從個人、家庭、學校探討台北市國中生憂鬱症狀的相關因素

Personal, Familial, and School Factors Related to the Symptoms of Depression among Junior High School Students in Taipei

謝佳容(Chia-Jung Hsieh)

指導教授 ： 張玨

國立臺灣大學/公共衛生學院/衛生政策與管理研究所/博士(2006年)

https://doi.org/10.6342/NTU.2006.01909

摘要

研究背景：21世紀心理衛生是重要的全球健康議題，特別是當憂鬱症在年輕世代逐漸增加，初次發病年齡亦逐漸下降之際，需要以生態觀點檢視影響青少年憂鬱症狀的相關因素，即從個人所身處的個人、家庭和學校來看影響青少年心理健康的因素。
研究目的：1.瞭解台北市國中學生憂鬱症狀的分佈2.瞭解影響台北市國中學生憂鬱症狀的相關因素3.分析影響台北市國中學生憂鬱症狀的相關因素之不同層級差異與效果
研究方法：本研究自民國92年3月15日至92年12月31日，以台北市各行政區國中內學校之學生為對象，採用『抽取率與單位大小成比例的多階段集體抽樣』，經由研究者與受訓過的訪員進行面對面實際問卷施測收集資料，問卷篩檢者為1009位，回應率為98.82％，有效問卷1000份，問卷完整率為99.11％，共施測五個行政區的十所學校。統計以套裝軟體「SPSS for Windows 12.0版」進行資料分析。方法包括描述性統計、信度、效度分析與各項檢定，設定α值0.05為顯著水準，並透過結構方程模式和階層線性模式進行複雜因素之間的因果關係和不同層級變項與變項之間的驗證。
研究結果：1.本研究對象重度憂鬱症狀的點盛行率為5.20％。2.憂鬱症狀與個人、家庭、學校各測量變項間具有重要的顯著相關性，在個人的『人格特質』方面，研究對象的憂鬱症狀與神經質人格具有統計顯著正相關。於『因應策略』方面，研究對象的憂鬱症狀與採取直接行動的因應策略具有統計顯著負相關，而與緩和延遲、自傷因應策略具有統計顯著正相關。於『生活總壓力』方面，憂鬱症狀與生活總壓力具有顯著正相關。於『家庭變項』方面，研究對象的憂鬱症狀與家庭關懷度具有顯著負相關。而憂鬱症狀得分亦與家庭社經地位指數具有顯著負相關。於『學校變項』方面，研究對象的憂鬱症狀與同學支持、師長支持以及社會資源具有顯著負相關。3.從結構方程式整體效果的分析顯示，個人「神經質人格」、『因應策略』可以直接的影響「憂鬱症狀」，而「生活總壓力」可以直接或間接的影響「憂鬱症狀」，且為干擾變項，可透過「家庭關懷度」和『學校支持』的中介機制而形成。4.透過階層線性模式，研究發現各個學校在憂鬱症狀得分上有顯著的差異，在憂鬱症狀的總變異之中有1.5％是由於學校所造成。
研究建議：本文針對個人、家庭和學校層面，提出增強保護因子和降低危險因子的方法，以達國中生心理健康促進和憂鬱症防治的目標。

關鍵字

國中生 ； 憂鬱症狀 ； 生態 ； 階層線性模式 ； 結構方程式

並列摘要

Background:
Mental health is a very important issue of global health. Unfortunately, depression has increased dramatically among young people, and the average age of onset has fallen. To understand mental health in adolescents, we need to explore the factors associated with depression symptoms in ecological aspect, that including personal, familial, and school factors.
Purpose:
1.To understand the distributions of depression symptoms among junior high school students in Taipei.
2.To explore the factors associated with depression symptoms among junior high school students in Taipei
3.To analyze the multi-level factors and effects related to depression symptoms among junior high school students in Taipei
Method:
The data were collected from March15 to Dec. 31, 2003. The study subjects represented the entire junior high school student population in Taipei. Probability proportional sampling was employed to select sample sizes in each school district. Data were collected face-to-face through training visits to subjects. 1009 subjects were screened; the response rate was 98.82%. 1000 questionnaires were collected, and the completion rate was 99.11%. In total, the sample included ten schools from five areas. Descriptive analysis, reliability, validity and correlation analysis were used to analyze the data by SPSS for Windows 12.0. The Cronbach's alpha coefficients were at a significant level, at 0.05. This study further utilized the structure equation model (SEM) and hierarchical linear model (HLM) to analyze the complexity of factors in causal relation to adolescent depression symptoms.
Results:
1.This prevalence of serious depression symptoms in subjects was 5.20%
2.The depression symptoms in subjects showed significant correlation to individual, family, and school variables. In the personal dimension, subjects’ depression symptoms showed significant positive correlation to personality neuroses. In the coping strategy dimension, subjects’ depression symptoms showed significant negative correlation to strategies of direct action, and these in turn showed positive correlation with delay strategies and strategies of self-harm. The subjects’ depression symptoms showed significant positive correlation to life stress. In the family dimension, subjects’ depression symptoms showed significant negative correlation to family concerns, and family economic status, too. In the school dimension, subjects’ depression symptoms showed significant negative correlation to classmate support, teacher support and social services.
3.Findings from the total effect of structure equation model analysis showed that the personality neuroses and coping strategy variables may have a direct effect on depression symptoms, and that life stresses may have both direct and indirect effects on depression symptoms. These stresses represent intervening variables which can be moderated through family concern and school support.
4.Findings from the multilevel analysis showed that the depression symptoms scores were significantly different in each school. The results found 1.5% total variance in depression symptoms caused by school variables. Community effects were not significant, however.
Recommendations:
We suggest designing multi-faceted programs which should be supported on personal, family, and school levels in this article. We need to enhance protection factors and reduce risk factors in order to promote the mental health and to prevent the adolescent depression.

並列關鍵字

Junior high school students ； Depression symptoms ； Ecological ； Hierarchical linear model ； Structure equation model

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