本文選題：心理解剖 + 自殺　； 參考：《山東大學(xué)》2009年博士論文

【摘要】：研究背景 自殺,尤其是農(nóng)村青年的自殺,是我國目前面臨的重大公共衛(wèi)生問題和社會問題。有效的自殺預(yù)防和干預(yù)策略的制訂,需要深入的自殺身亡研究作為其可靠的科學(xué)依據(jù)。而自殺死亡的研究,卻面臨著“如何有效地收集死者的全面信息”這一方法學(xué)問題。心理解剖的發(fā)展與應(yīng)用,則為該問題的解決提供了一個有效的途徑。心理解剖通過訪談“了解死者信息的其他人”等方式,可有效地重建與自殺死亡者有關(guān)的心理、社會因素,更好地了解其自殺原因,是目前最具有科學(xué)性和可操作性的自殺死亡研究方法。 心理解剖在我國自殺研究中的應(yīng)用仍處于起步階段,而且目前尚無專門針對我國農(nóng)村青年自殺死亡的心理解剖研究。而有效的自殺干預(yù),則需要根據(jù)不同人群的特征量身定制相應(yīng)的策略。為了更好地開展針對我國農(nóng)村青年的自殺預(yù)防與干預(yù)工作,運用心理解剖方法對農(nóng)村青年的自殺死亡特征進(jìn)行深入探討是非常必要的。 心理解剖的信息來源主要以信息人為主,而單一的信息來源往往不能夠全面地反映目標(biāo)人的情況,所以在人力物力及其它條件許可的情況下,可爭取選擇多位信息人作為心理解剖的信息來源。而當(dāng)心理解剖存在多位信息人,且不同信息來源所提供的信息不一致時,如何進(jìn)行信息的合成,到目前為止國際上尚無統(tǒng)一的操作規(guī)范,也沒有確鑿的證據(jù)來證明哪一種信息合成技術(shù)相對較佳。所以,如何運用多位信息人所提供的代理信息進(jìn)行死者或其它目標(biāo)人的信息重構(gòu),而且該技術(shù)所提供的代理信息能否有效地代表目標(biāo)人的實際信息,己成為心理解剖研究迫切需要解決的問題之一。 心理解剖的應(yīng)用,不應(yīng)該僅僅停留在理論上的探討,還應(yīng)該將之運用于自殺研究的實踐中,使之更好地服務(wù)于自殺的預(yù)防和干預(yù)工作。以往的心理解剖研究,主要側(cè)重自殺者的“單一特征”的識別,而非“特征群”的識別。特征群的分析,通常采用分類回歸樹進(jìn)行探討,它在自殺危險因素的探討及其它自殺研究中上已體現(xiàn)出其獨特的優(yōu)越性。而且眾多研究一致表明：自殺不是單一危險因素作用的結(jié)果,自殺者通常同時具有多種危險因素和保護(hù)因素。因此,運用心理解剖方法進(jìn)行自殺者“特征群”的探討比“單一特征”的識別,對于自殺的預(yù)防和干預(yù)將更具指導(dǎo)意義和可操作性。 針對上述多個問題,本研究為每例目標(biāo)人選擇了兩位信息人進(jìn)行心理解剖研究,并在國際上首次全方位地對不同信息重構(gòu)技術(shù)進(jìn)行效度探討,然后應(yīng)用已被證明相對較優(yōu)的心理解剖信息重構(gòu)技術(shù),對我國農(nóng)村青年自殺身亡者的特征群進(jìn)行分類樹分析,以期為我國自殺預(yù)防與干預(yù)工作提供科學(xué)依據(jù)。 研究目的 1.探討不同信息重構(gòu)技術(shù)的效度,為心理解剖的信息收集和目標(biāo)人的信息構(gòu)建提供科學(xué)依據(jù)； 2.探索我國農(nóng)村青年自殺死亡的高危特征群,為自殺預(yù)防和干預(yù)策略的制訂提供有效參考。 研究方法 在山東、遼寧和湖南三個省隨機(jī)抽取16個縣或縣級市,然后在上述16個縣市通過序貫抽樣的方法抽取2005年10月1日至2008年6月30日期間自殺死亡的15-34歲農(nóng)村居民作為研究對象,同時隨機(jī)抽取等數(shù)量同年齡段的農(nóng)村居民作為自殺身亡者的對照納入本次研究。自殺死亡者名單來自各縣級疾病預(yù)防控制中心死因監(jiān)測系統(tǒng)。此次調(diào)查共獲得392例自殺死亡者和416例對照的有效資料。 采用對照組的資料,以對照本人所提供的信息作為金標(biāo)準(zhǔn),進(jìn)行心理解剖信息重構(gòu)技術(shù)的效度評價。采用配對t檢驗并結(jié)合組內(nèi)相關(guān)系數(shù),對1st、2nd、A、B、C、D、E類共七種不同信息重構(gòu)技術(shù)在絕望感、社會支持、沖動性、特質(zhì)焦慮和應(yīng)對技能等數(shù)值型資料上的效度進(jìn)行評價；采用McNemar檢驗并結(jié)合靈敏度、特異度、約登指數(shù)、Kappa值等指標(biāo),對1st、2nd、D、E、G、H類共六種不同信息重構(gòu)技術(shù)在二分類變量如生活事件的發(fā)生情況上的效度進(jìn)行評價。 