前言：過去國外有多篇探討護理人員自殺相關性研究顯示，護理人員自殺死亡風險較一般民眾高。在先前探討醫護人員自殺與精神疾病之研究結果發現，不論精神疾病的有無，護理人員相較於其他族群有較高的自殺死亡風險，但在無精神疾病中的自殺相對風險較高，顯示精神疾病有無，會影響自殺風險差異。在年齡方面，發現在服用過量鎮定、安眠及精神疾病藥物之行為中，年齡越低，則護理人員的風險越高，而這是因為在護理人員自殺中，年齡為保護因子，亦或是隨著年齡增長，護理人員較常選擇其他的自殺方式，是過去研究未曾探討的。鑒於我國護理人員工作環境與他國有所差異，因此了解我國護理人員之自殺情形，是有其必要性的。同時，護理人員之年齡及精神疾病在自殺中扮演何種角色，也是過去研究並鮮少被探討之部分，所以本研究將以我國健保資料庫百萬歸人檔，深入探討護理人員自殺的風險分析，並進一步探討年齡、精神疾病是否在職業與自殺風險間具有調節作用。

研究方法：本研究為巢式病例對照研究，使用全民健康保險資料庫2010年承保抽樣歸人檔中2002年至2012年之承保資料檔（ID）、門診處方及治療明細檔（CD）之急診資料、住院醫療費用清單明細檔（DD）、醫事人員基本資料檔（PER）、醫事機構基本資料檔（HOSB）為研究資料。本研究之病例個案為首次發生急診、住院紀錄中判定為自殺事件的20~59歲個案。根據事件發生時病例個案之年齡、性別，以1:10的比例，配對承保檔內尚未發生事件者，為對照個案。再根據事件發生指標日向前回溯2年，判斷研究個案的職業/投保身份類別、精神症狀或疾病、投保金額、投保區域。以描述性統計呈現病例組及對照組人口學特徵，並以卡方檢定比較兩組差異，另以條件式邏輯斯迴歸分析護理人員及其他就業身分族群之自殺風險差異，並進行年齡、精神症狀或疾病分層分析。

研究結果：本研究在服用過量鎮定、安眠及精神症狀藥物的廣義自殺事件中，共納入2,877個研究期間發生事件之病例組個案，以及28,770人次之對照組個案。在控制潛在干擾因子後，護理人員發生服用過量鎮定、安眠及精神症狀藥物的廣義自殺事件風險是其他工作者的1.43倍（95％CI: 1.01-2.04）。以35歲為切點進行年齡分層，小於35歲護理人員自殺勝算是同年齡層其他工作者的1.86倍（95％CI: 1.26-2.76），而35歲以上之護理人員與其他工作者無顯著差異。本研究也發現小於35歲的護理人員，過去若無精神症狀或疾病的診斷，自殺風險較無患病之其他工作者高2.11倍（95%CI：1.30-3.41）。

結論：護理人員自殺就醫風險相較於其他工作者高，且年齡分層後也發現年輕護理人員的自殺就醫風險較一般有工作的民眾高，而資深護理人員則沒有此類風險。年輕（小於35歲）且沒有精神症狀或疾病之護理人員發生服用鎮定、安眠及精神症狀藥物的廣義自殺事件的就醫風險較同年齡層且沒有患病之其他工作者高。

This nested case-control study, including 2,877 cases with suicide attempts and 28,770 matched controls identified from medical claims of 1-million Taiwan's National Health Insurance program beneficiaries in 2002-2012, was conducted to compare the risk of suicide attempts among nurses, non-nursing medical personnel, unemployed and non-medical personnel. After controlling for potential confounders, the risk of suicide attempts compared to non-medical personnel were elevated in nurses. The risk of suicide attempts for nurses who were younger than 35 years old were higher than that of other workers, and after age stratification. We also found that young nurses with no psychiatric disorders had a higher risk of suicide than non-medical personnel of the same age who had not sick.

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