臺灣博碩士論文加值系統

背景：過去曾自我傷害或自殺行為為自殺的關鍵風險因子之一。本研究透過分析衛生福利部「自殺防治通報系統」中曾被通報自殺企圖者之自殺死亡風險，並探討其人口學、被通報時自傷方式，與合併有不同衛生福利服務系統身分之相關性，以辨識其再自殺身亡之高風險群。方法：本研究資料來源為2012-2017年衛生福利部自殺防治通報系統之自殺企圖被通報者資料，並串聯「精神照護資訊管理系統」、「保護資訊系統」、「替代治療作業管理系統」、「毒品成癮單一窗口服務系統」之註記資料。再自殺死亡資料來源為衛生福利部死因資料庫之2012-2017年自殺身亡者檔案。本研究計算標準化死亡比（standardized mortality ratio, SMR），藉此研析相對於一般民眾之風險，並透過Poisson回歸分析來計算合併有不同衛生福利服務系統身分之相對危險性（Rate Ratio, RR）。結果：衛生福利部自殺防治通報系統2012-2017年之自殺企圖被通報個案共123,354人，再自殺死亡共3,330人（佔2.7%）。總體SMR為146，在各組之間係以女性、年輕人、通報時自傷方式為自焚較其他類別高；合併衛生福利部服務系統身份註記部分，以替代治療作業管理系統、精神照護資訊管理系統，及多重註記最高；追蹤期間以第7-30天340最高，第2-3月劇降至125，第4-6月為70，隨後降幅漸趨平緩。Poisson多元回歸分析顯示RR較高為男性、老年人、通報時自傷方式為自焚、燒炭、上吊、溺水及農藥；合併衛生福利部服務系統身份註記部分，以替代治療作業管理系統及精神照護資訊管理系統高於其他類別。結論：本研究所辨識之自殺企圖被通報再自殺死亡高風險群，可供作為臺灣自殺企圖被通報個案關懷訪視服務之政策制定依據。

Background: A past history of self-harm or suicide attempt is one of the key risk factors of suicide. This study was aimed to i) investigate the risk of suicide among people who were registered in the national self-harm/suicide attempt surveillance system established by Taiwan’s Ministry of Health and Welfare and ii) to examine its association with demographic factors, self-harm methods, and being concurrently registered in other health and social care registries, in order to identify the high-risk groups of fatal self-harm repetition. Methods: Data were extracted for all people registered in the national self-harm/suicide attempt surveillance system in 2012 to 2017, with linkage to registers of patients with mental illness receiving post-discharge aftercare, offenders and victims of children and adolescent abuse, offenders and victims of domestic violence, victims of sexual abuse, people who used illicit drugs, and people who received opioids replacement therapy. Fatal self-harm repetition was identified thru linkage to the national suicide mortality data files. Standardized mortality ratio (SMR) for suicide was calculated to investigate suicide risk relative to the general population. Poisson regression analysis was conducted to calculate rate ratios for suicide in the sample of people who were registered to the national self-harm/suicide attempt surveillance system. Results: There were 123,354 reported cases of self-harm. Among them 3,330 (2.7%) died by self-harm repetition. The overall SMR for suicide was 146. In subgroup analyses, SMRs were higher in females, the younger groups, people who self-harmed using self-mutilation compared to their counterparts. SMRs were highest in people who were in the registries of people who received opioids replacement therapy, patients with mental illness receiving post-discharge aftercare, and those who were registered in multiple registers. The SMR was highest during the first 7-30 days post-registry (SMR = 340), followed by 125 in the 2nd to 3rd months, 70 in the 4th to 6th months, and became stable afterward. Poisson regression analysis showed that rate ratio of suicide was higher in males, older people, people who self-harmed using self-mutilation, charcoal burning, hanging, drowning, and pesticide poisoning, and people registered as those receiving opioids replacement therapy and patients with mental illness receiving post-discharge aftercare than their counterparts. Conclusion: High risk groups for fatal self-harm repetition were identified. The findings have implications for Taiwan’s national self-harm aftercare services.

第一章　導論 /Chapter 1 Introduction 11
第一節　研究背景與動機 11
第二節　研究目的 14
第三節　實習單位特色與簡介 14
第四節　與實習目標之相關性 14
第二章　文獻回顧 / Chapter 2 Literature Review 16
第一節　全球與臺灣之自殺數據現況 16
第二節　自殺行為與自我傷害，及非致死性重覆自傷 16
第三節　自我傷害者再自殺死亡 17
第三章　研究方法 /Chapter 3 Methods 19
第一節　研究設計 19
第二節　研究資料 19
第三節　研究對象 20
第四節　研究程序 20
第五節　統計方法 26
第四章　研究結果 /Chapter 4 Results 27
第五章　討論 /Chapter 5 Discussion 36
第一節　主要結果 36
第二節　研究限制 37
第三節　研究意涵 37
參考文獻 /References 40
附錄 /Appendix 43
附錄一　精神衛生法 43
附錄二　自殺風險個案危機處理注意事項 58
附錄三　自殺風險個案網絡處理流程圖 64
附錄四　自殺風險個案轉介表 65
附錄五　臺北市政府衛生局精神病患社區個案管理照護方案 69
附錄六　兒童及少年福利與權益保障法 75
附錄七　家庭處遇服務流程 117
附錄八　兒少保護案件通報表 118
附錄九　家庭暴力防治法 123
附錄十　各直轄市、縣（市）政府家庭暴力暨（及）性侵害防治中心受理家庭暴力事件應行注意事項 144
附錄十一　家庭暴力加害人處遇計畫規範 146
附錄十二　性侵害犯罪防治法 150
附錄十三　性侵害犯罪加害人身心治療及輔導教育辦法 162
附錄十四　鴉片類物質成癮替代治療作業基準 166
附錄十五　毒品危害防制條例 169
附錄十六　臺北市政府毒品危害防制中心設置要點 184

