跳到主要內容

臺灣博碩士論文加值系統

(3.236.110.106) 您好!臺灣時間:2021/07/25 23:20
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:李冠瑩
研究生(外文):Kuan-YingLee
論文名稱:父母親自殺與青少年自殺的關聯性
論文名稱(外文):The Association between Parental Suicide and Adolescent and Youth Suicide
指導教授:呂宗學呂宗學引用關係
指導教授(外文):Tsung-Hsueh Lu
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
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:2012
畢業學年度:100
語文別:中文
論文頁數:64
中文關鍵詞:家庭傳遞兒童自殺父母自殺仿同
外文關鍵詞:familial transmissionadolescent suicideparental suicideimitation
相關次數:
  • 被引用被引用:5
  • 點閱點閱:1083
  • 評分評分:
  • 下載下載:188
  • 收藏至我的研究室書目清單書目收藏:0
研究背景:過去已有研究顯示曾暴露在父母自殺的子女有較高的自殺風險。但是,有關進一步高風險因子探討還不足。
研究目的:首先比較曾暴露父母自殺死亡的子女與沒有暴露在父母自殺死亡的子女的自殺風險,接下來比較子女不同發展年齡暴露父母自殺死亡的自殺風險是否有差異,第三比較暴露父親自殺與暴露母親自殺子女自殺風險是否有差異,第四比較子女自殺所使用的方法與父母是否相同,最後探討曾暴露父母自殺死亡的子女死於自殺以外死因的風險是否也較高。
研究材料與方法:本研究採世代追蹤設計,先使用1978-1997年內政部出生登記資料中的父母資料,連結台灣行政院衛生署1985-2009年死因登記資料,得到自殺死亡的父母資料後再由出生登記資料取得子女資料(暴露組),接下來以1:10的比例匹配出生年與性別隨機選出父母沒有自殺的子女為非暴露組。統計分析以Cox對比涉險模式計算風險對比值(hazard ratio, HR)和95%的信賴區間(95% confidence interval, 95% CI)。
結果:曾經暴露父母親自殺死亡的子女自殺風險較高,為非暴露組的四倍多(HR 4.61,95% CI 3.69-5.75),在控制相關人口學變項後,仍有四倍的風險(HR4.24,95% CI 3.34-5.36)。以子女的暴露年齡來比較,大於10歲比0-10歲的子女自殺風險高(HR4.39, 95% CI 3.36-5.73 v.s. HR 3.57,95% CI 2.13-6.00)。子女的暴露年齡若是在孩童期,其自殺風險較其他三組略低(HR 3.95, 95% CI 2.59-6.02),成人早期(18~25歲)最高(HR 4.48, 95% CI 3.10-6.48)、其次為青春期(13~17歲)(HR 4.23, 95% CI 2.53-7.06)。子女暴露母親自殺風險為 5.13 ( 95% C I 3.72-7.07),比父親高(HR 3.89, 95% CI 2.93-5.18)。子女選擇自殺方法有仿同父母的現象,父親與兒子的組合一致率最高,(kappa 0.77, p= 0.6)。暴露與父母自殺死亡的子女的死亡風險為非暴露組的兩倍多(HR 2.15, 95% CI 1.92-2.41);死於他殺是非暴露組的6.96倍 (95%CI 3.55-13.67);死於意外死因是非暴露組的1.72倍 (95%CI 1.44-2.06);自然死因是非暴露組的1.72倍(95%CI 1.39-2.11)。
結論:曾暴露父母自殺死亡的子女自殺風險的確較高,與過去文獻一致。但本研究發現在青春期與成人早期暴露父母自殺死亡,自殺風險較兒童期暴露的自殺風險來得高。母親自殺死亡對子女的自殺風險影響比父親大。子女選擇自殺方法會仿同父母,尤其兒子仿同父親。暴露在父母自殺死亡的子女除了自殺風險高以外,他殺的風險達7倍,意外與自然死因也比非暴露組高。
臨床意涵:關心青少年心理健康的相關人員要非常注重有無父母親自殺史,且不管此青少年是在何發展年齡暴露到父母自殺的。我們也要特別留意母親自殺死亡的子女,還要記得進一步詢問父母親所使用的自殺方法。因為這樣才能仔細地辨識出特定高危險族群,進行危機處理(crisis intervention),後續以強化事後介入(postvention)的效果,提供必要的支持性環境與保護措施。

Objective: Previous studies showed the offsprings with exposure to parental suicide were at higher risk for suicide than non-exposure peers. However, few studies explore while offspring at different exposure age, that is critical period, if their suicide risk differ. Besides, no study examined the death of cause of the exposed offsprings except for suicide. Furthermore, few study aimed to assess the suicide method used by the exposed offsprings and their parents.
