不同物質使用中介注意力不足過動症與自殺相關研究：國軍新兵族群為例

Substance Uses Mediate Differently in Relation between ADHD and Suicidality: Study among New Soldiers in Taiwan

目的：注意力不足過動症及物質濫用長久來已被認為與憂鬱、對立性疾患及自殺相關行 為－－自殺意念、自殺傾向及自我傷害－－有關。然而針對軍人族群，不同物質濫用之中介效 果差異為何，則尚未有文獻比較。方法：本研究收集 1,120 名新訓中心新兵，並取得同意書 後完成自填問卷。填答內含包括 SNAP-IV 過動量表、成人自填健康量表 (ASRI-4) 及貝克憂 鬱量表。結果：不同物質（包含檳榔）使用者均有較高之三種自殺相關行為危險及機率 (p < 0.001)。路徑分析結果，「過動－－憂鬱－－自殺」及「過動－－對立反抗－－自殺」兩路徑較其他 路徑顯著 (p < 0.05)。針對不同使用物質而言，過去使用「鎮定安眠劑」有顯著中介於「過 動－－自殺意念」路徑及「過動－－自我傷害」路徑的效果 (p < 0.05)。討論：本研究呼應其他 相關研究結果，確定物質使用在過動症狀與自殺之間有顯著中介效果。本研究之發現顯示對 於新兵自殺防治作為中，篩檢過去過動症症狀、憂鬱、對立反抗及物質使用史──尤其是鎮定 安眠劑－－亦是重要一環。

Background: Attention deficit/hyperactivity disorder and substance use have been considered as strong predictors for depression, opposition, and suicidal behaviors-suicidal ideation (SI), suicide attempt (SA) and deliberate self-harm. The details in associations among various substance use are still unknown in military population. Methods: Totally, 1,120 new soldiers participated and completed copies of self-report questionnaire including demographic data, Swanson, Nolan, and Pelham, Version IV Scale-Chinese version (SNAP-IV); the Adult Self-report Scale Inventory-4-Chinese version (ASRI-4); and Beck Depression Inventory, 2nd edition (BDI-II). Results: The uses of substance, including betel nut, significantly raised the risks of all three suicidal behaviors (all p < 0.001). The paths of ADHDdepression-suicidal behaviors and ADHD-opposition-depression-suicidal behaviors were significantly superior to other paths (all p < 0.05). Past use of hypnotics was significantly superior to other types of used substances for its highest indirect effects on SI and SH (all p < 0.05). Conclusion: In line with other studies, this study confirms the mediation effects of substance use, especially hypnotics, in the associations between ADHD and SI, SA, and DSH behaviors. Our findings indicate that screening for suicidal tendency among those new soldiers with substances use, depression, opposition, and recalling either ADHD symptoms are all essential.