportion of AD/D+AD deaths of 100%, 99%, and 89%, respectively. The r values for the proportions and mortality rate for dementia and AD were 0.67 (95% CI: 0.44-0.81) and 0.46 (95% CI: 0.16-0.68), respectively. CONCLUSION: We identified a small number of countries with obvious natonal diagnosis and certification habits preferring dementia or AD and had moderate effects on international variations in the mortality rates of dementia and AD.

Dashboard With Bump Charts to Visualize the Changes in the Rankings of Leading Causes of Death According to Two Lists: National Population-Based Time-Series Cross-Sectional Study.

BACKGROUND: Health advocates and the media often use the rankings of the leading causes of death (CODs) to draw attention to health issues with relatively high mortality burdens in a population. The National Center for Health Statistics (NCHS) publishes "Deaths: leading causes" annually. The ranking list used by the NCHS and statistical offices in several countries includes broad categories such as cancer, heart disease, and accidents. However, the list used by the World Health Organization (WHO) subdivides broad categories (17 for cancer, 8 for heart disease, and 6 for accidents) and classifies Alzheimer disease and related dementias and hypertensive diseases more comprehensively compared to the NCHS list. Regarding the data visualization of the rankings of leading CODs, the bar chart is the most commonly used graph; nevertheless, bar charts may not effectively reveal the changes in the rankings over time. OBJECTIVE: The aim of this study is to use a dashboard with bump charts to visualize the changes in the rankings of the leading CODs in the United States by sex and age from 1999 to 2021, according to 2 lists (NCHS vs WHO). METHODS: Data on the number of deaths in each category from each list for each year were obtained from the Wide-ranging Online Data for Epidemiologic Research system, maintained by the Center for Disease Control and Prevention. Rankings were based on the absolute number of deaths. The dashboard enables users to filter by list (NCHS or WHO) and demographic characteristics (sex and age) and highlight a particular COD. RESULTS: Several CODs that were only on the WHO list, including brain, breast, colon, hematopoietic, lung, pancreas, prostate, and uterus cancer (all classified as cancer on the NCHS list); unintentional transport injury; poisoning; drowning; and falls (all classified as accidents on the NCHS list), were among the 10 leading CODs in several sex and age subgroups. In contrast, several CODs that appeared among the 10 leading CODs according to the NCHS list, such as pneumonia, kidney disease, cirrhosis, and sepsis, were excluded from the 10 leading CODs if the WHO list was used. The rank of Alzheimer disease and related dementias and hypertensive diseases according to the WHO list was higher than their ranks according to the NCHS list. A marked increase in the ranking of unintentional poisoning among men aged 45-64 years was noted from 2008 to 2021. CONCLUSIONS: A dashboard with bump charts can be used to improve the visualization of the changes in the rankings of leading CODs according to the WHO and NCHS lists as well as demographic characteristics; the visualization can help users make informed decisions regarding the most appropriate ranking list for their needs.

Ranking of Alzheimer's disease and related dementia among the leading causes of death in the US varies depending on NCHS or WHO definitions.

INTRODUCTION: We compared the ranking of Alzheimer's disease and related dementia (ADRD) among the leading causes of death (LCODs) between those according to the National Center for Health Statistics (NCHS) and the World Health Organization (WHO) lists by sex. METHOD: The number of deaths in each LCOD category was obtained from CDC WONDER. RESULTS: According to the WHO list, ADRD was the second LCOD from 2005 to 2013, the first from 2014 to 2020, and the third in 2021, respectively, for women and was the second in 2018 and 2019, the third in 2020, and the fourth in 2021, respectively, for men. According to the NCHS list, Alzheimer's disease was the fourth in 2019 and 2020 for women and was the seventh from 2016 to 2019 for men. DISCUSSION: The ranking of ADRD among the LCODs according to the WHO list was higher than those according to the NCHS list.

Suicide Misconceptions and Attitudes Toward Suicide Prevention Measures in Taiwan.

Background: Debunking suicide misconceptions is an important suicide prevention measure. Few studies on suicide misconceptions and their correlates have been conducted in East Asia, where suicide is known to be more permissible. Aims: We investigated the prevalence and associated characteristics of suicide misconceptions in Taiwan. Whether holding suicide misconceptions was associated with reduced support for governmental suicide prevention measures was also assessed. Method: A dual-frame nationally representative telephone survey combining landlines and mobiles was conducted with 1,087 respondents. Logistic regression analyses were used to examine factors associated with suicide misconceptions. Results: Nearly 82% of the respondents held at least one type of suicide misconceptions. The most commonly held misconception was "Talking about suicide would encourage suicide" (49.5%), followed by "People who talk about suicide do not mean to do it" (47.3%) and "Most suicides happen suddenly without any warning" (46.5%). Suicide misconceptions were more common in younger people, divorced/widowed individuals, and those with lower educational attainment. Individuals with suicide misconceptions were less likely to support governmental investments in suicide prevention. Limitations: Causality could not be inferred from the cross-sectional study. Conclusions: Suicide misconceptions are prevalent in Taiwan. Debunking suicide misconceptions should be an integral part of national suicide prevention strategies.

