臺灣博碩士論文加值系統

摘要
研究目的
臺灣在1992年爆發輻射污染鋼筋事件後，全國各地共有七千餘人受此事件影響。本研究主要是評估台灣輻射屋暴露族群處於擔心輻射污染的長期壓力下可能出現情緒變化乃至憂鬱症，透過自填式憂鬱量表瞭解此族群的憂鬱傾向分布特性及其相關危險因子，並探討過去暴露史是否與憂鬱傾向有關聯。

材料與方法
因輻射污染建築物之暴露族群每年皆會至特定的醫院進行健康檢查，研究者於2009年3月至12月間，針對2,143名參加追蹤健康檢查者由受過訓練的訪員指導進行問卷調查。在符合研究條件的對象中，共有1,707名同意參加本研究，並填寫個人資料、貝克憂鬱量表及憂鬱與身體症狀評估表。所有收集的資料再進一步以羅吉斯迴歸分析及線性迴歸分析，以發現可能與憂鬱傾向有關之因子。

研究結果
本研究結果顯示研究族群的憂鬱傾向盛行率為14.47％，相對高劑量族群(暴露值大於背景值5mSv)的憂鬱傾向為17.62％，明顯高於相對低劑量族群(暴露值大於背景值1-5mSv)(13.48％)。此外。教育程度越高者則越不容易有憂鬱傾向(OR 0.63，95% CI 0.49-0.80)；而越是擔心輻射汙染會對健康造成危害者則越容易有憂鬱傾向(OR 1.65，95% CI 1.41-1.94)。

結論
台灣長期低劑量率游離輻射暴露族群的憂鬱傾向盛行率為14.47%，而教育程度越低的人及越擔心輻射對健康造成不良影響者，越容易有憂鬱傾向。雖然沒有證據顯示過去的輻射暴露經驗會直接影響暴露族群的心理健康，但本研究之結果指出過去的輻射暴露經驗可能讓暴露族群有長期揮之不去的精神壓力，並因此產生憂鬱傾向及其他身心症狀。

關鍵字：憂鬱傾向、輻射汙染建築物、心理健康、貝克憂鬱量表

Abstract
Objectives
More than 7,000 people were found to be exposed to low-dose-rate gamma radiation contaminated building in Taiwan in 1992. The objective of this study was to assess possible emotional change and/or depression outcome secondary to long-term stress that was originated from the fear of radiation exposure among the above-mentioned exposed subjects. We used a self-administered questionnaire to understand the distribution of depression tendency and related risk factors in this “Radiation Contaminated Building (RCB)” cohort, and to analyze whether there was any relation between radiation exposure history and depression tendency.

Materials and Methods
Subjects included in the RCB cohort receive annual physical checkup at pre-specified hospitals. We conducted an interviewer-assisted questionnaire survey among 2,143 subjects who received physical checkup between March and December 2009. A total of 1,707 subjects who fulfilled the inclusion criteria agreed to participate in the study and filled out a questionnaire that included personal information, Beck Depression Inventory (BDI)-II Scale and Depression and Somatic Symptoms Scale (DSSS). All data were then analyzed by employing multivariate logistic regression and linear regression analyses to identify potential predictors of depression tendency.

Results
This study found that the prevalence of depression tendency was 14.47% among all study subjects (17.62% among subjects with relatively high dose exposure (excess dose >5mSV); and 13/48% among subjects with relatively low dose exposure group (excess dose= 1-5mSv). Moreover, education level was inversely associated with depression tendency (OR 0.63，95% CI 0.49-0.80). Individuals who worried more about the potential adverse health effects of radiation exposure were more likely to have depression tendency (OR 1.65，95% CI 1.41-1.94).

Conclusions
The prevalence of depression tendency in the RCB cohort was 14.47%. Less educated people and those who worried more about the potential adverse health effects of radiation exposure were more likely to have depression tendency. Although there was no evidence to show that prior experience of radiation exposure might directly affect the mental health of radiation exposed subjects, the findings of this study suggested that past radiation exposure experience might lead to long-term psychological stress, which could then result in depression tendency and other psychosomatic symptoms.

