Cut-off Values of Five-item Brief Symptom Rating Scale in Evaluating Suicidality among Military Recruits

以五題簡式健康量表（BSRS-5）篩選分數來評估新兵自殺的危險性

馬靖超(Chin-Chao Ma)；戴月明(Yueh-Ming Tai)

接受者操作特徵曲線分析 ； 自殺意念 ； 自殺嘗試 ； 故意自我傷害 ； receiver operating characteristic (ROC) curve analysis ； suicidal ideation ； suicidal attempt ； deliberate self-harm

台灣精神醫學

28卷2期（2014 / 06 / 01）

iii+109 - 120

英文

目的：自殺是重大的全球問題，也是國家公共健康議題。如何篩選軍中服役初期的高危險個案是必要的。本研究目的是針對不同自殺相關議題在新兵族群中，評估其盛行率、探討五題簡式健康量表的相關因子及測定其篩選分數。方法：北台灣軍方訓練基地1,222名完成所有問卷的新兵參與研究。簡式健康量表及成人自陳量表等兩份問卷由所有個案填寫，貝克自殺意念量表僅由曾有自殺相關問題的人填寫。結果：研究顯示軍人在自殺意念，自殺嘗試及故意自我傷害有高的盛行率。以五題簡式健康量表作為自殺意念、故意自我傷害及自殺嘗試的篩選工具時，建議篩選分數為7、8及8並與通用篩選分數相比，有相似曲線下面積量。另對軍人族群有較佳特定度且針對不同自殺相關議題，相關因子大致相似。結論：研究結果建議五題簡式健康量表能有效地將自殺相關議題從軍人中區辨出並且新的篩選分數具有較佳的特定度。此種容易施作的問卷能利於軍中自殺防治執行。

Objectives: Suicide is a big worldwide problem and also a national public health issue. How to screen high-risk soldiers is essential at an early stage of military service. The objectives of this study were to assess prevalences, to investigate the associated rôle in five-item Brief Symptom Rating Scale (BSRS-5), and to determine the cut-off scores of BSRS-5 in each type of suicidality in new military recruits. Methods: We recruited 1,222 soldiers who completed all copies of questionnaire from a military base in northern Taiwan. The subjects completed the copies of questionnaire of BSRS-5 and Adult Self-Report Scale Inventory-4 (the ASRI), and a copy of questionnaire of the optional Beck Scale for Suicide Ideation (BSS) was also completed for those who had ever had suicidality. Results: This study revealed high prevalences of suicidal ideation (SI), suicidal attempt (SA), and deliberate self-harm (DSH) of military recruits. While using BSRS-5 as a screening instrument for SI, DSH, and SA, the suggested cut-offs were 7, 8, and 8, respectively and had almost the same magnitudes of area under curves compared with the general cut-offs. In addition, better specificity for military recruits was noted and associated factors for each kind of suicidality were almost similar. Conclusion: The study results suggest that BSRS-5 can be efficiently used to distinguish suicidality from the military recruits and better specificity of new cut-offs. This easily administered tool can help screen high risk suicidal military recruits for suicide prevention.