Assessing Quality of Life with Community Dwelling Elderly Adults: A Mass Survey in Taiwan.

BACKGROUND: With the growing life expectancy for older adults, this study aims to examine the correlation among sociodemographic characteristics and the combined effect of QoL-related domains including physical health, psychological health, social relationships, and environmental factors with the overall QoL level of older adults in Taiwan. METHODS: The WHOQOL-BREF Taiwanese Version questionnaire was adopted and conducted using a randomized telephone interview system from community household elders. In total, 1078 participants aged 65 years and older were recruited. A multiple regression model was used to examine the statistical significance between the overall QoL score as the dependent variable and the sociodemographic characteristics, and 26 items of QoL-related questionnaires as the independent variables. RESULTS: Categories including female, aged 85 years and above, higher education level, and better financial situation had significantly higher overall QoL level. Except the physical health domain and six items, the correlations among all other domains and their including items of questionnaires with overall QoL level were significant. CONCLUSION: The Taiwanese WHOQOL-BREF questionnaire can be used to examine the overall QoL level of elders in Taiwan. Nevertheless, the robust systems of universal health care and long-term care in Taiwan may have led to the no significance of the six items.

Demographics, Socioeconomic Context, and the Spread of Infectious Disease: The Case of COVID-19.

IMPORTANCE: Due to the evolving variants of coronavirus disease 2019 (COVID-19), it is important to understand the relationship between the disease condition and socioeconomic, demographic, and health indicators across regions. BACKGROUND: Studies examining the relationships between infectious disease and socioeconomic variables are not yet well established. DESIGN: A total of 3042 counties in the United States are included as the observation unit in the study. Two outcome variables employed in the study are the control of disease spread and infection prevalence rates in each county. METHOD: Data are submitted to quantile regression, hierarchical regression, and random forest analyses to understand the extent to which health outcomes are affected by demographics, socioeconomics, and health indicators. RESULTS: Counties with better control of the disease spread tend to have lower infection rates, and vice versa. When measuring different outcome variables, the common risk factors for COVID-19 with a 5% level of statistical significance include employment ratio, female labor ratio, young population ratio, and residents' average health risk factors, while protective factors include land size, housing value, travel time to work, female population ratio, and ratio of residents who identify themselves as mixed race. CONCLUSIONS: The implications of the findings are that the ability to maintain social distancing and personal hygiene habits are crucial in deterring disease transmission and lowering incidence rates, especially in the early stage of disease formation. Relevant authorities should identify preventive factors and take early actions to fight infectious diseases in the future.

Changes in accessibility of suicide-related information on websites in Taiwan during 2016 and 2019.

BACKGROUND/PURPOSE: To the best of our knowledge, no studies have examined longitudinal changes in the accessibility of suicide-related content on Chinese-language websites. We investigated changes between 2016 and 2019 in suicide-related materials likely to be accessed by individuals through websites in Taiwan. METHODS: In March 2019, we searched the Taiwanese versions of Google and Yahoo! using six suicide-related terms and compared the results to a search performed in 2016. Website characteristics (e.g., pro- or anti-suicide) generated by various keywords were calculated and compared in 2016 and 2019. RESULTS: The number of anti-suicide websites exceeded that of pro-suicide websites in 2016 and 2019. Between 2016 and 2019, the proportion of pro-suicide sites decreased slightly from 16.3% (61 out of 375 sites) to 12.3% (51 out of 417 sites) (p = 0.10). User-generated webpages constituted the primary source of pro-suicide content at both time points. Over the same period, the proportion of pro-suicide information on internet forums decreased from 59.1% to 17.8% (p < 0.001); by contrast, pro-suicide content on news websites increased significantly, from 1.9% to 11.3% (p = 0.005). Searches with the term "painless suicide" were more likely to yield pro-suicide websites and less likely to generate anti-suicide ones than searches with "suicide" in both 2016 and 2019. CONCLUSION: Harmful suicide-related information circulating on websites remained easily accessible to internet users in Taiwan, particularly through user-generated and news websites. Proper site moderation and implementation of online suicide reporting guidelines are still warranted.

