請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/91674完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張書森 | zh_TW |
| dc.contributor.advisor | Shu-Sen Chang | en |
| dc.contributor.author | 黃薇嘉 | zh_TW |
| dc.contributor.author | Wei-Chia Huang | en |
| dc.date.accessioned | 2024-02-20T16:29:46Z | - |
| dc.date.available | 2024-02-21 | - |
| dc.date.copyright | 2024-02-20 | - |
| dc.date.issued | 2023 | - |
| dc.date.submitted | 2023-10-31 | - |
| dc.identifier.citation | Arsenault-Lapierre, G., Kim, C., & Turecki, G. (2004). Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry, 4, 37. https://doi.org/10.1186/1471-244x-4-37
Batty, G. D., Kivimäki, M., Bell, S., Gale, C. R., Shipley, M., Whitley, E., & Gunnell, D. (2018). Psychosocial characteristics as potential predictors of suicide in adults: an overview of the evidence with new results from prospective cohort studies. Translational Psychiatry, 8(1), 22. https://doi.org/10.1038/s41398-017-0072-8 Cairns, J. M., Graham, E., & Bambra, C. (2017). Area-level socioeconomic disadvantage and suicidal behaviour in Europe: A systematic review. Soc Sci Med, 192, 102-111. https://doi.org/10.1016/j.socscimed.2017.09.034 Chang, S. S., Sterne, J. A., Wheeler, B. W., Lu, T. H., Lin, J. J., & Gunnell, D. (2011). Geography of suicide in Taiwan: spatial patterning and socioeconomic correlates. Health Place, 17(2), 641-650. https://doi.org/10.1016/j.healthplace.2011.01.003 Chen, S. J., Chao, Y. L., Chen, C. Y., Chang, C. M., Wu, E. C., Wu, C. S., Yeh, H. H., Chen, C. H., & Tsai, H. J. (2012). Prevalence of autoimmune diseases in in-patients with schizophrenia: nationwide population-based study. Br J Psychiatry, 200(5), 374-380. https://doi.org/10.1192/bjp.bp.111.092098 Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis. JAMA Psychiatry, 74(7), 694-702. https://doi.org/10.1001/jamapsychiatry.2017.1044 Collings, S., Ivory, V., Blakely, T., & Atkinson, J. (2009). Are neighbourhood social fragmentation and suicide associated in New Zealand? A national multilevel cohort study. Journal of Epidemiology and Community Health, 63(12), 1035-1042. https://doi.org/10.1136/jech.2009.090985 Congdon, P. (2011). The spatial pattern of suicide in the US in relation to deprivation, fragmentation and rurality. Urban Stud, 48(10), 2101-2122. https://doi.org/10.1177/0042098010380961 Department of Household Registration. (2021). Population Density and Total Area for Counties and Cities. Retrieved Jun 10, 2022 from https://www.ris.gov.tw/app/portal/346?fbclid=IwAR0sZ5HWqLDHsaF5PGfT_wTc5CqQZWLe-1qIS40b7ttnieED1GTvw2e1YnA Durkheim, E. Suicide (originally published 1897). Routledge and Kegan Paul Ltd, London, 1951. Glasheen, W. P., Cordier, T., Gumpina, R., Haugh, G., Davis, J., & Renda, A. (2019). Charlson Comorbidity Index: ICD-9 Update and ICD-10 Translation. Am Health Drug Benefits, 12(4), 188-197. Guo, Y., Chang, S.