Molecular basis of glucose-6-phosphate dehydrogenase (G6PD) deficiency in three Taiwan aboriginal tribes.

We have investigated glucose-6-phosphate dehydrogenase (G6PD) deficiency in 220 unrelated aboriginal male subjects who belong to three different tribes (Saisiat, Ami, and Yami) in Taiwan. Our results show that the G6PD deficiency rates for Saisiat, Ami, and Yami people are 9.0% (6/67), 6.1% (6/99), and 0% (0/54), respectively. Among these deficiency cases, 4 of 6 (66.7%) Saisiat subjects have the 493 A-->G mutation and one carries the 1376 G-->T mutation, whereas, in Ami subjects, we found that four of six (66.7%) affected males have the 592 C-->T mutation and one carries the 493 A-->G mutation. These results contrast with our previous findings for Taiwan Chinese, in whom the 1376 G-->T mutation is the major mutant allele and accounts for 52.3% of the deficiency cases. This is the first report of G6PD deficiency characterized at the DNA level in Taiwan aboriginal populations.

Prevalence and molecular studies of thalassemia in five aboriginal groups in Taiwan.

A total of 1,342 blood samples from five aboriginal groups in Taiwan, comprising 522 of the Ami, 246 of the Bunum, 227 of the Atayal, 214 of the Paiwan and 133 of the Yami group, were collected. A complete blood count was performed in each case. In subjects with a mean corpuscular volume < 85 fl or hemoglobin (Hb) < 12 gm% (female) or 13 gm% (male), quantitation of Hb A2 and DNA analysis of alpha- and beta-globin genes were performed. Alpha-thalassemia was diagnosed by Southern hybridization of subject's DNA to alpha-, and zeta-globin gene fragments, and to Lo probe if needed. DNA from beta-thalassemia carriers was studied by polymerase chain reaction and direct sequencing. In the Ami, 42 (8.2%) were alpha-thalassemia 1 carriers, 42 (8.2%) were alpha-thalassemia 2 carriers, one had Hb H disease, and four (0.8%) were beta-thalassemia carriers. In the Bunun, one (0.2%) was an alpha-thalassemia 1 carrier, and two (0.4%) were alpha-thalassemia 2 carriers. In the Atayal, one (0.2%) was an alpha-thalassemia 1 carrier. In the Paiwan, seven (3.3%) were alpha-thalassemia 1 carriers, and one (0.5%) was an alpha-thalassemia 2 carrier. In the Yami, none were either alpha- or beta-thalassemia carriers. Diverse genetic origin, intragroup breeding and malarial selection may play a role in the significant differences of thalassemia prevalences both between the Chinese and the aborigines, and among different groups of aborigines.

Sex differences in minor psychiatric morbidity among three aboriginal groups in Taiwan: the effects of lineage.

Sex differences in minor psychiatric morbidity (MPM) have been investigated among three aboriginal groups in Taiwan. The study included both ethnographic observation and a sample survey (N = 733) using a modified Clinical Interview Schedule. The findings lend support to the hypothesis that although a female excess of MPM will be found among the patrilineal group (the Bunun), the reverse will be observed in the matrilineal group (the Ami); no such difference will be found in the bilateral group (the Atayal). Further analysis revealed sex differences in the mean duration of MPM and similar incidence ratios between two sexes in these three groups. Possible sociocultural explanations are proposed.

Psychiatric complications of family reunion after four decades of separation.

OBJECTIVE: After four decades of separation due to civil war, many people who had migrated to Taiwan from mainland China had the unexpected opportunity to briefly visit their families in mainland China. A study was conducted to examine psychiatric complications associated with these family reunions following long involuntary separation. METHOD: Eighty subjects who made the journey were given semistructured interviews investigating their psychological experiences relating to the family reunion. The variables investigated were sociodemographic characteristics, the subject's previsit emotional condition, factors related to the family reunion experience, and stress encountered during the visit. RESULTS: The survey indicated that more than one-fifth of the subjects (22.5%) developed psychiatric complications, mainly depression, immediately after the visit. Determinants found to contribute significantly to the occurrence of emotional disorders were previous ways of expressing homesickness, family members seen during the reunion, family misfortunes that the subjects discovered, family conflict encountered at the reunion, and tactics for coping with such stressors. CONCLUSIONS: The study results suggest that family reunions after long-term separation can be trauma-repairing experiences for some but for others can lead to trauma reexperiencing and psychiatric complications requiring mental health intervention.

A community study of mental disorders among four aboriginal groups in Taiwan.

In this paper background, objectives, methodology and a few preliminary findings of a comparative epidemiological study of mental disorders among four aboriginal groups in Taiwan are presented. The study includes both a cross-sectional sample survey (N = 993) and prospective cohort studies involving psychoses, minor psychiatric morbidity, alcoholism, suicide, and accidental death. The total response rate to the sample survey was 98.3%; respondents were found to be representative. A preliminary analysis found very high rates of death from suicide, accidents and chronic liver and lung disease with a previous history of alcoholism in many of these deaths. Implications of these findings and studies of risk factors of all these health problems and their relationships are discussed.

Internal consistency and factor structure of the Chinese Health Questionnaire.

