臺灣博碩士論文加值系統

現今對於受傷勞工的處理，不論是一般原因受傷或者是因為工作相關原因受傷的勞工，多半僅僅偏重於生理傷勢的診治與復健，對於受傷本身可能導致的心理障礙，如創傷後壓力障礙（posttraumatic stress disorder, PTSD），則多半被忽略。本研究之目的便在於探討受傷勞工可能存在的心理問題程度，以作為各個有關單位在服務受傷勞工或者制定相關政策時的參考。研究對象為臺大醫院骨科病房在民國九十三年七月到民國九十四年二月之間，於肢體外傷發生後七天以內住院的勞工，共47位，回收率69.1%。填寫問卷內容包括基本資料、中文版Mini-International Neuropsychiatric Interview（M.I.N.I.）問卷的PTSD部分以及中文版Brief Symptom Rating Scale-5（BSRS-5）問卷。其中27位傷者於受傷後一個月接受第二次調查，回收率57.4%。結果發現在受傷後立即受訪的傷者中，僅有兩位符合PTSD的診斷條件，與一般民眾的罹病率大致相符。然而卻有高達43%的傷者在BSRS-5的得分大於或等於6分，似乎比過去相關的研究要高，而且這個趨勢一直到受傷後一個月仍然一致。此外，對於PTSD亞型（subsyndromal PTSD）的盛行率則由立即受傷後的19%上升到一個月後的41%，主要可能來自於重複經驗（re-experience）的增加。因此，本研究結果初步顯示在協助處理受傷勞工的時候，勞工可能同時罹患的精神方面疾病與subsyndromal PTSD及其相關症狀將是必須被注意的課題。

Background: It has been known that while planning rehabilitation and treatment services for work-related injured workers, it is important to consider physical, social and personal factors. Consequently, psychiatric problems, especially post- traumatic stress disorder(PTSD), might play important roles for injured workers in return to work.
Objective: To investigate the prevalence of PTSD and other psychiatric diseases among limbs injured workers.
Methods: 47 limbs injured workers admitted in the Orthopedic ward of a teaching hospital in Taipei were recruited during July 2004 to February 2005. We interviewed those subjects within seven days after the injuries happened. Inform consents were signed. Basic information was collected using a questionnaire combined with the Chinese version of PTSD subschedule of the Mini-International Neuropsychiatric Interview(M.I.N.I.) and the Brief Symptom Rating Scale-5(BSRS-5) to explore the prevalence of PTSD and psychiatric comorbidities. 27 subjects were interviewed again one month after the injuries happened.
Results: Immediately after injuries, only two subjects fulfilled the full criteria of PTSD defined by the M.I.N.I., similar to the prevalence among general population, and 43% of the subjects got BSRS-5 scores equal to or greater than 6, which indicated that those subjects might have some kinds of psychiatric diseases and was estimated to be higher than that of previous studies. The condition still existed one month after injuries. Besides, the subsyndromal PTSD was much more prevalent among those subjects one month after injuries than immediately after injuries(41% vs. 19%), which was significantly different proved using McNemar’s test (p=0.01).
Conclusion: This primitive study suggested that psychiatric co-morbidities and subsyndromal PTSD might be important issues in treating limbs injured workers.

