第六章 結論與建議
第二節 應用與建議
我們從本研究發現在台灣物質使用疾患與精神疾病有高度密切的相關，由 於共病現象會影響治療的策略及效果，在臨床上我們須注意這個情形，以 減少治療的干擾因子並在臨床上做適當的處理。目前對精神疾病的診斷及 照護仍可能少於實際的盛行率，在公共衛生上可能需要對民眾的精神健康 衛教，減少汙名化的現象，鼓勵民眾留意精神衛生並尋找適當的協助。目
前我們無法從本研究中去探討物質使用疾患與精神疾病彼此的因果關係，
將需要進一步的研究來探討。
參考文獻
1. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of
DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51(1):8-19.
2. Jiang JJ, Dubios F, Driss F, Carnot F, Thepot V, Pol S, Berthelot P, Brechot C, Nalpas B. Clinical impact of drug addiction in alcoholics.
Alcohol Alcoholism 1995;30(1):55-60.
3. Chang CJ, Lin CH, Lee CT, Chang SJ, Ko YC, Liu HW. Hepatitis C virus infection among short-term intravenous drug users in southern Taiwan.
Europ J Epidemiol 1999;15:597-601.
4. 楊靖慧：台灣愛滋病流行現況與防治政策。感染控制雜誌 2006；16
（1）：17-23。
5. 王甯祺：愛滋病在台灣的新危機：靜脈毒癮與 C 型肝炎。感染控制雜 誌 2006;16(1):24-26。
6. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Co-morbidity of mental disorders with alcohol and other drug abuse:
results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264:2511-2518.
7. Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ.
The epidemiology of co-occurring addictive and mental disorders:
implications for prevention and service utilization. Am J Orthopsychiat.1996;66(1):17-31.
8. Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG.
Co-morbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. Br J of Psychiatry 1996:17–30.
9. Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, Pickering RP, Kaplan K. Prevalence and co-occurrence of substance use
National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004; 61:807–816
10. Harris KM, Edlund MJ. Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatr Serv 2005;
56:954-959.
11. Macleod J, Oakes R, Copello A, Crome I, Egger M, Hickman M,
Oppenkowski T, Stokes-Lampard H, Davey-Smith G. Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet 2004;363:1579-88.
12. Craig RJ. Personality characteristics of heroin addicts: review of empirical research 1976-1979. Int J Addict 1982;17:227-48.
13. Mueser KT, Yarnold PR, Levinson DF, Singh H, Bellack AS, Kee K, Morrison RL, Yadalam KG. Prevalence of substance abuse in
Schizophrenia: demographic and clinical correlates. Schizophr Bull 1990;16:31-56.
14. Shaner A, Khalsa ME, Roberts L, Wilkins J, Anglin D, Hsieh SC.
Unrecognized cocaine use among schizophrenia patients. Am J Psychiatry 1993; 150:758-62.
15. Wyatt SA, Ziedonis D. Psychological and psychiatric consequences of amphetamines. in Tarte RE, et al. ed. Handbook of Substance Abuse:
Neurobehavioral Pharmacology. NY: Plenum Press 1998:529-44.
16. Schifano F. Chronic atypical psychosis associated with MDMA (ecstasy) abuse. Lancet 1991;338:1335.
17. 莊淑棻、吳守謙、蔡文瑛、李志恆：台灣地區查獲之 MDMA 和 Ketamine 毒品分析。台灣衛誌 2005;24(3):264-273。
18. 林憲：臨床精神醫學。台北：茂昌圖書出版 1982:239。
19. Schladdt RG, Shannon PT. Drug of Choice: Current Perspectives on Drug
20. 蘇東平：台灣青少年之藥物濫用（上）。臨床醫學 1980;5(4):299-305。
24. 法務部：毒品危害防制條例。http://law.moj.gov.tw。民國 97 年 04 月 30 日 修正。
28. Poshyachinda V. Drug injection and HIV infection among the population of drug abusers in Asia. Bull Narcot 1993; 45:77-90.
29. Craig RJ. Prevalence of personality disorders among cocaine and heroin.
Addicts Subst Abus. 2000;21(2):87-94.
30. Goldstein RB, Compton WM, Pulay AJ, Ruan WJ, Pickering RP, Stinson FS, Grant BF. Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend, 2007;90(2-3):145-58.
