澳門中年男士焦慮狀況、求助態度與自殺意念之相關研究

過去十年,澳門的年平均自殺死亡率為 9.7,低於世界衛生組織(2014)所定的高風險地區指標(每 10 萬人中有 13 人死於自殺),從社會工作局婦女數據資料庫的自殺數據和澳門保安司的罪案數字發現,在 2012 年至 2021 年的十年間,澳門的自殺死亡數據的中年人自殺死亡數字有上升的趨勢,而且歷年男性自殺死亡數字均高於女性,澳門特區政府在近十年開始關注男性的身心健康問題,推出男士服務,但根據聖公會澳門社會服務處(2017)的調查顯示,澳門男士較少向社會服務機構求助,這一種現象也同樣出現在歐美和西亞的國家,這些國家也開始關注男性自殺的問題和求助行為的研究,提出提升男士的求助行為是防治自殺的發展策略。文獻指出自殺意念是自殺行為歷程的首要階段,要減少自殺行為的出現,需在自殺意念階段前介入。但為何男士在較少求助社會服務機構,卻自殺死亡又高於女性呢?中年男士的身心狀況和焦慮狀況是如何?他們的求助態度又是如何?中年男士的焦慮、求助態度和自殺意念的關聯是如何?
反觀澳門仍未有針對上述的問題進行研究探討,因此,本研究目的在探討澳門中年男士的人口變項(包括:年齡、教育程度、居住情況、宗教信仰、婚姻狀況、有沒有撫養孩子、經濟狀況、工作狀況、生活壓力程度、身體健康狀況、心理健康狀況、及有情緒困擾或焦慮狀況時會找什麼人求助)、焦慮狀況及求助態度與自殺意念之間的關係。
研究對象為 325 名,年齡介乎於 36-55 歲持有澳門身份證的澳門男性居民,以方便取樣及滾雪球方式獲取研究樣本,並以自編「澳門中年男士焦慮狀況、求助態度與自殺意念之研究問卷」,包括「人口變項」、「貝克焦慮量表」、「中文版專業心理支持求助態度量表簡版」、「貝克自殺意念量表中文版」等工具作數據收集。根據問卷回收的資料,利用描述性統計、單因子變異數分析、獨立樣本 T 檢定、卡方檢定、交叉分析、皮爾遜積差相關和 Tukey 事後檢定進行分析。研究發現,受訪者的人口變項分佈主要集中在 36-40 歲、大專或以上程度、與家人同住、無宗教信仰、已婚、有撫養孩子(2 名)、經濟狀況多屬一般、全職工作、生活壓力程度多屬於輕微,但也有 57 人表示好大及極度沉重壓力、身體健康狀況多屬一般,但也有 46 人表示差及很差、心理健康狀況多屬一般,但也有 47 人表示差及很差、當有情緒困擾或焦慮狀況時會找親密伴侶和朋友較多, 找心理健康專家者極少。
在焦慮狀況方面,以最輕度(0-7 分)最多 223 人(68.6%),但也有 41(12.7%)人屬中度至嚴重,當中有 49 人(15.1%)其焦慮程度被檢測為具臨床意義。人口變項中,經濟狀況越差、無工作者、生活壓力越大、身心健康狀況越差、無宗教信仰、心理健康狀況越差、不會向任何人士求助者,其焦慮狀況越嚴重。
在求助態度方面,大部分受訪中年男士的求助態度未有達到正向水平,大多數受訪中年男士相信心理治療,但非到最後關頭都不願意求助;人口變項中,已婚、有撫養孩子、有宗教信仰、懂得求助心理健康專家和醫生/門診者,其求助態度較正向;經濟狀況差、身體健康狀況差、心理健康狀況差,其求助態度越負向。
在自殺意念方面,有 49 位被篩檢出具有自殺意念,即每 100 人中將有 15 位有機會存有自殺意念;年齡越小自殺意念越高;有宗教信仰、會求助他人的中年男士,其自殺意念相對較低;經濟狀況越差、生活壓力越大、身心健康狀況越差的受訪中年男士,其自殺意念相對較高。
在相關分析方面,求助態度與焦慮狀況呈負相關,即求助態度越積極正向,其焦慮程度越低;生活壓力和焦慮狀況呈正相關,即壓力越大,其焦慮越嚴重;生活壓力和自殺意念呈正相關;焦慮狀況與自殺意念呈正相關,即焦慮越嚴重,其自殺意念越強;而求助態度與自殺意念沒有存在顯著的關係。
在迴歸分析方面,結果顯示中年男士的焦慮狀況和自殺意念之間具有顯著的相互預測力,但求助態度對於自殺意念沒有存在預測力,但求助態度卻與焦慮狀況存有顯著的相互預測力。
從上述結果我們發現,影響中年男士自殺意念的顯著因素,除了焦慮之外,還有中年男士的身心健康狀況、生活壓力程度、經濟壓力程度、他們會不會尋求他人幫助;當中雖然求助態度對自殺意念沒有直接的影響,但他們懂不懂得求助別人,卻有助於減低他們的焦慮產生和自殺意念,同時,研究證明宗教信仰是減低焦慮和自殺意念的保護因素,同時也能提升正面的求助態度。

In the past ten years, the average annual suicide death rate in Macau was 9.7, which was lower than the high-risk area indicator set by the World Health Organization (2014) (13 suicides per 100,000 people), from the Social Welfare Bureau Women’s Data Database The suicide data and the crime figures of the Macao Secretary for Security found that in the ten years from 2012 to 2021, the suicide death figures of middle-aged people in Macao’s suicide death data showed an upward trend, and the suicide death figures of males over the years were higher than that of females. In the past decade, the Macao SAR government has begun to pay attention to men’s physical and mental health and has launched services for men. However, according to a survey by the Anglican Macau (2017), men in Macao are less likely to seek help from social service agencies.