Method: We did a cohort study using the data from Taiwan longitudinal registers. The suicidal parents were selected from the linkage between Taiwan’s Birth Registry(TBR)(1978-1997) and Taiwan Mortality Registration (TMR)(1985-2009). Then we obtained the exposed offsprings data from TBR. A total of 37,172 offspring with exposure to parental committed suicide were enrolled in our study. Non-exposure group was randomly matched by sex and birth year. Cox proportional hazard model was used to compare suicide risk of exposed group and non-exposed group, computing hazard ratio, with adjustment for sociodemographic characteristics and perinatal risk factor.
Results: Offspring with exposure to parental suicide death were at increased risk for suicide (HR4.24, 95% CI 3.34-5.36), after adjustment of sociodemographic characteristics and perinatal risk factor. The risk for offspring suicide differed by the developmental period during which parental suicide occurred. The risk of offspring suicide was most pronounced among offspring exposed to parental suicide in early adulthood (HR 4.48, 95% CI 3.10-6.48). Maternal suicide death (HR 5.13, 95% C I 3.72-7.07) was higher associated with offspring suicide death than paternal suicide death (HR 3.89, 95% CI 2.93-5.18). Offspring exposed to parental suicide death are more likely to use the same suicide method employed by their suicidal parents than the method used by control group without exposure to parental suicide death, particularly in sons and their fathers with suicide death, seemly reflecting gender imitation. Considering the death of cause for offsprings with exposure to parental suicide, about 40% for those died of accident, 30% died of natural cause. All cause of death was 2.15 times higher (HR 2.15, 95% CI 1.92-2.41) among offsprings exposed to parental suicide compared to non exposed peers, homicide was the highest death of cause, 6.96 times higher (95%CI 3.55-13.67);accidental death was 1.72 times higher(95%CI 1.44-2.06), and natural death was also 1.72 times higher (95%CI 1.39-2.11)than non exposed peers, respectively.
Conclusions: The offspring with exposure to parental suicide death were at a markedly increased risk for suicide death than offspring without exposure to parental suicide death. The risk for offspring suicide didn’t differ by the developmental period during which parental suicide occurred. Maternal suicide death had higher impact than paternal suicide death for offspring suicide risk. The offspring with exposure to parental suicide death used the same method employed by their suicidal parents, particularly in the pair of son and father.
Clinical implications: Youth mental health related staff should pay attention to the family suicide history while the youth were referred, in spite of during which developmental period they exposed to the parental suicide. Those youth with maternal suicide should be more vulnerable than those with paternal suicide. Remember to obtain the information about suicide method employed by their parents. Because by identifying the specific risk group we could perform crisis intervention and enhance postvention.

