臺灣博碩士論文加值系統

背景：民國104年6月27日八仙樂園發生粉塵燃爆意外，為台灣近年來嚴重且大型的公安事件，造成近五百人燒傷，隨後15人不幸罹難。比起其他創傷族群，燒傷倖存者在傷後經常面對疤痕、攣縮、疼痛、癢等艱鉅挑戰，可能造成長期心理調適困難。本研究探討燒傷後創傷後壓力症狀（symptoms of posttraumatic stress disorder [PTSD]）的預測因子，主要包含三群變項：（一）由Ehlers與Clark（2000）的PTSD認知模型衍生的認知變項；（二）Ozer等人（2003）後設分析的PTSD症狀預測因子；以及（三）燒傷相關變項。本研究探討上述三類預測因子對燒傷PTSD症狀的貢獻，並檢驗理論衍生認知變項在燒傷倖存者中的預測效果是否優於其他預測因子。

方法：本研究招募106名八仙事故的燒傷倖存者，且採用兩波前瞻性設計，分別為事故後兩年（民106年6月）與三年（民107年6月）。參與者平均年齡23.97歲（SD = 4.10），61.3%為女性，平均燒傷體表面積50.51%（SD = 19.45）。

結果：大多數預測因子皆與第二年與第三年PTSD症狀存在中等至高的相關。多元迴歸分析指出燒傷變項、理論衍生認知變項與後設分析變項可分別大幅預測第二年PTSD症狀（R2 = 40.8%、58.0% 以及34.3%）與第三年PTSD症狀（R2 =34.8%、39.9% 以及33.5%）。階層迴歸分析顯示，在控制人口與燒傷變項後，理論衍生認知變項和後設分析變項可分別獨立預測第二年PTSD症狀（ΔR2 = .246與 .127）與第三年PTSD症狀（ΔR2 = .151 與 .106），前者的整體解釋變異量高於後者。然而進一步控制第二年PTSD症狀後，理論衍生認知變項與後設分析變項均無法再獨立預測第三年PTSD症狀（ΔR2 = .025 與.024），即使整體解釋變異量大（R2 = .670 與.669）。

討論：橫斷性分析與未控制第二年PTSD症狀的縱貫性分析，支持理論衍生認知變項對燒傷PTSD 症狀之獨特預測效果，然而在控制第二年PTSD 症狀後的縱貫性分析，此結果並未獲得支持。推測可能理由有二：其一，由於兩時間點PTSD症狀相關甚高，可能多數參與者的創傷症狀慢性化或趨於穩定；其二，本研究調查時間明顯較過去類似研究為遲，時間延宕可能影響預測因子之運作影響，建議後續應盡早於燒傷初期啟動調查。

Background: The Formosa Fun Coast Water Park explosion was a mass burn casualty disaster that occurred in northern Taiwan on June 27, 2015. Nearly 500 individuals were burned and 15 of them died afterward. Relative to other trauma populations, burn survivors often face several difficult challenges (e.g., scarring, contractures, pain, or itch), which possibly lead to long-term psychological maladjustment. This study investigated predictors of PTSD symptoms after burn injuries, consisting of three sets of variables: a) cognitive variables derived from Ehlers and Clark (2000)’s cognitive model of PTSD; b) predictors of PTSD symptoms from Ozer et al. (2003)’s meta-analysis, and; c) burn-related variables. Our study examined the contribution of these three set of variables and tested whether theory-derived cognitive variables have a better predictive effect than other predictors among burn survivors.

Method: This study recruited 106 survivors of the Formosa Fun Coast Dust Explosion as study participants. A two-wave prospective design was conducted at two years (Time 1 [T1], June 2017) and three years (Time 2 [T2], June 2018) after the explosion. The average age of participants was 23.97 years (SD = 4.10), 61.3% were women. The average total body surface area burned (TBSA) was 50.51% (SD = 19.45).

Results: Most predictors were moderately to highly correlated with both T1 and T2 PTSD symptoms. Multiple regressions indicated that burn-related variables, theory-derived cognitive variables, and variables from the meta-analysis all showed strong predictive validity in T1 PTSD (R2 = 40.8%, 58.0% and 34.3%) and T2 PTSD symptoms (R2 =34.8%, 39.9% and 33.5%). Hierarchical regressions demonstrated that, after controlling for demographic and burn-related variables, theory-derived cognitive variables and variables from the meta-analysis both had unique predictive validity in predicting T1 PTSD (ΔR2 = .246 and .127) and T2 PTSD symptoms (ΔR2 = .151 and .106). The total explained variance was greater for the former than the latter. However, after controlling for T1 PTSD symptoms, theory-derived cognitive variables and variables from the meta-analysis could not independently predict T2 PTSD symptoms (ΔR2 = .024 and .025, ps > .05), although with large total explained variances (R2 = .670 and .669).

