跳到主要內容

臺灣博碩士論文加值系統

(3.236.124.56) 您好!臺灣時間:2021/07/31 05:12
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:陳韻玲
研究生(外文):Yun-Ling Chen
論文名稱:憂鬱症生活品質的長期追蹤研究
論文名稱(外文):A Longitudinal Study of Quality of Life in Persons with Depression
指導教授:潘璦琬潘璦琬引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職能治療研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:英文
論文頁數:140
中文關鍵詞:職能治療憂鬱症生活品質藥物
外文關鍵詞:Occupational therapyDepressionQuality of lifeMedication
相關次數:
  • 被引用被引用:10
  • 點閱點閱:970
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:9
研究背景與目的
在1960年代,西方開始興起去機構化運動。而國內在1980年代,亦開始推動社區的精神復健方案,包括居家治療、日間留院、社區心理衛生中心以及庇護工廠,期使心理疾患能夠回歸社區獨立生活。過去30年來,台灣罹患憂鬱症的人數逐年攀升。商志雍等人在2003年的研究發現,所有精神科門診患者中,罹患憂鬱症的比例已從1995年佔14.5%增加到2000年佔27.3%,顯示憂鬱症已成為國內心理健康領域中常見且不容忽視的議題。
憂鬱症的症狀包括憂鬱情緒、失去興趣和快樂感、有罪惡感、自我價值低落、食慾與睡眠品質降低、失去精力以及注意力不佳等。有研究指出,到了2020年,憂鬱症在全球疾病負擔的排名將躍升為第二。憂鬱症不僅具高發生率,且常慢性化並潛在地損害個案的心理社會和職能功能,嚴重的話甚至會導致死亡。過去的研究顯示,藥物治療雖能即時有效控制症狀,但對於長期促進心理社會健康的效果有限。而職能治療的目標是幫助個案參與其重視且具目的性的職能活動,勝任其職能角色,促進生活調適度,著重改善與個案相關的心理社會要素,以期提升個案的生活品質。
“生活品質” 起源於亞里斯多德提出的“追求幸福感”概念,而此專有名詞於第二次世界大戰後首次使用。自此,社會科學類的文獻漸增生活品質的研究,包括社會學、政治學、人類學和心理學。過去30年,隨著醫療評估的派典演進,醫療照顧變成以個案為中心的模式,因此個案對於本身健康狀態的觀點已被視為醫療評估的指標,而生活品質即為目前心理健康照顧領域中重要的研究和療效指標。
至今,生活品質未有統一的定義,其中世界衛生組織將生活品質定義為「個人在所生活的文化價值體系中,對於自己的目標、期望、標準、關心等方面的感受程度,其中包括一個人在生理健康、心理狀態、獨立程度、社會關係、個人信念以及環境六大方面」。且許多詞彙在文獻中常被代替為生活品質的意義,如生活滿意度、安適感、快樂感與生活狀況。不過,生活品質目前一致地被視為是一個多層面的概念,描述個人對其生理健康、心理健康、社會關係和環境的評價。
自1980年代起,開始出現心理疾患的生活品質研究,不過大多針對精神分裂症患者或異質性族群,針對憂鬱症患者的研究較為缺乏。至今,台灣在生活品質方面的文獻發表,多侷限於診斷和橫跨性方法上的研究,少有探討影響生活品質的長期追蹤研究。
國外關於憂鬱症的自然式長期追蹤研究,且探討到生活品質的預測因素,研究者搜尋到十一篇相關的文獻。在這十一篇中,追蹤次數為1到4次不等,追蹤時間長度由半年至7~8年不等。每次追蹤時的個案流失率為6%至38%,個案流失的原因包括拒絕參與追蹤研究、病情嚴重或死亡、研究者未能聯絡到個案等。在大部分的研究中,個案的平均年齡介於為40~50歲,而60%以上的個案為女性。
過去的研究一致顯示疾病相關因素與個案的生活品質變化有顯著關係,疾病相關因素包括憂鬱嚴重度、發病年齡、疾病時間長度、服用的藥物,但對其生活品質各範疇有不同的影響性。在人口學特性方面,長期追蹤的研究中發現年齡對其生活品質未有影響;性別和就業與否對生活品質的影響力不一致;而教育程度和婚姻狀況對生活品質的影響則未得到證實,另外,從橫斷式的研究中顯示個案的人口學特性,對其生活品質各範疇有不同的影響性。
在心理社會因素方面,有研究顯示,個案具有健康的生活型態與積極的因應技巧,能提升兩年後的生理與心理健康層面生活品質。另一研究顯示,個案的社會功能與其社會關係範疇的生活品質有顯著的關聯。而在橫斷式的研究中發現,個案具有較高的職能勝任感、自我掌控信念、環境支持度和社會支持滿意度,與生活品質較佳有顯著關聯。Pan (2006) 提出自覺職能表現勝任感和滿意度是生活品質的重要預測因子,亦即個案所自覺到從事職能活動的能力,以及從參與過程中所產生的滿意度,對其生活品質有正向影響。
由於目前在探討心理社會因素對憂鬱症個案生活品質的長期追蹤研究較為缺乏,且個案的人口學特性和疾病相關因素對生活品質的影響程度未明確。另外,至今較少針對台灣族群進行研究,但個案對於生活品質的觀感可能會有文化差異。因此本研究目的為以長期追蹤的觀點,探討憂鬱症個案生活品質的變化與相關的預測因子。研究問題一為生活品質四大範疇:生理健康、心理健康、社會關係和環境,是否在追蹤期間內有顯著變化。研究問題二為人口學特性、疾病相關因素與心理社會因素,是否可預測個案在綜合生活品質、綜合健康及生活品質四個範疇於追蹤期間的良莠。

