校園青少年自殺防治模式比較研究

Abstract

本研究的目的，是希望藉由學校實證的、精神疾病完整篩選的、多種介入模式相互比較的實證研究當中，找出最為迅速有效的實用模式。 本研究經由三個子研究建立自殺防治整合模式，第一個子研究是經由自陳量表進行全校的篩選，找出自殺及憂鬱症高危險群的學生及分佈情形；第二個子研究將這些高危險的學生經由精神科醫師，使用標準化的診斷系統會談並藉以建立臨時診斷，再則可以決定高危險學生是否可以在學校處理；第三個子研究則是將這些高危險群的學生挑選出90人，隨機分派到密集介入、一般介入以及最少介入三種不同的介入方式，經由介入前以及介入後的測量，希望能夠比較三個方式的效果，以及那些部分達到顯著的差別。 研究樣本是在南部的某一所中學，學生的人數是1826人，使用的工具包括了貝克憂鬱量表、貝克焦慮量表、貝克絕望感量表、貝克自殺意念量表，來測量介入前後狀況的變化。結果發現： 一、第一個子研究：經由全校的篩選，憂鬱程度為中到重度者有13.14％。焦慮為中到重度者有15.61％。絕望感為中到重度者有19.71％。而曾出現自殺意念為者有44.43%。 二、第二個子研究：這些高危險群的學生經由精神科醫師診斷會談之後，最主要的診斷為適應障礙以及未分類憂鬱症，診斷的分配大致如下：診斷符合適應障礙診斷者共有33人，佔36.67％；符合未分類憂鬱症診斷者共有30人，佔33.33％；符合未分類憂鬱症合併其他診斷者共有7人，佔7.78％；符合適應障礙合併其他診斷者共有6人，佔6.67％。符合嚴重憂鬱症診斷者共有4人，佔4.44％；符合情緒低落障礙診斷者共有3人，佔3.33％。 三、第三個子研究：以隨機分配的方式進行，以單因子共變數分析實驗介入對依變項的影響，研究結果發現，密集介入組以及一般介入組在憂鬱、焦慮和自殺意念的改變程度都顯著優於最少介入組；而密集介入組在改善絕望感方面，顯著優於一般介入組和最少介入組，而在憂鬱、焦慮及自殺意念方面，密集介入組和一般介入組的效果並沒有顯著差異。但是這兩組仍然顯著優於最少介入組。 本研究結果支持整合的密集介入模式(篩選，診斷及密集介入)能夠藉由迅速的方式減少高危險青少年自我傷害的危險性，並能減少高危險群個案陷入絕望、不求助的再度危險性。雖然研究的樣本局限於南部的某一所公立完全中學，但是本研究驗證了以學校為本位的自殺防治模式在校園中是可行的，而且可以相當快速的減輕青少年的憂鬱症狀及自我傷害行為，值得後續進一步的研究加以推廣。

The purpose of this thesis is to establish the most effective, evidence-based model of adolescent suicide prevention, which combined of screening for psychiatric disorders andthree-leveled interventions. Procedures were divided into three steps. First, self-administered inventories were used as tools for large scale screening. Second, subjects with moderate to high cutoff scores were interviewed by psychiatrists to decide tentative diagnosis and exclude those who could not be managed in a school setting. Third, a group of 90 high risk subjects were randomly assigned to three different levels of interventions and received 6 successive weeks of suicide interventions among intensive, usual and minimal intervention groups. A total of 1826 subjects were recruited from one of the high school in southern part of Taiwan. Screening tools were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS) and Beck Suicide Scale (BSS). Results were summarized as the following: 1.Results of large scale screening by self-administered inventories were as follows, moderate to severe depression were 13.14%, moderate to severe anxiety were 15.61%, moderate to severe hopelessness were 19.71% and suicide ideations were 44.43%. 2.Results from high risk subjects interviewed by the psychiatrist, tentative diagnosis made and distributions were as follows, adjustment disorders with depressed mood 36.67% (n=33), depressive disorder, NOS 33.33% (n=30), depressive disorder with co morbidity 7.78%, adjustment disorder with co morbidity 6.67%, major depressive disorder 4.44% (n=4),dysthymic disorder 3.33% (n=3). 3.Comparison among three-level interventions shown, intensive and usual groups were significantly superior to minimal level intervention in BDI, BAI and BSS scales. Intensive group was significantly superior to usual group in BHS (Hopelessness) but not significantly superior to usual group in other three scales (BDI, BAI and BSS). Conclusions and suggestions: Integrated intensive model, which include large scale screening, diagnostic interview, and intensive interpersonal intervention were shown to be a superior and promising model in adolescent suicide prevention, especially the therapeutic effects by reduction of hopelessness level and further risk of suicide. The model extends medical diagnostic interviews and interventions to school-based suicide prevention. This model could be generalized to larger areas upon further research.