從生理、心理與社會層面檢視自殺行為的理論

Theories of Suicidal Behaviors from a Bio-psycho-social Perspective

陳柏妤(Po-Yu Chen) ； 游舒涵(Shu-Han Yu) ； 黃鈞蔚(Chun-Wei Huang) ； 陳映燁(Ying-Yeh Chen) ； 陳喬琪(Chiao-Chicy Chen) ； 李明濱(Ming-Been Lee)

《北市醫學雜誌》 2卷8期 (2005/08) Pp. 686-696

https://doi.org/10.6200/TCMJ.2005.2.8.01

摘要

自殺是一種複雜的行為，可以由不同的觀點加以討論，本文嘗試以社會學、行為學、心理學、生理學等觀點回顧有關自殺行為的機制之研究。以社會學的觀點而言，個體的自殺反映出社會集體現象，其與社會的整合度、社會結構變化、社會不穩定、社會價值觀瓦解相關。以行為學的角度觀之，自殺可能是一種社會訊號的釋放方式或求救行為，也可能是一種替代性的朝向自己的攻擊，或是欲引發他人反應的刺激訊號。近期的人類研究假設出生前後母親的照顧或環境因子對成年之後的自殺行為有影響。動物研究也提供人類自殺行為假說：自殺行為代表對包含「挫敗」、「無處可逃」以及「沒有解救因子」三種組成情境的反應。然而，仍然有其他因素影響同一壓力情境下個體採取不同的行動（自殺與否），個別化的心理學特徵或生理學特質可能是重要的因素。以心理學的角度觀之，個體感受失敗訊息的敏感度不同、因應壓力的處理辦法不同、對未來的評估也不同，因此最後做出的結論也不同。也就是個別的心理學特徵對自殺危險性有很重要的影響。以生理學的角度觀之，許多研究發現個別的心理學特徵具有生理學上的基礎。Stress-diathesis模型乃意圖描述出壓力引發的反應與個體特質間的交互作用：壓力引發hypothalamic-pituitary-adrenal (HPA) axis的過度活動，長期HPA axis的過度活動繼而引發血清素系統的失能，而血清素系統失能與憂鬱、焦慮、衝動、攻擊／自殺相關。而個體如何看待壓力則與個人特質相關，其與血清素系統的個別性相關。本文回顧自殺行為的各種觀點之理論，以期提供精神科研究者、臨床工作者或專業人員對自殺行為全面而簡明的了解。

關鍵字

自殺 ； 生理 ； 心理 ； 社會

並列摘要

Background and purpose: Suicidal behavior is complicated and should be examined from a variety of angles. Methods: In this article, we try to review associated articles to reveal the underlying mechanism of suicidal behavior from sociological, ethnological, psychological and biological perspectives. Results: From the sociological perspective, individual suicidal behavior may reflect underlying societal phenomena, such as social fragmentation, inadequate social integration and rapid social change. From the perspective of behavioral medicine, suicidal behavior is an act that turns aggression inward and provokes reactions in others. It also serves the function of relieving tension and calling for or seeking help. Human studies have shown that family environment, especially maternal care during the perinatal period, is a crucial determining factor for subsequent suicidal behavior. Animal studies suggest that suicidal behavior is a combined representation of ”defeat”, ”lack of escape” and ”absence of rescue”.
From the psychological perspective, the individual's psychological status influences sensitivity to life events, and the subsequent coping strategies and decision-making may then lead to suicidal behavior. From the biological perspective, psychology and physiology are not independent but closely correlated. For instance, the stress-diathesis model proposes that life events may activate the hypothalamic-pituitary-adrenal axis (HPA), and that prolonged hyperactivity of the HPA can affect the secretion of serotonin, the neurotransmitter related to depression, anxiety, impulsivity, aggression and suicide. On the other hand, how one perceives stress depends on one's trait-like factor, which is related to characteristics of the serotonergic system. Conclusion: In reviewing theories of suicide, this article provides psychiatric researchers, practitioners and professionals with a broad and convenient guide to suicidal behavior.

並列關鍵字

suicide ； sociology ； ethology ； biology ； psychology