1. Wu, YF,Chang, KJ,Chang, YC(2013).An investigation of factors associated with suicidal attempts among male military personnel.Taiwanese Journal of Psychiatry,27,41-51.
   連結：
2. Abdel-Khalek, A,Lester, D(2002).Can personality predict suicidality? A study in two cultures.Int J Soc Psychiatry,48,231-9.
3. Ansbacher, HL,Ansbacher, R(1970).Superiority and Social Interest by Alfred Adler.Evanston, Illinois, USA:Northwestern University Press.
4. Baca-Garcia, E,Perez-Rodriguez, MM,Keyes, KM(2010).Suicidal ideation and suicide attempts in the United States: 1991-1992 and 2001-2002.Mol Psychiatry,15,250-9.
5. Beautrais, AL(2006).Suicide in Asia.Crisis,27,55-7.
6. Beck, AT,Brown, GK,Steer, RA(1997).Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients.Behav Res and Ther,35,1039-46.
7. Beck, AT,Kovacs, M,Weissman, A(1979).Assessment of suicidal intention: the Scale for Suicide Ideation.J consult Clin Psychol,47,343.
8. Beck, AT,Steer, RA,Beck, JS(1993).Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression.Suicide Life Threat Behav,23,139-45.
9. Belik, SL,Stein, MB,Asmundson, GJ(2010).Are Canadian soldiers more likely to have suicidal ideation and suicide attempts than Canadian civilians?.Am J Epidemiol,172,1250-8.
10. Bossarte, RM,Knox, KL,Piegari, R(2012).Prevalence and characteristics of suicide ideation and attempts among active military and veteran participants in a national health survey.Am J Public Health,102(Suppl 1),S38-40.
11. Brodsky, BS,Groves, SA,Oquendo, MA(2006).Interpersonal precipitants and suicide attempts in borderline personality disorder.Suicide Life Threat Behav,36,313-22.
12. Burless, C,De Leo, D(2001).Methodological issues in community surveys of suicide ideators and attempters.Crisis,22,109-24.
13. Chen, HC,Wu, CH,Lee, YJ(2005).Validity of the fiveitem Brief Symptom Rating Scale among subjects admitted for general health screening.J Formos Med Assoc,104,824-9.
14. Chien, Y,Gau, S,Gadow, K(2011).Gender difference in psychiatric syndromes and psychiatric concurrent patterns in Taiwanese college students.Compr Psychiatry,52,195-207.
15. Gadow, K,Sprafkin, J,Weiss, M(2004).Adult Self-Report Inventory 4 manual.Stony Brook, NY:Checkmate Plus.
16. Giotakos, O(2003).Suicidal ideation, substance use, and sense of coherence in Greek male conscripts.Mil Med,168,447-50.
17. Groholt, B,Ekeberg, O,Haldorsen, T(2000).Adolescents hospitalised with deliberate self-harm: the signifi - cance of an intention to die.Eur Child Adolesc Psychiatry,9,244-54.
18. Haatainen, KM,Tanskanen, A,Kylma, J(2003).Stable hopelessness and its predictors in a general population: a 2-year follow-up study.Suicide Life Threat Behav,33,373-80.
19. Heider, F(1958).The psychology of interpersonal relations.New York:John Wiley.
20. Hirschfeld, RM,Russell, JM(1997).Assessment and treatment of suicidal patients.N Engl J Med,337,910-5.
21. Hoge, CW,Castro, CA(2012).Preventing suicides in US service members and veterans: concerns after a decade of war.JAMA,308,671-2.
22. Hsieh, TH,Chang, KJ,Lee, WK(2010).Factors associated with depressive symptoms among Soldiers.Taiwanese Journalof Psychiatry,24,51-60.
23. Jagodic, HK,Agius, M,Pregelj, P(2012).Inter-regional variations in suicide rates.Psychiatr Danub,24,S82-S5.
24. Kinyanda, E,Hjelmeland, H,Musisi, S(2005).Psychological factors in deliberate self-harm as seen in an urban african population in aganda: a case-control study.Suicide Life Threat Behav,35,468-77.
25. LeardMann, CA,Powell, TM,Smith, TC(2013).Risk Factors Associated With Suicide in Current and Former US Military PersonnelSuicide Risk Factors in US Military PersonnelSuicide Risk Factors in US Military Personnel.JAMA,310,496-506.
26. Lee, MB,Lee, YJ,Yen, LL(1990).Reliability and validity of using a Brief Psychiatric Symptom Rating Scale in clinical practice.J Formos Med Assoc,89,1081-7.
27. Lee, MB,Liao, SC,Lee, YJ(2003).Development and verifi cation of validity and reliability of a short screening instrument to identify psychiatric morbidity.J Formos Med Assoc,102,687-94.
28. Liao, SC,Lee, MB,Cheng, WJ(2006).Prevalence and correlates of suicide ideation, plans, and attempts in Taiwan communities: Results from the national mental health census.Proceedings of the 12th Pacific Rim College of Psychiatrist Scientific Meeting,Taipei, Taiwan:
29. Lin, JC,Shiah, IS,Shen, LJ(2011).A follow up study of soldiers with adjustment disorder.Taiwanese Journalof Psychiatry,15,310-8.
30. Lung, FW,Lee, MB(2008).The five-item Brief-Symptom Rating Scale as a suicide ideation screening instrument for psychiatric inpatients and community residents.BMC Psychiatry,8,53.
31. Lunsky, Y(2004).Suicidality in a clinical and community sample of adults with mental retardation.Res Dev Disabil,25,231-43.
32. Luxton, DD,Trofimovich, L,Clark, LL(2013).Suicide Risk Among US Service Members After Psychiatric Hospitalization, 2001-2011.Psychiatr serv
33. Meyer, RE,Salzman, C,Youngstrom, EA(2010).Suicidality and risk of suicide--defi nition, drug safety concerns, and a necessary target for drug development: a brief report.J Clin Psychiatry,71,1040-6.
34. Muehlenkamp, JJ,Gutierrez, PM(2007).Risk for suicide attempts among adolescents who engage in non-suicidal self-injury.Arch Suicide Res,11,69-82.
35. Rodham, K,Hawton, K,Evans, E(2004).Reasons for deliberate self-harm: comparison of self-poisoners and selfcutters in a community sample of adolescents.J Am Acad Child Adolesc Psychiatry,43,80-7.
36. Rodriguez, JR,Quinones-Maldonado, R,Alvarado-Pomales, A(2009).Military suicide: factors that need to be taken into consideration to understand the phenomena.Bol Asoc Med P R,101,33-41.
37. Smith, RH,Kim, SH(2007).Comprehending envy.Psycholo Bull,133,46.

1. Lin, Jin-Jia(2014).Suicide Prevention for Military Personnel.台灣精神醫學,28(2),65-66.
2. Yueh-Ming Tai,Szu-Nian Yang,Hui-Ying Chou,Fu-Shun Chang(2021)。Depression, Posttraumatic Stress, and Suicidal Ideation: A Linkage Study in Taiwanese Army。臺灣精神醫學，35(4)，180-187。
3. 戴月明,楊斯年(2019)。癌症病人之創傷後壓力症、憂鬱及自殺風險。源遠護理，13(2)，5-8。
4. 戴月明,鄭淑利,楊斯年(2018).Effect of Mindfulness Training (Body Scan) on the Five-item Brief Symptom Rating Scale of Depressive Inpatients of Military Personnel: A Pilot Study.臺灣精神醫學,32(4),306-313+ii.