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研究生:許家璋
研究生(外文):Chia-Chuang Hsu
論文名稱:青少年地震災難創傷後壓力疾患之追蹤研究
論文名稱(外文):A Prospective Study of Posttraumatic Stress Disorder Among Adolescent Earthquake Victims
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:2001
畢業學年度:89
語文別:中文
論文頁數:106
中文關鍵詞:地震創傷後壓力疾患青少年災難
外文關鍵詞:earthquakeposttraumatic stress disorderadolescentdisaster
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過去四十年人們從頻傳災變中探索災難心理,以瞭解重大壓力反應模式、對災難預作準備、並提供存活者及相關人員適當治療策略。各類災難心理研究始自臨床現象學之觀察,探討影響災難心理反應因素,從而建立反應模式,據此辨識慢性嚴重病理之高危險群或危險預測因子,為此一領域歷來之研究取向。
本研究主要目的在於瞭解青少年暴露災難經驗是否為創傷後壓力疾患之危險因子。是故,以經歷九二一地震之中寮鄉國中生為研究對象,災後一個月由精神科醫師以ChIPS結構式問卷進行診斷會談,請學生自陳壓力症狀嚴重度及一般身心健康狀況,並收集地震初級災難暴露經驗等資料,合計323名學生完成初期調查;災後四個月,請學生再次自陳壓力症狀嚴重程度;及至災後九個月,由精神科醫師再次進行診斷會談,請學生自陳壓力症狀嚴重度及憂鬱程度,並收集次級災難暴露經驗及後續生活壓力事件等資料,合計304名學生完成預後評估。
研究結果顯示此間國中生震災當時以居住房屋受損(49.5%)、目睹他人重傷(26.7%)、目睹他人死亡(18.6%)等經歷為最多;災後一個月21.7%學生罹患創傷後壓力疾患,而遭遇同住家人死亡(OR = 5.58,95% C.I.: 1.54~20.28)、個人身體受傷(OR = 2.35,95% C.I.: 1.06~5.21)為此一時期罹病之高危險因素;此外,個案組在一般身心症狀方面顯著較非個案嚴重,以焦慮、畏懼及強迫等為初期嚴重症狀。後續壓力源以餘震威脅(57.7%)、課業或升學(45.7%)、家庭經濟(38.0%)等最為常見;災後九個月僅4.9%學生為創傷後壓力疾患個案,而初期罹患創傷後壓力疾患(OR = 6.82,95% C.I.: 2.15~21.59)、與家人相處有壓力(OR = 4.31,95% C.I.: 1.39~13.40)為災後九個月罹病之高危險因素;除此,壓力疾患個案之自陳憂鬱症狀亦顯著較非個案組嚴重。追蹤創傷後壓力症狀演變,發現預後不佳者絕大部分在災變早期即已自陳嚴重症狀。
依據上述發現證實災難暴露經驗與創傷後壓力疾患之關聯,及創傷後壓力疾患與其他身心症狀之關聯。耑此,建議及早辨識壓力疾患危險群及慢性化個案,積極提供協助並預防合併症發生;而多面向、長期追蹤研究結果,可窺探災難心理病理全貌。
In recent decades, studies on disaster focus on reactions of victims exposed to the traumatic events, further to conceptualize models for various psychological reactions and to ascertain risks for developing post-traumatic stress disorders (PTSD). This prospective study aims at assessing the exposure experience and posttraumatic stress disorder among adolescent earthquake victims in the worst affected region close to the epicenter of the1999 Taiwan earthquake.
All remaining 323 students of the only 2 high schools at Chungliao were assessed for primary exposure experience and subjective symptoms via self-rated questionnaires one month after the earthquake, while psychiatrists made independent diagnosis for PTSD using the Children Interview for Psychiatric Syndromes (ChIPS). The above self-rated questionnaires were completed four months later. At 9th month after the earthquake, the students were follow-up by psychiatrists and assessment of secondary exposure experience and subjective symptoms were also evaluated.