Key words：Depression tendency, radiation contaminated building, mental health, Beck Depression Inventory

目錄
第一章、前言 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究目的 5
第四節 研究假說 6
第二章、文獻探討 7
第一節 國際輻射污染事件相關研究 7
壹、車諾比事件(The Chernobyl Accident) 7
貳、日本長崎、廣島原爆事件(Atomic Bombing at Hiroshima and Nagasaki) 9
参、三哩島事件(Three mile island accident) 11
肆、其他文獻 12
第二節 國內輻射鋼筋汙染事件之相關研究 14
壹、染色體變異 14
貳、血液免疫功能異常 15
參、甲狀腺病變 15
肆、眼睛水晶體相關病變 15
伍、身高影響 16
陸、癌症風險 16
柒、生育能力 17
捌、生活品質滿意度調查 17
第三節 憂鬱傾向評估的重要性 18
壹、憂鬱症的重要性及盛行率 18
貳、憂鬱症之機轉 21
参、憂鬱症之症狀 22
第四節 憂鬱傾向之評估量表 24
壹、中文版貝克憂鬱量表第二版(BDI-II) 24
貳、憂鬱與身體症狀評估表(DSSS) 26
第三章、材料與研究方法 27
第一節 資料蒐集與排除 27
第二節 問卷描述 30
第三節 變項解釋 31
壹、憂鬱傾向 31
貳、族群 31
參、人口學特質 31
肆、過去暴露情況 32
伍、追蹤健康檢查 33
第四節 統計分析方法 34
第四章、研究結果 37
第I部分：是否有憂鬱傾向之探討 37
第一節 憂鬱傾向之相關人口學變項分析 37
壹、敘述性統計分析 37
貳、羅吉斯迴歸分析 38
第二節 次分組之憂鬱傾向相關人口學變項分析 40
壹、年齡 40
貳、性別 41
參、族群 42
肆、是否曾有憂鬱病史 43
第三節 過去暴露情形與憂鬱傾向之分析 44
壹、描述性統計 44
貳、羅吉斯迴歸分析 45
第II部分：憂鬱分數之探討 47
第四節 線性迴歸分析 47
壹、基本人口學變項 47
貳、過去暴露情形 48
第五章 討論 50
第一節 總結 50
第二節 憂鬱情形之相關因子之探討 51
壹、性別 51
貳、年齡 51
参、教育程度 52
肆、工作狀況 52
伍、婚姻狀態 53
陸、身體化症狀 53
第三節 過去輻射暴露經驗與憂鬱傾向之關係 55
第四節 研究優點與限制 58
壹、研究優點 58
貳、研究限制 59
第六章 結論與建議 61
第七章、參考文獻 62
附件 89
附件一、台灣人憂鬱症量表 89
附件二、台灣地區憂鬱傾向盛行率 90
附件三、基本資料表(自填) 91
附件四、憂鬱與身體症狀評估表(自填) 92
附件五、貝克憂鬱量表(自填) 94
附件六、BDI-II與DSSS之相關性 97
附件七、甲狀腺功能異常與憂鬱傾向 98

