探討守門人訓練對提昇台灣志工擔任自殺防治守門人的成效

The Effects of the Gatekeeper Training for Taiwan Volunteers as Gatekeeper for Suicide Prevention

蔡文佩(Wen-pei Tsai)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/博士(2010年)

https://doi.org/10.6834/CSMU.2010.00066

摘要

研究背景：自殺在台灣是一個重要的公共衛生議題，自1997年起，台灣每年自殺死亡人數逐年上昇。多數人在自殺前不會求助醫療人員，但研究顯示超過一半的自殺者，在自殺前會向周圍的家人、朋友談及或以行為顯示自殺意圖。故自殺企圖者周遭的人，若能理解自殺徵兆，處於自殺高風險中的個案才能被發現且接受治療。所謂自殺防治守門人是指可以接觸到潛在自殺者，並能引導他們尋求醫療的人。其中志工是被視為擔任自殺防治守門人的最適人選之一。

研究目的：
一、了解台灣志工擔任自殺防治守門人的現況能力
二、針對台灣志工設計一個守門人核心教育內容
三、驗證守門人核心課程對提昇台灣志工擔任自殺防治守門人的成效
四、驗證守門人衛教手冊對提昇台灣志工擔任自殺防治守門人的成效

方法與材料：
本研究為一隨機控制試驗，研究對象經系統性分配，進入實驗組（奇數）或對照組（偶數）。研究分兩階段進行。第一階段的兩組研究對象在填寫前測問卷（自殺徵兆察覺能力量表與基本資料問卷）後的兩週，實驗組的研究對象接受90分鐘的「守門人核心課程」；對照組的研究對象自行閱讀「憂鬱症衛教手冊」。不同的介入措施完成後，兩組研究對象立即填寫相同的問卷以為後測。研究者以後測資料評值介入措施的成效。第二階段的研究過程與第一階段相同，只是實驗組的研究對象自行閱讀「守門人衛教手冊」，對照組的研究對象自行閱讀「憂鬱症衛教手冊」。
研究者使用SPSS/Windows(Version 11.0)統計軟體分析研究資料，研究對象的基本資料以描述性統計分析。至於分析性統計方法則使用了t-test、ANOVA、Mann-Whitney test、Kruskal-Wallis test和X2 test。預設檢定α值為0.05，採雙尾檢定。
研究結果：
ㄧ、研究者以第一階段研究的前測資料（191位研究對象）做為一個個案研究，探討台灣志工擔任自殺防治守門人的現況能力。研究結果顯示：(1)191位研究對象對自殺徵兆察覺能力的平均得分為3.99±0.67。僅有15題（46.88%）的平均得分超過4分，顯示研究對象僅能察覺不到一半的自殺徵兆。(2)191位研究對象中，僅有34位研究對象（17.80%）表示若面對潛在自殺者時，會建議他們去尋求專業協助。其餘157位研究對象（82.20%）表示不會建議潛在自殺者去尋求專業協助。
二、比較「守門人核心課程」與「憂鬱症衛教手冊」在提昇志工對自殺徵兆察覺能力與對潛在自殺者的轉介意願上之差異性。研究結果顯示：(1)在教育介入之前，兩組對自殺徵兆察覺能力的平均得分，分別是3.97±0.69和3.99±0.64 (p值=0.807)，沒有統計上顯著的差異。兩組會建議潛在自殺者尋求專業協助的人數分別是15人與12人(p值=0.534)，亦無統計上顯著的差異。(2)但在不同教育介入之後，實驗組與對照組在自殺徵兆察覺能力上的平均得分，分別是4.53±0.74和3.85±0.74，p值<0.001，具統計上顯著的差異。兩組能察覺自殺徵兆的題數分別是27題(84%)與13題(41%)。顯示「守門人核心課程」提昇志工對自殺徵兆的察覺能力優於「憂鬱症衛教手冊」。再者實驗組有61位研究對象（80.26%）會建議潛在自殺者尋求專業協助。對照組有39位研究對象（51.32%）會建議潛在自殺者尋求專業協助，p值<0.001，具統計上顯著的差異。顯示「守門人核心課程」在提昇志工對潛在自殺者的轉介意願上亦優於「憂鬱症衛教手冊」。
三、比較「守門人衛教手冊」與「憂鬱症衛教手冊」在提昇志工對自殺徵兆察覺能力與對潛在自殺者的轉介意願上之差異性，研究結果顯示：(1)在教育介入之前，兩組對自殺徵兆察覺能力的平均得分，分別是3.74±0.58和3.72±0.73，p值=0.833，沒有統計上顯著的差異。兩組會建議潛在自殺者尋求專業協助的人數分別是31人與24人(p值=0.203)，亦無統計上顯著的差異。(2)但在不同教育介入之後，實驗組與對照組對自殺徵兆察覺能力的平均得分，分別是4.04±0.92和3.87±0.63，p值=0.223，仍無統計上顯著的差異。兩組能察覺自殺徵兆的題數分別是19題(59%)與11題(34%)。顯示「守門人衛教手冊」相較「憂鬱症衛教手冊」，沒有顯著提昇志工對自殺徵兆的察覺能力。再者實驗組有39位研究對象（63.93%）表示若面對潛在自殺者時，會建議潛在自殺者尋求專業協助。反觀對照組有31位研究對象（50.82%）會建議潛在自殺者尋求專業協助，p值=0.143，沒有統計上顯著的差異。顯示「守門人衛教手冊」相較「憂鬱症衛教手冊」，也沒有顯著提昇志工對潛在自殺者的轉介意願。