31. Schifano F, Di Furia L, Forza G, Minicuci N, Bricolo R. MDMA
consumption in the context of polydrug abuse: a report on 150 patients.
Drug Alcohol Depend 1998;50:85-90.
32. Hall W, Hando J, Darke S, Ross J. Psychological morbidity and route of administration among amphetamine users in Sydney, Australia. Addiction 1996;91:81-7.
33. Watkins KE, Burnam A, Kung FY, Paddock S. A national survey of care for persons with co-occurring mental and substance use disorders.
Psychiatr Serv 2001;52:1062-8.
34. Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry:
behavior sciences, clinical psychiatry. In: Schizophrenia. 9th ed.
Philadelphia, PA: Lippincott Willlams and Wilkins,2003: 472.
35. Wobrock T, D'Amelio R, Falkai P. Pharmacotherapy of schizophrenia and comorbid substance use disorder. A systematic review. Nervenarzt.
2008;79(1):17-8, 20-2, 24-6 passim.
36. Vaz Carneiro S, Borrego M, Psychosis and substance abuse. Acta Medica Portug. 2007;20(5):413-22.
37. McGirr A, Turecki G. What is specific to suicide in schizophrenia disorder?
Demographic, clinical and behavioural dimensions. Schizophr Res. 2008;
98(1-3):217-24.
38. Potvin S, Stip E, Lipp O, Roy MA, Demers MF, Bouchard RH, Gendron A. Anhedonia and social adaptation predict substance abuse evolution in dual diagnosis schizophrenia. Am J Drug Alcohol Abuse. 2008;
34(1):75-82.
39. Archie S, Rush BR, Akhtar-Danesh N, Norman R, Malla A, Roy P, Zipursky RB. Substance use and abuse in first-episode psychosis:
prevalence before and after early intervention. Schizophr Bull, 2007;33(6):1354-63.
40. Harrison I, Joyce EM, Mutsatsa SH, Hutton SB, Huddy V, Kapasi M, Barnes TR. Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study. Psycho Med,2008;38(1):79-88.
41. Bimerew MS, Sonn FC, Kortenbout WP. Substance abuse and the risk of readmission of people with schizophrenia at Amanuel Psychiatric
Hospital, Ethiopia. Curationis. 2007; 30(2):74-81.
Espaze R, Falissard B, Giroult P, Houery M, Mahuzier G, Matheron I, Niel P, Padovani P, Poisson N, Richier JP, Rocher J, Ruetsh O, Touzeau D, Visinoni A, Molimard R. Comparison of self-reports and biological
measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients. Eur Psychiatry, 2007;22(8):540-8.
43. Sadock BJ, Sadock VA. Kaplan and Sadock’s synopsis of psychiatry:
behavior sciences, clinical psychiatry. In: Mood Disorders. 9th ed.
Philadelphia, PA: Lippincott Willlams and Wilkins, 2003: 535.
44. Grant BF. Comorbidity between DSM-IV drug use disorders and major depression: results of a national survey of adults. J Subst Abuse 1995;
7:481–497.
45. Grant BF, Harford TC. Comorbidity between DSM-IV alcohol use
disorders and major depression: results of a national survey. Drug Alcohol Depend 1995; 39:197–206
46. Merikangas KR, Herrell R, Swendsen J, Rossler W, Ajdacic-Gross V, Angst J. Specificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders: results from the Zurich cohort study.
Arch Gen Psychiatry,2008;65(1):47-52.
47. Wu LT, Howard MO. Psychiatric disorders in inhalant users: results from The National Epidemiologic Survey on Alcohol and Related Conditions.
Drug Alcohol Depend, 2007;88(2-3):146-55.
48. Garno JL, Gunawardane N, Goldberg JF. Predictors of trait aggression in bipolar disorder. Bipolar Disord, 2008;10(2):285-92.
49. Stewart SH. Alcoholics in acute medical settings have increased risk for other drug, mood, and personality disorders. Int J of Psychiatry Med, 2007; 37(1):59-67.
50. Merikangas KR, Kalaydjian A. Magnitude and impact of comorbidity of mental disorders from epidemiologic surveys. Curr Opin Psychiatry, 2007;
20(4):353-8.
51. Kessler RC. The epidemiology of dual diagnosis. Biol Psychiatry, 2004;56:730-737.
52. Watkins KE, Paddock SM, Zhang L, Wells KB. Improving Care for Depression in Patients With Comorbid Substance Misuse. Am J Psychiatry, 2006; 163:125–132.
