Mental health in biological disasters: From SARS to COVID-19.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), like severe acute respiratory syndrome (SARS), provokes fear, anxiety and depression in the public, which further affects mental health issues. Taiwan has used their experience of the SARS epidemic for the management of foreseeable problems in COVID-19 endemic. AIM/OBJECTIVE: This review summarizes issues concerning mental health problems related to infectious diseases from current literatures. RESULTS: In suspected cases under quarantine, confirmed cases in isolation and their families, health care professionals, and the general population and related effective strategies to reduce these mental health issues, such as helping to identify stressors and normalizing their impact at all levels of response as well as public information and communication messages by electronic devices. The importance of community resilience was also addressed. Psychological first aid, psychological debriefing, mental health intervention and psychoeducation were also discussed. Issues concerning cultures and religions are also emphasized in the management plans. CONCLUSION: Biological disaster like SARS and COVID-19 not only has strong impact on mental health in those being infected and their family, friends, and coworkers, but also affect wellbeing in general public. There are evidenced that clear and timely psychoeducation, psychological first aid and psychological debriefing could amileorate negative impact of disaster, thus might also be helpful amid COVID-19 pandemic.

Challenge and strategies of infection control in psychiatric hospitals during biological disasters-From SARS to COVID-19 in Taiwan.

Psychiatric hospitals play an important role in supporting patients with mental illness to relieve symptoms and improve functioning in a physically and psychologically safe environment. However, these hospitals are also vulnerable to emerging infectious diseases. In early 2020, a psychiatric hospital and a psychiatric unit were reported to have nosocomial coronavirus disease 2019 (COVID-19) infection. A large number of patients and staff were severely impacted. This type of nosocomial infection threatens patient safety and quality of care. By learning from previous experiences of severe acute respiratory syndrome (SARS) and previous studies, psychiatric hospitals can provide safeguards to prevent nosocomial infection among patients and staff during an epidemic or biological disaster. These strategies include a series of actions such as following national guidelines for infection control, reserving adequate support for disinfection equipment, providing relevant and sufficient pro-service and in-service education and training, establishing regular surveillance of hand hygiene habits, proper communication and health education, and providing opportunities for vaccination if possible. Based on the harm reduction concept, staff division of office breaks and ward classification and shunting are recommended and should be further implemented.

Comparison of Elixhauser and Charlson Methods for Discriminative Performance in Mortality Risk in Patients with Schizophrenic Disorders.

Although Charlson Comorbidity Index scores (CCIS) and Elixhauser comorbidity index scores (ECIS) have been used to assess comorbidity in patients with schizophrenia, only CCIS, not ECIS, have been used to predict mortality in this population. This nationwide retrospective study investigated discriminative performance of mortality of these two scales in patients with schizophrenia. Exploiting Taiwan's National Health Insurance Research Database (NHRID), we identified patients diagnosed with schizophrenia discharged from hospitals between Jan 1, 1996 and Dec 31, 2007. They were followed up for subsequent death. Comorbidities presented one year prior to hospital admissions were identified and adapted to the CCIS and ECIS. Discriminatory ability was evaluated using the adjusted hazard ratio and Akaike information criterion (AIC) and Harrell's C-statistic. We identified 58,771 discharged patients with schizophrenic disorders and followed them for a mean of 10.4 years, 16.6% of whom had died. Both ECIS and CCIS were significantly associated with mortality, but ECIS had superior discriminatory ability by a lower AIC and higher Harrell's C-statistic (201231 vs. 201400; 0.856 vs. 0.854, respectively). ECIS had better discriminative performance in mortality risk than CCIS in patients with schizophrenic disorders. Its use may be encouraged for risk adjustment in this population.

The risk of bone fracture after long-term risperidone exposure is not increased compared to other atypical antipsychotics: A retrospective cohort study.

