臺灣博碩士論文加值系統

精神官能症屬輕型之精神疾病，常見如焦慮症、恐慌症、強迫症、慮病症、輕鬱症等屬之，關於精神官能症之病因大致可由生理-心理-社會等三個角度來探討。臨床上，我們可以感覺到患者對死亡感到特別焦慮，或是特別恐懼死亡。本研究將由瞭解精神官能症患者的死亡態度切入，來看精神官能症之成因及治療。方法是由高雄長庚醫院精神科門診隨機抽樣選取一百名精神官能症患者為實驗組，並以其條件及背景類似之正常人一百名為對照組，以填寫結構式「死亡態度問卷」（內含「死亡恐懼」、「死亡逃避」、「死亡接受」三個向度，死亡接受又再細分為「趨近接受」、「中性接受」、「解脫接受」等三類）之方式，來瞭解精神官能症患者的死亡態度與一般正常人有何不同。研究並以病患自填之「中國人健康問卷」及「台灣人憂鬱問卷」來幫助瞭解病人最近之病況，以作者針對本研究設計的「心理治療需求問卷」來了解病人對其自身死亡態度的看法及對心理治療的需求。
研究結果發現精神官能症患者與正常人對照組在死亡態度上的確有所不同，精神官能症患者在「死亡恐懼」與死亡接受中之「解脫接受」等二項分數高於正常人對照組。而背景資料變項方面，發現有：一、男性患者之「死亡焦慮」及「死亡逃避」高於女性，而正常人對照組則無此現象；二、正常人對照組中西方宗教（含天主教及基督教）信仰者，其「趨近接受」高於無信仰者；三、其他變項如年齡、教育程度、婚姻狀況、宗教信仰、信仰虔誠度、自覺健康程度等則未見與死亡態度顯著相關。精神官能症患者之「中國人健康問卷」得分高低與「死亡恐懼」及「解脫接受」有顯著的正相關，而「台灣人憂鬱問卷」得分則與「解脫接受」有極顯著之正相關。可見精神官能症症狀較多者有較高之「死亡恐懼」，而憂鬱症狀嚴重者有較高之「解脫接受」。心理治療需求方面，則以「死亡恐懼」得分高者，有較高之心理治療需求。
作者依研究觀察所得，推論出一套「心理病理-死亡態度-精神治療」理論，提出一種以調整「死亡態度」為指標的「生理-心理-社會」治療模式，並建議以此作為精神官能症藥物及心理治療之參考。

Attitudes toward death in neurotic patients
Shih-Yong Chou, M.D.
Abstract
Neuroses are minor psychiatric disorders of various types. They include the following clinical syndromes: anxiety disorder, panic disorders, obsession-compulsion neurosis, hypochondriasis and minor depression. Neuroses are caused by various factors and can be broadly classified into biological, psychological, and social types. In clinical practice, some of neurotic patients are anxious about death, or particularly afraid of death. This study attempted to understand the neurotic patient’s attitudes toward death. One hundred neurotic patients were enrolled through random sampling of patients at Kaohsiung Changgung Memorial Hospital''s outpatient mental health clinic. The control group of 100 normal subjects was matched for demographic data and social characteristics. Each patient and subject filled out a structured questionnaire, the "Death Attitude Profile-Revised" (DAP-R), which included three scales: fear of death, death avoidance, and death acceptance. Death acceptance was further divided into approach acceptance, neutral acceptance and escape acceptance. The results of this questionnaire were used to determine whether there existed any difference in attitudes toward death between the two groups. These two groups patients also completed the "Chinese Health Questionnaire" and the "Taiwanese Depression Questionnaire" to assist in the assessment of their recent status. The "Psychotherapy Needs Questionnaire" designed by the authors was used to understand the subjects'' views on their attitudes toward death and their needs for psychotherapy.
Our results showed a significant difference in attitudes toward death between patients and the control subjects, with patients scoring significantly higher than the control group on "fear of death" and "escape acceptance" categories of the acceptance of death measure. In the neurotic group, males scored higher than females on "fear of death" and "death avoidance", whereas no difference was evident between males and females in the control group. Individuals in the control group with western religions (including Christian and Catholic) had higher approach acceptance toward death than those without religion beliefs. Other independent variables (age, educational level, marital status, religious belief, sincerity of belief, and self-perceived health) were unrelated to attitude toward death. Neurotic patients showed a positive correlation between scores on the "Chinese Health Questionnaire", "fear of death" and "escape acceptance" measures. Scores on the "Taiwanese Depression Questionnaire" showed a high correlation with scores on "escape avoidance". It implied that the patients with more neurotic symptoms had a greater "fear of death", and those with more serious depression had a higher "escape avoidance". In terms of request for psychotherapy, those patients with higher scores on "fear of death" showed a higher need for psychotherapy.