研究假設
1. 個案生活品質的四個範疇,包括生理健康、心理健康、社會關係和環境,在第一次至第二次追蹤期間內皆呈現顯著改變。
2. 個案的基本背景資料,包括年齡、性別、教育程度、婚姻狀況與就業狀況,可預測台灣簡明版世界衛生組織生活品質問卷中的綜合生活品質(G1)、綜合健康(G4)、生活品質四個範疇(生理健康、心理健康、社會關係、環境)與各範疇所包含的題目,在兩次追蹤期間之良莠。
3. 個案於兩次追蹤期間的疾病相關因素,包括憂鬱嚴重度、發病年紀、生病時間長度、抗憂鬱藥物種類、服用助眠劑與否,可預測台灣簡明版世界衛生組織生活品質問卷中的綜合生活品質(G1)、綜合健康(G4)、生活品質四個範疇(生理健康、心理健康、社會關係、環境)與各範疇所包含的題目,在兩次追蹤期間之良莠。
4. 個案於兩次追蹤期間的心理社會因素,包括職能勝任感、自我掌控信念、環境支持度以及社會支持度,可預測台灣簡明版世界衛生組織生活品質問卷中的綜合生活品質(G1)、綜合健康(G4)、生活品質四個範疇(生理健康、心理健康、社會關係、環境)與各範疇所包含的題目,在兩次追蹤期間之良莠。

研究方法
參與者:本研究個案來自於台大醫院的精神科門診。所有個案皆經由精神科醫師根據ICD-10或DSM-IV診斷系統確認患有憂鬱症、18歲以上、有意願參與研究且認知功能足夠完成自填問卷,排除條件為具嚴重精神疾病與物質濫用問題。

研究程序:本研究於初始點的樣本(T1)來自余姓與陳姓研究者收集而得,共有237位,本研究進行兩次追蹤共歷經三年(2005/08~2008/10),第一次追蹤的個案(T2)來自於論文指導教授(潘璦琬博士)的研究計畫資料。第二次追蹤個案(T3)由研究者以電話與每位個案聯繫,說明研究目的並經個案同意參與後,約定會面的時間和地點。會面時,先請個案填寫個案基本資料表與研究參與同意書,接著進行認知功能篩檢,當個案通過簡式智能量表(>24分)後,便進行相關的自評問卷測驗,本研究的程序獲得台大醫院研究倫理委員會的同意。