-S., Chen, M., & Yip, P. S. F. (2018). Do Poorer Areas Have Poorer Access to Services in Hong Kong? A Small-Area Analysis Based on Multiple Spatial Accessibility Indicators. Social Indicators Research, 138(1), 1-21. https://doi.org/10.1007/s11205-017-1658-5 Guo, Y., Chang, S. S., Chan, C. H., Chang, Q., Hsu, C. Y., & Yip, P. S. F. (2020). Association of neighbourhood social and physical attributes with depression in older adults in Hong Kong: a multilevel analysis. J Epidemiol Community Health, 74(2), 120-129. https://doi.org/10.1136/jech-2019-212977 Hester, R. D. (2017). Lack of access to mental health services contributing to the high suicide rates among veterans. International Journal of Mental Health Systems, 11(1), 47. https://doi.org/10.1186/s13033-017-0154-2 Hung, P., Busch, S. H., Shih, Y. W., McGregor, A. J., & Wang, S. (2020). Changes in community mental health services availability and suicide mortality in the US: a retrospective study. BMC Psychiatry, 20(1), 188. https://doi.org/10.1186/s12888-020-02607-y Johannessen, H. A., Dieserud, G., Claussen, B., & Zahl, P. H. (2011). Changes in mental health services and suicide mortality in Norway: an ecological study. BMC Health Serv Res, 11, 68. https://doi.org/10.1186/1472-6963-11-68 Kapusta, N. D., Posch, M., Niederkrotenthaler, T., Fischer-Kern, M., Etzersdorfer, E., & Sonneck, G. (2010). Availability of mental health service providers and suicide rates in Austria: a nationwide study. Psychiatr Serv, 61(12), 1198-1203. https://doi.org/10.1176/ps.2010.61.12.1198 Kawaguchi, H., & Koike, S. (2016). Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model. PLoS One, 11(2), e0148288. https://doi.org/10.1371/journal.pone.0148288 Knighton, A. J., Savitz, L., Belnap, T., Stephenson, B., & VanDerslice, J. (2016). Introduction of an Area Deprivation Index Measuring Patient Socioeconomic Status in an Integrated Health System: Implications for Population Health. EGEMS (Wash DC), 4(3), 1238. https://doi.org/10.13063/2327-9214.1238 Korosec Jagodic, H., Rokavec, T., Agius, M., & Pregelj, P. (2013). Availability of mental health service providers and suicide rates in Slovenia: a nationwide ecological study. Croat Med J, 54(5), 444-452. https://doi.org/10.3325/cmj.2013.54.444 Kposowa, A. J. (2009). Psychiatrist availability, social disintegration, and suicide deaths in U.S. Counties, 1990-1995. Journal of Community Psychology, 37(1), 73-87. https://doi.org/10.1002/jcop.20271 Lin, C. Y., Hsu, C. Y., Gunnell, D., Chen, Y. Y., & Chang, S. S. (2019). Spatial patterning, correlates, and inequality in suicide across 432 neighborhoods in Taipei City, Taiwan. Soc Sci Med, 222, 20-34. https://doi.org/10.1016/j.socscimed.2018.12.011 Lung, Y., Chang, S. S., Hsu, C. Y., Wu, S. C., Chen, C. Y., & Chen, W. J. (2020). Residential Socioeconomic Environments and Areca Nut Use in Taiwan: A Comparison with Alcohol and Tobacco Use in Multilevel Analysis. Substance Use and Misuse, 55(12), 2025-2034. https://doi.org/10.1080/10826084.2020.1788089 Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U., Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W., Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., Varnik, A., Wasserman, D., Yip, P., & Hendin, H. (2005). Suicide prevention strategies: a systematic review. JAMA, 294(16), 2064-2074. https://doi.org/10.1001/jama.294.16.2064 Martikainen, P., Mäki, N., & Blomgren, J. (2004). The Effects of Area and Individual Social Characteristics on Suicide Risk: A Multilevel Study of Relative Contribution and Effect Modification. European Journal of Population / Revue européenne de Démographie, 20(4), 323-350. https://doi.org/10.1007/s10680-004-3807-1 McDaid, D., Park, A. L., Tsiachristas, A., Brand, F., Casey, D., Clements, C., Geulayov, G., Kapur, N., Ness, J., Waters, K., & Hawton, K. (2022). Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis. Eur Psychiatry, 65(1), e16. https://doi.org/10.1192/j.eurpsy.2022.5 Merlo, J., Chaix, B., Ohlsson, H., Beckman, A., Johnell, K., Hjerpe, P., Råstam, L., & Larsen, K. (2006). A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health, 60(4), 290-297. https://doi.org/10.1136/jech.2004.029454 Penchansky, R., & Thomas, J. W. (1981). The concept of access: definition and relationship to consumer satisfaction. Med Care, 19(2), 127-140. https://doi.org/10.1097/00005650-198102000-00001 Pirkola, S., Sund, R., Sailas, E., & Wahlbeck, K. (2009). Community mental-health services and suicide rate in Finland: a nationwide small-area analysis. Lancet, 373(9658), 147-153. https://doi.org/10.1016/s0140-6736(08)61848-6 Taiwan Medical Association. (2022, 2020). Statistics of Medical Care Institution’s Status and Hospital Utilization. Retrieved Jun 10, 2022 from https://www.tma.tw/stats/index_AllPDF.asp?fbclid=IwAR35wAm-nQVj2iNa94TKo7xGdQZZBL6b5IX4CRwcf7g985Gyn986unCbtQQ Taiwan Ministry of Health and Welfare. (2022). Suicide Death and Attempt Statistics. Retrieved March 15, 2022 from https://dep.mohw.gov.tw/domhaoh/cp-4904-8883-107.html Tondo, L., Albert, M. J., & Baldessarini, R. J. (2006). Suicide rates in relation to health care access in the United States: an ecological study. J Clin Psychiatry, 67(4), 517-523. https://doi.org/10.4088/jcp.v67n0402 Wang, H. H., Chang, C. M., Chang, S. S., Yang, A. C., Liu, Y. H., Liao, S. C., & Wu, C. S. (2022). Ten-year trends in depression care in Taiwan. J Formos Med Assoc. https://doi.org/10.1016/j.jfma.2022.02.011 World Health Organization. (2012). Public health action for the prevention of suicide: a framework. https://apps.who.int/iris/handle/10665/75166 World Health Organization. (2021). Suicide worldwide in 2019. World Health Organization. Retrieved May 5 from https://www.who.int/publications/i/item/9789240026643 | - |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/91674 | - |
| dc.description.abstract | 研究背景：自殺是重要的公共衛生議題，精神醫療資源可近性可能為影響該地區自殺率的重要因子，然而過去精神醫療資源可近性與自殺之關聯性研究呈現不一致的結果，此不一致性可能自於不同研究間對於個人/地區層次特性的校正程度差異。
研究目的：本研究旨在校正已知影響自殺之重要個人及地區層次特性的情況下，探討精神科醫師密度及自殺率之關聯性。 研究方法：本研究自全國死因資料庫中納入2007年至2017年的所有自殺個案，每個自殺案例皆自健保承保檔中以年齡－性別匹配十名對照個案，並將所有個案依戶籍地分配至臺灣355個鄉鎮之一。本研究使用多層次模型估計自殺的勝算比（OR）與個人/地區層次變項的關聯性。精神科醫師密度之定義為每10萬人口之精神科醫師人數，取四分位數作為類別變項[Q1（0.01-3.02）；Q2（3.02-7.20）；Q3（7.20-13.82）；和Q4（>13.82）]，比較無精神科醫師鄉鎮與有精神科醫師鄉鎮的自殺勝算比。 結果： 本研究共納入40,930例自殺個案和409,300名年齡－性別匹配的對照個案。經校正個人層次變項（就業狀況、月收入、身體共病症和精神障礙診斷）及地區社經特性後，精神科醫師密度與自殺呈現負相關，精神科醫師密度Q1至Q4之校正後自殺勝算比及95%信賴區間分別為0.95, (0.90-1.01)，0.90, (0.85-0.96)，0.89, (0.83-0.94)，以及0.89, (0.83-0.95)。 結論：精神醫療資源可近性為自殺之潛在保護因子，提升地區精神醫療資源可近性或可做為自殺防治策略之一環。 | zh_TW |
| dc.description.abstract | Background: Access to psychiatric services could be an important factor influencing local suicide rates, but previous studies showed inconsistent findings in the association between psychiatrist density and suicide. The inconsistency could result from different levels of controlling of individual- and area-level characteristics.
