2000-2009年台灣地區自殺行為之危險因素探討:回溯性世代研究

Abstract

Objectives: Suicide is one of the major causes of deathin the world and has become an important public issue in the 21th century. It is estimated that 60 million people commit suicide annually and sixty one percent of the global death toll of suicide is in Asia. In 2012, the suicide rate in Taiwan was 16.18 per 100,000 people. Suicide is a complex behavior, which could result from negative individual factors as well as disadvantaged socioeconomic conditions in societies where individuals reside. Therefore, we attempted to examinethe relative risks of individual-level and social-level factors on individuals’ suicidal behaviors for a general population in Taiwan. Methods: A retrospective cohort study of 1,719,358 population with age 10 years and older who wereenrolled in the Taiwan National Health Insurance Research Database,2000-2009. We used Cox proportional hazards modelto examine the relative importance of individual-level and social-level risk factors for suicidalbehaviors. Results: Among 1,719,358 subjects, 3,905suicidal behaviors occurred. Several significant predictors of suicidal behaviorswere foundas follows: the hazard ratio for suicidal behaviors was 1.71 times higher in male than in female subjects(HR=1.71; 95% CI: 1.60-1.83). The risk of suicidal behaviors for 25-44 year older was highest (HR=1.55; 95% CI: 1.39-1.73). Divorced peoplehad a higher hazard ratiofor suicidal behaviors compared with those who never married. On the other hand, most mental disorder was associated with suicidal behaviors. Affective disorder wasthe robust predictor (HR=4.06; 95% CI: 3.68-4.48). People living in local districts with higher unemployment and divorce rates experienced higher risk. Conclusions: This study considers individual-level and the social-level factors were associated with individuals’ suicidal behaviors. The results showed the effects of individual-level risk factors tended to be more profound than social-level risk factors. And patients with mental disorders were associated with a higher risk of suicidal behaviors. Therefore, our findings suggest the prevention of suicidal behaviors should be focus on high-risk patients with mental disorder. Not only dealing with their mental health problems but also providing more employment chances in disadvantaged local districts for supporting people who lost their jobs. Further more public health organizations can implement comprehensive prevention programs for people at risk of committing suicide.