台灣地區老年憂鬱之危險因子探討 -- 十年追蹤結果分析

Risk Factors of Geriatric Depression in Taiwan: a Ten-Year Longitudinal Study

林惠文(Hui-Wen Lin)

指導教授 ： 李孟智 ； 顏啟華

中山醫學大學/醫學院/醫學研究所/碩士(2011年)

https://doi.org/10.6834/CSMU.2011.00003

摘要

前言：
人口老化乃全球性的現象，而老年人之心理健康更是現今社會所關注的議題；其中，又以老年憂鬱最為常見，且常被用以當作老年人心理健康狀態的指標。本研究主要探討台灣老年人憂鬱發生之盛行率及相關危險因素。
方法：
本研究利用行政院衛生署國民健康局所提供的「台灣地區中老年身心社會生活狀況長期追蹤調查」資料庫；以1993年年底滿65歲以上之社區老人為抽樣母群，排除居住長照機構及有憂鬱病史者後，共計1,540人，做為期十年的追蹤。在憂鬱評估方面，本研究係採用簡式之流行病學研究中心憂鬱量表 (10-item Center for Epidemiologic Studies Depression Scale, CES-D 10)，並針對可能潛在影響之相關變項，如人口學背景特徵、居住安排、健康功能狀況、休閒活動、經濟及情感支持系統等，重新編碼定義，再利用單變項分析進一步統計處理，續將有意義之變項以強迫輸入法進行邏輯斯迴歸分析，並定義p < 0.05為顯著意義。
結果：
針對1993年之1,540人進行為期十年的追蹤，發現其中有535人(34.7%)死亡，142人(9.2%)無法完成後續訪查或無法評估，故至2003年止僅餘863人；其中304人有憂鬱症狀，佔35.2%。而邏輯斯迴歸分析發現，女性相對男性發生老年人憂鬱之勝算比為1.80﹝95% CI = 1.28 ~ 2.51﹞，且日常生活功能(activity of daily living, ADL)障礙者較無障礙者易發生老年人憂鬱﹝OR = 8.74，95% CI = 1.04 ~ 73.57﹞。
結論：
由本研究得知，台灣地區老年人憂鬱的發生相當普遍，平均每三人中即有一人有憂鬱症狀；而日常生活功能狀態及性別更是影響日後老年憂鬱發生的重要危險因子。因此，及早認知老年憂鬱相關因素，並擬定相對因應策略以降低失能，進而提升老年生活滿意度及生活品質。

關鍵字

老年憂鬱 ； 日常生活功能 ； 性別

並列摘要

Objectives:
Depression, one of the most common mental disorders among the elderly population, is often used as an indicator of psychological health. This study aimed to identify the risk factors of depression among the elderly in Taiwan.
Methods:
Data were drawn from the “Survey of Health and Living Status of the Elderly in Taiwan”, a national longitudinal study launched in 1989. We recruited at baseline in 1993 community-dwelling respondents without depressive symptoms or disorders and followed them over a ten-year period. Depressive symptoms were assessed by the ten-item Center for Epidemiologic Studies Depression Scale (CES-D). Independent variables, including age, sex, education, marital status, living arrangement, poverty level, chronic diseases, physical functions, leisure activities, and mental support systems, were gathered at baseline in 1993. Multivariate logistic regression analysis was used to evaluate the associated risk factors for geriatric depression, and p < 0.05 represents statistical significance.
Results:
Of the eligible 1,540 respondents, 535 (34.7%) and 142 (9.2%) individuals did not complete the follow-up in 2003 due to death and uncompleted interview respectively. Among the remaining 863 individuals, 304 people had depression with prevalence being 35.2%. Based on the results, female (OR = 1.80, 95% CI = 1.28~2.51) and activities of daily living (ADLs) disability (OR = 8.74, 95% CI = 1.04~73.57) were independent risk factors for geriatric depression in Taiwan.
Conclusion:
The prevalence of geriatric depression was very common in Taiwan according to our results. Furthermore, female gender and ADLs disability were the important association factors for geriatric depression. The earlier we gathered information on depressive status of the elderly and carried out intervention, the better quality of life they could have.

並列關鍵字

geriatric depression ； activity of daily living (ADL) ； sex

參考文獻

Chen CS, Tsang HY, Chong MY, & Tang TC (2000). Validation of the Chinese Health Questionaire (CHQ-12) in Community Elders. Kaohsiung J Med Sci,16(11), 559-65。

莊凱迪、蔡佳芬(民97)。老年人的憂鬱症。台灣老年醫學暨老年學雜誌， 3(2)，182-90。

Anderson EM, Malmgren JA, Carter WB, & Patrick DL (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med, 10(2), 77–84.

Blazer D, Burchett B, Service C, & George LK (1991). The association of age and depression among the elderly: an epidemiologic exploration. J Gerontol, 46(6), M210-5.

Boey KW (1999). Cross-validation of a short form of the CES-D in Chinese elderly. Int J Geriatr Psychiatry, 14(8), 608–17.