述情特質為適應障礙男性軍人的篩檢指標

Alexithymia as a screening index for male soldiers with adjustment disorder

陳柏翡(Po-Fei Chen)

指導教授 ： 龍佛衛

共同指導教授 ： 陳正生(Cheng-Sheng Chen)

高雄醫學大學/健康科學院/心理學研究所/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00162

摘要

背景：述情障礙（alexithymia）的人較缺乏同理能力，而此障礙在精神疾病的發生率較高。過去不同的研究分別發現雙親教養、人格特質和述情障礙間的關係，然而此三者的路徑關係仍不明。因此本研究的目的為探討述情障礙是否為精神健康和適應障礙的預測因子，以及述情障礙與雙親教養風格和人格特質的路徑關係。此外，若述情障礙為適應障礙的促發因素，它是否為有效和具經濟效益的精神健康篩檢工具。
方法：本研究募集一百五十八位被診斷為適應障礙的義務役和一百五十五位控制組的年輕男性軍人。所有參與者均填答雙親教養態度量表、艾氏人格問卷、台灣版多倫多述情量表(TAS-20)以及華人健康問卷。
結果：適應障礙組的平均年齡為21.46（標準差=2.35），控制組為22.94（標準差=2.26）。邏輯回歸顯示年紀輕、高神經質人格特質、較差的心理健康狀況和無法區分內在情緒的述情特質，有較高的傾向會發展為適應障礙。結構方程式的路徑關係顯示雙親教養影響人格特質，人格特質影響述情特質，以及述情特質影響精神健康路徑的人比較可能發展為適應障礙。排除精神健康的中介因素，述情障礙能夠預測適應障礙。TAS-20的三個因素當中，無法區分內在情緒對適應障礙有直接的影響，而上述的因素能夠解釋本樣本59%的變異量。接受者操作特徵發現使用無法區分內在情緒篩檢適應障礙最佳的切分點為21/22，得到敏感性0.84、特異性0.87、陽性預測值0.87以及陰性預測值0.84。
討論：此研究發現雙親教養、人格特質、述情特質、精神健康和適應障礙間的路徑關係。進一步的，述情障礙中無法區分內在情緒分測驗可用為適應障礙的篩檢指標。由於述情障礙以及其他精神疾病間有高相關，特別在缺乏同理能力的疾病，因此未來研究應繼續探討無法區分內在情緒是否可類化到與同理能力相關的疾病和精神疾病篩檢的應用上。

關鍵字

適應障礙 ； 述情障礙 ； TAS-20 ； 情緒區辨困難 ； 結構方程模式 ； 接受者操作特徵

並列摘要

Background: Alexithymics are relatively lacking in the ability to empathize; this condition is also highly prevalent in psychiatric disorders. Previous studies have separately found the relationship between parental bonding, personality characteristics and alexithymia; however, the pathway relationship among the three is uncertain. Therefore, this study aimed to investigate both whether alexithymia is a predictor for mental health and adjustment disorder, and its pathway relationships with parental rearing style and personality characteristics. In addition, if alexithymia is a precipitating factor for adjustment disorder, whether it can be used as an efficient and cost-effective screening instrument for mental health.
Methods: One-hundred and fifty-eight young male compulsory military soldiers diagnosed with adjustment disorder and another 155 young normal male soldier controls were recruited. All participants had to fill out the Parental Bonding Inventory, Eysenck Personality Questionnaire, 20-item Toronto Alexithymia Scale (TAS-20), and Chinese Health Questionnaire.
Results: The mean age of the case group was 21.46 (standard deviation, SD=2.35), and the control group, 22.94 (SD=2.26). Structural equation modeling showed that those with the pathway relationships of parental bonding influencing personality characteristics, personality characteristics affecting alexithymic traits, and alexithymic traits affecting mental health were more likely to develop adjustment disorder. Without the mediating factor of mental health, alexithymia was predictive of adjustment disorder. Of the three factors in the TAS-20, DIF had a direct effect on adjustment disorder, and the above-mentioned factors accounted for a 59% variance within this sample. Receiver operating characteristic found the optimal cutoff point for screening of adjustment disorder using DIF was 21/22, resulting in a sensitivity of 0.84, specificity of 0.87, positive predictive value of 0.87, and negative predictive value of 0.84.
Discussions: This study found the pathway relationship between parental bonding, personality characteristics, alexithymia, mental health and adjustment disorder. In addition, the DIF sub-scale of alexithymia can be used as a screening index for adjustment disorder. With the high degree of association between alexithymia and other psychiatric disorders, especially in those relatively lacking in the ability to empathize, future studies should investigate whether DIF can be generalizable to the screening of other empathy-related and psychiatric disorders.

並列關鍵字

Adjustment disorder ； alexithymia ； TAS-20 ； difficulty identifying feelings ； structural equation modeling ； receiver operating characteristic

參考文獻

Akechi, T., Okuyama, T., Sugawara, Y., Nakano, T., Shima, Y., & Uchitomi, Y. (2004). Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. American Journal of Clinical Oncology, 22, 1957-1965.

Akimoto, M., Fukunishi, I., Baba, T., Matsumori, M., & Iwai, M. (2002). Alexithymia and sociocultural factors in a Japanese sample: a study with the Rorschach. Psychological Reports, 90, 205-211.

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4 ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text revision). Washington, DC: American Psychiatric Association.