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    Please use this identifier to cite or link to this item: http://asiair.asia.edu.tw/ir/handle/310904400/111312

    Title: 精神專科醫院急診室病患就醫相關因素分析與後續追蹤遵從探討
    Authors: 劉侰慧
    Contributors: 健康產業管理學系長期照護組碩士在職專班
    Keywords: 精神科急診、自殺壓力源、自殺防治、遵從性、psychiatric emergency room visit、suicide stressors、suicide prevention、compliance
    Date: 2018
    Issue Date: 2018-08-14 14:59:46 (UTC+8)
    Publisher: 亞洲大學
    Abstract: 背景
    本研究將2013-2015年樣本醫院急診就醫之次級資料庫進行分析,屬回溯性研究,針對填寫簡式症狀量表分數達高危險族群依程度納入觀察對象,透過電話訪談追蹤三次,總計研究對象121人。整體資料以SPSS 22.0版行統計分析,進行描述性統計及二元羅吉斯迴歸分析。
    In Taiwan, there are approximately 170,000 deaths every year, 3,600 of which are caused by suicides. Among those who are 25–44 years of age, intentional injury to self was the third leading cause of death. In Nantou County, the suicide mortality rate has increased since 2000 and reached 26.5 per 100,000 people in 2008, ranking number 1 in the nation. The crude death rate of Nantou County has also consistently exceeded the national average in the past 10 years. The most common causes of psychiatric emergency room visits are suicide and self-harm, violent attacks, anxiety, and substance abuse. Mental illness have a higher risk of suicide than the average person, as well as high lifelong risk of repeated suicide attempts, it is necessary to establish a complete notification system and care process for these high-risk groups to reduce repeated suicide attempts, integrate medical resources, and prevent suicides. In this study, a sample database was used to analyze patients treated in emergency rooms with severe suicidal ideation who had attempted suicide. Systematic follow-up observations were subsequently made to determine background factors affecting compliance for self-harm and suicide.
    The objectives of this study are as follows: (a) identify the major causes of self-harm and suicide attempts among ER patients between 2013 and 2015 who had attempted self-harm or suicide; (b) compare the characteristics of ER patients with single or repeated suicide attempts between 2013 and 2015; and (c) determine the background factors affecting compliance among ER patients exhibiting self-harm and suicide attempts.
    This study analyzed the secondary database of a hospital sample containing information on ER patients who attempted suicide between 2013 and 2015. Thus, this study was a retrospective study. Patients whose scores were classified as “high risk group” on the Brief Symptom Rating Scale were included as study participants according to their risk levels. Three rounds of follow-up phone interviews were conducted with patients and a total of 121 patients were interviewed. The overall data underwent descriptive statistical analysis and binary logistic regression analysis using SPSS 22.0.
    Demographic information on the ER patients who attempted self-harm or suicide between 2013 and 2015 indicated that female patients, 20–44 years of age, lived in Nantou County, primary stressor was mental health problems, had attempted suicide, and had attempted suicide for the first time accounted for the majority. Those with a single suicide attempt were mostly 20–44 years of age, whereas those with repeated attempts were mostly 45–64 years of age. Mental health problems were the primary stressor of these patients. Among those with a single suicide attempt, most patients experienced failed suicide attempts (71.6%). Among those with repeated attempts, failed suicide attempt and suicidal ideation each accounted for 50%. After controlling social demographic variables and examining compliance effect, the results showed that among high-risk ER patients who attempted self-harm or suicide, those who were 20–44 years of age and those whose primary stressor was family problems or substance abuse problems exhibited poor medication compliance. Patients with failed suicide attempts exhibited a lower willingness to return for outpatient follow-up visits than those who only exhibited suicidal ideation.
    This study found that among ER patients who attempted self-harm or suicide, different stressors significantly correlated with their medication compliance and return visits. Mental health problems were the primary stressor of the patients in this study. Therefore, this study recommends that in addition to existing pre-packaged follow-up methods, observation mechanisms should include follow-up of primary caregivers and whether these caregivers live with patients, as well as whether these caregivers are employed and, if employed, their occupational fields. Such efforts facilitate understanding of the patients’ social adaptability and living conditions. In combination with crucial assessments of patients’ performance and depression levels after leaving emergency rooms, further in-depth investigations can be conducted. For high-risk groups with different stressors, the hospital sample is recommended to work with suicide care visitors from different regions of Nantou County in addition to following the national suicide prevention notification and follow-up processes. These efforts provide individualized interventional care to patients and teach them skills to adapt to traumatic stressful events, minimizing the irreversible damage created by repeated suicide attempts and motivating them to make regular outpatient follow-up visits for comprehensive mental care.
    Appears in Collections:[健康產業管理學系] 博碩士論文

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