第五章 討論與建議
第六節 研究限制與建議
本研究難免有一些限制：（1）本研究參與者僅包含高中與高職學生，因此研究 結果將無法推論到其他年齡層，建議未來研究能納入不同年齡層之研究參與者，如 大學生或成人；（2）本研究在測量工具上係以自陳式量表來測量相關變項，故可能 會有反應心向的情形，即受研究參與者是否誠實填答與相關個人因素影響，可能造 成反應上偏誤或誤差，因此建議未來研究可使用多元衡鑑方式，如加入晤談
（interview）方式或是加入教師、家人、同學等其他觀察者之資料進行交叉檢證，
以提供更精確分析；（3）本研究為橫斷性研究，無法提供在發展上連續性資料、也 無法知曉發展過程中的個別差異性，以及變項間因果關聯較難確定，建議未來研究 可進行追蹤式研究；（4）本研究的家庭功能與壓力因應方式等兩個預測變項，在過 往研究中有許多不同的分類與定義，故易造成解釋上的差異；（5）由於張宇岱 （2003）
所修訂之壓力因應量表是針對成人的六種壓力情境，請研究參與者評估其可能會有 的反應方式，且儘管林旻沛（2014）已特別針對高中職學生常見的四種壓力情境，
來做壓力情境調整，但題目內容仍須針對高中職學生常見的因應方式來做修訂，因 此建議未來研究能針對青少年或高中職學生，發展出專屬於他們的壓力情境、因應 方式及壓力因應量表。
本研究發現，不佳家庭功能會透過逃避-情緒取向壓力因應方式的完全中介來預 測自傷行為，即家庭功能不佳易提升高中職學生面對壓力時，採逃避-情緒取向因應 方式，進而增高自傷行為風險；筆者認為有效的篩檢出高危險群之學生是預防自傷 行為的第一步，針對這群高危險之學生，透過學校老師、輔導老師、諮商師、社工 師等相關實務工作者，進一步了解其目前所面臨之困境與面對問題時之因應方式，
以利可掌握、瞭解學生目前之困境、並可在知道後的第一時間給予情緒上的支持與 關懷，同時透過調整或提供適當之因應方式去協助學生度過困境。
59
由於許多學生之所以會選擇以逃避取向方式因應問題，很多時候是因為他們不 知道還有其他的因應方式，因為在他們的成長過程中，並未學習到適當、有效的因 應策略，使得當面臨挫折時，在有限的因應策略中感到習得無助。
因此，筆者認為，面對高危險群之學生，可提供或與其討論面對壓力事件的有 效方法，進而取代以逃避做為因應壓力事件的方法，例如習慣以躲在家裡看電視不 出門、借酒消愁者，與其討論可替代之因應方式，例如找親朋好友傾訴、尋求他人 意見、幫忙；或是面對壓力事件時，習慣以發洩情緒來做為舒緩壓力之方式者，與 其討論情緒宣洩後的感受，對於壓力本身是否有幫助，有助於個案去檢核所使用的 因應方式效果，進而促發改變動機。
有關增進壓力因應能力以降低自傷行為發生，過去研究已指出「認知行為治療」
（Cognitive Behavior Therapy）具有良好成效（蔡佳吟、余靜雲，2010；Beech, 2000;
Rupke, Blecke & Renfrow, 2006）；透過協助自傷行為者對壓力當下的思考進行監測，
找出負向自動化思考，讓自傷行為者覺察負向思考對自傷行為之影響，並引導對負面 思考進行駁斥，矯正偏差的認知模式，接著從個案經驗中與個案討論替代自傷行為的 問題解決策略，並討論取代逃避-情緒取向因應方式之行為，最後當自傷行為者有實 際正向轉變時，立即給予正向回饋、以達正增強效果，使自傷行為者以適當因應方式 取代逃避-情緒取向壓力因應行為和自傷行為。
總而言之，本研究希望可以提供後續的研究者、教育界或相關助人工作領域的 實務工作者做為參考，除了提升學生家庭功能外，更重要的是協助學生當面臨壓力 情境時能減少逃避-情緒取向因應行為、培養適當且有效能的壓力因應方式，進而降 低青少年自傷行為之風險。
60
61
62
63
https://csrc.edu.tw/Content/FileManageFiles/20150413044423-102 年校園事件統計分析報告.pdf，2015 年 4 月 13 日。
64
65
287-304。
鄭夙芬、鄭期緯、林雅琪（2005）：以充權為觀點的早期療育家庭之家庭功能探 討。臺灣社會工作學刊，3，51-97。
鄭丞斌（2004）：國中階段自傷青少年成長歷程、自我概念、自傷經驗之研究，
國立中正大學犯罪防治研究所碩士論文。
廖冠霖（2009）：大學生自我傷害與復原歷程之研究，國立臺中教育大學諮商與 應用心理學系研究所碩士論文。
蔡佳吟、余靜雲（2010）：日間病房反覆自傷之憂鬱症患者的護理經驗。精神衛生
護理雜誌，5（1），66-73。
劉惠青、劉珣瑛、黃郁心、鍾嫈嫈、方俊凱（2011）。北台灣高中職學生自傷盛行 率及其危險因子之研究。臺灣家庭醫學雜誌，21（1），27-39。
蕭淑惠、陳若琳（2010）：國小高年級學童知覺家庭功能與家庭滿意度之相關研究，
輔仁民生學誌，16（2），95-110。
顏澤賢（1995）：現代系統理論。台北：遠流。
