Fu-Huang Lin

Depression and suicide risk among low-income individuals not only share common epidemiological patterns but may also be driven by underlying bidirectional mechanisms. On one hand, the social causation hypothesis suggests that financial stress, food insecurity, and unstable housing significantly increase the risk of developing depression. On the other hand, the social drift hypothesis indicates that depression often leads to impaired occupational functioning, job loss, and financial decline, creating a feedback loop where poverty exacerbates depression, and depression, in turn, perpetuates poverty. In this context, we hypothesized that depressed patients from low-income backgrounds would have a higher propensity for suicide, as the risk may arise both because of poverty and as a consequence of untreated or chronic depression. This is also consistent with behavioral economic evidence showing that clinical depression alters time and risk preferences and consumption-related dysfunction. We acknowledge the feedback loop where depression exacerbates poverty and vice versa, thus further increasing suicide risk among low-income individuals. To evaluate this, we utilized the Taiwan National Health Insurance Research Database to examine whether depression in low-income individuals is significantly associated with an elevated risk of suicide. The present cohort study obtained data from the National Health Insurance Research Database. From a total of 1,936,512 patients included in the Longitudinal Health Insurance Dataset between 2000 and 2015, 771 low-income participants who had suffered from depression and 3084 controls matched for gender and age were selected. Cox proportional hazard regression analysis was employed to explore the hazard ratio, and 95% confidence intervals (CIs) for low income being associated with the risk of developing psychiatric disorders during the 16-year follow-up period were calculated. Of the 771 low-income, depressed patients and 3084 control participants, 60 (8514.66 per 105 person-years) and 138 (36,269.29 per 105 person-years) developed suicidal thoughts, respectively. The Cox regression model revealed an adjusted hazard ratio (AHR) of 1.771 (95% CI = 1.289–2.432, P < .001) after adjusting for all the covariates. Depression among low-income individuals was associated with Charlson Comorbidity Index (AHR = 1.097; 95% CI = 1.004–1.186, P = 1.186). Factors of suicide methods by using Cox regression included other gases and vapors (AHR = 8.149; 95% CI = 5.926–11.196, P < .001), and cutting and piercing (AHR = 2.789; 95% CI = 2.021–3.864, P < .001). Depression and low income are independent risk factors for suicide. Depressed low-income patients are at higher risk of developing suicidal thoughts compared with depressed non-low-income patients. Among suicide methods, gases and vapors have the highest risk. Therefore, clinicians should pay attention to the income level of depressed patients.

Acute influenza-like illnesses (ILIs) are primarily caused by influenza type A or type B viruses. Several factors influence the risk of the spread of ILIs. The present study investigated the epidemiological characteristics, differences, and epidemiological trends of influenza viruses, noninfluenza respiratory pathogens, and locations where clusters occurred in Taiwan between 2011 and 2020. The study analyzed publicly available data on 1,545 confirmed ILI clusters, with the data obtained from the Taiwan Centers for Disease Control. In total, 1,334 ILI clusters were caused by influenza virus infection, 11 ILI clusters were caused by noninfluenza respiratory pathogens, and 78 ILI clusters were caused by pathogens not detected in routine testing. Additionally, for 122 ILI clusters, no pathogen detection was initiated. Significant differences were observed (p < 0.001) in the number of ILI clusters between influenza and noninfluenza respiratory pathogens in 2011–2020. In addition, significant differences were observed (p < 0.001) in the number of ILI clusters between locations in 2011–2020. In terms of specific pathogens within ILI clusters, single infections with influenza A virus accounted for the highest number of cases (69.6%, 1076/1358, odds ratio: 1.740–2.957, p < 0.001–0.012), followed by adenovirus infections among noninfluenza respiratory pathogens (58.3%, 7/12). Schools had the highest number of ILI clusters (47.3%, 731/1545) among the investigated institutions (odds ratio: 1.438–1.556, p < 0.001–0.012). This study provides valuable insights into ILI cluster transmission patterns in Taiwan over a 10-year period and highlights the importance of long-term studies covering a wide geographic area as a means of understanding the implications of such patterns.

