Barriers to depression care among middle-aged and older adults in Taiwan's universal healthcare system

Chang, Ting-Yu; Liao, Shih‐Cheng; Chang, Chia‐Ming; Huang, Wei‐Lieh; Hwang, Juey‐Jen; Hsu, Chih‐Cheng

doi:10.1016/j.lanwpc.2022.100501

Cited by 12 publications

(12 citation statements)

References 27 publications

(37 reference statements)

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“…The prevalence of depressive disorders was found to be lower than in a previous study (4). According to our previous investigation, only 27% of patients sought treatment for depression (26). It is possible that some patients with depression who were neither diagnosed nor treated could have been misclassified into the comparison group.…”

Section: Discussioncontrasting

confidence: 63%

“…Possible factors associated with the outcome include hormonal factors, help-seeking behaviors, and medication compliance. The treatment rate for depression was lower in men than in women, and undertreatment might deteriorate treatment response and increase costs (26). No previous study has explored the role of sex on the association between depression and This study has several limitations.…”

Section: Discussionmentioning

confidence: 91%

“…Overall, the treatment rate for depression varied, ranging from 16.8% in low-income countries to 48.3% in high-income countries (25). In Taiwan, the treatment rate was approximately 27% of patients (26). Furthermore, we only identified pre-existing depression cases in the year preceding the RA diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Estimation of life expectancy and healthcare cost in rheumatoid arthritis patients with and without depression: a population-based retrospective cohort study

Chiu,

Lan,

Huang

et al. 2023

Front. Med.

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PurposeThis study aimed to estimate the lifetime healthcare costs and loss of life expectancy (loss-of-LE) among patients with incident rheumatoid arthritis (RA) with and without depression.MethodsThis 18 years longitudinal cohort study used data from Taiwan’s National Health Insurance Research Database. In total, 43,311 patients with RA were included. Among them, 1,663 patients had depressive disorders in the year preceding the RA diagnosis. The survival function for patients with RA with or without depression was estimated and extrapolated over a lifetime using the rolling extrapolation algorithm. The loss-of-LE was calculated by comparing the sex, age, and calendar year-matched referents from vital statistics. The average monthly cost was calculated as the sum of the monthly costs for all patients divided by the number of surviving patients. Lifetime healthcare costs were estimated by multiplying the monthly average cost by the monthly survival probability.ResultsThe loss-of-LE for RA patients with and without depression was 5.60 years and 4.76 years, respectively. The lifetime costs of RA patients with and without depression were USD$ 90,346 and USD$ 92,239, respectively. However, the annual healthcare costs were USD$ 4,123 for RA patients with depression and USD$ 3,812 for RA patients without depression. Regardless of sex or age, RA patients with depression had higher annual healthcare costs than those without depression.ConclusionPatients with RA and depression have a high loss-of-LE and high annual healthcare costs. Whether treating depression prolongs life expectancy and reduces healthcare costs warrants further investigation.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 91%

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Estimation of life expectancy and healthcare cost in rheumatoid arthritis patients with and without depression: a population-based retrospective cohort study

Chiu,

Lan,

Huang

et al. 2023

Front. Med.

Self Cite

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“…Multicollinearity was examined using the variance inflation factor (VIF) [24]. The examination results of all included variables were under 10 by VIF (Supplementary Table S4).…”

Section: Discussionmentioning

confidence: 99%

Impacts of environmental factors on the aetiological diagnosis and disease severity of community-acquired pneumonia in China: a multicentre, hospital-based, observational study

Zhang,

Li,

et al. 2024

Epidemiol. Infect.

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Environmental exposures are known to be associated with pathogen transmission and immune impairment, but the association of exposures with aetiology and severity of community-acquired pneumonia (CAP) are unclear. A retrospective observational study was conducted at nine hospitals in eight provinces in China from 2014 to 2019. CAP patients were recruited according to inclusion criteria, and respiratory samples were screened for 33 respiratory pathogens using molecular test methods. Sociodemographic, environmental and clinical factors were used to analyze the association with pathogen detection and disease severity by logistic regression models combined with distributed lag nonlinear models. A total of 3323 CAP patients were included, with 709 (21.3%) having severe illness. 2064 (62.1%) patients were positive for at least one pathogen. More severe patients were found in positive group. After adjusting for confounders, particulate matter (PM) 2.5 and 8-h ozone (O 3 -8h) were significant association at specific lag periods with detection of influenza viruses and Klebsiella pneumoniae respectively. PM10 and carbon monoxide (CO) showed cumulative effect with severe CAP. Pollutants exposures, especially PM, O 3 -8h, and CO should be considered in pathogen detection and severity of CAP to improve the clinical aetiological and disease severity diagnosis.

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“…Although females are more likely to contact healthcare services, major depression remains largely underdiagnosed for both genders, which may reflect a cultural bias against confronting emotional/psychological problems. Of note, initial contact between the patient and healthcare professional appears to constitute the primary bottleneck of depression care in Taiwan [ 16 ].…”

Section: Unmet Needs In Treatment Of Depression In Taiwanmentioning

confidence: 99%

What Do Patients Want in the Treatment of Major Depressive Disorder? Taiwan’s TAILOR Survey

Chang¹

2023

Neurol Ther

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In Taiwan, the number of patients being treated for depression has been increasing over recent decades, but there remain some key unmet needs for these patients. One issue is the low rate of help-seeking, which may be at least partially attributable to the stigma of depression in Asian societies. Stigma also contributes to underdiagnosis, because stigmatised patients may emphasise somatic symptoms (e.g. lethargy/fatigue, sleep disorders or changes in appetite), fearing how they will be perceived if they discuss psychological symptoms with their physician. Underdiagnosis may also result from cross-cultural differences, because assessment scales and screening tools are usually developed in Western populations and may not have the same validity in Asian patients. Depression in Taiwan appears to be undertreated, with a high rate of suboptimal antidepressant dosages and inadequate duration of therapy. Patients may discontinue treatment earlier than recommended for a number of reasons related to their own beliefs about treatment, their relationship with their physicians, or the effects of the medication (adverse effects, slow onset of effect, or lack of effect on comorbid symptoms). Moreover, frequently there is discordance between how patients and physicians define treatment success in depression. Patients are more likely to achieve a benefit from treatment which remains persistent when physicians and patients are closely aligned on treatment goals. To better understand the experiences, preferences and attitudes of patients with depression in Taiwan, the Target Antidepressant Initiation choice to unLock positive patient Outcomes and Response (TAILOR) survey was conducted in 340 adult outpatients receiving treatment for major depressive disorder (MDD). The results of the TAILOR survey highlight the personal and perceived stigma of depression, current barriers to seeking help and maintaining treatment, and opportunities to improve shared decision-making, medication adherence and clinical outcomes for Taiwanese patients with MDD.

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Barriers to depression care among middle-aged and older adults in Taiwan's universal healthcare system

Cited by 12 publications

References 27 publications

Estimation of life expectancy and healthcare cost in rheumatoid arthritis patients with and without depression: a population-based retrospective cohort study

Estimation of life expectancy and healthcare cost in rheumatoid arthritis patients with and without depression: a population-based retrospective cohort study

Impacts of environmental factors on the aetiological diagnosis and disease severity of community-acquired pneumonia in China: a multicentre, hospital-based, observational study

What Do Patients Want in the Treatment of Major Depressive Disorder? Taiwan’s TAILOR Survey

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