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研究生:黃灶生
研究生(外文):Tsao-Sheng Huang
論文名稱:臺北地方法院檢察署轄區2010至2014年上吊自殺案例分析
論文名稱(外文):The Analysis of Suicide by Hanging in The Jurisdiction of Taipei District Prosecutors Office, 2010-2014
指導教授:孫家棟孫家棟引用關係
口試委員:方中民許敏能
口試日期:2016-06-13
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:法醫學研究所
學門:醫藥衛生學門
學類:其他醫藥衛生學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:89
中文關鍵詞:臺北地檢署轄區上吊司法解剖率遺書複合性自殺
外文關鍵詞:Jurisdiction of Taipei District Prosecutors OfficeHangingForensic autopsy rateSuicide notesComplex suicide
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在臺灣上吊是一種常見且高致死率的自殺方式.本研究分析臺北地檢署轄區2010至2014年314件上吊自殺案件,以便了解此類案件的基本型態。評估變項包含了性別、年齡、婚姻狀況、教育程度、精神健康狀況、上吊地點、上吊使用材料、屍體姿勢型態、留有遺書與否、自殺過往史、自殺原因、屍體相驗外觀。結果呈現:男女上吊比例為1.6:1;在45-64歲年齡層,女性上吊比例(43.9%)高於男性(31.9%),在25-44歲年齡層,男性上吊比例(28.8%)反高於女性(21.1%);女性有輕生念頭比例(69.9%)高於男性(56.5%);女性有自殺過往史比例(37.4%)高於男性(22.5%);上吊姿勢分為懸空82件(26.1%),非懸空173件(55.1%),不詳59件(18.8%) ;懸空與非懸空上吊姿勢比例為1:2.1;男性選擇戶外上吊比例(22.5%)遠高於女性(1.6%);男性於浴室內自殺比例(3.7%)遠低於女性(17.9%);女性使用絲巾、絲襪、布條或布繩比例明顯高於男性,而使用童軍繩或電線比例卻明顯低於男性;男女皆以繩結位於後枕部上方為最多;頸前水平沿耳後向上延伸呈現U型217件(69.1%),頸前倒U3件(1%);索溝位置在甲狀軟骨上方有267件(85%);本研究遺留遺書比例為36%;精神疾病比例為46.2%;其中上吊司法解剖率為1.3%;毒物分析比例1.9%。至於上吊自殺原因以精神疾病/物質濫用所占比例最高(44.3%),其次為生理疾病(20.4%)。最後,建議提高司法解剖率及毒物分析比例,並配合現場調查來決定死因及死亡方式。

Hanging is a common and highly lethal suicidal method in Taiwan. This study analyzed 314 suicides by hanging between 2010 and 2014 from the Jurisdiction of Taipei District Prosecutors Office, in order to understand the basic patterns for such cases. Assessment variables included gender, age, marital status, education, mental health, hanging place, use of tools, body posture patterns, leaving a suicide note or not, the past history of suicide, suicide reason, external appearance of inspected corpse. The results are as follows: Male to female ratio was 1.6:1. In the 45-64 age group, the proportion of hanging in female (43.9%) was higher than that in men (31.9%) , but in the 25-44 age group, the proportion of hanging in male (28.8%) was higher than that in female (21.1%). The proportion with presence of suicidal thoughts in female (69.9%) was higher than that in men (56.5%). Female has a higher proportion of suicide past history (37.4%) than male (22.5%). Commit suicide by hanging posture is divided into complete suspension 82 (26.1%), the incomplete suspension 173 (55.1%), and unknown posture 59 (18.8%). The hanging position ratio was 1:2.1. Male selection hanging outside ratio (22.5 %) was significantly higher than that of female (1.6 %). Male in bathroom suicide ratio (3.7%) was far below that of female (17.9 %). Female used scarves, stockings, or cloth roping ratio significantly higher than male, however the use of wire and Scout rope ratio was significantly lower than men. Both male and female with knots located above the occipital for most. The ligature runs from the midline above the thyroid cartilage symmetrically encircling the neck on both sides to the occipital region
217(69.9%).Hanging with point of suspension on front of neck has 3(1%). Ligature mark above the thyroid cartilage 267(85%).In this study revealed the proportion of leaving a suicide note , mental illness, forensic autopsy rate and toxic analysis would be 36%, 46.2%, 1.3% and 1.9%, represently. The cause of hanging related to mental illness / substance abuse occupied the highest proportion (44.3%), followed by physical illness (20.4%).
Finally, we suggest that we have to promote the frequency of forensic autopsy and toxicological analysis , which are associated with the scene investigation to determine the cause and manner of death.


