初中生自杀意念的个体易感因素及心理干预效果的研究
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摘要
自杀已经成为全世界共同关注的社会和公共卫生问题，青少年自杀更引起了社会各界的广泛关注。据推算，全球每年自杀死亡者超过100万人。而我国自杀死亡的发生率远远高于美国等发达国家和世界平均水平。调查发现，我国自杀死亡的人数约占世界总自杀死亡人数的30%，年平均自杀死亡率为23/100,000，已经成为我国第5大死亡原因。更应当引起我们重视的是青少年已经成为自杀死亡的高危人群。在我国，自杀已经成为儿童青少年死亡的前3位原因，而且有逐年增高的趋势。
导致青少年自杀的原因是多方面的。按照Richard Lerner发展情境论的观点，个体是情境的主要构建者。因此，作为自杀行为的主体，青少年自身往往存在某些易感因素，而且个体易感因素对自杀意念和自杀行为起着至关重要的作用。我们强调自杀是一个发展的心理行为过程，通过对个体易感因素的心理干预，以降低自杀意念和自杀行为的产生。
本研究由两部分组成。1）探讨初中生自杀意念的个体易感因素。选取部分在校初中生，利用标准化调查工具进行调查，获取自杀意念的检出率并筛选出影响自杀意念的个体易感因素。2）心理干预及效果评价。针对所筛选出的个体易感因素，制定相应的干预措施。考虑到研究对象为在校学生，且样本量较大，故决定采用集体心理干预的方式对所研究对象进行集体心理干预。心理干预效果的主要评价指标为自杀意念检出率的变化、相关易感因素的改善情况以及他们之间的关系。
通过对1815名初中生的调查，我们发现初中生自杀意念的整体检出率为18.18%，处于较高水平。导致自杀意念的个体易感因素主要包括：个性特征的内向性、神经质和精神质；自杀态度，特别是对自杀性质的认识、对自杀者和对自杀者家属持认可、接纳、肯定、理解和宽容等；消极情绪，特别是抑郁焦虑情绪和孤独感对自杀意念的产生具有明显影响作用；睡眠问题，如入睡时间延长、白天精力不足等。这些因素直接或通过中介变量间接作用于自杀意念。
针对上述个体易感因素，我们对他们进行了为期约20周的集体心理干预，干预内容包括：1）让学生了解心理活动的基本知识，包括认知活动、情感活动和意志活动三大主要心理活动组成部分，以及各部分之间的相互关系。了解影响初中生日常心理活动的主要因素，包括外界环境因素和个体自身因素。强调个体自身因素在应对学习压力、生活事件和环境改变等活动中的作用。2）了解个性特征及其影响因素。分析自己的个性特点，并努力改变个性特征中某些不足。指导如何充分利用自己的特点调节心理状态，更好地适应学习生活。3）认识常见的情绪反应，如快乐、抑郁、焦虑、愤怒、恐惧等。了解消极情绪的不良影响。指导摆脱消极情绪的基本方法。4）认识孤独感。理解积极参加集体活动的重要性。掌握同伴交往的技巧。5）认识失眠的危害。强调良好睡眠与身心健康、学习生活及情绪的关系。认识常见失眠的表现、原因及对策。6）认识自杀现象。了解自杀行为发生过程。了解自杀的有关危险因素。帮助他们对自杀现象树立正确的认识。7）简单易行的自我心理干预技术，如不良情绪的自我分析、自我放松训练等。
心理干预后，初中生的自杀意念检出率由原来的18.18%下降为9.86%。其中，干预前有自杀意念者中46.36%的在干预后得以消失。说明集体心理干预措施可以显著降低初中生的自杀意念。同时，他们的抑郁情绪、焦虑情绪和孤独感明显降低。睡眠质量明显提高。自杀态度发生了改变，表现为对自杀者的态度、对自杀者家属的态度和对安乐死态度的认可度、支持程度降低，转而拒绝、反对和不支持。这些个体易感因素改变与自杀意念的降低具有密切关系。虽然本研究没有观察到个性特征的明显改变，但使他们了解了自己个性特征，并能够利用自己的特点积极调整心态，对自杀意念的降低可能起到了一定作用。
本研究的结论是：目前初中生自杀意念的检出率较高；个体易感因素对自杀意念具有重要影响；针对个体易感因素的集体心理干预，可以有效降低自杀意念的发生。
Suicide, as a severe problem of social and public health, has been brought to the hub of attention all over the world, especially for the suicide in adolescents. It is estimated that more than1,000,000people take their own lives annually. In our country, the prevalence of suicide is noticeably higher than both that in the United States and the average of the world. According to the investigation and statistics, the suicide death in our country accounts about30%for that all over the world and the annual suicide mortality is about23for every100,000people. Suicide has been ranked as the fifth leading cause of death in our country. What is more, adolescents are becoming as the high risk population for suicide. In our country, suicide constitutes one of the first top three causes of death in adolescences, and is increasing alarmingly every year.
