探討台灣孤寂和復原力與自殺風險之相關性: 代表性樣本調查

Abstract

研究背景 自殺是一個重大的公共衛生問題，各年齡層皆有可能發生自殺意念與行為，根據衛生福利部心理健康司的統計資料，111年全國的標準化死亡率是12.3人，相較於110年上升0.7人，死因排名第十二位。男性自殺死亡人數是女性2倍(男性為2,419人、女性為1,368人)。自殺危險因子包括孤寂感、憂鬱、藥物濫用、精神疾病史等，孤寂感是民眾常見的心理議題，常伴隨心理困擾與自殺風險，近年有關自殺復原力的研究逐漸受重視，復原力或韌力有助於提升自殺風險的保護作用。然而，對於一般代表性人口群進行自殺風險與孤寂感的研究不多，且針對復原力之於自殺風險的探討也有限。本研究目的為探討一般民眾在孤寂感、復原力之現況，及與自殺風險暨心理困擾相關性。 研究方法 本研究是橫跨四年的全國代表性樣本調查，經台灣自殺防治學會同意並通過倫理審查後，採用該學會每年所進行的全國「自殺防治認知調查」民調為樣本，研究者整理四年資料(2015年、2016年、2017年和2020年)為本研究之分析樣本，資料收集過程以電腦輔助電話訪問系統(Computer-Assisted Telephone Interviewing, CATI)對於全台灣以縣市為單位進行分層比例隨機抽樣的代表性樣本，每年樣本都並不是同一群人。研究變項含基本人口學資料、單題孤寂量表、復原力因應量表、自覺健康相關變項(包括自覺心理健康、自覺身體健康、自我效能)、簡式健康量表(Five-item Brief Synptom Rating Scale, 又稱心情溫度計，用於測量精神病理症狀或心理困擾程度)、簡明心理健康篩檢表(Nine-item Concise Mental Health Checklist, 用於測量整體自殺風險)、自殺歷程(Suicidality, 包括終生/近一年/近一週自殺意念或企圖)等項目。其中，簡明心理健康篩檢表共9題，以前五題簡式健康量表評估加上四項自殺危險因子：「一生曾經傷害過自己或企圖自殺」(簡稱終生自殺企圖)、「想著未來要自殺」(簡稱未來自殺意圖)、「過度飲酒或長期服用某種藥物，而影響生活」(簡稱物質濫用)、及「沒有值得信任的人可傾吐心聲」(簡稱缺乏支持來源)作為「整體自殺風險」的篩檢，每題的評估皆為是或否。本研究設定兩個主要的結果變項，一為「整體自殺風險」、一為「近期自殺意向」，前者定義如前，後者定義為同時具有”近一周自殺想法”及”未來具有自殺意圖(未來有自殺計畫)”兩個概念。研究統計以SPSS 25進行，採描述性分析、相關性分析、多元線性迴歸統計暨PROCESS程式分析調節效應。 研究結果 本研究共有8460名參與者，比較四年資料顯示，各年度樣本在性別、年齡、職業、教育程度和婚姻狀況上的基本人口學組成無顯著差異。四年樣本的孤寂感盛行率平均為12.6%，孤寂者出現終生自殺意念、終生自殺企圖和未來自殺意向的比例分別是非孤寂者的4.9倍、5.1倍和9.2倍。相關性統計指出孤寂與心理困擾、整體自殺風險、物質濫用、以及缺乏支持來源呈正相關；與自覺健康相關變項則呈負相關。另一方面，復原力與婚姻狀況、工作狀況有關，已婚者的復原力比單身或離婚/喪偶者高，白領工作者的復原力分數高於退休或家庭主婦者。以相關矩陣評估迴歸統計相關變項，發現整體自殺風險與復原力(r=-0.152)、自覺健康相關變項呈負相關（自覺心理健康r=-0.294、自覺身體健康r=0.379、自我效能r=0.320），而與孤寂呈中度負相關(r=0.470)。最終以「整體自殺風險」與「近期自殺意向」兩主要結果變項，分別進行線性迴歸模型結果顯示：整體自殺風險與工作、婚姻狀況、孤寂、復原力、自我效能、自覺心理健康、自覺身體健康等變項呈現顯著相關，整體變異數之解釋力為31.9%（F=67.491, p < 0.001）；在近期自殺意向與孤寂感、失眠、易怒、憂鬱、自覺心理健康呈現顯著相關，整體變異數之解釋力為14.4%（F=2.635, p < 0.001）。進一步評值復原力與孤寂的調節作用發現：復原力與失眠、復原力與自卑兩兩的交互作用顯示復原力對近期自殺意向有調節（降）作用；而孤寂與易怒、孤寂與憂鬱兩兩的交互作用顯示孤寂對近期自殺意向有調節（升）作用，因此復原力具有自殺保護作用，而孤寂會增加近期自殺風險。 結論 本研究以代表性樣本大數據分析臺灣民眾孤寂與復原力現況及其與自殺風險之相關性，近十分之一民眾感到孤寂，整體自殺風險與復原力、孤寂感、自覺心理健康、自覺身體健康、自我效能顯著相關，而近期自殺意向與孤寂感、失眠、易怒、憂鬱、自覺心理健康達顯著相關。孤寂會加劇易怒、憂鬱和近期自殺意向的風險，而復原力能減輕自卑感和失眠對近期自殺意向的影響，研究結果凸顯了孤寂和復原力與整體自殺風險的顯著性。因此，建議未來研究進一步制定減少孤寂和增強復原力的策略，普遍增進民眾心理健康，以達到自殺防治的目標。