黃慧真（譯）（1989）：發展心理學-人類發展（原作者：Papalia, D. E., & Olds, S. W.）。
台北：桂冠。圖書股份有限公司。
66
英文部分
Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39(3), 389-400. DOI:
10.1007/s10802-010-9465-3.
Andover, M. S., Pepper, C. M., & Gibb, B. E. (2007). Self-mutilation and coping strategies in a college sample. Suicide and Life-Threatening Behavior,37(2), 238-243. DOI: 10.1521/suli.2007.37.2.238.
Andrews, T., Martin, G., Hasking, P., & Page, A. (2014). Predictors of onset for
non-suicidal self-injury within a school-based sample of adolescents. Prevention Science, 15(6), 850-859. DOI: 10.1007/s11121-013-0412-8.
Aquilino, W. S., & Supple, A. J. (2001). Long-term effects of parenting practices during adolescence on well-being outcomes in young adulthood. Journal of Family Issues, 22(3), 289-308. DOI: 10.1177/019251301022003002.
Asarnow, J. R. (1992). Suicidal ideation and attempts during middle childhood:
Associations with perceived family stress and depression among child psychiatric inpatients. Journal of Clinical Child Psychology, 21(1), 35-40.
DOI: 10.1207/s15374424jccp2101_6.
Asgeirsdottir, B. B., Sigfusdottir, I. D., Gudjonsson, G. H., & Sigurdsson, J. F. (2011).
Associations between sexual abuse and family conflict/violence, self-injurious behavior, and substance use: The mediating role of depressed mood and anger. Child Abuse & Neglect, 35(3), 210-219.
DOI: 10.1016/j.chiabu.2010.12.003.
Baetens, I., Claes, L., Martin, G., Onghena, P., Grietens, H., Leeuwen, K. V., & Griffith J. W. (2014). Is nonsuicidal self-injury associated with parenting and family
67
factors? Journal of Early Adolescence, 34(3), 387-405.
DOI: 10.1177/0272431613494006.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distiniction in social psychological research: conceptual, strategic, and statistical
considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
DOI: 10.1037/0022-3514.51.6.1173.
Beech, B. F. (2000). The strengths and weaknesses of cognitive therapy approaches to treating depression by mental health nurses. Journal of Psychiatric & Mental Health Nursing, 7(4), 343-354. DOI: 10.1046/j.1365-2850.2000.00298.x.
