Correlates and psychiatric disorders associated with psychotropic drug use in Taiwan.

PURPOSE: We used the population-based National Health Insurance database to investigate correlates and psychiatric disorders associated with psychotropic drug use in Taiwan. METHODS: The National Health Research Institute provided a database of 200,000 random subjects for study. We obtained a random sample of 145,304 subjects aged 18 years or older in 2004. Study subjects who had made at least two psychotropic drug prescriptions during this year were identified. We detected factors associated with psychotropic drug use. In addition, we examined the prevalence of antipsychotic, antidepressant, mood stabilizer, sedative-hypnotic-anxiolytic (SHA) agent, and any psychotropic drug use according to psychiatric disorders. RESULTS: Higher prevalence of any psychotropic drug use was found in the 25-44, 45-64, and 65 or older age groups, females, aborigine, with a lower premium, with disability, and among those who lived in central region, suburban or rural area. Among those subjects with any major psychiatric disorders, the prevalence of antipsychotic, antidepressant, mood stabilizer, SHA agent, and any psychotropic drug use were 59.3, 49.7, 17.9, 78.6, and 92.0%, respectively. Among those subjects with any minor psychiatric disorders, the prevalence of antipsychotic, antidepressant, mood stabilizer, SHA agent and any psychotropic drug use were 17.5, 41.8, 4.0, 85.5, and 89.4%, respectively. CONCLUSIONS: Thus, those subjects with any psychiatric disorders had a high percentage of any psychotropic drug use in National Health Insurance program in Taiwan. Future studies should focus on the outcome evaluation and correlates associated with individual psychotropic use.

Prevalence of diabetes in patients with schizophrenia in Taiwan: a population-based National Health Insurance study.

OBJECTIVE: We conducted this study to investigate the prevalence and correlates of diabetes in patients with schizophrenia in Taiwan. METHODS: The National Health Research Institute provided a database of 1,000,000 random subjects for study. We obtained a random sample aged 18 years and over of 766,427 subjects in 2005. Those study subjects who had at least one service claim during this year for either ambulatory or inpatient care, with a primary diagnosis of schizophrenia or with a prescription for treatment of diabetes, were identified. RESULTS: The prevalence of diabetes in patients with schizophrenia was higher than in the general population (7.90% vs. 5.57%, odds ratio [OR], 1.81; 95% confidence interval [CI], 1.61-2.03). Compared with the general population, patients with schizophrenia revealed a higher prevalence of diabetes in all age groups, except age 70 or more years; among females (10.30% vs. 5.42%, p<0.001), and males (5.93% vs. 5.73%, p<0.001); among all insurance amount groups; among those living in the northern (7.56% vs. 4.89%, p<0.001), central (8.26% vs. 5.61%, p<0.001), southern regions (8.45% vs. 6.62%, p<0.001); and among residents living in urban (8.18% vs. 5.19%, p<0.001) and rural areas (7.99% vs. 6.15%, p<0.001). CONCLUSIONS: Patients with schizophrenia had a much higher prevalence of diabetes in younger adult age groups and in females than in the general population, a finding that deserves further biological and psychosocial study in the future.

Prevalence, correlates, and disease patterns of antipsychotic use in Taiwan.

AIM: The population-based National Health Insurance database was used to investigate the prevalence, correlates, and disease patterns of antipsychotic use in Taiwan. METHODS: The National Health Research Institutes provided a database of 200,000 random subjects for study. A random sample of 145 304 subjects was obtained, aged > or =18 years in 2004. Study subjects who had been given at least two antipsychotic drug prescriptions during this year were identified. The factors associated with any antipsychotic use were identified. The proportion of antipsychotic use for psychiatric and non-psychiatric disorders was also examined. RESULTS: The 1-year prevalence of antipsychotic use was 3.5%. Antipsychotic use was found to be more prevalent by age; for women; for individuals with a lower insurance amount; for individuals with disability; and among those subjects who lived in the central or southern area. Among subjects with antipsychotic use, higher proportions of psychiatric disorders were found for schizophrenia, anxiety state, major depressive disorder, neurotic depression, dementia, and bipolar disorder. With respect to medical disorder, higher proportions of antipsychotic use were found for diseases of the digestive system; symptoms, signs, and ill-defined conditions; diseases of the respiratory system, musculoskeletal system and connective tissue, circulatory system, nervous system and sense organs, and genitourinary system. CONCLUSIONS: Higher proportions of antipsychotic use were found for schizophrenia, depressive disorder, anxiety disorder, dementia, and bipolar disorder. More than 60% of subjects used antipsychotics for non-psychiatric disorders in Taiwan, which deserves further study for the sake of patient safety.