Background Suicide is a significant public health concern in Taiwan, with a standardized mortality rate of 12.3 per 100,000 population in 2022, ranking twelfth among causes of death. Risk factors include loneliness, depression, substance abuse, and a history of mental illness. Loneliness is particularly prevalent and linked to psychological distress and suicide risk. Addressing these issues and enhancing resilience are critical, yet research in this area is limited. This study aims to explore the correlation between loneliness, psychological distress, and suicide risk, and the influence of resilience. Method This study is a four-year nationwide representative sample survey, conducted with the approval of the Taiwan Suicide Prevention Society and after passing ethical review. The data used in this study is derived from the Society's annual "Suicide Prevention Awareness Survey" polls. The researchers compiled four years of data (2015, 2016, 2017, and 2020) as the analytical sample for this study. The data collection process involved a Computer-Assisted Telephone Interviewing (CATI) system, which was used to conduct stratified proportional random sampling of representative samples across Taiwan at the city and county levels. The sample each year did not consist of the same group of people. The study variables included basic demographic information, a single-item loneliness scale, the Brief Resilience Coping Scale (BRCS), self-rated health variables (including self-rated mental health, self-rated physical health, and self-efficacy), the Five-item Brief Symptom Rating Scale (BSRS-5) to measure the degree of psychopathology or psychological distress, the Nine-item Concise Mental Health Checklist (CMHC-9) to measure overall suicide risk, and suicidality (including lifetime, past-year, and past-week suicidal ideation or attempts). The CMHC-9 includes first five items from the BSRS-5 and four items assessing the following suicide risk factors: "Have you ever self-harmed or attempted suicide in your life?" ("Lifetime suicide attempt"), "Are you thinking about attempting suicide in the future?" ("Future suicide intent"), "Have you ever took drug overdosed or abused alcohol and affected your life in the past?" ("Substance abuse"), "When feeling down, would you have no one trustworthy to talk to?" ("Lack of support"). The CMHC-9 was used to screen for "Overall Suicide Risk". There were two main outcome variables in this study: "Overall Suicide Risk" and "Recent Suicide Intent." The former was defined as described above, while the latter was defined as having both "suicide ideation in the past week" and "future suicidal intent". Statistical analysis was conducted using SPSS 25, with descriptive analysis, correlation analysis, multiple linear regression, and moderation effect analysis using the PROCESS program. Results This study included a total of 8,460 participants. A comparison of the data over the four years shows that there were no significant differences in the basic demographic composition of the samples across the years in terms of gender, age, occupation, education level, and marital status. The average prevalence of loneliness across the four-year samples was 12.6%. Those who experienced loneliness were 4.9 times more likely to have lifetime suicidal ideation, 5.1 times more likely to have attempted suicide, and 9.2 times more likely to have future suicidal intentions compared to those who did not experience loneliness. Correlation statistics indicated that loneliness was positively correlated with psychological distress, overall suicide risk, substance abuse, and lack of support; it was negatively correlated with self-rated health-related variables. On the other hand, resilience was related to marital status and employment status, with married individuals having higher resilience than those who were single, divorced, or widowed, and white-collar workers scoring higher on resilience than retirees or homemakers. A regression analysis using a correlation matrix of relevant variables revealed that overall suicide risk was negatively correlated with resilience (r = -0.152) and self-rated health-related variables (self-rated mental health r = -0.294, self-rated physical health r = 0.379, and self-efficacy r = 0.320), while it was moderately positively correlated with loneliness (r = 0.470). Linear regression models were conducted using "Overall Suicide Risk" and "Recent Suicidal Intent" as the two main outcome variables. The results showed that Overall Suicide Risk was significantly related to variables such as employment, marital status, loneliness, resilience, self-efficacy, self-rated mental health, and self-rated physical health, with an explained variance of 31.9% (F = 67.491, p < 0.001). For Recent Suicidal Intent, it was significantly related to loneliness, insomnia, irritability, depression, and self-rated mental health, with an explained variance of 14.4% (F = 2.635, p < 0.001). Further evaluation of the moderating effects of resilience and loneliness revealed that the interaction between resilience and insomnia and between resilience and inferiority showed a moderating (reduction) effect of resilience on Recent Suicidal Intent. Conversely, the interaction between loneliness and irritability and between loneliness and depression indicated that loneliness had a moderating (increasing) effect on Recent Suicidal Intent. Therefore, resilience served as a protective factor against suicide, while loneliness increased the risk of recent suicidal ideation. Conclusion The study analyzed a big data from representative samples among the Taiwanese public to assess the current state of loneliness and resilience, as well as their correlation with suicide risk during the study period. Nearly one-tenth of the population in Taiwan reported feeling lonely. The outcome of Overall Suicide Risk was significantly associated with resilience, loneliness, self-rated mental health, self-rated physical health, and self-efficacy; while another outcome of Recent Suicidal Intent was significantly related to loneliness, insomnia, irritability, depression, and self-rated mental health. Loneliness exacerbates the risk of irritability, depression, and recent suicidal intent, whereas resilience can mitigate the impact of inferiority and insomnia on recent suicidal intention. The findings highlight the significance of loneliness and resilience in relation to overall suicide risk. Therefore, further research are suggested to develop strategies to reduce loneliness and strengthen resilience to improve overall mental health and achieve the goal of suicide prevention.