人際間心理理論於台灣自殺傾向軍人的初步運用

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

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 - 0.579p p < 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: Suicide rates are higher in the military personnel than those in the general population even though owning the same risk factors. The interpersonalpsychological theory of suicide (IPTS) could provide an empirical explanation. To investigate the relevance of IPT with respect to suicides among soldiers in Taiwan, we designed a case control study. Methods: With a suicide-reporting system in a teaching general hospital in southern Taiwan, we enrolled 226 at-risk maladjusted soldiers and 229 well-adjusted matched controls. We collected basic information and completed four IPTS-based questions in the study participants. Suicide risk was assessed using the Brief Symptom Rating Scale (BSRS) item 6, with scores equal to and larger than one, indicating a risk of suicide. All study participant received MINI-interview to screen the latent mental illness and to recheck the suicidal tendency. Results: Poor academic performance (β = 0.163, 95% confi dence interval (CI) = 0.200 - 0.487, p < 0.001), conduct-related issues in childhood (β = 0.108, 95% CI = 0.102 - 0.540, p < 0.05), exposure to domestic violence (β = 0.128, 95% CI = 0.155 - 0.652, p < 0.05), and life-threatening situations (β = 0.096, 95% CI = 0.059 - 0.500, p < 0.05) are all risk factors to suicide. The maladjusted suicidal soldiers showed a sense of thwarted belongingness (β = 0.169, 95% CI = 0.269 - 0.796, p < 0.001), perceived burdensomeness (β = 0.342; 95% CI = 0.743 - 1.256, p < 0.001), and less fear of death (β = 0.127, 95% CI = 0.150 - 0.579, p < 0.001). Conclusion: These results provide more insight into the risk of suicides among soldiers. IPTS could be used to assess suicide risk and to prevent suicide attempts.