Among the 323 students, more than one-fifth (21.7%) demonstrated PTSD one month after the earthquake. Those with PTSD showed significant psychiatric symptomatology than those with non-PTSD. Physical injury and death of family members living together were two major factors at risk for PTSD. Nine months after the earthquake, only 4.9% students had PTSD. Being a case of PTSD at 1-month interval after the earthquake and excessive worry about relational problems with family members were two major factors at risk for PTSD. Cases with PTSD also had significant depressive symptoms than non-cases.
This study demonstrated that certain earthquake-exposure experience was highly related to the PTSD and distress symptoms. Long-term follow-up of the victims is suggested to prevent the development of other psychiatric complications.
第壹章 緒論
第一節 研究背景
第二節 研究動機
第三節 研究目的
第四節 研究假設
第五節 名詞定義及解釋
第貳章 文獻回顧
第一節 災難
1.1 災難之定義
1.2 災難之類型
1.3 災難之流行病學
第二節 壓力疾患
2.1 急性壓力疾患與創傷後壓力疾患
2.2 壓力症狀及疾患之評估與診斷工具
2.3 壓力疾患之流行病學
第三節 影響災難反應之相關因素
3.1 災難前之前置因素
3.2 災難當時之誘發因素
3.3 災難後之維持因素
第四節 青少年之創傷後壓力症狀及疾患
4.1 青少年之創傷後壓力反應
4.2 青少年創傷後壓力反應之評估
第五節 災難研究方法學
5.1 研究設計常遭遇之問題
5.2 研究工具常遭遇之問題
5.3 資料分析常遭遇之問題
第參章 研究方法
第一節 研究對象
第二節 研究工具
第三節 研究流程
第四節 資料分析
第肆章 研究結果
第一節 中寮鄉國中生災後一個月之身心概況
1.1 地震災後一個月初級災難暴露經驗
1.2 地震災後一個月罹患創傷後壓力疾患之盛行率
1.3 地震災後一個月災難暴露經驗與創傷後壓力疾患之關係
1.4 地震災後一個月罹患創傷後壓力疾患之危險因素
1.5 地震災後一個月一般身心健康狀況之比較
1.6 摘要災後一個月之發現
第二節 中寮鄉國中生災後九個月之追蹤概況
2.1 地震災後九個月次級災難暴露經驗
2.2 地震災後九個月罹患創傷後壓力疾患之盛行率
2.3 地震災後災難暴露經驗與災後九個月創傷後壓力疾患之關係
2.4 地震災後九個月罹患創傷後壓力疾患之危險因素
2.5 地震災後九個月憂鬱症狀與創傷後壓力疾患之關係
2.6 地震災後九個月憂鬱症狀與生活壓力事件之關係
2.7 摘要災後九個月之發現
第三節 中寮鄉國中生地震災後一、四、九個月創傷後壓力症狀之演變
3.1 創傷後壓力症狀嚴重度之追蹤變化
3.2 創傷後壓力症狀之追蹤變化
3.3 摘要創傷後壓力疾患及症狀之演變
第伍章 討論
第一節 研究方法的考量
1.1 研究對象與樣本
1.2 研究工具
1.3 研究設計
第二節 創傷後壓力疾患之盛行率
第三節 災難暴露經驗與災難心理病理反應
3.1 災後一個月
3.2 災後九個月
第四節 創傷後壓力症狀及疾患之病程
第陸章 結論與建議
第一節 結論
第二節 建議
參考文獻
附錄
附錄一 研究工具
中寮鄉國中生基本資料表暨受災經驗調查表
生活壓力事件調查表
壓力疾患結構式診斷性會談問卷(ChIPS)
事件衝擊量表(Impact of Event Scale)
身心健康評估表(Symptom Check List — 90R)
貝氏憂鬱量表(Beck Depression Inventory)
附錄二 相關投稿文章
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