新型冠狀病毒 (COVID-19) 的全球爆發，對傳染病醫學與精神保健均是前所未有的挑戰。在關注COVID-19本身所造成的死亡同時，我們也應該關注COVID-19帶來的次生災害，例如自殺。而自殺念頭/想法是一個評估自殺風險的良好指標。
 因此，本文希望通過收集有關新冠疫情大流行期間不同人群自殺風險的研究文章，並使用薈萃分析中的薈萃迴歸，篩選出可能造成大流行期間的人群自殺風險增加的因素。在使用自殺念頭/想法這個指標的同時，我們也使用了自傷和自殺企圖這兩個指標幫助探究。
  本文針對收集到的115篇探究新冠大流行期間自殺風險的文章進行研究。其中提供自殺念頭/想法數據的115篇，提供自傷數據的22篇，提供自殺企圖數據的30篇。根據115篇文章，整理的可能影響因素有：評估量表(scale)種類、參與者罹患憂鬱症狀(depression)的比例、參與者罹患焦慮症狀(anxiety)的比例、罹患身體症狀(somatic symptom)比例、參與者罹患創傷症候群(ptsd)的比例、參與者罹患失眠症(insomnia)的比例、參與者男性(male)的比例、平均年齡(age)、白種人(Ethnicity)比例、有精神病史(History of psychiatric follow-up)的比例、罹患身體疾病(Physical diseases)的比例、罹患患慢性身體疾病(Chronic physical illness)的比例、有感染COVID-19風險的身體狀況(physical condition at risk of COVID-19)的比例、有接受高等教育(education)的比例、失業(Unemployed)的比例、低收入(Low income)的比例、因疫情而失業(lost income)的比例、因疫情而經濟惡化(Economy worsened)的比例、從事醫護工作(Healthcare workers)的比例、疫情期間參與第一線工作(participate in frontline work)的比例、疫情期間確診者(COVID-19 diagnosis)的比例、疫情期間出現染疫症狀(Symptoms consistent with COVID-19)的比例、得知某人染疫的訊息(Know someone who had positive test results for SARS-CoV-2)的比例、親友染病 (Relatives or friends infected)的比例、得知某人死於COVID-19(knew someone who died from covid-19)的比例、居住於城市(urban)的比例、已婚(marital status)的比例、有小孩(having children)的比例、獨居者(living alone)的比例、目前是吸菸者(currently smoker)的比例及目前有飲酒習性(alcohol use)。
  研究結果顯示，憂鬱症狀比例、焦慮症狀比例、罹患創傷症候群比例、平均年齡、失業比例、男性比例影響自殺念頭/想法之風險。沒有找到影響自傷的因素。 已婚比例、男性比例、飲酒者比例與獨居者比例顯著影響自殺企圖之風險。

  The global outbreak of the coronavirus disease 2019 (COVID-19) has brought unprecedented challenge not just for infectious disease medicine but also for mental healthcare.While focus on the deaths caused by the COVID-19 itself, we should also pay a great attention to the secondary disasters caused by the COVID-19, such as suicide. And suicidal thoughts/ideation is a well indicator of suicidal risk.
  Therefore, this study hopes to screen out the factors that may increase the suicide risk of the population during the pandemic by collecting studies which on the suicide risk of different populations during the COVID-19 pandemic and using meta analyses。In addition to suicidal thoughts/ideation, we also used the indicators of self-harm and suicide attempts to help study.
  This article examines a collection of 115 articles exploring suicide risk during the COVID-19 pandemic.Among them , 115 provided data on suicidal thoughts/ideation, 22 provided data on self-harm, and 30 provided data on suicide attempts. According to 115 articles, the possible influencing factors are: scale、depression、anxiety、somatic symptom、ptsd、insomnia、male、age、Ethnicity、History of psychiatric follow-up、Physical diseases、Chronic physical illness、physical condition at risk of COVID-19、education、Unemployed、Low income、lost income、Economy worsened、Healthcare workers、participate in frontline work、COVID-19 diagnosis、Symptoms consistent with COVID-19、Know someone who had positive test results for SARS-CoV-2、Relatives or friends infected、knew someone who died from covid-19、urban、marital status、having children、living alone、currently smoker、alcohol use。
  The results showed that depression、anxiety、ptsd、age、unemployment and male influence the risk of suicidal thoughts/ideation. No factors were found to have a certain influence on the self-harm. The risk of suicide attempt was significantly affected by the being married, males, alcohol use and living alone.