摘要 I
目錄 VII
表目錄 IX
圖目錄 X
第1章 前言 1
1.1 研究背景 1
1.1.1 青少年的自殺問題 1
1.1.2 自殺有家庭傳遞的現象 2
1.2 研究目的 4
第2章 文獻探討 5
2.1 自殺在家庭中傳遞的機制 5
2.1.1 遺傳因子 5
2.1.2 環境因子 6
2.1.3 遺傳因子與環境因子的交互作用 6
2.1.4 社會學習理論(Social Learning Theory) 6
2.2 過去研究結果 8
2.2.1 性別 8
2.2.2 年齡 9
2.2.3 社經地位與城鄉差距 10
2.2.4 子女自殺與父母自殺的時間差距 10
2.2.5 父親自殺與母親自殺的比較 11
2.2.6 自殺方法 12
2.2.7 小結 12
2.3 過去研究的方法學 12
2.3.1 資料庫的介紹 13
2.3.2 大型資料庫的限制 14
2.3.3 大型資料庫的優點 14
2.4 文獻查證小結 14
第3章 研究問題 16
第4章 研究方法 17
4.1 資料來源 17
4.1.1 出生檔介紹 17
4.1.2 死亡檔介紹 17
4.2 研究設計與資料分析 18
4.2.1 研究架構 18
4.2.2 資料處理流程 18
4.2.3 個案定義說明 19
4.2.4 統計分析 19
第5章 研究結果 21
5.1 暴露組與非暴露組之特性分佈 21
5.2 暴露組之自殺風險分析 22
5.3 子女在不同暴露年齡的結果 23
5.4 父親或母親對自殺子女的風險比較 23
5.5 子女與父母的自殺方法分析 24
5.6 子女的其他死因分析 24
第6章 討論 26
6.1 主要研究結果 26
6.2 與過去研究對話 27
6.2.1 暴露父母自殺死亡的子女的死亡風險 27
6.2.2 子女暴露父母自殺死亡時的年齡 27
6.2.3 父母與子女的性別 28
6.2.4 自殺方法 30
6.2.5 其它死因分析 30
6.3 研究限制與優點 31
6.4 臨床意涵 32
第7章 結論 33
第8章 參考文獻 34
表 39
圖 57
附錄 63


陳錦宏(2010)。青少年自殺防治(Ι):流行病學。精神醫學通訊,30(4),94-97。
張莞婷、李中一(2010)。父母親死亡對青少年自殺死亡影響之重疊病例對照研究。國立台北護理學院健康事業管理研究所碩士班碩士論文。
鄭泰安(2008)。媒體與自殺:自殺可以預防嗎?。臺北市:臺灣商務。

Agerbo, E., Nordentoft, M., & Mortensen, P. B. (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study. BMJ, 325(7355), 74.
Anderson, P. L., Tiro, J. A., Price, A. W., Bender, M. A., & Kaslow, N. J. (2002). Additive impact of childhood emotional, physical, and sexual abuse on suicide attempts among low-income African American women. Suicide and Life-Threatening Behavior, 32(2), 131-138.
Beautrais, A. L. (2000a). Methods of youth suicide in New Zealand: trends and implications for prevention. Australian and New Zealand Journal of Psychiatry, 34(3), 413-419.
Beautrais, A. L. (2000b). Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry, 34(3), 420-436.
Beautrais, A. L. (2003). Suicide and Serious Suicide Attempts in Youth: A Multiple-Group Comparison Study. American Journal of Psychiatry, 160(6), 1093-1099.
Biddle, L., Brock, A., Brookes, S. T., & Gunnell, D. (2008). Suicide rates in young men in England and Wales in the 21st century: time trend study. BMJ, 336(7643), 539-542.
Boscarino, J. A. (1997). Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care. Psychosomatic Medicine, 59(6), 605-614.
Boscarino, J. A. (2004). Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiologic Studies. Annals of the New York Academy of Sciences, 1032(1), 141-153.
Bowlby, J. (1982). Attachment and loss: Retrospect and Prospect. American Journal of Orthopsychiatry, 52(4), 664-678.
Brent, D. A. (2010). What family studies teach us about suicidal behavior: Implications for research, treatment, and prevention. European Psychiatry, 25(5), 260-263.
Brent, D.A., Bridge, J., Johnson, B. A., & Connolly, J. (1996). Suicidal behavior runs in families: A controlled family study of adolescent suicide victims. Archives of General Psychiatry, 53(12), 1145-1152.
Brent, D. A., & Mann, J. J. (2005). Family genetic studies, suicide, and suicidal behavior. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 133C(1), 13-24.
Brent, D. A., Moritz, G., Bridge, J., Perper, J., & Canobbio, R. (1996). Long-term impact of exposure to suicide: a three-year controlled follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 35(5), 646-653.
Brent, M. D. D., Melhem, N., Donohoe, M.B., & Walker, M. (2009).The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death. American Journal of Psychiatry, 166(7), 786-794.
Brodsky, B.S., Mann, J.J., Stanley, B., Tin, A., Oquendo, M., Birmaher, B., Greenhill, L., Kolko, D., Zelazny, J., Burke, A.K., Melhem, N.M., & Brent D.(2008). Familial transmission of suicidal behavior: factors mediating the relationship between childhood abuse and offspring suicide Attempts. J Clin Psychiatry, 69(4), 584-596.
