臺灣學生自我傷害之特徵與相關因素的性別與年齡差異

Abstract

研究背景：自殺防治是重要的公共衛生議題，而自傷是自殺的重要危險因子。自傷是由許多面向的因素而產生的。近期青少年自傷行為的增加受到許多關注。過去在青少年自傷的特徵及相關因素的研究，大部分是基於臨床樣本的評估或是進行問卷調查，並且聚焦在特定的因素。但是過去的研究缺乏在學青少年因為自傷而被學校通報的特徵及相關因素。研究目的：本研究旨在分析臺灣教育部的「學校安全與災害事件通報」系統裡的自傷事件，並且探討自傷的特徵與相關因素在性別與年齡的差異。研究方法：學生自傷資料來自於臺灣教育部民國107年至民國110年，「學校安全與災害事件通報」系統裡的自傷事件。兩位研究員瀏覽並編碼自傷事件的通報內容，評分者間信度kappa值為0.754。自傷相關因素的定義是參酌英國「National Confidential Inquiry into Suicide and Safety in Mental Health Illness」計畫對兒童與青少年自殺危險因子之分類。使用卡方檢定，趨勢檢定與羅吉斯迴歸來探討特徵和相關因素在性別與年齡的差異。結果：民國107年至民國110年總共有20,176筆學生自傷事件。排除掉沒有相關因素的事件後，進行分析的有14,223筆年齡為6至29歲的學生自傷事件。女性的事件數占多數(77.1%)。超過三分之一的事件數是發生在13到15歲(36.8%)。常見的自傷方式包括割腕(47.2%)、藥物過量(18.7%)以及意圖跳樓(10.7%)。自傷地點通常在家中(39.5%)、校外不詳(14.4%)、教室及校內室內空間(13.7%)，校內不詳(10.4%)。精神疾病(36.3%)為主要導致自傷的相關因素，接著是家庭關係問題(26.8%)、同儕關係問題(15.6%)、學業相關問題(14.6%)、自我傷害史(14.2%)、和感情問題(12.8%)。相關因素裡，女性在精神疾病、家庭關係問題以及自我傷害史的占比較男性多。同儕關係問題、師生關係問題、身體疾病、網路過度使用、學業相關問題和同時傷人的風險是男性占比較女性多。6到12歲和13到15歲的年齡層比年長的學生更普遍有家庭關係問題的相關因素。相對地，16到18歲及19到29歲的年齡層比年輕學生更常見有精神疾病的相關因素。與其他年齡層比較後，家人精神疾病與自我傷害史比較常見在13到15歲的年齡層。而學業相關問題則比較常見於6到12歲的年齡層。感情問題的占比隨著年齡而上升，特別是男性。精神疾病的占比也隨著年齡而上升，女性比較明顯。師生關係問題以及家庭關係問題的占比隨著年齡而下降，而且這樣的情形，男性比女性明顯。自傷網路相關使用，主要是，將自殺訊息po文於網路上，趨勢隨著年齡而上升，而且主要出現在男性，女性沒有這樣的情形。結論：自傷學生的一些特徵與相關因素顯示性別與年齡的差異。對於年輕族群自傷的偵測與管理應該考量到性別角色與發展階段。

Background: Suicide prevention is a critical public health concern, and self-harm is a significant risk factor of suicide. There are multidimensional factors related to self-harm. There are concerns about recent increases in adolescent self-harm behaviors. Past research into the characteristics and related factors of self-harm in adolescents was mostly based on assessments of clinical samples or self-reports from questionnaire-based studies and often focused on specific factors. However, there is a lack of previous studies of the characteristics and related factors among students who self-harmed and were reported by schools.Aim: This study aimed to analyze student self-harm data from the Campus Security Report Center, the Ministry of Education, Taiwan, and to investigate the sex and age differences in the characteristics and related factors of self-harm.Method: Students' self-harm data were from the Campus Security Report Center, the Ministry of Education, Taiwan, from 2018 to 2021. Two researchers reviewed and coded the narrative contents of reported-self-harm episodes, with good inter-rater reliability (kappa=0.754). The definitions of self-harm related factors were developed based on the report published by the UK National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Chi-square tests, Cochran-Armitage trend test, and logistic regression models were used to investigate sex and age differences in the characteristics and related factors of self-harm.Results: There were 20,176 students self-harm episodes in 2018-2021. After excluding episodes with limited information about related factors, 14,223 self-harm episodes by students aged 6-29 were analyzed. The majority of episodes (77.1%) were by females. Over one-third of the episodes were by students aged 13-15 (36.8%). The common methods of self-harm included cutting wrists (47.2%), overdose (18.7%), and attempt of falling from height (10.7%). The locations of self-harm were usually at home (39.5%), unknown sites off the campus (14.4%), indoor locations on the campus (13.7%), and unknown sites on the campus (10.4%). Mental illness (36.3%) was the leading related factor of self-harm, followed by family relationship issues (26.8%), peer relationship issues (15.6%), academic-related issue (14.6%), history of self-harm (14.2%), and relationship issues (12.8%). Mental illness, family relationship issues, and a history of self-harm were more common in females than males. Peer relationship issues, teacher-student relationship issues, physical illness, problematic internet use, academic-related issues, and concurrent risk of harming others were more common in males than females. Family relationship issues were more prevalent in students aged 6-12 and 13-15 than in older students. By contrast, mental illness was more prevalent in students aged 16-18 and 19-29 than in younger students. Family mental illness and history of self-harm were more common in students aged 13-15 compared with other age groups. Academic-related issues were more prevalent in students aged 6-12 compared with other age groups. The prevalence of relationship issues increased with age, particularly in males. By contrast, mental illness also increased with age, but this was more evident in females. Teacher-student and family relationship issues decreased with age, and this pattern was more marked in males than in females. Self-harm related internet use, mainly posting suicidal messages online, increased with age, and this was found mainly in males but not in females. Conclusion: Some characteristics and related factors of self-harm in students showed distinct sex and age patterns. This has implications for the detection and management of youth self-harm by paying attention to the gender role and developmental stages.