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題名：一次單元諮商在自殺處遇上之應用
作者：林美芳
作者(外文)：Mei Fang Lin
校院名稱：國立彰化師範大學
系所名稱：輔導與諮商學系所
指導教授：王智弘
學位類別：博士
出版日期：2013
主題關鍵詞：自殺處遇；一次單元諮商；混合方法研究；Suicide Intervention；One Single Counseling；Mixed- Method Research
原始連結：連回原系統網址new window
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研究背景與目的：自民國88年起至99年，自殺已連續12年名列主要死亡原因的第9名，近年行政院衛生署也特別委託台灣自殺防治學會辦理自殺防治工作，並成立國家級自殺防治中心，協助各縣市推動自殺防治關懷網絡，顯見自殺已成為全國所關切的議題，而民國100年之自殺統計數據顯示自殺率較上年減少，自殺防治之工作已獲得部分成效，並應持續推動以維我國人心理健康。不論就學術或實務場域出發，國內在自殺介入方案的發展顯較貧乏，多數皆以理論層次來論述自殺危機處遇的運用，缺乏實證研究之資料。本研究期望採自殺警訊與保護因子評量為前提，並依前述評量結果中進行並發展一次單元自殺處遇模式，透過實證研究所發現以供目前日益嚴重的社會自殺議題所使用並能採取適切有效的危機處遇計畫。
材料與方法：研究對象多為自殺危險個案，以立意取樣為主，透過自殺防治中心、生命線、社區諮商中心、學校諮商中心、醫療院所門診等尋找個案，後續質性受試者為接受量化研究之個案。排除條件：排除兩次以上精神科住院經驗與經診斷為人格疾患者。研究工具包括：「自殺危險程度量表」、「無望感量表」、「台灣人憂鬱症量表」、「活下來理由量表」、「研究者」、「協同研究者」、「訪談大綱」與「訪談日誌」等8部份。研究方法在瞭解一次單元自殺處遇之成效與理解受試者對處遇成效的解釋與經驗，經考量後採二階段嵌入式實驗模式。量化資料以描述性統計、相關分析、Mann-Whitney U test, Wilcoxon matched-pairs signed-ranks test進行分析；統計顯著水準設α=.05。質性資料在一次單元自殺處遇後加入，採類別-內容分析法，以對量化研究提供強化與補足無法說明處遇何以發生療效之提問限制。
結果：首次一次單元自殺處遇在自殺危險程度（Z=-2.67, p =.008）與自殺意念（Z=-2.67, p =.008）前後測顯著性考驗達.01之顯著水準；一次單元自殺處遇在憂鬱（Z=-1.99, p =.046）與生存及因應信念（Z=-2.20, p =.028）前後測顯著性考驗達.05之顯著水準。質性資料分析發現接受一次單元自殺處遇之療效發生在個人層次之情緒、認知、行為層面，關係層次及靈性層次，經彙整發現與一次單元自殺處遇階段所強調的介入重點–活下來理由、希望灌注、替代的問題解決策略及生命價值與意義–有所契合。一次單元自殺處遇進行兩個時間點追蹤，整體看來第二個追蹤點之自殺危險程度低於第一個追蹤點，且正向感高於第一個追蹤點，顯見一次單元自殺處遇之追蹤測持續有達到減緩自殺危險程度與穩定提升正向感之效果。細部分析接受不同單元數組，在處遇之初始自殺警訊與保護因子特性不同。單元數1組（接受單次自殺處遇組）高度自殺危險程度、極重度憂鬱情緒、有時出現無望感；單元數2以上數組（接受兩次以上自殺處遇組）自殺危險程度中等、重度憂鬱情緒、有時出現無望感。此外單元數2以上組在自殺意念前後差異考驗達顯著差異，生存及因應信念達邊緣臨界顯著，顯示一次單元自殺處遇特別適用於中等自殺危險程度、有明顯憂鬱情緒、有時出現無望感之個案。
結論與討論：研究顯示一次單元自殺處遇能有效減低自殺危險性，特別是自殺意念，此外研究參與者回應憂鬱情緒減低且獲得較正向的生存及因應信念，故一次單元自殺處遇針對自殺危機者可有效減除自殺行為、情緒與認知等三方面問題，而質性分析也有此三層面之一致結論，除此之外質性資料另發現導致研究參與者改變之靈性層次與關係層次。細部分析發現一次單元自殺處遇特別適用於有中等自殺危險程度、明顯憂鬱情緒，但是有時出現無望感之自殺個案，此外宜提升接受後續單元處遇之動機，如此將更有助於減緩自殺危險性、提升保護因子並維持療效。
Background and Aims of this Study: Since 1999 to 2010, suicide was continuous the nineth of the main cause of death last twelve years. In the recently, the Department of Health, Executive Yuan authorized Suicide Prevention Center of Taiwan to conduct suicide prevention work, and established the national suicide prevention center to help all the cities set into motion for caring the suicidal person. It’s noticeable that suicide was the concerned issue of the nation- wide, and the suicide rate of 2011 was less than the former year. The suicide prevention has had a good outcome, so it needed to keep moving for the mental health all the nation. Whether discipline or practice it was lack of crisis prevention models in our country, most of models discussed suicide from the level of theory, but lack for the evidence- base. The aims of our study were ahead of suicidal signs and protective factors assessment, and following the one-single suicide crisis intervention to attempt establishing the crisis prevention model for providing the suicide issue an alternative program.
