災難影響主觀知覺與後續適應及正向成長之關聯：以高雄氣爆災民為例

The Relationship Between Disaster Subjective Perception and Posttraumatic Adaptation and Positive Growth: A Case of Kaohsiung Gas Explosions

嚴翰威(Han-Wei Yen)

指導教授 ： 謝碧玲

高雄醫學大學/人文社會科學院/心理學系碩士班/碩士(2018年)

摘要

過去研究發現，人們對於重大壓力事件的主觀評估或解釋，會決定其後續發展，當有較負面或不利的評估，會導致個人較不適應的因應和適應結果（Lazarus & Folkman, 1984; Leventhal, 2003），反之個體能夠從災難或是創傷事件中覺察出正向的改變時，這會與創傷後成長有關（Tandon & Mehrotra, 2007）。因此本研究的目的為檢驗災難影響量表（Impact of Disaster Scale , IDS）之信效度，並用以測量個體對於高雄氣爆事件所造成生活的全面影響之主觀知覺，進而探討對災難事件的主觀知覺與後續心理適應和創傷後成長的關聯。
本研究招募1017位高雄氣爆災區民眾（女性59.1%；平均年齡49.29歲，SD = 14.81），於氣爆發生兩個月後（第一點）之健康檢查中填寫PTSD篩檢量表、病人健康狀況問卷以及負向IDS、，之中抽取481位災區民眾（女性57.6%；平均年齡49.33歲，SD = 14.37 ）在氣爆一年後（第二點）填寫負向及正向IDS及其他心理適應相關量表，並在氣爆後第二年（第三點）持續進行追蹤，共回收問卷338份（女性56.2%；平均年齡50.28歲，SD = 14.25 ）。 災難影響量表，為四點量表（從沒有變差/好，到非常差/好），測量災難對民眾在生活的五個領域包含：「健康」、「日常生活」、「環境」、「人際」、和「自我」的正向與負向之影響。
由驗證式因素分析結果顯示，以氣爆一年後為樣本在正影響量表（ CFI = .97, RMSEA = .068）及負影響量表（CFI = .96, RMSEA = .061 ）之五因素與高階一因素模式皆達良好之適配度；而在氣爆兩年後之追蹤樣本結果的分析也顯示，正影響量表 （CFI = .97 , RMSEA = .071） 與負影響量表 （CFI = .93, RMSEA = .078）之結構適配度同樣為可接受的。由迴歸分析顯示，第二點負向災難影響知覺能預測第三點之憂鬱（β = .403, p < .001）、焦慮（β = .473, p < .001）、創傷後壓力反應（β = .494, p < .001）、生活滿意度（β = - .306, p < .001），但無法預測創傷後成長；正向災難影響知覺不僅也能預測憂鬱、焦慮、創傷後壓力反應和生活滿意度，此外，正向影響的自我領域也能預測創傷後成長（β = .332, p < .001）。
災難影響量表之因素結構在高雄氣爆事件災民之樣本中亦具有一致之穩定性，顯示災難影響是由五個生活領域之影響所組成，並且能有效預測災民在後續的心理適應，而對比於負向影響的不同，正向影響能預測創傷後成長，此研究結果可能有助於描繪氣爆災民之創傷後成長歷程。

關鍵字

高雄氣爆事件 ； 災難影響主觀知覺 ； 災難影響 ； 災後適應 ； 創傷後成長

並列摘要

Objective: Even encountering the same disaster, people manifest different adaptation outcomes （Linley & Joseph, 2004）. One key factor to consider is how negatively or positively people appraise the impacts of disaster on their lives（Collins, Taylor, & Skokan, 1990）. And the concept that when individuals can perceive a positive changes from a disaster or trauma is very similar to the course of post-traumatic growth （Tandon & Mehrotra, 2007）. In addition, previous studies paid more attention to the results of post-traumatic growth, where there was little to explore the course of development of post-traumatic growth （Tedeschi & Calhoun, 2004; Zoellner & Maercker, 2006）. For these reasons, the purposes of this research were to establish the reliability and validity of the Impact of Disaster Scale （IDS） and to investigate how people’s appraisals, both negative and positive, related to psychological adaptation and post-traumatic growth after disaster.
Methods: 1017 people （59.1% female; mean age = 49.29, SD = 14.81; most married; and most with high school or college education） affected by the gas explosions in Kaohsiung 2014 filled the negative scales of IDS 2 months afterwards in a physical check-up; of them, 481 people （57.2% female; mean age = 49.33, SD = 14.37） filled both negative and positive scales of IDS in a physical check-up again about a year afterwards, and 338 people（56.2% female; mean age = 50.28, SD = 14.25）continue to track after two years of events, and participated in the study with informed consent. The Impact of Disaster Scale （IDS） using a 4-point scale （from no impact to highly impact） measures both positive and negative impacts, each with five domains: physical and mental health （HE）, daily life and activities （DC）, living environments （EN）, social and intimate relationships （RE）, and faith and goals （FG）.These domains were based on the fields of the World Health Organization Quality of Life assessment instrument-Taiwan version （Yao, 2002）.
Results: It was found that: （1）Second-order confirmatory factor analysis showed that the fit indices for both positive IDS （CFI = .97, RMSEA = .068）and negative IDS （CFI = .96, RMSEA = .061）have shown a good fitness. And this model were acceptable with the sample of the event two years later.（2）The higher the perceived negative impacts from Kaohsiung gas explosions, the higher the levels of depression（β = .403, p < .001）, anxiety（β = .473, p < .001）, PTSD symptoms（β = .494, p < .001）, and the lower the level of life satisfaction（β = - .306, p < .001）, but cannot predict the post-traumatic growth. On the other hand, positive impacts can predict not only depression, anxiety, PTSD symptoms, and life satisfaction, but post-traumatic growth（positive Faith and goals , β = .332, p < .001）.
Conclusions: It was found that (1) The factor structure of the disaster impact scale also has consistent stability in the sample of the Kaohsiung gas explosions. And also indicating that the disaster impact is composed of the impact of five living areas. (2) IDS can effectively predict the psychological adaptation of the victims, and contrast in the negative impact, positive impact can predict post-traumatic growth. In conclusion, the results showed that the Impacts of Disaster Scale has good reliability and validity, and it is useful in assessing disaster victims’ concerns which may lead to emotion difficulties and can be a focus for intervention. Moreover, the Impacts of Disaster scale and findings of the study can be helpful to further the understanding of post-traumatic growth process.

並列關鍵字

Kaohsiung Gas Explosions ； Subjective perceptions of impacts after disaster ； Impacts of disaster, Psychological adaptation after disaster ； Post-traumatic growth

參考文獻

車先蕙、盧孟良、陳錫中、張尚文、李宇宙（2006）。中文版貝克焦慮量表之信效度。台灣醫學，10(4)，447-454。

翁德怡、石富元（2002）。災難事件的定義、分類與分級標準。台灣醫學，6（3），350-356。

楊聰財、李明濱（2004）。九二一集集大地震災後精神疾病研究論文之分析。台灣醫學，8（3），301-312。

中文文獻

2014 年臺灣高雄氣爆事故（2014 年11 月15 日）。取自維基百科：http://zh.wikipedia.org/w/index.php?title=2014%E5%B9%B4%E8%87%BA%E7%81%A3%E9%AB%98%E9%9B%84%E6%B0%A3%E7%88%86%E4%BA%8B%E6%95%85&oldid=33343507