OBJECTIVE: Antipsychotic agents can increase circulating serum prolactin levels, potentially leading to osteoporosis and increased risk of bone fracture. The risk appears to be lower for atypical antipsychotics. We investigated whether risperidone was associated with an increased fracture risk by estimating the incidence of hip/femur and non-hip/femur fractures in users of risperidone, other atypical, and typical antipsychotics. METHODS: This retrospective cohort study with a nested case-control study used claims data from the Taiwan National Healthcare Insurance database. All new users of antipsychotics between 2000-2012 were included. Incident fractures were identified using ICD-9 codes from inpatient records. Cox proportional hazards models compared fracture incidence among exposure groups. Conditional logistic regression models compared antipsychotic exposure among fracture cases versus matched controls. RESULTS: 340,948 patients were included in the analysis. There were 2832 hip/femur fractures and 2693 non-hip/femur fractures: Hip/femur fracture incidence 636.8/100,000 person-years (Risperidone), 885.7/100,000 person-years (Other Atypical), 519.4/100,000 person-years (Typical). The adjusted hazard ratio of hip/femur fracture was 0.92 (95%CI 0.84-1.01) comparing Other Atypical with Risperidone, and 1.00 (95%CI 0.89-1.11) comparing Typical with Risperidone. The adjusted hazard ratio of non-hip/femur fracture was 1.08 (95%CI 0.98-1.20) for Other Atypical versus Risperidone, and 1.10 (95%CI 0.99-1.22) for Typical versus Risperidone. The adjusted odds ratio for hip/femur fractures was 0.92 (95% CI 0.83-1.01) in cases and controls exposed to other atypical antipsychotics compared with risperidone for 1 year prior to fracture date, 0.97 (95% CI 0.87-1.07) during 1-3 years, and 0.92 (95% CI 0.81-1.06) during 3-5 years prior to fracture date. The adjusted odds ratio for non-hip/femur fractures were 1.11 (95% CI 0.99-1.24), 1.02 (95% CI 0.0.91-1.14), and 0.95 (95% CI 0.82-1.09), respectively. CONCLUSION: There was no increased risk of bone fracture in long-term users of risperidone compared to users of other atypical antipsychotics.

Depression may not be a risk factor for mortality in stroke patients with nonsurgical treatment: A retrospective case-controlled study.

Patients with depression have more comorbidities than those without depression. The cost of depression-associated comorbidities accounts for the largest portion of the growing cost of depression treatment. Patients with depression have a higher risk of stroke with poor prognoses than those without depression; however, previous studies evaluating the relationship between depression and stroke prognosis have not accounted for surgical treatment or other risk factors. Therefore, we investigated whether depression is a risk factor for mortality in stroke patients with nonsurgical treatment after adjusting for other risk factors.We retrospectively analyzed the data of patients with major depressive disorder (MDD) and age and sex-matched controls without MDD during 1999 to 2005. We then identified patients who developed stroke in both groups and analyzed risk factors for death in these stroke patients who received nonsurgical treatments during a follow-up period from 2006 to 2012.Patients with MDD had higher Charlson Comorbidity Index Scores (CCISs) and exhibited higher frequencies of comorbidities such as diabetes mellitus, hypertension, hyperlipidemia, and coronary heart disease than controls without MDD, and most of MDD patients had very low or high socioeconomic status (SES) and lived in urban settings. Most stroke patients with MDD who received nonsurgical treatment were female, had very low or high SES, and lived in urban settings; in addition, stroke patients with MDD who received nonsurgical treatment had higher CCISs and frequencies of hyperlipidemia and coronary heart disease than those without MDD who received nonsurgical treatment. However, depression was not a risk factor for death in stroke patients with nonsurgical treatment.Hemorrhagic stroke, age, sex, and CCISs were risk factors for death in stroke patients with nonsurgical treatment, but depression did not affect the mortality rate in these patients.

Reduced risk of stroke among psychiatric patients receiving ECT: A population-based cohort study in Taiwan.

Electroconvulsive therapy (ECT) as well as the diseases it treats have been associated with stroke and cognitive impairment. We investigate the relationship between ECT and the subsequent development of stroke in patients with different severe mental illnesses. Tapping Taiwan's National Health Insurance Research Database, we identified patients diagnosed with severe mental illnesses who had received ECT between Jan 1, 2002 and Dec 31, 2007. A comparison cohort was constructed of patients who were matched by age, gender, and diagnosis but did not receive ECT. The patients were then followed up for occurrence of subsequent new-onset stroke. We identified 6264 patients had been diagnosed with mental illness and had received ECT. They were matched with 18,664 mentally ill patients who had not. The study cohort had a lower incidence of subsequent stroke than the matched controls, after controlling for age, diabetes, hypertension, coronary heart disease and enrollee sociodemographic category, risk factors for stroke in both study and control cohorts. ECT is associated with reduced risk of subsequent stroke in patients with severe mental illnesses in Taiwan. Therefore, clinicians should not let risk of stroke stop them from suggesting ECT to physically healthy patients who might benefit from this therapy.

