北臺灣高中職學生自傷盛行率及其危險因子之研究

A Study of the Prevalence and Risk Factors for Self-harming Behaviors among High School Students in Northern Taiwan

目的：研究顯示青少年自傷行為會增加將來自殺死亡的危險。本研究旨在找出台灣青少年自傷行為的盛行率及其危險因子，以利臨床辨識及治療之參考。方法：以立意取樣邀請13所台北縣市高中職之在學學生填寫電腦問卷，問卷內容包括基本資料及家庭狀況、過去是否有過故意自傷行為•自殺念頭、自殺計畫、吸菸、喝酒、非法物質濫用箏。另外以身心健康量表(PHQ-9)到量學生之憂鬱程度，以多面向社會支持量表(MDSS)到量社會支持程度，以羅氏自重感量表(RSES)到量學生之自尊程度。結果：共有2,480位學生完成電腦問卷，平均年齡15.4歲，60.2%是女生。結果委現有24.8%學生曾有過自傷行為，平均故意自傷次數為3.9次，22.9%有自殺意圖。北台灣高中職學生自傷行為之危險因子為女性、郊區學校、憂鬱、曾有吸菸習慣、酒精使用、曾有自殺念頭及自殺計畫者。結論：台灣青少年自傷行為是很常見且重要的行為問題，其危險因子為憂鬱、自殺念頭及計畫、吸菸、喝酒等，基層醫療中應多關注此議題，以利及時治療及轉介。

Objective: Deliberate self-harm (DSH) by adolescents increases the risk for future suicide. This study investigated the prevalence and risk factors for DSH in adolescents attending high school in northern Taiwan. Method: A cross-sectional survey was carried out in 13 secondary schools in Taipei City and Taipei County from October 2008 to January 2009. All questionnaires were self-completed online in the participating schools. Information was collected about basic socio-demographic data, the lifetime prevalence of self-harming behavior including the number of self-harming acts, and the intent for suicide. The Patient Health Questionnaire (PHQ-9) was used to measure the students' level of depression. The Multi-dimensional support scale (MDSS) was used to measure their social support and the Rosenberg self-esteem scale (RSES) to measure their level of selfesteem. Results: A total of 2,480 students completed the questionnaire. Their mean age was 15.44 (SD 0.61) and the majority was female (n=1494; 60.2%). The lifetime prevalence of DSH among the participants was 24.8% (n=616). The mean number of self-harming acts was 3.9 (SD 3.4) and 22.9% (n=141) had suicidal intent when they harmed themselves. A multivariate logistic regression model showed that the risk factors for DSH among high school students in northern Taiwan were female gender, schools in suburban areas, depression, use of cigarettes and alcohol, and the presence of suicidal ideation and suicide plans. Conclusion: DSH is a significant behavioral problem among adolescents in Taiwan. The presence of depression, suicidal ideation and suicide plans, smoking, and the use of alcohol were important factors in this problem. More attention should be paid to this phenomenon in primary care settings and appropriate referral to child psychiatrists is crucial.