還不想死的理由與想死的理由對自殺意念和自殺企圖的影響──以台灣安心專線為例

The Relation of Reasons for Not Dying Yet vs. Reasons for Dying on Suicidal Ideation and Suicide Attempts: An Analysis of the Taiwan An Hsin Hotline

研究目的：自殺防治在台灣至關重要。本研究以內在辯證觀點探討「還不想死的理由」對自殺意念者或自殺企圖者是否具有減緩「想死的理由」對自殺風險的作用，以及兩者的關係是否可區辨當下自殺意念或自殺企圖。研究方法：研究資料取自台灣安心專線2013至2018年首次來電者的錄音檔，隨機抽取自殺意念組（31位男性，29位女性）與自殺企圖組（33位男性，27位女性）各60人，重新編訂想死的理由及還不想死的理由類別。研究結果：自殺意念組的還不想死的理由顯著多於自殺企圖組，兩組在想死的理由數量上則無顯著差異。「還不想死的理由」和「想死的理由」相減後的差值，自殺意念組顯著低於自殺企圖組；二元邏輯斯迴歸分析顯示，「還不想死的理由」和「想死的理由」的交互作用無法顯著區分兩組。研究結論：「還不想死的理由」較多時，可能可以減緩「想死的理由」所提高的自殺風險。此結果呼應內在辯證觀點，自殺意念者同時想死也想被救活。實務上面對自殺意念者時，可考慮與其討論「還不想死的理由」，此與較低自殺行動風險有關。

Purpose: Suicide prevention is a major mental health issue in Taiwan. Empirical research comparing groups with only suicidal ideation and those with past suicide attempts in terms of their reasons for dying and reasons for living remains limited. Based on Shneidman’s and Kovacs & Beck’s internal debate hypothesis, we examined the reasons provided for dying and for not dying yet of people who called a suicide hotline in Taiwan in order to explore the relation of these reasons to immediate suicidal ideation and immediate risk of a suicide attempt. Methods: Data were collected from first-time callers to the Taiwan National Suicide Prevention Hotline between 2013 and 2018. After transcribing the recordings, 2 clinical psychology scholars rated each caller’s suicide risk as no suicide risk, suicidal ideation, or immediate risk of a suicide attempt. We randomly selected 60 callers (31 men, 29 women) who indicated immediate suicidal ideation, and 60 callers (33 men, 27 women) at immediate risk of a suicide attempt for a total of 120 participants. We integrated established frameworks and applied inductive analysis to the An Hsin Hotline transcripts to refine 2 categories of the callers’statements: reasons for dying and reasons for not dying yet. We developed a coding manual with good inter-rater reliability. Statistical methods employed in this study included Chi-square tests, independent samples t-tests, and binary logistic regression. Results: The suicidal ideation group reported significantly more reasons for not dying yet than the suicide attempt risk group, but the number of reasons for dying did not significantly differ between the 2 groups. The difference score between reasons for dying and for not dying yet was significantly lower in the suicidal ideation group than in the suicide attempt risk group. However, binary logistic regression analysis showed that the interaction between reasons for dying and reasons for not dying yet did not significantly distinguish the groups. Chi-square tests indicated no significant group differences in gender. Conclusion: The presence of a greater number of reasons for not dying yet may be an indication of reduced suicide risk. From an internal debate perspective, those with suicide ideation experience a simultaneous wish to die and to be saved. This ambivalence could potentially enable the reasons for not dying yet to ameliorate the increased suicide risk associated with their reasons for dying. Conversely, according to the Integrated Motivational-Volitional (IMV) model, those at risk for a suicide attempt may experience a decline in reasons for not dying yet related to their heightened suicidal capability. A future study should adopt a longitudinal design to investigate whether changes in reasons for not dying yet precede changes in suicidal risk. For individuals with suicidal ideation, practitioners may consider discussing their reasons for not dying yet, as these reasons are associated with a lower risk of progressing to suicidal acts.