Traditional Chinese Medicine and Healthcare Utilization in Bipolar Disorder: A Population-Based Study with Propensity-Matched and Mirror-Image Analyses

Authors

• SHU-PING CHEN, Graduate Institute of Chinese Medical Science, China Medical University,Taichung, Taiwan
• SU-TSO YANG, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
• KAI-CHIEH HU, Department of Imaging Diagnosis, China Medical University Hospital, Taichung, Taiwan
• HUI-CHIH CHANG, College of Medicine, China Medical University, Taichung, Taiwan
• JANE PEI-CHEN CHANG, College of Medicine, China Medical University, Taichung, Taiwan
• KUAN-PIN SU, College of Medicine, China Medical University, Taichung, TaiwanFollow

Abstract

Background: Bipolar disorder (BD) is a chronic relapsing illness associated with high rates of acute psychiatric hospitalizations (APH) and emergency services (ES) use, placing burdens on healthcare systems. Many patients seek complementary modalities, including traditional Chinese medicine (TCM), alongside standard pharmacotherapy. However, population-based evidence regarding TCM’s effect on acute healthcare utilization in BD is lacking.

Methods: Using data from Taiwan’s Longitudinal Health Insurance Database 2000 (LHID 2000), this population-based study employed propensity score matching (PSM) based on age, gender, the index year (defined as the calendar year of the index date for TCM users and their matched nonTCM counterparts), and logistic regression analyses to compare patients receiving TCM with those who did not. As exploratory outcomes, a one-year mirrorimage analysis assessed changes in psychiatric service utilization before and after TCM intervention for each patient.

Results: The PSM analysis showed no significant difference between the

TCM and non-TCM groups in the overall number of APH and ES patients, or in the total APH and ES times. However, for TCM users with a cumulative length of stay (LOS) of 31-90 days, the odds ratio was 0.69 (95% CI = [0.50, 0.95]), p-value = 0.02. The mirror-image analysis showed a statistically significant reduction in ES utilization (58.3%, from 24 to 10 visits) in the specific subgroup of BD patients in the TCM group without prior hospitalization. However, clinical relevance remains uncertain due to missing per-patient rates and confidence intervals.

Conclusion: TCM intervention may be associated with a numerically lower but clinically uncertain reduction in acute ES utilization, particularly in BD patients with less severe illness trajectories (without prior hospitalization). Conversely, its use alongside mood stabilizers in higher-risk patients warrants cautious interpretation. These findings support TCM as a potential complementary strategy, but further prospective research is needed to clarify mechanisms and optimize patient selection.

Recommended Citation

CHEN, SHU-PING; YANG, SU-TSO; HU, KAI-CHIEH; CHANG, HUI-CHIH; CHANG, JANE PEI-CHEN; and SU, KUAN-PIN (2026) "Traditional Chinese Medicine and Healthcare Utilization in Bipolar Disorder: A Population-Based Study with Propensity-Matched and Mirror-Image Analyses," BioMedicine: Vol. 16 : Iss. 3 , Article 4.
DOI: 10.37796/2211-8039.1716

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