Cancer in patients with schizophrenia: What is the next step?

People with schizophrenia, who constitute approximately 0.3-1% of the general population, have a nearly 20% shorter life expectancy than the general population. The incidence of varied types of cancers in patients with schizophrenia is controversial. The majority of previous research has demonstrated that patients who have schizophrenia and cancer have early mortality compared to the general population with cancer. The causes of early mortality in patients with schizophrenia and cancer might be attributed to a lower cancer screening rate and lack of effective treatment, including: (i) patient factors, such as poor lifestyle, passive attitude toward treatment, or comorbidity; (ii) physician factors, such as physician bias, which may decrease the delivery of care for individuals with mental disorders; and (iii) hospital administration factors, such as stigma and discrimination. Additional studies on patients with schizophrenia and cancer are warranted and should include the following: a comprehensive review of previous studies; a focus on differentiating the specific types of cancer; and methods for improvement. To decrease the early mortality of patients with schizophrenia, the following measures are proposed: (i) enhance early detection and early treatment, such as increasing the cancer screening rate for patients with schizophrenia; (ii) provide effective, timely treatment and rehabilitation; (iii) improve patients' psychiatric symptoms and cognitive impairment; (iv) promote healthy behavior in the general population and emphasize healthy lifestyles in vulnerable populations; and (v) remove the stigma of schizophrenia. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this group of patients.

The risks of major osteoporotic fractures in patients with schizophrenia: a population-based 10-year follow-up study.

OBJECTIVE: The aim of the study is to explore the incidence and the risks associated with major osteoporotic fractures, all-cause mortality with osteoporotic fractures and the effect of the psychiatric drug exposure in patients with schizophrenia during a 10-year follow-up period. METHODS: Two nationwide cohorts were selected from the Taiwan National Health Insurance Research Database (NHIRD) consisting of 30,335 patients with schizophrenia (age ≥ 40 years) and 121,340 age- and sex-matched control participants without schizophrenia. The psychiatric proportion of days covered (PDC) is an indicator of the intensity of drug exposure in patients with schizophrenia. The incidence and risk factors of major osteoporotic fractures were calculated for both cohorts. Additionally, the patient survival rate after major osteoporotic fractures was also calculated. RESULTS: During a 10-year follow-up period, 1677 (5.53%) schizophrenia and 4257 (3.51%) control subjects had major osteoporotic fractures (P < 0.001). The schizophrenia patients with a PDC > 0.1 showed a significantly higher incidence of major osteoporotic fractures than did the non-schizophrenia controls; however, those with a psychiatric PDC ≤ 0.1 did not. After adjustment, the psychiatric PDC was significantly and independently associated with the risk of major osteoporotic fractures except some medical morbidities but the schizophrenia diagnosis was not. In addition, among all 5934 patients with major osteoporotic fracture, the adjusted mortality hazard ratio for psychiatric PDC was 1.92 (95% CI = 1.63-2.26). CONCLUSIONS: Patients with schizophrenia are at a higher risk for major osteoporotic fractures than the general population and also have a higher mortality rate due to major osteoporotic fractures. These findings may be caused by psychiatric drug use rather than schizophrenia, which suggests that directions can be taken in future studies.

Association of hypnotics with stroke risk: a population-based case-control study.

