- 學位論文
生活品質SF-8與PHQ-9高危險群之相關分析-以高齡者憂鬱社區服務計畫為基礎
Association between SF-8 and PHG-9 risk group: A Community-based Service Program for Elderly Residents
摘要
研究背景 隨著高齡人口逐年攀升，而高齡者自殺死亡率又是全年齡層之冠，因此針對65歲以上高齡族群之憂鬱篩檢及關懷訪視乃為高齡者自殺防治之手段之一，再者，高齡者自殺傾向除了憂鬱之外，尚可能合併其他生理問題，進而影響自身情緒，因此本研究藉由彰化縣衛生局的主動到點高齡者整合式健康檢查，推估社區長者以PHQ-9問卷所定義的中憂鬱傾向及高憂鬱傾族群的盛行率，並與SF-8生活品質量表進行關聯分析，探討兩者之間的關係，及其與生活習慣、個人病史、跌倒史及認知功能之相關。 材料與方法 本研究為橫斷性研究，以彰化縣結合長照C據點，於108年底開始推動辦理的「高齡者整合式健康檢查」為基礎，針對65歲以上長者提供主動到點的健康檢查，篩檢項目包含憂鬱(Depression)、失智(Dementia)、失能(Disability)及骨密度雙能量X光吸收儀(Dual-energy X-ray Absorptiometry, DXA)檢查，簡稱為「4D健檢」。利用結構式問卷進行變項收集，包括病人健康狀況量表(PHQ-9)、生活品質量表(SF-8)、人口學變項、生活習慣、跌倒狀況、個人病史及認知功能等。本研究先以PHQ-9分數將長者憂鬱傾向分為低(分數介於0-2分)、中(分數介於3-9分)及高憂鬱傾向(分數為10分以上或具死亡念頭)三類，分別以多元羅吉斯迴歸分析(Polytomous logistic regression)及比例風險模式(Proportional Odds Model)探討各因子與憂鬱傾向之相關。 結果 本研究共納入2,861位長者，其中PHQ-9分數介於0-2分的佔72.1% (n=2063)、介於3-9分者佔23.8% (n=682)，而PHQ-9分數在10分以上或者有死亡念頭的長者—亦即憂鬱傾向較高者佔約4% (n=116)。在基本人口學變項、生活習慣、個人跌倒史與病史及認知功能置入多元羅吉斯迴歸模式後加入生活品質變項，結果發現人口學變項中的年齡每增加一歲，其中憂鬱傾向勝算比會增加至3% (95%信賴區間：1-5%)、高傾向的勝算比則增高1% (aOR=1.01，95%信賴區間：0.97-1.06)，抽菸、喝酒、喝咖啡及運動習慣的顯著性則被其他因子解釋後不再具顯著意義，擔心跌倒程度較高者會增加憂鬱傾向的風險且具統計顯著性(中傾向aOR=1.47，95%信賴區間：1.18-1.83；高傾向aOR=1.39，95%信賴區間：0.75-2.59)，慢性病也會會增加憂鬱傾向的風險(中傾向aOR=1.56，95%信賴區間：0.97-2.52；高傾向aOR=5.08，95%信賴區間：1.98-13.00)，認知功能差者有較高的憂鬱傾向(中傾向aOR=2.62，95%信賴區間：1.84-3.73；高傾向aOR=7.07，95%信賴區間：3.81-13.10)，而生活品質量表中的整體快樂程度、自許健康狀況、自許健康限制活動力、情緒問題、自許健康限制社交活動及情緒限制社交等單一題目同樣具顯著影響力，此外，SF-8總分亦仍然顯著影響PHQ-9的健康狀況分類(每增加一分，中傾向aOR=1.19，95%信賴區間：1.16-1.22；高傾向aOR=1.40，95%信賴區間：1.33-1.47)。比例風險模式亦呈現相似的結果，顯示利用PHQ-9分數所定義出的低、中、高憂鬱傾向具有等比例風險的性質。 結論 本研究利用社區主動到點篩檢進行長者關懷與憂鬱篩檢，結果發現生活品質與憂鬱傾向息息相關，而在考慮生活品質之下，個案本身的慢性疾病史、擔心跌倒程度、認知功能及年齡仍為獨立危險因子。而利用PHQ-9分數所定義出的低、中、高憂鬱傾向在本研究中具有等比例風險的性質，顯示長者憂鬱程度可能是循序漸進，因此主動及早期的偵測與關懷可做為高齡者自殺防治策略。
並列摘要
Background Given a trend of ageing population and the fact that suicide rate among elderly is higher than other age groups, early detection of depression has been treated as one means to prevent suicide among elderly. Besides, poor physical conditions might affect elderly people’s emotion and further lead to suicide. This study is based on the community-based out-reaching screening for elderly in Changhua County to estimate the prevalence of depression of high risk group measured by PHQ-9. We further associate the relationship of high risk for depression with quality of life, taking into account of life style, personal disease history, falling history and recognition function. Materials and Method This is a cross-sectional study. The community-based outreaching integrated screening program, named as 4D check, in Changhua County targeted at residents aged 65 and elder for depression, dementia, disability, and Dual-energy X-ray Absorptiometry, DXA. We defined low, medium, and high risk of depression with PHQ-9 questionnaire as score between 0-2, 3-9, and 10+. Those replied experience of death thought would be categorize into high risk group regardless of their PHQ-9 score. Polytomous logistic regression and Proportional Odds Model were used to associate the risk factors and risk group for depression. Results A total of 2,861 elder residents were recruited in this study. The prevalence of low-, medium, and high-risk group were 72.1% (n=2063), 23.8% (n=682), and 4% (n=116), respectively. In the multivariate polytomous regression, per 1-year advanced age increased 3% (95% CI: 1-5%) odds for medium-risk and 1% (aOR=1.01, 95% CI: 0.97-1.06) for high risk. The effects of smoking, alcohol drinking, coffee drinking, and exercise identified in the univariate analysis became insignificant in the multivariate analysis. Worries for falling increased risk of being medium risk (aOR=1.47, 95% CI: 1.18-1.83) and high risk (aOR=1.39, 95% CI: 0.75-2.59). So are personal history of chronic disease (medium-risk: aOR=1.56, 95% CI: 0.97-2.52; high-risk: aOR=5.08, 95% CI: 1.98-13.00) and poor recognition function (medium-risk: aOR=2.62, 95% CI: 1.84-3.73; high-risk: aOR=7.07, 95% CI: 3.81-13.10). For quality of life, individual items for happiness, perceived health-status, the associated restrict for daily life, emotion, and restricted social activity all show significant effect on the degree of depression. Per one score worse quality of life would advance the risk of depression (medium risk: aOR=1.19, 95% CI: 1.16-1.22; high risk: aOR=1.40, 95% CI: 1.33-1.47). The proportional odds models show the similar results, indicating the proportional risk between high and medium-risk and between medium and low-risk。 Conclusion The association between quality of life and the risk for depression was shown in this community-based outreaching screening program for elder residents. Personal history of chronic disease, worries for falling, poor recognition function, and age were also identified as independent risk factors for depression. The property of proportional odds from low, medium, and high-risk defined by PHQ-9 supports the progressive process of depression in elderly. Hence, active and early detection together with intervention is convincing for preventing suicide in elderly people.