誌謝 I
中文摘要 II
ABSTRACT III
圖目錄 VII
表目錄 VIII
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 2
1.3 研究目的 2
第二章 文獻縱覽 4
2.1 絞殺(STRANGULATION)種類 4
2.2 絞殺機轉 5
2.3 上吊之流行病學研究 5
第三章 研究方法與步驟 9
3.1 研究方法 9
3.2 研究對象 9
3.3 研究對象所屬轄區範圍 9
3.4 分析項目定義 10
3.5 資料統計及分析 12
3.6 研究限制 12
第四章 結果 13
4.1 臺北地檢署轄區2010 至2014 年自殺案件統計 13
4.2 人口學特徵之統 13
4.3 上吊自殺案件特徵分析 15
4.4 年齡分層與不同類別變項間分析比較 19
4.5 自殺過往史與輕生念頭分析比較 20
4.6 都市化程度與各類別變項分析比較 20
4.7 精神狀況與各類別變項分析比較 21
4.8 遺書與人口學變項分析比較 22
4.9 合併其他方法上吊自殺分析 23
4.10 上吊案件解剖率、解剖結果及毒藥物分析比例 23
第五章 討論 24
5.1 臺北地檢署轄區2010 至2014 年自殺案例統計分析比較 24
5.2 死亡地點、上吊使用材料、屍體姿勢型態、婚姻、季節比較 25
5.3 上吊姿勢與身體外觀特徵分析比 26
5.4 留有遺書與否分析比較 27
5.5 自殺原因 27
5.6 送醫後延遲死亡 28
5.7 合併其他方法自殺 29
5.8 頸部骨折 30
5.9 相驗時應注意細節 30
第六章 結論 32
參考文獻 34
圖目錄 38
圖 1 臺灣臺北地方法院檢察署轄區分布圖 38
圖 2 2010 至2014 年臺北地檢署轄區自殺方式分布圖 39
圖3 2010 至2014 年臺北地檢署轄區自殺方式趨勢圖 40
圖4 三地區自殺方式比較 41
圖5 上吊發現地點 42
圖6 上吊發現地點所屬行政區 43
圖7 上吊工具 44
圖8 上吊使用工具_性別分布 45
表目錄 46
表1 2010 至2014 年臺北地檢轄區自殺方式統計表 46
表2 性別與年齡分布 47
表3 性別與婚姻分布 48
表4 性別與職業分布 49
表5 性別與教育程度分布 50
表6 性別與輕生念頭分布 51
表7 性別與自殺過往史分布 52
表8 性別與財務狀況分布 53
表9 上吊自殺季節分布 54
表10 性別與發現地點分布 55
表11 性別與工具分布 56
表12 性別與繩結位置分布 57
表13 性別與索溝走向分布 58
表14 性別與索溝數目分布 59
表15 性別與索溝位置分布 60
表16 性別與結膜出血 61
表17 性別與臉部鬱血分布 62
表18 性別與皮膚點狀出血分布 63
表19 性別與舌尖外露齒列間分布 64
表20 性別與口鼻分泌物分布 65
表21 性別與耳道/肛門出血分布 66
表22 性別與脫糞分布 67
表23 性別與遺精分布 68
表24 性別與遺尿分布 69
表25 性別與送醫分布 70
表26 性別與遺書有無分布 71
表27 性別與自殺原因分布 72
表28 上吊姿勢與身體外觀特徵分析 73
表29 年齡層與不同變項比較分析 75
表30 自殺過往史與輕生念頭(言語) 比較分析 77
表31 都市化程度與人口學變項比較分析 78
表32 都市化程度與不同變項比較分析 80
表33 精神狀況與各類別變項比較分析 82
表34 遺書與人口學變項比較分析 85
表35 遺書有無與教育程度、性別比較分析 86
表36 性別與合併其他方法比較分析 87
表37 頸部軟骨及骨骼傷害分佈 88
表38 送醫後延遲死亡時間 89

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