自我傷害者之精神疾患：一個案對照研究

Psychiatric disorders in self-harm patients: a case-control study

田正儀(Jeng-Yi Tyan)

指導教授 ： 丁化 ； 陳錦宏

中山醫學大學/醫學院/醫學研究所/碩士(2013年)

摘要

研究動機及目的：自殺死亡是目前世界上大多數國家前十大死因，台灣也是如此。而自我傷害為自殺死亡最重要的預測因子，因此了解自我傷害個案之特質為預防自殺之重要步驟。本研究以個案對照之標準化評估方法探討自我傷害個案之精神疾病盛行率，並比較和一般對照組精神疾患盛行率有無差異。

研究方法：個案組納入條件為：半年內有自我傷害行為者、簽署同意書、大於20歲以上。評估內容包括：中文版神經精神醫學臨床評估表、中文版自殺意圖量表、中文版生活事件評估表、中文版家庭功能量表等。由關懷員陪同研究者至個案家中進行訪談。

研究結果：本研究共收集了202份有效樣本，年齡介於20歲至95歲之間，所蒐集之資料並以SPSS 18.0版t檢定和卡方檢定進行統計分析。有自我傷害行為組有75.9%被診斷精神疾患，無自我傷害行為組佔14.4%。自我傷害行為以鎮靜劑/安眠劑居多，佔51%。有自我傷害行為組以酒精疾患(42%)的比例佔最多，其次是憂鬱症疾患(34.8%)、睡眠疾患(32.1%)。無自我傷害行為組也以酒精疾患(7.8%)的比例佔最多，其次是憂鬱症疾患(4.4%)、睡眠疾患(2.2%)。

結論與建議：臨床上考驗醫師察覺病患自殺意念的敏感度，精神醫療相關人力普遍不足，關懷員和精神醫療相互配合能有效幫助自我傷害的個案。

關鍵字

自我傷害行為 ； 精神疾患

並列摘要

Motive and Objective: Suicidality pose one of the top ten mortality causes in most developed countries, including Taiwan. For the self-harm was proved to be the major indicated for suiciding to death. Therefore it is crucial to prevent from suicidality in understanding the feature of self-harm sufferers. Accordingly, the present study was conducted in case-control study to investigate the prevalence of psychological disorders and to evaluate any specific characters in self harm subjects.

Methods and Materials: The inclusion criteria were those who had been self harmed in recent half year, aged 20 years or older, and willing to joint our study with their written consent form available. Several scaling questionnaires should be completed such as Schedules for Clinical Assessment in Neuropsychiatry, Suicide Intent Scale, List of Threatening Experiences, and Family Apgar Score. The interview was undertaken at home of each self-harm subject or control individual.

Results: Of all, 202 eligible participants, aged from 20 to 95 years, were recruited to our study with their completed questionnaires. All data were processed statistically by Student t test and Chi-square test. SPSS 18.0 soft ware was used. The prevalent rate of psychological disordered were 75.9% and 14.4%, in self-harm and control individuals respectively. The most frequent way to self-harm is sedatives or hypnotics taken. The frequency of psychological disorders were alcohol disorder, depression disorder and sleep disturbance sequentially, in with self-harm (42%, 7.8%, and 34.8%, respectively) and control (7.8%, and 32.1%, 2.2% respectively) groups

Conclusion and Suggestion: Significantly higher prevalence of psychological disorders in self-harm group, those who are likely alcoholic and preferred to taking sedative or hypnotics as the way to commit suicide

並列關鍵字

Self-harm ； Psychiatric disorders

參考文獻

Abram, K. M., Choe, J. Y., Washburn, J. J., Teplin, L. A., King, D. C., & Dulcan, M. K. (2008). Suicidal ideation and behaviors among youths in juvenile detention. J Am Acad Child Adolesc Psychiatry, 47(3), 291-300.

Alessi, N. E., McManus, M., Brickman, A., & Grapentine, L. (1984). Suicidal behavior among serious juvenile offenders. Am J Psychiatry, 141(2), 286-287.

Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol, 47(2), 343-352.

Bertolote, J. M., & Fleischmann, A. (2009). A global perspective on the magnitude of suicide mortality. Oxford: Oxford University Press.

Brugha, T., Bebbington, P., Tennant, C., & Hurry, J. (1985). The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med, 15(1), 189-194.