第一章 緒論	1
第一節 研究背景	1
第二章 研究方法	1
第一節 薈萃分析	1
第二節 統計方法	2
第三節 研究資料	4
第三章 研究結果	4
第一節 自殺念頭/想法	5
1.1自殺念頭/想法薈萃分析	5
1.1.1固定效應模式	5
1.1.2隨機效應模式	9
1.2單一因子薈萃迴歸	15
1.3多元薈萃迴歸	24
第二節 自傷	29
2.1薈萃分析	29
2.1.1固定效應模式	29
第三節 自殺企圖	32
3.1薈萃分析	32
3.1.1固定效應模式	33
3.1.2隨機效應模式	34
3.2單一因素薈萃迴歸	37
3.3多元薈萃迴歸	43
第四章 結論	44
參考文獻	46

圖目錄
圖3.1.1.2.1 自殺念頭/想法隨機效應模式之森林圖	14
圖3.1.1.2.2 自殺念頭/想法隨機效應模式之漏斗圖	14
圖3.1.3.1 憂鬱比例與年齡對自殺念頭/想法之風險的薈萃迴歸之預測模型	25
圖3.1.3.2 年齡與失業比例對自殺念頭/想法之風險的薈萃迴歸之預測模型	26
圖3.1.3.3 年齡與焦慮比例對自殺念頭/想法之風險的薈萃迴歸之預測模型	27
圖3.1.3.4 年齡、男性比例與焦慮比例對自殺念頭/想法之風險的薈萃迴歸之預測模型	28
圖3.2.1.2.1 自傷固定效應模式之森林圖1	32
圖3.2.1.2.2 自傷固定效應模式之森林圖2	32
圖3.2.1.2.3 自傷固定效應模式之漏斗圖	32
圖3.3.1.2.1 自殺企圖隨機效應模式之森林圖	36
圖3.3.1.2.2 自殺企圖隨機效應模式之漏斗圖	37
圖3.1.3.4 男性比例與目前有飲酒習性比例對自殺企圖之風險的薈萃迴歸之預測模型	44

表目錄
表3.1.1.1.1 自殺念頭/想法固定效應模式之薈萃分析	5
表3.1.1.2.1 自殺念頭/想法隨機效應模式之薈萃分析	9
表3.1.2.1 評估量表對自殺念頭/想法之風險的薈萃迴歸表	15
表3.1.2.2 憂鬱對自殺念頭/想法之風險的薈萃迴歸表	16
表3.1.2.3 焦慮對自殺念頭/想法之風險的薈萃迴歸表	16
表3.1.2.4 創傷症候群對自殺念頭/想法之風險的薈萃迴歸表	17
表3.1.2.5 失眠症對自殺念頭/想法之風險的薈萃迴歸表	17
表3.1.2.6 男性比例對自殺念頭/想法之風險的薈萃迴歸表	18
表3.1.2.7 平均年齡比例對自殺念頭/想法之風險的薈萃迴歸表	18
表3.1.2.8 白種人比例對自殺念頭/想法之風險的薈萃迴歸表	18
表3.1.2.9 有精神病史比例對自殺念頭/想法之風險的薈萃迴歸表	19
表3.1.2.10 有接受高等教育比例對自殺念頭/想法之風險的薈萃迴歸表	19
表3.1.2.11 失業比例對自殺念頭/想法之風險的薈萃迴歸表	20
表3.1.2.12 低收入比例對自殺念頭/想法之風險的薈萃迴歸表	20
表3.1.2.13 從事醫護工作比例對自殺念頭/想法之風險的薈萃迴歸表	21
表3.1.2.14 疫情期間確診者比例對自殺念頭/想法之風險的薈萃迴歸表	21
表3.1.2.15 親友染病比例對自殺念頭/想法之風險的薈萃迴歸表	21
表3.1.2.16 居住於城市比例對自殺念頭/想法之風險的薈萃迴歸表	22
表3.1.2.17 已婚比例對自殺念頭/想法之風險的薈萃迴歸表	22
表3.1.2.18 獨居者比例對自殺念頭/想法之風險薈萃迴歸表	23
表3.1.2.19 目前是吸菸者比例對自殺念頭/想法之風險的薈萃迴歸表	23
表3.1.2.20 目前有飲酒習性比例對自殺念頭/想法之風險的薈萃迴歸表	24
表3.1.3.1 憂鬱比例與年齡對自殺念頭/想法之風險的薈萃迴歸表	24
表3.1.3.2 失業比例與年齡對自殺念頭/想法之風險的薈萃迴歸表	25
表3.1.3.3 焦慮比例與年齡對自殺念頭/想法之風險的薈萃迴歸表	26
表3.1.3.4 年齡、男性比例與焦慮比例對自殺念頭/想法之風險的薈萃迴歸表	27
表3.2.1.1.1 自傷固定效應模式之薈萃分析	29
表3.3.1.1.1 自殺企圖固定效應模式之薈萃分析	33
表3.3.1.1.2 自殺企圖隨機效應模式之薈萃分析	34
表3.3.2.1 評估量表對自殺企圖之風險的薈萃迴歸表	37
表3.3.2.2 憂鬱對自殺企圖之風險的薈萃迴歸表	38
表3.3.2.3 焦慮對自殺企圖之風險的薈萃迴歸表	38
表3.3.2.4 男性比例對自殺企圖之風險的薈萃迴歸表	39
表3.3.2.5 平均年齡對自殺企圖之風險的薈萃迴歸表	39
表3.3.2.6 有精神病史比例對自殺企圖之風險的薈萃迴歸表	40
表3.3.2.7 有接受高等教育比例對自殺企圖之風險的薈萃迴歸表	40
表3.3.2.8 失業比例對自殺企圖之風險的薈萃迴歸表	40
表3.3.2.9 疫情期間確診者比例對自殺企圖之風險的薈萃迴歸表	41
表3.3.2.10 已婚比例對自殺企圖之風險的薈萃迴歸表	41
表3.3.2.11 獨居者比例對自殺企圖之風險的薈萃迴歸表	42
表3.3.2.12 目前是吸菸者比例對自殺企圖之風險的薈萃迴歸表	42
表3.3.3.1 男性比例與有飲酒習性比例對自殺企圖之風險的薈萃迴歸表	43