表格目錄
表 1、長期低劑量輻射暴露族群有無憂鬱傾向者之基本特性敘述統計分析 70
表 2、長期低劑量輻射暴露族群憂鬱傾向與基本人口學變項的關係(logistic regression) 72
表 3、年齡之次分組分析-憂鬱傾向與人口學變項之羅吉斯迴歸(logistic regression)分析- Adjusted model 74
表 4、性別之次分組分析-憂鬱傾向與人口學變項之羅吉斯迴歸(logistic regression)分析- Adjusted model 75
表 5、族群之次分組分析-憂鬱傾向與人口學變項之羅吉斯迴歸(logistic regression)分析- Adjusted model 76
表 6、是否曾有憂鬱病史者之次分組分析-憂鬱傾向與人口學變項之羅吉斯迴歸(logistic regression)分析- Adjusted model 77
表 7、2009年相對低劑量族群參加仁愛醫院輻射健康檢查者其過去暴露情形描述 78
表 8、2009年相對低劑量族群參加仁愛醫院輻射健康檢查者憂鬱傾向之羅吉斯迴歸(logistic regression)分析 81
表 9、長期低劑量輻射暴露族群憂鬱狀況與基本人口學變項的關係(simple linear regression) 83
表 10、長期低劑量輻射暴露族群憂鬱狀況與基本人口學變項的關係(multiple linear regression) 85
表 11、2009年參加追蹤健檢之相對低劑量族群暴露史之簡單線性迴歸分析(simple linear regression) 86
表 12、2009年相對低劑量族群參加仁愛醫院輻射健康檢查者其過去暴露情形之複線性迴歸(multiple linear regression)分析 88