Background: Japanese encephalitis (JE) is a zoonotic parasitic disease caused by the Japanese encephalitis virus (JEV), and may cause fever, nausea, headache, or meningitis. It is currently unclear whether the epidemiological characteristics of the JEV have been affected by the extreme climatic conditions that have been observed in recent years. Objective: This study aimed to examine the epidemiological characteristics, trends, and potential risk factors of JE in Taiwan from 2008 to 2020. Specifically, the study focused on gender, age, season, residential area, clinical manifestations, high-risk areas, and the impact of environmental and climate factors. Methods: This study reviewed publicly available annual summary data on reported JE cases in the Taiwan Centers for Diseases Control between 2008 and 2020. Results: This study collected 309 confirmed domestic patients and 4 patients with imported JE. There was an increasing trend in the incidence of JE, 0.69‐1.57 cases per 1,000,000 people, peaking in 2018. Case fatality rate was 7.7% (24/313). Comparing sex, age, season, and place of residence, the incidence rate was highest in males, 40‐ to 59-year-old patients, summer, and the Eastern region, with 1.89, 3.27, 1.25, and 12.2 cases per million people, respectively. The average coverage rate of the JE vaccine for children in Taiwan is 94.9%. Additionally, the major clinical manifestations of the cases included fever, unconsciousness, headache, stiff necks, psychological symptoms, vomiting, and meningitis. The major occurrence places of JE included paddy fields, pig farms, pigeon farms, poultry farms, and ponds. For air pollution factors, linear regression analysis showed that SO₂ (ppb) concentration was positively associated with JE cases (β=2.184, P=.02), but O₃ (ppb) concentration was negatively associated with them (β=−0.157, P=.01). For climate factors, relative humidity (%) was positively associated with JE cases (β=.380, P=.02). Conclusions: This study is the first to report confirmed cases of JE from the surveillance data of the Taiwan Centers for Diseases Control between 2008 and 2020. It identified residence, season, and age as risk factors for JE in Taiwan. Air pollution and climatic factors also influenced the rise in JE cases. This study confirmed that JE remains a prevalent infectious disease in Taiwan, with its epidemic gradually increasing in severity. These findings empower clinicians and health care providers to make informed decisions, guiding their care and resource allocation for patients with JE, a disease that significantly impacts the health and well-being of the Taiwanese population.

Although the World Health Organization (WHO) certified Taiwan as being malaria-free in 1965, there are reports of a few imported cases each year by travelers who visit malaria-endemic areas. This study examined the epidemiology of imported malaria cases in Taiwan from 2014 to 2020, utilizing national surveillance data from the Taiwan Centers for Disease Control. Malaria cases were confirmed through the application of standard laboratory methods. Passenger data came from the Tourism Bureau, Ministry of Transportation and Communication, Taiwan (TBMTC). All data were analyzed using SPSS version 21. The analysis included a dataset comprising 64 cases of imported malaria. Of the total cases, 77.8% were acquired from Africa, and 17.5% from Asia. Plasmodium falciparum was responsible for more than half (57.1%) of the cases, Plasmodium vivax malaria for 25.4% of cases, Plasmodium malariae malaria for 6.3%, Plasmodium ovale malaria for 4.8%, and unspecified pathogen malaria for 6.3% of the cases. Majority of the patients were male (75%) and were predominantly aged 20 to 59 years (70.3%). Most cases of imported malaria occurred during the fall season, and 51.6% of cases occurred in 8 cities during the period of 2014 to 2020. No evidence exists to indicate that indigenous malaria transmission occurs in Taiwan. Anopheles minimus was found in 4 cities (counties), namely Tainan City and Pingtung County in Southern Taiwan; Hualien County and Taitung County in Eastern Taiwan. The findings of this study highlight the necessity for robust surveillance systems, effective vector control measures, and targeted interventions for travelers and immigrants to prevent malaria outbreaks and maintain Taiwan’s malaria-free status.

