澎湖老人憂鬱症狀及相關因素之探討

Depressive Symptoms and Correlated Factors in Older Persons in Penghu

10.6834/CSMU.2005.00032

韓玉蘭

憂鬱症狀 ； 日常活動功能 ； 社會支持 ； depressive symptoms ； activities of daily living ； social support

中山醫學大學護理學系學位論文

2005年

碩士

曾月霞

繁體中文

本研究目的為了解澎湖老人憂鬱情形，以及人口學特性、日常活動功能和社會支持與憂鬱的關係，並比較老人憂鬱量表（GDS-SF）與台灣人憂鬱量表所測量憂鬱結果的差異性。採橫斷式相關研究設計，以簡單隨機抽樣選取澎湖65歲以上老人200位參與本研究。以台灣人憂鬱量表、GDS-SF、日常活動功能量表及社會支持量表進行資料收集，以描述性統計、卡方檢定、t檢定、單因子變異數分析、Pearson 相關分析、逐步多元迴歸進行資料分析。結果顯示：（1）澎湖老人憂鬱比例以GDS-SF測量達34.5%，以台灣人憂鬱量表測量為18.5%。（2）台灣人憂鬱量表及GDS-SF所測量憂鬱比例有顯著差異性。（3）澎湖老人日常活動功能以能獨立活動者居多。（4）澎湖老人社會支持以子女支持為最主要來源，以提供情緒支持為較高。（5）GDS-SF測量的憂鬱症狀因性別、婚姻、教育及罹病情形的不同而有所差異，其中以女性、喪偶、未接受教育者及有罹病者憂鬱症狀較嚴重。（6）日常活動功能越好，憂鬱症狀越少。（7）社會支持越多，憂鬱症狀越少。（8）老人憂鬱之預測因子有社會支持滿意度、有接受教育、日常活動功能、整體社會支持、有罹病等五項，可解釋28.9%變異量。研究結果呈現澎湖老人憂鬱普遍存在，而其影響因素是多元，因此健康專業人員應深入評估老人身體及社會等層面，才能有效介入適當措施，來協助預防及治療老人的憂鬱症狀。

The purpose of this study was to explore depression in older persons in Penghu, and identify the relationships between depression and demographic variable, activities of daily living and social support. In addition, the percentages of older persons with depression were compared from Geriatric Depression Scale-Short (GDS-SF) and Taiwanese Depression Questionnaire (TDQ). A cross-sectional correlational research design was employed. Simple random sampling was used to obtain 200 subjects who were 65 years of age and above to participate in the study. TDQ, GDS-SF, Activities of Daily Living Scale and Inventory of Socially Supportive Behavior were used to collect data. The statistics used data analysis included descriptive statistics, chi-square test, t-test, one-way analysis of variance, Pearson correlation, and stepwise multiple regression. The findings of the study were: (1) The percentage of the participants with depression that was measured by GDS-SF was 34.5%, and 18.5% measured by TDQ. (2) It was significantly different between the percentages of older persons with depression measured by GDS-SF and TDQ. (3) Most of the participants performed activities of daily living independently. (4) Support from adult children was important resource of social support for older persons. Emotion support was primary type of social support provided by adult children.(5) Depressive symptoms were different in different gender, marital status, and illness status. Female, widowed, under-educated, and ill older persons were more depressive than those who were married, educated, and healthy. (6) Older persons who performed activities of daily living better were less depressive. (7) Older persons who had more social support were less depressive. (8) Satisfaction of social support, educated, activities of daily living, total social support and illness were the predictors of depression in older persons. These predictors explained 28.9% variance of depression. The findings of the study indicate that depression in older persons in Penghu is prevalent. Depression is affected by numerous factors. Health professional should assess physical and social aspects of older persons comprehensively so effective interventions could been administered to prevent older persons from depression