Differences in Reactions to Media Reporting of a Celebrity Suicide Between Emotionally Distressed and Nondistressed Individuals in Taiwan.

Background: The differences in emotional reactions toward media reports of celebrity suicides between distressed and non-distressed individuals have rarely been explored. Aim: We aimed to explore differences in reaction patterns to the news coverage of a celebrity's suicide between distressed and nondistressed individuals in Taiwan. Method: We conducted an Internet survey to assess the impact of the news coverage of a celebrity's suicide. A series of χ2 tests, Spearman's rank correlations, and logistic regression analyses were performed to compare the differences in emotional involvement and psychological impact after exposure to suicide news between distressed and nondistressed individuals. Results: A total of 1,258 Internet users responded to the survey (236 men and 1,020 women). Compared with nondistressed individuals, distressed individuals (n = 537) were more likely to feel suicidal (11% vs. 2%, p < .001) after reading the news. They were less willing to seek help when in need (62% vs. 77%, p < .001). All the variables remained significant after adjustment for sociodemographic variables in regression analyses. Limitations: The Internet-based survey may suffer from selection bias. Conclusion: Extensive media reporting of suicide stories has a profound impact on readers, particularly on vulnerable groups. Responsible reporting of suicide incidents is crucial for suicide prevention.

Effect of a multi-disciplinary active aging intervention among community elders.

BACKGROUND: Active aging has been the paradigm of the old-age lifestyle. We aimed to investigate the efficacy of a multi-disciplinary intervention program in community-based elderly. METHODS: We conducted a 2-arm trial comparing the effectiveness between the study group and the control group. The intervention contents included active aging concepts and preparation, physical activity, health care management, cognitive training, emotional awareness and coping skills, family relationship and resilience, and internet use. A questionnaire tapping into the constructs of the expanded healthy life, mental health, social participation, and active aging was administered at baseline, 7th week, and 19th week. RESULTS: The generalized estimating equations analysis revealed that the study group exhibited significant improvements in healthy life, mental health, social participation, and active aging compared with the control group (P < .001). CONCLUSIONS: This study provided a good evidence supporting the effectiveness of a multi-disciplinary intervention program in improving the cognition of healthy life, mental health status, social participation activities, and active aging. A promotion of similar intervention is recommended.

Factors associated with psychological impact of celebrity suicide media coverage: An online survey study.

BACKGROUND: We investigated factors associated with vulnerability to the psychological impact of celebrity suicide news reporting after the suicide of an emerging Taiwanese novelist, Ms Yi-Han Lin. METHODS: We conducted a cross-sectional online survey. Participants completed a questionnaire which asked whether they were affected by the media coverage of Lin's suicide and whether they would seek help if affected. Logistic regression was used to identify factors associated with being affected by the celebrity suicide media reporting and, among those affected, factors associated with feeling suicidal or not seeking help. RESULTS: A total of 1258 respondents (81% females) completed the survey. Affected individuals (n=907; 70%) were more likely to be females, younger (age < 40 years), have past psychiatric treatment, and show increased interest in the incident (e.g., spending more time on reading the celebrity suicide news) than non-affected individuals. Among those affected, negative views of the media reporting impact, pessimistic attitude toward both depression treatment and suicide prevention, and having a history of past psychiatric treatment were associated with feeling suicidal, while low education attainment, increased interest in the celebrity suicide, and permissive attitude toward inappropriate media reporting were additionally associated with not seeking help. LIMITATIONS: Selection bias of participants through internet-based surveying should be considered. CONCLUSION: Individuals affected by the media coverage of celebrity suicide showed similar demographic and mental health characteristics as those of the deceased celebrity. Poor mental health and suicide prevention literacy may increase the risk of psychological impact and not seeking help. Future interventions could target at enhancing mental health literacy and help seeking intention in vulnerable individuals.

Changing Indications for Corneal Transplantations in Southern Taiwan From 2008 to 2018.