The causes of adolescent suicide are complicated. According to the view of Richard Lerner’s development contextualism, a person is the main constructor of the context. So, for adolescents themselves, the subject of suicide, should have some personal risk factors, which play much more important roles in suicide behavior. We specially stress that suicide is a process of a series psychological behaviors, and by active intervention to the personal risk factors, the rate of suicidal iodation and behavior should be decreased dramatically.
Our study was proposed in two parts. Part1: The aim of this part was to explore the personal risk factors for suicide in junior high students. We firstly selected some junior high students as the study subjects, and then investigated the personal risk factors by standardized questionnaires. Finally, we determined the personal risk factors for suicidal ideation by statistical analysis. Part2： The assignment for this part was to give the students active group psychological intervention and to evaluate the effects of the group psychological intervention. According to the personal risk factors that were found in the study of part1, we designed the corresponding intervention contents and methods. Considering that the number of students was so many and they were still studying in the school, we adopted group psychological intervention for them. The primary evaluation index of outcome was the reduction of suicidal ideation, the changes of personal risk factors, and their relations.
By investigation of the1815junior high students, we found that the prevalence of suicidal ideation was18.18%in the subjects, which meant a comparatively high level. The risk personal factors for suicidal ideation included such traits of personality as introversion, neuroticism and psychoticism; suicide attitudes, especially attitudes such as acceptance, surporting and tolerance towards the nature of suicidal behavior, the suicide victims and the relatives of the suicide victim. Negative emotion, especially depression, anxiety and loneliness, affected suicidal ideation evidently. Sleep problems, for example, the prolonged time between going to bed and falling sleep, lack of energy during daytime, might also influence their suicidal ideation. These factors might affect suicidal ideation directly and/or indirectly by mediators.
According to the above personal risk factors for suicidal ideation, we carried out a series of group psychological intervention during about20weeks. The contents included as follows:1) Basic psychological knowledge, such as cognition, emotion and will, and the interactions among them. Discussing the factors influencing our psychological everyday activities, including both external‐environmental factors and internal‐personal factors. Stressing the importance of internal‐personal factors in dealing with the pressure of studying, life events and environmental changes.2) The knowledge about personality and its influencing factors. Helping them to analyze the characters of their own personality. Guiding them how to overcome the weakness and how to use their strongpoint in adjusting their psychological status and their school life.3) Recognizing the common emotions, such as joy, depression, anxiety, anger, fear and so on. Understanding the influence of negative emotions on daily life, and mastering the skills of getting rid of them.4) Recognizing loneliness. Understanding the importance of joining group activities. Telling them the skills of communicating with classmates or other compeers.5) Recognizing the harm of sleep problem. Stressing the relationship between good sleep and psychological/physical health, studying activities and emotion reactions. Mastering the manifestations, causes and countermeasures of sleep problems.6) Recognizing suicidal ideation and behaviors. Understanding the process of suicide and its risk factors. Helping them to develop the correct attitude to suicide.7) Teaching them some simple but practical skills of self‐psychological interventions, such as self‐analysis of negative emotions and self‐relaxation.
After group psychological intervention, the prevalence of suicidal ideation was reduced dramatically from18.18%to9.86%in total. For the students with suicidal ideation before intervention,46.36%of them were got rid of the ideation after intervention. These results indicated that group psychological intervention for junior high students reduced suicidal ideation remarkably. At the same time, their depression, anxiety and loneliness relieved greatly. The quality of their sleep was also increased remarkably. Their attitude towards suicide has been changed, they tended to reject and refuse suicide behaviors. All these changes contributed significantly to the reduction of suicidal ideation. Although we did not notice the changes of their personality characters, the effects on reduction of suicidal ideation might be due to the use of their personality strongpoint because the time of intervention was too short.