研究結論：
自殺防治守門人的功能在察覺自殺徵兆與建議潛在自殺者尋求專業協助。根據本此研究結果顯示：（1）現階段台灣志工僅能察覺不及一半的自殺徵兆。（2）研究對象接受「守門人核心課程」後，其察覺自殺徵兆的題數由15題（47%）增加至27題（84%），會建議潛在自殺者尋求專業協助的人數也由15人（19.7%）增加至61人（80.3%）。顯示「守門人核心課程」確能提昇志工對自殺徵兆的察覺能力和對潛在自殺者的轉介意願。（3）比較守門人衛教手冊和憂鬱症衛教手冊在提昇志工對自殺徵兆的察覺能力和對潛在自殺者的轉介意願的成效，沒有統計上的顯著差異。

關鍵字

守門人訓練 ； 志工 ； 自殺防治守門人

並列摘要

Background: Suicide is a major public health issue in Taiwan where incidence has escalated annually since 1997. Although most suicide victims did not actively seek professional help for their suicidal ideation before taking action, however, in one week to ten days before the attempts of self harm, more than half of all suicidal individuals conveyed verbal, nonverbal or behavioral clues that were evident to nearby individuals. Therefore, if these clues can be identified, these potential suicide victims can be targeted for intervention. The term “Gatekeepers” refers to persons who can be the first contact for potentially suicidal individuals and who can direct them towards treatment. By this definition, volunteers are regarded as one of candidates for gatekeepers.

Purpose: The purpose of this study are: (1) to explore Taiwan volunteers’ ability as gatekeeper for suicide prevention (2) to build a gatekeeper core program (GCP) for volunteers of Taiwan (3) to evaluate the effects of the gatekeeper core program in enhancing volunteers as gatekeeper for suicide prevention (4) to evaluate the effects of the gatekeeper handbook in enhancing volunteers as gatekeeper for suicide prevention

Methods and Materials: The study is a randomized controlled trial. The participants were systematically allocated, in sequential order of entrance, to an experimental group (odd numbers) or a control group (even numbers). There were two phases in this study. The participants of two groups in the first phase were asked to complete questionnaires (including the "Awareness of Suicide Warning Signs Questionnaire" and "Demographic Data") before the education intervention. Two weeks after the questionnaires were completed; the participants of the experimental group received a 90-minute GCP, while the participants of the control group read a handbook about major depressive disorder by themselves. Immediately after education interventions, participants in both groups were asked to complete the same questionnaires again. The pre- and post-test questionnaires were then compared to evaluate the effects of the education interventions. The process of two phases in this study was similar. There was only difference between two phases that the participants of the experimental group in the second phase read gatekeeper handbook by themselves.
The researcher used the SPSS/Windows (version 11.0) statistical software to analyze the data and obtained data on the frequency, percentage, mean and standard deviation, and we performed t-test, ANOVA, Mann-Whitney test, Kruskal-Wallis test, and X2 test. The α value (two sided) was set at 0.05.

