自殺個案生前的求醫行為與憂鬱症相關性之探討-健保資料庫分析

中山醫學大學機構典藏 CSMUIR > 附設醫院 > 精神科 > 研究計劃 > Item 310902500/3195

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/3195

Title:	自殺個案生前的求醫行為與憂鬱症相關性之探討-健保資料庫分析 The Contact with Health Services before Suicide and Its Relations with Depressive Disorders- Health Insurance Database Analysis
Authors:	張家銘;呂宗學;賴德仁 Chang,Chia-ming;Lu,Tsung-Hsueh;Lai,Te-Jen
Contributors:	中山醫學院精神科
Keywords:	自殺;醫療接觸;憂鬱症;精神疾病;健保 suicide;health care contact;depressive disorder;psychiatric disorders
Date:	2004
Issue Date:	2010-12-16T03:15:08Z (UTC)
Abstract:	背景：文獻顯示，自殺者生前接觸一般醫療者多於接觸精神醫療。以前對於去了解自殺者生前的求醫行為與特徵，多採用心理解剖或醫療紀錄回顧的方法，結果會受限於地域，無法具有全國的代表性。台灣的健保資料庫提供了了解自殺者生前實際就醫行為的機會。本研究的目的在利用死亡資料檔連結健保資料庫，分析台灣地區自殺個案生前的求醫行為的特徵。方法：採個案對照研究法。利用行政院衛生署民國九十年的台灣地區死因資料檔，選取所有自殺死亡（[E950-E959]）2781人為研究樣本，並以1:2:3的人數比例分年齡層抽樣，選取出意外死亡者5562人、自然死亡者8343人為對照組。將三組死亡者依身分證號碼，連接健保資料庫中八十九年到九十年的「住院醫療費用醫令清單明細檔」 (DD)、「門診處方及治療明細檔」 (CD)，以獲取自殺者生前一年的門診與住院資料。結果：自殺死亡組、意外死亡組與自然死亡組，生前一年內有過健保住院紀錄的分別是45.6%：45.0%：82.9%；有過健保門診紀錄的分別是89.2%：89.0%：91.2%。自殺死亡組最後一次住院有精神疾病診斷為5.6%；最後一次住院為精神科有4.0%；最後一次門診有精神疾病診斷是11.8%；最後一次門診為精神科有6.5%，皆顯著高於意外死亡與自然死亡組。自殺死亡者最後一次門診有精神疾病診斷、情感相關疾病、憂鬱相關疾病診斷的比例分別是11.8%、4.0%、2.6%。最後一次住院有精神疾病、情感相關疾病、憂鬱相關疾病診斷的比例分別是5.5%、2.1%、2.0%。自殺死亡者在生前一月69.9%有過門診就醫、27.0%有過住院就醫紀錄。結論：本研究發現自殺死亡者生前最後一次門診或住院有精神疾病診斷、為精神科的比例，皆高於意外死亡與自然死亡組，但自殺者生前最後一次就醫有精神疾病診斷的比例仍是偏低，需要加強。 Background？HGPrevious literatures demonstrated the suicide subjects visited more general practitioners than psychiatrists before death. Most of these studies used the methods of psychological autopsy or records review, which will be restricted by regions and limited their generalization. National Taiwan Insurance Database provides an opportunity to understand the characteristic of health care contact before suicide. This study was aimed to using the data linkage between death records and National Health Insurance Database to analysis the characteristics of health care contact before suicide. Methods？HGThis is a case-control study. Data of 2781 suicide subjects were identified using Taiwan Death Records in the period of January 1 2001 to December 31 2001. Accident death and natural death groups were randomly selected by age level with 1:2:3 in numbers. These data were linked, using personal ID, with National Health Insurance Database (CD, DD) of 2000-2001 to obtain the data of inpatient and outpatient records within the one year before their death. Results？HGWithin the last year before death, 45.6% of suicide group, 45.0% of accident group, and 82.9% of natural death group had been hospitalization. Besides, 89.2% of suicide group, 89.0% of accident group, and 91.2% of natural death group had been treatment in outpatient clinics within the last year before death. Among suicide groups, 5.6% had psychiatric diagnosis in the last admission, 4.0% had been hospitalization in psychiatry in the last admission, 11.8% had psychiatric diagnoses in the last outpatient visit, 6.5% had treated psychiatric department in the last outpatient visit. In the last outpatient visit, among suicide subjects, 11.8 % had psychiatric diagnoses, 4.0% had mood- related diagnoses, and 2.6% had depressive-related diagnoses. Among suicide subjects, 5.5 % had psychiatric diagnoses, 2.1% had mood-related diagnoses, and 2.0% had depressive-related diagnoses in the last outpatient visit. There were 69.9% and 27.0 % of suicide subjects had outpatient and inpatient records within the last month before death. Conclusion？HGThis study found suicide subjects were significant more than the accident and natural death subjects to have psychiatric diagnoses or to visit psychiatric department in the last inpatient and outpatient records. However, the proportions of psychiatric diagnoses in the last inpatient or outpatient visits are still low.
URI:	https://ir.csmu.edu.tw:8080/handle/310902500/3195
Appears in Collections:	[精神科] 研究計劃

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