1. 余幸宜、于漱、李蘭（2004）•老年人之健康促進•台灣醫學，8（4），582-589。
   連結：
2. 呂淑妤、林宗義（2000）•南部社區老人憂鬱症狀盛行率及相關因素研究•中華公共衛生雜誌，19（1），50-60。
   連結：
3. 吳淑瓊、徐慧娟、莊媖智、張明正（1996）•功能評估在估計台灣社區老人長期照護需要的應用•中華衛誌，15（6），533-545。
   連結：
4. 呂寶靜（2000）•老人朋友網絡支持功能之初探•社會政策與社會工作學刊，4（2），
   連結：
5. 林怡君、余豎文、張宏哲（2004）．新店地區機構與非機構老人憂鬱情形及相關因素之調查．台灣家醫誌，14（2），81-93。
   連結：
6. 邱啟潤、張永源、陳武宗、黃洽鑽、黃忠信（2000）．高樹鄉農村老人健康狀況的評估
   連結：
7. 施春華、侯淑英、楊明仁、張麗珍、張自強、黃俊仁（2005）．社區老人憂鬱症狀的流行病學及活動參與介入之成效．實証護理，1（1），29-34。
   連結：
8. 傅振宗、李燕鳴、陳仲達（2003）•臺灣某鄉村社區老人憂鬱症狀與12年後死亡率的關連•臺灣醫學會雜誌，102（4），234-239。
   連結：
9. 謝佳容、劉淑娟、張鈺（2005）•從WHO心理衛生報告：探討台灣社區老人心理衛生問題和政策•護理雜誌，52（3），56-61。
   連結：
10. 戴玉慈、羅美芳（1996）．身體功能評估的概念與量表．護理雜誌，34（2），63-69。
    連結：
11. Alloy, L. B., Abramson, L. Y., Whitehouse, W. G., Hogan, M. E., Tashman, N. A., Steinberg, D. L., et al. (1999). Depressogenic cognitive styles: Predictive validity, information processing and personality characteristics, and developmental origins. Behaviour Research & Therapy, 37 (6), 503-531.
    連結：
12. American Psychiatry Association. (1994). Diagnostic and Statistical Manual of Mental
    連結：
13. Arling, G. (1987). Strain social support, and distress in old age. Journal of Gerontology, 42 (1), 107-113.
    連結：
14. Barrera, M. Jr., Sandler, I. N., & Ramsay, T. B. (1981). Preliminary development of a scale of social support: Studies on college students. American Journal of Community Psychology, 9, 435-447.
    連結：
15. Beck, A. T. (1961). An inventory for measuring depression. Archive of General Psychiatry, 4, 561-571.
    連結：
16. Belloc, N. B., Breslow, L., & Hochstim, J. R. (1971). Measurement of physical health in a general population survey. American Journal of Epidmiol, 93, 328-336.
    連結：
17. Bruce M. L. (2001). Depression and Disability in Late Life. American Journal of Geriatric Psychiatry , 9, 102–112.
    連結：
18. Chen, R., Hu, Z., Qin, X., Xu, X. & Copeland, J. R. M. (2004). A community-based study of depression in older people in Hefei, China-the GMS-AGECAT prevalence, case validation and socio-economic correlates. International Journal of Geriatric Psychiatry, 19, 407-413.
    連結：
19. Cole, M. G., & Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: A systematic review and Meta-Analysis. American Journal of Psychiatry, 160 (6), 1147–1156.
    連結：
20. Eisses, A. M. H., Kluiter, H., Jongenelis, K., Pot, A. M., Beekman, A. T. F., & Ormel, J. (2004). Risk indicator of depression in residential home. International Journal of Geriatric Psychiatry, 19, 634-640.
    連結：
21. Fiske, A., Gate, M., & Pedersen, N. L. (2003). Depressive symptoms and aging: The effects of illness and non-health-related events. The Journal of Gerontology, 58 (6), 320-328.
    連結：
22. Grant, J. S., & Davis, L. L (1997). Selection and use of content experts for instrument development. Research in Nursing & Health, 20, 269-274.
    連結：
23. Harris, T., Cook, D. G., Victor, C., Rink, E., Mann, A. H., Shah, S., et al. (2003). Predictors of depressive symptoms in older people: A survey of two general practice populations. Age and Ageing, 32 (5), 510-518.
    連結：
24. House, J. S. (1981). Work Stress and Social Support. Reading, Mass: Addison-Wesley.
    連結：
25. Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., Jaffe, M. W., & Cleveland (1963). Studies of illness in the aged. JAMA, 185 (12), 914-919.
    連結：
