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研究生:張曉雲
研究生(外文):NITA
論文名稱:青少年自殺死亡與家人自殺及精神疾病史之研究
論文名稱(外文):Adolescent suicide related to family history of completed suicide and mental illness study
指導教授:陳富莉陳富莉引用關係
指導教授(外文):FULI
學位類別:碩士
校院名稱:輔仁大學
系所名稱:公共衛生學系碩士班
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2007
畢業學年度:96
語文別:中文
論文頁數:102
中文關鍵詞:15-19歲青少年自殺台灣1996-200515-19歲青少年自殺青少年自殺風險因素家人精神疾病史家人自殺及精神疾病史家人精神疾病史
外文關鍵詞:Youth suicidefamily history of completed suicide and mental
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本研究以1996至2005年期間15-19歲青少年為對象,探討(一)了解自殺死亡的青少年,在人口特質、自殺類型、健康狀況的分布情形。(二)了解自殺死亡的青少年與未自殺青少年,在人口特質、健康狀況等方面的差異。(三)了解自殺死亡青少年的家人與未自殺青少年的家人,在人口特質、健康狀況、死亡原因等方面的差異。(四)分析青少年人口特質、個人健康狀況,對於其自殺行為的風險影響程度。(五)分析家人的人口特質、家人健康狀況、家人死亡,對青少年自殺行為的影響。
本研究使用行政院衛生署死因登記檔1996-2005年15-19歲自殺死亡之青少年483人者為個案組,比對全民健保承保歸戶檔找出其家人(父、母、兄弟姊妹)計812人;對照組為選取與個案組當年度相同出生年月日、性別,且為個案自殺當日仍存活者,以1:3 0比率隨機抽取,計15,188人為對照組,再找出其家人計29,607人,研究對象總計為46,090人。採用次數分配、比值、卡方檢定、多項邏輯迴歸分析等方式完成統計分析。
結果顯示,1996至2005年15-19歲青少年自殺死亡者,男性為女性的2.1倍,平均年齡17.7歲,且自殺人數隨年齡增長而增加。
個案組本身及其家人為殘障、罹患精神病及重大傷病均高於對照組,顯示個案組家庭成員的健康狀況較不佳;另個案組家人在自殺者死亡前一年死亡者也高於對照組家人。
青少年本身為低收入戶、無職業地區團體、罹患精神病、慢性精神分裂症、慢性情感性精神病,對其自殺風險的增加有顯著影響。尤其青少年罹患精神疾病時,其自殺風險大幅提高,是青少年自殺的重要風險因子。
原住民家庭、低收入戶、無職業、殘障、罹患情感性精神病、慢性精神分裂症、於自殺者死亡前一年死亡,是15-19歲青少年自殺的風險因子。其中父親為原住民、第六類保險對象、罹患情感性精神病、在自殺者死亡前一年死亡,母親為第五、六類保險對象、罹患慢性精神分裂症、情感性精神病,兄弟姊妹為原住民、第六類保險對象、殘障,對15-19歲青少年自殺風險有顯著影響。
根據本研究結果,謹建議透過行政院衛生署、原住民委員會、醫療機構、各級學校及民間組織共同建立合作機制,研訂青少年自殺防治計畫及精神疾病輔導等措施,並對於失業、低收入、原住民、殘障等社會弱勢族群,優先輔導,建立完整之社會扶助體系。並期望未來能透過各部會的合作,如內政部戶政資料、財政部賦稅資料、主計處及健保局醫療利用等資料,由行政院衛生署自殺防治中心結合國內學術機構深入探討自殺行為及其風險因素,針對各類高風險族群分別研訂自殺防治計畫,以達確實防治自殺之目標。關鍵詞:青少年自殺、家人自殺及精神疾病史、自殺風險因素、個案對照
ABSTRACT

This study focuses on youths aged between 15 and 19 as well as their immediate family members. It is aimed at 1) exploring the demographic characteristics, health status and causes of death for people within the targeted age range who have committed suicide and 2) identifying the risk factors of youth suicide.

The researcher conducted this study by comparing the subject group and a control group. The researcher used 483 completed suicide cases, (coded ICD-9-CM E950 to E959, from the registry for ‘the causes of death’ as compiled by the Department of Health, during the period 1996 to 2005) to link to the NHI medical data for their parents and siblings. Including the family members totaled 812 people.

The control group was selected from individuals, alive at the time of the study, who were of the same gender and had the same birth date as the individual who committed suicide in the study group. The control group was randomly drawn by 1:30, this subtotaled 15,188 cases, and links with the NHI medical data for their parents and siblings brought the total to 29,607 people.

The researcher conduct statistics analysis, frequency, ratio, Chi-square test and Logistic Regression.

During 1996 and 2005, in terms of youth suicide, (ages 15 to 19) the ratio of male to female suicide was 2:1 and the number of suicides increased with an increase in age.

The suicide cases were comprised mainly of low-income households, the unemployed and disabled people. The research indicated that individuals with schizophrenia and emotional mental disorders made up a significant number of the suicide cases.