Discussion: The cross-sectional and prospective analysis (with the T1 PTSD symptoms uncontrolled) supported the unique predictive power of the theory-derived cognitive variables for PTSD symptoms post-burn. However, this finding was unsupported by the prospective analysis after controlling for T1 PTSD symptoms. There were two possible reasons: First, due to the high correlation between T1 and T2 PTSD symptoms, it is possible that the symptoms of most participants were chronic or stable; and b) our investigation was much later than the previous similar studies. The time lag may affect the operation of the predictors examined in this study. Future research should begin soon after burn injury.

目錄
指導教授推薦書
口試委員會審定書
誌謝 iii
中文摘要 iv
英文摘要 vi
第一章 緒論 1
第一節 創傷與創傷後壓力症 2
第二節 燒傷與創傷後壓力症 3
第三節 創傷後壓力症狀的發展與維持：認知取向 5
壹、 創傷後壓力症：認知取向 5
貳、Ehlers & Clark的PTSD認知模型 6
第四節 一般創傷PTSD症狀之預測因子 11
壹、後設分析衍生之PTSD症狀預測因子 11
貳、PTSD認知模型衍生之認知預測因子 12
參、PTSD症狀之預測：認知理論衍生變項 vs. 後設分析衍生變項 13
第五節 燒傷PTSD症狀的特有預測因子 14
第六節 燒傷PTSD症狀預測：以往不足與待探討議題 16
第七節 研究目的與假設 16
壹、研究目的 16
貳、研究假設 17
第二章 研究方法 18
第一節 參與者和研究設計 18
第二節 研究工具 19
壹、燒傷相關變項 19
貳、理論衍生認知變項 20
參、後設分析變項 22
第三節 資料分析 24
第三章 研究結果 25
第一節 人口學變項與變項間之相關分析 25
第二節 第二年調查資料之橫斷性分析 28
壹、研究探討預測因子對第二年PTSD症狀之預測性 28
貳、後設分析變項與理論衍生認知變項對第二年PTSD症狀之獨特預測性驗證：階層迴歸分析 30
第三節 第二與三年調查資料之縱貫性分析 32
壹、研究探討預測因子對第三年PTSD症狀之預測 32
貳、後設分析變項與理論衍生認知變項對第三年PTSD症狀之獨特預測性驗證：階層迴歸分析 33
第四章 綜合討論 40
第一節 第二年變項的橫斷性分析結果 40
第二節 第二至三年變項的縱貫性分析結果 45
第五章 研究貢獻、限制與未來方向 52
第一節 研究貢獻 52
第二節 研究限制 53
第三節 未來研究與臨床應用 54
參考文獻 58
附錄 研究工具 71


表目次
表1 第二年時間點參與者人口學背景變項之百分比整理表 26
表2 各預測變項與結果變項間之皮爾森相關矩陣表（n = 106） 27
表3 燒傷相關變項預測第二年與第三年PTSD症狀：多元迴歸分析（n = 106） 29
表4 後設分析變項預測第二年與第三年PTSD症狀：多元迴歸分析（n = 106） 29
表5 理論衍生認知變項預測第二年與第三年PTSD症狀：多元迴歸分析（n = 106） 29
表6 後設分析變項與燒傷變項預測第二年與第三年PTSD症狀（n = 106） 36
表7 認知變項與燒傷變項預測第二年與第三年PTSD症狀（n = 106） 37
表8 後設分析變項與燒傷變項預測第三年PTSD症狀-控制第二年PTSD症狀（n = 106） 38
表9 認知變項與燒傷變項預測第三年PTSD症狀-控制第二年PTSD症狀（n = 106） 39

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林祺育, 陳依欣, 張承騏, 楊芷凌, 詹閎鈞, 鄭伃均, 簡苑玲, 羅
雁婷（民107）：《結痂週記：八仙事件 他們的生命經驗，我們不該遺忘》台灣：時報出版