將“各信息人在絕望、社會支持、沖動性、特質(zhì)焦慮和應(yīng)對技能量表的分量表上對目標(biāo)人的量表評分”與“相應(yīng)分量表目標(biāo)人自我評估得分”的“差值的絕對值”的總分作為因變量,信息人的“與目標(biāo)人的關(guān)系”、“對目標(biāo)人的了解程度”、性別、年齡、婚姻狀況、職業(yè)、受教育程度、宗教信仰、家庭年收入、健康狀況和CES-D抑郁評分作為自變量,以“比例偏差”和"Pearson卡方”作為模型篩選和評估參數(shù),進(jìn)行廣義線性模型的擬合,篩選對代理信息效度有影響的信息人特征變量。 分別采用相應(yīng)的最優(yōu)或相對較優(yōu)的心理解剖信息重構(gòu)技術(shù),對392例自殺死亡者和416例對照的不同方面的信息進(jìn)行構(gòu)建。然后在校正信息人特征對代理效度的影響的基礎(chǔ)上,采用病例對照研究的方法,進(jìn)行我國農(nóng)村青年自殺身亡影響因素的探討,并應(yīng)用分類樹分析對他們的高危特征群進(jìn)行探索。 主要結(jié)果 1.心理解剖不同信息重構(gòu)技術(shù)效度評價 lst、2nd、A、B、C、D、E、G、H類這九種信息重構(gòu)技術(shù)所構(gòu)建的信息的組內(nèi)相關(guān)系數(shù)或Kappa值均小于0.6,代理信息與對照本人所提供的信息的一致性均未達(dá)到良好的程度,即代理信息的精確度均不高。 lst、2nd、A、D和E類這五種信息重構(gòu)技術(shù)所構(gòu)建的信息在絕望量表總量表及其三個分量表、社會支持量表的社會交往及工具性支持兩個分量表、沖動性量表的功能性沖動分量表、特質(zhì)焦慮量表、應(yīng)對技能量表的“積極行動應(yīng)對維度及其四個分量表”和“消極回避應(yīng)對維度及其兩個分量表(認(rèn)知回避、尋求代償)”上與對照本人信息均無統(tǒng)計學(xué)差異。而它們在社會支持量表的可覺察社會支持分量表上的信息均欠佳,均高于對照本人信息(P0.05)；在沖動性量表的非功能性沖動分量表、消極回避應(yīng)對維度的發(fā)泄情緒分量表上則均低于對照本人信息(P0.05)。上述五種信息重構(gòu)技術(shù)在沖動性總量表、應(yīng)對技能量表的消極回避應(yīng)對維度的“接受或放棄”分量表與對照本人信息的差異性則不盡相同：(1)在沖動性總量表上,1 st、2nd與D類這三類代理信息與對照本人無差異,而A和E類的代理信息則均小于對照本人信息(P0.05)；(2)在“接受或放棄”分量表上,1 st與D類信息重構(gòu)技術(shù)所提供的信息與對照本人無顯著性差異,2nd、A和E類這三種代理信息則均小于對照本人信息(P0.05)。另外,B類與C類信息重構(gòu)技術(shù)所構(gòu)建的信息在上述量表與對照本人信息均有統(tǒng)計學(xué)差異,前者的信息均比對照本人信息大,而后者則均比對照小�？傮w而言,在上述各量表上,1st與D類信息重構(gòu)技術(shù)的效度比其它五類(2nd、A、B、C和E類)信息重構(gòu)技術(shù)略好。 在“婚姻相關(guān)問題”、“工作和學(xué)習(xí)相關(guān)問題”、“健康相關(guān)問題”和“法律相關(guān)問題及其它”這四大類生活事件上,“取陽性值”的G類信息重構(gòu)技術(shù)所提供的信息與對照本人的信息無統(tǒng)計學(xué)差異,P值依次為0.810、0.363、0.534、0.477；而在“家庭生活相關(guān)問題”這一類生活事件上,1 st類代理信息與對照本人無顯著性差異(P=0.828)。其他四種信息重構(gòu)技術(shù)(2nd, D, E, H類)在上述生活事件上所構(gòu)建的信息與本人信息差異較大。另外,這六種信息重構(gòu)技術(shù)所提供的信息在生活事件量表上的靈敏度、特異度及約登指數(shù)均有顯著性差別；其中,“取陽性’值”的G類信息重構(gòu)技術(shù)所提供的信息的靈敏度及約登指數(shù)均最高,但特異度最差。2.我國農(nóng)村青年自殺死亡的高危特征群探索 在我國農(nóng)村青年中,受教育程度越高、軀體健康狀況越好、尋求指引與支持的能力越好、過去一年中發(fā)生的與婚姻相關(guān)的負(fù)性生活事件越少,自殺風(fēng)險越低；愿望未實現(xiàn)、患有精神疾病是自殺的危險因素,其OR值分別為4.19、9.95；絕望量表的“對未來的感覺”和“對未來的期望”分量表得分越高,自殺風(fēng)險越高；消極回避應(yīng)對技能的“發(fā)泄情緒”分量表得分越高、“自殺家族史”陽性,均呈現(xiàn)增加自殺風(fēng)險的趨勢,但無統(tǒng)計學(xué)意義(OR=1.09、4.50,P=0.183、0.157)。社會支持、沖動性、特質(zhì)焦慮均不是我國農(nóng)村青年自殺身亡的重要影響因素。 