Billings, A. G., & Moos, R. H. (1984). Coping, stress, and social resources among adults with unipolar depression. Journal of Personality and Social Psychology, 46 (4), 877-891. DOI: 10.1037/0022-3514.46.4.877.
Borrill, J., Fox, P., Flynn, M., & Roger, D. (2009). Students who self-harm: Coping style, rumination and alexithymia. Counselling Psychology Quarterly, 22(4), 361-372. DOI: 10.1080/09515070903334607.
Bowlby, J. (1969). Attachment and loss, volume 1: Attachment. London, England:
Hogarth.
Brent, D. A., Kolko, D. J., Allan, M. J. & Brown, R. V. (1990). Suicidality in
affectively disordered adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 29(4), 586-593.
DOI: 10.1097/00004583-199007000-00012.
Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples:
Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68(4), 609-620. DOI: 10.1037/h0080369.
Cawood, C. D., & Huprich, S. K. (2011). Late adolescent nonsuicidal self-injury: The
68
roles of coping style, self-esteem, and personality pathology. Journal of Personality Disorders, 25(6), 765-781. DOI: 10.1521/pedi.2011.25.6.765.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate selfharm: The experiential avoidance model. Behaviour Research & Therapy,
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending linehan’s
theory. Psychological Bulletin, 135(3), 495-510. DOI: 10.1037/a0015616.
Cruz, D., Narciso, I., Pereira, C. R., & Sampaio, D. (2014). Risk trajectories of self-destructiveness in adolescence: Family core influences. Journal of Child
Dusek, J. B., & Danko, M. (1994). Adolescent coping styles and perceptions of parental child rearing. Journal of Adolescent Research, 9(4), 412-426.
DOI: 10.1177/074355489494002.
Ehnvall, A., Parker, G., Hadzi-Pavlovic, D., & Malhi, G. (2008). Perception of rejecting and neglectful parenting in childhood relates to lifetime suicide attempts for
69
females-but not for males. Acta Psychiatrica Scandinavica, 117(1), 50-56.
DOI: 10.1111/j.1600-0447.2007.01124.x.
Endler, N. S., & Parker, J. D. A. (1990). Multidimensional assessment of coping: A critical evaluation. Journal of Personality and Social Psychology, 58(5),
844-854. DOI: 10.1037//0022-3514.58.5.844.
Epstein, N. B., Ryan, C. E., Bishop, D. S., Miller, I. W., & Keitner, G. I. (2003). The McMaster model: A view of healthy family functioning. In F. Walsh (Ed.), Normal Family Process (pp. 581-607). New York, NY: Guilford Press.
Evans, E., Hawton, K., & Rodham, K. (2005). In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of helpseeking, communication and coping strategies? Journal of Adolescence, 28(4), 573-587. DOI: 10.1016/j.adolescence.2004.11.001.
Evans, E., Hawton, K., Rodham, K., Psychol, C., & Deeks, J. (2005). The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies. Suicide and Life-Threatening Behavior, 35(3), 239-250.
DOI: 10.1521/suli.2005.35.3.239.
Evren, C., Evren, B., Bozkurt, M., & Can, Y. (2014). Non-suicidal self-harm behavior within the previous year among 10th-grade adolescents in Istanbul and related variables. Nordic journal of psychiatry, 68(7), 481-487.
DOI: 10.3109/08039488.2013.872699.
Favazza, A. R., & Conterio, K. (1989). Female habitual self-mutilators. Acta Psychiatry Scand, 79(3), 283-289. DOI: 10.1111/j.1600-0447.1989.tb10259.x.
Fliege, H., Lee, J. R., Grimm, A., & Klapp, B. F. (2009). Risk factors and correlates of deliberate self-harm behavior: A systematic review. Journal of Pychosomatic Rsearch, 66(6), 477-493. DOI: 10.1016/j.jpsychores.2008.10.013.
70
Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion and coping during their stages of a college examination. Journal of Personality and Social Psychology, 48(1), 150-170.
