東臺灣家庭暴力傷害與飲酒之相關性研究

Domestic Violence and Relationship to Alcohol Use at an Emergency Department in Eastern Taiwan

目的：蓄意傷害是臺灣地區年輕人的主要健康問題。家庭暴力事件亦威脅家人的健康和安全，飲酒可能在暴力事件扮演部份的角色。本文目的是評估東臺灣急診處理的家庭暴力傷害和飲酒的關係及其相關因素。材料與方法：自2004年起某一醫學中心依世界衛生組織建議建立外傷監控系統，由護理人員常規性登錄事故傷害資料及評估每位傷者是否有酒味和酒後行為，本研究選出2004年資料檔內回應是在家裡與他人衝突所致受傷的求診者為研究對象，並查閱病歷確定是家庭內暴力傷害事故，亦檢閱有否肇事者身份及傷者心理疾患的病史；護理人員評定為「有酒味」或「明顯酒醉」的個案界定為飲酒相關；以邏輯迴歸分析評估飲酒相關的家庭暴力傷害重要相關因素。結果：研究期間共有11,837外傷求診人次，其中142位屬家庭暴力傷患，傷者中女性占62.6%和59.1%年齡在24歲至44歲間，在142位傷者中有53人(37.3%, 95% CI 29.4-45.3)被評定是飲酒相關，屬飲酒相相關的家庭內暴力事故的比例，在男性傷患是50.0%(95%CI 36.1-63.8)，在女性傷患是31.3%(95% CI 22.0-40.5)，多變項分析發現男性(OR 4.3; 95% CI 1.7-12.0)，年齡25至44歲(OR 3.4; 95% CI 1.3-8.9)，在午夜(OR 7.8; 95% CI 2.1-28.6)、晚間(OR5.7; 95% CI 1.8-18.4)和週日(OR 3.8, 95% CI 1.5-10.1)求診者，是預測是飲酒相關家庭暴力傷害的重要因子。結論：約三成東臺灣急診室所處理的家庭暴力傷害是與飲酒相關，其因果關係需進一步的流行病學研究。

Objectives: Intentional injuries cause major health issues in young adults in Taiwan. Domestic violence (DV) also threatens the health and safety of family members in Taiwan, and alcohol involvement may play a role in the violence. This study investigated the characteristics of DV patients and their association with alcohol drinking. Materials and Methods: Since 2004, an injury surveillance system has been set up in a medical center, collecting the minimal information recommended by the World Health Organization. For each patient, the attending nurse completed an injury-coding sheet that included the results of an assessment of whether the patient had an alcohol odor or alcohol consumption related behavior. Patients admitted to the emergency department (ED) because of an injury that was the result of violence (being in a fight or being attacked by someone at home) were included in this study. Injuries were defined as alcohol-associated based on the report of ”alcohol odor” or ”intoxicated” by the nurse. Medical records of DV injuries were reviewed for confirmation of DV, record of the offender and any known mental disorder. Logistic regression was used to assess the significant factors related to alcohol-associated violent injuries. Results: Of 11,837 trauma visits, 142 patients had DV injuries. Females accounted for 67.6% of injured patients and 59.2% were aged 24-44 years. Of the 142 patients, 37.3% (95% confidence interval [CI], 29.4-45.3) of them had alcohol-associated injuries. The percentage of alcohol-associated DV injuries was 50.0% (95% CI, 36.1-63.8) for males and 31.3% (95% CI, 22.0-40.5) for females. Multiple logistic regression analysis found that being male (odds ratio [OR] 4.3; 95% CI, 1.7-12.0), being aged 25 to 44 years (OR 3.4; 95% CI, 1.3-8.9), visiting after midnight (OR 7.8; 95% CI, 2.1-28.6), presenting at the ED between 4 pm and midnight (OR 5.7; 95% CI, 1.8-18.4) or on a week day (OR 3.8; 95% CI, 1.5-10.1) meant a significant increase in the likelihood of alcohol involvement. Conclusions: Alcohol use was found to be present in one-third in the DV injuries from an ED in eastern Taiwan. Ongoing epidemiological investigations of the causal relationship between alcohol use and DV are urgently needed.