26. Kempen, G. I. J. M., & Surrmeijer, T. P. B. M. (1990). The development of a hierarchical polytomous ADL-IADL scale for noninstitutionalized elders. Gerontologist, 30, 497-502.
    連結：
27. Kessler, R. C., Zhao, S., Blazer, D. G., & Swartz, M. (1997). Prevalence correlates, and course of minor depression and major depression in the national comorbidity survey. Journal of Affective Disorder, 45, 19-30.
    連結：
28. Kim, J. M., Stewart, R., Shin, I. S., Yoon, J. S., & Lee, H.Y. (2004). Lifetime urban/rural residence, social support and late-life depression in Korea. International Journal of Geriatric Psychiatry, 19, 843-851.
    連結：
29. Liu , C. Y., Wang , S. J., & Teng, E. L. (1997). Depressive disorder among older residents in a Chinese rural community. Psychological Medicin, 27, 943-949.
    連結：
30. Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33 (3), 187-205.
    連結：
31. Nacoste, D., & Wise, W. (1991). The relationship among negative life events, cognitions and depression within three generations. The Gerontologist, 31, 397- 403.
    連結：
32. O’Sullivan, C. B. (2004). The psychosocial determinants of depression: A lifespan perspective. The Journal of Nervous and Mental Disease, 19 (9), 585-594.
    連結：
33. Oxman, T. E., & Hull, J. G. (2001). Social support and treatment response in older depressed primary care patients. Journal of Gerontology, 56(1), 35-45.
    連結：
34. Power, D. V., Thompson, L., Futterman, A., & Thompson, D. G. (2002). Depression in later life epidemiology, assessment, impact, and treatment. In I. H. Gotlib. & C. L. Hammen (Eds.), Handbook of depression (pp. 560-580). New York: Guilford.
    連結：
35. Robert, R. E., Kaplan, G. A., Shema, S. J., & Strawbridge, W. J. (1997). Prevalence and correlates of depression in aging cohort: The Alameda study. Journal of Gerontology, 52 (5), 252-258.
    連結：
36. Shari, M. (1999). Geriatric Depression Scale. American Journal of Nursing, 99 (1), 24.
    連結：
37. Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent finding and development of a shorter version. In T. L. Brink (Ed.), Clinical Gerontology (pp.165-173). New York: Howarth .
    連結：
38. Stek, M. L., Gussekloo, J., Beekman, A. T. F., Tilburg, W. van ., & Westendorp, R. G. J. (2004). Prevalence, correlates and recognition of depression in the oldest old: The Leiden 85-plus study. Journal of Affective Disorder, 78, 193-200.
    連結：
39. Wada, T., Ishine, M., Sakagami, T., Okumiya, K., Fujisawa, M., Murakami, S., et al. (2004). Depression in Japanese community-dwelling eldly─prevalence and association with ADL and QOL. Archives of Gerontology and Geriatrics, 39, 15-23.
    連結：
40. Wang, H. H., Wu, S. Z., & Liu, Y. Y. (2003). Association between social support and health outcomes: A meta-analysis. Kaohsiung Journal of Medicine Science, 19 (7), 345-351.
    連結：
41. Wang, J. J. (2001). Prevalence and correlates of depressive symptoms in the elderly of rural communities in southern Taiwan. The Journal of Nursing Research, 9 (3), 1-12.
    連結：
42. Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M. B., et al. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37- 49.
    連結：
43. 參考資料
44. 內政部（2005，3月31日）．臺閩地區現住人口數按性別及年齡分．取自http://www.moi.gov.tw/stat/
45. 行政院經建會（2004，7月30日）．中華民國臺灣民國93年至140年人口推計．
46. 取自http://www.cepd.gov.tw/upload/MANP/Plan/98137.7154883945.report
47. _table pdf.
48. 李昱、楊明仁、賴德仁、邱念睦、周騰達（2000）•台灣人憂鬱問卷之發展•長庚醫學，23（11），688-694。
49. 43-90。
50. 周玉慧、楊文山、莊毅利（1998）•晚年生活壓力、社會支持與老人身心健康•人文及社會科學集刊，10（2），227-265。
