探討憂鬱症患者自殺意念與人格疾患之相關性研究

目的：自殺為全球重要公共衛生議題，自殺意念為自殺行為的重要前驅指標。憂鬱症患者屬自殺高風險族群，其自殺意念除受憂鬱症狀影響外，亦可能與人格疾患、焦慮症狀、反芻思考及家庭功能有關。因此，本研究旨在探討憂鬱症患者自殺意念與人格疾患之相關性，並分析相關因素與自殺意念之關聯。方法：本研究採橫斷式研究設計，以南部某醫學中心精神科門診及住院之憂鬱症患者為研究對象，共納入162位個案。研究工具包括病人健康問卷（PHQ-9）、貝克自殺意念量表（BSS）、醫院焦慮憂鬱量表（HADS）、迷你國際神經精神科會談量表（MINI）、人格疾患標準化評估工具（SAP）、家庭功能量表（Family APGAR）及反芻反應量表（RRS）。資料分析採描述性統計、卡方檢定、單因子變異數分析及二元羅吉斯迴歸分析。結果：研究結果顯示，自殺意念組與非自殺意念組在婚姻狀況、職業狀況及年齡方面具有顯著差異。自殺意念組之憂鬱程度、焦慮程度及反芻思考得分顯著高於非自殺意念組，而家庭功能得分則顯著較低。人格疾患方面，邊緣型人格特質與自殺意念具有顯著相關。羅吉斯迴歸分析結果顯示，重鬱症（OR = 4.19）及重鬱症合併鬱型特徵（OR = 4.88）為自殺意念之重要危險因子；家庭功能則為顯著保護因子（OR = 0.83）。結論：本研究結果顯示，重鬱症、重鬱症伴隨憂鬱特徵及家庭功能與憂鬱症患者自殺意念具有獨立關聯性。在評估憂鬱症狀外，亦應同時考量精神疾病診斷、人格相關特質及家庭功能，以利早期辨識高風險個案。本研究整合人格疾患、精神疾病診斷、反芻思考及家庭功能等多項心理社會因素，提供國內憂鬱症患者自殺意念相關因素之本土實證資料，可作為臨床評估、自殺防治及未來相關研究之參考。

Purpose: This study investigated the association between personality disorders and suicidal ideation among patients with major depressive disorder (MDD) and examined the relationships between suicidal ideation and demographic, clinical, and psychosocial factors.Methods: A cross-sectional study was conducted among 162 patients with MDD recruited from the psychiatric outpatient and inpatient departments of a medical center in southern Taiwan. Data were collected using standardized questionnaires and analyzed with descriptive statistics, chi-square tests, one-way analysis of variance, and binary logistic regression.Results: Significant differences were found between patients with and without suicidal ideation in marital status, employment status, age, depression, anxiety, rumination, and family functioning. Borderline personality disorder traits were significantly associated with suicidal ideation. Binary logistic regression analysis showed that major depressive disorder (OR = 4.19), major depressive disorder with melancholic features (OR = 4.88), and family functioning (OR = 0.83) remained significantly associated with suicidal ideation.Conclusions: Major depressive disorder, melancholic features, and family functioning were independently associated with suicidal ideation. Comprehensive assessment of psychiatric diagnosis, personality-related characteristics, and family functioning may facilitate early identification of patients at high risk for suicide and provide evidence for clinical assessment and suicide prevention.