Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.
J Formos Med Assoc. 2022 Oct;121(10):2001-2011. doi: 10.1016/j.jfma.2022.02.011. Epub 2022 Feb 25.
BACKGROUND/PURPOSE: The number of psychiatrists working in community clinics in Taiwan has increased dramatically in the recent decade. This study aimed to investigate the trend of prevalence and incidence of depressive disorders and assess the quality of depression care between 2007 and 2016 in Taiwan.
We used the claims database derived from Taiwan's National Health Insurance (NHI) program, in which approximately 23.0 million individuals were enrolled, translating to a coverage rate of 99%. Patients with depressive disorders were identified based on International Classification of Diseases codes. The process indicators of depression care quality included visit, duration, and dose adequacy. The outcome indicators included the rate of psychiatric hospitalisation, emergency visit, self-harm hospitalisation, and suicide.
The prevalence of treated depressive disorders increased from 1.61% in 2007 to 1.92% in 2016, i.e., a 25% increase, whereas the incidence of first-ever or recurrent depressive disorder did not change significantly. The number of patients treated by psychiatrists and in community clinics also increased. The quality of depression care improved, the proportion of patients receiving minimum psychiatric clinic follow-up and adequate medication increased, and the rate of emergency visits, psychiatric hospitalisation, and self-harm hospitalisation declined.
The community-based psychiatric services increased and the quality indicators of depression care in Taiwan improved during 2007-2016. The causality warrants further investigations.
背景/目的：在过去的十年中，在社区诊所工作的精神科医生数量在台湾急剧增加。本研究旨在调查 2007 年至 2016 年期间台湾地区抑郁障碍的患病率和发病率趋势，并评估抑郁护理的质量。
我们使用了来自台湾全民健康保险（NHI）计划的索赔数据库，其中约有 2300 万人参加，覆盖率约为 99%。通过国际疾病分类（ICD）代码确定抑郁障碍患者。抑郁护理质量的过程指标包括就诊次数、持续时间和剂量充足性。结果指标包括精神病院住院率、急诊就诊率、自残住院率和自杀率。
经治疗的抑郁障碍的患病率从 2007 年的 1.61%增加到 2016 年的 1.92%，即增加了 25%，而首次或复发性抑郁障碍的发病率没有明显变化。接受精神科医生和社区诊所治疗的患者人数也有所增加。抑郁护理质量得到改善，接受最低限度精神病诊所随访和适当药物治疗的患者比例增加，急诊就诊、精神病院住院和自残住院的比例下降。
2007-2016 年间，台湾的社区精神科服务增加，抑郁护理质量指标得到改善。其因果关系需要进一步调查。