工具:所有問卷皆已翻譯為中文版,並經過信、效度的驗證。除了個案的認知功能由研究者以簡式智能量表所評估外,其他皆是個案自評的中文版問卷。以下為本研究各變項所使用的工具:綜合生活品質、綜合健康、生活品質四範疇與相關層面是由台灣簡明版世界衛生組織生活品質量表進行評量;職能勝任感由職能自我評估量表的職能勝任感部份作評估;環境支持度由職能自我評估量表的環境支持度部分作評估;自覺掌控信念由自覺掌控信念量表評估;社會支持度由社會支持量表的滿意度部分作評估;憂鬱嚴重度由流行病學研究中心憂鬱量表作評估。

資料分析:將所有個案的測驗分數經由羅序測量模式轉換為羅序分數,採用的統計軟體為WINSTEPS 3.56版。羅序測量模式的特性為可將順序資料轉換為等距資料,以符合連續性資料的分析假設。接著,所有資料以SPSS 軟體15.0版及SAS 軟體9.1版進行統計分析。推論性統計方面,採用雙尾檢定且顯著水準定為α=0.05。
1. 以描述性統計分析全部個案於初始點(T1)及兩次追蹤時間點(T2, T3)時的人口統計學資料、疾病相關變項與所有測驗的原始分數。類別型資料以次數分配表及百分比呈現,而連續型資料以平均數、標準差和範圍呈現。
2. 統計每次追蹤的追蹤率和流失原因,並分析個案接受追蹤與否在人口統計學資料、疾病相關變項上的差異。連續型資料以獨立樣本t檢定(independent sample t-test)分析,類別型資料以卡方檢定(χ2 test)分析,包括從T1至T2及T1至T3兩個時間階段。
3. 統計追蹤的間隔時間長度,包括從T1至T2、T1至T3及T2至T3三個時間階段。
4. 針對研究假設,資料分析方式如下:
(1) 以趨勢圖呈現參與所有測驗的個案於三次測量時間點(T1, T2, T3),生活品質各範疇原始平均分數的變化。
(2) 分析預測變項 (人口學特性、疾病相關因素與心理社會因素)與生活品質各範疇在T2時的關連,預測變項為類別變項者採用獨立樣本t檢定(Independent sample t-test)或單因子變異數分析 (One-way ANOVA),為連續變項者則採用皮爾森積差相關分析 (Pearson product-moment correlations),測驗分數皆採用其羅序分數。
(3) 在T2與T3期間,以綜合生活品質、綜合健康、生活品質四範疇及26個相關的層面為依變項,採用混合效應模式(Mixed-effect model)建立32個憂鬱症個案的生活品質預測模式,固定效應的自變項包括人口學特性、疾病相關因素、心理社會因素,而個體間在作答上的差異及隨時間的變化則視為隨機的效應。測驗分數皆採用其羅序分數

結果
所有個案在研究初始點的人口學背景與疾病相關因素特性
個案平均年齡為47.1歲(標準差=13.5,範圍=18.3~76.7歲),以女性居多(74.3%),69.6%的個案教育程度為高中以上,62.4%的個案已婚並與配偶同住,僅35.4%的個案就業中,其他個案可能待業中、身為學生、家庭主婦或已退休。91.9%的個案與家人或朋友同住,53.2%的個案月收入介於10,000~50,000之間。在疾病相關變項方面,個案的平均發病年齡為40.0歲(標準差=14.2,範圍=11.0~76.0),平均發病時間長度為7.1年(標準差=7.8,範圍=0.1~43.6),62.9%的個案有合併其他生理疾病的困擾,59.5%的個案因憂鬱症住院過,70.0%的個案正服用憂鬱劑,87.3%的個案表示生活中有受到藥物副作用的影響。

追蹤反應率、流失原因、平均追蹤時間
有104位個案參與T2的追蹤研究(反應率=43.9%),90位個案同意參與T3的追蹤研究(反應率=38.0%),未參與追蹤的原因包括個案表示不願參與研究、因居住於外地工作或求學而不方便參與以及未能聯絡上個案,最後一項原因包括個案的電話更換、聯絡期間已聯絡五次但都未能接通等原因。完整接受兩次追蹤的個案有70位。接受T2追蹤的個案中,有23位個案已停藥而有5位個案離開台大醫院就診;接受T3追蹤的個案中,有24位個案已停藥而有7位個案離開台大醫院就診。未接受追蹤的個案中,有9位個案表示已停藥與未回診而拒絕T2追蹤,有11位個案表示已停藥與未回診而拒絕T3追蹤。
本研究的總平均追蹤時間為44.9個月(標準差=5.2,範圍=36.5~54.5),T1至T2的平均追蹤時間為19.5個月 (標準差=9.8,範圍=5.8~43.6),有60.0%的個案接受追蹤的時間間距為12.1~30.0個月。T2至T3的平均追蹤時間為26.1個月 (標準差=7.4,範圍=7.8~35.9),其中75.7%的個案接受追蹤的時間間距為24.1至36.0個月。

