Loading...
|
Please use this identifier to cite or link to this item:
https://nccur.lib.nccu.edu.tw/handle/140.119/136833
|
| Title: | 臺灣慢性精神病發生、死亡、醫療利用分析
A Study of Incidence, Death, and Medical Utilization of Mental Illness Patients in Taiwan |
| Authors: | 方永翔
Fang, Yung-Hsiang |
| Contributors: | 楊曉文
余清祥
Yang, Sheau-Wen
Yue, Ching-Syang
方永翔
Fang, Yung-Hsiang |
| Keywords: | 慢性精神病
全民健康保險
死亡率
醫療利用
空間分析
Mental Illness
National Health Insurance
Mortality rate
Medical Utilization
Regional disparity |
| Date: | 2021 |
| Issue Date: | 2021-09-02 15:44:02 (UTC+8) |
| Abstract: | 現代人由於社會及環境壓力，慢性精神病的盛行率有升高的趨勢，而且常因生活而忽略這類型疾病對我們的影響，包括危害個人身心健康、甚至是社會安全。臺灣罹患慢性精神病人數相當多，截至108年國人約有近20萬人持有慢性精神病重大傷病卡，佔所有重大傷病卡的21%，在重大傷病中僅次於癌症（來源：衛生福利部健保署）。慢性精神病中最多為「思覺失調症」（俗稱精神分裂症），卡數超過10萬張，第二名為「情感性精神疾病」（俗稱躁鬱症），是所有精神疾病中遺傳相關性最高，近年廣受關注的「老年期及初老年期器質性精神病態」（俗稱失智症）排名第三，預計隨著國人壽命延長而逐年增加。由於不少國人對於精神病存有誤解，國內對慢性精神病之研究也較少，精神病患之醫療與需求仍不夠清楚，因此本文以探究我國慢性精神病現況，以及患者的醫療利用及地區特性為目標，希冀研究成果可提供政府與各界之參考。
本研究以重大傷病中之慢性精神病作為研究對象，探討慢性精神病之患者特性與醫療需求，透過發生、死亡、醫療利用之計算，分析慢性精神病重大傷病於時間、空間的趨勢與特性。本文使用之重大傷病資料庫來自於全民健保，資料年份為2003年至2013年，資料內容包括重大傷病證明明細檔(HV)、門診處方及治療明細檔(CD)、住院醫療費用清單明細檔(DD)、醫事機構基本資料檔(HSOB)等。分析發現慢性精神病發生率逐年下降，死亡率則呈現波動向下之趨勢，與癌症、整體重大傷病之發生率、死亡率趨勢有明顯差別。慢性精神病者的住院天數高於整體重大傷病者的平均，且為癌症患者的四倍。研究也發現10歲以下幼兒慢性精神病患者有較高醫療利用， 20歲左右有較高的住院需求，甚至超過癌症和整體重大傷病。
Mental illness becomes very common in modern world and many believe that the pressure in workplace and technological advance in social media are making us ill. People often neglect the impacts of mental conditions, including harm to personal physical and mental health, and even national security. Mental illness is the second leading catastrophic illness (CI) in Taiwan, accounting for 21% of all CI patients. Schizophrenia is the most common mental disease in CI, about 0.1 million patients, following by bipolar disorder and dementia. However, there were only a few researches on mental illness in Taiwan and the medical utilization of mental patients remains unknown. Thus, we aimed to explore the medical utilization of mental patients and if the number of mental patients will grow in this study.
