台灣自殺死亡率趨勢之改變：連結點迴歸分析（1971-2018年）

Changing suicide trends in Taiwan: a joinpoint regression analysis from 1971 to 2018

台灣自殺死亡率在近十年間不再明顯下降，本研究藉由分析1971-2018年間性別、 年齡別和方法別自殺率趨勢之轉折，了解近十年自殺率趨勢改變之特徵。方法：使用全國死 因資料，計算15歲以上年齡標準化年自殺率和性別別、年齡別（15-24、25-44、45-64和65歲以 上，即青、壯、中和老年）與方法別（上吊、中毒、燒炭、墜落、溺水和其他方法）自殺率。 使用連結點迴歸分析來確認自殺率趨勢的轉折點。結果：整體自殺率在1971-1992年間呈下降 趨勢，降幅以1980年代晚期最為明顯，其後自殺率上升至2006年達到高峰後下降，在2011年發 生轉折，未再有明顯下降，此轉折主要發生於青、壯、中年男性和青年女性，他們的主要自殺 方法包括上吊、燒炭與墜落都呈現類似變化。研究期間台灣主要自殺方法由中毒轉變為上吊、 燒炭、中毒與墜落，同時，不同性別年齡層有不同的主要自殺方法。結論：近十年間台灣自殺 率不再繼續下降，不同性別年齡層的自殺率趨勢與常見自殺方法亦有所差異。未來需進一步研 究導致不同人口族群自殺率趨勢改變的性別年齡別特定因素，以利防治策略之擬定。（台灣衛 誌 2020；39（5）：536-552）

Suicide rates in Taiwan did not continue their previous downward trend during the past ten years. This study aimed to investigate suicide trends and assess differences by sex, age, and method in Taiwan between 1971 and 2018 to better understand the pattern of changes in trends over the last ten years. Methods: Suicide data were extracted from Taiwan's national cause-of-death mortality data files. Annual age-standardized suicide rates for population aged ≥ 15 years and suicide rates by sex, age (15-24, 25-44, 45-64, and ≥65 years), and method (hanging, poisoning, charcoal burning, jumping, drowning, and other methods) were calculated. Joinpoint regression was used to identify the years in which suicide trends changed. Results: Age-standardized suicide rates decreased between 1971 and 1992, with the most marked decline observed during the late 1980s. Suicide rates subsequently increased to reach a relative peak in 2006 and then decreased until 2011, after which the downward trend changed to a stable trend. The recent changes in suicide trends were mainly observed in males aged 15-64 and females aged 15-24. We observed similar changes in these groups for trends in suicide rates of common suicide methods including hanging, charcoal burning, and falling. The most common methods of suicide changed from poisoning to hanging, charcoal burning, poisoning, and falling in Taiwan over the study period. Furthermore, the main methods of suicide differed by sex and age groups in recent years. Conclusions: Suicide rates did not continue to fall in Taiwan over the last decade, with differences in trends and common suicide methods across different sex and age groups. Further research is required to identify sex- and age-specific factors contributing to recent changes in suicide trends in various demographic groups to inform suicide prevention strategies. (Taiwan J Public Health. 2020;39(5):536-552)