OBJECTIVES: To investigate the changing indications for corneal transplantations in southern Taiwan from 2008 to 2018 and compare the results with those of other previous studies. METHODS: We retrospectively reviewed the records of patients who underwent corneal transplantations from January 2008 to December 2018 at Kaohsiung Veterans General Hospital. The patients' age, sex, indication for corneal transplantation, and the surgical technique were recorded and analyzed. RESULTS: In total, 336 patients (421 eyes) were included in our study from January 1, 2008, to December 31, 2018. The mean age was 63.6±15.3 years; 371 penetrating keratoplasty (88.1%), 35 deep anterior lamellar keratoplasty (8.3%), and 15 Descemet-stripping automated endothelial keratoplasty (3.6%) were performed. The leading indication for corneal transplantation was regraft (n=103, 24.5%), followed by bullous keratopathy (n=82, 19.5%), corneal scar and opacity (n=79, 18.8%), keratitis (n=59, 14.0%), corneal dystrophy (n=58, 13.8%), other indications (n=26, 6.2%), and keratoconus (n=14, 3.3%). CONCLUSION: The indications for corneal transplantations changed with time in Taiwan. Regraft was the leading indication, but there was a decreasing trend over time. The proportion of bullous keratopathy increased significantly over the past decade and is the second most common indication, similar to the most developed countries. Both corneal scar and opacity, and keratitis showed a decreasing trend of occurrence compared with a previous study in Taiwan. The proportion of keratoconus remained low, making it the least common indication for corneal transplantation.

Increased risk of periodontitis among patients with Crohn's disease: a population-based matched-cohort study.

BACKGROUND: Periodontitis is a frequently cited extraintestinal manifestation of Crohn's disease (CD). Despite a plethora of investigations and a recent meta-analysis linking CD and periodontitis, no study has estimated the risk of periodontitis among CD patients with respect to a comparison group nor has any investigation analyzed the effect of CD-specific medications on the risk of periodontitis. The present cohort study compared CD patients and matched subjects without a history of inflammatory bowel disease (IBD) to estimate the effect of CD and CD-specific pharmaceutical prescriptions on the risk of developing periodontitis by leveraging a population-based dataset in Taiwan. METHODS: We sourced 6657 CD patients and 26,628 comparison subjects without a history of IBD from the Taiwan National Health Insurance Database. Cox proportional hazards regressions were used to estimate the risk of subsequent periodontitis by CD status and pharmaceutical prescription during the follow-up period. RESULTS: After adjusting for socioeconomic status (SES), urbanicity, selected medical co-morbidities, and CD-specific pharmaceutical prescriptions, the hazard ratio (HR) for subsequent periodontitis among patients with CD was 1.36 (95% CI = 1.25-1.48) that of comparison subjects. There was not a significant difference in risk between genders or across ages. Steroids (95% CI = 0.66-0.77) appeared to confer a protective effect and Aspirin, Plavix, and Licodin were marginally protective (95% CI = 0.76-0.95). CONCLUSION: This is the first study to report an increased HR for subsequent periodontitis among CD patients when compared to matched comparison subjects without IBD. The protective effect of some pharmaceuticals may suggest that treatment of CD protects against periodontitis.

Randomized comparison of group versus individual educational interventions for pregnant women to reduce their secondhand smoke exposure.

BACKGROUND: Secondhand smoke (SHS) exposure is deleterious to pregnant women and their unborn children. The prevalence of SHS exposure among pregnant women is particularly high in many Asian countries where approximately half of the male population smokes. We aim to investigate the efficacy of an intervention based on an expanded Health Belief Model (HBM) incorporating self-efficacy to educate and empower pregnant women to reduce their SHS exposure. METHODS: We conducted a 3-arm randomized controlled trial (N = 50 in each arm) comparing the effectiveness of group-based and individual-based interventions with a treatment-as-usual group. A questionnaire tapping into constructs of the expanded HBM was administered at baseline and 1- and 2-month follow-ups. Exhaled carbon monoxide was used to determine SHS exposure (>=6 ppm). ANOVA was used to compare HBM construct scores, self-efficacy for rejecting SHS exposure, and SHS rejection behavior among the 3 groups at baseline and the 1- and 2-month follow-ups, while logistic regression analysis was used to compare the risk of exposure to SHS at each follow-up. RESULTS: The group-based intervention significantly improved health beliefs, self-efficacy, and self-reported rejection behaviors. The individual-based intervention effect was limited to some health belief constructs and SHS rejection behaviors. Both group- and individual-based interventions showed significant reductions in SHS exposure 2 months after the intervention (P < 0.0001). CONCLUSION: Group-based educational interventions based on the HBM are particularly effective in training pregnant women to avoid and refuse exposure to SHS. Policy makers should consider offering group-delivered programs to educate and empower pregnant women to reduce their SHS exposure.

The Role of Physical Activity in Harm Reduction among Betel Quid Chewers from a Prospective Cohort of 419,378 Individuals.

