农村自杀遗族的心理需求状况及专业心理帮助需求的相关影响因素研究

发布时间：2018-06-17 01:07

本文选题：农村 + 自杀遗族　；参考：《大连医科大学》2012年硕士论文

【摘要】：研究背景：自杀是我国第五位死因。每年我国死于自杀的人数高达28.7万，其中80%以上的自杀是发生在农村。Shneidman通过研究保守的估计每个自杀死亡者会使6位亲友遭受沉痛的打击，这些因自杀而失去亲友的丧亲者被称为自杀遗族（suicide survivors/survivors of suicide）。自杀遗族的丧亲哀伤过程较复杂，典型的反应有认知混乱、烦躁不安、躯体障碍、社会职能受损和工作中断等，特殊的感受包括被拒绝感、内疚、羞愧、耻感、愤怒、自杀的牵连和自责感、对自杀死因不断寻求解释等。这些问题若长时间得不到解决，会严重影响自杀遗族的身心健康，甚至会产生不同程度的自杀行为，是自杀的危人群，并急待援助和干预。了解自身遗族的心理需求以及对专业心理帮助需求状况及其相关影响因素是进行有效干预的基础和前提。研究目的：目的是揭示农村自杀遗族的心理需求现状和专业心理帮助需求的状况及其相关影响因素，为自杀遗族的心理干预和心理服务系统的构建，提供科研依据和实际指导。研究方法：本研究在辽宁省庄河市所有乡镇中整群随机抽取8个乡镇农村地区的自杀遗族作为被试取样现场，对在2006年6月1日至2011年5月30日期间目标乡镇所有自杀死亡的目标人，对每个目标人根据实际情况选取自愿参加本研究的四级亲属中的父母、配偶、子女和兄弟姐妹中的1-3名被访人，采取现场一对一半结构式心理访谈和心理评估、问卷调查等工作。研究结果：（1）254例农村自杀遗族被试是来自202例自杀死亡目标人的四类亲属，其中配偶最多（n=86，33.86%），其次为子女（n=68，26.77%），再次是父母（n=54，21.26%），最少为兄弟姐妹（n=46，18.11%）；本次调查的自杀遗族年龄在16-89周岁之间，平均55.95±13.12岁；平均受教育年限4.11±2.24年；65.40%是文盲或小学文化，32.30%初中文化，仅2.4%为高中文化；202例自杀死亡目标人平均受教育年限3.32±3.25年，自杀者和自杀遗族的受教育水平普遍偏低；53.50%的自杀遗族经济状况较差；58.3%（n=148）的遗族罹患慢性疾病；39%健康状况较差；43.70%的遗族曾与自杀目标人一起同住；46.9%的遗族报告自杀死亡者曾是被试遇到困境时的主要帮助对象和安慰的精神支柱。（2）254例自杀遗族希望获得正式或专业机构帮助前三位的是政府（62.2%）、乡村医生（22.4%）和医院（19.7%）。仅有11.8%的人实际获得了政府的帮助，其中绝大部分是“低保户”；4.3%的遗族得到了乡村医生的帮助；6.7%的遗族得到了乡镇医院的帮助；希望获得与实际获得的帮助之间均差异显著（p0.05）。农村自杀遗族被试从未获得的专业帮助资源有电话热线服务、心理服务中心、危机干预组织、法院和法律事务所等专业机构。且获得帮助人数的百分比均低于1%。（3）自杀遗族实际获得的非专业资源支持的前五位依次为子女（55.1%）、邻居（55.1%）、兄弟姐妹（45.7%）、配偶或伴侣（37.0%）和朋友（35.8%）；69.3%自杀遗族希望从孩子那里能获得帮助，而实际获得55.1%。46.9%的遗族希望能够在配偶或伴侣那里获得帮助，实际获得37.0%，差异显著（p㩳0.05）。45.9%遗族期望能获得兄弟姐妹的帮助和理解，与实际获得的帮助状况基本相符（45.7%）；邻居的援助是实际获得（55.1%）高于期望获得的（45.3%）的10%（p0.05）。期望来自朋友的心理帮助（33.9%）与实际获得的相当（35.8%）。（4）自杀遗族自我调适的方式有自我安慰（79.1%）、多劳动和多干农活（55.9%）以及与亲友和邻居多沟通（49.2%）等；37.8%的遗族报告已恢复其正常生活；48.40%部分恢复；仅有11.8%的遗族其悲伤状况没有得到改善；2%的农村自杀遗族则表示自己的悲伤感更严重了。（5）25.2%的自杀遗族报告知道心理咨询和心理治疗能够帮助自己；14.6%的遗族知道电视和广播节目中有自己需要的信息；8.3%的遗族知道有关与自杀、悲伤调适方面的书籍和资料对自己有益。但对于心理电话热线、心理服务中心和危机干预机构、心理救援网站、丧亲互助小组等方面的知晓率均低于5%；还有个别专业机构闻所未闻。（6）55.5%的自杀遗族未获得过心理帮助障碍的主要原因是“不愿意寻求心理帮助”55.51%（n=141）；39.0%的遗族是因为“不知道如何能够找到帮助资源”（n=99）；28.3%农村自杀遗族报告自己“没有钱去寻求心理帮助”。（7）有46.9%（n=119）的遗族报告愿意接受的专业心理帮助形式的需求是“一对一的心理咨询或治疗”，前提是“国家和专业组织免费提供”。34.6%的自杀遗族认为听有关心理健康和家庭幸福的专家讲座会对自己有帮助；32.3%的农村自杀遗族愿意接受一些对身心有益的音乐帮助自己疗愈创伤；只有14.10%的自杀遗族愿意接受专业的精神药物治疗。