我國農(nóng)村青年自殺的高危特征群主要為：(1)絕望感分量表“對未來的感覺”得分大于17.5,而且“對未來的期望”得分大于12.5；(2)絕望感分量表“對未來的感覺”得分小于或等于17.5,但患有精神疾病；(3)絕望感分量表“對未來的感覺”得分小于或等于17.5,并未患有精神疾病、“尋求指引和支持”的能力相對尚可,但受教育年限較低、“發(fā)泄情緒”量表得分大于5.5；(4)絕望感分量表“對未來的感覺”得分小于或等于17.5,不患有精神疾病,但“尋求指引和支持”的能力差；(5)絕望感分量表“對未來的期望”得分小于或等于12.5,但“對未來的感覺”得分大于17.5。訓(xùn)練樣本的結(jié)果表明,該自殺身亡分類樹的靈敏度為84.34%,特異度為92.08%。檢驗樣本對上述分類樹進(jìn)行再驗證,結(jié)果表明：該自殺身亡分類樹的靈敏度為76.47%,特異度為85.92%。訓(xùn)練樣本與檢驗樣本的靈敏度和特異度一致表明：該自殺身亡分類樹的判別效果較好。 結(jié)論與意義 盡管心理解剖代理信息的精確度不高,但是合適的信息重構(gòu)技術(shù)仍可有效地估計目標(biāo)人的信息。在心理解剖研究中,以親屬為主的第一信息人足以有效地構(gòu)建目標(biāo)人的絕大部分信息。而以朋友、鄰居為主的第二信息人的增加,對于提高絕大部分代理信息的效度未見顯著功效。對于生活事件信息,采訪兩位信息人可達(dá)到更好的效度,但必須借助于合適的信息重構(gòu)技術(shù)。增加第二信息人卻采取不合適的信息合成方式,如對數(shù)值型資料取極大值或極小值,將會導(dǎo)致代理信息嚴(yán)重偏離目標(biāo)人信息。 我國農(nóng)村青年存在多種不同的自殺高危特征群,它們并不只包含自殺高危因素,可能還會伴有其他自殺保護(hù)因素,或者只是多個自殺低危因素的集合體。不能因為某些個體伴有自殺保護(hù)因素、或不具備一些常見自殺高危特征,而忽視其潛在的自殺高風(fēng)險。有效的預(yù)防自殺,有賴于自殺高危特征群的識別、相應(yīng)篩查工具的研制、個體自殺風(fēng)險的綜合評估。 本研究在國際上首次對心理解剖不同信息重構(gòu)技術(shù)的效度進(jìn)行全方位的探討,為心理解剖信息收集和數(shù)據(jù)合成提供了科學(xué)依據(jù),也為今后心理解剖信息構(gòu)建的標(biāo)準(zhǔn)化奠定了部分基礎(chǔ)；本研究還率先對我國農(nóng)村青年自殺死亡的高危特征群進(jìn)行有益探索,為我國自殺干預(yù)策略的制訂提供了有效的參考。
[Abstract]:Research background
Suicide, especially the suicide of the young people in the countryside, is a major public health and social problem in our country. Effective suicide prevention and intervention strategies are made, and the study of suicide is a reliable scientific basis. The study of suicide death is faced with "how to effectively collect the comprehensive information of the dead". The development and application of psychological anatomy provides an effective way to solve this problem. Psychological anatomy can effectively reconstruct the psychological, social factors and better understand the cause of suicide by interviewing "the others of the deceased" and so on. It is the most scientific at present. Sexual and operable methods of suicide research.
The application of psychosocial anatomy in China's suicide study is still in its infancy, and there is no psychosocial research on suicide deaths in rural youth in China. Effective suicide intervention needs to be tailored according to the characteristics of different populations. In order to better carry out suicide prevention against young people in rural areas of China It is very necessary to conduct in-depth discussions on the characteristics of suicide among rural youth by means of psychological intervention and intervention.
The information source of the psychological anatomy is mainly based on the information man, and the single information source often cannot reflect the situation of the target person in an all-round way. So, in the case of the human resources and other conditions, the multiple information people can be selected as the information source of the psychological dissection. When the information provided by the source is inconsistent, the information is synthesized, and so far there is no unified operating specification in the world, and there is no conclusive evidence to prove that the information synthesis technology is relatively good. So, how to use the proxy information provided by the multi information person to reconstruct the information of the deceased or other target people, And whether the proxy information provided by the technology can effectively represent the actual information of the target person has become one of the urgent problems to be solved in the study of psychological anatomy.
The application of psychological anatomy should not only stay in theory, but should also be used in the practice of suicide research to better serve the prevention and intervention of suicide. Previous psychological anatomy studies mainly focus on the "single characteristics" of suicides, rather than the identification of "characteristic groups", and the analysis of characteristic groups, The classification regression tree is usually used to explore the unique advantages of the suicidal risk factors and other suicide studies. Moreover, many studies have shown that suicide is not the result of a single risk factor, and the suicides usually have many risk factors and protective factors at the same time. Therefore, the use of psychological anatomy is used. It is more instructive and feasible to identify the "feature group" of suicide than "single feature" in the prevention and intervention of suicide.