Based on the results of this investigation, the authors developed a "psychopathology--death attitude─psychiatric treatment" theory and proposed a "biological-psychological-social" treatment model using the "attitudes toward death" as an index, and suggest that this model may be useful as a reference in medical treatment and psychotherapy for neurotic patients.

第一章 緒論
第一節 研究動機 1
第二節 研究目的 3
第二章 文獻探討
第一節 死亡態度之內涵及其量表之發展史 4
第二節 死亡態度的相關研究 13
第三節 精神官能症之心理動力學理論 17
第四節 DSM-Ⅳ對各種精神官能症的定義 23
第三章 研究方法
第一節 研究架構與研究假設 36
第二節 名詞解說 38
第三節 研究對象 39
第四節 研究工具 39
第五節 統計分析 48
第四章 資料分析結果
第一節 敘述性統計 50
第二節 不同基本背景變項、中國人健康問卷、台灣人憂鬱問卷與死亡態度的分析 64
第三節 死亡態度量表、中國人健康問卷、台灣人憂鬱問卷與心理治療的需求的分析 79
第四節 實驗組與對照組的死亡態度量表、心理治療需求的分析
81
第五章 結論與建議
第一節 研究發現 83
第二節 討論 85
第三節 研究限制與建議 92
第六章 參考書目
一、 中文書目 93
二、 英文書目 96
三、 附錄 研究問卷 106
圖 表 目 次
圖目次
圖一：本研究之架構圖 37
圖二：以死亡態度為切入點的「心理病理-死亡態度-精神治療」模式 88
表目次
表3-4-1 實驗組死亡態度量表Cronbachα係數分析 41
表3-4-2 對照組死亡態度量表Cronbachα係數分析 41
表3-4-3 實驗組死亡態度量表因素分析結果 43
表3-4-4 對照組死亡態度量表因素分析結果 44
表3-4-5 實驗組心理治療需求問卷Cronbachα係數分析 48
表3-4-6 對照組心理治療需求問卷Cronbachα係數分析 48
表 4-1-1 有效問卷回收數量 50
表 4-1-2 實驗組年齡及教育水準統計 51
表 4-1-3 對照組年齡及教育水準統計 51
表 4-1-4 實驗組與對照組年齡 t檢定 51
表 4-1-5 實驗組與對照組受教育時間 t檢定 51
表 4-1-6 實驗組的DSM-IV 診斷分類 52
表 4-1-7 實驗組類別型基本資料之分布情形 53
表 4-1-8 對照組類別型基本資料之分布情形 54
表 4-1-9 「中國人健康問卷」得分表 55
表 4-1-10 實驗組與對照組之「中國人健康問卷」與「台灣人憂鬱問卷」得分 t 檢定 56
表 4-1-11 實驗組死亡態度量表得分統計 59
表 4-1-12 對照組死亡態度量表得分統計 60
表 4-1-13 實驗組心理治療需求問卷分數統計 63
表 4-1-14 對照組心理治療需求問卷分數統計 63
表4-2-1 實驗組 : 死亡態度的五個向度與其他變項的相關 65
表4-2-2 對照組 : 死亡態度的五個向度與其他變項的相關 66
表4-2-3 實驗組與對照組之年齡分類敘述統計 67
表4-2-4 實驗組與對照組之教育分類敘述統計 67
表4-2-5 實驗組：不同基本背景變項對精神官能症患者之死亡態度的單因子變異數分析摘要表 71
表4-2-6 對照組：不同基本背景變項對一般人之死亡態度的單因子變異數分析摘要表 73
表4-2-7 實驗組：鬼神信仰、宗教信仰對精神官能症患者之死亡態度的單因子變異數分析摘要表 74
表4-2-8 對照組：鬼神信仰、宗教信仰對一般人之死亡態度的單因子變異數分析摘要表 75
表4-2-9 實驗組 中國人健康問卷、台灣人憂鬱問卷與死亡態度的相關分析 78
表4-2-10 對照組 中國人健康問卷、台灣人憂鬱問卷與死亡態度的相關分析 78
表4-2-11 兩組合併 中國人健康問卷、台灣人憂鬱問卷與死亡態度的相關分析 78
表4-3-1 實驗組死亡態度的五個向度與心理治療之相關分析 80
表4-4-1 實驗組與對照組在「死亡態度」得分的 t檢定 82
表4-4-2 實驗組與對照組在「心理治療需求」得分的 t檢定 82

一、中文書目：
文榮光（民90）：附身關聯症與民俗信仰─臨床特徵與深度心理治療的發現。「宗教現象之心理學研究-應用心理學的研究方法探討宗教現象」國際學術研討會論文。台北：真理大學。
王素貞（民83）：台北市國小教師死亡態度、死亡教育態度及死亡教育需求之研究。國立台灣師範大學教育研究所碩士論文。
丘愛鈴（民78）：台北市國中教師對死亡及死亡教育態度之研究。國立台灣師範大學教育研究所碩士論文。
吳麗玉（民86）；護理學校學生死亡態度、安樂死態度之研究─以耕莘護理學校學生為例。國力台灣師範大學衛生教育學系碩士論文。
吳麗玉、林旭龍、呂昌明（民88）；護理學院學生死亡態度之研究。康寧學報，第三期，83-106頁。
