臺灣老年人憂鬱傾向之發展軌跡及影響因素：18年之長期追蹤研究

The trajectory of depression tendency and affecting factors among the elderly in Taiwan: an 18 years panel study

王長偉(Chang-Wei Wang)

指導教授 ： 張珏

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10528

摘要

研究目的:本研究欲藉由具代表性之長期固定追蹤樣本，探討臺灣老年人之憂鬱傾向發展軌跡類型、研究調查期間之變化趨勢，及其預測因子。
研究方法: 本研究採用『臺灣地區中老年身心社會生活狀況長期追蹤調查』於1989年至2007年間所進行之六波追蹤調查進行次級資料分析。以10題版本之流行病學研究中心憂鬱量表（Center for Epidemiological Studies Depression Scale, CES-D）評估憂鬱傾向。在排除代答資料後，以756位CES-D資料完整之60歲以上老年人為研究要本，其中男性佔52.0％。本研究以Group-Based Trajectory Modeling 進行憂鬱傾向之發展軌跡分析，以多變項羅吉斯迴歸探討發展軌跡類型之影響因素。
研究結果: 研究樣本之憂鬱傾向於六波調查期間呈現先下降後上升之趨勢，平均分數介於4.75~5.91間，並以2007年第六波追蹤調查時最高。且女性之憂鬱傾向於各波追蹤時均顯著較男性為高。就男性而言，憂鬱傾向之發展軌跡可區分為三種類型：輕微且下降(51.9％)、中等且後期上升（42.0％）、嚴重且上升（6.1％）。女性之憂鬱傾向發展軌跡可區分為四種種類型：輕微且下降（62.3％）、中等變嚴重後下降（14.6％）、中等且上升成嚴重（17.1％）、持續嚴重（6.1％）。研究結果顯示男、女性之憂鬱傾向發展軌跡類型不盡相同。在相關之影響因素方面，不論是男性或女性，IADLs失能數多、自評健康狀況不佳、生活滿意度低等因素，對發展為較不理想之憂鬱傾向發展軌跡類型均有顯著影響。但教育程度較高、自評經濟狀況較滿意、社會支持中之工具性支持較高等因素，則僅對女性不易發展成較不理想之憂鬱傾向發展軌跡類型有顯著影響。
結論：整體而言，女性之憂鬱傾向顯著高於男性，且男、女性之憂鬱傾向長期發展軌跡，在軌跡類型及憂鬱傾向程度均有所不同，故在制訂或執行相關心理健康政策或改善方案時，應將性別差異納入考量。

關鍵字

憂鬱症 ； 老年人 ； 發展軌跡 ； 性別差異 ； 縱貫性研究

並列摘要

Objectives: The purposes of this study were to identify the developmental trajectories of depressive tendency and to explore the related risk factors among the elderly in Taiwan.
Methods: The study used data from six waves of the Taiwan Longitudinal Study on Aging (TLSA) panel survey conducted in 1989 to 2007. Depressive tendency was assessed longitudinally using 10-item version of Center for Epidemiological Studies Depression Scale (CES-D) in 756 participants (52% male) aged 60 or above. The group-based trajectory modeling and multinomial logistic regression were used in the statistical analysis.
Results: The depressive tendency decresed and then rising over time in the study period. Female had significantly higher depressive tendency than male in the six wave survey. Three trajectories of depressive tendency were identified for male: persistent low (51.9%), median (42.0%), and chronic (6.1%). Four trajectories of depressive tendency were identified for female: low (62.3%), high decling (14.6%), late peak (17.1%), and severe chronic (6.1%). The high-level trajectories of depressive tendency were significantly associated with more physical disabilities (IADLs), poor perceived health status, poor life satisfaction for both male and female. Higher education level, higher perceived economic status and higher instrumental social support were significantly associated with low-level trajectories of depressive tendency for female elderly only.
Conclusions: The depressive tendency was significant higher in female than in male during the study period. The trajectories of depressive tendency were different in the pattern and severity level between male and femal. Therefore, gender difference should take into consideration when implementing mental health promotion policy.

並列關鍵字

depression ； elderly ； group-based trajectory modeling ； gender difference ； longitudinal study

參考文獻

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