Prevalence of mental health disorders and cost of medical utilization in elderly taiwan military veterans vs non-veterans.

Table 2. Adjusted odds ratio and 95% confidence interval of risk ofmental health disorders in veterans compared with non-veterans.

Table 3. Medical utilization between veterans and non-veterans in 2013.

Table 4. Adjusted odds ratio and 95% confidence interval of risk of medical utilization in veterans compared with non-veterans.

Discussion

The aim of the study was to compare the prevalence of mental health disorders and costs of medical utilization in elderly Taiwanese veterans and non-veterans.

Major and minor neurocognitive disorder

In Taiwan, the prevalence rate of major neurocognitive disorder in men aged over 65 years in 2010 was 7.3% [7], which was consistent with our findings. In the U.S., a study performed by [8] revealed that the prevalence of major neurocognitive disorder in older veterans in the U.S. was higher when compared with elderly veterans in Taiwan (10.7% vs 9.6%).

Schizophrenia

Our study showed that the prevalence of schizophrenia in both elderly veterans and non-veterans was 0.1% in 2010, almost the same as it was in Taiwan in 1996 [9]. The reason why the prevalence of schizophrenia in elderly veterans was lower in Taiwan compared with that in the U.S. (0.1% vs 0.3~12.2%) requires further study. Disease progression and a decreased life expectancy in veterans diagnosed with schizophrenia must be considered.

Major depressive disorder and dysthymic disorder

Although the prevalence of major depressive disorder was not significant between veterans and non-veterans after adjustment (OR=1.58, 95% CI=0.93-2.67, p=0.089), veterans experienced a significantly high prevalence of dysthymic disorder (OR=1.41, 95% CI=1.04-1.92, p=0.026). The prevalence of major depressive disorder and dysthymic disorder in veterans was 0.8% and 2.0% respectively, which was low compared with the veteran depression prevalence in the U.S. report put out by Williamson V et al. (3-19%) (8).

Bipolar disorder

In our study, the prevalence of bipolar disorder in elderly veterans was 0.5%. This is consistent with the prevalence seen in U.S. veterans, where elderly bipolar veterans ranged between 0.2% and 2.9%.

Adjustment disorder

The prevalence of adjustment disorder in veterans and nonveterans was relatively low in our study compared with what revealed (3.7%) [10]. This result may reflect on the study’s population because geriatric adjustment disorder is more common in primary care and mental health care patients.

Post-Traumatic Stress Disorder (PTSD)

Only one veteran in our study was diagnosed with PTSD, which was inconsistent with the results from a previous study [11]. Showed a significant dose-dependent association between PTSD and its severity, and an increased risk of developing dementia later in life. In addition, patients with PTSD had a high comorbidity with depressive disorder rate (77.3%). This may explain the low prevalence of PTSD and high prevalence of major and minor neurocognitive disorder and depression in elderly veterans.

Anxiety disorder

The prevalence of anxiety disorder in elderly male veterans was 4.7% in our study. According to [12], in 2010, the prevalence of anxiety disorder in the general population was 6.09% in Taiwan. Why our study had a relatively low prevalence rate may be due to the study population, in that females are at a greater risk for anxiety disorder [12]. In the U.S., the prevalence rates for veterans experiencing non- PTSD anxiety disorder is estimated to range between 2.4% and 7.2% [13].

Sleep disorder

There is a wide variation in reports regarding the prevalence of sleep disorder in elderly populations from different parts of the world (from 6% in Taiwan to 62.1% in Egypt) [14]. As with anxiety disorder, rates of sleep disorder are generally found to be higher in woman than in men. In addition, sleep problems can also be related to symptoms surrounding many psychiatric illnesses, such as major and minor neurocognitive disorder, depressive disorder, anxiety disorder and other known disorders. In our study, the prevalence of sleep disorder was significantly higher in veterans than in non-veterans (OR=1.22, 95% CI=1.08-1.39, p=0.002), which remained consistent with our findings that veterans experience a high prevalence of major and minor psychiatric illness.

