摘要：本計畫的整體目標是進行三個相扣連的研究，以提供實證基礎來促進自我傷害病人的照護品質、連續性，與有效性，以減少自我傷害的發生率與負擔，以及預防死亡的結果，即自殺。自殺是重大公共衛生議題，是個人、家庭與社會整體的悲劇與損失。在台灣與世界，自殺都是造成早逝的主要原因，而自我傷害是後續自殺的一個主要危險因子。 高品質的自傷病人照護，有賴良好整合急診的治療、住院治療、門診追蹤，與社區後續關懷。然而，台灣和世界的現有文獻尚未能針對自傷照護提供足夠的實證基礎，也缺乏對台灣近年之全國自殺關懷訪視的效果評估。 本三年計畫包含三個相關連的量性、質性與先導介入研究，以提供全面的知識，以了解自傷照護如何影響病人的預後，並發展創新簡短介入模式。 研究1. 自我傷害照護有效性的全人口世代研究：我們將研究急診的精神科照會與出院後的關懷訪視兩者對減少重複自我傷害與自殺死亡的效果。本研究將使用2011-2019年間的串連資料，包括全國自殺通報、死因資料，以及全民健保資料庫。 研究2. 對自傷照護與其整合性之需求與看法的質性研究：我們將針對自傷病人、家屬或照顧者，急診室臨床人員，與關懷訪視員進行深度訪談，以了解其對臨床服務與整合照護的需求與看法，包括急診治療、住院治療，門診治療，以及全國關懷訪視服務等。 研究3. 創新簡短介入以提升關懷訪視成效的先導研究：基於上述兩個研究的結果，我們將發展一個使用簡訊的介入，內含網路連結到各種資源，包括一個簡短心理介入的個人網頁。我們並將執行先導隨機分派控制試驗，以了解新介入的可行性與接受度。 研究發現將有助於深入了解影響自傷照護的因素，協助擬定策略以改善自傷照護的品質、連續性，與效果，並發展創新介入方法，以提升病人滿意度、遵囑性，與預防重複自我傷害與自殺死亡。
Abstract: The overall aim of this project is to conduct three linked studies aimed at providing empirical evidence that will inform strategies to enhance the quality, continuity, and effectiveness of care for self-harm, with a goal to reduce the incidence and burden of self-harm and its most tragic outcome, i.e. suicide. Suicide is a major public health issue and a tragic loss to individuals, family, and the society as a whole. Suicide is a leading cause of premature mortality in Taiwan and worldwide, and self-harm is a major risk factor for suicide. High quality self-harm care requires a well coordination of acute care at the emergency department, inpatient care, outpatient follow-up, and community-based aftercare. However, existing research literature from Taiwan and worldwide has been limited in providing an evidence base to inform quality care for self-harm. There are no recent studies of the effectiveness of Taiwan’s national self-harm aftercare program. This three-year project will comprise three linked qualitative, quantitative, and pilot intervention studies to achieve the overarching goal of providing a holistic understanding into self-harm care that would influence patients’ outcomes of and developing an innovative brief contact intervention for self-harm. Study 1: a population-based cohort study of the effectiveness of self-harm care. We will investigate the effectiveness of psychiatric assessment at the emergency department and aftercare post discharge from the emergency department on reducing repeat self-harm and suicide. The study will be based on a linked dataset (2011-2019) of the national self-harm registry, national cause-of-death data files, and the national health insurance claim data. Study 2: a qualitative study to understand needs and views of self-harm care and its coordination. We will conduct in-depth interviews with self-harm patients, family and caregivers, clinical staff, and care workers of the national self-harm aftercare program, to better understand needs and views towards clinical services for self-harm and the coordination of care provided at emergency department, inpatient ward, outpatient clinic, and aftercare. Study 3: a pilot study of an innovative brief contact intervention to enhance the effect of self-harm aftercare. Informed by findings from the qualitative and quantitative studies 1 and 2, we will develop a text messages-based intervention with embedded hyperlinks connecting to rich resources, including a personalized website of a brief psychological intervention, and will examine the feasibility and acceptability of the intervention in a pilot randomized controlled trial. Research findings will contribute to a better understanding of factors influencing self-harm care, inform strategies to improve care quality, continuity and effectiveness, and develop innovative measures that will increase service user satisfaction and treatment adherence and prevent repeat self-harm and suicide.