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研究生:李宜珈
研究生(外文):Yi-Chia Lee
論文名稱:運用多層次分析探討社區老人憂鬱之相關因素
論文名稱(外文):Multi-level analysis on depression and its associated factors in community-based older population
指導教授:林寬佳林寬佳引用關係
指導教授(外文):Kuan-Chia Lin
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:130
中文關鍵詞:老人憂鬱多層次分析地理區位脈絡因素個人層級因素
外文關鍵詞:elderly depressionmulti-level analysisarea levelcontextual factorindividual level factor
相關次數:
  • 被引用被引用:3
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論文摘要

由於人口老化的趨勢,使得老人相關的議題逐漸受到重視。老人精神違常盛行率最高者為憂鬱,但目前對於老人憂鬱之相關研究,多以個人層次為重點,有關區位層次之相關研究仍較為缺乏。本研究是以1999年「臺灣地區老人保健與生活問題長期追蹤調查系列研究調查資料」資料庫為基礎,並結合行政院主計處、內政部戶政司及社會司網站1999年之區位層級統計資料,運用多層次分析模式探討老人憂鬱之相關因素。
研究結果發現若以一般線性複迴歸模式將區位層級與個人屬性之研究變項併入分析,將使區位變項對於老人憂鬱的相關性產生低估,並違反一般線性迴歸模式之獨立性假設。進一步以多層次分析實證發現,若區分縣轄市、鄉、鎮等37個台灣地理區位後,以台東縣內各鎮的老人憂鬱程度最高 (CES-D mean=14.68,SD=3.34),而彰化縣內縣轄市的老人憂鬱程度最低(CES-D mean=1,SD=2.24)。整體區位層級之解釋變異量達11.8%。而影響老人憂鬱的個人層級因素依序為健康特質(自評健康、14項疾病罹病數)、身體功能(年齡、教育程度、ADL分數、IADL分數、身體功能分數)、良好睡眠品質及婚姻狀態,累計解釋變異量達24.1%。然而在脈絡因素部份,本研究結果僅呈現獨居老人比率達統計上之顯著意義,但與個人層級之相關因素並無交互作用。
ABSTRACT

As Taiwan’s population is aging, a substantial increase in the studies for older people can be seen. The most prevalent mental disorder of elderly is depression, but associated researches present regarding the depression of elderly are many take individual level as the key point, the related area level or macro-level associated research was still to lack.

In the current study, data from "The survey of the elderly people's health and life problem in Taiwan" in 1999” which was conducted by Taiwan Provincial Institute of Family Planning and its successor national health bureau was strictly applied. On the other hand, in order to apply the multi-level analysis, the area level statistical data of 1999 were then collected from website position of DGBAS(Directorate-General of Budget, Accounting and Statistics, Executive Yuan, R.O.C.), the Ministry of Interior Household Politics Department and Department of Social Affairs, Ministry of Interior.

The results primary revealed that the association between area level (macro-level) and depression of elderly would underestimate when using conventional linear regression model which simply merge the area level variance and individual level variance. Besides, the independence assumption of general linear regression was also found to be violated.

The current study consequently apply multi-level analysis and the results showed that, based on 37 Taiwan geography areas, the tendency of elderly depression was found highest in Taidong County (CES-D mean=14.68,SD=3.34); but lowest in Zhanghua County. (CES-D mean=1,SD=2.24). Explained variation of elderly depression for area level reaches 11.8%.

The associated factors of elderly depression in individual level were health characteristics (self-rated health, 14 diseases numbers), bodily function (age, education level, the ADL score, the IADL score, bodily function score), the good sleep quality and the marital condition. The cumulate explained variation of individual level reaches 24.1%. Furthermore, in the contextual factor part, the current study only presents the ratio of old person lives alone to reach the statistical significance, but no interaction with individual level factors.
目錄
中文摘要..................................................................I
英文摘要..................................................................II
第一章 緒論..............................................................1
第一節、研究動機....................................................1
第二節、研究目的....................................................8
第三節、研究問題....................................................8
第二章 文獻查證與相關文獻探討............................................9
第一節、老人與成功老化..............................................9
第二節、老人憂鬱...................................................11
第三節、老人憂鬱與生理影響.........................................16
第四節、老人憂鬱與心理影響.........................................17
第五節、老人憂鬱與環境、社會之影響.................................18
第六節、老人憂鬱相關因素...........................................19
第七節、多層次分析統計方法應用.....................................28
第三章 研究方法.........................................................33
第一節、研究資料來源與對象.........................................33
第二節、研究架構...................................................33
第三節、研究變項操作型定義與測量...................................34
第四節、統計軟體與方法.............................................40
第四章 研究倫理.........................................................44
第五章 研究結果與分析...................................................45
第一節、資料來源與範圍.............................................45
第二節、描述性統計.................................................47
第三節、老人憂鬱與個人層級因素之相關...............................53
第四節、老人憂鬱與區位層級因素之相關...............................63
第五節、多層次迴歸分析.............................................82
第六節、老人憂鬱與個人層級因素及區位層級因素之交互作用.............91
第六章 討論.............................................................96
第一節、區位之影響與討論...........................................97
第二節、個人層級之影響.............................................98
第三節、脈絡因素之影響............................................101
第七章 結論、限制與建議................................................105
第一節、 結論.....................................................103
第二節、限制與建議................................................108
參考文獻................................................................111
中文部份................................................................108
英文部份................................................................116
附件一 CES-D量表......................................................126
附件二 身體活動功能分數及工具性日常活動功能............................127
附件三 日常活動功能....................................................128
附件四 行政院衛生署國民健康局人口調查中心之資料使用同意函..............129
附件五 國立台北護理學院護理研究所機構審查委員(Institutional Review Board)審查
通過通知書......................................................130
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