Aim: To investigate the association between psychiatrist density and suicide, accounting for individual- and area-level characteristics. Methods: We investigated all suicide cases in 2007-2017 identified from the national cause-of-death data files, with each suicide case matched to ten controls by age and sex and each suicide case/control assigned to one of the 355 townships across Taiwan. Our primary outcomes were the odds ratios (OR) of suicide and its 95% confidence interval (CI) estimated via multi-level models, which included both individual-level and area-level characteristics. Townships with no psychiatrists were compared with the quartiles of townships with psychiatrists (density per 100,000 population): Q1 (0.01-3.02); Q2 (3.02-7.20); Q3 (7.20-13.82); and Q4 (>13.82). Results: A total of 40,930 suicide cases and 409,300 age-sex-matched controls were included. We found that increased psychiatrist density was associated with decreased suicide risk (Q1: adjusted OR [aOR]=0.95 [95% CI 0.90-1.01]; Q2: aOR=0.90 [95% CI 0.85-0.96]; Q3: aOR=0.89 [95% CI 0.83-0.94]; Q4: aOR=0.89 [95% CI 0.83-0.95]) after adjusting for individual-level characteristics (employment state, monthly income, physical comorbidities, and the diagnosis of psychiatric disorders) and area socioeconomic characteristics. Conclusions: The psychiatrist density-suicide association suggests an effect of increased availability of psychiatric services on preventing suicide. Suicide prevention strategies could usefully focus on enhancing local access to psychiatric services. | en |
| dc.description.provenance | Submitted by admin ntu (admin@lib.ntu.edu.tw) on 2024-02-20T16:29:46Z No. of bitstreams: 0 | en |
| dc.description.provenance | Made available in DSpace on 2024-02-20T16:29:46Z (GMT). No. of bitstreams: 0 | en |
| dc.description.tableofcontents | 口試委員會審定書 i
致謝 ii 中文摘要 iv Abstract vi Table of contents viii Tables ix Chapter 1 Introduction 1 1.1 Suicide and the availability of mental health services 1 1.2 Inconsistent findings of the suicide-mental health services availability association 2 1.3 Suicide and area socioeconomic characteristics 3 1.4 Study aim 3 Chapter 2 Methods 5 2.1 Study setting 5 2.2 Definition of cases and controls. 5 2.3 Measurements 6 2.3.1 Psychiatrist density 6 2.3.2 Individual-level variables 8 2.3.3 Area socioeconomic characteristics 9 2.4 Statistical analysis 10 Chapter 3 Results 12 3.1 Descriptive analysis 12 3.2 Multi-level analysis 12 3.3 Cross-level interaction 14 Chapter 4 Discussion 15 4.1 Main findings 15 4.2 Strengths and limitations 15 4.3 Comparison with previous findings 17 Chapter 5 Conclusion 24 Ethical considerations 25 References 26 | - |
| dc.language.iso | en | - |
| dc.subject | 精神科醫師密度 | zh_TW |
| dc.subject | 自殺 | zh_TW |
| dc.subject | 多階層分析 | zh_TW |
| dc.subject | 精神醫療資源 | zh_TW |
| dc.subject | 可近性 | zh_TW |
| dc.subject | availability | en |
| dc.subject | mental health services | en |
| dc.subject | multilevel analysis | en |
| dc.subject | psychiatrist density | en |
| dc.subject | suicide | en |
| dc.title | 精神科醫師密度與自殺率關聯性：臺灣全國性樣本的多層次個案對照研究 | zh_TW |
| dc.title | Psychiatrist density and risk of suicide: a multi-level case-control study based on a national sample in Taiwan | en |
| dc.type | Thesis | - |
| dc.date.schoolyear | 112-1 | - |
| dc.description.degree | 碩士 | - |
| dc.contributor.oralexamcommittee | 廖士程;吳其炘 | zh_TW |
| dc.contributor.oralexamcommittee | Shih-Cheng Liao;Chi-Shin Wu | en |
| dc.subject.keyword | 自殺,精神科醫師密度,可近性,精神醫療資源,多階層分析, | zh_TW |
| dc.subject.keyword | suicide,psychiatrist density,availability,mental health services,multilevel analysis, | en |
| dc.relation.page | 32 | - |
| dc.identifier.doi | 10.6342/NTU202304382 | - |
| dc.rights.note | 同意授權(限校園內公開) | - |
| dc.date.accepted | 2023-10-31 | - |
| dc.contributor.author-college | 公共衛生學院 | - |
| dc.contributor.author-dept | 公共衛生碩士學位學程 | - |
| 顯示於系所單位： | 公共衛生碩士學位學程 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-112-1.pdf 授權僅限NTU校內IP使用（校園外請利用VPN校外連線服務） | 1.35 MB | Adobe PDF |
系統中的文件，除了特別指名其著作權條款之外，均受到著作權保護，並且保留所有的權利。