The conclusion of this study is as follows. The prevalence of suicidal ideation in junior high students is at a comparatively high level. The personal risk factors play very important roles in suicidal ideation. The group psychological intervention aiming at the personal risk factors can reduce the prevalence of suicidal ideation effectively.
导致青少年自杀的原因是多方面的。按照Richard Lerner发展情境论的观点，个体是情境的主要构建者。因此，作为自杀行为的主体，青少年自身往往存在某些易感因素，而且个体易感因素对自杀意念和自杀行为起着至关重要的作用。我们强调自杀是一个发展的心理行为过程，通过对个体易感因素的心理干预，以降低自杀意念和自杀行为的产生。
本研究由两部分组成。1）探讨初中生自杀意念的个体易感因素。选取部分在校初中生，利用标准化调查工具进行调查，获取自杀意念的检出率并筛选出影响自杀意念的个体易感因素。2）心理干预及效果评价。针对所筛选出的个体易感因素，制定相应的干预措施。考虑到研究对象为在校学生，且样本量较大，故决定采用集体心理干预的方式对所研究对象进行集体心理干预。心理干预效果的主要评价指标为自杀意念检出率的变化、相关易感因素的改善情况以及他们之间的关系。
通过对1815名初中生的调查，我们发现初中生自杀意念的整体检出率为18.18%，处于较高水平。导致自杀意念的个体易感因素主要包括：个性特征的内向性、神经质和精神质；自杀态度，特别是对自杀性质的认识、对自杀者和对自杀者家属持认可、接纳、肯定、理解和宽容等；消极情绪，特别是抑郁焦虑情绪和孤独感对自杀意念的产生具有明显影响作用；睡眠问题，如入睡时间延长、白天精力不足等。这些因素直接或通过中介变量间接作用于自杀意念。
针对上述个体易感因素，我们对他们进行了为期约20周的集体心理干预，干预内容包括：1）让学生了解心理活动的基本知识，包括认知活动、情感活动和意志活动三大主要心理活动组成部分，以及各部分之间的相互关系。了解影响初中生日常心理活动的主要因素，包括外界环境因素和个体自身因素。强调个体自身因素在应对学习压力、生活事件和环境改变等活动中的作用。2）了解个性特征及其影响因素。分析自己的个性特点，并努力改变个性特征中某些不足。指导如何充分利用自己的特点调节心理状态，更好地适应学习生活。3）认识常见的情绪反应，如快乐、抑郁、焦虑、愤怒、恐惧等。了解消极情绪的不良影响。指导摆脱消极情绪的基本方法。4）认识孤独感。理解积极参加集体活动的重要性。掌握同伴交往的技巧。5）认识失眠的危害。强调良好睡眠与身心健康、学习生活及情绪的关系。认识常见失眠的表现、原因及对策。6）认识自杀现象。了解自杀行为发生过程。了解自杀的有关危险因素。帮助他们对自杀现象树立正确的认识。7）简单易行的自我心理干预技术，如不良情绪的自我分析、自我放松训练等。
心理干预后，初中生的自杀意念检出率由原来的18.18%下降为9.86%。其中，干预前有自杀意念者中46.36%的在干预后得以消失。说明集体心理干预措施可以显著降低初中生的自杀意念。同时，他们的抑郁情绪、焦虑情绪和孤独感明显降低。睡眠质量明显提高。自杀态度发生了改变，表现为对自杀者的态度、对自杀者家属的态度和对安乐死态度的认可度、支持程度降低，转而拒绝、反对和不支持。这些个体易感因素改变与自杀意念的降低具有密切关系。虽然本研究没有观察到个性特征的明显改变，但使他们了解了自己个性特征，并能够利用自己的特点积极调整心态，对自杀意念的降低可能起到了一定作用。
本研究的结论是：目前初中生自杀意念的检出率较高；个体易感因素对自杀意念具有重要影响；针对个体易感因素的集体心理干预，可以有效降低自杀意念的发生。
Suicide, as a severe problem of social and public health, has been brought to the hub of attention all over the world, especially for the suicide in adolescents. It is estimated that more than1,000,000people take their own lives annually. In our country, the prevalence of suicide is noticeably higher than both that in the United States and the average of the world. According to the investigation and statistics, the suicide death in our country accounts about30%for that all over the world and the annual suicide mortality is about23for every100,000people. Suicide has been ranked as the fifth leading cause of death in our country. What is more, adolescents are becoming as the high risk population for suicide. In our country, suicide constitutes one of the first top three causes of death in adolescences, and is increasing alarmingly every year.
