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系統識別號 U0026-2708201421583400
論文名稱(中文) 自殺危機個案管理中運用因應卡對預防社區自殺未遂個案三個月內再度自殺的成效評估
論文名稱(英文) The effectiveness of case management using coping cards on the prevention of suicide reattempt within three months during crisis intervention for suicide attempter in community
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 102
學期 2
出版年 103
研究生(中文) 王瀅琄
研究生(英文) Ying-Chuan Wang
學號 s86984042
學位類別 碩士
語文別 中文
論文頁數 99頁
口試委員 共同指導教授-柯慧貞
口試委員-林以正
口試委員-謝碧玲
指導教授-黃惠玲
中文關鍵字 自殺未遂  再度自殺  自殺危機個案管理  因應卡 
英文關鍵字 suicide attempt  reattempted  case management  coping card 
學科別分類
中文摘要 研究背景及研究目的:
國外文獻實證,再度企圖自殺個案是自殺死亡的高危險群,且已提出多種有效降低自殺未遂者再度自殺的介入模式,但國內仍少有相關研究;另外,過往研究指出,相較於心理治療,透過電話聯繫或郵寄信件等低成本方式來關懷自殺未遂個案,是自殺防治普遍的介入模式之一,而另一種常見方法就是訓練使用因應卡。因應卡可當作自救工具,內容是預先訓練個案面臨心理健康危機時可使用的因應方法。惟國內關於因應卡運用的實務成效相關文獻數量並不多,是故,本研究分析某生命線於自殺危機模式中運用因應卡或一般關懷訪視對於降低自殺未遂個案再度自殺企圖的成效。

研究方法:
本研究利用某生命線自殺未遂個案危機介入之資料庫進行分析。研究對象:總個案數83人,完整接受三個月介入的個案數為64人,參與率77.11%;其中關懷訪視組32人,因應卡組32人。研究工具:資料庫所載個案基本資料與數據,全由自殺關懷訪視人員於家訪時獲致,包括:個人資料表、自殺危險程度量表、簡式健康量表和貝克絕望感量表。研究程序:除依規定申請資料庫授權分析與人體試驗外,篩選符合納入條件者,再以不同介入模式將研究對象分為兩組,並分析這兩組因不同介入模式而發生再度自殺行為的比例與臨床症狀的變化。統計分析:廣義估計方程式驗證介入組別、時間、以及組別與時間交互作用之效果;驗證組別效果、前後測效果,以及組別是否在後測效果上有所不同,再以存活分析比較關懷訪視組與因應卡組個案的再度企圖自殺天數。

結果與討論
於憂鬱、絕望、焦慮與自殺想法等臨床症狀部分,介入前,兩組間並無差異,但廣義估計方程式(GEE)分析顯示時間、時間與組別的交互作用顯著;亦即經過三個月介入後,兩組於介入前後測的改善效果皆達顯著差異,而因應卡組在所有臨床症狀的改善程度均較關懷訪視組為大。另外,研究發現因應卡組均無個案再度自殺,且於於介入後60天與90天時,明顯較關懷訪視組有較長的未再度自殺天數。

結論與建議
自殺危機個案管理模式中運用因應卡可降低自殺未遂者於自殺企圖後的自殺危險程度、憂鬱與絕望感等臨床症狀,且再度自殺行為的發生亦有顯著減少。未來宜藉由追蹤研究,驗證自殺危機個案管理模式中因應卡運用的長期成效,以建立本土化之自殺未遂個案關懷訪視介入模式。
英文摘要 This is a randomized controlled trial designed to evaluate the effectiveness on the prevention of reattempted suicide in the case management with crisis coping cards group (n = 32) compared to case management without coping card group (n = 32) over a 3-month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety and hopelessness. Result indicated that subsequent suicide behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, the survival curves of time to reattempt demonstrated the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention.
論文目次 中文摘要.................................................................................................................................I
Extended Abstract.................................................................................................................III
誌謝...................................................................................................................................VIII
目錄......................................................................................................................................IX
表目錄................................................................................................................................XII
圖目錄...............................................................................................................................XIII
附錄目錄...........................................................................................................................XIV