BACKGROUND: The aim of this study was to determine what association, if any, hypnotics have on the risk of stroke events. METHOD: In a nationwide population-based case-control study, cases were patients with incident stroke diagnosed between January 1, 2006, and December 31, 2006. Patients with hemorrhagic or ischemic stroke diagnosis codes (ICD-9-CM codes 430-438) and who had been hospitalized for further treatment were included in the study. Patients with any type of stroke diagnosed before 2006 were excluded. The authors selected 2,779 stroke patients and 27,790 controls matched for age, gender, physician visit date, and comorbidities. The impact of hypnotics on stroke was examined by multiple logistic regression models and sensitivity analyses. RESULTS: Individuals prescribed any hypnotic had elevated risk of stroke compared to those prescribed no hypnotics. For groups prescribed 1-27, 28-148, and ≥ 149 pills, odds ratios for stroke were 1.71 (95% CI, 1.49-1.96), 1.84 (95% CI, 1.62-2.11), and 1.45 (95% CI, 1.26-1.68), respectively. Adjusted odds ratios were elevated in separate analyses for zolpidem and estazolam. The observed results were robust with stratification by comorbidities, such as hypertension and diabetes, and using ischemic stroke as the case group. CONCLUSIONS: This study shows that, in a case-control study matched for age, gender, and comorbidities using multiple logistic regression and sensitivity tests, zolpidem and estazolam were slightly associated with an increased risk of stroke. Further large-scale and in-depth studies should be performed. Use of hypnotics should always be determined by specialists, and adverse effects should be continuously monitored.

Is low individual socioeconomic status (SES) in high-SES areas the same as low individual SES in low-SES areas: a 10-year follow-up schizophrenia study.

OBJECTIVE: This study investigates the relationship between individual and neighborhood socioeconomic status (SES) and mortality among patients with schizophrenia. METHODS: A study population was identified from the National Health Insurance Research Database (NHIRD) prior to the end of 1999 that included 60,402 patients with schizophrenia. Each patient was tracked until death or to the end of 2009. Individual SESs were defined by enrollee category. Neighborhood SES was defined by enrollee category (as a proxy for occupation) and education, which were classified according to the conventions of Hollingshead. Neighborhoods were also grouped into advantaged and disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rate between the different SES groups after adjusting for possible confounding factors and risk factors. RESULTS: During the 10-year follow-up period, the mortality rates among high, moderate, and low individual SES groups were 12.22, 14.75, and 18.48%, respectively (P < 0.001). Schizophrenia patients with low individual SESs in disadvantaged neighborhoods had a risk of death that was 18-22% higher than that of those with high individual SES in advantaged neighborhoods. The analysis of the combined effect of individual SES and neighborhood SES revealed that the death rates were highest among those with low individual SES and low neighborhood SES (P < 0.001). CONCLUSIONS: Schizophrenia patients with low individual SES in disadvantaged neighborhoods have the highest risk of mortality despite a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.

The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study.

OBJECTIVE: This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder. METHODS: This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors. RESULTS: A total of 472 (2.81%) patients with bipolar disorder and 1,443 (2.14%) controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12-1.38; p<0.0001) after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8%) patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06-1.55; p = 0.012) after adjusting for patient, physician and hospital variables. CONCLUSIONS: The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period.

The incidence and all-cause mortality of pneumonia in patients with schizophrenia: a nine-year follow-up study.

OBJECTIVE: This study sought to estimate the incidence, all-cause mortality and relative risks for patients with schizophrenia after a pneumonia diagnosis. METHODS: The population was identified from the Taiwanese National Health Insurance Research Database (NHIRD) in 1999 and included 59,021 patients with schizophrenia and 236,084 age- and sex-matched control participants without schizophrenia. These participants were randomly selected from the 23,981,020-participant NHIRD, which contain 96% of the entire population. Using the 2000-2008 NIHRD, the incidence and nine-year pneumonia-free survival rate of pneumonia (ICD-9-CM codes 486 and 507.0-507.8) were calculated. RESULTS: Over nine years, 6055 (10.26%) patients with schizophrenia and 7844 (3.32%) controls had pneumonia. The pneumonia incidence density was 11.4/1000 person-years among the patients with schizophrenia, who experienced a 3.09-fold increased risk of developing pneumonia. After adjusting for other covariates, the patients with schizophrenia still experienced a 1.77-fold increased risk of developing pneumonia. Although, without adjustment, fewer schizophrenia patients than controls died after having pneumonia (2121 [35.12%] vs. 3497 [44.62%]), after adjusting for other variables, the mortality hazard ratio for patients with schizophrenia was 1.39. CONCLUSIONS: During a nine-year follow-up, the likelihood of developing pneumonia and all-cause mortality among patients with schizophrenia was higher than that of the non-schizophrenia group as was the mortality rate. Interestingly, the psychiatric proportion of days covered (PDC) was positively associated with pneumonia (OR: 2.51) but negatively associated with death (HR: 0.72). These findings imply the importance of iatrogenic factors and psychotropic drugs (including their benefits and side effects) and highlight the directions for future studies.