There is no consensus on the definition of mental illness and we adapted that of CI in this study. We used experienced data from Taiwan’s National Health Insurance to estimate the incidence rates, mortality rates, and medical utilization of mental patients. The analysis results showed that the incidence rates and mortality rate of mental disease decrease with time, indicating there will be fewer mental patients. The average inpatient days of mental patients were significantly higher than those of other CI patients, e.g., four times higher than those of cancer patients. However, because the mortality rates of CI mental patients are among the lowest in CI patients, the overall medical utilization of CI mental patients is not necessary to be the smallest in CI patients (e.g., ages 10 and below). |
| Reference: | 一、 中文部分
行政院衛生福利部（2020）。世界心理健康日衛生福利統計通報 。
江博煌、董何銳、張育嘉、徐尚為（2014）。「智能障礙老年人使用抗精神疾病用藥之趨勢分析」。《台灣老人保健學刊》，10卷2期，127-139。
李大正、楊靜利、王德睦（2011）。「人口老化與全民健保支出：死亡距離取向的分析」。《人口學刊》，43卷，1-35。
李玫姿（2003）。「精神疾病就診行為分析」。衛生與健保統計應用座談會 。
余清祥、王信忠、許筱翎（2019）。「從全民健保評估高齡人口的醫療需求」。《人口學刊》，58卷，89-120。
林秀縵、黃景揚、歐晏伶、邱政元、陳敏郎（2020）。「利用健保資料庫分析常見自體免疫疾病患者新發精神疾病之相關性分析」。《醫務管理期刊》，21卷2期，73-92。
林正祥、劉士嘉、劉于琪（2014）。「臺灣事故傷害對潛在生命年數、工作年數及社會經濟損失影響探討」。《人口學刊》，48卷，141-171。
郭孟坤、余清祥（2008）。「電腦模擬、隨機方法與人口推估的實證研究」。《人口學刊》，36卷，67-98。
陳芝嘉、余清祥、蔡偉德（2015）。「921震災對中老年人死亡風險的影響」。《人口學刊》，50卷，61-99。
陳政勳、余清祥（2010）。「小區域人口推估研究：臺北市、雲嘉兩縣、澎湖縣的實證分析」。《人口學刊》，41卷，153-183。
傅千芬、謝佳容、張國榮（2013）。「居家慢性精神障礙者的醫療利用及影響因素」。《醫務管理期刊》，14卷2期，87-106。
黃意萍、余清祥（2002）。「台灣地區生育率模式的推估研究」。《人口學刊》，25卷，145-171。
鄒秉諺、林藍萍、徐尚為、林金定（2016）。「台灣慢性精神障礙盛行率長期變化趨勢分析 2000-2014 年」。《身心障礙研究》，14卷，75-85。
葉玲玲、藍忠孚、鄭若瑟（2003）。「台灣精神分裂症患者精神醫療利用與費用之分析探討」。《台灣衛生公共雜誌》，22卷3期，194-203。
蔡艷清、嚴嘉楓、林金定（2004）。「精神疾病與智能障礙：流行病學與醫療照護需求分析」。《身心障礙研究季刊》，2卷2期，95-108。
劉玟宜、戎瑾如、李坤黛（2012）。「社區精神病患之照護需求—系統性文獻回顧」。《精神衛生護理雜誌》，7卷2期，1-13。
簡以嘉（2004）。「台灣全民健保精神疾病盛行率、醫療利用及費用分析研究」，國立陽明大學公共衛生研究所博士論文。
蘇明道、劉士永、詹大千（2015）。「運用網格空間單元分析疾病之時空變化」。《自然科學簡訊》，27卷4期，169-177。
二、 英文部分
Sara A., Mimmi B. & Gunilla S. (2021). Mental health and academic performance: a study on selection and causation effects from childhood to early adulthood. Soc Psychiatry Psychiatr Epidemiol 56, 857–866.
Angermeyer M.C. & Matschinger H. (2003). The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatr Scand, 108(4): 304-9.
Baxter A.J., Scott K.M., Ferrari A.J., Norman R.E., Vos T. & Whiteford H.A. (2014). Challenging the myth of an “epidemic” of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010. Depress Anxiety, 31, 506-516.
Blader J.C. (2011). Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Arch Gen Psychiatry, 68, 1276-1283.
Brouhns N., Denuit M. & Vermunt J. (2002). A Poisson log-bilinear regression approach to the construction of projected lifetables. Insurance: Mathematics and Economics, 31(3), 373–393.
Chiu M, Amartey A, Wang X, Vigod S & Kurdyak P. (2020). Trends in objectively measured and perceived mental health and use of mental health services: a population-based study in Ontario, 2002-2014. CMAJ, 192, 329-337.
Janice C., John B., Alicia O., Myfanwy L.J. & Suzy P. (2012). Quality of life of people with mental health problems: a synthesis of qualitative research. Health Qual Life Outcomes 10, 138.
Curtin L.R. & Klein R.J. (1995). Direct standardization (age-adjusted death rates). National Center for Health Statistics. Healthy People 2000: Statistical notes, no 6 revised.
Bruce P.D., Donna T.C. & Louis V. (1999). Life expectancy and causes of death in a population treated for serious mental illness. Psychiatric services, 50(8), 1036-1042.
Ferrari A.J., Charlson F.J., Norman R.E., Patten S.B., Freedman G., Murray C.J., Vos T. & Whiteford H.A. (2013). Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med, 10(11)
Fletcher J.M. (2010). Adolescent depression and educational attainment: results using sibling fixed effects. Health Econ, 19, 855-871.
Fu T.S., Lee C.S., Gunnell D., Lee W.C. & Cheng A.T. (2013). Changing trends in the prevalence of common mental disorders in Taiwan: a 20-year repeated cross-sectional survey. Lancet 381, 235-241.