（8）自杀遗族对非专业心理帮助形式的需求是来自亲友的理解（60.63%）、安慰（33.86%）和陪伴（31.50%）。（9）自杀遗族中仅有0.78%（n=2）曾有过专业心理帮助行为，26.8%的遗族有专业心理帮助的意向（n=68）。其中表示需要长期心理援助者55.90%；22.8%的人认为家人需要专业的心理帮助，其中50%的人认为自己全家人都需要专业心理帮助；还有50%的遗族认为自己部分家人需要，其中认为母亲需要者为最多(n=11)，，其次是妻子需要专业心理帮助(n=7)。（10）254例自杀遗族的的SCL-90总分及各因子的平均分均高于常模，有专业心理帮助需要的遗族心理健康状况比没有者更差一些。（11）二分类Logistic回归分析结果显示，影响农村自杀遗族专业心理帮助需要的主要因素有性别（OR=3.299）、GEQ悲伤水平(OR=1.019)、SCL-90焦虑因子(OR=1.125)和精神病性因子(OR=1.133)。结论: （1）农村自杀遗族在心理帮助资源方面，国家各级政府的专业（或正式）帮助资源的需求远远未得到满足。在非专业支持资源方面，期望获得子女、配偶或伴侣上帮助的遗族最多，但均未得到满足。兄弟姐妹的帮助和支持满足了遗族们的心理需求，而邻居的帮助则超过了期望。（2）农村自杀遗族的自我调适对恢复有一定的效果，但大部分遗族仍未走出丧亲的悲伤。（3）自杀遗族对于专业帮助信息的知晓率较低，多数未获得心理帮助的障碍是不知道如何获得专业心理帮助的信息和资源。（4）自杀遗族在专业的心理帮助方面，多数遗族希望通过免费的一对一的心理咨询和治疗、听心理健康和家庭幸福方面的专家讲座、听对身心有益的音乐来帮助自己走出悲伤；最不愿意接受的是精神药物治疗。在非专业的心理帮助上，自杀遗族最希望得到的是亲友的理解。（5）农村自杀遗族专业心理帮助需求较低，这与对专业心理帮助信息的知晓率较低有关。（6）有专业心理帮助需求的自杀遗族比没有需求的自杀遗族心理健康状况差，其SCL-90总分及各因子分既高于常模又高于没有心理帮助需求的自杀遗族。（7）影响农村自杀遗族专业心理帮助的因素是性别、悲伤水平、SCL-90焦虑因子和精神病性因子。说明女性较男性遗族更易产生专业心理帮助的需求。（8）农村自杀遗族干预计划和策略的建议：首先是全面普及和实行九年义务教育，提高农民的文化程度和受教育水平；其次，充分利用农村家家户户都有的电视和广播的优势，通过政府的垂直系统，计生委的县、乡、村和重点户的家庭健康辅导站，大力宣传和普及精神卫生、危机干预和健康家庭促进计划的知识，定期举办有关心理健康和家庭幸福的专家讲座，播放一些心灵疗愈和放松的音乐，让农村的丧亲遗族尤其是自杀遗族了解专业支持资源的信息，获得相关的知识与心理技能，从而提高生活质量。这是建立我国农村自杀预防和干预以及自杀遗族的精神健康和危机干预的切实可行的策略。
[Abstract]:Research Background : Suicide is the fifth cause of death in our country . The number of suicide deaths in our country is as high as 28,700 million per year , of which more than 80 per cent of suicides occur in rural areas . Shneidman , through a study of conservative estimates , will cause six relatives and friends to suffer a painful blow , and those who lose their relatives and relatives by suicide are referred to as suicide survivors ( suicide suicide / suicide of suicide ) . These problems can seriously affect the physical and mental health of the suicide survivors and even generate different levels of suicidal behavior , which is the basis and prerequisite for the effective intervention to understand the psychological needs of their families and their influence factors on the situation of professional psychological help demand and their related factors .

