新兵自殺行為與睡眠問題的相關：探討焦慮及憂鬱的中介效應

The Association between Sleep Problems and Suicidality of Military Recruits: Focusing on Mediation Effects of Anxiety and Depression

目的：本研究為探究新兵的睡眠問題與自殺行為的可能關聯性，詳細區分自殺行為為自 殺意念、自殺企圖及蓄意自我傷害三類。同時也檢測焦慮及憂鬱在此關聯性的中介效應。 方法：本研究收集2013 年1 月至7 月在北台灣軍事訓練中心入伍新兵的自我精神狀態的報 告，個案年齡從18 歲至34 歲，共1,222 位。在個案入伍後兩週內完成成人身心狀況自我評 量表(ASRI-4)，使用邏輯斯回歸模式分析新兵目前睡眠問題與自殺之間的相關性，以及焦慮 與憂鬱的中介效應。結果：研究參與者的自殺行為與中斷睡眠 (p < 0.05) 與惡夢 (p < 0.05) 有 顯著相關。其中，中斷睡眠與自殺意念顯著相關 (p < 001)；惡夢與自殺企圖顯著相關 (p < 001)；白天猝睡與蓄意自我傷害顯著相關 (p < 001)。在控制焦慮與憂鬱的效應後，所有上述 的顯著關聯繼續存在。結論：各類特殊種類的睡眠問題在預測新兵的自殺風險時是重要的線 索，治療內在的精神病理，例如焦慮及憂鬱，可能在軍人自殺預防方面是最有效的策略。

Objectives: In this study, we intended to scrutinize the possible association between the sleep problems of military recruits and their suicidality (deliberate self-harm, suicide ideation, and suicide attempt), as well as to examine the mediation effects of anxiety and depression. Methods: From January 2013 to June 2013, we collected the self-reported psychiatric conditions of 1,222 military recruits, aged 18 to 34 years from a military training center in northern Taiwan. Those new military recruits were asked to complete the self-administrated Adult Self-Report Inventory (ASRI-4) during the fi rst two weeks of their military training. With logistic regression model, we analyzed the relationship between their current sleep problems and situations of suicidality, as well as the effects of anxiety and depression. Results: The participant’s general suicidality was signifi cantly associated with interrupted sleep (p < 0.05), and nightmare (p < 0.05). We also found that subjects’ interrupted sleep, nightmare, and sleep attack were signifi cantly dominant for suicide idea (p < 0.001), suicide attempt (p < 0.001), and deliberate selfharm (p < 0.001), respectively. All the signifi cant associations mentioned above remained signifi cant after controlling the effects of anxiety and depression. Conclusion: Some specifi c, but not all, types of sleep problems are essential clues in predicting the risk of suicidality among military recruits. The treatments for underlying depressive and/or anxiety disorders might be the most effective approaches in military suicide prevention.