The study also identified that a significant number of the suicide cases came from family backgrounds experiencing economic difficulties, employment problems and poor health status.These factors include aboriginal families, low-income households, unemployment and patients with mental disorders or schizophrenia.

Many of the studies about suicide focus mainly on the case studies and few aim at population and household studies. This study uses cohort groups to analyze the family characteristics and their mental illness history to identify the relationships with the risks of youth suicide.

Identifying high-risk families, in terms of youth suicide and preventing potential suicides will be the final goal of this study.

Key Words: Youth suicide, family history of completed suicide and mental
illness, suicide risk factors, population-based case-control study.
目 錄
目錄................................................... 1
表目錄................................................. 2
圖目錄................................................. 3
中文摘要............................................... 4
英文摘要............................................... 6
第一章 緒論.......................................... 7
第一節 研究動機................................ 7
第二節 研究目的................................ 9
第三節 研究假設................................ 10
第四節 名詞界定................................ 11
第二章 文獻探討...................................... 14
第一節 自殺之意義.............................. 14
第二節 自殺之盛行情形.......................... 16
第三節 自殺行為之理論觀點...................... 21
第四節 青少年自殺之風險因素.................... 29
第三章 研究方法...................................... 41
第一節 研究架構................................ 41
第二節 研究對象及資料來源...................... 42
第三節 資料處理................................ 48
第四章 研究結果...................................... 55
第一節 1996-2005年青少年自殺死亡情形分布..... 55
第二節 個案組、對照組及家人之人口特質、個人健康
狀況及死因分布.......................... 60
第三節 個案組、對照組及家人之人口特質、個人健康
狀況及死因比較.......................... 70
第四節 15-19歲青少年自殺行為之風險分析......... 82
第五節 研究結果與討論.......................... 92
第五章 結論與建議....................................98
第一節 結論....................................98
第二節 建議.............................99
第三節 研究限制.................................... 101
參考文獻............................................... 102

表 目 錄
表2-1 OECD HEALTH DATA-2006年10月.................... 18
表2-2 90國15-19歲青少年死因統計...................... 19
表2-3 青少年自殺之相關理論............................ 28
表2-4 青少年自殺之風險因素相關研究結果................ 38
表3-1 研究變項操作型定義.............................. 50
表3-2-1 研究統計方法(一).............................. 52
表3-2-2 研究統計方法(二).............................. 53
表4-1 1996-2005年15-19歲青少年自殺人數.............. 53
表4-2 青少年自殺者性別年齡分布........................ 55
表4-3 健保投保類別.................................... 56
表4-4 自殺類型........................................ 58
表4-5 個案組、對照組及其家人之原住民分布情形........... 59
表4-6 個案組、對照組及其家人之投保類別分布情形......... 60
表4-7 個案組、對照組及其家人殘障之分布情形............ 61
表4-8-1 個案組及其家人罹患精神病之分布情形............ 62
表4-8-2 對照組及其家人罹患精神病之分布情形........... 63
表4-9 個案組及對照組罹患重大傷病之分布情形........... 63
表4-10 個案組及對照組罹患重大傷病類別之分布情形...... 64
表4-11 個案組及對照組死因之分布情形.................. 66
表4-12 個案組及對照組家人前一年死亡原因之分布情形.... 68
表4-13 個案組及對照組為原住民之比較.................. 69
表4-14 個案組及對照組在投保類別之比較................ 70
表4-15 個案組及對照組殘障之比較...................... 71
表4-16 罹患精神病之比較.............................. 72
表4-17 個案組及對照組罹患重大傷病之比較.............. 74
表4-18 家人為原住民之比較............................ 75
表4-19 家人投保類別之比較............................ 76
表4-20 家人殘障人數之比較............................ 77
表4-21 患重大傷病之比較........................ 78
表4-22 家人罹患精神病之比較...................... 79
表4-23 家人罹患精神病型態之比較...................... 80
表 4-24 19歲青少年自殺行為之風險因素..................... 87
表4-25-1 父親對15-19歲青少年自殺行為之風險因素....... 88
表4-25-2 母親對15-19歲青少年自殺行為之風險因素....... 89
表4-25-3 兄弟姊妹對15-19歲青少年自殺行為之風險因素... 90
表4-25-4 所有家人對15-19歲青少年自殺行為之風險因素... 91
圖目錄
圖2-1 世界各國自殺率地圖.............................. 16
圖2-2 1997年至2006年每十萬人口死亡率................ 17
圖2-3 1997年至2006年15-19歲青少年每十萬人口自殺死亡率 20
圖2-4 Shneidman自殺立方體理論模式.................... 23
圖2-5 Pescosolido理論模型............................ 25
圖2-6 1950-2000年全球自殺率之演進.................... 30
圖2-7 2000年全球自殺率分布-性別、年齡別.............. 31
圖3-1 研究架構........................................ 41
圖3-2 資料處理架構.................................... 44
圖3-3 資料整理架構.................................... 49
圖4-1 1996-2005年青少年自殺死亡人數................. 55
圖4-2 青少年自殺者性別年齡分布........................ 56
圖4-3 自殺及自傷類型.................................. 59
圖4-4 個案組及對照組投保類別之比較.................... 72
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