OBJECTIVE: To assess the benefits of regular exercise in reducing harms associated with betel quid (BQ) chewing. METHODS: The study cohort, 419,378 individuals, participated in a medical screening program between 1994 and 2008, with 38,324 male and 1,495 female chewers, who consumed 5-15 quids of BQ a day. Physical activity of each individual, based on "MET-hour/week", was classified as "inactive" or "active", where activity started from a daily 15 minutes/day or more of brisk walking (≥3.75 MET-hour/week). Hazard ratios for mortality and remaining years in life expectancy were calculated. RESULTS: Nearly one fifth (18.7%) of men, but only 0.7% of women were chewers. Chewers had a 10-fold increase in oral cancer risk; and a 2-3-fold increase in mortality from lung, esophagus and liver cancer, cardiovascular disease, and diabetes, with doubling of all-cause mortality. More than half of chewers were physically inactive (59%). Physical activity was beneficial for chewers, with a reduction of all-cause mortality by 19%. Inactive chewers had their lifespan shortened by 6.3 years, compared to non-chewers, but being active, chewers improved their health by gaining 2.5 years. The improvement, however, fell short of offsetting the harms from chewing. CONCLUSIONS: Chewers had serious health consequences, but being physically active, chewers could mitigate some of these adverse effects, and extend life expectancy by 2.5 years and reduce mortality by one fifth. Encouraging exercise, in addition to quitting chewing, remains the best advice for 1.5 million chewers in Taiwan.

Scoliosis and the Subsequent Risk of Depression: A Nationwide Population-based Cohort Study in Taiwan.

STUDY DESIGN: A retrospective cohort study by using the Taiwanese National Health Insurance Research Database (NHIRD). OBJECTIVE: The purpose of this study is to conduct a large-scale cohort study to investigate the relationship between scoliosis and depression. SUMMARY OF BACKGROUND DATA: The association between scoliosis and depression has rarely been studied in Asian populations. METHODS: The study cohort consisted of patients with diagnosis of scoliosis between 2003 and 2005 (N = 1409). A comparison cohort was constructed from five age- and gender-matched control subjects selected via random sampling (N = 7045). Data on adjusted hazard ratios (AHRs) of depression, 5-year freedom from depression rates, and risk factors for depression for the two cohorts were compared. All subjects were tracked for 5 years from the date of cohort entry to identify the development of depression. Cox proportional hazard regressions were performed to evaluate the 5-year freedom from depression rates. This study is supported by the University research grant without any study-specific conflicts. RESULTS: During the 5-year follow-up period, 116 and 307 depression patients belonged to the scoliosis cohort and the comparison cohort, respectively. The AHRs of depression in patients with scoliosis was higher [AHR 1.95; 95% confidence interval (95% CI) 1.58-2.42; P < 0.001] than that of the controls during the 5-year follow-up. The risk of depression also demonstrated to be age-dependent for scoliosis patients. The middle-age (41-65 years old) and young adults (18-40 years old) scoliosis patients had higher AHRs (middle-age: AHR 2.45; 95% CI 1.67-3.59; P < 0.05; young adult: AHR 1.99; 95% CI 1.41-2.82; P < 0.05). CONCLUSION: The population-based study indicated that patients with scoliosis may have an increased risk of depression. Health care professionals should consider designing and planning effective psychological prevention and treatment for scoliosis patients. LEVEL OF EVIDENCE: 4.

Traumatic brain injury and affective disorder: A nationwide cohort study in Taiwan, 2000-2010.

BACKGROUND: Studies investigating the relationship between head injury and the subsequent onset of affective disorders often show conflicting results. AIMS: To investigate the risk of affective disorders following traumatic brain injury in a large Taiwanese cohort. METHOD: This retrospective cohort study makes use of the National Health Insurance Research Database. A cohort containing 68,376 individuals who experienced traumatic brain injury (TBI) during 2000-2010 and had no prior history of mental disorders before the injury was identified. Using Cox Proportional Hazards regression, the subsequent risk of affective disorders was determined. RESULTS: TBI was associated with a higher risk of both bipolar disorder (Hazard Ratio [HR]=1.42, 95% Confidence Interval [CI]=[1.26, 1.59]) and major depression (HR=1.41, 95% CI=[1.28, 1.54]). More severe injury was associated with greater risk. The first year following the injury was the highest risk period for major depression, while the highest risk period for bipolar disorder was delayed until two to four years following the injury. LIMITATIONS: Using a claims database, we were unable to assess confounding variables that were not contained in the data set. CONCLUSIONS: The elevated risks of affective disorders after TBI speak to the psychiatric need of individuals who suffer from brain injury. Early detection and timely intervention may help prevent secondary and tertiary disability associated with head trauma.