The incidence and relative risk of stroke in patients with schizophrenia: a five-year follow-up study.

OBJECTIVE: This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality in patients with schizophrenia. METHODS: This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 80,569 patients with schizophrenia and 241,707 age- and sex-matched control participants without schizophrenia. The participants were randomly selected from the 23,981,020-participant NHIRD, which consists of 96% Taiwanese participants. Participants who had experienced a stroke between 1999 and 2003 were excluded. Using data from the NHIRD between 2004 and 2008, the incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups. After adjusting for confounding risk factors, a Cox proportional-hazards model was used to compare the five-year stroke-free survival rate to the all-cause mortality rate across the two cohorts. RESULTS: Over five years, 1380 (1.71%) patients with schizophrenia and 2954 (1.22%) controls suffered from strokes. After adjusting for demographic characteristics and comorbid medical conditions, patients with schizophrenia were 1.13 times more likely to have a stroke (95% CI=1.05-1.22; P=0.0006). In addition, 1039 (24%) patients who had a stroke died during the follow-up period. After adjusting for patient, physician and hospital variables, the all-cause mortality hazard ratio for patients with schizophrenia was 1.23 (95% CI=1.06-1.41; P=0.0052). CONCLUSIONS: During a five-year follow-up, the likelihood of developing a stroke and the all-cause mortality rate were greater among patients with schizophrenia as compared with the control group.

The incidence and relative risk factors for developing cancer among patients with schizophrenia: a nine-year follow-up study.

OBJECTIVE: To estimate the incidence and relative risk of developing cancer as well as the mortality rate after cancer diagnosis for patients with schizophrenia compared with the general population. METHODS: Our population for this study was identified before the end of 1999. The study included 59,257 patients with schizophrenia and 178,156 age- and gender-matched individuals without schizophrenia as controls, who were selected from the 23,981,020 subjects in the National Health Insurance Research Database (NHIRD), which consists of 96% of the entire Taiwanese population. From the 2000 to 2008 NHIRD, we calculated the cancer incidence and survival time after cancer diagnosis in each of the two groups. Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), the cancers were divided into nine groups. RESULTS: During the nine-year follow-up period, 1145 (1.93%) of the patients with schizophrenia and 5294 (2.97%) of the control group developed cancer. The patients with schizophrenia had a significantly lower cancer incidence than those in the control group in both the male (OR=0.50, 95% CI, 0.46-0.55) and female (OR=0.81, 95% CI, 0.74-0.88) populations. Patients with schizophrenia were less likely to develop cancer than individuals in the control group for every cancer type except breast and cervical/uterine cancer. After adjustment using the Cox regression model, patients with schizophrenia had an overall decreased cancer risk (adjusted hazard ratio 0.71, 95% CI, 0.66-0.76) compared to the control population. For all cancer patients, the mortality adjusted hazard ratio for patients with schizophrenia versus the control group was 1.36 (95% CI, 1.24-1.50) after adjusting for other variables. CONCLUSIONS: Although the likelihood of developing cancer among patients with schizophrenia (0.64) was less than that of the non-schizophrenia group, the mortality rate among patients with schizophrenia was higher than that of the control group.

The establishment of a standard operation procedure for psychiatric service after an earthquake.

This study presents information on the design and creation of a standard operation procedure (SOP) for psychiatric service after an earthquake. The strategies employed focused on the detection of survivors who developed persistent psychiatric illness, particularly post-traumatic stress and major depressive disorders. In addition, the study attempted to detect the risk factors for psychiatric illness. A Disaster-Related Psychological Screening Test (DRPST) was designed by five psychiatrists and two public health professionals for rapidly and simply interviewing 4,223 respondents within six months of the September 1999 Chi-Chi earthquake. A SOP was established through a systemic literature review, action research, and two years of data collection. Despite the limited time and resources inherent to a disaster situation, it is necessary to develop an SOP for psychiatric service after an earthquake in order to assist the high number of survivors suffering from subsequent psychiatric impairment.