參考文獻
1. 行政院原子能委員會編印. 輻射汙染建築物之處理及善後 (Page 53). 行政院原子能委員會年報. 2003;2.
2. Zablotska LB, Bogdanova TI, Ron E, et al. A cohort study of thyroid cancer and other thyroid diseases after the Chornobyl accident: dose-response analysis of thyroid follicular adenomas detected during first screening in Ukraine (1998-2000). Am J Epidemiol. 2008;167(3):305-312.
3. Tronko MD, Howe GR, Bogdanova TI, et al. A cohort study of thyroid cancer and other thyroid diseases after the chornobyl accident: thyroid cancer in Ukraine detected during first screening. J Natl Cancer Inst. 2006;98(13):897-903.
4. Davis S, Stepanenko V, Rivkind N, et al. Risk of thyroid cancer in the Bryansk Oblast of the Russian Federation after the Chernobyl Power Station accident. Radiat Res. 2004;162(3):241-248.
5. Vrijheid M, Cardis E, Ashmore P, et al. Ionizing radiation and risk of chronic lymphocytic leukemia in the 15-country study of nuclear industry workers. Radiat Res. 2008;170(5):661-665.
6. Noshchenko AG, Bondar OY, Drozdova VD. Radiation-induced leukemia among children aged 0-5 years at the time of the Chernobyl accident. Int J Cancer. 2010;127(2):412-426.
7. Noshchenko AG, Zamostyan PV, Bondar OY, Drozdova VD. Radiation-induced leukemia risk among those aged 0-20 at the time of the Chernobyl accident: a case-control study in the Ukraine. Int J Cancer. 2002;99(4):609-618.
8. Pukkala E, Kesminiene A, Poliakov S, et al. Breast cancer in Belarus and Ukraine after the Chernobyl accident. Int J Cancer. 2006;119(3):651-658.
9. Sigurdson AJ, Doody MM, Rao RS, et al. Cancer incidence in the US radiologic technologists health study, 1983-1998. Cancer. 2003;97(12):3080-3089.
10. Chodick G, Bekiroglu N, Hauptmann M, et al. Risk of cataract after exposure to low doses of ionizing radiation: a 20-year prospective cohort study among US radiologic technologists. Am J Epidemiol. 2008;168(6):620-631.
11. Worgul BV, Kundiyev YI, Sergiyenko NM, et al. Cataracts among Chernobyl clean-up workers: implications regarding permissible eye exposures. Radiat Res.2007;167(2):233-243.
12. Liu RS, Chen WL, Chen FD. Health examination and chromosome aberration analysis of residents living in 60Co-contaminated rebar buildings. Int J Radiat Biol. 2002;78(7):635-639.
13. Hsieh WA, Ni C, Hwang JJ, et al. Evaluation of the frequencies of chromosomal aberrations in a population exposed to prolonged low dose-rate 60Co gamma-irradiation. Int J Radiat Biol. 2002;78(7):625-633.
14. Chen WL, Hwang JS, Hu TH, Chen MS, Chang WP. Lenticular opacities in populations exposed to chronic low-dose-rate gamma radiation from radiocontaminated buildings in Taiwan. Radiat Res. 2001;156(1):71-77.
15. Hsieh WA, Lin IF, Chang WP, Chen WL, Hsu YH, Chen MS. Lens opacities in young individuals long after exposure to protracted low-dose-rate gamma radiation in 60Co-contaminated buildings in Taiwan. Radiat Res. 2010;173(2):197-204.
16. Chang TC, Chen WL, Chang WP, Chen CJ. Effect of prolonged radiation exposure on the thyroid gland of residents living in 60Co-contaminated rebar buildings. Int J Radiat Biol. 2001;77(11):1117-1122.
17. Hwang SL, Guo HR, Hsieh WA, et al. Cancer risks in a population with prolonged low dose-rate gamma-radiation exposure in radiocontaminated buildings, 1983-2002. Int J Radiat Biol. 2006;82(12):849-858.
18. Hwang SL, Hwang JS, Yang YT, et al. Estimates of relative risks for cancers in a population after prolonged low-dose-rate radiation exposure: a follow-up assessment from 1983 to 2005. Radiat Res. 2008;170(2):143-148.
19. Loganovsky K, Havenaar JM, Tintle NL, Guey LT, Kotov R, Bromet EJ. The mental health of clean-up workers 18 years after the Chernobyl accident. Psychol Med. 2008;38(4):481-488.
20. Yamada M, Izumi S. Psychiatric sequelae in atomic bomb survivors in Hiroshima and Nagasaki two decades after the explosions. Soc Psychiatry Psychiatr Epidemiol. 2002;37(9):409-415.