53. Wilk J, West JC, Rae DS, Regier DA. Relationship of comorbid substance and alcohol use disorders to disability among patients in routine
psychiatric practice. Am J Addict,2006;15:180-185.
54. el-Guebaly N, Currie S, Williams J, Wang J, Beck CA, Maxwell C,
Patten SB. Association of mood, anxiety, and substance use disorders with occupational status and disability in a community sample. Psychiatr Serv, 2007;58(6):863.
55. Mason WA, Hitchings JE, Spoth RL. Emergence of delinquency and depressed mood throughout adolescence as predictors of late adolescent problem substance use. Psycho Addict Behav, 2007; 21(1):13-24.
56. Borges G, Wang PS, Medina-Mora ME, Lara C, Chiu WT. Delay of first treatment of mental and substance use disorders in Mexico. Am J Public Health, 2007;97(9):1638-43.
圖表
Table 1. The prevalence and incidence of drug use disorders identified from the National Health Insurance cohort data in Taiwan, 1996-2003.
Year Population size Prevalence
n (rate per 10000)
New claims n (rate per 10000)
1996 189999 66(3.47)
1997 192724 37(1.92) 34(1.76)
1998 195050 62(3.18) 56(2.87)
1999 197486 100(5.06) 86(4.35)
2000 200000 104(5.20) 86(4.30)
2001 199495 113(5.66) 86(4.31)
2002 198989 180(9.05) 152(7.64)
2003 193966 286(14.7) 230(11.9)
Total 195964 796 730
Table 2. The prevalence of mental disorders in cases with drug use disorders diagnosed in the National Health Insurance cohort in Taiwan, 1996-2003.
Age(years)
＜20 20-29 ＞29 Total
Psychiatric diseases N=37 N=186 N=573 N=796
n(rate/1000) n(rate/1000) n(rate/1000) n(rate/1000) Senile and early senile psychotic condition
Alcoholic psychosis Drug related psychosis Transient organic disorder
Other organic brain syndrome (chronic) Schizophrenia
Affective psychosis Paranoid state
Other and unspecified reactive psychosis Psychosis with origin specific to childhood Neurotic disorder
Personality disorder Psychosexual disorder
Alcohol dependence syndrome Psycho-physiological malfunction
Other and unspecific special symptoms and syndromes
Acute reaction to stress Adjustment reaction
Depression, not elsewhere classified Hyper kinetic syndrome in childhood Other specified delays in development Psychotic factors associated with diseases classification
Mild mental retardation
Other specific mental retardation Unspecific mental retardation
0
Table 3. The prevalence of mental disorders identified for controls in the National Health Insurance cohort in Taiwan, 1996-2003.
Age (years)
＜20 20-29 ＞29 Total
Psychiatric diseases N=111 N=558 N=1719 N=2388
n(rate/1000) n(rate/1000) n(rate/1000) n(rate/1000) Senile and early senile psychotic condition
Alcoholic psychosis Drug related psychosis Transient organic disorder
Other organic brain syndrome (chronic) Schizophrenia
Affective psychosis Paranoid state
Other and unspecified reactive psychosis Psychosis with origin specific to childhood Neurotic disorder
Personality disorder Psychosexual disorder
Alcohol dependence syndrome Psycho physiological malfunction
Other and unspecific special symptoms and syndromes
Acute reaction to stress Adjustment reaction
Other specified non-psychotic mental disorder Depression, not elsewhere classified Other conduct disorder
Unspecific emotional disturbance, in childhood and adolescent
Hyper kinetic syndrome in childhood Other specified delays in development
Psychotic factors associated with diseases classification
Mild mental retardation
Other specific mental retardation Unspecific mental retardation
0
Table 4. Odds ratios of psychiatric diseases estimated in nested case-control groups of the National Health Insurance cohort in Taiwan, 1996-2003.