Beghi, M., Rosenbaum, J. F., Cerri, C., & Cornaggia, C. M. (2013). Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review. Neuropsychiatr Dis Treat, 9, 1725-1736. doi:10.2147/ndt.S40213
Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital presenting self-harm and risk of fatal and non-fatal repetition: systematic review and meta-analysis. PLoS One, 9(2), e89944. doi:10.1371/journal.pone.0089944
Chan, M. K., Bhatti, H., Meader, N., Stockton, S., Evans, J., O''Connor, R. C., Kendall, T. (2016). Predicting suicide following self-harm: systematic review of risk factors and risk scales. Br J Psychiatry, 209(4), 277-283. doi:10.1192/bjp.bp.115.170050
Chang, S. S., Lu, T. H., Eddleston, M., Konradsen, F., Sterne, J. A., Lin, J. J., & Gunnell, D. (2012). Factors associated with the decline in suicide by pesticide poisoning in Taiwan: a time trend analysis, 1987-2010. Clin Toxicol (Phila), 50(6), 471-480. doi:10.3109/15563650.2012.688835
Chen, I. M., Liao, S. C., Lee, M. B., Wu, C. Y., Lin, P. H., & Chen, W. J. (2016). Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan. J Formos Med Assoc, 115(5), 364-371. doi:10.1016/j.jfma.2015.07.009
Chen, V. C., Cheng, A. T., Tan, H. K., Chen, C. Y., Chen, T. H., Stewart, R., & Prince, M. (2009). A community-based study of case fatality proportion among those who carry out suicide acts. Soc Psychiatry Psychiatr Epidemiol, 44(12), 1005-1011. doi:10.1007/s00127-009-0021-9
Chen, V. C., Chou, J. Y., Hsieh, T. C., Chang, H. J., Lee, C. T., Dewey, M., Tan, H. K. (2013). Risk and predictors of suicide and non-suicide mortality following non-fatal self-harm in Northern Taiwan. Soc Psychiatry Psychiatr Epidemiol, 48(10), 1621-1627. doi:10.1007/s00127-013-0680-4
Chen, V. C., Tan, H. K., Chen, C. Y., Chen, T. H., Liao, L. R., Lee, C. T., . . . Cheng, A. T. (2011). Mortality and suicide after self-harm: community cohort study in Taiwan. Br J Psychiatry, 198(1), 31-36. doi:10.1192/bjp.bp.110.080952
De Leo, D., Burgis, S., Bertolote, J. M., Kerkhof, A. J., & Bille-Brahe, U. (2006). Definitions of suicidal behavior: lessons learned from the WHo/EURO multicentre Study. Crisis, 27(1), 4-15. doi:10.1027/0227-5910.27.1.4
Kuo, C. J., Gunnell, D., Chen, C. C., Yip, P. S., & Chen, Y. Y. (2012). Suicide and non-suicide mortality after self-harm in Taipei City, Taiwan. Br J Psychiatry, 200(5), 405-411. doi:10.1192/bjp.bp.111.099366
Large, M. M., Ryan, C. J., Carter, G., & Kapur, N. (2017). Can we usefully stratify patients according to suicide risk? BMJ, 359, j4627. doi:10.1136/bmj.j4627
Muehlenkamp, J. J., & Gutierrez, P. M. (2004). An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide Life Threat Behav, 34(1), 12-23.
Pan, Y. J., Chang, W. H., Lee, M. B., Chen, C. H., Liao, S. C., & Caine, E. D. (2013). Effectiveness of a nationwide aftercare program for suicide attempters. Psychol Med, 43(7), 1447-1454. doi:10.1017/s0033291712002425
Yip, P. S., Caine, E. D., Kwok, R. C., & Chen, Y. Y. (2012). A decompositional analysis of the relative contribution of age, sex and methods of suicide to the changing patterns of suicide in Taipei City, 2004-2006. Inj Prev, 18(3), 187-192. doi:10.1136/injuryprev-2011-040177
W.H.O. (2014). Prevention suicide: A global imperative. Retrieved from: http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1.
Local suicide prevention planning: A practice resource. (2016). Public Health England. Retrieved from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/585411/PHE_local_suicide_prevention_planning_practice_resource.pdf.
National Institute for Health and Clinical Excellence. (2011). Self-harm in over 8s: long-term management (NICE clinical guideline 133). Retrieved from: https://www.nice.org.uk/guidance/cg133.
陳建仁（1999）。流行病學：原理與方法。臺北市：聯經。
衛生福利部統計處。死因統計資料。取自https://dep.mohw.gov.tw/ DOS/ np-1776 -113.html.
衛生福心理及口腔健康司。歷年臺灣自殺死亡資料統計暨自殺通報統計（更新至107年）。取自https://dep.mohw.gov.tw/domhaoh/cp-332-8883-107.html
衛生福心理及口腔健康司。全國自殺防治中心歷年成果報告（更新至107年）。取自https://dep.mohw.gov.tw/domhaoh/lp-331-107.html.