Burke, A. K., Galfalvy, H., Everett, B., Currier, D., Zelazny, J., Oquendo, M. A., et al. (2010). Effect of exposure to suicidal behavior on suicide attempt in a high-risk sample of offspring of depressed parents. Journal of the American Academy of Child & Adolescent Psychiatry, 49(2), 114-121.
Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation. Psychological Review, 106(4), 676-713.
Carter, D. B. (1987). Current conceptions of sex roles and sex typing: Theory and research. New York, NY, England: Praeger Publishers.
Cheng, A. T. A., Chen, T. H. H., Chen, C.C., & Jenkins, R. (2000). Psychosocial and psychiatric risk factors for suicide. The British Journal of Psychiatry, 177(4), 360-365.
De Leo, D., & Heller, T. (2008). Social modeling in the transmission of suicidality. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 29(1), 11-19.
Dervic, K., Brent, D. A., & Oquendo, M. A. (2008). Completed suicide in childhood. Psychiatric Clinics of North America, 31(2), 271-291.
Geulayov, G., Gunnell, D., Holmen, T. L., & Metcalfe, C. (2011). The association of parental fatal and non-fatal suicidal behaviour with offspring suicidal behaviour and depression: a systematic review and meta-analysis. Psychological Medicine, FirstView, 1-14.
Goldman, J. D. G., & Goldman, R. J. (1983). Children's perceptions of parents and their roles: A cross-national study in Australia, England, North America, and Sweden. Sex Roles, 9(7), 791-812.
Goodwin, R. D., Beautrais, A. L., & Fergusson, D. M. (2004). Familial transmission of suicidal ideation and suicide attempts: evidence from a general population sample. Psychiatry Research, 126(2), 159-165.
Gould, M. S., Fisher, P., Parides, M., Flory, M., & Shaffer, D. (1996). Psychosocial risk factors of child and adolescent completed suicide. Archives of General Psychiatry, 53(12), 1155-1162.
Gould, M. S., Greenberg, T. E. D., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42(4), 386-405.
Gould, M. S., Wallenstein, S., & Davidson, L. (1989). Suicide clusters: a critical review. Suicide and Life-Threatening Behavior, 19(1), 17-29.
Gravseth, H. M., Mehlum, L., Bjerkedal, T., & Kristensen, P. (2010). Suicide in young Norwegians in a life course perspective: population-based cohort study. Journal of Epidemiology and Community Health, 64(5), 407-412.
Herbert, T. B., & Cohen, S. (1993). Stress and immunity in humans: a meta-analytic review. Psychosomatic Medicine, 55(4), 364-379.
Ironson, G., Wynings, C., Schneiderman, N., Baum, A., Rodriguez, M., Greenwood, D., et al. (1997). Posttraumatic stress symptoms, intrusive thoughts, loss, and immune function after Hurricane Andrew. Psychosomatic Medicine, 59(2), 128-141.
Johnson, B. A., Brent, D. A., Bridge, J., & Connolly, J. (1998). The familial aggregation of adolescent suicide attempts. Acta Psychiatrica Scandinavica, 97(1), 18-24.
Kendler, K. S. (1995). Is seeking treatment for depression predicted by a history of depression in relatives? Implications for family studies of affective disorder. Psychological Medicine, 25(04), 807-814.
Kim, C. D., Seguin, M., Therrien, N., Riopel, G., Chawky, N., Lesage, A. D., et al. (2005). Familial aggregation of suicidal Behavior: a family study of male suicide completers from the general population. American Journal of Psychiatry, 162(5), 1017-1019.
Kuebli, J., Butler, S., & Fivush, R. (1995). Mother-child talk about past emotions: Relations of maternal language and child gender over time. Cognition & Emotion, 9(2-3), 265-283.
Kuebli, J., & Fivush, R. (1992). Gender differences in parent-child conversations about past emotions. Sex Roles, 27(11), 683-698.
Lewis, M. (2002). Child and adolescent psychiatry: A comprehensive textbook (3rd ed.). Philadelphia, PA, US: Lippincott Williams & Wilkins Publishers.