Drug abuse
Odds ratio (95%CI interval) Yes
N=796
No
N=2388 Adjusted the density of population n(％) n(％) Univariable Including neurotic
disorder
Yes 93(11.7) 310(13.0) 0.89(0.69-1.14) 0.87(0.68-1.11)
No 703(88.3) 2078(87.0) 1.0 1.0
Yes 29(3.64) 99(4.15) 0.87(0.57-1.33) 0.88(0.58-1.34) 1.15(0.67-1.96)
No 767(96.4) 2289(95.9) 1.0 1.0 1.0
*：p＜0.05, ＊＊：p＜0.001, ＊＊＊：p＜0.0001
Table 5. Odds ratios of psychiatric disease (any of drug related psychosis, other organic brain syndrome, schizophrenia, affective psychosis, personality disorder, alcohol dependence syndrome, adjustment reaction) estimated in nested case-control groups of the National Health Insurance cohort in Taiwan, 1996-2003.
Drug use disorder Psychiatric disease Yes No
N=796 N=2388
Odds ratio (95% Confidence interval)
n(％) n(％)
Yes 131(16.5) 97(4.1) 4.65(3.53-6.13) No 665(83.5) 2291(95.9) 1.0
Table 6. Prevalence of schizophrenia, alcohol and drug use disorders by year in 1997-2006, Taiwan (rate per 10,000)
Schizophrenia Affective disorder Alcohol dependence
Alcohol abuse Drug dependence Drug abuse Year
n rate n rate n rate n rate n rate n rate 1996 2790 33.1 3050 36.2 355 4.2 161 1.9 128 1.5 16 0.2 1997 3036 34.7 4911 56.2 511 5.8 51 0.6 120 1.4 17 0.2 1998 3287 37.1 6298 71.1 653 7.4 71 0.8 139 1.6 26 0.3 1999 3476 38.7 5321 59.2 797 8.9 140 1.6 135 1.5 66 0.7 2000 3619 39.7 5207 57.2 889 9.8 208 2.3 172 1.9 103 1.1 2001 3888 41.9 5770 32.1 964 10.4 227 2.4 149 1.6 117 1.3 2002 4170 44.6 6307 67.4 949 10.2 287 3.1 203 2.2 105 1.1 2003 4353 45.7 6885 72.3 1011 10.6 381 4.0 226 2.4 143 1.5 2004 4656 48.7 7816 81.8 1323 13.8 501 5.2 310 3.2 212 2.2 2005 4758 47.6 8776 87.8 1402 14.0 629 6.3 349 3.5 236 2.4 2006 4847 48.8 8776 88.3 1319 13.3 659 6.6 253 2.6 185 1.9
Table 7. Incidence of schizophrenia, alcohol and drug use disorders by year in 1997-2006, Taiwan (rate per 10,000)
Schizophrenia Affective disorder Alcohol dependence
Alcohol abuse Drug dependence Drug abuse Year
n rate n rate n rate n rate n rate n rate 1997 872 10.0 3507 40.1 447 5.1 45 0.51 108 1.2 17 0.2 1998 774 8.7 3895 44.0 526 5.9 67 0.76 121 1.4 25 0.3 1999 702 7.8 2753 30.7 599 6.7 133 1.48 107 1.2 63 0.7 2000 604 6.6 2524 27.7 628 6. 9 186 2.04 134 1.5 98 1.1 2001 620 6.7 2566 27.6 662 7.1 190 2.05 107 1.2 103 1.1 2002 595 6.4 2660 28.4 628 6.7 230 2.46 151 1.6 86 0.9 2003 580 6.1 2737 28.8 648 6.8 298 3.13 154 1.6 126 1.3 2004 596 6.2 2876 30.1 842 8.8 375 3.92 219 2.3 177 1.9 2005 497 5.0 3139 31.4 807 8.1 470 4.70 223 2.2 190 1.9 2006 443 4.5 2721 27.4 719 7.2 443 4.46 137 1.4 133 1.3 total 6283 6.7 29378 31.8 6506 7.0 2437 2.61 1461 1.6 1018 1.1
圖 1.