This phenomenon also occurs in Europe, America and West Asia. These countries have also begun to pay attention to the problem of male suicide and research on help-seeking behavior, and propose that improving men's help-seeking behavior is a development strategy for suicide prevention. The literature points out that suicidal ideation is the first stage in the process of suicidal behavior, and to reduce the occurrence of suicidal behavior, intervention before the stage of suicidal ideation is required. But why are men less likely to seek help from social services, yet more suicide deaths than women? What is the physical and mental condition and anxiety of middle-aged men? What is their attitude towards help? What is the relationship between anxiety, help-seeking attitudes and suicidal ideation in middle-aged men?
On the other hand, Macao has not conducted research and discussion on the above-mentioned issues. Therefore, the major purpose of this study was to investigate the relationship among middle-age men’s demographic characteristics (including: age, education level, living conditions, religious beliefs, marital status, whether they have children, economic status, work status, level of life stress, physical health status, psychological health status, and who to turn to for help when you have emotional distress or anxiety), anxiety, and attitudes toward seeking help, and suicidal ideation.
Participants of this study were 325 middle-age men who received services provided by non-government organization, government department, private company etc. Data were collected using Beck Anxiety Inventory (BAI), Chinese version of the Attitudes toward Seeking Professional Psychological Help Scale-Short Form (CV-ATSPPH-SF), Beck Scale for Suicide Ideation(BSS). Data were analyzed using descriptive statistics, Independent Sample t-test, One-way ANOVA, Chi-Square Test, Pearson correlation, and Tukey HSD.
Study found that respondents of the population variable distribution mainly concentrates in 36-40 years old, college degree or above degree, with family, no religious beliefs, married, have children (2), the economy more generally, a full-time job and life stress level belongs to the minor, but there are 57 people say good big, extremely heavy pressure and physical health is more general, However, 46 people said they were poor or very poor, and their mental health was generally average, while 47 people said they were poor or very poor. When they had emotional distress or anxiety, they often sought intimate partners and friends, and seldom sought mental health experts.
In terms of anxiety, the most mild (0-7 points) was 223 (68.6%), while 41(12.7%) were moderate to severe, among which 49 (15.1%) had clinically significant anxiety. Among the demographic variables, those with worse economic status, no work, more pressure in life, worse physical and mental health, no religious belief, worse mental health, and would not seek help from anyone, had more serious anxiety.
In the aspect of hell-seeking attitude, most of the interviewed middle-aged men did not reach the positive level of hell-seeking attitude, most of the interviewed middle-aged men believe in psychological therapy, but are not willing to help until the last minute; Among the demographic variables, those who are married, have raised children, have religious beliefs, and know how to seek help from mental health experts and doctors/clinics are more likely to have positive attitudes towards seeking help; Poor economic status, poor physical health, poor mental health, the more negative their help-seeking attitude.
In terms of suicidal ideation, 49 people were screened for suicidal ideation, that is, 15 out of 100 people had the chance to have suicidal ideation; The younger the age, the higher the suicidal ideation; Middle-aged men who had religious beliefs and sought help from others had lower rates of suicide ideation. The worse the economic status, the greater the life pressure, the worse the physical and mental health status of the middle-aged men surveyed, the suicide ideation is relatively higher.
In the aspect of correlation analysis, help-seeking attitude is negatively correlated with anxiety, that is, the more positive help-seeking attitude is, the lower its anxiety degree is; There is a positive correlation between life pressure and anxiety, that is, the greater the pressure, the more serious the anxiety. There was a positive correlation between life stress and suicidal ideation. Anxiety was positively correlated with suicidal ideation, namely, the more serious anxiety, the stronger suicidal ideation; There was no significant relationship between help-seeking attitude and suicidal ideation.
In terms of regression analysis, the results showed that middle-aged men's anxiety status and suicidal ideation had significant mutual predictability, but help-seeking attitude did not have predictive power for suicidal ideation, but help-seeking attitude and anxiety status had significant mutual predictability.
From the above results, we found that in addition to anxiety, the significant factors affecting suicidal ideation in middle-aged men are their physical and mental health, life stress, financial stress, and whether they will seek help from others; Attitude has no direct effect on suicidal ideation, but whether they know how to ask for help can help reduce their anxiety and suicidal ideation. At the same time, research has shown that religious belief is a protective factor for reducing anxiety and suicidal ideation, and it can also improve Positive help-seeking attitude.