Results: The researcher explored Taiwan volunteers’ ability as gatekeeper for suicide prevention via the data of pre-test of 191 participants of the first phase in this study. The outcomes of study were: (1) The mean score of 191 participants on awareness of suicide warning signs was 3.99± 0.67. The participants only had 15 items (46.88%) scored more than 4; it indicates that the participants just perceived less than half suicide warning signs. (2) Thirty four (17.80%) of 191 participants presented that they would suggest seeking professional help if encountering a potentially suicidal individual, while 157 (82.20%) wouldn’t.
Compare the effects between the GCP and the handbook about major depressive disorder in enhancing volunteers’ suicide awareness and willingness in referral. The outcomes of study are: (1) Before the education intervention, the mean scores on awareness of suicide warning signs of two groups were 3.97± 0.69 and 3.99± 0.64 respectively (p value =0.807). It shows that there were no statistically significant differences between two groups on suicide awareness at that point of time. And fifteen of the experimental group and twelve of the control group indicates they would suggest seeking professional help if encountering a potentially suicidal individual in the pre-test (p value =0.534). It also showed that there were no statistically significant differences between two groups on willingness in referral. (2) However after different education interventions, the mean scores on awareness of suicide warning signs of experimental and control groups were 4.53± 0.74 and 3.85± 0.74 respectively (p value <0.001). It showed that there were statistically significant differences between two groups on suicide awareness. The participants of experimental group could perceive 84% (27 items) suicide warning signs, while the participants of control group just perceive 41% (13 items). Moreover sixty one of the experimental group and thirty nine of the control group indicates they would suggest seeking professional help if encountering a potentially suicidal individual in the post-test (p value <0.001). It also showed that there were statistically significant differences between two groups on willingness in referral. So it indicates the GCP is more efficient than the handbook about major depressive disorder in enhancing volunteers as gatekeeper for suicide prevention.
Compare the effects between the gatekeeper handbook and the handbook about major depressive disorder in enhancing volunteers’ suicide awareness and willingness in referral. The outcomes of study showed are: (1) The mean scores on awareness of suicide warning signs of two groups were 3.74± 0.58 and 3.72± 0.73 respectively (p value =0.833) before the education intervention. It showed that there were no statistically significant differences between two groups on suicide awareness. And thirty one of the experimental group and twenty four of the control group presented that they would suggest seeking professional help if encountering a potentially suicidal individual in the pre-test phase (p value =0.203). It also showed that there were no statistically significant differences between two groups on willingness in referral. (2) The mean scores on awareness of suicide warning signs of experimental and control groups were 4.04± 0.92 and 3.87± 0.63 respectively (p value = 0.223) after different education interventions. It still showed that there were no statistically significant differences between two groups on suicide awareness. The participants of experimental group perceived 59% (19 items) suicide warning signs, while the participants of control group perceived 34% (11 items). Moreover 39 of the experimental group and 31 of the control group presented that they would suggest seeking professional help if encountering a potentially suicidal individual in the post-test phase (p value = 0.143). It also showed that there were no statistically significant differences between two groups on willingness in referral. So it implied the gatekeeper handbook is not more efficient than the handbook about major depressive disorder in enhancing volunteers as gatekeeper for suicide prevention.

Conclusion: The primary function of the gatekeeper for suicide prevention is to perceive suicide warning signs and suggest seeking professional help if encountering a potentially suicidal individual. The outcomes of the study are: (1) Taiwan volunteers in the present just perceive less than half suicide warning signs. (2) After the GCP, the participants can perceive the items of suicide warning signs from 15 items (47%) to 27 items (84%), and the number which the participants would suggest seeking professional help increases from 15 (19.7%) to 61 (80.3%). This shows that the GCP can enhance volunteers’ suicide awareness and willingness in referral. (3) The gatekeeper handbook is not better than the handbook about major depressive disorder in enhancing volunteers as gatekeeper for suicide prevention.

並列關鍵字

gatekeeper training ； volunteer ； gatekeeper for suicide prevention

參考文獻

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