21. 李慧珍. 輻射污染建築物健檢居民生活品質之研究. 國立陽明大學 碩士論文. 2007.
22. Yen PN, Yang CC, Chang PW, et al. Perception of quality of life of a cohort population years after relocation from previous low-dose radiation exposure in Co-60 contaminated buildings in Taiwan. Int J Radiat Biol. 2011.
23. Bozhok Y, Greenebaum E, Bogdanova TI, et al. A cohort study of thyroid cancer and other thyroid diseases after the Chernobyl accident: cytohistopathologic correlation and accuracy of fine-needle aspiration biopsy in nodules detected during the first screening in Ukraine (1998-2000). Cancer. 2009;117(2):73-81.
24. Ivanov VK, Gorski AI, Tsyb AF, Maksioutov MA, Tumanov KA, Vlasov OK. Radiation-epidemiological studies of thyroid cancer incidence among children and adolescents in the Bryansk oblast of Russia after the Chernobyl accident (1991-2001 follow-up period). Radiat Environ Biophys. 2006;45(1):9-16.
25. Ivanov VK, Tsyb AF, Gorsky AI, et al. Leukaemia and thyroid cancer in emergency workers of the Chernobyl accident: estimation of radiation risks (1986-1995). Radiat Environ Biophys. 1997;36(1):9-16.
26. Shibata Y, Yamashita S, Masyakin VB, Panasyuk GD, Nagataki S. 15 years after Chernobyl: new evidence of thyroid cancer. Lancet. 2001;358(9297):1965-1966.
27. Viel JF, Curbakova E, Dzerve B, Eglite M, Zvagule T, Vincent C. Risk factors for long-term mental and psychosomatic distress in Latvian Chernobyl liquidators. Environ Health Perspect. 1997;105(Suppl 6):1539-1544.
28. Havenaar JM, Rumyantzeva GM, van den Brink W, et al. Long-term mental health effects of the Chernobyl disaster: an epidemiologic survey in two former Soviet regions. Am J Psychiatry. 1997;154(11):1605-1607.
29. Ginzburg HM. The psychological consequences of the Chernobyl accident--findings from the International Atomic Energy Agency Study. Public Health Rep. 1993;108(2):184-192.
30. Rahu K, Rahu M, Tekkel M, Bromet E. Suicide risk among chernobyl cleanup workers in estonia still increased: an updated cohort study. Ann Epidemiol. 2006;16(12):917-919.
31. Foster RP. The long-term mental health effects of nuclear trauma in recent Russian immigrants in the United States. Am J Orthopsychiatry. 2002;72(4):492-504.
32. Bromet EJ, Havenaar JM. Psychological and perceived health effects of the Chernobyl disaster: a 20-year review. Health Phys. 2007;93(5):516-521.
33. Preston DL, Kusumi S, Tomonaga M, et al. Cancer incidence in atomic bomb survivors. Part III. Leukemia, lymphoma and multiple myeloma, 1950-1987. Radiat Res. 1994;137(Suppl 2):S68-97.
34. Thompson DE, Mabuchi K, Ron E, et al. Cancer incidence in atomic bomb survivors. Part II: Solid tumors, 1958-1987. Radiat Res. 1994;137(Suppl 2):S17-67.
35. Cologne JB, Tokuoka S, Beebe GW, Fukuhara T, Mabuchi K. Effects of radiation on incidence of primary liver cancer among atomic bomb survivors. Radiat Res. 1999;152(4):364-373.
36. Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res. 2000;154(2):178-186.
37. Tokunaga M, Land CE, Yamamoto T, et al. Incidence of female breast cancer among atomic bomb survivors, Hiroshima and Nagasaki, 1950-1980. Radiat Res. 1987;112(2):243-272.
38. Ohta Y, Mine M, Wakasugi M, et al. Psychological effect of the Nagasaki atomic bombing on survivors after half a century. Psychiatry Clin Neurosci. 2000;54(1):97-103.
39. Hatch M, Susser M. Background gamma radiation and childhood cancers within ten miles of a US nuclear plant. Int J Epidemiol. 1990;19(3):546-552.
40. Hatch MC, Beyea J, Nieves JW, Susser M. Cancer near the Three Mile Island nuclear plant: radiation emissions. Am J Epidemiol. 1990;132(3):397-412.
41. Wing S, Richardson D, Armstrong D, Crawford-Brown D. A reevaluation of cancer incidence near the Three Mile Island nuclear plant: the collision of evidence and assumptions. Environ Health Perspect. 1997;105(1):52-57.
42. Baum A, Gatchel RJ, Schaeffer MA. Emotional, behavioral, and physiological effects of chronic stress at Three Mile Island. J Consult Clin Psychol. 1983;51(4):565-572.