The purpose of this study is to reveal the psychological needs of suicide survivors in rural areas and the status of professional psychological help demand and their influencing factors , and provide scientific basis and practical guidance for the construction of psychological intervention and psychological service system of suicide survivors .

The research method : In this study , the suicide survivors of eight villages and towns were randomly selected in all villages and towns in the province of Liaoning Province as the sampling site . The target persons who had committed suicide in the target towns during the period from June 1 , 2006 to May 30 , 2011 were selected to take 1 - 3 of the parents , spouses , children and siblings of the four - level relatives who voluntarily participated in the study according to the actual situation , and a half - structured psychological interview and psychological assessment and questionnaire survey were taken on the site .

Results of the study :

( 1 ) 254 cases of suicide survivors were attempted to be four relative relatives from 202 suicide target persons , among whom the spouse was the largest ( n = 86 , 33.86 % ) , followed by children ( n = 68 , 26.77 % ) , again the parents ( n = 54 , 21.26 % ) , and at least siblings ( n = 46 , 18.11 % ) ;
The suicide survivors of the survey ranged from 16 to 89 years old , with an average of 55.95 卤 13.12 years .
The average duration of schooling is 4.11 卤 2.24 years .
65.40 % is illiterate or primary culture , 32.30 % junior high school culture , only 2.4 % is high school culture ;
In 202 cases of suicide , the average age of suicide was 3.32 卤 3.25 years . The educational level of suicide and suicide remains low .
53.50 % of the suicide survivors have poor economic conditions ;
58.3 % ( n = 148 ) of the survivors suffered from chronic diseases ;
39 % of them are in poor health ;
43 . Seventy per cent of the survivors were living with the suicide target ;
46.9 % of the survivors reported that suicide - fatalities were the main objects of help and consolation to the subjects who had been tried in distress .

( 2 ) 254 suicide survivors wish to receive formal or professional assistance from the Government ( 62.2 per cent ) , rural doctors ( 22.4 per cent ) and hospitals ( 19.7 per cent ) . Only 11.8 per cent actually received the Government ' s help , most of which were " low - holders " ;
4.3 % of the survivors were assisted by village doctors ;
6.7 % of the survivors were assisted by township hospitals ;
There was a significant difference ( p . 05 ) between what was expected to be achieved and the assistance actually obtained . The rural suicide survivors were tried never to receive professional help resources such as telephone hotline services , psychological service centres , crisis intervention organizations , courts and law firms , and the percentage of people assisted was less than 1 per cent .

( 3 ) The first five of the non - professional resources supported by the suicide survivors were children ( 55.1 % ) , neighbors ( 55.1 % ) , siblings ( 45.7 % ) , spouses or partners ( 37.0 % ) and friends ( 35.8 % ) ;
69.3 % of the suicide survivors wished to receive assistance from their children , and 55.1 % were actually obtained . 46.9 % of the survivors wished to be able to receive assistance from their spouses or partners , with a significant difference of 37.0 % ( p ? 0.05 ) . 45.9 % of the survivors were expected to receive the help and understanding of the siblings , which was substantially in line with the actual help status ( 45.7 % ) ;
The assistance of the neighbours was actually achieved ( 55.1 per cent ) higher than the 10 per cent ( 45.3 per cent ) of the expected ( 45.3 per cent ) . It was expected that psychological assistance from friends ( 33.9 per cent ) was comparable to that achieved ( 35.8 per cent ) .

( 4 ) There were self - comfort ( 79.1 % ) , multi - labor and multi - dry farming ( 55.9 % ) and multi - communication with relatives and friends ( 49.2 % ) .
39.8 per cent of the survivors reported that their normal life had been restored ;
48.40 % recovery ;
Only 11.8 per cent of the family ' s grief had not improved ;
Two percent of rural suicide survivors say their grief is more serious .

