運用創新心理與遺傳因素來預測與預防自殺行為
Innovative approaches to better prediction and prevention of suicidal behavior based on psychological and epi-/genetic factors
1. Subproject 1: the effect of a brief psychological intervention on reducing repeat self-harm: a feasibility study
In this project we developed a Chinese modified version of ‘volitional help sheet’, a brief psychological intervention to reduce rsh based on three psychological theories / models, i.e. integrated motivational-volitional model of suicidal behaviour, transtheoretical model, and implementation intentions. The Chinese version was developed to taylor the Taiwanese context and a web-based platform was also created (figure 5-1). This project was conducted in two stages. In the first stage we interviewed 14 patients who had self-harmed. A ‘crisis coping framework’ was developed based on a qualitative analysis of patients’ accounts to illustrate factors associated with self-harming and non-self-harming behaviors (figure 5-2). We modified the volitional help sheet based on patients’ feedback. In the second stage, we prepared for a small sample pilot randomised controlled trial. The recruitment procedure at the emergency department was developed and found to be feasible. The data collection and intervention can be completed in 45-60 minutes before the patient was discharged. The findings contribute to the planning of a larger, multi-center trial that can verify the effectiveness of the intervention.
2. Subproject 2: An investigation into microRNA expression as potential peripheral blood biomarkers of suicide risk in patients with major depressive disorder
In this project we conducted a pilot study to examine microRNA expression as a biological marker of suicidal tendency. Participants were patients with major depressive episode. We collected data for clinical information, suicidal ideation and behaviors, and peripheral bloods which provide samples for extracting microRNA. We completed data collection for 18 patients; the blood samples of 11 of them were analysed using microarrays for microRNA analysis (figure 5-3). These preliminary results provide foundation for a study of larger sample to investigate the link between the expression of microRNA and suicidal tendency.
(一) 研究計劃一：「使用簡短心理介入減少重覆自我傷害之效果：可行性研究」
本計劃運用以實證為基礎的三項心理學理論，包括執行意向（implementation intentions）、自殺行為的整合動機意志模式（The Integrated Motivational-Volitional Model of Suicidal Behaviour），與跨理論模式
（Transtheoretical Model），建構出適用於臺灣，並以智慧型手機/網路為介面的簡短心理介入工具，也就是「自助技巧清單（Volitional help sheet）」(見圖 5-1)，以減少自傷病人再次自我傷害的機會。本研究為兩階段研究，已完成第一階段的介入工具接受度與可行性訪談（N=14），從中建構出一個危機因應模式來說明自傷行為與不自傷行為（轉向自助與求助）的相關因素 (見圖 5-2)，並根據病人的回饋改進介入工具。第二階段的先導性研究小樣本隨機分派試驗，已完成建構介入平台與台大醫院急診收案管道，初步顯示於急診處收案為可行，每位個案可在 45-60 分鐘內完成資料收集與介入。將來則希望進行大型、多中心的臨床試驗，確立此介入的有效性。
(二) 研究計劃二：「周邊血液微小核糖核酸表現作為重鬱症患者自殺風險潛在生物標記之研究」
本計劃進行微小核糖核酸（microRNA）作為自殺傾向之生物標記之先導性研究。研究對象為處於重鬱發作之病人，在基線、一個月，及三個月收集患者的臨床資訊、自殺意念與行為，與周邊血液，用以檢驗微小核糖核酸與自殺意念與行為之關聯。在 18 位已完成收案個案裡，其中有 11 位個案血液樣本已作 microRNA晶片初步分析 (見圖 5-3)，將來希望收集更多樣本數作分析，確認自殺傾向與微小核糖核酸之間關連性。
以主成分分析此11位個案在三個不同時間點之結果