個案接受追蹤與否之差異
個案接受追蹤與否於人口學特性與疾病相關變項的差異方面,不同追蹤階段的結果如下:個案接受T2追蹤與否,僅在其T1的婚姻狀況上有顯著差異(P=0.011);個案接受T3追蹤與否,在T1的年齡、性別、工作狀況和發病年齡上有顯著差異(P< 0.05)。另外,個案服用抗憂鬱藥物是否影響其參與度方面,兩次追蹤的結果皆發現未參與研究的個案,停用抗憂鬱藥物的比例顯著低於參與研究的個案(P≤ 0.001)。

個案的生活品質
針對70位接受兩次追蹤測驗的個案分析自初始點至兩次追蹤期間(T1~T3)在生活品質四個範疇上的平均原始分數之變化,發現到個案於環境範疇的生活品質皆最高,依序為生理範疇和社會關係範疇,而心理範疇最低。與世界衛生組織台灣版問卷發展小組所建立的健康人常模相比,發現到本研究的憂鬱症個案於生理健康、心理健康範疇的平均分數低於健康人平均分數一個標準差。由趨勢圖觀察顯示在兩次追蹤期間 (T2, T3),個案於生理健康和心理健康範疇上有稍微下降的趨勢,而在社會關係與環境範疇上則相對穩定。個案於社會關係範疇上的平均分數較健康人常模稍低(介於平均值與負一個標準差之間),但環境範疇的平均分數稍高於健康人常模。

個案的生活品質預測因素
由詳盡的混合效應模式的分析結果顯示,門診憂鬱症個案在兩年追蹤期間的四個生活品質範疇未隨時間呈現顯著變化,但由生活品質範疇各自包含的題目來看,發現個案雖然醫療需求隨時間顯著減少,但個案的活力與對生命正面意義的觀感也隨之顯著降低。個案的年齡、發病年紀、生病時間長度皆未能顯著預測個案的生活品質。不過,個案的職能勝任感、環境支持度、自我掌控信念、憂鬱嚴重度、服用抗憂鬱藥物、一些人口學因素是個案生活品質的重要預測因子。
本研究證實心理社會因素對於個案生活品質的長期影響。個案自覺具有較高的職能勝任感與環境支持度傾向感受到較好的綜合生活品質。再者,職能勝任感對於生活品質四個範疇的諸多題項有正面的效果。個案具有較高的職能勝任感傾向滿意自己在日常生活活動、工作和休閒方面的效能感,並對於社會支持和人際關係具有正面的觀感。而環境支持度高除了能提升個案在環境範疇上的滿意度,亦能對心理範疇上的題項有正面的效果。個案具有較高的環境支持度,傾向對於自己的生命意義有正面觀感。個案的自我掌控信念較高,傾向對於自己在日常生活和工作上的表現較為滿意,並享受於有意義的生活。
憂鬱嚴重度對於個案的綜合生活品質、綜合健康以及在生理健康、心理健康和社會關係範疇上的生活品質的諸多題項具有影響。個案具有較高的職能勝任感與較輕的憂鬱嚴重度傾向對於健康照護的需求較少,而可能降低社會負擔。另外,我們也發現到抗憂鬱藥物的種類對於個案在生活品質四個範疇上有所影響。而個案的性別、婚姻狀況、教育程度和工作狀況也對於生活品質不同層面有所影響。

