癌症照顧的自殺防治

Suicide Prevention in Cancer Care

李政洋(Cheng-Yang Lee) ； 陳虹汶(Hong-Wen Chen) ； 李玉嬋(Yu-Chan Li) ； 唐婉如(Woung-Ru Tang) ； 方俊凱(Chun-Kai Fang)

《內科學誌》 22卷5期 (2011/10) Pp. 335-343

https://doi.org/10.6314/JIMT.2011.22(5).05

摘要

癌症病人的自殺率較一般人口高出數倍。與各國相比，台灣癌症病人的自殺死亡率非常高。不同的癌症群在自殺的危險性上也有差異，高自殺率的癌症別相較於其他癌症病人有較高的心理痛苦指數與較低的生活品質。隨著疾病嚴重度的增加，自殺的危險性亦愈高。台灣與其他國家在不同癌症別病人自殺死亡人數排序上稍有不同，其中第一、二名與其他國家相仿，分別為肺癌與口腔癌，然而第三、四名卻是其他國家自殺死亡較低的乳癌及血液類腫瘤。個人經濟資源不足，醫護人員無法發現癌症病人的自殺意念，會增加自殺的危險性。由於癌症病人的憂鬱症、失志症候群，與自殺行為息息相關，因此需提升癌症病人情緒障礙的篩檢率，並積極介入處理病人的憂鬱及「失志」（demoralization）問題。建議以心理痛苦溫度計（Distress Thermometer, DT）、病人健康問卷（Patient Health Questionnaire, PHQ-9）、中文版失志量表（Demoralization Scale- Mandarin Version, DS-MV）來進行癌症病人心理評估的初步篩檢。期待未來透過更多實證研究在政府相關政策支持下，發展可行的臨床路徑，達到癌症自殺防治的具體成果。

關鍵字

癌症 ； 憂鬱 ； 失志症候群 ； 自殺防治

並列摘要

The risk of suicide in cancer patients is higher than that in the general population. As compared to other countries, the suicidal rate of cancer patients in Taiwan is much higher. Patients with certain cancer types, who have lower quality of life and more emotional distress, seem to carry higher suicide risk. There is an increased risk of suicide associated with cancer severity. Lung and buccal cancer patients carried the highest suicidal risk in Taiwan. Whereas breast and hematological cancers carried the third and the fourth highest suicidal risk, respectively, which carried lower suicidal risk in other countries. This finding is different from other countries. Socioeconomic hardships and suicidal ideation in cancer patients underestimated by both their nurses and physicians may relate to the risk of suicide. The screening rate of emotional distress in cancer patients must be elevated. Depression and demoralization in cancer patients are related to suicidal behavior. Depression among patients diagnosed with cancer should be treated, and demoralization also needs to be addressed. We suggest using Distress Thermometers, Patient Health Questionnaires, and Demoralization Scale-Mandarin Version to screen. We are hopeful that future research and government policies will develop the clinical pathway to suicide prevention in cancer care.

並列關鍵字

Cancer ； Depression ； Demoralization syndrome ； Suicide prevention