Figure 1. Chronological incident trend of (per 10,000) of patients receiving care for alcohol dependence, alcohol abuse, drug dependence, drug abuse, schizophrenia and affective disorder
0 5 10 15 20 25 30 35 40 45 50
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 year
Alcohol dependence
Alcohol abuse
Drug dependence
Drug abuse
Schizophrenia
affective disorder
rate (per 10,000)
Table 8. Incident cases of schizophrenia by age and sex in 1997-2006, Taiwan (rate per 10,000) Frequency Missing = 4
Table 9. Incident cases of affective disorder by age and sex in 1997-2006, Taiwan (rate per 10,000) Frequency Missing = 1
Age Males Females total
n（%） rate n（%） rate n（%） rate
<20 1276（11.5） 9.2 1694（ 9.3） 12.1 2970（10.1） 10.7 20-29 1699（15.3） 21.3 3029（16.6） 36.7 4728（16.1） 29.2 30-44 3131（28.2） 26.2 5376（29.4） 45.1 8507（29.0） 35.6 45-64 3018（27.2） 35.2 5661（31.0） 62.9 8679（29.5） 49.4
>=65 1976（17.8） 58.7 2517（13.8） 78.9 4493（15.3） 68.5 Total 11100（100） 24.3 18277（100） 39.4 29377（100） 31.9
Males Females total Age
n（%） rate n（%） rate n（%） rate
<20 516 （16.2） 3.7 357（11.6） 2.6 873（13.90） 3.1 20-29 848 （26.6） 10.7 640（20.7） 7.8 1488（23.70） 9.2 30-44 1079 （33.8） 9.0 946（30.6） 7.9 2025（32.25） 8.5 45-64 503 （15.8） 5.9 829（26.8） 9.2 1332（21.21） 7.6
>=65 244 （ 7.6） 7.3 317（10.3） 9.9 561（8.93） 8.6
Total 3190 （100） 7.0 3089 （100） 6.7 6279 6.8
圖 2.
Figure 2. Incidnece of schizophrenia, affective disorder, alcohol dependence, alcohol abuse, drug dependence adn drug abuse
0 10 20 30 40 50 60 70 80
<20 20-29 30-44 45-64 >=65 age
rate (per 10,000) schizophrenia
affective disorder alcohol dependence alcohol abuse drug dependence drug abuse
Table 10. Co-morbidity rates (1/10,000) of alcohol dependence, alcohol abuse, drug dependence and drug abuse among schizophrenia cases and non-schizophrenia general population by age in males, in 1997-2006, Taiwan
age Alcohol dependence Alcohol abuse Drug dependence Drug abuse
schizophrenia Non schizophrenia
schizophrenia Non schizophrenia
schizophrenia Non schizophrenia
schizophrenia Non schizophrenia
<20 116.3 1.4 77.5 0.7 271.3 0.8 310.1 0.7 20-29 1014.2 9.9 448.1 3.6 801.9 3.1 660.4 2.0 30-44 1631.1 17.4 463.4 5.9 454.1 2.3 315.1 1.2 45-64 1232.6 16.8 357.9 5.4 198.8 1.4 178.9 0.7
>=65 204.9 7.2 0 1.9 41.0 1.5 41.0 0.6 Total 1050.2 10.4 344.8 3.5 445.1 1.9 363.6 1.1
Table 11. Co-morbidity rates (1/10,000) of alcohol dependence, alcohol abuse, drug dependence and drug abuse among schizophrenia cases and non-schizophrenia general population by age in females, in 1997-2006, Taiwan
age Alcohol dependence Alcohol abuse Drug dependence Drug abuse
schizophrenia Non
schizophrenia
schizophrenia Non
schizophrenia
schizophrenia Non
schizophrenia
schizophrenia Non
schizophrenia
<20 140.1 1.2 28.0 0.9 112.0 0.4 168.1 0.4 20-29 375.0 4.6 234.4 2.1 390.6 1.4 359.4 1.2 30-44 401.7 4.4 200.9 1.9 306.6 1.1 222.0 0.8 45-64 217.1 2.2 36.2 0.9 168.9 1.0 24.1 0.5
>=65 63.1 1.0 0 0.4 63.1 0.7 0 0.8
Total 281.6 2.8 123.0 1.3 239.6 0.9 168.3 0.7
Table 12. Co-morbidity schizophrenia cases to general population rate ratios of alcohol dependence, alcohol abuse, drug dependence and drug abuse by age in males and females, in 1997-2006, Taiwan
age Alcohol dependence Alcohol abuse Drug dependence Drug abuse
males females males females males females males females
<20 84.3 115.8 119.3 31.8 361.8 320.1 419.0 480.2 20-29 102.3 82.1 124.5 114.3 255.4 271.3 326.9 294.3 30-44 93.7 91.5 78.9 108.0 195.7 281.2 260.4 288.3 45-64 73.2 97.4 62.8 40.2 144.1 170.6 252.0 45.5
>=65 28.5 61.3 0 0 28.1 91.4 69.5 0
Table 13. Co-morbidity rates (1/10,000) of alcohol dependence, alcohol abuse, drug dependence and drug abuse among Affective disorder cases and non-affective disorder general insured population by age in males, in 1997-2006, Taiwan
