青少年焦慮症與自殺意行之風險：台灣全國精神疾病調查之研究

黃雅芬

doi:10.6342/NTU.2008.01194

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青少年焦慮症與自殺意行之風險：台灣全國精神疾病調查之研究

Adolescent Anxiety Disorders and Risk for Suicidality in the Taiwan National Psychiatric Morbidity Survey

黃雅芬 , Masters　　Advisor：陳為堅　　Co-advisor ：高淑芬

英文 DOI： 10.6342/NTU.2008.01194

台灣；青少年；調查；焦慮症；自殺； Taiwan ； adolescents ； survey ； anxiety disorder ； suicide

Abstract │ Reference (58) │ Times Cited (2) │ Altmetrics

Abstract 〈TOP〉

目的：過去西方研究已顯示焦慮症為最常見的青少年精神疾病，但相似之流行病學資料在亞洲國家包括台灣仍十分缺乏。自2004年至今，自殺持續位居台灣15-24歲族群之第二大死因，因此青少年自殺防治實為近年重要的公共衛生議題之一。由於先前研究結果的不一致，焦慮症對於自殺風險是否存有獨立於其他精神病理的相關性，至今仍無明確結論，且此議題在青少年族群仍少有研究。本研究藉由分析某全國代表性青少年樣本以估計焦慮症與自殺意行（suicidality）之盛行率及相關因素，並探討青少年焦慮症與自殺意行風險的關聯性。  方法：分析樣本取自2003-2005年間於台灣進行之全國精神疾病調查，以多階段分層隨機抽樣法取得1117位12-17歲青少年（反應率48%），接受全結構式診斷性訪談。整體研究設計主要參考世界衛生組織於各國進行之世界心理衛生研究（The World Mental Health Survey）所使用之方式。研究人員以青少年版組合型國際診斷性會談（adolescent version of the Composite International Diagnostic Interview）探詢數種符合第四版精神疾病診斷與統計手冊（Diagnostic and Statistical Manual of Mental Disorders, fourth edition）之精神病理（psychopathology），另收集自殺意行及人口學相關變項。統計分析使用STATA 8.0處理在複雜抽樣設計下所得之數據，並加入事後分層加權指數（post-stratification weight）以獲得較精確之估計值。  結果：台灣青少年焦慮症的終身盛行率為：核心症狀36.5% (SE, 1.5)；臨床症候群12.3% (SE, 1.0)；DSM-IV診斷1.9% (SE, 0.4)。有明顯焦慮症狀之青少年很少求助相關專業。青少年焦慮症的相關因素為：女性、較差之自覺身體健康狀況、較差之自覺心理健康狀況、重鬱症（major depressive disorder）、對立反抗疾患（oppositional-defiant disorder）以及自殺意行。台灣青少年自殺意行（包括自殺意念、計畫或行為）之總盛行率為3.7% (SE, 0.6)，其相關危險因子為：較大年紀、女性、以及主要精神病理（包括情緒疾患、物質使用疾患、衝動控制相關疾患）。在控制其他精神疾病與人口學變項後，多變量邏輯迴歸分析（multivariable logistic regression analysis）顯示焦慮症與自殺意行風險彼此間仍呈現統計顯著意義。  結論：焦慮症是台灣青少年常見的精神疾病，有明顯焦慮症狀的個案很少尋求協助。台灣青少年自殺意行的盛行率不低，值得相關各界注意。本研究顯示焦慮症對自殺意行有獨立於其他危險因素的相關性。心理衛生促進與疾病預防相關工作在未來仍須努力，尤應加強焦慮症之覺察度與求助率；在臨床情境中，專業人員應例行針對高焦慮青少年進行自殺風險評估；在針對高自殺風險青少年所進行之精神狀態檢查中，也應包含對焦慮症狀的例行篩檢。

Parallel Abstract 〈TOP〉

Objectives: anxiety disorders have been shown to be the most prevalent mental disorders among adolescents, while suicide is one of the leading causes of death among adolescents in many countries. However, whether anxiety disorders alone contribute to increased risk of suicidality in adolescents has been rarely evaluated, particularly in a nationally representative sample. This study aimed to estimate the prevalence and correlates of several anxiety disorders as well as suicidality among Taiwanese adolescents. The association between anxiety disorders and suicidality was also examined.  Methods: subjects were selected via the household of participants in a nationally representative, face-to-face mental health survey for residents 18 years or older, conducted during 2003-2005 in Taiwan, which was implemented using the same methodology of the World Mental Health Survey by the World Health Organization (WHO). Adolescents aged 12-17 years living in a participant’s household were recruited and interviewed with the adolescent version of the WHO Composite International Diagnostic Interview. Diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Prevalence estimation and logistic regression analysis with post-stratification weights was conducted using statistical software STATA 8.0.  Results: among 1117 adolescent respondents, the lifetime prevalence of anxiety psychopathology was: 36.5% (SE, 1.5) for core symptoms, 12.3% (SE, 1.0) for clinical syndromes, and 1.9% (SE, 0.4) for DSM-IV diagnoses. Few people suffering from significant anxiety had look for professional help. The risk of anxiety psychopathology increased with female gender, poorer self-perceived physical or mental health state, major depression, oppositional-defiant disorder, and suicidal ideation. The overall lifetime prevalence of suicidality was 3.7% (SE, 0.6), with significant gender and slight age differences. Multivariable logistic regression analysis showed that anxiety disorders were significantly associated with increasing risk of suicidality among adolescents in Taiwan, independent from the effect of major depressive disorder, substance use disorders and disorders with impulse control problems.  Conclusions: both anxiety syndromes and suicidality were frequently reported among Taiwanese adolescents, and several anxiety disorders were associated with increased risk for suicidality independently from other psychopathologies. The results indicate that more aggressive mental health promotion and disease prevention programs directed to anxiety disorders are warranted, with special attention on increasing disease awareness and help-seeking.

Reference ( 58 ) 〈TOP〉

Aina, Y. & Susman, J. L. (2006). Understanding Comorbidity With Depression and Anxiety Disorders. J Am Osteopath Assoc 106, S9-14.
連結：
Allgulander, C. (1994). Suicide and mortality patterns in anxiety neurosis and depressive neurosis. Archives of General Psychiatry 51, 708-12.
連結：
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV
連結：
Andrews, J. A. & Lewinsohn, P. M. (1992). Suicidal attempts among older adolescents: Prevalence and co-occurrence with psychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry 31, 655-662.
連結：
Beidel, D. C., Christ, M. G. & Long, P. J. (1991). Somatic complaints in anxious children. Journal of Abnormal Child Psychology 19, 659-70.
連結：

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