內文目錄
第一章、緒論..........................................................................................................................1
第一節、自殺議題的重要性............................................................................................1
壹、自殺死亡人數逐年攀升........................................................................................1
貳、自殺方式致命性漸高............................................................................................4
參、自殺對個人、家庭與社會的影響........................................................................6
肆、再度自殺個案是自殺死亡的高危險族群............................................................7
第二節、再度自殺的定義與臨床現況............................................................................8
壹、自殺行為的定義....................................................................................................8
一、何謂自殺企圖....................................................................................................8
二、自殺企圖的盛行率與嚴重性..........................................................................10
貳、再度自殺的定義..................................................................................................11
一、再度自殺的界定..............................................................................................11
二、再度自殺的盛行率與嚴重性..........................................................................12
第三節、從自殺危機個案管理模式探討預防自殺未遂個案再度自殺的實徵研究回顧......................................................................................................................14
壹、自殺危機個案管理模式的介紹..........................................................................15
一、何謂自殺危機與自殺風險評估......................................................................15
(一)自殺危機的界定......................................................................................15
(二)自殺風險評估的基本要素......................................................................16
二、自殺危機介入與症狀管理..............................................................................18
三、個案管理的定義..............................................................................................19
四、自殺危機個案管理模式的執行要務..............................................................20
貳、探討自殺危機個案管理模式的實徵研究..........................................................22
一、概觀自殺危機介入模式的種類......................................................................22
二、國外自殺危機介入模式之成效與相關實徵研究..........................................24
三、國內自殺危機介入模式之成效與相關實徵研究..........................................31
四、國內外自殺危機介入模式之缺失與未來研究方向......................................34
第四節、研究目的..........................................................................................................36
第二章、研究方法..............................................................................................................38
第一節、研究對象與抽樣方法......................................................................................38
壹、研究對象..............................................................................................................38
貳、抽樣方法..............................................................................................................40
第二節、研究工具..........................................................................................................41
壹、個人資料表..........................................................................................................41
貳、自殺危險程度量表..............................................................................................41
參、簡式健康量表......................................................................................................41
肆、貝克絕望感量表..................................................................................................42
第三節、研究程序..........................................................................................................43
壹、資料庫授權與人體試驗申請..............................................................................43
貳、資料篩選與研究程序..........................................................................................44
參、資料庫之介入執行歷程......................................................................................46
一、自殺關懷訪視人員相關教育訓練內容..........................................................46
(一)自殺危機個案管理模式的教育訓練......................................................46
(二)因應卡運用的教育訓練..........................................................................47
二、介入流程..........................................................................................................47
(一)自殺危機個案管理模式的執行歷程......................................................49
(二)因應卡運用的執行歷程..........................................................................52
第四節、統計方法與資料處理......................................................................................56
第三章、研究結果..............................................................................................................57
第一節、篩案對象之樣本結構......................................................................................57
第二節、兩組樣本特性比較..........................................................................................59
壹、基本人口學比較..................................................................................................59
貳、臨床資料比較......................................................................................................62
第三節、自殺危機個案管理模式中因應卡的運用對預防自殺未遂個案自殺企圖後再度自殺的成效分析...........................................................................................64
壹、介入前後不同時間,自殺危險程度、簡式健康量表和貝克絕望感量表的變化..........................................................................................................................64
貳、不同介入模式的存活分析..................................................................................66
第四章、討論......................................................................................................................71
第一節、本研究之主要發現與解釋..............................................................................71
第二節、本研究之限制與未來研究方向......................................................................75
第三節、本研究之學術與應用貢獻..............................................................................76
壹、學術貢獻性..........................................................................................................76
貳、應用貢獻性..........................................................................................................76
第五章、參考文獻..............................................................................................................78
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