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研究生:陳正生
研究生(外文):Cheng-Sheng Chen
論文名稱:社區老人憂鬱疾患之身體狀況
論文名稱(外文):The Physical Status of Geriatric Depression in the Community
指導教授:張明永張明永引用關係
指導教授(外文):Mian-Yoon Chong
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:行為科學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2000
畢業學年度:88
語文別:中文
論文頁數:88
中文關鍵詞:憂鬱疾患老人身體狀況社區
外文關鍵詞:depressive disordersagedphysical statuscommunity
相關次數:
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憂鬱症是最常見的老年精神疾患之一,而且身體疾病在老年人也是常見的。研究在社區憂鬱症老人的身體健康狀況,以了解憂鬱症與身體疾病關係對於未來在社區預防或治療憂鬱症是必要的。許多文獻證實了身體疾病與憂鬱症的相關,但仍有一些問題仍待解決,例如老年憂鬱症診斷的不一致、研究樣本的代表性、身體疾病的多樣性等。
本研究主要的目的在了解有社區憂鬱疾患老人的身體狀況及分析老年憂鬱症相關的社會屬性及身體疾病的危險因子。
以前驅研究的結果推估研究樣本數,在都市區、次都市區及鄉村區以隨機取樣方式抽取各500名作為研究樣本。精神科醫師以老年精神狀態表(Geriatric Mental Status Schedule)(GMS)及電腦輔助診斷軟體AGECAT作為診斷精神疾病的工具,並收集老年人罹患的身體疾病、感官或語言障礙、日常生活失能、疼痛及藥物服用等身體狀況。
共1350名完成研究,發現有21.2%的老年人有憂鬱症(重度憂鬱症5.9%、官能型憂鬱症15.3%),84.8%的老年人有身體疾病,37.0%有感官或語言障礙,19.5%有日常生活失能,33.7%有疼痛症狀,61.8%服用藥物。以憂鬱症為個案組,沒有任何精神疾患841名(62.4%)為對照組,發現白內障、關節炎、胃腸系統疾病、心臟病、腦血管疾病、腎臟疾病及肝臟疾病為憂鬱症的危險因子,重度憂鬱症與官能型憂鬱症有不同的身體疾病種類危險因子。性別、年齡、教育程度、婚姻狀態及地區對憂鬱症與不同的身體狀況的相關有調節效應。以多變項對數回歸統計進一步分析憂鬱症與身體疾病的關係,發現女性、低教育程度、疼痛、日常生活失能、感官或語言功能障礙、藥物服用為憂鬱症的危險因子。如分開重度憂鬱症與官能型憂鬱症分析,則重度憂鬱症的危險因子為女性、低教育程度、疼痛、日常生活失能與感官或語言障礙;官能型憂鬱症的危險因子為女性、疼痛、日常生活失能,而日常生活失能與感官或語言功能障礙有交互作用。
本研究的結果建議,除了憂鬱症本身治療模式外,預防或治療老年人的身體疾病,減輕疼痛、減少身體疾病衍生的障礙與失能以及注意藥物的副作用,也可以有效預防或治療老年憂鬱症的發生。而重度憂鬱症與官能性憂鬱症身體疾病危險因子的差異,可以作為未來研究進一步探討。
Depressive disorders are the most common psychiatric disorders among the old age population. Although the relationship between depressive disorders and physical morbidity has been established, there are some issues remained to be resolved, like heterogeneity of late life depression, representatives of study sample, and diversity of physical morbidity.
This study aims at assessing the prevalence rate of depressive disorders and physical morbidity among the community old age population, and further examining the sociodemographic and physical status related risk factors.
A randomized sample of 1500 subjects age 65 and over was selected from 3 communities. Research psychiatrists conducted psychiatric assessment using the GMS, and depressive disorders were diagnosed with the computer-assisted system, AGECAT.
One-month prevalence of depressive disorders was found to be 21.2% (5.9% major depression; 15.3% neurotic depression) among the 1350 respondents. The prevalence of physical illness, sensory impairment, disability in daily living activities, pain complaints and medication use were found to be 84.8%, 37.0%, 19.5%, 33.7%, 61.8% respectively. Cataract, arthritis, gastrointestinal illness, heart problem, stroke, renal disease and liver disease were found associated with depressive disorders. Different risk factors regarding type of physical illness between major depressive disorder and neurotic depressive disorder would found. Sex, age, educational level, marital status and living area had the modulating effect on the relationship between depressive disorders and physical status. A logistic regression model revealed high risk of depressive disorders among female, low education level, subjects with pain complaints, sensory impairment, disability in daily living activities and medication use.
The result of this study re-emphasized the importance of physical illness and the relationship to depression. Compression of physical morbidity is thus reiterated.