43. Cleary PD, Houts PS. The psychological impact of the Three Mile Island incident. J Human Stress. 1984;10(1):28-34.
44. Auvinen A, Pukkala E, Hyvonen H, Hakama M, Rytomaa T. Cancer incidence among Finnish nuclear reactor workers. J Occup Environ Med. 2002;44(7):634-638.
45. Cardis E, Vrijheid M, Blettner M, et al. Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries. BMJ. 2005;331(7508):77-83.
46. Bender MA, Griggs HG, Bedford JS. Mechanisms of chromosomal aberration production. 3. Chemicals and ionizing radiation. Mutat Res. 1974;23(2):197-212.
47. Tsai MH, Hwang JS, Chen KC, Lin YP, Hsieh WA, Chang WP. Dynamics of changes in micronucleus frequencies in subjects post cessation of chronic low-dose radiation exposure. Mutagenesis. 2001;16(3):251-255.
48. Hsieh WA, Ni C, Hwang JJ, et al. Evaluation of the frequencies of chromosomal aberrations in a population exposed to prolonged low dose-rate 60 Co gamma -irradiation. Int J Radiat Biol. 2002;78(7):625-633.
49. Kindzel'skii LP, Zlochevskaia LL, Tsyganok TV, Shabaeva MM. [The natural body resistance of the inhabitants of the city of Kiev subsequent to the accident at the Chernobyl Atomic Electric Power Station]. Lik Sprava. 1993(4):25-28.
50. Pivnik AV, Moiseeva TN, Domracheva EV, et al. [The clinico-hematological indices of the participants in the cleanup of the aftermath of the Chernobyl accident]. Ter Arkh. 1996;68(7):73-77.
51. Chang WP, Hwang JS, Hung MC, Hu TH, Lee SD, Hwang BF. Chronic low-dose gamma-radiation exposure and the alteration of the distribution of lymphocyte subpopulations in residents of radioactive buildings. Int J Radiat Biol. 1999;75(10):1231-1239.
52. Chang WP, Lin Y, Hwang P, Tang JL, Chen JD, Lee SD. Persistent leucocyte abnormalities in children years after previous long term low dose radiation exposure. Br J Haematol 1999;106(4):954-959.
53. Ron E, Lubin JH, Shore RE, et al. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res. 1995;141(3):259-277.
54. 王蓉君、張武修、王榮德. 游離輻射暴露對孩童成長影響之探討. 中華衛誌. 1999;18(1):3-12.
55. Wang JC, Lin YP, Hwang JS, Hsieh WH, Tsai YJ, Chang WP. Physical heights of children with prolonged low dose-rate gamma-radiation exposure in radiocontaminated buildings. Int J Radiat Biol. Jan 2001;77(1):117-125.
56. Lin CM, Chang WP, Doyle P, et al. Prolonged time to pregnancy in residents exposed to ionising radiation in cobalt-60-contaminated buildings. Occup Environ Med. 2010;67(3):187-195.
57. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999;341(18):1329-1335.
58. Fava M. Somatic symptoms, depression, and antidepressant treatment. J Clin Psychiatry. 2002;63(4):305.
59. Stordal E, Bjelland I, Dahl AA, Mykletun A. Anxiety and depression in individuals with somatic health problems. The Nord-Trondelag Health Study (HUNT). Scand J Prim Health Care.2003;21(3):136-141.
60. Haug TT, Mykletun A, Dahl A. The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosom Med.2004;66(6):845-851.
61. 張春興. 張氏心理學辭典. 台北市: 東華書局; 2006.
62. Stephen AD. Encyclopedia of psychology and religion. 2010.Page220-223.
63. (WHO) WHO. WHO initiative on Depression in Public Health. http://www.who.int/mental_health/management/depression/definition/en/print.html.
64. Ustun TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ. Global burden of depressive disorders in the year 2000. Br J Psychiatry. 2004;184:386-392.
65. 薛文傑、葉佳祐、顏銘漢、林可寰、陳菊珍、徐玉英. 淺談抗憂鬱劑之治療. 家庭醫學與基層醫療. 2009;24(5):160-166.
66. 黃隆正、李明濱. 憂鬱症與自殺. 台灣醫學雜誌. 2003;7(6):929-934.
67. Hatcher-Kay C, King CA. Depression and suicide. Pediatr Rev . 2003; 24(11): 363-371.
68. 張家銘. EQ殺手 — 認識憂鬱. 2009; http://www.depression.org.tw/knowledge/know_info_part.asp?paper_id=64.
69. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder. JAMA. 2003;289(23): 3095-3105.