1.Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar 26;382(13):1199-1207. doi: 10.1056/NEJMoa2001316. Epub 2020 Jan 29. PMID: 31995857; PMCID: PMC7121484.
2.Linton NM, Kobayashi T, Yang Y, Hayashi K, Akhmetzhanov AR, Jung SM, Yuan B, Kinoshita R, Nishiura H. Incubation Period and Other Epidemiological Characteristics of 2019 Novel Coronavirus Infections with Right Truncation: A Statistical Analysis of Publicly Available Case Data. J Clin Med. 2020 Feb 17;9(2):538. doi: 10.3390/jcm9020538. PMID: 32079150; PMCID: PMC7074197.
3.Khan KS, Mamun MA, Griffiths MD, Ullah I. The Mental Health Impact of the COVID-19 Pandemic Across Different Cohorts. Int J Ment Health Addict. 2020 Jul 9:1-7. doi: 10.1007/s11469-020-00367-0. Epub ahead of print. PMID: 32837440; PMCID: PMC7347045.
4.González-Sanguino C, Ausín B, Castellanos MÁ, Saiz J, López-Gómez A, Ugidos C, Muñoz M. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun. 2020 Jul;87:172-176. doi: 10.1016/j.bbi.2020.05.040. Epub 2020 May 13. PMID: 32405150; PMCID: PMC7219372.
5.Brooks JT, Butler JC. Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2. JAMA. 2021 Mar 9;325(10):998-999. doi: 10.1001/jama.2021.1505. PMID: 33566056; PMCID: PMC8892938.
6.Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. 2020 Mar 17;9(1):29. doi: 10.1186/s40249-020-00646-x. PMID: 32183901; PMCID: PMC7079521.
7.Saltzman LY, Hansel TC, Bordnick PS. Loneliness, isolation, and social support factors in post-COVID-19 mental health. Psychol Trauma. 2020 Aug;12(S1):S55-S57. doi: 10.1037/tra0000703. Epub 2020 Jun 18. PMID: 32551762.
8.Nordt C, Warnke I, Seifritz E, Kawohl W. Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000-11. Lancet Psychiatry. 2015 Mar;2(3):239-45. doi: 10.1016/S2215-0366(14)00118-7. Epub 2015 Feb 25. PMID: 26359902.
9.Cuijpers P, Quero S, Dowrick C, Arroll B. Psychological Treatment of Depression in Primary Care: Recent Developments. Curr Psychiatry Rep. 2019 Nov 23;21(12):129. doi: 10.1007/s11920-019-1117-x. PMID: 31760505; PMCID: PMC6875158.
10.Alonso J, Lépine JP; ESEMeD/MHEDEA 2000 Scientific Committee. Overview of key data from the European Study of the Epidemiology of Mental Disorders (ESEMeD). J Clin Psychiatry. 2007;68 Suppl 2:3-9. PMID: 17288501.
11.Wittchen HU, Kessler RC, Beesdo K, Krause P, Höfler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63 Suppl 8:24-34. PMID: 12044105.
12.Möller-Leimkühler AM. The gender gap in suicide and premature death or: why are men so vulnerable? Eur Arch Psychiatry Clin Neurosci. 2003 Feb;253(1):1-8. doi: 10.1007/s00406-003-0397-6. PMID: 12664306.
13.Houle J, Mishara BL, Chagnon F. An empirical test of a mediation model of the impact of the traditional male gender role on suicidal behavior in men. J Affect Disord. 2008 Apr;107(1-3):37-43. doi: 10.1016/j.jad.2007.07.016. Epub 2007 Aug 16. PMID: 17707084.
14.Porthé V, García-Subirats I, Ariza C, Villalbí JR, Bartroli M, Júarez O, Díez E. Community-Based Interventions to Reduce Alcohol Consumption and Alcohol-Related Harm in Adults. J Community Health. 2021 Jun;46(3):565-576. doi: 10.1007/s10900-020-00898-6. PMID: 32770477.
15.Ryan SM, Jorm AF, Kelly CM, Hart LM, Morgan AJ, Lubman DI. Parenting strategies for reducing adolescent alcohol use: a Delphi consensus study. BMC Public Health. 2011 Jan 6;11:13. doi: 10.1186/1471-2458-11-13. PMID: 21210993; PMCID: PMC3022696.