A Preliminary Application of Interpersonal Psychological Theory on Suicidal Soldiers in Taiwan

人際間心理理論於台灣自殺傾向軍人的初步運用

黃凱呈(Kai-Cheng Huang)；曾冬勝(Dong-Sheng Tzeng)

自殺 ； 軍人 ； 人際間心理理論 ； 適應不良 ； MacArthur Competence Assessment Tool for Clinical Research (MacCATCR) ； decision-making capacity ； schizophrenia ； informed consent

台灣精神醫學

29卷3期（2015 / 09 / 01）

163 - 172+ii

英文

目的：自殺是軍人重要議題，即使有相同的自殺風險因子，其自殺率仍比一般平民為高，人際間心理理論可用於經驗性的解釋在於這種現象。我們使用病例對照研究方法探討台灣軍人人際間心理理論與自殺，尤其是在感覺成為他人負擔與受挫的歸屬感。方法：利用南部某教學醫院的軍人自殺通報系統，226位具有自殺風險且適應不良為個案組，229位則為適應良好作為控制組。我們收集基本資料且參與者必須回答和人際間心理理論相關的四個問題。自殺風險則使用簡式自殺量表第六題評估。所有受測者均須接受MINI-interview篩選可能的精神疾病以及二度確認其自殺傾向。結果：自殺風險的迴歸模式精簡模型顯示較差的學業表現（β=0.163, 95%CI=0.200-0.487, p＜0.001）、孩童時代的行無偏差（β=0.108, 95%CI=0.102-0.540, p＜0.05）、暴露於家庭暴力（β=0.128, 95%CI=0.155-0.652, p＜0.05）以及可能危及生命安全的事件中（β=0.096, 95%CI=0.05-0.500, p＜0.05）都是顯著的重要危險因子。而這些適應不良的自殺高風險軍人也顯示較高的受挫歸屬感（β=0.169, 95%CI=0.269-0.796, p＜0.001），較高的感覺成為他人負擔（β=0.342, 95%CI=0.743-1.256, p＜0.001），以及不害怕死亡（β=0.127, 95%CI=0.150-0.579pp＜0.05）。討論：這些結果提供具有自殺風險軍人更多的內視，人際間心理理論可用於評估自殺風險和預防自殺的嘗試。

Objectives: Inconsistent results exist about which domain of psychopathology, i.e, positive or negative symptoms affects the decision-making capacity to consent to clinical research (DMC) most in patients with schizophrenia spectrum disorders (SSD). The current study was to explore this topic using a regression model controlling for related covariates. Methods: All 177 patients with schizophrenia or schizoaffective disorders were assessed with the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), the Positive and Negative Syndrome Scale, and other measures. We used a linear regression model to find the association between psychotic symptoms and MacCAT-CR. Results: The mean age of subjects was 51.4 years. The majority of subjects were male (68.9%). The mean duration of schizophrenia and hospitalization were 27.9 years and 15.1 years, respectively. Negative symptoms were found to be significantly to have negative association with appreciation (B=-0.06, t=-2.27, p ＜ 0.05) and reasoning scores (B=-0.09, t=-2.65, p ＜ 0.01). Some components of MacCAT-CR scores were significantly to have positive association with educational years (p ＜ 0.01), cognitive function (p ＜ 0.01), male sex (p ＜ 0.05), and negative association with the length of stay (p ＜ 0.05). Conclusion: The most central finding of this study was that SSD patients with severe negative symptoms performed poorly on DMC. Beside, females, those with longer length of stay, lower educational level, and cognitive deficit were associated with impaired DMC. Those findings suggest that study investigators and institutional review boards should consider more intensive surveys for SSD patients with risk factors for impaired DMC and administer educational interventions to improve capacities to make decisions in the process of recruitment.

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