役男重度憂鬱症之研究

Study for Major Depression during the Military Service

張國榮(Kao-Jung Chang)

指導教授 ： 陳端容 博士

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2005年)

https://doi.org/10.6342/NTU.2005.00969

摘要

目的：
近年來役男憂鬱症問題經常被社會大眾討論，其中以「重度憂鬱症」問題為最為嚴重；但過去多年以來，一直缺乏有關役男「重度憂鬱症」之研究，所以無法對問題是作適當之解釋，或提供完整有效的防範措施。
因此本研究嘗試從役男個人、家庭、及部隊等三個方向進行探討，希望能找出造成役男「重度憂鬱症」之危險因素，並提出相關預防措施，以減少服役後疾病的發生。

方法：
研究樣本分為「重度憂鬱症」及「非重度憂鬱症」役男兩組，其中「重度憂鬱症」役男來自國軍北投醫院、三軍總醫院、及國軍松山醫院之住院患者，而「非重度憂鬱症」役男則來自台北地區三個營區；樣本選擇採立意取樣方式，調查時間自民國九十三年五月至九十三年八月止。
　　研究工具包括個人背景調查、家庭背景調查、服役背景調查、役男壓力源量表、及役男因應量表等；其中役男壓力量表包括軍中勤務壓力、軍中生活壓力、軍中階級壓力、家庭擔心壓力、家庭變故壓力、個人感情壓力、及個人前途壓力等七項分量表；役男因應量表則包括積極想法因應、積極活動因應、積極調適因應、及消極因應等四項分量表。
研究過程為比較「重度憂鬱症」役男與「非重度憂鬱症」役男之個人背景、家庭背景、服役背景、軍中勤務壓力、軍中生活壓力、軍中階級壓力、家庭擔心壓力、家庭變故壓力、個人感情壓力、及個人前途壓力、積極想法因應、積極活動因應、積極調適因應、及消極因應等變項是否具有顯著性差異；並進一步探討上述變項與「重度憂鬱症」發生之相關性；最後建立迴歸模式，用以預測「重度憂鬱症」發生的可能性。
　　使用統計工具為SPSS (10.0)版，統計方法包括使用Factor analysis分析量表的效度，用Reliability analysis-scale分析量表的信度，用Descriptive statistics對「重度憂鬱症」役男與「非重度憂鬱症」役男作描述性分析，用Chi-square test及t-test對「重度憂鬱症」役男與「非重度憂鬱症」役男作差異性分析，用logistic regression 探討各變項與「重度憂鬱症」發生之相關性，並建立迴歸模式。

結果：
對「重度憂鬱症」役男發出182份問卷，回收174份，回收率為95.6%，扣除填答不全之問卷後，有效問卷共155份；對「非重度憂鬱症」役男發出265份問卷，回收256份，回收率為96.6%，扣除填答不全之問卷後，有效問卷共247份。
研究樣本結果發現，「重度憂鬱症」役男相較於「非重度憂鬱症」役男之主要差異特徵為，(1)無業者較多、(2)與家人互動少者較多、(3)有個人精神疾病史者較多、(4)父母婚姻不完整者較多、(5)父親管教方式為嚴格且缺乏溝通者較多、(6)母親管教方式為嚴格且缺乏溝通者較多、(7)家庭年收入低者較多、(8)有家人有精神疾病史者較多、(9)下部隊時間三個月內者較多、(10)對軍中勤務壓力感受較大、(11)對軍中生活壓力感受較大(12)對軍中階級壓力感受較大(13)對家庭擔心壓力感受較大、(14)對家庭變故壓力感受較大、(15)對個人感情壓力感受較大、(16)對個人前途壓力感受較大、(17) 積極想法因應較少、(18) 積極活動因應較少、(19) 積極調適因應較少、(20)消極因應較多。
　　預測「重度憂鬱症」發生之顯著因素包括(1)過去工作狀況、(2)個人精神病史、(3)父親管教態度、(4)家人精神病史、(5)軍中階級壓力、(6)家庭擔心壓力、(7)積極調適因應、(8)消極因應等八項，其所建立之模式對「重度憂鬱症」發生之整體正確預測率為88.9%。

結論：
「重度憂鬱症」役男與「非重度憂鬱症」役男在個人背景、家庭背景、服役背景、壓力源、及因應方式上會有所差異；結果證實「重度憂鬱症」發生的確會受到個人、家庭、及軍中等多重因素影響。因此為了減少「重度憂鬱症」的發生，役男個人、父母、及長官皆有責任，彼此應共同努力合作，注意發病原因及疾病特徵，方能達到防治效果。