Materials and Methods： Subjects our study adopted the purposive selection for the suicide risk client, to find the participants through the Suicide Prevention Center, Lifeline, Community Counseling Center, School Counseling Center, Hospital outpatient, and the following subjects collected qualitative data were the same as the quantity. Exclusion conditions were exception for the twice above psychiatry inpatient, and personality disorder patient. Instruments There were eight parts of them including suicidal risk inventory, hopelessness scale, Taiwan depression scale, reasons for surviving, researcher, co-researcher, outline of interview, and diaries of interview. Design In deep consideration we adopted explanatory design- embedded model. The quantitative date were used descriptive statistics, correlation analysis, Mann-Whitney U test, Wilcoxon matched-pairs signed-ranks test, and the significant statistic was set α= .05. Qualitative data was collected after the one-single suicide crisis intervention, we selected category-content analysis to complement and strengthen the research results about telling why and how it effective.
Results：At first one single suicide crisis intervention, the suicide risk(Z=-2.67, p=.008) and suicide ideation(Z=-2.67, p=.008) had the significant effect on the pre and post-test intervention; Otherwise, at the end one single suicide crisis intervention, depression and survival and copying belief had the significant effect on the pre and post-test intervention. Qualitative analysis found that clients reported how they felt good and gone far away suicide were in their personal level about affect, cognition and behavior. In addition, our study discovered the levels of relationship and spirit. In sum, we converged the findings and obtained the same as what we think important to stress in one single suicide crisis intervention, such as the reasons for living, to implant hope, to find alternative copying strategies, and the meanings of the life. There were two following stage in our study, at the second stage the suicide risk was lower than the first, besides the positive feelings were the higher than the first. Those showed that one single suicide crisis intervention at following stages still achieved the effects on decreasing suicide risk and improving the positive feelings. In details, the clients accept the different session had different property on initial suicide signs and protecting factors. The session one group (accept one session intervention) had the high risk of suicide, the profound depression, the sometimes hopelessness; In addition, above of session two (accept two or three session interventions), it had the moderate risk of suicide, the severe depression, and the sometimes hopelessness. Moreover, the above session 2 group had the significant effect on suicide ideation at pre and post-test intervention, and borderline significant effect on survival and copying beliefs, so it revealed one single suicide crisis intervention was specific to the client who at moderate suicide risk, severe depression and no obvious hopelessness.
Conclusion and Discussion：The results showed one single suicide crisis intervention could lessen the suicide risk, especially for suicide ideation, moreover clients responded decreasing the depression, and gained the more survival and copying beliefs, so the one single suicide crisis intervention has good effect on behavior, affect, and cognition of suicide. Those same findings had been found from qualitative analysis, furthermore the levels of relationship and spirit played the important roles on the curative effect. In details, one single suicide crisis intervention was specific impacted on the clients they had moderate suicide risk, severe depression, but no obvious hopelessness, and if the clients accepted more than one session intervention they would gain more help keep from suicide and facilitate the outcomes.
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