本研究的目的在於透過全民健保資料庫分析自殺與慢性疾病之相關性。根據世界衛生組織的資料顯示，全世界每年有超過一百萬人死於自殺 (WHO, 2014)。自殺行為通常與許多身體慢性疾病或精神疾病有著密切關係。就慢性疾病而言，在台灣，最常見的慢性病為：高血壓、白內障、心臟病。高血壓也就是常說的三高疾病之一（高血壓、高血糖、高血脂），三高患者亦是腎臟病及心臟病的高風險族群。就精神疾病而言，最高的十大「疾病與傷害」當中，重鬱症排名第2位，僅次於缺血性心臟病。重鬱症是現代文明病，亦是精神疾病的一種，通常會伴隨著其他疾病而出現的共病，除了生理的病痛之外，精神上的疾病往往會增加病患的負擔，最嚴重可能引發自殺問題。
健保資料庫為台灣醫療產業大數據的代表，本研究透過全民健保資料庫，以大量的數據來分析自殺行為與慢性疾病：(1) 慢性腎衰竭、(2) 冠狀動脈疾病、以及(3) 心臟衰竭之間的關聯性，並將結果提供醫療單位參考，期望能透過健保系統及早警示介入， 降低自殺行為。
本研究採用巢式病歷對照研究。研究數據採自全民健保資料庫2000年至2012年底之數據，將死亡登記檔與全民健康保險資料庫等資料串連後加以分析。個案選擇為患有慢性腎衰竭、心臟病（冠狀動脈疾病、心臟衰竭）自殺死亡者，並以1比10的比例隨機選出對照組，分析方法採用條件式邏輯回歸進行分析，且所有資料以統計軟體SAS 9.3版進行整理與分析。
研究發現，患有慢性腎衰竭、心臟病（冠狀動脈疾病、心臟衰竭）患者之自殺死亡的比例相當高，也就是說患有慢性疾病的病患是屬於自殺的高危險群。例如：慢性腎衰竭會增加自殺死亡的風險。透析患者在透析開始後最初3個月以及接受透析超過24個月的自殺風險較高；急性冠狀動脈疾病診斷後的前6個月內最高；心臟衰竭患者比一般健康人有較高的自殺風險，且自殺的風險尤其在心臟衰竭初診斷後的前6個月內最高，有精神疾病的心臟衰竭患者更會增加自殺的風險。研究發現，相較於一般人，若有較多的心理或身體疾病者，會有較多的就醫次數，多重身體或心理疾病會增加自殺的風險。病患自殺死亡前的就醫次數增加，若能早期介入評估病患之憂鬱狀態，早期發現有憂鬱傾向之病患，早期治療，進而降低自殺的發生率。
自殺是可以預防的，本研究分析台灣健保資料庫資料，希望此研究結果能回饋給衛生福利部，對於患有慢性腎衰竭，特別是早期透析患者，以及急性冠狀動脈疾病以及心臟衰竭患者定期主動評估病患之憂鬱狀態，周遭的親友多一分關心與注意，或許就能夠挽救一條生命。針對評估有憂鬱傾向之病患，建議轉介身心科，早期發現，早期治療，以減輕病患憂鬱問題並提升其生活品質，進而降低自殺的發生率。

The National Health Insurance (NHI) programme in Taiwan is a health insurance programme established by the government on 1 March 1995, under the jurisdiction of the Ministry of Health and Welfare. It offers comprehensive, compulsory universal health care coverage to 99.9% of Taiwan’s population, and 93% of the country’s hospitals and clinics are contracted to provide health care services under the NHI programme. The National Health Insurance Database (NHID) provides medical information on inpatients and outpatients, including gender, birth date, dates of admission and discharge, services provided by medical institutions, medication records, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes, and medical procedures.
Suicide is a global public health threat and the 10th leading cause of death worldwide, with 800 000 to one million people dying annually from suicide. In Taiwan, suicide has been one of the leading causes of death for almost 2 decades with a suicide rate of 15.2 per 100 000 population in 2014. Suicides in the Han Chinese population constitute one-fifth of all recorded suicides worldwide.
The high prevalence of chronic kidney disease, coronary heart disease and heart failure represent a significant burden on healthcare resources. Patients with acute life-threatening physical illnesses, such as stroke, myocardial infarction and chronic kidney disease, are at a significantly increased risk for both suicidal ideation and suicide attempts. We conducted a population-based case-control study in Taiwan and selected all persons older than 18 years who died from suicide between 2000 and 2012. After potential confounders were controlled for, CKD was significantly associated with an increased risk of suicide (aOR = 1.25, 95% confidence interval [CI] = 1.17–1.34). ESRD patients on haemodialysis had an increased risk of suicide compared with controls (aOR = 3.35, 95% CI = 3.02–3.72). Moreover, patients who initially underwent dialysis within 0–3 months had a significantly increased risk of suicide (aOR = 20.26, 95% CI = 15.99–25.67). ACS was significantly associated with an increased risk of suicide (aOR = 1.15, 95% confidence interval [CI] = 1.05–1.26). The risk of suicide was the highest during the initial 6 months post-ACS (aOR = 3.01, 95% CI = 2.52–3.60) and remained high for at least 4 years after ACS diagnosis. HF was associated with an increased risk of suicide (OR = 1.68, 95% CI = 1.59–1.79). The risk of suicide was the highest during the initial 6 months post-HF (aOR = 7.04, 95% CI = 5.37–9.22) and declined gradually (aOR = 0.55, 95% CI = 0.50–0.62 at 48 months post HF diagnosis).
We found that chronic kidney disease, acute coronary syndrome and heart failure were associated with a markedly increased risk of suicide. Our results suggest the importance of screening patients with chronic kidney disease, acute coronary syndrome and heart failure for depression and suicidal ideation.

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