大學生自殺意念歷程模式之驗證： 以生死態度與無望感為中介

Abstract

本研究的主要目的在於探討憂鬱與自殺意念間之可能的中介歷程變項。整合過去文獻研究，本研究根據與自殺意念有關的三個認知因素，即情緒（無望感）、行為（問題解決缺失）、及態度（生死態度），建構出「憂鬱自殺歷程中介模式」與「憂鬱自殺歷程調節模式」兩模式，進行模式比較。並且嘗試瞭解人格特質與歷程模式中各變項之間的關係。本研究採自評式問卷調查法，以社會問題解決量表-修正版、貝克憂鬱量表、多元態度自殺傾向量表、貝克無望量表、自殺意念量表、及NEO人格測驗為研究工具，針對大學生實施大樣本研究。將第一樣本受試分為一般組、憂鬱組、及自殺意念組考驗其組間差異，並針對社會問題解決量表-修正版與多元態度自殺傾向量表進行探索性因素分析。本研究據因素分析所得之因素結構進行結構模型分析，再以第二樣本受試比較兩模之適合度。本研究以潛在變項路徑分析來檢驗大學生自殺模式的適切性。研究結果顯示憂鬱自殺歷程中介模型之契合度較佳，顯示大學生受試者之憂鬱自殺模型具有相當的適切性，即生死的態度與無望感為憂鬱至自殺意念之中介歷程變項，在自殺歷程中扮演著重要的角色。且問題解決能力與憂鬱症狀存在共變關係。本研究主要貢獻，首先在於針對社會問題解決量表-修正版與多元態度自殺傾向量表進行探索性因素分析，提出該量表在台灣樣本可能的因構結構；其次是整合過去自殺相關研究，提出可能的自殺歷程模式，進行模式考驗與比較。本研究發現，生死態度與無望感為憂鬱至自殺意念之中介歷程。本中進一步討論關於該模式之臨床應用與未來的研究方向。

Depression has been found to be a significant factor in predicting suicidal ideation but some others revealed opposite findings. Therefore, this study investigated some possible mediators (hopelessness, attitude toward life, and attitude toward death) and moderators (social problem solving) which linked or buffered depression and suicidal ideation. Based on previous research findings, this study proposed two possible models and tested the model fits. Beck Depressive Inventory (BDI), Multi-Attitude Suicide Tendency Scale (MAST), Beck Hopelessness Scale (BHS), Social Problem-Solving Inventory-Revised (SPSI-R), NEO-Five Factor Inventory (NEO-FFI), and Scale for Suicide Ideation (SSI) were administered to 946 college students. Bivariate analyses of associations as well as between group comparisons for the depressed subjects with or without suicide ideation and the normal control were conducted on their hopelessness, attitude toward death, problem-solving deficit, and personality scores. The depressed suicidal group was the most depressed, hopeless, and suicidal. Both the two depressed groups showed more neurotic personality and problem solving deficits, indicating a tendency to use more avoidance and impulsive/carelessness problem solving styles. Factor analyses of the SPSI-R and the MAST revealed that both scales consisted of four factors. Structural equation modeling (SEM) resulted in acceptable fit of the depressed suicidal mediated model to account for the proposed process model of suicidality for the college sample. In sum, attitude toward life, attitude toward death, and hopelessness played important roles in mediating depression and suicidal ideation. Furthermore, problem-solving deficits were co-varied with depression. The implications of the present findings and future research possibilities are discussed.