2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/648065摘要：臺灣的自殺問題一直是醫療與社會各界重視的議題，2010 年雖然已不在十大死因之列，老年人的自殺死亡率卻依舊居高不下且有增加趨勢，去年一年中每十萬人口有35.8 名老人死於自殺，老人自殺高危險群－特別是具潛在風險但未被辨識出高危險者，是我們未來需積極介入的重點族群。世界衛生組織建議以隨機研究針對重點高危險群進行自殺防範措施的效益評估，而目前守門人策略及自殺篩檢是學者提出有效但需進一步驗證的方法。本研究共計三年，於北部某醫學中心兩個內科病房（一為實驗組一為控制組）分別針對護理師與住院病患收案，目的即在探討護理師自殺守門人訓練以及自殺風險篩檢與個案管理之結果與效益。研究者將根據研究團隊已建立之守門人訓練模式，採標準化方式訓練15 名內科護理師有關自殺守門人之概念與技巧，隨後進行護理師守門人知識、態度、行為及自我效能上的成效評估，並從中培養一群護理師守門人種子團隊以便進行第二與第三年醫院自殺防治成效評估與守門人推展之重要人力。研究者隨後將分別進行六個月的篩檢與個案管理，其中個案管理的對象來自於篩檢出高風險(SAD PERSONS 6OR “Brief Symptoms Rating Scale” 10)之後以隨機分派方式獲得，控制組乃接受原病房照護方式。預計第一年將篩檢660 位住院病患，約可得132 位病患(20% Suicide High riskrate)進行隨機分派，預計收66 位個管組個案與66 位控制組病患進行就醫利用與身心健康之比較，以評估顯著差異性。個案管理的成本效益將於第二及第三年進行持續收案與分析，希能驗證本研究之個管模式是具有經濟效益的自殺防治措施。<br> Abstract: Although suicide has fell out of the ten leading cause of death and the number of death wasdecreasing for the most age groups in 2010, elderly people were the only population with anincreasing trend of suicide death. Approximately 35.8 per 100,000 elderly people committedsuicide in 2010. Older people appear to be a primary target for suicide prevention. Among WHOhighlighted topics for Asian suicide prevention, educating gatekeepers plays a role in reducingsuicide rate by identifying suicidal behavior at an early stage and facilitating pathways toappropriate mental health care. Moreover, suicide risk screening has also been suggested as apromising strategy among other suicide prevention methods. Thus the aim of the study will be toestablish a nurse-led hospital suicide screening program and a case management service modelwith feasible and standardized operation procedures, and to evaluate the outcomes andcost-effectiveness of case management strategy.Based on a prior-year training model, the researchers will perform standardized training on 15medical nurses about gatekeeper concepts and skills, followed by consecutive inpatient screeningof their suicide risks. Those screened out as suicide high-risk will be invited to a casemanagement service. The screening tool of the “SAD PERSONS” is a 10-item suicide riskassessment scale which was suggested to be a rapid and accurate measurement for suicide risk.Both the nurses and the inpatients of the study wards, an experimental and a control ward,will be participants of this three-year prospective controlled clinical trial. The nurses whoare trained with suicide risk identification skills in the experimental ward will implementa screening program on consecutive inpatients, which effects will be compared to thecontrol group. An RCT (Randomized controlled trial) of case management interventionwill then be performed on the high-risk group of suicide identified through the screening.Caseness for the RCT will compose a “patient cohort” for long-term observations. Theresearchers will follow the patient cohort for six months and measure the outcomes andeffectiveness of case management. An estimation of 660 inpatients will be screened inthe first year, with 132 patients being randomized to be receivers of case managementservice (based on an estimation of 20% suicide risk rate defined by the “Brief-SymptomsRating Scale” over 10 points or the “SAD PERSONS” over 6 points). In the 2nd and 3rd year,we will perform a cost-effectiveness evaluation to assess the outcomes of the case managementservice. The “incremental cost effectiveness analysis” approach will be adopted in this study.醫院自殺防治護理師自殺篩檢個案管理前瞻性研究Hospital suicide preventionnursessuicide screeningcase managementprospective study