We collected data on imported dengue cases between 2011 and 2020 from Taiwan’s Centers for Disease Control to determine changes in the case number and importation rate of dengue. We used open data provided by Taiwan’s Centers for Disease Control to extract the number of confirmed imported cases of dengue between 2011 and 2020. From 2011 to 2020, 2883 imported cases of dengue were reported in Taiwan. The importation rate was 25.8 to 46.4 per 100,000 inbound travelers from 2011 to 2020, peaking in 2020. Disease incidence varied between sexes, age groups, seasons (P < .001), and residence from 2011 to 2020. Numerous dengue cases were imported from Indonesia (548 cases), Vietnam (516 cases), and the Philippines (500). For travelers from Taiwan, the risk ratio of becoming infected by dengue was 31,712 for traveling to the Maldives, 3153 to Cambodia, and 996 to Myanmar. In this study, more serotype 1 and 2 strains were reported by Vietnam, and more serotype 3 and 4 strains were reported by Indonesia. Our data indicate that the rate of imported cases of dengue significantly increased annually from 2011 to 2020 in Taiwan, especially during the COVID-19 pandemic (46.4 per 100,000 inbound travelers).

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The 2003 SARS outbreak led to both acute health impacts and lasting effects on survivors and their families. Objective: Study investigates the increased risk of accidental and intentional injuries among SARS survivors and their relatives, with implications for future pandemics, including COVID-19. Methods: This retrospective cohort study utilized data from Taiwan’s National Health Insurance Research Database, focused on 285 individuals diagnosed with SARS in 2003 and 699 of their relatives, matched in a 1:10 ratio with controls. Injury risks were assessed using Fine and Gray’s competing risk models, adjusting for sociodemographic and clinical covariates, over a follow-up period of up to 15 years. Results: SARS survivors had a higher risk of accidental injuries (AHR = 1.631, 95% CI: 1.184–2.011, p < 0.001), as did their relatives (AHR = 1.572, 95% CI: 1.148–1.927, p < 0.001). Subgroup analysis showed elevated risks of poisoning and falls among survivors, while relatives had higher risks of traffic accidents, poisoning, medical incidents, falls, and crushing injuries. Conclusions: SARS survivors and relatives face increased injury risks, highlighting long-term physical and psychosocial vulnerabilities after severe infectious outbreaks. These findings suggest healthcare systems should provide preventive and supportive measures to mitigate long-term impacts for those affected by pandemics.

BACKGROUND The 2003 SARS outbreak led to both acute health impacts and lasting effects on survivors and their families. OBJECTIVE Study investigates the increased risk of accidental and intentional injuries among SARS survivors and their relatives, with implications for future pandemics, including COVID-19. METHODS This retrospective cohort study utilized data from Taiwan’s National Health Insurance Research Database, focused on 285 individuals diagnosed with SARS in 2003 and 699 of their relatives, matched in a 1:10 ratio with controls. Injury risks were assessed using Fine and Gray’s competing risk models, adjusting for sociodemographic and clinical covariates, over a follow-up period of up to 15 years. RESULTS SARS survivors had a higher risk of accidental injuries (AHR = 1.631, 95% CI: 1.184–2.011, p < 0.001), as did their relatives (AHR = 1.572, 95% CI: 1.148–1.927, p < 0.001). Subgroup analysis showed elevated risks of poisoning and falls among survivors, while relatives had higher risks of traffic accidents, poisoning, medical incidents, falls, and crushing injuries. CONCLUSIONS SARS survivors and relatives face increased injury risks, highlighting long-term physical and psychosocial vulnerabilities after severe infectious outbreaks. These findings suggest healthcare systems should provide preventive and supportive measures to mitigate long-term impacts for those affected by pandemics.

