臺北市自殺意念與自殺企圖者自殺死亡風險之比較

Abstract

背景：自殺意念及自殺企圖皆為自殺死亡的風險因子之一，對於臺灣自殺通報之自殺意念者及企圖者是否存在再自殺死亡風險差異性，並無相關研究予以討論。全國各縣市衛生機關對於自殺意念者，是否需比照自殺企圖者，依據衛生福利部自殺通報後關懷訪視流程予以關懷服務，亦未有一致做法。本研究分析臺北市政府「自殺個案管理系統」中曾被通報自殺風險者之再自殺死亡風險，以辨識自殺意念與自殺企圖者再自殺身亡之風險是否有差異。 方法：本研究資料來源為2010年8月1日至2019年7月31日臺北市政府自殺個案管理系統之自殺被通報者資料。再自殺死亡資料來源為衛生福利部死因資料庫之2010年8月1日至2020年7月31日自殺身亡者檔案。本研究計算自殺標準化死亡比（standardized mortality ratio，SMR），藉此分析相對於一般民眾之自殺風險，並使用Poisson迴歸分析來計算自殺企圖被通報者與自殺意念被通報者之相對再自殺身亡危險性（Rate Ratio，RR）。 結果：研究期間之自殺被通報個案共19,946 人，再自殺死亡共559人（2.79%），一年內為313人（1.57%）；其中自殺意念者共5,120 人，再自殺死亡共100人（1.95%），一年內62人（1.21%）；自殺企圖者共14,826 人，再自殺死亡共456人（3.08%），一年內251人（1.69%）。自殺企圖或自殺意念被通報者的一年內再自殺死亡百分比，男性約為女性的兩倍，且隨年齡層增加而上升。全部個案在追蹤一年內再自殺死亡之SMR為45.1，自殺意念者SMR略低於自殺企圖者（40.2 vs 46.4）；自殺企圖或自殺意念者的男性SMR均略高於女性SMR，同時在被通報第一年內，第一個月的自殺SMR遠高於其它時間，第2-3月劇降，第4-6月較前期略降，之後趨於平緩；相較下，在年齡分組上，自殺企圖者與自殺意念者則呈現不同趨勢，自殺企圖者SMR隨年齡增加，自殺意念者則隨年齡增加而下降。在自殺企圖者，使用溺水、上吊，與農藥等方法的一年內再自殺SMR高於其它方法。調整性別及年齡之 Poisson 迴歸分析顯示，自殺意念者一年內再自殺死亡風險為自殺企圖者的0.61倍（95%信賴區間0.46-0.81）。 結論：自殺意念被通報者再自殺死亡風險低於自殺企圖被通報者約40%，但仍屬於高風險群，可供作為臺灣各縣市政府擬訂自殺意念被通報個案關懷訪視服務之政策及方案之參考。

Background: Suicidal ideation and suicide attempt are both among the key risk factors for suicide. There is no past research of the difference in suicide risk between individuals who were reported to have suicide ideation or suicide attempt in Taiwan. Health departments of county/city government in Taiwan have no consistent guidelines of providing aftercare for people who presented with suicide ideation, given the national aftercare program for people who attempted suicide and were reported to the National Suicide Surveillance System. We investigated and compared suicide risk among those who had suicide ideation or attempted suicide and were reported to the “Suicide Case Management System of the Taipei City Government”. Method: Data were extracted for all people reported to the Suicide Case Management System of the Taipei City Government from August 1, 2010, to July 31, 2019. Suicide deaths were identified thru linkage to the national suicide mortality data files of Taiwan’s Ministry of Health and Welfare from August 1, 2010 to ,July 31, 2020. We calculated the standardized mortality ratio (SMR) for suicide to investigate suicide risk in the study population relative to the general population. Poisson regression analysis was conducted to calculate rate ratios (RRs) for suicide in people who presented with suicide ideation compared with those presented with suicide attempt. Results: During the study period, there were 19,946 cases with suicide ideation or suicide attempt; among them, 559 (2.79%) later died by suicide over the study period, and 313 (1.57%) died by suicide within one year. Among 5,120 people presenting with suicide ideation, 100 (1.95%) and 61 (1.21%) died by suicide over the study period and within one year, respectively. Among 14,826 people presenting with suicide attempt, 456 (3.08%) and 251 (1.69%) died by suicide over the study period and within one year, respectively. The risk of suicide within one year was two times higher in males than in females and increased with age. Within one year after being reported to the system, the overall SMR for suicide was 45.1 in the study population, and those with suicide ideation had slightly lower SMR for suicide than those with suicide attempt (40.2 vs 46.4). The SMR for suicide was higher in males than in females and was the highest during the one month period after being reported to the system. By contrast, the age pattern differed in the two groups: the SMR for suicide increased with age among people with suicide attempt and decreased with age among people with suicide ideation. Among people with suicide attempt, the SMR for suicide was higher in those who attempted suicide by drowning, hanging, and pesticide ingestion than those using other methods. Sex-age-adjusted Poisson regression analysis showed that the RR of suicide was 0.61 (95% confidence interval 0.46-0.81) in people with suicide ideation compared with those with suicide attempt. Conclusion: Suicide risk was approximately 40% lower in people presenting with suicide ideation than those presenting with suicide attempt to the system. However, suicide ideation was still associated with a marked increase in suicide risk compared to the general population. The finding has implications for Taiwan city/county government’s policies and programs of aftercare targeted at people with suicide ideation.