中文摘要 5
英文摘要 6
前言 8
材料與方法 15
結果 21
討論 25
結論 30
研究限制 31
參考資料 32

1.賴靜芬：影響職業災害上肢骨折勞工復工相關因素之探討。台大職業醫學與工業衛生研究所民國九十三年碩士論文。
2.Benjamin J. Sadock, Virginia A. Sadock, Kaplan & Sadock’s comprehensive textbook of psychiatry, 8th ed. Lippincott Williams % Wilkins, United States of America, 2005
3.Benjamin James Sadock, Virginia Alcott Sadock, Kaplan & Sadock''s synopsis of psychiatry : behavioral sciences, clinical psychiatry, Philadelphia, PA : Lippincott Williams & Wilkins, c2003
4.Bradley D. Grinage. Diagnosis and management of post-traumatic stress disorder. American Family Physician. 2003;68(12);2401-2408
5.Larry S. Goldman, Thomas N. Wise, David S. Brody, Psychiatry for primary care physicians. AMA press 2004, 167-71
6.David P, Moore, James W. Jefferson, Handbook of medical psychiatry, 2nd ed. Elsevier Mosby 2004, 171-3
7.Rosario B. Hidalgo, Jonathan R.T. Davidson. Posttraumatic Stress Disorder: epidemiology and health-related considerations. J Clin Psychiatry. 2000;61(suppl 7):5-13
8.Dieter Wagner, Markus Heinrichs, Ulrike Ehlert. Prevalence of symptoms of posttraumatic stress disorder in German professional firefighters. Am J Psychiatry 1998; 155:12 P1727-1732
9.Carol S. Fullerton, Robert J. Ursano, Leming Wang. Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J psychiatry 2004; 161:8 P1370-1376
10.C Cothereau, C de Beaurepaire, C Payan, J P Cambou, F Rouillon, F Conso. Professional and medical outcomes for French train drivers after “person under train” accidents: three year follow up study. Occup Environ Med 2004; 61:488-494
11.Angelina O.M. Chan, Chan Yiong Huak. Influence of work environment on emotional health in a health care setting. Occupational Medicine 2004; 54:207-212
12.Angelina O.M. Chan, Chan Yiong Huak. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occupational Medicine 2004; 54:190-196
13.Ulrich Schnyder, Hanspeter Moergeli, Otmar Trentz, Richard Klaghofer, Claus Buddeberg. Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up. Am J Respir Crit Care Med 2001; 164:653-656
14.Chian-Jue Kuo et al. Prevalence of psychiatric disorders among bereaved survivors of a disastrous earthquake in Taiwan. Psychiatric Services. 2003;54(4):249-251
15.Cheng TA. Psychological stress and minor psychiatric morbidity: A community study in Taiwan. Journal of Affective Disorders. 1989;17:137-152
16.Liao SC, Lee YJ, Liu SK, Lee MB, Wang SC, Chen JS, Cheng CT. Acute stress syndromes of rescue workers within one month after major earthquake. Formos J Med 2002; 6:1-9
17.Kumar Vedantham et al. Posttraumatic stress disorder, trauma exposure, and the current health of Canadian bus drivers. Can J Psychiatry. 2001; 46:149-155
18.Ronald C. Kessler, Textbook in psychiatric epidemiology, chapter 7: epidemiology of psychiatric comorbidity, John Wiley & Sons, Ltd. United States of America, 1995, p179-95
19.Ronald C. Kessler, Amanda Sonnega, Evelyn Bromet, Michael Hughes, Christopher B. Nelson. Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry. 1995;52(12);1048-1060
20.Foa EB, Davidson JRT, Frances A, The expert consensus guideline series: Treatment of posttraumatic stress disorder. J Clin Psychiatry 1999;60(suppl 16):1-76
21.張彧、黃曼聰、謝清麟、李文淑：影響手部外傷勞工重返工作因素之探討。職能治療學會雜誌，1996；14：115-125
22.謝清麟、李孟峰：影響中風病人重返工作之因素。職能治療學會雜誌，1996；14：27-34
23.Mario Maj, et al. Psychiatric diagnosis and classification, Chapter 8: Clinical assessment instruments in psychiatry, Wiley, 2002, 177-217
24.呂美嬅：放鬆反應於改善癌症末期病患之疼痛程度、情緒狀態及生理反應之成效。臺北醫學院護理學研究所民國九十年碩士論文
25.李怡祥：磨牙症患者的心理特徵及人格特質。臺北醫學大學口腔復健醫學研究所民國九十一年碩士論文。
26.Lee MB, Lee JY, Yen LL, et al. Reliability and validity of using a Brief Psychiatric Symptom Rating Scale in clinical practice. J Formos Med Assoc 1990; 89:1081-7
27.Liu SI, Prince M, Blizard B, et al. The prevalence of psychiatric morbidity and its associated factors in general health care in Taiwan. Psychological Medicine, 2002, 32, 629-37
28.Sheehan et al. M.I.N.I. mini international neuropsychiatric interview. J Clin Psychiatry 1998; 59(suppl 20):34-57
29.Sheehan et al. M.I.N.I. mini international neuropsychiatric interview. J Clin Psychiatry 1998; 59(suppl 20):22-33
30.Scheehan DV, Lecrubier Y, Harnett-Sheehan K, et al. The validity of the Mini-International Neuropsychiatric Interview (M.I.N.I.) according to the SCID-P and its reliability. Eur Psychiatry 1997; 12:232-241
31.Michael W. Vasey, Mark R. Dadds, The developmental psychopathology of anxiety. Oxford University Press 2001, 386-406
32.Terr, L.C. Childhood trauma: An outline and overview. American Journal of Psychiatry, 148, 10-20
33.John P. Wilson, Terence M. Keane, Assessing psychological trauma and PTSD, 2nd ed. The Guilford Press, 2004
34.Jerrold F. Rosenbaum, Essentials of neuroimaging for clinical practice, American Psychiatric Publishing, Inc. 2004, 55
35.Tamara V. Gurvits, et al. Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder, Bio Psychiatry, 1996; 40:1091-9
36.Lee-Ellen C. Copstead, Jacquelyn L. Banasik, Pathophysiology, biological and behavioral perspectives, 2nd ed. W. B. Saunders Company, 2000, 974
37.George Pickett, John J. Hanlon, Public health, Administration and practice, 9th ed. Times Minrror/Mosby College Publishing, United States of America, 1990, p83-4
38.Eugene S. Paykel, Rachel Jenkins, Prevention in psychiatry. Gaskell, London, 1994, p161-3