臺灣性/別少數族群心理健康急救指引之文化調適:德菲法研究

Abstract

前言 在臺灣，多元性別社群（Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and Asexual, LGBTIQA+）以及其他性/別少數族群（Sexual and Gender Minority, SGM），因長期承受少數壓力與社會污名，而面臨較高的心理健康問題及自殺風險。心理健康急救（Mental Health First Aid, MHFA）是一套源自澳洲、具實證基礎的公眾教育訓練計畫，旨在提升民眾辨識心理困擾早期徵兆及提供初步協助的能力。本研究目的在於依據臺灣的社會文化脈絡，對澳洲心理健康急救支持性/別少數族群的指引進行文化調適。 研究方法 本研究於2026年在臺灣採用三回合修正式德菲法（Modified Delphi）專家共識研究，共招募三個專家小組：（1）具有服務性/別少數族群經驗的心理健康專業人員；（2）具有心理健康困擾經驗的性/別少數族群當事人；以及（3）曾支持具有心理健康困擾之性/別少數族群當事人的支持者。所有專家針對各項協助行動陳述的重要性，以五點李克特量表進行評分。共識標準預先設定為三個獨立專家小組皆有至少80%的成員評定為「非常重要（Essential）」或「重要（Important）」。第一回合的開放式意見經主題分析後，用於新增及修訂符合臺灣文化情境的條目。 研究結果 第一回合共有131位專家完成調查，包括44位心理健康專業人員、38位具有心理健康困擾經驗的性/別少數族群當事人，以及49位支持者；其中102位完成全部三個回合，整體留存率達78%。初始190項陳述中，共有148項獲得共識納入，42項遭刪除。根據第一回合的質性回饋，新增21項陳述，三回合共評估211項陳述，其中19項獲得共識納入。主要的文化調適內容包括：尊重當事人的自主性、避免以文化刻板印象看待性/別少數族群、納入臺灣家庭中「出櫃」歷程的特殊家庭互動情境，以及新增「Chemsex（藥物性愛）」專章，涵蓋其相關症狀及其與心理健康困擾的關聯。 結論 本研究完成了臺灣首套專為支持性/別少數族群所設計的文化調適版心理健康急救指引。透過心理健康專業人員、具有心理健康困擾經驗的性/別少數族群當事人，以及支持者三方的共識，確保最終指引能充分反映臺灣當代性/別少數族群的真實需求與生活經驗。未來研究應進一步評估本指引於不同人口特性及社會經濟背景學員中的實際應用成效與教育效益。

Introduction In Taiwan, Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and Asexual (LGBTIQA+), or Sexual Gender Minority (SGM), individuals experience elevated risks of developing mental health challenges and suicidality due to chronic minority stress and social stigma. Mental Health First Aid (MHFA) is an evidence-based public education program developed in Australia designed to equip the public with skills to identify early signs of mental distress and provide initial support. This study aims to culturally adapt the Australian MHFA guidelines for supporting an SGM person to align with the Taiwanese sociocultural context. Methods A three-round Modified Delphi expert consensus study was conducted in Taiwan in 2026. Three panels of experts were recruited, consisting of: (1) Mental Health Professionals (MHP) with experience working with SGM individuals; (2) SGM individuals with lived experience of mental health challenges (SGM-LE); and (3) individuals who support SGM individuals with lived experience (support person, SP). Panelists rated potential helping action statements on a 5-point Likert scale regarding their importance. Consensus was predefined as >= 80 endorsement as "Essential" or "Important" across all three independent panels. Round 1 qualitative feedback was coded to generate and refine context-specific items. Results Round 1 was completed by 131 experts (44 MHP, 38 SGM-LE, 49 SP), with 102 experts completing all three rounds, demonstrating a robust overall retention rate of 78%. Out of the initial 190 statements, 148 were endorsed and 42 were rejected. 21 new statements were added, resulting in a total of 211 items rated across three rounds. 19 of the 21 new statements were endorsed. Key adaptations primarily concentrated on respecting autonomy, rejecting cultural preconceptions, recognizing unique family dynamics of "coming out" within Taiwanese households, and introducing a new section on "Chemsex", its symptoms and its association with mental health distress. Conclusion This study presents the first culturally adapted MHFA guidelines specifically tailored for supporting SGM individuals in Taiwan. The distinct multi-perspective agreement among MHP, SGM-LE, and SP successfully anchors the final guidelines in the contemporary lived realities of the local community. Future research should systematically evaluate the practical implementation and educational outcomes of these guidelines across trainees of diverse demographic groups and socio-economic backgrounds in Taiwan.