結論
經本研究三年的長期追蹤結果顯示,門診憂鬱症個案在環境範疇的生活品質最高,心理健康範疇最低。對於居住於台灣的慢性憂鬱症個案而言,我們建議臨床處置應更積極,且著重於提升個案在生理健康、心理健康和社會關係範疇的生活品質。經由詳盡的研究分析方法,本研究確認全面性的生活品質預測模式,作為職能治療針對憂鬱症個案處置的參考。
本研究證實憂鬱嚴重度、服用抗憂鬱劑對於個案的生活品質有顯著長期效應。因此,臨床治療人員應加強教育憂鬱症個案藥物順從性的重要,以降低其憂鬱嚴重度,但也須同時注意不同種類的抗憂鬱劑對於個案在生活品質之影響。例如,選擇性血清素再吸收抑制劑 (SSRI)可能會使個案對於自己在日常生活表現上的觀感有負面的影響。性別、教育程度、婚姻狀況與工作狀況等人口學特性能對個案生活品質的不同層面有所影響,因此,臨床治療人員應該根據個案不同的人口學背景建立適合個案的生活型態。
除了改善憂鬱程度的處置,也應該著重提升個案的職能勝任感與環境支持度,並強化其自我掌控信念,以提升與維持個案的生活品質。本研究強調職能治療師應該幫助個案設計均衡的生活型態,有效地表現其重視的職能角色,如家庭成員與工作者。我們建議使個案投入其重視與有興趣的職能活動可能是一個適當的方法,以降低其憂鬱嚴重度,並促進自我效能感、均衡生活型態、調適能力,以及與環境產生正向互動。另外,本研究也提供一些或可幫助提升個案生活品質的活動,與幫助他們更容易投入活動的原則。我們建議未來應以長期追蹤研究,驗證以職能為基礎的治療模式在憂鬱症個案生活品質上的成效。
Background
The number of persons with depression has been increasing in the recent 30 years in Taiwan (商志雍, 廖士程, & 李明濱, 民92). Depression is a chronic disorder that substantially impairs a client’s psychosocial and occupational functioning, as well as resulted in significant morbidity and mortality (Bakish, 2001; Trivedi et al., 2006; World Heath Organization, 2007). Although many longitudinal studies have investigated the predictors of Quality of Life (QOL) in persons with depression (Pyne et al., 2003; Ruggeri, Bisoffi, Fontecedro, & Warner, 2001), few of these studies have emphasized on the contribution of psychosocial factors.
Results from the longitudinal studies have demonstrated that healthy lifestyle and active coping skills are strong predictors of QOL in physical health and psychological health domain, respectively (Sherbourne, Hays, & Wells, 1995). A study by Goldberg and Harrow (2005) found a significant relationship between objective social functioning and social aspect of QOL among persons with depression (J. F. Goldberg & Harrow, 2005). Several cross-sectional studies suggested that occupational competence, mastery, environmental affordance and social support may have contribution to enhance QOL for persons with depression (Carpiniello, Lai, Pariante, Carta, & Rudas, 1997; Chan, Chiu, Chien, Thompson, & Lam, 2006; Chung, Pan, & Hsiung, 2008 Accepted; Kuehner & Buerger, 2005; Pan, Chan, Chung, Chen, & Hsiung, 2006; 陳韻玲, 熊秉荃, 陳詞章, & 潘璦琬, 民97).
The severity of depression and the demographic characteristics have been proposed to predict clients’ long-term QOL but the results of studies investigating these factors have been inconsistent.
To date, there are few internationally published studies on the factors affecting QOL for Taiwanese or eastern people with depression and these studies delineated the predictors of QOL were restricted in using the cross-sectional study design (Chan et al., 2006; Hung, 2006; Pan et al., 2006; 陳韻玲 et al., 民97). As QOL in depression may have cultural differences, we deemed it worthwhile to conduct a study in Taiwan (Berzon, Hays, & Shumaker, 1993).Thus, the aim of this study is to examine the change in QOL and predictive factors of QOL in persons with depression from longitudinal perspective.