Li, C.-Y., Chen, H.-F., Sung, F.-C., Chen, C.-C., Lu, T.-H., Yang, C.-H., et al. (2010). Offspring birth weight and parental cardiovascular mortality. International Journal of Epidemiology, 39(4), 1082-1090.
Lieb, R., Bronisch, T., HÖfler, M., Schreier, A., & Wittchen, H.-U. (2005). Maternal suicidality and risk of suicidality in offspring: findings from a community study. American Journal of Psychiatry, 162(9), 1665-1671.
Lytton, H., & Romney, D. M. (1991). Parents' differential socialization of boys and girls: A meta-analysis. Psychological Bulletin, 109(2), 267-296.
Mitchell, A. M., Wesner, S., Brownson, L., Gale, D. D., Garand, L., & Havill, A. (2006). Effective communication with bereaved child survivors of suicide. Journal of Child and Adolescent Psychiatric Nursing, 19(3), 130-136.
Mittendorfer-Rutz, E., Rasmussen, F., & Wasserman, D. (2004). Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. The Lancet, 364(9440), 1135-1140.
Mittendorfer-Rutz, E., Rasmussen, F., & Wasserman, D. (2008). Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. Social Psychiatry and Psychiatric Epidemiology, 43(1), 28-36.
Niederkrotenthaler, T., Floderus, B., Alexanderson, K., Rasmussen, F., & Mittendorfer-Rutz, E. (2012). Exposure to parental mortality and markers of morbidity, and the risks of attempted and completed suicide in offspring: an analysis of sensitive life periods. Journal of Epidemiology and Community Health, 66(3), 233-239.
Paula P. Schnurr, P., & Bonnie L. Green, P. (2004). Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress: American Psychological Association.
Pfeffer, C. R., Normandin, L., & Kakuma, T. (1994). Suicidal children grow up: suicidal behavior and psychiatric disorders among relatives. Journal of the American Academy of Child &Adolescent Psychiatry, 33(8), 1087-1097.
Phillips, D. P., & Carstensen, L. L. (1986). Clustering of teenage suicides after television news stories about suicide. New England Journal of Medicine, 315(11), 685-689.
Qin, P., Agerbo, E., & Mortensen, P. B. (2002). Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers. The Lancet, 360(9340), 1126-1130.
Qin, P., Agerbo, E., & Mortensen, P. B. (2003). Suicide Risk in Relation to Socioeconomic, Demographic, Psychiatric, and Familial Factors: A National Register-Based Study of All Suicides in Denmark, 1981-1997. American Journal of Psychiatry, 160(4), 765-772.
Reinherz, H. Z., Giaconia, R. M., Silverman, A. B., Friedman, A., Pakiz, B., Frost, A. K., et al. (1995). Early psychosocial risks for adolescent suicidal ideation and attempts. Journal of the American Academy of Child & Adolescent Psychiatry, 34(5), 599-611.
Roy, A. (1983). Family history of suicide. Archives of General Psychiatry, 40(9), 971-974.
Runeson, B., & Åsberg, M. (2003). Family history of suicide among suicide victims. American Journal of Psychiatry, 160(8), 1525-1526.
Sørensen, H., Mortensen, E., Wang, A., Juel, K., Silverton, L., & Mednick, S. (2009). Suicide and mental illness in parents and risk of suicide in offspring. Social Psychiatry and Psychiatric Epidemiology, 44(9), 748-751.
Schmidtke, A., & Schaller, S. (2008). The role of mass media in suicide prevention The International Handbook of Suicide and Attempted Suicide: John Wiley & Sons, Ltd.
Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53(4), 339-348.
Sledjeski, E., Speisman, B., & Dierker, L. (2008). Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). Journal of Behavioral Medicine, 31(4), 341-349.
Thompson, R. (1991). Emotional regulation and emotional development. Educational Psychology Review, 3(4), 269-307.
Wilcox, H. C., Kuramoto, S. J., Lichtenstein, P., Långström, N., Brent, D. A., & Runeson, B. (2010). Psychiatric Morbidity, Violent Crime, and Suicide Among Children and Adolescents Exposed to Parental Death. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 514-523.

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top