Pathways to Care and Help-Seeking Experience Prior to Self-Harm: A Qualitative Study in Taiwan

自傷前求醫途徑與求助經驗：一項台灣質性研究

10.1097/JNR.0b013e3182466e64

吳佳儀(Chia-Yi Wu)；Rob Whitley；Robert Stewart；劉珣瑛(Shen-Ing Liu)

自我傷害 ； 求助行為 ； 社會支持 ； 求醫途徑 ； deliberate self-harm ； help-seeking behavior ； social support ； pathways to care

The Journal of Nursing Research

20卷1期（2012 / 03 / 01）

32 - 42

英文

背景 求助行為是自我傷害的一個保護因子，但鮮少有研究探討自傷者如何及為何求助於一般人與專業人員的協助。目的 探索台灣自我傷害者於自傷前之求助經驗與就醫途徑。方法 本研究運用質性訪談及內容分析法，藉由選樣方格選取參與者，並以標準訪談指引，深度訪談二十位介於18－55歲的自傷者之求助歷程與求醫經驗。結果 受訪者表示，求醫歷程中的轉介者包括了朋友、家人、健康醫療工作者或是透過其自行就醫。求助經驗與護病關係、社會支持及治療遵從性有關，這些亦是受訪者提到影響求醫過程最主要的主題。結論／實務應用 來自一般非正式與醫療照護的支持性態度和持續性照護，可能是促進求助行為最重要的因素，但來自重要他人的負面影響可能會引發自傷行為。自殺／自傷防治策略中，應特別注意與多重就醫有關的存藥行為及重要他人的負面關係影響所導致的自傷行為。

Background: Help-seeking behavior may protect people from harming themselves. However, few studies have discussed how and why people access lay or professional help prior to self-harm.Purpose: This study explored the subjective experiences of individuals with deliberate self-harm in terms of help-seeking behavior and medical care pathways.Methods: Researchers performed qualitative in-depth interviews and content analysis and used a sampling grid to recruit participants. Twenty emergency attendees between the ages of 18-55 years were interviewed on their help-seeking pathways and experiences using a standardized topic guide.Results: Participants identified friends, family members, healthcare personnel, and their own initiative as the primary medical care pathways. Analysis showed help-seeking experiences significantly related to the physician-patient relationship, social support, and treatment adherence. These factors were also identified as prominent themes related to medical help-seeking behavior.Conclusions: Supportive attitudes and continuous care from formal and informal sources of help may facilitate help-seeking behavior, whereas negative influences from close friends or relatives may trigger a self-harm episode. Medication stockpiling and the negative aspects of close relationships should be addressed and minimized to raise the effectiveness of self-harm or suicide prevention efforts.

