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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
    台灣每年約有17萬人死亡,自殺死亡佔3600人,其中25-44歲的主要死因,蓄意傷害高為第三;南投縣自殺死亡率自2000年來呈現持續上升趨勢,並在2008年自殺粗死亡率每十萬人高達26.5人,居全國之冠,且近十年來皆持續高於全國平均粗死亡率。精神科急診原因多為自殺自傷、攻擊暴力、焦慮、與物質濫用,然而精神疾患自殺風險高於一般人,且終生重複自殺亦甚高,故需對高危險族群建立一串完整的通報系統和關懷流程,以降低個案重複自殺、整合醫療資療,並落實自殺防治。本研究利用樣本資料庫分析急診高度自殺意念及未遂個案,提供系統性追蹤觀察,期待能分析影響自殺自傷者遵從性背景因素。
    目的
    本研究目的(一)瞭解2013-2015年間急診個案自殺自傷的就醫主要因素。(二)比較2013-2015年單次與重複自殺急診個案特性。(三)分析影響自殺自傷急診個案追蹤遵從性的背景因素。
    方法
    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。
    結果
    2013-2015年經急診自殺自傷高危險群個案的人口學特性:「女性、20-44歲族群、居住在南投縣族群、急診主要壓力源為精神健康問題、自殺未遂、初次自殺」為主要特徵。初次自殺個案主要集中在20-44歲族群,重複自殺個案則為45-64歲族群,急診主要壓力源皆以精神健康問題為主要因素,初次自殺個案自殺程度以自殺未遂佔71.6%,重複自殺個案自殺未遂與自殺意念各佔一半比例。若以遵從性成效來看,在控制社會人口學變項下,則「20-44歲」族群、主要壓力源為「家庭問題」或「物質濫用問題」的急診自殺自傷高危險群個案,其服藥遵從性欠佳;另外「自殺未遂族群」願意返回門診追蹤的可能性較「僅有自殺意念」族群低。
    結論
    本研究發現不同急診自殺自傷壓力源對服藥遵從性、返診有顯著相關,急診主要壓力源為精神健康問題族群為主對象,建議在運用觀察機制時除了提供原有包裹式追蹤,另需增加追蹤主要照顧者、是否有同住、有無工作及職業別,以了解在社會適應能力及居家生活狀態,配合個案離開急診後的重要表現與憂鬱程度評估,進一步做更深入的項目探討。建議樣本醫院針對不同急診壓力源的高危險族群,未來除遵循全國自殺防治通報流程及追蹤模式,亦可搭配南投縣地區不同鄉鎮市的自殺關懷訪視員,提供個別性介入關懷與教導創傷壓力事件調適技巧,以減少重複自殺造成不可逆的傷害,並能規律返回門診追蹤獲得完善精神照護。
    Background
    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.
    Objectives
    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.
    Methods
    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.
    Results
    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.
    Conclusion
    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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