2000-2009年台灣地區自殺行為之危險因素探討:回溯性世代研究

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题名:	2000-2009年台灣地區自殺行為之危險因素探討:回溯性世代研究 A Cohort Study on Exploring the Risk Factors for Suicide Act in Taiwan, 2000-2009
作者:	陳沛慈;Pei-Cih Chen
贡献者:	公共衛生學系碩士班
关键词:	自殺行為;精神疾病;世代研究;健保資料庫;suicide act;mental disorder;cohort study;National Health Insurance Research Database
日期:	2013-08-01
上传时间:	2013-10-02 09:51:28 (UTC+8)
出版者:	中國醫藥大學
摘要:	目的：自殺是全球主要死因之一，世界上有61％的自殺發生於亞洲，且每年約有6千萬人自殺或企圖自殺，而台灣於2012年自殺死亡率每十萬人口為16.18人，自殺儼然成為二十一世紀公共衛生重要的議題。自殺是一複雜的行為非單一因素所致，除了個人因素外，社會環境因素也可能反應出群體的自殺現象，人們的健康受社會環境因素之變遷所影響。為規劃有效的防治策略，本研究擬以此為探討重點，分析台灣一般族群自殺行為發生情形，並探討與自殺行為有關的個人層次和社會層次之危險因素。方法：本研究為一回溯性世代追蹤研究，主要是利用2000-2009年「全民健康保險研究資料庫」200萬抽樣檔。以2001年所有仍在保者為研究對象，追蹤到自殺行為發生、退保或觀察期結束即2009年12月底。使用Kaplan-Meier繪製各變項之自殺累積發生率，並使用Cox比例風險模式估計各變項之自殺行為危險比。結果：在1,719,358位年齡10歲的研究者中，有3,905人發生自殺行為。而男性自殺行為風險約為女性的1.71倍高 (HR=1.71; 95% CI: 1.60-1.83)；年齡以25-44 歲該年齡組之風險比為最高 (HR=1.54; 95% CI: 1.38-1.72)；與未婚的人相比，離婚的人之自殺行為風險比較高 (HR=1.69; 95% CI: 1.49-1.91)。疾病方面，多數精神疾病皆與自殺行為有關，其中以情感性精神病之自殺行為風險比最高，該患者之自殺行為風險是未患有情感性精神病者的4倍 (HR=4.06; 95% CI: 3.67-4.48)。結論：本研究首次同時考量社會與個人層面之因素作為影響自殺行為相關危險因素分析之考量，而本研究結果顯示個人層次比社會層次為更好的自殺行為解釋因素，其中又以精神疾病與自殺行為發生最具相關性。因此在預防自殺行為上應將自殺高風險精神疾病患者納入自殺防治預防計畫之主要對象和政策規劃之重點。 Objectives: Suicide is one of the major causes of death in the world. It is estimated that annually 60 million people commit suicide and sixty one percent of the global death toll of suicide is in Asia. The suicide rate was 16.18 per 100,000 people in Taiwan, 2012. Suicide has become an important public health issue in the 21 century. Suicide is a complex behavior. In addition to personal factors, people suicide behavior is affected by social economic condition factors change. The purpose of this study was to explore suicidal act occurs in the general population in Taiwan. And we were to examine whether individual-level and the social-level factors was associated with suicide act. Methods: A retrospective cohort study of 1,719,358 Taiwan population age 10 years and older was conducted. Data from the Taiwan National Health Insurance Research Database, 2000-2009. During the period of year 2001 as observational subjects, and followed until 2009 for date and cause of suicide act. The Cox proportional hazards model was used to examine the hazard ratios for socio-demographic and physical factors at the individual level such as age, sex, income, with or without mental disorder or cancer, and the social factors at the neighborhood level such as unemployment, divorce, the poverty, and crime rate. Results: Among 1,719,358 subjects, 3,905 suicide act occurred. Several significant predictors of suicide were found, including the following: the HR for suicide act was 1.71 (HR=1.71; 95% CI: 1.60-1.83) times higher in male than in female. The risk of suicide act for 25-44 year older was highest (HR=1.54; 95% CI: 1.38-1.72). Divorced had a higher HR for suicide act compared with never married. On the other hand, most mental disorder was associated with suicide act. The risk of suicide act for affective psychoses patients was highest (HR=4.06; 95% CI: 3.67-4.48) Conclusions: This first study considers individual-level and the social-level factors were associated with suicidal act. The results showed more significant associations between suicide act and individual-level factor. And patients with mental disorder were associated with the higher risk of suicide act. Therefore, we suggest the prevention of suicidal should be focus on high-risk patients with mental disorder, and provide further suggestions for public health organizations to plan comprehensive prevention programs for people at risk from committing suicide.
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