The treated prevalence and incidence of bipolar disorder among national health insurance enrollees in Taiwan, 1996-2003.

We used the NHI database to estimate the treated prevalence and incidence of bipolar disorder. The national health research institute (NHRI) provided a population based data file of 200,432 random subjects, about 1% of the population, for the study. We obtain a random sample of 136,045 subjects as a fixed cohort from 1996 to 2003. We identified study subjects who had at least one service claim during these years for either ambulatory or inpatient care with a principal diagnosis of bipolar disorder. The cumulative treated prevalence increased from 0.60 per 1,000 to 4.51 per 1,000 from 1996 to 2003. The annual treated incidence was around 0.48 per 1,000 per year to 0.71 per 1,000 per year during 1997-2003. Higher treated incidence was detected in the 45-64 (hazard ratio [HR], 1.63; 95% CI, 1.26-2.12) and 65 years or older age groups (HR, 1.57; 95% CI, 1.14-2.15), female (HR, 1.23; 95% CI, 1.04-1.46), non-aborigine (HR, 3.12; 95% CI, 1.26-7.75), with a fixed premium (HR, 1.60; 95% CI, 1.18-2.17), and those who lived in the eastern region (HR, 3.26; 95% CI, 2.31-4.59). According to the trends from 1996 to 2003, more persons with bipolar disorder had sought treatment in the NHI program in Taiwan. However, the treated prevalence of bipolar disorder in NHI was still lower than those of community studies in Western countries. In the future, we will continue to use NHI data to perform outcome evaluation and follow-up studies of bipolar disorder.

Treated prevalence and incidence of dementia among National Health Insurance enrollees in Taiwan, 1996-2003.

The National Health Insurance database to determine the treated prevalence and incidence of dementia in Taiwan was used in this study. A population-based random sample of 22 118 subjects aged 65 or older was obtained as a dynamic cohort. Those study subjects who had filed at least one service claim from 1996 to 2003 for either outpatient care or inpatient care with a principal diagnosis of dementia were identified. The annual treated prevalence increased from 0.71% to 1.92% from 1996 to 2003. The annual treated incidence rates were around 0.76% to 1.04% per year from 1997 to 2003. The annual treated incidence rates for the 5-year age groups, from 65 to 90 years and older, were 0.44%, 0.65%, 0.98%, 1.46%, 1.81%, and 1.80%, respectively. Both the treated prevalence and incidence rates of dementia in National Health Insurance were lower than those of community studies.

Trends in the use of psychotropic drugs in Taiwan: a population-based national health insurance study, 1997-2004.

OBJECTIVE: This study examined changes in the use of psychotropic agents in Taiwan between 1997 and 2004. METHODS: The population-based National Health Insurance database was used to detect trends in the use of psychotropic drugs in Taiwan. A dynamic random sample of 200,432 persons was gathered and followed from 1997 to 2004. Persons in the sample who had made at least one service claim during these years for either ambulatory or inpatient care with a psychotropic drug prescription were identified. RESULTS: The prevalence of any psychotropic drug use increased from 7.1% in 1997 to 12.0% in 2004. The changes in prevalence of use of four kinds of psychotropic drugs from 1997 to 2004 were as follows: antipsychotics, 3.4% to 3.7%, although this finding was not significant; antidepressants, 2.2% to 4.4% (p<.001); mood stabilizers, .6% to 1.3% (p<.001); and anxiolytic-hypnotic drugs, 3.0% to 7.3% (p<.001). CONCLUSIONS: Overall, the prevalence of use of three kinds of psychotropic drugs (antidepressants, mood stabilizers, and anxiolytic-hypnotic drugs) increased greatly from 1997 to 2004.

The prevalence and incidence of treated major depressive disorder among National Health Insurance enrollees in Taiwan, 1996 to 2003.

OBJECTIVE: We used the National Health Insurance (NHI) database to examine the prevalence and incidence of treated major depressive disorder (MDD) and their associated factors. METHOD: The National Health Research Institute provided a database of 200 432 randomly selected subjects for study. We obtained a population-based random sample aged 15 years or older (n = 136 045) as a fixed cohort dated 1996 to 2003. We identified study subjects with a principal diagnosis of MDD who had at least one service claim during these years for either ambulatory or inpatient care. RESULTS: From 1996 to 2003, the cumulative treated prevalence increased from 1.67 per 1000 to 17.24 per 1000. From 1997 to 2003, the annual treated incidence increased from 1.89 per 1000 to 2.58 per 1000. A higher incidence of treated MDD was detected in the groups aged 25 to 44 years (hazard ratio [HR] 1.28; 95% confidence interval [CI], 1.13 to 1.45), 45 to 64 years (HR 1.90; 95% CI, 1.66 to 2.16), and 65 years or older (HR 1.87; 95% CI, 1.59 to 2.20); in female subjects (HR 1.97; 95% CI, 1.80 to 2.15); in those with with an insurance amount of US $1281 or more (HR 1.15; 95% CI, 1.01 to 1.31); in those with a fixed premium (HR 1.44; 95% CI, 1.27 to 1.62); and among those who lived in urban areas (HR 1.22; 95% CI, 1.10 to 1.35). CONCLUSIONS: For treated MDD, the prevalence and incidence in Taiwan were lower than in community studies in Western countries. Individuals with MDD are underdiagnosed and undertreated in Taiwan.