關鍵字：役男、重度憂鬱症、壓力源、因應方式

關鍵字

因應方式 ； 役男 ； 壓力源 ； 重度憂鬱症

並列摘要

Object
Depression among enlist men in national service is a widely discussed issue by general public recently. The most serious form of depression is major depression. However, in the past years, there were few researches focusing on this issue. Therefore, no proper explanation was given, nor effective preventive measures were suggested on this issue.
This study attempts to approach this issue from the perspectives of individual, family, and military, and hopes to find out risk factors for Major depression among enlist men in national service, and to suggest preventive measures, in order to decrease morbidity after recruitment into military.

Method
The sample of this study was conducted in two different groups: soldiers with major depression, and soldiers without major depression. Soldiers with major depression were sampling from hospital inpatients from Armed Forces Beitou Hospital, Tri Service General Hospital and Armed Forces Songshan Hospital. The soldiers without major depression were sampling from three military bases in Taipei. Samples were selected by purposive sampling. The survey was conducted from May 2004 to August 2004.
Various data was collected from each individual recruited into this study, including general personal background, family background, military service background, stressor inventory for enlist men, coping skill inventory for enlist men. There were seven factors in the stress inventory: “military duty, military lifestyle, military hierarchy, family concern, family event, personal affection, and personal future stress”; there were four factors in the coping skill inventory : “positive thinking, positive action, positive accommodation, and negative coping”.
General personal background, family background, military background, stress caused by 7 different factors including military duty, military lifestyle, military hierarchy, family concern, family event, personal affection, personal future, and 4 coping styles including positive thinking, positive action, positive accommodation, and negative coping, all were compared to decide if there was significant difference between enlist men of major depression group and non-major depression group. Moreover, correlation of above items and presence of major depression was investigated. Finally, a regression model was developed to predict probability of occurrence of major depression.
SPSS (10.0) was used for statistic analysis in this study. The statistic methods included: using factor analysis to determine the validity of inventories, using reliability analysis-scale to determine the reliability of inventories, using descriptive statistics to perform the descriptive analysis of major depression group and non-major depression group, using chi-square test and t-test to perform the differential analysis between major depression group and non-major depression group, and using logistic regression to explore the correlation between all variables mentioned in above paragraph and the occurrence of major depression in order to develop the regression model.

Result
182 questionnaires were distributed to the group of enlist men with major depression, and 174 of them were returned. The return rate was 95.6%. Excluding the incomplete ones, there were 155 effective questionnaires. 265 questionnaires were distributed to the non-major depression group, and 256 were returned. The return rate was 96.6%. Excluding incomplete ones, there were 274 effective questionnaires.
After analysis of complete questionnaires of both sets, the major depression group of enlist men have following characteristics compared to the non-major depression group: 1. most of them being unemployed before recruitment, 2. less interaction with family members, 3. more psychiatric history, 4. most of their parents marriage status being incomplete, 5. harsher discipline and less proper communication from father, 6. harsher discipline and less proper communication from mother, 7. less family revenue, 8. more psychiatric history among family members, 9. most just being placed at current base in the past three months, 10. perceiving more stress from military duty, 11. perceiving more stress from military lifestyle, 12. perceiving more stress from military hierarchy, 13. perceiving more stress from family concern, 14. perceiving more stress from family event, 15. perceiving more stress from personal affection, 16.perceuving more stress from personal future, 17.less positive thinking for coping, 18, less positive action for coping, 19. less positive accommodation for coping, 20. more negative coping.
The logistic regression model developed in order to predict occurrence of major depression utilizing the following eight factors: past vocational function, personal psychiatric history, discipline attitude of father, psychiatric history in family members, stress caused by military hierarchy, stress caused by family concern, positive accommodation for coping, and negative coping. The predictive accuracy is 88.9%.

Conclusion
Enlist men with major depression and non-major depression soldiers showed significant differences in the aspects of personal background, family background, military background, stressors, and coping; occurrence of major depression was affected by personal, familial, military factors. Therefore, in order to reduce the incidence of major depression, the individual, the parents and the superior officers all share the responsibility of noticing possible symptoms cooperatively to prevent major depression effectively.

Key words: solider, major depression, stressor, coping skill

並列關鍵字

coping skill ； stressor ； solider ； major depression

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