Major and minor psychiatric illness

The prevalence of major and minor psychiatric illness was 10.7% and 15.2% in elderly veterans and 8.5% and 11.3 % in elderly non-veterans. These data rates are consistent with what [15,16]. Discovered, showing that almost 20% of people without dementia aged 65 years and older did have mental disorders. In veterans, the prevalence of mental disorders was even higher, as shown in our study (Table 2).

Medical utilization

As revealed in the study performed by Lu WH [17-19], elderly people required higher medical utilization than the general population, with our study showing that the elderly veterans required significantly more medical utilization in both psychiatric and non-psychiatric events when compared with elderly non-veterans in Taiwan. Although this suggested that elderly veterans have more health problems than the elderly non-veterans, it also showed that the availability of health services provided to elderly veterans in Taiwan is good.

Conclusion

In 1949, approximately 500,000 military personnel came to Taiwan with the central government of Mainland China. As time went by, they integrated and became a part of Taiwan’s people and landscape, with many of them remaining single while living in a Veterans Home after having left the army. In addition to the daily life care of elderly veterans, the Veterans Home also paid attention to their health problems and provided them with medical care through the Veterans Medical System of the Veterans Affairs Council. This is the reason as to why the elderly veterans in Taiwan are able to participate in the country’s sound health care services.

However, as the Covid-19 pandemic continued to spread across the world, Taiwan announced a nationwide level 3 epidemic alerts on May 19, 2021, then lowering to level 2 on July 27, 2021. Through October 2021, the total number of coronavirus cases in Taiwan was less than 20,000, with fewer than 1,000 deaths (most of whom were older than 60 years). hypothesized that there would be a considerable increase in anxiety and depressive symptoms among people who do not have any pre- existing mental health conditions, with some experiencing post-traumatic stress disorder in due course. As previous studies have shown, quarantine periods during Covid-19 are associated with an acute worsening of clinical symptoms in patients diagnosed with dementia. The quarantined respondents also experienced higher incidences of both depression and anxiety. In addition, the side-effects of vaccinations may also cause anxiety in the general population. During this Covid-19 period and afterwards, the mental health condition of the elderly, vulnerable population must be considered, while the government should enact laws which positively effect change during post-pandemic life, as well as changes in the medical systems.

Limitations

The study examined the prevalence of mental health disorder in elderly Taiwanese veterans and non-veterans, and subsequently compared the results with previous studies. However, there are some limitations to the study. First, although the study used data from the NHI program which represented nationwide population, it did not represent the prevalence of mental health illness within the Taiwan community. For instance, alcohol and substance abuse were not included in our study because the NHI program doesn’t include these disorders, thus their prevalence would be underestimated. The number of alcohol and substance abuse cases may be diagnosed as co-morbid mental health disorders such as depressive disorder, anxiety disorder or sleep disorder. Second, both the CCI and medical utilization were significantly higher in the elderly veteran group than in the non-veteran group, as well as in the odds ratio for risk of mental health disorders. For veterans compared with non-veterans, was adjusted for age, living location, CCI and number of out-patient departments. We did not have any data regarding the usage of pharmacological treatments or the residual confounding factors associated with personal characteristics such as education, socioeconomic status and supportive systems, along with others. These may also have been confounding factors. Further studies are still required in order to better investigate the prevalence of mental health disorders that can be seen in various settings.

References

1. Cohen GH, Fink DS, Sampson L, et al. Mental health among reserve component military service members and veterans. Epidemiol Rev. 2015;37:7-22.

Indexed at, Google Scholar, Cross ref

2. Crum-Cianflone NF, Powell TM. Mental health and comorbidities in U.S. Military Members. Mil Med. 2016;181(6):537-45.

Indexed at, Google Scholar, Cross ref

3. Stevelink SA, Malcolm EM, Mason C, et al. The prevalence of mental health disorders in (ex-) military personnel with a physical impairment: A systematic review. J Occup Environ Med. 2015;72(4):243-51.

