台灣老人精神抑鬱的狀況、改變及影響因子:10年長期追蹤研究

The Status, Changes and Determinants of Depression of the Elderly in Taiwan: A Ten-Year Longitudinal Study

楊景閔(Chin-Min Yang)

指導教授 ： 林惠生 ； 翁玉青

中山醫學大學/健康管理學院/營養學研究所/碩士(2005年)

https://doi.org/10.6834/CSMU.2005.00081

摘要

目的：本研究旨在以十年長期追蹤的老人樣本來探討台灣地區六十歲以上老人，其精神抑鬱(Depression)的狀況及程度，及其伴隨老人年齡的增加所發生的改變，以及不同出生世代、性別、教育程度及族群間所發生之抑鬱狀況與程度上的差異。最後則是從十年間老人家庭、社會經濟與健康狀況的變化，來分析其與老人抑鬱的關係，以找出影響老人發生精神抑鬱的因子。

方法：利用行政院衛生署國民健康局提供的1989年、1993年、1996年以及1999年四次主波的『台灣地區老人保健與生活問題長期追蹤調查』的資料進行分析，以四波抑鬱量表（CES-D）皆完整回答者共1,755位60歲以上老年人當作研究樣本，建構老人抑鬱程度指數，並以此指數值10分或以上列為有抑鬱之老人，以此二者做為本研究之依變項。比較1989年與1999年之家庭狀況、社會經濟及健康狀況以及其抑鬱程度指數及有抑鬱者的比例，來測量其情境狀況及抑鬱狀況之變化，再以複迴歸（Multiple Regression）以及邏輯斯迴歸（Logistic Regression）進行多變數分析其與抑鬱程度及有無抑鬱者比例間的關係，以探討老人精神抑鬱的影響因子。

結果：總體來看，臺灣地區1989年初訪時為六十歲以上之受訪老人，1989年之抑鬱盛行率為21.7%，經比較四次追蹤調查抑鬱狀況，發現十年間四次訪查顯示皆沒有抑鬱的老人有49.0%，而有11.7%的老人這十年間具有三至四次以上的抑鬱狀況。具有三至四次以上的抑鬱狀況係以1914年或以前出生世代（75歲以上）的老年人比例為最高（21.1%）；女性高於男性（女：17.9%；男：6.7%）；教育程度較高之國中以上的老年人其有三至四次抑鬱的較少（無受教育：17.9%；國小：29.0%；國中：4.1%；高中及以上：3.6%）。抑鬱程度及有抑鬱者老年人的比例十年間都是伴隨老年人年齡的增長呈現提高或增加的趨勢。且十年前後從有配偶變為無配偶者（有→無）、經濟狀況從良好到不好者（良好→不好）、自評健康狀況從良好到不好者（良好→不好）、失能狀況由無失能到有失能（無→有）以及體能狀況從良好到不好者（良好→不好），其十年間抑鬱程度、及有抑鬱者老年人的百分比皆顯著上升。在控制了其他因子後，複迴歸以及邏輯斯迴歸分析皆顯示老年失去配偶、經濟狀況不好或變不好、自評健康不好或變不好、失能或變失能以及體能狀況不好或變不好等因子，對於十年後的抑鬱狀況及程度具有顯著影響，此外，原來有抑鬱也會增加十年後仍有抑鬱的風險，這些均為台灣老人抑鬱的重要影響因子。至於與子女同住狀況之變化和工作狀況之變化對於老年人的抑鬱狀況之影響，其結果並不明顯。

關鍵詞：長期追蹤、台灣地區、老人、精神抑鬱

關鍵字

長期追蹤 ； 台灣地區 ； 老人 ； 精神抑鬱

並列摘要

Objectives The purposes of this research are to study the status and level of depression, their changes following the increase of age, and the differences of the status and level of depression as well as their changes among the elderly of different birth cohort , gender, level of education and ethnicity in Taiwan aged 60 and above. Moreover, the effects of the depressive status in 1989 and changes in the status of spouse availability, co-residence with children, working, economy and health between 1989 and 1999 on the status and level of depression of the elderly in 1999 were analyzed to find out the determinants of depression of the elderly in Taiwan.

Methods This research used representative panel sample survey data collected in the four waves of “The Longitudinal Sample Survey of Health and Living Status of the Elderly in Taiwan” conducted in 1989, 1993, 1996 and 1999 by the predecessor organization of the Bureau of Health Promotion, Department of Health. A panel sample of 1775 elderly who were 60 years old and over at the time of first interview in 1989 and re-interviewed in 1993, 1996 and 1999 with complete depression scale (CES-D) data was taken for this analysis. Depression index score (CES-D score) was constructed from ten items of depression measure (CES-D) to measure the level of depression and CES-D score equal or higher than 10 (CES-D≧10) was used to measure if the elderly has depression (depression status). A comparison of the family, social economic and health status as well as mean CES-D score and depression status in 1989 and 1999 was used to measure their changes. Multiple regression and logistic regression were used to do multivariate analysis of the determinants of depression level and status.

Results The prevalent rate of depression for the elderly aged 60 and above in Taiwan in 1989 was 21.7%. A comparison of the depression status in 1989, 1993, 1996 and 1999 indicated that about half (49.0%) of the elderly aged 60 and above in Taiwan in 1989 showed no depression at the four times of interview spanning over the 10 years period. Slightly more than one-tenth (11.7%) of the elderly was found to have depression in three or four times of interview. Among them, more were born in 1914 or earlier (i.e., age 75 and over in 1989). Much more female than male (17.9% vs. 6.7%) was found to have depression in three or four times of interview in the 10 years period. The elderly with higher educational attainment tends to have less proportion having depression in three or four times of interview than those with lower education (senior high and above: 3.6%; junior high: 4.1%; primary: 29.0% and none: 17.9%). Both level of depression and the proportion having depression increased by the increase of age of the elderly. However, the effect of aging on depression of the elderly tends to be indirectly through other intermediate covariates. Those elderly, who had depression in 1989 or who lost spouse, became disable, and became poor in economic status and health status from good status between 1989 and 1999 are significantly more likely to increase level of depression and risk of becoming depression in 1999. These tendencies existed even controlling for the effects of other covariates on the level of depression in the multiple regression analysis and on the likelihood of becoming depression in the logistic regression analysis. Thus, losing spouse, becoming disability and deterioration of economic and health status tend to be important determinants of level and status of depression of the elderly in Taiwan. Changes in co-residence with children and in working status do not have significant effect on level of depression and risk of becoming depression of the elderly in Taiwan.

Key words： Panel study, Taiwan area, the elderly, depression

並列關鍵字

Panel study ； Taiwan area ； the elderly ； depression

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