Background/Objectives: According to the 2023 Ministry of Health and Welfare statistics, the suicide rate among adolescents aged 15 to 24 has steadily increased since 2018, from 3.7 to 5.5 per 100,000 populations, reaching a recent high. Although previous studies have pointed out that the future risk of suicide of those who had suffered from abuse was higher than that of the general population, researchers seldom focused on adolescent groups. Therefore, the aim of this study was to explore the risk of suicide after youth violence and the impact of subsequent comorbid mental illness and suicide risk. Methods: This retrospective matched cohort study analyzed data from the NHIRD, covering the period from 2000 to 2015. A total of 976 cases aged 10–18 who had experienced violence were included in this study. Controlled grouping was conducted by 1:10 matching based on gender, age, and the time of medical treatment, and a control group who had not experienced violence was selected for comparison. We used the Cox proportional hazards model to analyze the risk of suicide among adolescents after exposure to violence. Results: The suicide rate among adolescents who have experienced violence was significantly higher than that of the control group after 15 years of follow-up (1.0% vs. 0.5%). The prevalence of mental illness or disorders in adolescents exposed to violence was significantly higher than in the control group (45.2% vs. 40.1%). Among adolescents who had experienced violence, the methods of suicide included poisoning (solid and liquid) (53.6% vs. 43.2%), hanging (1.2% vs. 0.6%), firearms (2.4% vs. 0%), and cutting instruments (27.4% vs. 22.8%), all of which were significantly higher than in the control group. After adjusting for gender, age, residential area, and mental health comorbidities, the risk of suicide in those who had experienced violence was 1.475 times that of the control group (95% CI = 1.125–1.933; p = 0.005). Conclusions: In this study, female, younger age, and comorbid mental disorders were identified as risk factors for suicide among the adolescent victims of violence. Exposure to youth violence was associated with an increased prevalence of emotional disorders, including depression and social isolation, which subsequently elevated the suicide risk. These findings underscore the urgent need for governmental attention to the mental health of adolescent victims of violence. Implementing targeted psychological support and intervention programs could play a crucial role in mitigating the risk of suicide among this vulnerable population.

Background/Objectives: According to 2023 Ministry of Health and Welfare statistics, the suicide rate among adolescents aged 15 to 24 has steadily increased since 2018, from 3.7 to 5.5 per 100,000 populations, reaching a recent high. Although previous studies have pointed out that the risk of suicide in the future of those who had suffered from abuse was higher than that of the general population, seldom the researches focused on adolescent groups. Therefore, this aim of the study was exploring the risk of suicide after youth abuse and the impact of subsequent comorbid mental illness and suicide risk. Methods: This retrospective matched-cohort study analyzed data from the NHIRD covering the period from 2000 to 2015.A total of 976 cases aged 10-18 who had experienced abuse. Controlled group was conducted by 1:10 matching based on gender, age and time of medical treatment, and a control group who had no experienced violence was selected for comparison. We used the Cox proportional hazards model to analyze the risk of suicide among adolescents after exposure to violence. Results: The suicide rate among adolescents who have experienced violence was significantly higher than that of the control group after 15 years of follow-up (1.0% vs. 0.5%). The prevalence of mental illness or disorders in adolescents exposed to violence was significantly higher than in the control group (45.2% vs. 40.1%). Among adolescents who had experienced violence, the methods of suicide included poisoning (solid and liquid) (53.6% vs. 43.2%), hanging (1.2% vs. 0.6%), firearms (2.4% vs. 0%), and cutting instruments (27.4% vs. 22.8%), all of which were significantly higher than in the control group. After adjusting for gender, age, residential area, and mental health comorbidities, the risk of suicide in those who had experienced Abuse was 1.475 times that of the control group (95% CI = 1.125–1.933; P = 0.005). Conclusions: In this study, female gender, younger age, comorbid depression, and substance abuse were identified as risk factors for suicide among adolescent victims of violence. Exposure to youth violence was associated with an increased prevalence of emotional disorders, including depression and social isolation, which subsequently elevated the suicide risk. These findings underscore the urgent need for governmental attention to the mental health of adolescent victims of violence. Implementing targeted psychological support and intervention programs could play a crucial role in mitigating the risk of suicide among this vulnerable population.