臺灣自殺企圖被通報者併有不同衛生福利服務系統身分之再自殺死亡風險

Abstract

背景：過去曾自我傷害或自殺行為為自殺的關鍵風險因子之一。本研究透過分析衛生福利部「自殺防治通報系統」中曾被通報自殺企圖者之自殺死亡風險，並探討其人口學、被通報時自傷方式，與合併有不同衛生福利服務系統身分之相關性，以辨識其再自殺身亡之高風險群。方法：本研究資料來源為2012-2017年衛生福利部自殺防治通報系統之自殺企圖被通報者資料，並串聯「精神照護資訊管理系統」、「保護資訊系統」、「替代治療作業管理系統」、「毒品成癮單一窗口服務系統」之註記資料。再自殺死亡資料來源為衛生福利部死因資料庫之2012-2017年自殺身亡者檔案。本研究計算標準化死亡比（standardized mortality ratio, SMR），藉此研析相對於一般民眾之風險，並透過Poisson回歸分析來計算合併有不同衛生福利服務系統身分之相對危險性（Rate Ratio, RR）。結果：衛生福利部自殺防治通報系統2012-2017年之自殺企圖被通報個案共123,354人，再自殺死亡共3,330人（佔2.7%）。總體SMR為146，在各組之間係以女性、年輕人、通報時自傷方式為自焚較其他類別高；合併衛生福利部服務系統身份註記部分，以替代治療作業管理系統、精神照護資訊管理系統，及多重註記最高；追蹤期間以第7-30天340最高，第2-3月劇降至125，第4-6月為70，隨後降幅漸趨平緩。Poisson多元回歸分析顯示RR較高為男性、老年人、通報時自傷方式為自焚、燒炭、上吊、溺水及農藥；合併衛生福利部服務系統身份註記部分，以替代治療作業管理系統及精神照護資訊管理系統高於其他類別。結論：本研究所辨識之自殺企圖被通報再自殺死亡高風險群，可供作為臺灣自殺企圖被通報個案關懷訪視服務之政策制定依據。

Background: A past history of self-harm or suicide attempt is one of the key risk factors of suicide. This study was aimed to i) investigate the risk of suicide among people who were registered in the national self-harm/suicide attempt surveillance system established by Taiwan’s Ministry of Health and Welfare and ii) to examine its association with demographic factors, self-harm methods, and being concurrently registered in other health and social care registries, in order to identify the high-risk groups of fatal self-harm repetition. Methods: Data were extracted for all people registered in the national self-harm/suicide attempt surveillance system in 2012 to 2017, with linkage to registers of patients with mental illness receiving post-discharge aftercare, offenders and victims of children and adolescent abuse, offenders and victims of domestic violence, victims of sexual abuse, people who used illicit drugs, and people who received opioids replacement therapy. Fatal self-harm repetition was identified thru linkage to the national suicide mortality data files. Standardized mortality ratio (SMR) for suicide was calculated to investigate suicide risk relative to the general population. Poisson regression analysis was conducted to calculate rate ratios for suicide in the sample of people who were registered to the national self-harm/suicide attempt surveillance system. Results: There were 123,354 reported cases of self-harm. Among them 3,330 (2.7%) died by self-harm repetition. The overall SMR for suicide was 146. In subgroup analyses, SMRs were higher in females, the younger groups, people who self-harmed using self-mutilation compared to their counterparts. SMRs were highest in people who were in the registries of people who received opioids replacement therapy, patients with mental illness receiving post-discharge aftercare, and those who were registered in multiple registers. The SMR was highest during the first 7-30 days post-registry (SMR = 340), followed by 125 in the 2nd to 3rd months, 70 in the 4th to 6th months, and became stable afterward. Poisson regression analysis showed that rate ratio of suicide was higher in males, older people, people who self-harmed using self-mutilation, charcoal burning, hanging, drowning, and pesticide poisoning, and people registered as those receiving opioids replacement therapy and patients with mental illness receiving post-discharge aftercare than their counterparts. Conclusion: High risk groups for fatal self-harm repetition were identified. The findings have implications for Taiwan’s national self-harm aftercare services.