age Alcohol dependence Alcohol abuse Drug dependence Drug abuse
Affective disorder
Non affective disorder
Affective disorder
Non affective disorder
Affective disorder
Non affective disorder
Affective disorder
Non affective disorder
<20 247.9 1.1 108.4 0.6 247.9 0.6 216.9 0.6 20-29 804.7 9.1 355.2 3.2 516.1 2.9 382.9 1.9 30-44 1299.1 15.8 457.8 5.1 285.4 2.1 181.3 1.1 45-64 656.6 15.8 225.3 4.9 127.0 1.1 61.9 0.6
>=65 169.2 6.7 23.5 1.8 65.8 1.2 28.2 0.5 Total 729.6 9.4 264.1 3.1 233.6 1.5 155.8 1.0
Table 14. Co-morbidity rates (1/10,000) of alcohol dependence, alcohol abuse, drug dependence and drug abuse among Affective disorder cases and non-affective disorder general insured population by age in females, in 1997-2006, Taiwan
age Alcohol dependence Alcohol abuse Drug dependence Drug abuse
Affective disorder
Non affective disorder
Affective disorder
Non affective disorder
Affective disorder
Non affective disorder
Affective disorder
Non affective disorder
<20 181.4 1.0 140.4 0.7 105.3 0.2 105.3 0.3 20-29 345.7 3.4 176.1 1.5 246.5 0.8 179.3 0.8 30-44 263.5 3.6 114.2 1.6 168.6 0.4 130.0 0.4 45-64 94.4 2.0 37.4 0.8 83.0 0.7 24.4 0.4
>=65 25.6 1.0 18.3 0.3 44.0 0.5 40.3 0.6 Total 182.5 2.3 88.7 1.1 130.9 0.5 89.7 0.4
Table 15. Relative risk of alcohol dependence, alcohol abuse, drug dependence and drug abuse between incident affective cases and general insured population by age in males and females, in 1997-2006, Taiwan
age Alcohol dependence Alcohol abuse Drug dependence Drug abuse
males females males females males females males females
<20 219.4 185.1 197.2 206.5 420.1 438.8 349.8 421.3 20-29 88.3 101.4 112.4 115.1 176.1 304.3 197.4 224.1 30-44 82.1 73.2 89.4 73.2 135.2 411.3 163.4 317.0 45-64 41.6 47.0 45.8 50.0 115.4 125.8 98.3 56.8
>=65 25.2 26.7 12.8 59.1 54.8 91.6 60.0 73.3
Total 78.0 80.0 86.0 84.43 152.7 242.5 160.6 203.8
圖 3.
圖 4.
Figure 3 Relative risk rations of alcohol dependence, alcohol abuse,
drug dependence and drug abuse between incident schizophrenia cases and general insured population by age in males, in 1997-2006, Taiwan 0
<20 20-29 30-44 45-64 >=65
age
Figure 4. Relative risk rations of alcohol dependence, alcohol abuse, drug dependence and drug abuse between incident schizophrenia cases and general insured population
by age in females, in 1997-2006, Taiwan 0
<20 20-29 30-44 45-64 >=65
age
附錄
20-24 89(11.3) 267(11.3)
25-29 97(12.1) 291(12.1)
30-34 101(12.8) 303(12.8)
35-39 105(13.2) 315(13.2)
40-44 107(13.6) 321(13.6)
45-49 69(8.54) 207(8.54)
≧50 191(24.0) 573(24.0)
南區：嘉義縣市、台南縣市、高雄縣市、屏東縣 東區：花蓮縣、台東縣
外島：澎湖縣、金門縣、連江縣
b：人口密度高：基隆市、新竹市、臺北縣市、台中市、高雄市、台南市、嘉義市 人口密度中：桃園市、台中縣、彰化縣、雲林縣、台南縣、高雄縣、屏東縣
人口密度低：新竹縣、宜蘭縣、苗栗縣、南投縣、嘉義縣、花蓮縣、台東縣、外島
2. Table 1997-2006 平均人口
Age
Male （％） Female （％） total
<20
138266 （30.3） 140266（30.2） 278532（30.3）
20-29
79640 （17.4） 82454 （17.8） 162094（17.6）
30-44
119649 （26.2） 119312（25.7） 238961（26.0）
45-64
85673 （18.8） 89940 （19.4） 175614（19.1）
>=65
33676 （ 7.4） 31908 （ 6.9） 65584 （ 7.1）
total
456904 （100） 463881（100） 920785 Frequency Missing = 170477
Male : female 465831 （49.7） : 472002 （50.3） 937833 （100.00 ）
; missing 3
3. 預投稿之文章
Title: Trend of drug abuse care and risk of psychiatric co-morbidity in an universal health insurance cohort in Taiwan
Abstract
Purpose: This study investigates the trend of drug abuse care in a national representative sample, and estimates the risk for co-occurring mental disorders among abusers. Method: Using a randomly selected cohort with 189,999 persons in 1996 from the insured in the National Health Insurance (NHI) program, the Department of Health, Taiwan, we assessed the annual prevalence and new claims rates for drug abuse treatment in 1996-2003, and conducted a nested case-control analysis to compare the psychiatric co-morbidity between users and nonusers. Results: Among 796 persons with diagnosed drug use disorders in the cohort (72.7% males), 37 persons were teens. There was a 6.8-fold increase of new medical claims for drug use disorders in six years, from 1.76/10,000 in 1997 to 11.9/10,000 in 2003. The corresponding prevalence had a 7.1-fold increase, from 1.92/10,000 to 14.7/10,000, respectively. The nested case-control analyses showed that abusers were more prevalent than nonusers in mental disorders, particularly for the affective psychosis (ICD 296) (66.6 per 1000 vs. 19.3 per 10000), drug related psychosis (ICD 292) (40.2 per 1000 vs.