The internal consistency and factor structure of the Chinese Health Questionnaire (CHQ) were investigated in 2 samples in Taiwan, one from 3 communities (n = 1023) and the other from consecutive attenders for health screening in a general hospital (n = 386). Cronbach's alpha coefficients were calculated to be 0.84 and 0.83 for the 12-item and 0.90 and 0.92 for the 30-item CHQ version. Four factors similarly extracted for the CHQ-30 in both samples include somatic symptoms, anxiety and worrying, social dysfunction, and depression and poor family relationship. The implications of these findings were discussed from a cross-cultural perspective.

Urbanisation and minor psychiatric morbidity. A community study in Taiwan.

The relationship between urbanisation and minor psychiatric morbidity (MPM) was investigated in one rural, one suburban, and one urban community in Taiwan. While there was no significant difference between communities in weighted prevalence of total morbidity, anxiety states, and a number of main symptoms, significantly lower rates of depressive illness/symptom were found in both native and migrant urban young women. Both the adverse rural environment with more chronic stressors and selective migration to the cities might explain the higher rates of depression in rural young women. Although no significant interaction between community and other demographic factors on the risk of MPM was found, psychosocial stresses associated with such morbidity were different between communities. It is hypothesised that the higher rate of depression in rural women will revert as urbanisation goes on.

Sex difference in prevalence of minor psychiatric morbidity: a social epidemiological study in Taiwan.

The female excess in prevalence of minor psychiatric morbidity (MPM) evident in a community study in Taiwan (n = 1023) was further investigated in terms of demographic variables, socioenvironmental risk factors and psychosocial stresses. It was suggested that a stronger effect of chronic psychosocial stressors accounted for the higher prevalence of MPM in women. Further analysis has revealed a longer mean duration of MPM in women and an incidence ratio close to unity between the sexes. These retrospective findings were further examined in a small one-year prospective outcome study; a poorer outcome was found among older subjects and female subjects. It is suggested that more females have MPM because chronic psychosocial stressors more adversely affect the course of such morbidity. These results are discussed in a cross-cultural context.

Psychosocial stress and minor psychiatric morbidity: a community study in Taiwan.

The relationship between acute life events, chronic psychosocial stressors, sociodemographic variables, and minor psychiatric morbidity (MPM) was investigated in a community sample (n = 489) in Taiwan. A higher risk of MPM was found among women with chronic stressors and respondents with both events and stressors. There was no sex difference over the impact of events on such morbidity. The relative odds of MPM for respondents exposed to event(s) was found to be 8.9.

Symptomatology of minor psychiatric morbidity: a crosscultural comparison.

The basic symptoms of minor psychiatric morbidity (MPM) reported elsewhere were also found in a community survey in Taiwan. However, differences in the patterns of and manifestations of the symptoms were evident. Contrary to most Western surveys, the prevalence of anxiety (24.7%) was found to be higher than that of depression (8.3%) in Taiwan. Possible explanations based on sociocultural characteristics of the Chinese family were proposed. The notion of somatization as a predominant symptom in Chinese neurotic patients advocated by some research workers was not supported in this study. As a result of findings in community cases, it is argued that the importance of somatization has been considerably overemphasized as a factor in the illness behaviour of neurotic cases in Chinese and other cultures, and it is therefore not a culture-specific disease phenomenon. It is also suggested that certain culture-specific neurotic syndromes reported in Chinese, such as shen-ching-shuai-jo (neurasthenia) and shen-k'uei (semen loss syndrome), are clinically equivalent to MPM. Implications of the present findings on crosscultural research and management of MPM were discussed.

A community study of minor psychiatric morbidity in Taiwan.

A community study of minor psychiatric morbidity (MPM) was carried out on three population samples aged 15 and above randomly selected from rural (Yenpu), suburban (Chishan), and urban (Kaohsiung) communities (N = 350 for each) in Taiwan. A two-stage case finding strategy was applied with a newly developed and validated screening questionnaire (CHQ), and a modified Chinese version of the Clinical Interview Schedule (CIS-CV). The total response rate was 99.4% and there was no time lag between the CHQ screening and the second stage clinical interview conducted by a psychiatrist. The weighted validity of the CHQ was found to be acceptable (sensitivity 69.6%, specificity 94.8%, misclassification rate 11.4%). The overall weighted prevalence rate was 18.0% for men and 33.3% for women. Both the CIS and the CHQ data are used as the morbidity indices to investigate the sociodemographic risk factors of MPM. A higher risk of MPM, which occupied 92% of the total morbidity, was found to be associated with women aged 35 and above, the unemployed men, and the lower socioeconomic status after linear modelling.

The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan.

The problems which arise in the use of a psychiatric screening instrument in a language and culture other than that in which it was designed and developed are considered. An account is given of the development of a psychiatric screening questionnaire suitable for use in Chinese community samples. The questionnaire was derived from a Chinese translation of the General Health Questionnaire, with the addition of specially designed, culturally-relevant items. Discriminant function analysis was then used to select a subset of 12 items which discriminated well between 'cases' and 'normals' in the community.

A pilot study of mental disorders in Taiwan.

A two-stage case-identification method, using a modified General Health Questionnaire (GHQ) and the Clinical Interview Schedule (CIS), was applied in a pilot study of mental disorders in an urban city in Taiwan. The validity of the modified GHQ was proved to be greater than that of the original, with a very high sensitivity and specificity. The Chinese version of the CIS was found to be feasible for community study in Taiwan. The total prevalence rate of all mental disorders was 26.0%, with a higher morbidity among females.