| Summary: | 博士 === 國立成功大學 === 健康照護科學研究所 === 101 === Background
Attempted suicide among college-aged young adults is a significant public health concern in Taiwan. Due to its prevalence and repetition, coexisting physical and psychiatric problems, and its associated burden of high costs, attempted suicide among college-aged young adults is a tremendous health issue. However, recent domestic researches on suicide attempt among college students are largely limited to lack of a decent sampling method in the recruitment of a representative undergraduates sample and studies consist of a cross-sectional study design in Taiwan. Thus, to explore the specific risk factors associated with suicide attempts among college student using longitudinal designs is needed.
Numerous factors that contribute to suicide attempts have been identified. In the west, neuroticism, dysfunctional attitudes, depressive symptoms and suicide ideations were risks for suicide attempts. However, neuroticism and dysfunctional attitudes were also risks for depressive symptoms. The relationships between neuroticism and suicide attempts and the correlations between dysfunctional attitudes and suicide attempts were both mediated by depressive symptoms. In addition, the relationships between depressive symptoms and suicide attempts were mediated by suicide ideations. Thus, the correlations between neuroticism and suicide attempts and the associations between dysfunctional attitudes and suicide ideations were both mediated by depressive symptoms; suicide ideations directly predicted the suicide attempts. Besides, previous research has found that reasons for living can prevent potential attempters from attempting suicide and that it can be used to distinguish between patients with major depression who have or have not attempted suicide. Therefore, the relationships between depressive symptoms and suicide attempts were moderated by reasons for living. However, few studies have examined the above-mentioned characteristics associated with suicide attempts among college students in Taiwan.
Since the pathways between the above-mentioned risks for suicide attempts have not been verified among college students in Taiwan, we conducted a longitudinal representative survey to investigate the above-mentioned risk factors associated with suicide attempts. The present study adopted a longitudinal study design to explain the cause and effect relationship, and constructed a psychological process model for suicide attempts.
We hypothesized that:
(1)The relationships between neuroticism and suicide ideations was mediated by depressive symptoms; depressive symptoms predicted suicide attempts.
(2)The associations between dysfunctional attitudes and suicide ideations was mediated by depressive symptoms; depressive symptoms predicted suicide attempts.
(3)Suicide ideations was predicted by depressive symptoms; suicide ideations predict suicide attempts.
(4)The correlations between depressive symptoms and suicide attempts and the correlations between suicide ideations and suicide attempts were both moderated by reasons for living.
Methods
The present study was constructed using a one-year follow-up longitudinal design. The data used in this study came from the Mental Health Survey of College Students in Taiwan, which was conducted during the period between the fall semester of 2004 and the spring semester of 2005. College students in Taiwan were first stratified by administrative regions. Second, the students in each region were stratified by educational systems. Third, the sample in each educational system was stratified by different majors. Fourth, a random cluster sampled by department was used to randomly choose participants from each major. Finally, we executed gender distribution on the participants. The Shortened Chinese version of the Neuroticism Extraversion Openness Five Factor Inventory (SC-FFI), Chinese Version of the Dysfunctional Attitude Scale-Revised (CDAS-R), Ko Depression Inventory (KDI), Adult Suicidal Ideation Questionnaire-Revised (ASIQ), Reasons for Staying Alive Inventory, and suicide attempts were used to collect the risks for suicide attempts.
Results
A total number of 4,885 college students were invited to participate in the study. Of them, 3,731 students participated, resulting in a response rate of 76.38%. The final valid sample included 3,078 students (the valid rate: 82.50%) in time 1. In order to conduct a second year follow-up and to avoid senior-level students from dropping out due to graduation, 525 senior students were excluded from our research. The final follow-up sample included 797 students (the follow up rate: 31.24%) in time 2.
In cross-sectional study, both in 2004 and 2005, the results showed that the relationship between neuroticism and suicide attempts was partially mediated by depressive symptoms. Depressive symptoms directly predicted suicide attempts. The correlations between depressive symptoms and suicide ideations were moderated by reasons for living. However, we only found that the associations between suicide ideations and suicide attempt were moderated by reasons for living in 2004.
In longitudinal study, we found that suicide attempts in 2004 directly predicted suicide attempts in 2005. The associations between neuroticism in 2004 and depressive symptoms in 2005 were mediated by neuroticism in 2005. Depressive symptoms in 2005 directly predicted suicide attempts in 2005. In addition, the correlations between depressive symptoms in 2005 and suicide ideations in 2005 were moderated by reasons for living in 2005. However, we found that reasons for living in 2005 directly predicted suicide attempts in 2005.
Conclusions
The present study used a longitudinal design to test the impact of neuroticism, dysfunctional attitudes, depressive symptoms, suicide ideations and reasons for living on suicide attempts among college students in Taiwan. Our findings give empirical evidence to verify the theoretical effectiveness of neuroticism, dysfunctional attitudes, depressive symptoms, suicide ideations and reasons for living on suicide attempts, which should be incorporated when designing prevention programs and strategies for helping college students that engaged in suicidal behavior last year. In primary prevention, prevention programs should focus on enhancing the awareness for depressive symptoms and suicide ideation and developing a psycho-education programme, such as career planning, problem solving, and emotional regulation, thanks-giving and empathy, to improve the reasons for living. In secondary prevention, school-based screening programs for high-risk college students with suicide attempts shoud focus on identifying the depressive symptoms, suicide ideations and suicide attempt last year.
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