背景：雖然內化精神疾患如，單極性憂鬱疾患、自殺傾向及焦慮疾患，在一般族群當中已相當普遍，但探討其家族聚集及其對子女精神疾病的影響的研究仍然不多。目的：檢驗單極性憂鬱疾患及其相關精神疾患（自殺傾向及焦慮疾患）家族聚集的模式是否有相似的情形。此三種內化精神疾患對子女精神疾病的危險性也將一併探討。方法：透過對照式家族研究設計，研究對象選自醫院門診及一般社區，共109戶家庭，包含177位父母及其189位子女納入研究。每位成員均在家中由訓練過的訪員作一對一面訪，並根據訪談內容做最佳的診斷。精神疾患家族聚集的危險性由recurrence risk ratio評估；父母精神疾患對其子女患病的危險性則用邏輯斯迴歸分析在控制了可能的人口特性後評估。結果：單極性憂鬱疾患、自殺傾向及焦慮疾患的recurrence risk ratio分別為3.1 (95%C.I.=1.9-4.3), 4.3 (95%C.I.=3.1-5.5)以及2.1 (95%C.I.=1.1-3.1)。此外，在控制了子女的性別及年齡後，父母當中任一有自殺傾向的子女有較高的危險性具有單極性憂鬱(AOR=9.2，95%C.I.=2.4-44），自殺傾向(AOR=4.7，95%C.I.=1.1-21.1）及焦慮(AOR=5.0，95%C.I.=1.7-14.4）。焦慮疾患的子女和健康對照組的子女比較起來，亦有些微增高的危險性具有自殺傾向(AOR=13.6, 95% C.I.=1.4-667)。然而，本研究中在父母單極性憂鬱疾患及其子女的單極性憂鬱之間並無看到顯著關係。結論：本研究結果顯示三種內化精神疾患中，只有自殺傾向家族聚集的程度較為明顯，單極性憂鬱及焦慮疾患並無顯著的家族聚集。而本研究也另外顯示，自殺傾向的家族傳遞對子女精神疾患的影響並無專一性。

Background: Although some selective internalizing disorders in terms of unipolar depressive disorders, suicidality, and anxiety disorders were common in general population, still little is known about the degrees of familial aggregation and the risks on children’s psychopathology of these disorders. Objective: To examine whether unipolar depression and its related disorders, i.e., suicidality and anxiety disorders, aggregate in families in a similar pattern. The risks of having psychiatric disorders in children of parents with the three disorders are estimated as well. Methods: By using a design of controlled family study, one hundred and nine families comprising 177 parents and 189 children from hospital and community were ascertained. They were all interviewed by well-trained interviewers at home and their psychopathological statuses were evaluated by a best-estimate diagnostic process. The degree of familial aggregation was evaluated by using the recurrence risk ratio; and the effects of parental psychopathology on children’s were estimated by multivariable logistic regression models controlling for potential demographic confounding covariates. Results: The recurrence risk ratios of unipolar depression, suicidality, and anxiety disorders were 3.1 (95% C.I.=1.9-4.3), 4.3 (95% C.I.=3.1-5.5), and 2.1 (95% C.I.=1.1-3.1), respectively. Additionally, after controlling for children’s gender and age, children of either parent affected by suicidality exhibited increased risks than those of neither parent affected to have unipolar depression (AOR=9.2, 95% C.I.=2.4-44), suicidality (AOR=4.7, 95% C.I.=1.1-21.1), and anxiety disorders (AOR=5.0, 95% C.I.=1.7-14.4), respectively. Parental anxiety disorders exhibited a slightly higher risk (AOR=13.6, 95% C.I.=1.4-667) than non-affected controls on suicidality of their children. No significant association was found between parents’ and their children’s unipolar depression. Conclusions: The results indicated that among the three internalizing disorders, only suicidality, but not unipolar depression or anxiety disorders, exhibited a substantial familial aggregation. Moreover, the effect of familial transmission of parental suicidality appears to be non-specific on children’s psychopathology.

Text contents
致謝 i
Abstract iii
摘要 v
Text contents vii
Table contents ix
Introduction 1
Definition of unipolar depressive disorders 3
Prevalence rates of depressive disorders across different population 4
Comorbidity of depressive disorders 5
Familial aggregation for depressive disorders 6
Objectives 8
Methods 9
Study design and procedure 9
Participants 11
Assessments 12
Statistical analysis 14
Results 16
Distribution of socio-demographic characteristics for subjects 16
Psychiatric disorders in hospital and community samples 17
Internalizing disorders in children of affected and non-affected parents 19
Familial risks for unipolar depressive disorders, suicidality, and anxiety disorders 20
Associations of internalizing disorders between parents and their children 21
Discussion 22
References 28



Table contents
Table 1 Sociodemographic characteristics of parents and their children from hospital and community 44
Table 2 Psychiatric disorders of parents from hospital and community (n=177) 45
Table 3 Psychiatric disorders of probands and their spouses from hospital and community (n=177) 46
Table 4 Psychiatric disorders in children of probands from hospital and community (n=189) 47
Table 5 Internalizing disorders in children of parents with and without any psychiatric disorder (n=189) 48
Table 6 Internalizing disorders in children of parents with and without Unipolar depression (n=188) 49
Table 7 Internalizing disorders in children of parents with and without Suicidality (n=188) 50
Table 8 Internalizing disorders in children of parents with and without Anxiety disorders (n=188) 51
Table 9 Recurrence risk ratio for any disorder among children of at least one parent with any psychiatric disorder 52
Table 10 Recurrence risk ratio for unipolar depression among children of any parent with unipolar depression 53
Table 11 Recurrence risk ratio for suicidality among children of any parent with suicidality 54
Table 12 Recurrence risk ratio for anxiety disorders among children of any parent with anxiety disorders 55
Table 13 Multiple logistic regression analyses of children’s unipolar depression, suicidality, and anxiety disorders on their parents’ psychopathologies 56

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