70. Kessler RC, Birnbaum HG, Shahly V, et al. Age differences in the prevalence and co morbidity of DSM IV major depressive episodes: results from the WHO World Mental Health Survey Initiative. Depress Anxiety. 2010 ;27(4):351-364.
71. 國民健康局. 民國91年台灣地區健康促進知識、態度與行為調查. 2000; http://olap.bhp.doh.gov.tw/system/ListNews.aspx?menu=100000000000.
72. 李昱、楊明仁、賴德仁、邱念睦、周騰達. 台灣人憂鬱症量表. 2000; http://www.jtf.org.tw/overblue/taiwan1/.
73. 楊浩然. 青少年憂鬱疾患及憂鬱症狀之追蹤研究: 流行病學研究所, 國立臺灣大學; 2002.
74. 劉嘉年. 社會經濟狀況、一般健康狀態、健康行為與社區成年民眾憂鬱情緒的關係. 臺灣公共衛生雜誌. 2009;28(4):300-311.
75. 陳純誠. 重鬱症生理病理機轉. 台灣精神醫學. 2001;15(14):3-13.
76. 鄧惠文、沈武典. 拋開憂鬱. 台灣精神醫學. 2001;15:165-166.
77. Lacasse JR, Leo J. Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Med. 2005;2(12):1211-1127.
78. Duric V, Banasr M, Licznerski P, et al. A negative regulator of MAP kinase causes depressive behavior. Nat Med.2010;16(11):1328-1332..
79. Timonen M, Liukkonen T. Management of depression in adults. BMJ. 2008;336(7641):435-439.
80. DSM I. Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association. 1994;358.
81. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996; 67(3):588-597.
82. Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation. 1996:1-82.
83. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-571.
84. 陳心怡. 貝克憂鬱量表第二版(中文版)指導手冊. 台灣發行: 中國行為科學社 2000.
85. 盧孟良、車先蕙、張尚文、沈武典. 中文版貝克憂鬱量表第二版之信度和效度. 台灣精神醫學. 2002;16:301-310.
86. Hung CI, Weng LJ, Su YJ, Liu CY. Depression and somatic symptoms scale: a new scale with both depression and somatic symptoms emphasized. Psychiatry Clin Neurosci. 2006;60(6):700-708.
87. Hung CI, Wang SJ, Liu CY. Validation of the Depression and Somatic Symptoms Scale by comparison with the Short Form 36 scale among psychiatric outpatients with major depressive disorder. Depress Anxiety. 2009;26(6):583-591.
88. Lai CH. Major Depressive Disorder: Gender Differences in Symptoms, Life Quality, and Sexual Function. J Clin Psychopharmacol. 2011;31(1):39-44.
89. Silverstein B. Gender difference in the prevalence of clinical depression: the role played by depression associated with somatic symptoms. Am J Psychiatry. 1999;156(3):480-482.
90. Lai CH. Major depressive disorder: gender differences in symptoms, life quality, and sexual function. J Clin Psychopharmacol. 2011;31(1):39-44.
91. Lin HC, Tang TC, Yen JY, et al. Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan. Psychiatry Clin Neurosci. 2008;62(4):412-420.
92. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097-1106.
93. Ross CE, Mirowsky J. Sex differences in the effect of education on depression: resource multiplication or resource substitution? Soc Sci Med. 2006;63(5):1400-1413.
94. Alvarado BE, Zunzunegui MV, Beland F, Sicotte M, Tellechea L. Social and gender inequalities in depressive symptoms among urban older adults of latin america and the Caribbean. J Gerontol B Psychol Sci Soc Sci. 2007;62(4):S226-236.
95. 王春展. 台灣地區大學生情緒智慧、憂鬱傾向與情緒調整策略之研究. 嘉南學報. 2004;30:443-460.
96. 王復維. 工作特質、疲勞及憂鬱傾向對新陳代謝症候群關係之研究 -以某醫學中心自費健檢(職業健檢)個案為例, 高雄醫學大學職業安全衛生研究所; 2005.
97. 丁思惠、陳喬琪. 憂鬱症的婚姻與家庭治療. 台北市醫學雜誌. 2006;3(10):954-961.
98. 連廷嘉；劉文華；陳志賢. 大學生親子關係、非理性信念與憂鬱之相關研究 大仁學報. 2008;32:115-133.
99. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999;341(18):1329-1335.
100. Haug TT, Mykletun A, Dahl AA. The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosom Med. 2004;66(6):845-851.
101. Bromet EJ, Havenaar JM, Guey LT. A 25 year retrospective review of the psychological consequences of the chernobyl accident. Clin Oncol (R Coll Radiol). 2011;23(4):297-305.
102. Honda S, Shibata Y, Mine M, et al. Mental health conditions among atomic bomb survivors in Nagasaki. Psychiatry Clin Neurosci. 2002;56(5):575-583.
103. Depression, the Thyroid, and Hormones. http://www.webmd.com/depression/guide/depression-the-thyroid-and-hormones.
104. Iosifescu DV, Nierenberg AA, Mischoulon D, et al. An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder. J Clin Psychiatry. 2005;66(8):1038-1042.