1. Department of Health, Executive Yuan, Taiwan, ROC. (2011). Statistics in cause of mortality. Retrieved from http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=11962&class_no=440&level_no=4 (in Chinese)
2. Biddle, L.,Gunnell, D.,Sharp, D.,Donovan, J. L.(2004).Factors influencing help seeking in mentally distressed young adults: A cross sectional survey.The British Journal of General Practice,54(501),248-253.
3. Biddle, L.,Sharp, D.,Gunnel, D.,Donovan, J.(2006).Young adults' reluctance to seek help and use medications for mental distress.Journal of Epidemiology & Community Health,60(5),426.
4. Bureau of National Health Insurance, Department of Health, Executive Yuan(2011).National Health Insurance in Taiwan: 2011 Annual report.Taipei City, Taiwan, ROC:Author.
5. Chen, Y. Y.,Lee, M. B.,Chang, C. M.,Liao, S. C.(2009).Methods of suicide in different psychiatric diagnostic groups.The Journal of Affective Disorder,118(1-3),196-200.
6. Cheng, A. T.,Hawton, K.,Chen, T. H.,Yen, A. M.,Chen, C. Y.,Chen, L. C.,Teng, P. R.(2007).The influence of media coverage of a celebrity suicide on subsequent suicide attempts.The Journal of Clinical Psychiatry,68(6),862-866.
7. Cheng, S. T.,Chan A. C. M.(2007).Multiple pathways from stress to suicidality and the protective effect of social support in Hong Kong adolescents.Suicide & Life-Threatening Behavior,37(2),187-196.
8. Chew-Graham, C.,Bashir, C.,Chantler, K.,Burman, E.,Batsleer, J.(2002).South Asian women, psychological distress and self-harm: Lessons for primary care trusts.Health & Social Care in the Community,10(5),339-347.
9. Chiu, C. H.、Lee, M. B.(2006)。Characteristics of the suicide attempters。Formosan Journal of Medicine，10(3)，339-342。
10. Cooper, J.,Kapur, N.,Webb, R.,Lawlor, M.,Guthrie, E.,Mackway-Jones, K.,Applby, L.(2005).Suicide after deliberate self-harm: A 4-year cohort study.The American Journal of Psychiatry,162(2),297-303.
11. De Leo, D.,Padoani, W.,Lonnqvist, J.,Kerkhof, A. J. F. M.,Bille-Hrahe, U.,Michel, K.,Scocco, P.(2002).Repetition of suicidal behavior in elderly. Europeans: A prospective longitudinal study.Journal of Affective Disorders,72(3),291-295.
12. Glaser, B. G.,Strauss, A. L.(1967).The discovery of grounded theory: Strategies for qualitative research.Chicago, IL:Aldine Publishing.
13. Grohol, J. M.(2008).Suicide and the internet: Study misses internet's greater collection of support websites.British Medical Journal,336(7650),905-906.
14. Harriss, L.,Hawton, K.(2005).Suicidal intent in deliberate selfharm and the risk of suicide: The predictive power of the Suicide Intent Scale.Journal of Affective Disorders,86(2-3),225-233.
15. Hawton, K.,Harriss, L.,Hall, S.,Simkin, S.,Bale, E.,Bond, A.(2003).Deliberate self-harm in Oxford, 1990Y2000: A time of change in patient characteristics.Psychological Medicine,33(6),987-995.
16. Henggeler, S. W.,Schoenwald, S. K.,Rowland, M. D.,Cunningham, P. B.(2002).Multisystemic treatment of children and adolescents with serious emotional disturbance.NewYork, NY:Guilford Press.
17. Horwitz, A. V.(Ed.),Schied, T. L.(Ed.)(1999).A handbook for the study of mental health: Social contexts, theories and systems.Cambridge, England:Cambridge University Press.
18. Houston, K.,Haw, C.,Townsend, E.,Hawton, K.(2003).General practitioner contacts with patients before and after deliberate self harm.British Journal of General Practice,53(490),365-370.
19. Ilgen, M. A.,Czyz, E. K.,Welsh, D. E.,Zeber, J. E.,Bauer, M. S.,Kilbourne, A. M.(2009).A collaborative therapeutic relationship and risk of suicidal ideation in patients with bipolar disorder.Journal of Affective Disorders,115(1-2),246-251.
20. Kapur, N.,Gask, L.(2009).Introduction to suicide and selfharm.Psychiatry,8(7),233-236.
21. Kaslow, N. J.,Thompson, M. P.,Okun, A.,Price, A.,Young, S.,Bender, M.,Parker, R.(2002).Risk and protective factors for suicidal behavior in abused African American women.Journal of Consulting and Clinical Psychology,70(2),311-319.
22. King, C. A.,Kramer, A.,Preuss, L.,Kerr, D. C. R.,Weisse, L.,Venkataraman, S.(2006).Youth-nominated support team for suicidal adolescents (version 1): A randomized controlled trial.Journal of Consulting and Clinical Psychology,74(1),199-206.
23. Kleinman, A.(Ed.)(1980).Patients and healers in the context of culture.London, England:University of California Press.
24. Knox, K. L.,Litts, D. A.,Talcott, G. W.,Feig, J. C.,Caine, E. D.(2003).Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: Cohort study.British Medical Journal,327(7428),1376-1380.
25. Kuo, C. J.,Conwell, Y.,Yu, Q.,Chiu, C. H.,Chen, Y. Y.,Tsai, S. Y.,Chen, C. C.(2008).Suicide by charcoal burning in Taiwan: Implications for means substitution by a case-linkage study.Social Psychiatry & Psychiatric Epidemiology,43(4),286-290.
26. Lakeman, R.,Fitzgerald, M.(2008).How people live with or get over being suicidal: A review of qualitative studies.Journal of Advanced Nursing,64(2),114-126.
27. Mays, N.,Pope, C.(1995).Rigour and qualitative research.British Medical Journal,311(6997),109-112.
28. McLaren, S.,Challis, C.(2009).Resilience among men farmers: The protective roles of social support and sense of belonging in the depression-suicidal ideation relation.Death Studies,33(3),262-276.
29. Morgan, C.,Mallett, R.,Hutchinson, G.,Leff, J.(2004).Negative pathways to psychiatric care and ethnicity: The bridge between social science and psychiatry.Social Science & Medicine,58(4),739-752.
30. Pierce, D. W.(1981).The predictive validation of a suicide intent scale: A five year follow-up.British Journal of Psychiatry,139,391-396.
31. Pompili, M.,Serafini, G.,Del Casale, A.,Rigucci, S.,Innamorati, M.,Girardi P.,Lester, D.(2009).Improving adherence in mood disorders: The struggle against relapse, recurrence and suicide risk.Expert Review of Neurotherapeutics,9(7),985-1004.
32. Sinclair, J.,Green, J.(2005).Understanding resolution of deliberate self harm: Qualitative interview study of patients' experiences.British Medical Journal,330(7500),1112-1115.
33. Stansfeld, S.,Marmot, M.(1992).Deriving a survey measure of social support: The reliability and validity of the close persons questionnaire.Social Science & Medicine,35(8),1027-1035.
34. Suominen, K. H.,Isometsa, E. T.,Ostamo, A. I.,Lőnnqvist, J. K.(2002).Health care contacts before and after attempted suicide.Social Psychiatry and Psychiatric Epidemiology,37(2),89-94.
35. Wasserman, D.(Ed.)(2001).Suicide-An unnecessary death.London, England:Martin Dunitz.
36. Whitley, R.,Crawford, M.(2005).Qualitative research in psychiatry.Canadian Journal of Psychiatry,50(2),108-114.
37. Wu, C. Y.,Stewart, R.,Huang, H. C.,Prince, M.,Liu, S. I.(2011).The impact of quality and quantity of social support on helpseeking behavior prior to deliberate self-harm.General Hospital Psychiatry,33(1),37-44.

1. Yang, Cheng-I,Wu, Chia-Yi,Tzeng, Wen-Chii(2017).Factors Infl uencing Psychiatric Nurses' Attitudes toward Suicide Attempters: Implications for Nursing Education in Suicide Prevention.醫學教育,21(2),59-72.
2. 路馥銘,侯庭凱,汪聖偉,李明濱,吳欣庭,吳佳儀(2023)。北台灣某大學學生接受心理健康促進與自殺防治守門人課程之效益研究。台灣公共衛生雜誌，42(2)，233-250。