研究目的:探討台灣中老年人之自覺壓力來源、社會支持與憂鬱傾向間之相關性。 方法:本研究為橫斷式研究設計,使用行政院衛生署國民健康局之2003年「台灣地區中老年身心社會生活狀況長期追蹤調查」資料進行次級資料分析。研究對象為能夠自己回答問卷且有完成憂鬱量表的50歲以上中老年人,共計4,987位。本研究以流行病學研究中心量表(Center for Epidemiologic Studies Depression Scale, CES-D)的10題版本進行憂鬱傾向的測量;自覺壓力源包括自己的健康、自己的經濟、自己的工作狀況、家人問題(健康、經濟、工作或婚姻等)與家人的相處關係等五項壓力來源;社會支持則包括工具性支持與情感性支持。本研究使用SPSS12.0套裝軟體進行卡方檢定以及邏輯斯迴歸分析。 研究結果:台灣中老年人憂鬱傾向比例為16.3%;自覺生活中曾感受到壓力者則佔64.4%,樣本自述有工具性社會支持與情感性社會支持者則各佔71.5%及70.4 %。研究樣本中以女性、年齡越高、教育程度越低、沒有配偶、沒有工作、經濟狀況越差、自評健康越差、疾病數越多、有跌倒經驗者,較容易出現憂鬱傾向。而在控制了人口學特質、健康狀況等相關因素後,樣本對個人的健康(OR=2.19,95%CI=1.78-2.67)、經濟(OR=2.07,95%CI=1.67-2.57)、工作狀況(OR=1.65,95%CI=1.27-2.15)、家人問題(OR=1.59,95%CI=1.29-1.95)和家人相處關係(OR=2.32,95%CI=1.78-3.03)等五種壓力源有感受到壓力時,均分別有較高的機會出現憂鬱傾向;且自覺壓力來源越多,有憂鬱傾向的機會越高;而研究樣本本身所得到的情感性社會支持越多(OR=0.60),有憂鬱傾向的機會則顯著較低。 結論:台灣中老年人的各種自覺壓力源均和憂鬱傾向有顯著相關,顯示中老年人在感受到生活壓力時,連帶地容易對心理健康產生影響;而情感性社會支持則能夠顯著降低中老年人出現憂鬱傾向的機會。建議衛生單位可加強對中老年人宣導造成憂鬱症的常見原因,在中老年人面對生活狀況改變時而產生憂鬱傾向前期,即能適時掌握個人心理健康狀況;並提供壓力調解的有效方法,減少中老年人因生活壓力導致憂鬱症的發生。當中老年人自我檢測有憂鬱傾向的可能時,更應宣導適當使用身心科相關門診、及時就醫,避免憂鬱狀況惡化。
Objectives: The purpose of this study was to explore the relationships between perceived stress, social support and depression tendency among the middle aged and elderly in Taiwan. Methods: This study was a cross-sectional design and used secondary data from Survey of the Health and Living Status of the Middle-Aged and the Elderly in Taiwan in 2003. There were 4987 samples who have completed the CES-D scale. In this study, depressive tendency was measured by the “Center for Epidemiologic Studies Depression Scale”, version of 10 questions. Perceived stress included the press from their own health status, economy, working conditions and family issues (including health, economy, work, marriage). Social support included instrumental and emotional support of respondents. Results: The results indicated that 16.3% of the respondents were likely to have depressive tendency, 64.4% perceived life have felt the pressure and 71.5% and 70.4% reported having instrumental and emotional support. Female, respondents who were older, lower education, with no spouse, unemployed, lower economic status, poor self-rated health, illnesses and had fall experience were more likely to have depressive tendency. After controlling for the demographic characteristics, health status and other relevant factors, respondents had pressure from own health(OR=2.19,95%CI=1.78-2.67), economic status(OR=2.07,95%CI=1.67-2.57), working status(OR=1.65,95%CI=1.27-2.15), family issues(OR=1.59,95%CI=1.29-1.95) and their family relations(OR=2.32,95%CI=1.78-3.03)were more likely to have depressive tendency. However, when respondents received more emotional social support(OR=0.60), they had significantly lower chance to have depressive tendency. Conclusion: A variety of perceived stressors were significantly associated with depression, it meant that the pressure were easily related to impact mental health, and emotional social support can significantly reduce the opportunity of depression tendency for middle aged and elderly. We suggested that the health agency can strengthen the awareness of depression for middle aged and elderly and help the elderly to adapted the difference of living conditions and provide effective program to reduce the occurrence of life stress. Meanwhile, we should promote proper use of mental health department, to prevent depression from depressive tendency.
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