以緩解與縱貫設計探討憂鬱症患者缺乏自我肯定行為與憂鬱症狀的關係：以某地區醫院為例

Exploring the Relationship between Lack of Assertive Behaviors and Depressive Symptoms in Depressed Individuals: Using Remission and Longitudinal Designs in a Local Hospital

方格正(Ko-Cheng Fang) ； 楊政璋(Cheng-Chang Yang) ； 武維馨(Wei-Hsin Wu) ； 李佩怡(Pei-Yi Li)

《臨床心理學刊》 6卷2期 (2012/12) Pp. 31-39

https://doi.org/10.6550/ACP.201212_6(2).0004

摘要

目的：本研究透過（1）比較憂鬱發作者、緩解者及控制組之自我肯定行為，及（2）分析缺乏自我肯定行為對其未來憂鬱症狀的預測力等兩個設計，探討缺乏自我肯定行為是否為憂鬱症之脆弱因子（vulnerability）。方法：參與者包含憂鬱發作組30人、緩解組21人，及控制組30人。以「人際行為量表」評估自我肯定行為，「貝克憂鬱量表」評估憂鬱症狀。憂鬱症患者在初次施測兩個月之後再次追蹤其憂鬱症狀。結果：（1）憂鬱發作組在自我肯定各分量尺上均低於控制組，緩解組與控制組間則無顯著差異。（2）在控制初次憂鬱症狀後，自我肯定行為中的自信心分量尺仍可顯著預測兩個月後之憂鬱症狀。結論：研究結果支持缺乏人際互動中的自信心為憂鬱症之脆弱因子。臨床工作可著重於增加案主人際互動自信心與動機，進而緩解憂鬱症狀。

關鍵字

自我肯定 ； 憂鬱（症） ； 人際行為 ； 脆弱因子 ； 緩解 ； 縱貫設計

並列摘要

Objective: Lack of assertive behaviors has been considered a possible vulnerability to depression; the cross-sectional design was utilized in most past studies to investigate the relationship between assertive behaviors and depressive symptoms, which can not clarify whether non-assertiveness is a vulnerability to depression, or just a consequence of depression. Moreover, assertiveness is a concept from Western culture, and the relationship between non-assertiveness and depression for people who live in Chinese culture remains uncertain. This study used the remission and longitudinal designs to explore the relationship between assertive behaviors and depressive symptoms in patients who had been diagnosed with major depressive disorder in Taiwan. Method: (1) In the remission design, the participants included 30 patients who were under a major depressive episode currently, 21 patients with remitted major depressive disorder, and 30 normal controls. Assertive behaviors were measured by the Interpersonal Behavior Survey (IBS), including four assertive behavior subscales (self-confidence, initiating assertiveness, defending assertiveness, and frankness). Depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II). (2) In the longitudinal design, the depressive symptoms of both depressed and remission patients were reassessed after two months from the first assessment. Thirty participants completed the BDI at the reassessment. Results: (1) The depressed group demonstrated lower scores than the controls did on four assertive behavior subscales, while the remission and control groups did not show significant difference in the four subscales. (2) After controlling the first BDI assessment scores, self-confidence subscale still significantly predicted the second BDI assessment scores. Conclusion: The results revealed that lack of interpersonal self-confidence predicted future depressive symptoms, which supported that lack of self-confidence could be a vulnerability to depression. For implication in clinical practice, therapists can help clients by focusing on their assertive behaviors and enhancing clients’ self-confidence and motivation for interpersonal interaction to relieve depressive symptoms.

並列關鍵字

self-assertion ； depression ； interpersonal behaviors ； vulnerability ； remission ； longitudinal design