早期不適應基模與兒童受不當對待在慢性和非慢性憂鬱症之危險因子初探

The Risk Factors in Chronic and Nonchronic Depression: Early Maladaptive Schemas and Child Maltreatment

陳契宏(Chi-Hung Chen)

指導教授 ： 譚偉象

中原大學/理學院/心理學研究所/碩士(2014年)

https://doi.org/10.6840/cycu201400329

摘要

背景：近年來研究逐漸顯示可以將憂鬱症區分為慢性、非慢性憂鬱症兩種精神疾病分類診斷，以及大約有1/4的非慢性憂鬱症患者也會進入慢性化的憂鬱症病程之中。相較於非慢性憂鬱症而言，慢性憂鬱症往往為患者帶來更嚴苛的挑戰與苦難，研究已發現慢性憂鬱症患者往往獲得更少的社會支持、偏低的社經地位、更多的身體疾病與耗費更高度的健康照護資源等等，顯示如果能夠早期篩選出高憂鬱慢性化風險的患者，及早提供可能之協助，將對於患者、社會、醫療與科學領域皆會有所貢獻。目前關於慢性憂鬱症危險因子的研究累積仍屬不足，尤其在認知與發展的危險因子更是缺乏，故本研究決定選用兩個目前研究累積似乎能夠有效區辨慢性、非慢性憂鬱症的危險因子進行研究，分別為：「早期不適應基模」與「兒童受不當對待」。

目的：本研究假設「早期不適應基模」與「兒童受不當對待」能夠有效區辨慢性憂鬱症患者、非慢性憂鬱症患者與一般健康個體，表示兩個因子為慢性憂鬱症的危險因子。

方法：樣本為慢性憂鬱症患者30人、非慢性憂鬱症患者24人與一般健康個體30人，邀請患者填寫相關量表與使用精神疾病診斷系統進行分組，之後進行相關統計分析。

結果：「早期不適應基模」在總分與分向度上可以有效區辨慢性憂鬱症患者、非慢性憂鬱症患者與一般健康個體，支持本研究假設。「兒童受不當對待」總分在慢性憂鬱症患者與非慢性憂鬱症患者未達到顯著差異，在非慢性憂鬱症患者與一般健康個體也未達到顯著差異，未通過本研究假設，但是在慢性憂鬱症患者與一般健康個體則有達到顯著差異。

討論：本研究顯示「早期不適應基模」為有效的慢性憂鬱症認知危險因子，其中「失去聯結與拒絕」與「過度警戒與抑制」更是具有區辨貢獻的向度。儘管本研究在「兒童受不當對待」無法通過假設考驗，然而似乎對於一部分的憂鬱症患者而言，其仍是一個可以考慮納入的發展危險因子，尤其對於憂鬱病程特別長的患者更是成立。期本研究可供醫療相關領域人員參考。

關鍵字

早期不適應基模 ； 慢性 ； 憂鬱症 ； 兒童受不當對待

並列摘要

Objective: Recent research reveals depression can be categorized into chronic and nonchronic depression. About 1/4 nonchronic depressive patients will follow chronic depressive course. Compared with nonchronic depressive patients, chronic depressive patients have more harsh challenge and burden. Research shows that chronic depressive patients always have less social support, lower socioeconomic status, more body diseases, and more health care costs. If we could detect high-risking chronic depressive patients and supply possible help earlier, it would have abundant of benefits for patients, as well as for the social, medical and scientific fields. Nowadays, research about chronic depressive risk factors is still rare, especially on the cognitive and developmental aspects. The present study explored these two aspects, namely, “Early Maladaptive Schemas (EMS)” and “Child Maltreatment (CM)”.

Purpose: The present study hypothesized EMS and CM could separate individuals having chronic depression, nonchronic depression, and normal mental health. Thus, EMS and CM are risk factors for chronic depression.

Method: The sample consisted of 30 chronic depressive patients(CD), 24 nonchronic depressive patients(ND) and 30 mental healthy individuals(MH). The instruments used included psychiatric diagnostic interview and questionnaires. Statistical analysis was used to analyze the data.

Results: EMS could differentiate the three groups, especially the dimensions “Disconnection & Rejection” and “Over-vigilance & Inhibition”. This supported the hypotheses. CM couldn’t differentiate CD from ND, and ND from MH neither. Thus, the hypotheses were not supported. However, CM could differentiate CD from MH.

Discussion: EMS was a valid chronic depressive cognitive risk factor, especially the dimensions “Disconnection & Rejection” and “Over-vigilance & Inhibition”. Although the hypotheses on CM were not supported, CM was still a chronic depressive developmental risk factor that might be considered, especially importamt for more long-term chronic depressive patients. The present study might be useful for the medical field.

並列關鍵字

child maltreatment ； depression ； chronicity ； early maladaptive schemas

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