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研究生:謝佑欣
研究生(外文):Yu-Hsin Hsieh
論文名稱:參與課後照顧之國小學童憂鬱傾向及其相關影響因子流行病學研究
論文名稱(外文):Depression tendency and its related factors among a group of elementary school children attending after-school programs
指導教授:林富宮林富宮引用關係
指導教授(外文):Fu-Gong Lin
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:中文
論文頁數:121
中文關鍵詞:兒童課後照顧國小兒童憂鬱傾向憂鬱危險因子
外文關鍵詞:after-school programselementary childrendepression tendencyrelative depression factors
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憂鬱症被聯合國世界衛生組織認定為本世紀三大疾病之一,它不但會危害個人的身心健康亦會影響家庭甚至社會安全。近年來因為社會變遷、經濟衰退及家庭結構等改變,罹患憂鬱症的年齡層也逐漸往下降。憂鬱症的兒童因症狀較不明顯且情緒表達能力較為不佳,常常容易被忽略;但兒童期的憂鬱卻可能會延續至青春期及成年期,因此提早發現此疾病及其可能的致病因子,是防止兒童憂鬱延伸的重要任務之一。台灣在社會型態改變下,促使雙薪家庭、單親家庭的上升,造成許多兒童在課後無父母照顧及陪伴,進而使參與課後安親的比率亦上升,因此本研究進一步探討苗栗縣參與「兒童課後照顧服務」之國小學童,環境背景因素對其憂鬱的影響及憂鬱盛行率。

本研究為橫斷式調查研究,研究對象為民國99學年度上學期12-1月間,36所參加「苗栗縣財團法人生命之愛文教基金會」所開設的「兒童課後照顧服務」之國小,其中三至六年級學生共計2109人。並針對實際參與之29所國小,1643位中高年級學生進行問卷調查,最後獲得634份有效樣本,經統計分析後,研究主要結果如下:
壹、樣本中國小兒童疑似有15.9%有憂鬱傾向。
貳、睡眠時數越少、父親教養方式為權威專制相對於權威開明、獨生子/女、手足關係疏離
相對於親近、同儕一般相對於親近、學業成績中後相對於前段的兒童憂鬱得分較高。
參、睡眠時數≤8.0小時相對於≥9.0小時、父親教養方式為權威專制相對於權威開明、母親
關係疏離相對於親近、手足關係疏離相對於親近、同儕一般相對於親近、學業成績中
段相對於前段的兒童有憂鬱傾向的風險較高。

依據本研究結果,建議父母因注意兒童夜眠時間,並培養良好家庭關係、改善教養方式及降低兒童因學業而產生的負向經驗,以其能對兒童憂鬱傾向有所改善。
Depression has been considered one of the top three health issues for the 21st century by the World Health Organization (WHO). Not only would depression afflict the suffering person’s health, it could also have negative influences on the well-being of the person’s families and the society. The average age suffering from depression is decreasing these years because of the changes of social structure, economic decline, and family structure. However, children can’t express their emotions so well and the symptom is less obvious, depression among children is often ignored. More important, childhood depression might last into adolescence and adulthood. More efforts should be directed to investigate the etiology and factors associated with depression among children.

Using a cross-sectional design, we investigated a group of elementary- school children attending on-campus after-school programs in Miaoli County. There were 2109 children (in their third to sixth grades) participated in the after-school classes managed by the Love of Life cultural educational foundation. After seeking consents from their parents, 634 of them were administered to a structural questionnaire with a child depression scale. Depression status and its associated factors were analyzed and our main findings include:
1.In this sample, 15.9% elementary children has tendency of
depression.
2.Children with shorter length of sleep, an authoritarian paternal
style, whowere the only child, a detached sibling relationship,
normal classmate relationship, and a mediocre school performance
have scored higher in the depression scale.
3.Children with length of sleeping less than 8 hours, an
authoritarian paternal style, a detached maternal relationship and
sibling relationship, a normal classmate relationship, and a
mediocre school performance have higher risk of depression
tendency.

According to our findings, it seems that child depression is associated with the length of sleep, relationships with family, parenting styles, and lowering the expectation and demanding from school performance. Child depression intervention programs should pay more attention to these factors.
目錄
第一章 緒論 ………………………………………………………… 1
第一節 研究動機 ……………………………………………… 1-3
第二節 研究目的 ……………………………………………… 4
第三節 名詞定義 ……………………………………………… 5
第二章 文獻探討 …………………………………………………… 6
第一節 憂鬱概論 ……………………………………………… 7
第二節 憂鬱診斷 ……………………………………………… 8-9
第三節 兒童憂鬱症狀 ………………………………………… 10-11
第四節 影響憂鬱相關因素 …………………………………… 12-18
第五節 兒童憂鬱測量工具及相關研究 ……………………… 19-21
第三章 研究方法 …………………………………………………… 22
第一節 研究架構及取樣方法 ………………………………… 22-23
第二節 研究工具 ……………………………………………… 24-26
第三節 研究分析方法 ………………………………………… 27-28
第四章 結果 ………………………………………………………… 29
第一節 兒童憂鬱量表信度分析 ……………………………… 29
第二節 兒童基本資料分析 …………………………………… 30-33
第三節 不同背景變項對兒童憂鬱得分之影響 ……………… 34-39
第四節 不同背景變項對兒童憂鬱傾向之影響 ……………… 40-42
第五節 不同背景變項對兒童憂鬱得分之預測 ……………… 43-46
第六節 不同背景變項對兒童憂鬱傾向之風險預測 ………… 47-48
第七節 弱勢與一般兒童在背景變項的差異 ………………… 49-50
第五章 討論 ………………………………………………………… 51
第一節 兒童憂鬱傾向之探討 ………………………………… 51
第二節 個人因素對兒童憂鬱之探討 ………………………… 52-54
第三節 家庭因素對兒童憂鬱之探討 ………………………… 55-58
第四節 學校因素對兒童憂鬱之探討 ………………………… 59
第五節 影響兒童憂鬱的預測因子 …………………………… 60
第六章 結論 ………………………………………………………… 61
第一節 結論 …………………………………………………… 61-63
第二節 研究限制 ……………………………………………… 64
第三節 建議 …………………………………………………… 65
參考文獻 ……………………………………………………………… 66-77

表目錄
表1 國中小學生憂鬱篩檢量表的信度係數 ……………………… 78
表2 兒童連續背景變項之分佈情形 ……………………………… 79
表3 兒童類別背景變項之分佈情形 ……………………………… 80-81
表4 不同背景變項與兒童憂鬱量表得分之T檢定 ……………… 82
表5 不同背景變項與兒童憂鬱量表得分之變異數分析 ………… 83-84
表6 兒童憂鬱症狀與不同背景變項之卡方檢定 ………………… 85-86
表7 不同背景變項與兒童憂鬱量表得分之多元階層回歸分析 … 87
表8 憂鬱傾向兒童憂鬱得分之相關變項分析 …………………… 88
表9 不同背景變項與兒童憂鬱傾向之Logistic回歸分析 ……… 89
表10 不同背景變項與父母憂鬱傾向之Logistic回歸分析 ……… 90
表11 一般/弱勢兒童與不同背景變項之卡方檢定 ………………… 91-92

圖目錄
圖1 研究架構 ……………………………………………………… 93
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