51. 林文鎮（1999）•澎湖社區營造的困境與前景--以馬公市菜園社區為例•西瀛風物，6，73-95。
52. 林松齡（1993）•老人社會支持來源與老人社會需求：兼論四個社會支持模式•於王國羽，社會安全問題之探討（頁256-289）．嘉義：國立中正大學。
53. 林正介、李燕鳴、劉樹泉（1995）．影響新店社區老人憂鬱情緒之因素．中華民國家庭
54. 醫學雜誌，5（1），1-10。
55. 侯慧明（2004）•長期照護機構老人憂鬱狀態、社會支持與孤寂感相關性之探討•未發表的碩士論文，台中:中國醫藥大學。
56. 研究．護理研究，8（2），227-240。
57. 邱裕峰、張智仁、葉宗烈（1991）．北門鄉老人認知障礙和憂鬱症狀的盛行率問卷調查．
58. 中華精神醫學，5，123-131。
59. 許毅貞（1993）．鹿港地區65至74歲社區老人之老人態度、社會支持、健康狀態與憂
60. 鬱程度之關係研究．未發表的碩士論文，台北:國立師範大學。
61. 黃繼慶（1994）•社會支持系統對社區老人心理健康的影響•未發表的碩士論文，台北：國立台灣大學。
62. 黃春太、姜逸群（2001）•城鄉地區老人的社會支持體系及健康狀況之比較•衛生教育學報，133-154。
63. 曾譯令、李淑杏、李孟智（1995）．偏遠地區與城市地區老人健康狀態之比較．中山醫學雜誌，6，65-87。
64. 熊曉芳（2000）•獨居老人之社會支持及相關探討•長庚護專學報，2，53-69。
65. 蔡崇煌、劉永昌、汪美鳳、王雪鳳、林正介（2003）•老人健檢常見身體症狀憂鬱症狀之相關探討•臺灣醫界，46（8），14-17。
66. 謝瀛華、鄭惠信、林章賢、林英欽、洪清霖（1995）．台北市某社區六十五歲以上老人
67. 日常生活依賴程度之研究．北醫學報，24，9-17。
68. 謝瀛華、鄭惠信、張利中（1992）．六十五歲以上健診老人之家庭支持與其憂鬱及痴呆
69. 傾向之相關研究．公共衛生，19（1），86-92。
70. 鄭惠信、史麗珠、謝瀛華、盧成皆（1995）．老年人憂鬱因子之相關研究．內科學誌，6，125-134。
71. Abolfotouh, M. A., Daffallah, A. A., Khan, M. Y., Khattab, M. S., & Abdulmoneim, I. (2001). Psychosocial assessment of geriatric subjects in Abha City, Saudi Arabia. Eastern Mediterranean Health Journal, 7 (3), 481-491.
72. Disorders(DSM-Ⅳ). Washington, DC: Author.
73. Becker, J., & Kleinman, A. (1991). Psychosocial aspects of depression. Hillsdale, NJ: Lawrence Erlbaum.
74. Fu, C. C., Tseng, L. D., & Lee, C. C. (1988). Correlates of CESD-D depressive score in the elderly of a rural community. Journal of Formosa Medicine Association, 87 (3), 365-369.
75. Gallo, J. J., Fulmer, T., Paveza, G. J., & Reichel, W. (2000). Handbook of geriatric assessment ( ed). Caithershurg, MD: Aspen.
76. Glanz, K., Rimer, B. K., & Lewis, F. M. (2002). Health behavior and health education :
77. Theory, research, and practice ( ed). San Francisco: Jossey-Bass.
78. Hooyman, N. R., & Kiyak, H. A. (2003)•社會老人學（林歐貴英、郭鐘隆譯）•台北：五南。
79. Loughlin, A. (2004). Depression and social support. Journal of Gerontological Nursing, 11-15.
80. Meyers, S. (2000). Use of neurotransmitter precursors for treatment of depression. Alternative Medicine Review, 5 (1), 64-71.
81. Miller, C. A. (1999). Nursing care of older adults ( ed.). New York: Lippincott.
82. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for
83. research in general population. Applied Psychology Measurement, 1, 385-394.
84. Schofield, I., Stark, S., Lowndes, A., & Tolson, D. (2004). The detection and prevention of depression in older people. Nursing Times, 100 (21), 32-35.
85. Schwartz, A., & Schwartz, R. M. (1993). Depression theories and treatments: Psychological,
86. biological, and social perspectives. New York: Columbia.
87. Sheets, D. J., Emerman, J., & LaBuda, D. (1997). The aging network and the home modification needs of elders. Technology and Disability, 7, 165-173.
88. Thorson, J. A. (1999)•老人與社會（潘英美譯）•台北：五南。（原著：1995）
89. World Health Organization (2004 ) .Towards age-friendly primary health care. Retrieved Otcober 24, 2004, from http://www.who.int/hpr/ageing/af_report. pdf.

1. 蘇育民(2011)。退休與社會資本之相關性探討。長榮大學醫務管理學系(所)學位論文。2011。1-85。 
2. 李婉蔆(2010)。台灣中老年人自覺壓力、社會支持和憂鬱傾向之相關性探討。長榮大學醫務管理學系(所)學位論文。2010。1-96。 
3. 謝宜芳(2008)。老年人個人屬性、依附風格、心理需求與憂鬱情緒之關係研究~以高雄市長青學苑老年人為例。臺灣師範大學教育心理與輔導學系學位論文。2008。1-178。
4. 葉昭君(2015)。家庭照顧者健康狀況及睡眠品質之探討-以居家護理個案為例。高雄醫學大學護理學系碩士班學位論文。2015。1-123。
5. 劉由貴(2015)。高齡學習者社會支持、情緒管理與成功老化關係之研究。中正大學成人及繼續教育學系學位論文。2015。1-224。
6. 吳雅婷(2016)。社區高齡長者憂鬱及其相關因素探討。義守大學管理碩博士班學位論文。2016。1-72。