In view of the above problems, this study has chosen two information persons for each person to carry out a psychological anatomy study, and the validity of different information reconstruction techniques in the world for the first time, and then the technology of psychological anatomy information reconstruction which has been proved relatively superior to the characteristic groups of the suicide of the young people in China's rural areas Classification tree analysis was conducted in order to provide a scientific basis for the prevention and intervention of suicide in China.
research objective
1. to explore the validity of different information reconstruction techniques, and to provide scientific evidence for the collection of psychological anatomic information and the information construction of target persons.
2. explore the high risk characteristics of suicide deaths among rural youth in China, so as to provide an effective reference for the development of suicide prevention and intervention strategies.
research method
In three provinces of Shandong, Liaoning and Hunan, 16 counties or county-level cities were randomly selected, and then 16 counties and cities were selected by sequential sampling to study the suicide deaths of 15-34 year old rural residents during the period from October 1, 2005 to June 30, 2008 as the research object, and the rural residents of the same age group were randomly selected as suicide victims. The list of suicidal deaths came from the CDC death surveillance system at the county level. The survey obtained 392 suicidal deaths and 416 control data.
The data of the control group were used as the gold standard to evaluate the validity of the psychological dissection information reconstruction technology. Seven different information reconstruction techniques, such as 1st, 2nd, A, B, C, D, E, were measured by paired t test and combined with the correlation coefficient in the group, and the number of different information reconfiguration techniques were in the sense of expectation, social support, impulsiveness, trait anxiety and coping skills. The validity of the value type data was evaluated, and the validity of six different information reconstruction techniques, such as 1st, 2nd, D, E, G, H, was evaluated by McNemar test and the sensitivity, specificity, the Kappa index, and the value of the value of the class, such as 1st, 2nd, D, E, G, H.
A total score of "the absolute value of the difference between the target person's scale score" and "the target person self evaluation score of the corresponding subscale target person" is taken as the dependent variable, the "relation of the target person", "the understanding of the target person", "the relationship between the target person" and the target person's understanding of "the information person's subscale on the scale of despair, social support, impulse, trait anxiety and coping skills scale" Degree ", sex, age, marital status, occupation, education, religious belief, family income, health status and CES-D depression score as independent variables, using" proportional deviation "and" Pearson card "as model screening and evaluation parameters, fitting the generalized linear model to screen the informational characteristics that have influence on the validity of agent information. Variable.
Using the corresponding optimal or relatively superior psychological anatomy information reconstruction techniques, the information of 392 cases of suicide deaths and 416 cases of the control were constructed. Then, on the basis of correcting the influence of the information human characteristics on the agent validity, the case control study was adopted to carry out the influence of the suicide of the rural youth in our country. We also explored their high risk characteristics using classification tree analysis.
Main results
1. validity evaluation of different psychological dissection information reconstruction techniques
In LST, 2nd, A, B, C, D, E, G, and H, the intra group correlation coefficient or Kappa value of the nine kinds of information reconstruction techniques are less than 0.6. The consistency of proxy information and the information provided by the control is not good, that is, the accuracy of proxy information is not high.
