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Time trends in first admission rates for schizophrenia and other psychotic disorders in Taiwan, 1998–2007: a 10-year population-based cohort study

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Abstract

Purpose

To examine the trend in annual first admission rates for psychotic disorders as a whole as well as individual psychotic disorders in Taiwan from 1998 to 2007, and influences of age, sex, and geographic region on the trend.

Method

Using the inpatient claims records in the National Health Insurance Research Database, we estimated the yearly first admission rates for schizophrenia and other psychotic disorders, including voluntary (1998–2007) and involuntary (2004–2007) admissions. Both narrow and broad definitions of psychotic disorders were examined.

Results

While involuntary first admission rates were stable, a crescendo–decrescendo change in voluntary first admission rates for psychotic disorders was observed, peaking in 2001. The increase from 1998 to 2001 was closely associated with health insurance expansion. Before 2001, the voluntary first admission rates in males aged 15–24 were underestimated as military personnel records were not included in the database. From 2001 to 2007, voluntary first admissions for psychotic disorders decreased 38%; the decrease could not be accounted for by the mild diagnostic shifts away from schizophrenia to affective psychosis or substance-induced psychosis. During the entire observation period, first admission rates for schizophrenia decreased 48%, while affective psychosis increased 84%. Gender disparities in the first admission rates gradually diminished, but geographic disparities persisted.

Conclusions

First admission rates for psychosis significantly reduced in Taiwan between 1998 and 2007, mainly driven by the reduced hospitalization risk for schizophrenia. Special attention should be paid to the increased hospitalization for other types of psychotic disorders (especially affective psychosis) and the unresolved geographic disparities.

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Acknowledgements

This study was supported by a grant from the National Science Council (Grant Number NSC101-3114-Y-002-003) to Prof. Ming-Je Tang and a Grant from the “Aim for the Top University Project” of National Taiwan University, funded by the Ministry of Education of Taiwan, to Wei J. Chen (Grant Number 103RH00240). This study is based in part on data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare, and managed by National Health Research Institutes. We thank Ms. Chia-Hsien Yang (project manager) in the Health Data Research Center, National Taiwan University, for her assistance in the conduct of the project.

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Authors and Affiliations

  1. Master of Public Health Degree Program, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 100, Taiwan

    Chih-Lin Chiang & Wei J. Chen

  2. Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

    Chih-Lin Chiang

  3. Division of New Drugs, Center for Drug Evaluation, Taipei, Taiwan

    Chih-Lin Chiang

  4. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

    Pei-Chun Chen, Po-Hsiu Kuo & Wei J. Chen

  5. Department of Public Health, China Medical University, Taichung, Taiwan

    Pei-Chun Chen

  6. Health Data Research Center, National Taiwan University, Taipei, Taiwan

    Ling-Ya Huang

  7. Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan

    Yu-Chi Tung

  8. Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan

    Chen-Chung Liu & Wei J. Chen

  9. Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan

    Chen-Chung Liu & Wei J. Chen

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  1. Chih-Lin Chiang
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  7. Wei J. Chen
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Corresponding author

Correspondence to Wei J. Chen.

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The Institutional Review Board of the National Taiwan University Hospital approved this study.

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Chiang, CL., Chen, PC., Huang, LY. et al. Time trends in first admission rates for schizophrenia and other psychotic disorders in Taiwan, 1998–2007: a 10-year population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 52, 163–173 (2017). https://doi.org/10.1007/s00127-016-1326-0

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  • DOI: https://doi.org/10.1007/s00127-016-1326-0

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