The causes of adolescent suicide are complicated. According to the view of Richard Lerner’s development contextualism, a person is the main constructor of the context. So, for adolescents themselves, the subject of suicide, should have some personal risk factors, which play much more important roles in suicide behavior. We specially stress that suicide is a process of a series psychological behaviors, and by active intervention to the personal risk factors, the rate of suicidal iodation and behavior should be decreased dramatically.
Our study was proposed in two parts. Part1: The aim of this part was to explore the personal risk factors for suicide in junior high students. We firstly selected some junior high students as the study subjects, and then investigated the personal risk factors by standardized questionnaires. Finally, we determined the personal risk factors for suicidal ideation by statistical analysis. Part2： The assignment for this part was to give the students active group psychological intervention and to evaluate the effects of the group psychological intervention. According to the personal risk factors that were found in the study of part1, we designed the corresponding intervention contents and methods. Considering that the number of students was so many and they were still studying in the school, we adopted group psychological intervention for them. The primary evaluation index of outcome was the reduction of suicidal ideation, the changes of personal risk factors, and their relations.
By investigation of the1815junior high students, we found that the prevalence of suicidal ideation was18.18%in the subjects, which meant a comparatively high level. The risk personal factors for suicidal ideation included such traits of personality as introversion, neuroticism and psychoticism; suicide attitudes, especially attitudes such as acceptance, surporting and tolerance towards the nature of suicidal behavior, the suicide victims and the relatives of the suicide victim. Negative emotion, especially depression, anxiety and loneliness, affected suicidal ideation evidently. Sleep problems, for example, the prolonged time between going to bed and falling sleep, lack of energy during daytime, might also influence their suicidal ideation. These factors might affect suicidal ideation directly and/or indirectly by mediators.
According to the above personal risk factors for suicidal ideation, we carried out a series of group psychological intervention during about20weeks. The contents included as follows:1) Basic psychological knowledge, such as cognition, emotion and will, and the interactions among them. Discussing the factors influencing our psychological everyday activities, including both external‐environmental factors and internal‐personal factors. Stressing the importance of internal‐personal factors in dealing with the pressure of studying, life events and environmental changes.2) The knowledge about personality and its influencing factors. Helping them to analyze the characters of their own personality. Guiding them how to overcome the weakness and how to use their strongpoint in adjusting their psychological status and their school life.3) Recognizing the common emotions, such as joy, depression, anxiety, anger, fear and so on. Understanding the influence of negative emotions on daily life, and mastering the skills of getting rid of them.4) Recognizing loneliness. Understanding the importance of joining group activities. Telling them the skills of communicating with classmates or other compeers.5) Recognizing the harm of sleep problem. Stressing the relationship between good sleep and psychological/physical health, studying activities and emotion reactions. Mastering the manifestations, causes and countermeasures of sleep problems.6) Recognizing suicidal ideation and behaviors. Understanding the process of suicide and its risk factors. Helping them to develop the correct attitude to suicide.7) Teaching them some simple but practical skills of self‐psychological interventions, such as self‐analysis of negative emotions and self‐relaxation.
After group psychological intervention, the prevalence of suicidal ideation was reduced dramatically from18.18%to9.86%in total. For the students with suicidal ideation before intervention,46.36%of them were got rid of the ideation after intervention. These results indicated that group psychological intervention for junior high students reduced suicidal ideation remarkably. At the same time, their depression, anxiety and loneliness relieved greatly. The quality of their sleep was also increased remarkably. Their attitude towards suicide has been changed, they tended to reject and refuse suicide behaviors. All these changes contributed significantly to the reduction of suicidal ideation. Although we did not notice the changes of their personality characters, the effects on reduction of suicidal ideation might be due to the use of their personality strongpoint because the time of intervention was too short.
The conclusion of this study is as follows. The prevalence of suicidal ideation in junior high students is at a comparatively high level. The personal risk factors play very important roles in suicidal ideation. The group psychological intervention aiming at the personal risk factors can reduce the prevalence of suicidal ideation effectively.
引文
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