Federico G. & Gary K. (2007). Understanding the Lee–Carter mortality forecasting method.
Halpern-Manners A., Schnabel L., Hernandez E. M., Silberg J. L. & Eaves L. J. (2016). The relationship between education and mental health: new evidence from a discordant twin study. Social Forces, 95(1), 107–131.
Hong-Chih H., Jack C. Yue & Sharon S. Yang. (2008). An empirical study of mortality models in Taiwan. Asia-Pacific Journal of Risk and Insurance, 3, 140-154.
Huang R.R., Chou C.H., Chen C.M., Su S.F., Chang L.S. & Kao M.H. (2011). Factors associated with subjective health`s outcome among patients with severe mental illness. Taiwanese Journal of Psychiatry, 25(3), 145-157.
Jahangiri K., Aghamohamadi S., Khosravi A. & Kazemi E. (2018). Trend forecasting of main groups of causes-of-death in Iran using the Lee-Carter model. Med J Islam Repub Iran, 32, 124.
Leah S. Richmond-Rakerd, Stephanie D’Souza, Barry J. Milne, Avshalom Caspi & Terrie E. Moffitt (2021). Longitudinal associations of mental disorders with physical diseases and mortality among 2.3 million NewZealand citizens. JAMA Network Open, 4 (1).
Ronald D. Lee & Lawrence R. Carter. (1992). Modeling and forecasting U.S. mortality. Journal of the American Statistical Association, 87 (419), 659-671.
Li N., Lee R. D. & Tuljapurkar S. (2004). Using the Lee-Carter method to forecast mortality for populations with limited data. International Statistical Review, 72, 19-36.
Hans L. & Jan Q. (2004). Mortality forecasting and trend shifts: an application of the Lee-Carter model to Swedish mortality data. Int. Stat. Rev. 72(1), 37-50.
Manwell L. A., Barbic S. P., Roberts K., Durisko Z., Lee C., Ware E. & McKenzie K. (2015). What is mental health? Evidence towards a new definition from a mixed methods multidisciplinary international survey. BMJ Open.
Dominic M. (2003). Attitudes towards patients with a diagnosis of `borderline personality disorder`: Social rejection and dangerousness. Journal of Mental Health, 12(6), 595–612.
Mental Health America (2021). The state of mental health in America .
National Institute of Mental Health (2021). Mental illness in US .
Oleguer Plana-Ripoll, Nanna Weye, Natalie C. Momen, Maria K. Christensen, Kim M. Iburg, Thomas Munk Laursen & John J. McGrath (2020). Changes over time in the differential mortality gap in individuals with mental disorders. JAMA Psychiatry, 77 (6), 648-650.
Davide P. & Silvana G. (2020). Controversial issues in current definitions of mental health. Archives of Psychiatry & Psychotherapy, 22(1), 7-11.
Ronald P. (2009). Should DSM-V Designate “Internet Addiction” a Mental Disorder? Psychiatry, 6(2), 31-37.
Renshaw A. & Haberman S. (2003). Lee-Carter mortality forecasting with age-specific enhancement. Insurance: Mathematics and Economics, 33(2), 255–272.
Shivani S., Debdulal D.R. & Partha S.K. (2015). Cognitive self-regulation, social functioning and psychopathology in schizophrenia. Industrial Psychiatry Journal, 24(2), 129-134.
Telles-Correia D., Saraiva S. & Gonçalves J. (2018). Mental disorder—the need for an accurate definition. Front. Psychiatry 9, 64.
Üstün T., Ayuso-Mateos J., Chatterji S., Mathers C. and Murray C. (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry, 184(5), 386-392.
World Health Organization (2013). Premature death among people with severe mental disorders. https://www.who.int/mental_health/management/info_sheet.pdf
World Health Organization (2017). Depression and other common mental disorders. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
Yue J.C., Wang H-C, Leong Y-Y and Su W-P. (2018). Using Taiwan National Health Insurance Database to Model Cancer Incidence and Mortality Rates. Insurance: Mathematics and Economics 78, 318-324. |
| Description: | 碩士
國立政治大學
統計學系
108354020 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0108354020 |
| Data Type: | thesis |
| DOI: | 10.6814/NCCU202101093 |
| Appears in Collections: | [統計學系] 學位論文
|
Files in This Item:
| File |
Description |
Size | Format | |
|---|
| 402001.pdf | | 8255Kb | Adobe PDF2 | 205 | View/Open |
|
All items in 政大典藏 are protected by copyright, with all rights reserved.
|