第壹章 緒論……………………………………………………………..1
第一節 研究背景…………………………………………………………1
第二節 研究的動機與重要性……………………………………………2
第 1 項 老年憂鬱症仍未受到重視…….…………….………………..2
第 2 項 身體疾病及失能在老年人是常見的…………………………..3
第 3 項 合併身體疾病與憂鬱症增加醫療服務之困難度……………..4
第 4 項 社區研究可利於公共衛生的推廣……………………………..4
第貳章 文獻回顧…………………………………………………………5
第一節 老年憂鬱症………………………………………………………5
第 1 項 流行病學資料……………………………….………………….5
第 2 項 老年憂鬱症危險與保護因子……………….………………….6
第 3 項 評估與診斷………………………………….………………….7
第二節 老年身體疾病與症狀……………………………………………9
第 1 項 流行病資料………………………………….………………….9
第 2 項 評估………………………..……………….………………….10
第三節 老年憂鬱症與身體疾病的相關性………………………………11
第 1 項 身體症狀或身體疾病對老年憂鬱症診斷之影響….………….11
第 2 項 與憂鬱症相關的身體疾病…………………………….……….12
第四節 影響老年憂鬱症與身體疾病相關性的社會屬性因子…………13
第五節 研究方法討論……………………………………………………13
第 1 項 老年憂鬱症診斷的異質性……………………………………..13
第 2 項 未同時考慮多種身體疾病相關的變項………………………..14
第 3 項 未考慮地區的差異性…………………………………………..14
第參章 研究目的與假設………………………………………………..15
第一節 研究目的…………………………………………………………15
第二節 研究假設…………………………………………………………15
第肆章 研究方法…………………………………………………………16
第一節 研究背景…………………………………………………………16
第二節 研究對象…………………………………………………………16
第三節 研究流程…………………………………………………………17
第四節 研究工具…………………………………………………………17
第五節 資料分析與統計方法……………………………………………19
第 1 項 描述性統計……………………………………………………..19
第 2 項 推論性統計……………………………………………………..20
第伍章 研究結果…………………………………………………………21
第一節 完成個案之社會屬性……………………………………………21
第二節 未完成個案分析…………………………………………………21
第三節 憂鬱症及身體疾病之盛行率……………………………………21
第 1 項 憂鬱症盛行率…………………………………………………..21
第 2 項 身體疾病盛行率………………………………………………..22
第四節 社會屬性與身體疾病及憂鬱症之相關………………………..23
第 1 項 社會屬性與身體疾病相關……………………………………..23
第 2 項 社會屬性與憂鬱症相關………………………………………..23
第五節 身體疾病相關變項與憂鬱症之相關………….……………….24
第 1 項 憂鬱症…………………………………………………………..24
第 2 項 重度憂鬱症……………………………………………………..25
第 3 項 官能型憂鬱症…………………………………………………..26
第六節 社會屬性是否會影響(調節)身體疾病與憂鬱症之相關………27
第 1 項 性別……………………………………………………………..27
第 2 項 年齡……………………………………………………………..27
第 3 項 教育程度……………….……………………………………….27
第 4 項 婚姻……………………………………………………………..28
第 5 項 地區……………………………………………………………..28
第七節 多變項分析憂鬱症之相關因子………………………………..28
第 1 項 憂鬱症…………………………………………………………..28
第 2 項 重度憂鬱症……………………………………………………..29
第 3 項 官能性憂鬱症…………………………………………………..29
第陸章 討論………………………………………………………………30
第一節 研究方法的考量…………………………………………………30
第 1 項 個案……………………………………………………………..30
第 2 項 研究工具與設計………………………………………………..30
第二節 憂鬱症與身體疾病盛行率………………………………………31
第 1 項 憂鬱症盛行率…………………………………………………..31
第 2 項 身體疾病盛行率………………………………………………..32
第三節 與憂鬱症有高相關的身體疾病及障礙與失能…………………32
第 1 項 身體疾病種類…………………………………………………..32
第 2 項 感官功能障礙…………………………………………………..33
第 3 項 日常生活失能…………………………………………………..33
第 4 項 疼痛……………………………………………………………..33
第 5 項 藥物服用………………………………………………………..33
第四節 社會屬性的獨立主效應及調節效應(modulating effect)….34
第 1 項 性別……………………………………………………………..34
第 2 項 年齡……………………………………………………………..35
第 3 項 教育程度………………………………………………………..35
第 4 項 婚姻……………………………………………………………..36
第 5 項 地區……………………………………………………………..36
第 6 項 獨居……………………………………………………………..37
第五節 重度憂鬱症與官能型憂鬱症的差異
─從身體疾病的危險因子比較…………………………….............37
第 1 項 身體疾病種類…………………………………………………..37
第 2 項 感官或語言功能障礙…………………………………………..38
第 3 項 日常生活失能與疼痛………………………………………....38
第 4 項 藥物服用………………………………………………………..38
第柒章 結論與建議………………………………………………………39
參考文獻…………………………………………………………………….41
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