巫珍宜（民80）：青少年死亡態度之研究。國立彰化師範大學輔導研究所碩士論文。
李明濱（民88）：實用精神醫學。台北，國立台灣大學醫學院出版社。
李復惠（民76）：某大學學生對死亡及瀕死態度之研究。國立台灣師範大學衛生教育研究所碩士論文。
沈楚文（民86）：新編精神醫學。台北，永大書局有限公司。
周建聖（民82）：心理治療學。台北，合記圖書出版社。
林志龍（民88）: 台北市某醫學院學生死亡焦慮及其相關因素。台北醫學院醫學研究所碩士論文。
林清山（民77）：多變項變異數分析統計法。東華社會科學叢書。
紀惠馨（民88）：護理校院生死學課程內容的需求差異探討─以一個學校為例。南華大學生死學研究所碩士論文。
徐士虹（民85）：國中生死亡態度之研究∼以宜蘭礁溪國中為例。中國文化大學應用科學研究所碩士論文。
高淑芬、洪麗玲、邱佩怡（民87）：某大學護生對死亡態度之探討。長庚護理，第九卷，第四期，20-29頁。
張文初（民85）：死之默想。台北，新視野圖書出版公司。
張春興（民81）：張氏心理學辭典。台北：台灣東華書局。
張淑美（民82）：國中生死亡概念與死亡態度之研究：質的分析。國立高雄師大學報，第4期，141-193頁。
陳順宇（民87）：多變量分析。台北：華泰書局。
陳瑞珠（民83）：台北市高中生的死亡態度、死亡教育態度及死亡教育需求。國立台灣師範大學衛生教育研究所碩士論文。
陳增穎（民87）：同儕死亡對青少年死亡態度、哀傷反應、因應行為影響之研究。國立高雄師範大學輔導研究所碩士論文。
傅偉勳（民82）：死亡的尊嚴與生命的尊嚴。台北：正中書局。
曾煥棠（民88）：生死學對護理學院畢業生的死亡處理態度與臨終照護行為之效果探討。中華心理衛生學刊，12（2），1-21。
黃天中（民80）：死亡教育概論Ⅰ--死亡態度及臨終關懷研究，增訂三版。台北：業強出版社。
黃天中（民81）：死亡教育概論Ⅱ。台北：業強出版社。
黃宇達（民86）：死亡焦慮：性別、年齡與死亡焦慮歸因之角色探討。中原大學心理學系碩士論文。
黃安邦（民80）：社會心理學。台北：五南出版社。
黃國彥（民75）：老人健康自評生活改變及生命意義與其生活滿意和死亡焦慮之關係。國科會（計畫編號：NSC74-0301-H004-03）。
黃琪璘（民80）：台北市綜合醫院醫師對死亡及瀕死態度之研究。國立台灣師範大學衛生教育研究所碩士論文。
葉寶玲（民88）：死亡教育課程對高中生死亡態度、憂鬱感及自我傷害行為影響效果之研究。國立彰化師範大學輔導研究所碩士論文。
廖芳娟（民89）：台灣警察之死亡態度研究。南華大學生死學研究所碩士論文。
劉明松（民86）：死亡教育對國中生死亡概念、死亡態度影響之研究。國立高雄師範大學教育學系碩士論文。
劉俊宏、楊明仁、蘇東平(民89)：台灣人憂鬱篩選問卷得分之效度分析。台灣精神醫學會89年度年會暨學術研討會論文摘要集,118頁
蔡秀錦（民80）：城鄉學童死亡之概念、焦慮度及教育需求之研究。國立台灣師範大學衛生教育研究所碩士論文。
蔡明昌（民84）：老人對死亡及死亡教育態度之研究。國立高雄師範大學成人教育研究所碩士論文。
鄭曉江（民83）：中國人死亡智慧。台北：東大圖書公司。
賴怡妙（民86）：死亡教育團體對台灣師大學生死亡態度及生命意義感之影響。國立台灣師範大學教育與輔導學系碩士論文。
鍾思嘉（民75）：老人死亡態度之調查研究。國科會補助研究論文。
鍾春櫻（民81）：死亡教育對護專學生死亡態度之影響。國立彰化師範大學輔導研究所碩士論文。
藍育慧（民84）：護專學生死亡恐懼、死亡態度及照顧瀕死患者時個人需求與因應行為之探討。護理雜誌，第42卷，第1期，75-90頁。
藍育慧、李選（民86）：死亡教育對改善護專學生死亡恐懼成效之探討。長庚護理，8卷，第1期，42-52頁。
羅素如（民89）：殯葬人員對死亡的態度與生死學課程需求之初探。南華大學生死學研究所碩士論文。
蘇完女（民80）：死亡教育對國小中年級兒童死亡態度的影響。國立彰化師範大學輔導研究所碩士論文。
顧豔秋（民86）：北部某護專學生對死亡所持態度之探討。榮總護理，第14卷，第2期，154-232頁。
二、英文書目
Abdel-Khalek, Ahmed M.(1997). Death, anxiety, and depression. Omega - Journal of Death & Dying. Vol 35(2), 219-229.
Abengozar, M-super(a) Carmen; Bueno, Belen; Vega, Jose Luis. (1999). Intervention on attitudes toward death along the life span. [Journal Article] Educational Gerontology. Vol 25(5), Jul-Aug, 435-447.
Aronow, E., Rauchway, A., Peller, M. & Vito, A. D. (1980). The Value of the self in relation to fear of death. Omega, 11(1), pp. 37-44.
Backer, B. A., Hannon, N., & Russell, N. A. (1982). Death and Dying, New York, John Willey & Sons.