Prevalence and incidence of schizophrenia among national health insurance enrollees in Taiwan, 1996-2001.

As many as 96% of all residents of Taiwan have been enrolled in the National Health Insurance (NHI) program since 1996. The NHI database was used to examine the prevalence and incidence of schizoprenia. The National Health Research Institute provided a database of 200 432 random subjects, about 1% of the population, for study. By means of exclusion criteria, a random sample of 136 045 subjects as a fixed cohort dated from 1996-2001 was obtained. Those study subjects who had at least one service claim during these years for either ambulatory or inpatient care, with a principal diagnosis of schizophrenia, were identified. The cumulative prevalence increased from 3.34 per 1000 to 6.42 per 1000 from 1996 to 2001. The annual incidence density decreased from 0.95 per 1000/year to 0.45 per 1000/year from 1997 to 2001. Male subjects had higher treated prevalence in younger age groups than did female subjects. Higher prevalence was associated with the 25-44 and 45-64 age groups, insurance amount less than US$640, the eastern region, and suburban areas. Lower incidence was associated with the 45-64 age group. Higher incidence was associated with insurance amount less than US$640, and the eastern region. According to the trends of cumulative prevalence and incidence density, the treated prevalence and incidence rate will be approximate to community rates gradually. Most persons with schizophrenia had received treatment in Taiwan after the NHI program was implemented. Future studies should focus on outcome and cost evaluation.

Use of health care services and costs of psychiatric disorders among National Health Insurance enrollees in Taiwan.

The National Health Insurance (NHI) database in Taiwan was used to detect the use of health care services and the costs of psychiatric disorders among NHI enrollees. Data were analyzed for 126,146 enrollees. Four categories were used for enrollees: no psychiatric disorder, a minor psychiatric disorder, a major psychiatric disorder without catastrophic illness registration, and a major psychiatric disorder with catastrophic illness registration (which eliminates copayments). Compared with enrollees with a minor psychiatric disorder, those with a major psychiatric disorder, either with or without catastrophic illness registration, had higher use and costs of mental health care services. Compared with enrollees without a psychiatric disorder, those with a minor psychiatric disorder or a major psychiatric disorder without catastrophic illness registration had higher use and costs of non-mental health care services. Both the mental and general health care of persons with psychiatric disorders are important.

Prevalence of psychiatric disorders among National Health Insurance enrollees in Taiwan.

OBJECTIVE: About 96 percent of all residents of Taiwan were enrolled in the National Health Insurance (NHI) program in 2000. This study used claims data from the NHI database to determine the prevalence of and the demographic characteristics that are associated with psychiatric disorders. METHODS: A total of 200,432 persons, about 1 percent of Taiwan's population, were randomly selected from the NHI database. Persons under the age of 18 years and persons who were not eligible for NHI in 2000 were excluded, leaving 137,914 persons available for this study. Data for enrollees who had at least one service claim during 2000 for ambulatory or inpatient care for a principal diagnosis of a psychiatric disorder were classified into one of the psychiatric disorder categories according to ICD-9-CM diagnostic criteria. Data from the 2000 NHI study were compared with data from a 1985 community survey, the Taiwan Psychiatric Epidemiological Project, to determine how the prevalence of psychiatric disorders changed over the 15-year period. RESULTS: The one-year prevalence of any major psychiatric disorder, any minor psychiatric disorder, and any psychiatric disorder were 1.37 percent, 4.26 percent, and 5.30 percent, respectively. The differences in prevalence between the sexes were significant for five major and nine minor psychiatric disorders. The prevalence for eight psychiatric disorders were lower in the 2000 NHI study than in the 1985 community survey. However, the prevalence of schizophrenic disorder was found to be higher in the 2000 study and the prevalence of bipolar disorder was found to be the same in both studies. CONCLUSIONS: Because the prevalence of psychiatric disorders were generally lower in this study and in the 1985 community survey than those in other countries, it was concluded that both major and minor psychiatric disorders were undertreated in Taiwan. It is necessary for the public health department and the general population to emphasize mental illness education, prevention, and treatment in Taiwan.