DOI: 10.1037/0022-3514.48.1.150.
Fotti, S. F., Katz, L.Y., Afifi, T. O. & Cox, B. J. (2006). The associations between peer and parental relationships and suicidal behaviours in early adolescents.
Canadian Journal of Psychiatry, 51(11), 698-703.
Friedrich, W., Reams, R., & Jacobs, J. (1982). Depression and suicidal ideation in early adolescents. Journal of Youth and Adolescence, 11(5), 403-407.
DOI: 10.1007/BF01540377.
Gratz, K. L. (2006). Risk factors for deliberate self-harm among female college students:
The role and interaction of childhood maltreatment, emotional inexpressivity and affect intensity/reactivity. American Journal of Orthopsychiatry, 76(2), 238-250. DOI: 10.1037/0002-9432.76.2.238.
Guan, k., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal self-injury as a
time-invariant predictor of adolescent suicide ideation and attempts in diverse community sample. Journal of Consulting and Clinical Psychology, 80(5),
842-849. DOI: 10.1037/a0029429.
Guerreiro, D. F., Figueira, M. L., Cruz, D., & Sampaio, D. (2015). Coping strategies in adolescents who self-harm. Crisis, 36(1), 31-37.
DOI: 10.1027/0227-5910/a000289.
Haines, J., & Williams, C. L. (1997). Coping and problem-solving of self-mutilators.
Journal of Clinical Psychology, 53(2), 177-186. DOI: 10.1002/jclp.10202.
Halpern, L. F. (2004). The relations of coping and family environment to preschoolers' problem behavior. Journal of Applied Developmental Psychology, 25(4),
71
399-421. DOI: 10.1016/j.appdev.2004.06.001.
Halstead, R. O., Pavkov, T. W., Hecker, L. L., & Seliner, M. M. (2014). Family dynamics and self-injury behaviors: A correlation analysis. Journal of Marital and Family Therapy, 40(2), 246-259. DOI: 10.1111/j.1752-0606.2012.00336.x.
Hamid, P. N., Yue, X. D., & Leung, C. M. (2003). Adolescent coping in different Chinese family environments. Adolescence, 38(149), 112-130.
DOI: apa.org/?uid=2003-06113-009.
Henry, C. S., Sager, D. W., & Plunkett, S. W. (1996). Adolescents’ perceptions of family system characteristics, parent-adolescent dyadic behaviors, adolescent qualities, and adolescent empathy. Family Relations, 45(3), 283-292.
DOI: 10.2307/585500.
Holahan, C. J., Moos, R. H., & Schaefer, J. A.(1996). Coping, stress resistance, and growth: Conceptualizing adaptive functioning. In M. Zeidner & N. S.
Endler(Eds.), Handbook of coping: Theory, research, application (pp. 24-43).
Oxford, England: John Wiley & Sons, Inc.
Huss, M., & Lehmkuhl, U. (1996). Coping in the family context: Active and avoidance strategies in adolescents from divorced families. Praxis der Kinderpsychologie und Kinderpsychiatrie, 45(3-4), 123-130.
Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11(2), 129-147.
DOI: 10.1080/13811110701247602.
Jella, S. H. (2007). The family environments of self-injuring female adolescents.
ProQuest Dissertations & Theses A&I.
Kliewer, W., & Lewis, H. (1995). Family influences on coping processes in children
72
and adolescents with sickle cell disease. Journal of Pediatric Psychology, 20(4), 511-525. DOI: 10.1093/jpepsy/20.4.511.
Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between
nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122(1), 231-237.
DOI: 10.1037/a0030278.
Ko, H. C., Lin, M. P., Liao, L. C., Yu, R. L., Su, L. C., & Chang, E. W. C. (2004). The prevalence and psychosocial risk factors for internet addiction among college students in Taiwan. Paper presented at the 1st Asia Pacific Institute of Addictions
Conference, Singapore.