Backer, E. (1973). The denial of death. New York: Free Press.
Bermann, S., & Richardson, V.(1987). Social change in the salience of death among adults in American: A projective assessment. Omega, 17(3), pp. 195-207.
Bugen, E.(1980-81).Coping: Effects of death education. Omega, 11, pp. 175-183.
Cataldo, Janine K. Hardiness and death attitudes: Predictors of depression in the institutionalized elderly. Archives of Psychiatric Nursing. Vol 8(5), Oct 1994, 326-332.
Chaggaris, Michelle; Lester, David. (1989). Fear of death and religious belief. Psychological Reports. Vol 64(1), Feb, 274.
Cheng TA, Wu JT, ChongMY, Williams P. Interal consistency and factor structure of the Chinese Health Questionnair. Acta Psychiatr Scand 1990:82:304-308.
Chong MY & Wilkinson,G (1989) Validation of 30-and 12-version of the Chinese Health Questionnaire (CHQ) in patients admitted for general health screening. Psychological Medicine 19,495-505
Clair, J. M., & Hashimoto, S. (1985). Contrasts and similarities in attitudes toward death of health care providers.（ERIC Document Reproduction Service No. ED. 263 507）.
Cole, M. (1978). Sex and martial status differences in death anxiety. Omega, 9(2), pp. 139-147.
Collett, L. J. & Lester, D. (1969). The fear of death and the fear of dying. The Journal of Psychology, 12, pp. 179-181.
Conte, H. R., & Weiner, M. B., & Plutchik, R.（1982）. Measuring death anxiety：Conceptual, Psychomotric, and factor-analytic aspects. Journal of Personality and Social Psychology, 43（4）,775-785.
Corr, C. A., Nabe, C. M., & Corr, D. M. (1997). Death and Dying: Life and Living(2nd).CA:Brooks/Cole Publishing Cmpany.
Curl, K. L. (1984). Attitudes of vocational home economics teachers toward death with implications for in-service education. DAI-A, 46(5), p. 1244.
Dattel, Andrew R; Neimeyer, Robert A. Sex differences in death anxiety: Testing the emotional expressiveness hypothesis. Death Studies. Vol 14(1), Jan-Feb 1990, 1-11.
Davis, S. F., Bremer, S. A., Anderson, B. J., & Tramill, J. L. (1983). The interrelationships of ego strength, self-esteem, death anxiety, and gender in undergraduate college students. The Journal of General Psychology, 108, pp. 55-59.
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