Indexed at, Google Scholar, Cross ref

4. Wisco BE, Marx BP, Miller MW, et al. Probable posttraumatic stress disorder in the US veteran population according to DSM-5: Results from the national health and resilience in veterans study. J Clin Psychiatry. 2016;77(11):1503-10.

Indexed at, Google Scholar, Cross ref

5. Chou HW, Tzeng WC, Chou YC, et al. Stress, sleep and depressive symptoms in active duty military personnel. Am J Med Sci. 2016;352(2):146-53.

Indexed at, Google Scholar, Cross ref

6. Tseng CW, Lin CL, Chen YT, et al. Ischemic bowel syndrome in patients with spinal cord Injury: A Nationwide Study. PloS one. 2017;12(1):e0169070.

Indexed at, Google Scholar, Cross ref

7. Liu CC, Li CY, Sun Y, et al. Gender and age differences and the trend in the incidence and prevalence of dementia and alzheimer’s disease in Taiwan: A 7-year national population-based study. Biomed Res Int. 2019.

Indexed at, Google Scholar

8. Williamson V, Stevelink SAM, Greenberg K, et al. Prevalence of mental health disorders in elderly U.S. military veterans: A Meta-analysis and systematic review. Am J Geriatr Psychiatry. Official journal of the American Association for Geriatric Psychiatry. 2018;26(5):534-45.

Indexed at, Google Scholar, Cross ref

9. Chien IC, Chou YJ, et al. Prevalence and incidence of schizophrenia among national health insurance enrollees in Taiwan, 1996–2001. Psychiatry and clinical Neurosci. 2004; 58(6):611-8.

Indexed at, Google Scholar

10. Arbus C, Hergueta T, Duburcq A, et al. Adjustment disorder with anxiety in old age: Comparing prevalence and clinical management in primary care and mental health care. European Psychiatry. 2014; 29(4):233-8.

Indexed at, Google Scholar, Cross ref

11. Wang TY, Wei HT, Liou YJ, et al. Risk for developing dementia among patients with posttraumatic stress disorder: A nationwide longitudinal study. J Affect Disord. 2016;205:306-10.

Indexed at, Google Scholar, Cross ref

12. Tu HP, Lin CH, Hsieh HM, et al. Prevalence of anxiety disorder in patients with type 2 diabetes: A nationwide population-based study in Taiwan 2000-2010. Psychiatric Quarterly. 2017;88(1):75-91.

Indexed at, Google Scholar

13. Little JT. Prevalence of mental health disorders in geriatric U.S. military veterans. Am J Geriatr Psychiatry. 2018;26(5):546-7.

Indexed at, Google Scholar

14. Gulia KK, Kumar VM. Sleep disorders in the elderly: A growing challenge. Psychogeriatrics. 2018;18(3):155-65.

Indexed at, Google Scholar

15. Skoog I. Psychiatric disorders in the elderly. Can J Psychiatry. 2011;56(7):387-97.
16. Lu WH, Lee WJ, Chen LK, et al. Comparisons of annual health care utilization, drug consumption, and medical expenditure between the elderly and general population in taiwan. J Clin Gerontol. 2016;7(2):44-7.

Indexed at, Google Scholar, Cross ref

17. Cullen W, Gulati G, Kelly B. Mental health in the COVID-19 pandemic. QJM: Int J Med. 2020;113(5):311-2.

Google Scholar

18. Rainero I, Bruni AC, Marra C, et al. The impact of COVID-19 quarantine on patients with dementia and family caregivers: A nation-wide survey. Front Aging Neurosci. 2021;12:507.

Google Scholar

19. Tang F, Liang J, Zhang H, et al. COVID-19 related depression and anxiety among quarantined respondents. Psychology & health. 2021;36(2):164-78.

Indexed at, Google Scholar, Cross ref