Kopp, C. B. (1989). Regulation of distress and negative emotions: A developmental view. Developmental psychology, 25(3), 343-354.
DOI: 10.1037/0012-1649.25.3.343.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY:
Springer Publishing Company.
Lazarus, R. S. (1991). Emotion and adaptation. New York, NY: Oxford University Press.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002).
A comparison of methods to test mediation and other intervening variable effect.
Psychological Methods, 7(1), 83-104.DOI: 10.1037//1082-989X.7.1.83.
Martens, M. P. (2005). The use of structural equation modeling in counseling psychology research. The Counseling Psychologist, 33(3), 269-298.
DOI: 10.1177/0011000004272260.
73
Martin, J., Bureau, J. F., Cloutier, P., & Lafontaine, M. F. (2011). A comparison of invalidating family environment characteristics between university students engaging in self-injurious thoughts & actions and non-self-injuring university students. Journal Youth Adolescence, 40(11), 1477-1488.
DOI: 10.1007/s10964-011-9643-9.
McAuliffe, C., Corcoran, P., Keeley, H. S., & Perry, I. J. (2003). Risk of suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in university students. Crisis, 24(4), 160-167.
DOI: http://dx.doi.org/10.1027//0227-5910.24.4.160.
McCubbin, H. I., & Thompson, A. I. (1987). Family assessment inventories for research and practice. Madison, WI: University of Wisconsin-Madison.
McMahon, E. M., Corcoran, P., McAuliffe, C., Keeley, H., Perry, I. J., & Arensman, E. (2013). Mediating effects of coping style on associations between mental
health factors and self-harm among adolescents. The Journal of Crisis Intervention and Suicide Prevention, 34(4), 242-250.
DOI: 10.1027/0227-5910/a000188.
McWhirter, J. J., McWhirter, B. T., McWhirter, A. M., & McWhirter, E. H.
(1993). At-risk youth: A comprehensive response. International Journal of Disability Development and Education, 60(1), 68-69. Belmont, CA: Thomson Brooks/Cole. DOI: 10.1080/1034912X.2013.757148.
Mikolajczak, M., Petrides, K. V., & Hurry, J. (2009). Adolescents choosing self-harm as an emotion regulation strategy: The protective role of trait emotional intelligence.
British Journal of Clinical Psychology, 48(2), 181-193.
DOI: 10.1348/014466508X386027.
Moos, R. H., & Schaefer, J. A. (1993). Coping resources and processes: Current
74
concepts and measures. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: theoretical and clinical aspects (pp. 234-257). New York, NY: The Free Press.
Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18(2), 78-83. DOI: 10.1111/j.1467-8721.2009.01613.x.
Olson, D. H., Sprenkle, D. H., & Russell, C. S. (1979). Circumplex model of marital and family systems: Cohesion and adaptability dimensions, family, types and dinical applications. Family Process, 18(1), 3-28.
DOI: 10.1111/j.1545-5300.1979.00003.x.
Olson, D. H. (1993). Circumplex model of marital and family systems: Assessing family functioning. In F. Walsh (Ed.), Normal Family Processes (pp. 104-137).
New York, NY: Guildford Press.
Olson, D. H. (2000). Circumplex model of marital and family systems. Journal of Family Therapy, 22(2), 144-169. DOI: 10.1111/1467-6427.00144.
Portzky, G., De Wilde, E. J., & Van Heeringen, K. (2008). Deliberate self-harm in young people: Differences in prevalence and risk factors between The Netherlands and Belgium. European Child & Adolescent Psychiatry, 17(3), 179-186. DOI: 10.1007/s00787-007-0652-x.
Ross, S., & Heath, N. (2002). A Study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31(1), 67-77. DOI: 10.1023/A:1014089117419.
Rupke, S. J., Blecke, D., & Renfrow, M. (2006). Cognitive therapy for depression.
American Family Physician, 73(1), 83-86.
Seiffge-Krenke, I. (2013). Stress, coping, and relationships in adolescence. Psychology