( 5 ) Twenty - two per cent of the suicide survivors reported that psychological counselling and psychotherapy could help themselves ;
14.6 % of the survivors are aware of the information they need in the television and radio programmes ;
8.3 % of the family members know that books and materials related to suicide and grief adaptation are good for themselves . But the awareness rate is less than 5 % for psychological telephone lines , psychological service centers and crisis intervention agencies , psychological rescue websites , funeral and mutual aid groups , etc .
There are also individual professional bodies to smell it .

( 6 ) 55.5 % of the suicide survivors did not receive psychological help , the main reason was " reluctance to seek psychological help " 55.51 % ( n = 141 ) ;
39.0 % of the survivors were due to " no knowledge of how to find help resources " ( n = 99 ) ;
28 . 3 % of the rural suicide survivors reported that they had " no money to seek psychological help " .

( 7 ) The needs of 46.9 % ( n = 119 ) of the family ' s psychological help form are " one - to - one psychological counseling or treatment " , provided that " national and professional organizations are provided free of charge " . 34 . 6 % of the suicide survivors believe that listening to expert lectures on mental health and family happiness will help themselves ;
32 . 3 % of the rural suicide survivors are willing to accept some of the physical and psychological benefits of music to help heal the wounds themselves ;
Only 14.10 % of the suicide survivors were willing to receive professional psychiatric medications .

( 8 ) The demand of suicide survivors in the form of non - professional psychological help is from relatives and friends ( 60.63 % ) , comfort ( 33.86 % ) and company ( 31.50 % ) .

( 9 ) Only 0.78 % ( n = 2 ) of the suicide survivors had a professional psychological help behavior , 26 . 8 % of the survivors had professional psychological help ( n = 68 ) , which indicated that 55.90 % of the long - term psychological assistance was needed ;
22 . 8 % believe family members need professional psychological help , 50 % of whom think their families need professional psychological help ;
There are also 50 % of the family ' s family members who believe that their mothers need to be the most ( n = 11 ) , followed by the need for professional psychological assistance ( n = 7 ) .

( 10 ) The total score of SCL - 90 and the average score of all factors in 254 suicide survivors were higher than those of norm , and the mental health status of the survivors with professional psychological help was worse than that of no one .

( 11 ) Logistic regression analysis showed that the main factors affecting the psychological help of suicide survivors in rural areas were gender ( OR = 3.299 ) , GEQ sad level ( OR = 1.019 ) , SCL - 90 anxiety factor ( OR = 1.125 ) and psychogenic factor ( OR = 1.133 ) .

Conclusion :

( 1 ) The need for professional ( or formal ) assistance resources at all levels of government in rural suicide remains is far from being met . In the area of non - professional support resources , it is expected that children , spouses or partners who are assisted in a partner are the most , but are not met . The assistance and support of siblings meet the psychological needs of the survivors , and the help of the neighbours exceeds expectations .

( 2 ) The self - adaptation of suicide survivors in rural areas has a certain effect on the restoration , but most of the survivors have not yet come out of mourning .

( 3 ) There is a low awareness rate of suicide survivors for professional help information , and most of the obstacles that do not get psychological help are information and resources that don ' t know how to get professional psychological help .

( 4 ) In the field of professional psychological help , most of the survivors want to listen to expert lectures on mental health and family happiness through a free one - on - one psychological consultation and treatment , listen to the music of physical and mental health and help themselves out of sadness ;
The most reluctant to accept is the treatment of psychotropic substances . In non - professional psychological help , the suicide survivors want to be understood by relatives and friends .

( 5 ) The psychological help demand of suicide survivors in rural areas is low , which is related to the low awareness rate of professional psychological help information .

( 6 ) The mental health status of suicide survivors with professional psychological help demand is worse than those without the demand . The scores of SCL - 90 and the scores of SCL - 90 are higher than those of suicide survivors without psychological help .

( 7 ) The factors that affect the psychological help of suicide survivors in rural areas are gender , sadness level , SCL - 90 anxiety factor and psychogenic factor .

( 8 ) Suggestions for the intervention plans and strategies of the rural suicide survivors : first , to popularize and implement nine - year compulsory education to improve the cultural level and educational level of farmers ;
Secondly , to make full use of the advantages of TV and broadcasting in rural family households , through the government ' s vertical system , the county , township , village and key family health assistant station of the government , vigorously promote and popularize the knowledge of mental health , crisis intervention and healthy family promotion plan , and regularly organize lectures on mental health and family well - being , play some spiritual healing and relaxation music , and get relevant knowledge and psychological skills so as to improve the quality of life . This is a practical strategy for the prevention and intervention of suicide prevention and intervention in rural areas as well as the mental health and crisis intervention of suicide survivors .
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：B846

【参考文献】