From 1998 to 2007, the nationwide first admission rates for schizophrenia in Taiwan had fallen by almost 50 percent, according to a new study by researchers at National Taiwan University (NTU). This study has been published online on 27 December 2016 in Social Psychiatry and Psychiatric Epidemiology.
Schizophrenia is a serious mental illness, affecting up to 0.5 to 1 percent of the general population. Patients can suffer from their abnormal thoughts, disorganized behaviors, perceptual disturbances, and gradual deterioration in everyday functioning to such a level that their symptoms pose great burdens to their family and neighborhood. Hospitalization, which is often necessary to control a patient’s psychotic episode, constitutes a major part of health expenditure for the illness. Reduction in first admission rates for schizophrenia, therefore, suggests the disease burden is easing.
“To our knowledge, this is the first epidemiologic finding of the decreasing first admission rates for schizophrenia outside Western countries,” says Dr. Chih-Lin Chiang, the first author of this study, who is a MPH graduate from NTU and a psychiatrist at Shin Kong Wu Ho-Su Memorial Hospital. Even nowadays, the mental health resources in Taiwan have been much more limited and less organized compared to the Western countries. Nevertheless, it is likely that the increased supply in mental health professionals and the implementation of universal health coverage have helped bridge the treatment gap and facilitate early recognition and management of mental illnesses in Taiwan.
In addition, the researchers also found that the excessive hospitalization risk of men for psychosis had gradually resolved. In 2007, the first admission rate of men became almost the same as that of female. It is well known that young men are more likely to develop schizophrenia or psychosis than young female probably because of biological underpinnings. The new epidemiologic evidence suggests that such gender inequity can be effectively mitigated.
The findings of this study have many policy implications, pointed out by Dr. Wei J. Chen, the corresponding author of this study and Dean of College of Public Health at NTU. Most importantly, the changing case mix of hospitalization patients from schizophrenia toward mood disorders and substance-induced disorders in Taiwan is a call for a continual paradigm shift of psychiatric treatment, from the traditional hospital-based to community-based care model.