A three-year follow-up study of the psychosocial predictors of delayed and unresolved post-traumatic stress disorder in Taiwan Chi-Chi earthquake survivors.

AIMS: To predict the longitudinal course of post-traumatic stress disorder (PTSD) in survivors three years following a catastrophic earthquake using multivariate data presented six months after the earthquake. METHODS: Trained assistants and psychiatrists used the Disaster-related Psychological Screening Test (DRPST) to interview earthquake survivors 16 years and older and to assess current and incidental psychopathology. A total of 1756 respondents were surveyed over the three-year follow-up period. RESULTS: A total of 38 (9.1%) of the original 418 PTSD subjects and 40 of the original 1338 (3.0%) non-PTSD subjects were identified as having PTSD at the 3-year post-earthquake follow up. Younger age, significant financial loss, and memory/attention impairment were predictive factors of unresolved PTSD and delayed PTSD. CONCLUSIONS: The longitudinal course of PTSD three years after the earthquake could be predicted as early as six months after the earthquake on the basis of demographic data, PTSD-related factors, and putative factors for PTSD.

A comparison of quality of life and depression between female married immigrants and native married women in Taiwan.

BACKGROUNDS: Immigration to Taiwan is often connected with marriage, resulting in the presence of so-called married immigrants or foreign brides. AIMS: To compare the quality of life (QOL) and prevalence of depression between female married immigrants and native married women. METHODS: Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the disaster-related psychological screening test (DRPST) to interview 1,602 married women who were 16-50 years of age. Half (801) of the participants were female immigrants, whilst the remainder comprised the age-matched control group that consisted of 801 native married women. Participants who scored C2 (probable major depressive episode) on the DRPST were assessed according to DSM-IV criteria by a senior psychiatrist. The MOS SF-36 measures QOL and has two dimensions: the physical component summary (PCS) and the mental component summary (MCS). RESULTS: Married immigrants had a lower prevalence (3.5%) of major depressive episodes than native women (8.9%) in Taiwan. Variables such as an increased severity of psychosocial impact were the best predictors of a lower PCS and MCS. CONCLUSION: Compared to Taiwanese native married women, fewer married immigrants had stressful life events or depression, and they reported higher QOL. After controlling for putative confounding factors, the married immigrants still had better mental QOL and a lower prevalence rate of depression

The relationship between quality of life and posttraumatic stress disorder or major depression for firefighters in Kaohsiung, Taiwan.

OBJECTIVE: The work of firefighters involves the risk of exposure to the harmful effects of toxic substances as well as the possibility of enormous emotional shock from disasters, which may result in psychiatric impairments and a lower quality of life. Therefore, we examined quality of life, prevalence of posttraumatic stress disorder (PTSD) and major depression, and the related risk factors for firefighters in Kaohsiung, Taiwan. METHODS: This is a two-stage survey study. During the first stage, we used the 36-item Short-Form Health Survey (SF-36) and the Disaster-Related Psychological Screening Test (DRPST) to assess quality of life, probable PTSD, probable major depression, and the related risk factors for 410 firefighters. During the second stage, psychiatrists categorized these probable cases according to self-reported questionnaires against DSM-IV into PTSD or major depression group, subclinical group, and health group. All the data were analyzed with SPSS 10.0 Chinese version. RESULTS: The estimated current prevalence rates for major depression and PTSD were 5.4% (22/410) and 10.5% (43/410), respectively. The firefighters with estimated PTSD or major depression scored significantly lower on quality of life measures than subclinical PTSD/major depression and mentally healthy groups, which was evident in eight concepts and two domains of the SF-36. The major predictors of poor quality of life and PTSD/major depression were mental status, psychosocial stressors, or perceived physical condition. CONCLUSION: Firefighters have a higher estimated rate of PTSD, and the risk factors that affect quality of life and PTSD/major depression should encourage intervention from mental health professionals.

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.