1.26 per 1000), schizophrenia (33.9 per 1000 vs. 12.1 per 1000) and alcohol dependence syndrome (30.2 per 1000 vs. 6.7 per 1000). With an overall odds ratio of 4.65 (95% confidence interval (CI) 3.53-6.13) for having psychiatric diseases, the risk to have the drug associated psychosis was 33.3 fold stronger for substance users than for controls. The odds ratio increased to 85.8 if the neurotic disorders were excluded from the data analysis (p ＜ 0.0001).
Conclusions: There was a rapid increase in substance use disorders in the recent years in Taiwan. Higher prevalence rate of psychiatric co-morbidity among drug abusers underscores the urgent need to target public health prevention.
Keywords ： Universal insurance, mental health, nested case-control study, prevalence, substance abuse, Taiwan
Introduction
Drug abuse is in a rapid rising trend worldwide, threatening an individual’s healthy life, including the risk of mental health related consequence (1-4). Approximately one half patients may have a co-occurring mental disorder, while fewer individuals with mental disorder have the addictive disorders (5, 6). In a forensic sample, Kalechistein et al. found that methyl amphetamine users have two times higher risk than nonusers to seek psychological care and attempt suicide(1).
Persons with dual diagnoses use both mental health and addictive treatment services more frequently than persons with only one disorder.
However, most persons received no treatment in the previous year (2, 7, 8). More than 70 percent of individuals with co-occurring mental and substance use disorders receive neither mental health care nor substance abuse treatment. A national survey in the U.S. found that only 8 percent of substance use disorders with co-occurring mental disorders had received an integrated care in the past year (9).
It is not clear whether substance abuse increased the vulnerability to specific co-occurring disorders, most of them are not cause-effect dependent (5). Other environmental conditions may also underlie the co-morbidity without a temporal relation between the substance misuse and the psychiatric illness. People with mental illness also have the access to substances, substance use and mental disorders may share common antecedents (10). However, it is clear that individuals with substance abuse and co-morbidities have more health problems and more difficult to
Drug abuse in the population of Taiwan is also in rapid rising trend (11). Hepatitis virus C infection was also high among drug abusers in Taiwan (12). To our knowledge, no epidemiologic study has examined the population based drug abuse and the psychiatric co-morbidity.
Effective prevention plan requires the epidemiology data on substance use disorders and co-morbid mental health problems. There is a need to investigate the temporal relation between drug abuse and mental health problem. It requires longitudinal data to ascertain causal sequences. At the same time, the power of detecting significance may be limited because of the low prevalence in general population and the involvement of many potentially confounding factors (7).
In this study, we used the database of electronic medical records
In this study, we used the database of electronic medical records