臺灣博碩士論文加值系統

糖尿病已成為國內最盛行的慢性疾病之ㄧ，而慢性病患者在種種壓力之下，較易產生低落負面的情緒，經長時間累積後，患者易罹患憂鬱症，而罹患重鬱症的族群通常有曠職、個人生產能力的損害情形，並且有高度的醫療資源耗用。因此檢視罹患糖尿病暨重鬱症患者所造成健康經濟層面的威脅勢必為當前重要的課題，雖然國外已有相關研究，但國內學者針對糖尿病提出合併憂鬱症的議題卻不多。本研究希藉由2005年全民健康保險資料庫100萬人承保抽樣歸人檔的使用，以針對國內糖尿病患者罹患憂鬱症之經濟層面進行探討。
在該資料庫中凡符合「1次以上的門診主、次診斷」為糖尿病者，並經過篩選與除錯程序後，最後判定有34,003名糖尿病病患，其中患憂鬱症者為1,048人(3%)。研究結果發現即使在控制性別、年齡、每月投保金額及有有無貧血、有無高血脂、無高血壓、有無冠心病、有無末期腎病變、有無腦血管疾病、有無慢性肺阻塞、投保地區別以及都市化程度的條件下，罹患憂鬱症的糖尿病患者相較於沒有憂鬱症的糖尿病病患，仍顯著使用較多的醫療資源。如門診就醫次數比率明顯增加了1.58倍的利用；而有憂鬱症者的住院天數，仍比沒有憂鬱症者高出2.60天；門診平均就醫費用部分則是多出23,649元的花費；有憂鬱症的糖尿病患仍比無憂鬱症者增加8,209元的住院費用；總醫療費用方面則為31,858元。
本研究希望能提供有關當局與臨床人員進一步思考糖尿病病患罹患憂鬱症的狀況與因應對策。如醫事人員在面對糖尿病病患時，應主動細心觀察病患是否有憂鬱傾向，並促使該族群盡速就醫諮詢或治療憂鬱。

Diabetes is one of the most serious chronic diseases in Taiwan. Chronic patients are always suffering by their ill-condition, and it might cause them to be depressive. The worse is those patients with depression are more possible to absent from their job, and that might decrease their production and increase their health utilization. Although there are some relative studies overseas, the Taiwanese conditions are still unknown. In this study, we explore the utilizations of diabetes with depression in Taiwan by the use of the Longitudinal Health Insurance Database 2005 (LHID2005) contained 1,000,000 beneficiaries’ original claim data and sampled from the National Health Insurance Research Database (NHIRD).In this database, there are 34,003 diabetes patients whose International Classification of Disease Ninth revision (ICD-9) code of 2005 ambulatory claims are 250, of which 1,048 were suffering from depression (3%).This study is trying to control gender, age, insurance amount every month, anemia, high cholesterol, high blood pressure, coronary heart disease, endstage renal disease, cerebrovascular disease, chronic obstructive pulmonary disease, area and urbanization, diabetes with depression use more medical resources than diabetes without depression in 2005. Such relative risk of outpatient visits was 1.58, length-of-stay raised 2.60 days, outpatient expenditure increased 23,649 NT dollars, inpatient expenditure increased 8,209 NT dollars, and total expenditure raised 31,858 NT dollars.

致謝 I
論文摘要 II
Abstract III
目錄 IV
表目次 VI
圖目次 VII

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 糖尿病的定義與概況 4
第二節 憂鬱症的定義與概觀 7
第三節 Andersen醫療服務利用理論 9
第四節 糖尿病合併憂鬱症的盛行率與相關性 13
第五節 糖尿病合併憂鬱症的醫療資源利用 19
第六節 小結 21
第三章 研究方法 22
第一節 研究架構 22
第二節 研究假說 24
第三節 資料來源與研究對象 25
第四節 研究變項及其操作型定義 27
第五節 資料處理與分析方法 33
第四章 結果 36
第一節 研究對象資料之描述性統計 36
第二節 糖尿病病患之基本特質與罹與憂鬱症之相關性分析 40
第三節 憂鬱症、糖尿病患的特質與醫療利用的相關性分析 43
第四節 糖尿病病患的醫療利用之迴歸分析 58
第五章 討論與建議 74
第一節 糖尿病病患的憂鬱症分佈情形與醫療耗用 74
第二節 糖尿病病患的基本特質與醫療耗用 76
第三節 研究限制 78
第四節 研究建議 80

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