The five information reconstruction techniques of LST, 2nd, A, D and E are constructed with the information of the despair scale and its three subscales, the social interaction and instrumental support of the social support scale, the functional impulse subscale of the impulsive scale, the trait anxiety scale, and the "positive action response dimension and the four" of the skill scale. There was no statistical difference between the subscales and the negative avoidance response dimensions and their two subscales (cognitive avoidance, seeking compensation). The information on the perceived social support subscale of the social support scale was poor, higher than the control personal information (P0.05), and the non functional impulse of the impulse scale. Dynamic subscales, negative avoidance response dimensions were lower than the control personal information (P0.05). The above five information reconstruction techniques were in the impulsivity table, and the difference of "acceptance or abandonment" of the negative avoidance response dimension of the coping skill scale was different from the control information: (1) impulsiveness On the aggregate table, the three kinds of agent information of 1 st, 2nd and D are not different, while the proxy information of the A and E class is less than the control information (P0.05); (2) on the "acceptance or abandonment" subscale, there is no significant difference between the information provided by the 1 st and D information reconfiguration technology and the contrast of the control, 2nd, A and E, the three proxy information In addition, the information of the information reconstruction technology of class B and C has statistical difference between the above scale and the control information. The information of the former is larger than the control, and the latter is smaller than the control. In general, the validity of the 1st and D information reconstruction techniques is better than the others on the above scales. The five classes of information refactoring (2nd, A, B, C, and E) are slightly better.
In the "marriage related issues", "work and learning related issues", "health related issues" and "legal related issues and other" four major life events, the information provided by the G information reconstruction technology of "positive value" is not statistically different from that of the control itself, and the value of P is 0.810,0.363,0.534,0.477 in turn. There is no significant difference between the 1 st agent information and the control (P=0.828). The other four information reconstruction techniques (2nd, D, E, H) are different from the personal information. In addition, the information provided by these six information reconstruction techniques is in life. There are significant differences between the sensitivity, the specificity and the Jordan index on the scale. Among them, the information provided by the G information reconstruction technology of "positive 'value" is the highest, but the difference is the worst.2. in the high risk group of suicide death in the rural youth of China
In the rural youth of China, the higher education level, the better the physical health, the better the ability to seek guidance and support, the less negative life events associated with marriage in the past year, the lower the risk of suicide, the lack of aspiration, the mental illness as a risk factor for suicide, the OR value of 4.19,9.95, and the despair scale. The higher the score of "feeling for the future" and "expectation for the future", the higher the score, the higher the risk of suicide; the higher the score of the "vent emotion" subscale of the negative avoidance coping skills, the positive family history, and the tendency to increase the risk of suicide, but there was no statistical meaning (OR=1.09,4.50, P=0.183,0.157). Social support, impulse. Sex and trait anxiety are not important factors affecting the suicide of rural youth in China.
The high risk groups of suicide in China's rural youth are as follows: (1) the subscale of the sense of despair "feeling for the future" is more than 17.5, and the score of "expectation for the future" is greater than 12.5; (2) the subscale of the sense of despair "feeling for the future" is less than or equal to 17.5, but there is a mental illness; (3) the sense of despair is "the sense of the future." The score was less than or equal to 17.5, not suffering from mental illness. The ability to "seek guidance and support" was relatively available, but the number of years of education was lower and the score of the "vent emotion" scale was greater than 5.5; (4) the subscale of the sense of despair was less than or equal to 17.5 for the sense of the future, without mental illness, but "seek guidance and support". Poor ability; (5) the sense of despair subscale "expectation for the future" score is less than or equal to 12.5, but the result of "feeling for the future" greater than the 17.5. training sample shows that the sensitivity of the suicide classification tree is 84.34%, and the specificity is 92.08%. test samples to re verify the above classification tree, the result shows that the suicide score is the result. The sensitivity of the class tree is 76.47%, and the specificity of the 85.92%. training sample is consistent with the sensitivity and the specificity of the test sample, which shows that the discriminant effect of the suicide classification tree is better.
Conclusion and significance
Although the accuracy of the psychosocial proxy information is not high, the appropriate information reconstruction technology can still effectively estimate the information of the target person. In the psychosocial study, the first information of the first person is sufficient to effectively construct the vast majority of the information of the target person. The increase of the second information based on friends and neighbours is improved. The validity of most of the agent information is not significant. For the information of life events, the two people can achieve better validity, but it is necessary to use the appropriate information reconstruction technology. The increase of second information is taken.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2009
【分類號】：B846

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