Methods
The study is a naturalistic longitudinal study and the subjects were adult outpatients with depression recruited from the psychiatric outpatient clinic of the National Taiwan University Hospital (NTUH) in Taipei, Taiwan. All subjects met the ICD-10 system (F32, F33, F34) (World Health Organization, 1992) or DSM-IV system (296.2, 296.3, 300.4, 311) (American Psychiatric Association, 1994) for a diagnosis of Depressive Disorder. Diagnosis was established by an attending psychiatrist during the subject’s first visit to the clinic.
A total of 237 subjects agreed to participate in the study at baseline (T1) that obtained from the studies of Yu and Chen by purposive sampling method (余春娣, 民94; 陳靜紋, 民94). The subjects were followed up twice during the period of three years. The data from the 1st follow up (T2) were existing data from a previous project of my advisor Dr. Pan (潘璦琬, 民94a, 民94b). The data from the 2nd follow up (T3) were collected by the principal researcher of this study. Subjects were contacted by telephone and assessed using a standardized procedure. Ethical clearance for this study was approved by the Institutional Review Board of the NTUH.
Following consent to participate in the study, subjects were screened for cognitive function using the Mini-Mental State Examination-Chinese version (MMSE-C) and were excluded from the study if they had a score of 24 or below. Afterwards, they were administered other self-rated questionnaires to examine their QOL, occupational competence, sense of mastery, environmental affordance, social support, and severity of depression. The measures included The World Health Organization Quality of Life-BREF-Taiwan version (WHOQOLBREF-TW), the Occupational Self Assessment-Chinese version (OSA-C), Mastery scale-Chinese version (Mastery-C), Social Support Questionnaire-Chinese version (SSQ-C), Center of Epidemiology Study-Depression Scale-Chinese version (CESD-C).
Raw data obtained from all self-rated instruments was transformed for Rasch analysis using WINSTEPS 3.56 (Linacre, 2006). All data was analyzed using SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA) and Statistical Analysis System (SAS), version 9.1 (SAS Institute, Cary, NC). The level of significance was set at two-tailed with an alpha level of 0.05.
The measured scores in the overall QOL, overall health, 4 domains of QOL and related 26 items between T2 and T3 were fitted with linear mixed-effects model with covariates, including 5 demographic variables, 5 disease-related variables and 4 psychosocial variables. We chose the random intercept and slope model to establish these 32 predictive models of QOL.

Results
The average length of involvement in this study was 44.9 months (SD=5.2, range=36.0-54.5). The average length from T1 to T2 was 19.5 months (SD=9.8, range=5.8-43.6) and the average length from T2 to T3 was 26.1 months (SD=7.4, range=7.8-35.9). 104 subjects (response rate: 43.9%) were assessed at T2 and 90 subjects (response rate: 38.0%) were assessed at T3.
The most significant differences of variables at T1 between respondents and nonrespondents were subjects’ demographic characteristics, including marital status, gender, age, employment and onset age. In addition, the subjects who had not taken antidepressants tended to participate in the follow-up study.
The results of this 3-year longitudinal study of QOL among adults with chronic depression suggested that the majority of subjects were satisfied with their environmental domain of QOL, followed by the physical health, social relationships and the psychological health was the least satisfied aspect.
The subjects’ QOL in the physical health and psychological health domains were poorer than that of the healthy populations in Taiwan. Also, there were slightly decreasing in these two domains of QOL between T2 and T3. The persons with depression had slightly poorer QOL in the social relationships domain than the healthy populations but had better QOL in the environmental domain but the changes in these two domains were relative stable. For the persons with chronic depression lived in Taiwan, we suggested that our treatments should be more intensive and pay much more attention on the enhancement of their QOL in the physical health, psychological health and social relationships domains than in the environmental domain.
The present study provides a broad but detailed inquiry to understand the predictors of QOL longitudinally in persons with chronic depression in Taiwan. After the analyses on the domains and items of QOL with mixed-effects model, we found that the subjects’ age, onset age and onset duration had no significant effect on the QOL in persons with depression. Rather, occupational competence, environmental affordance, sense of mastery, severity of depression, the antidepressants and several demographic characteristics were the important predictors of QOL over time and the predictive model of QOL in persons with chronic depression was validated.
Importantly, we proved the positive effect of psychosocial factors, including occupational competence, sense of mastery and environmental affordance, on the QOL in different aspects over time. When a person perceived higher occupational competence and environmental affordance, he or she tends to feel better overall QOL. In addition, the occupational competence had positive effect on the items of QOL across all the domains. Subjects with higher occupational competence tended to have the sense of capacity and efficacy in personal performance on the ADL, work and leisure as well as have positive perceptions of social support and interpersonal relationships with others.
Except for the environmental domain of QOL, environmental affordance also had positive effect on the item of the psychological health domain. Subjects with higher environmental affordance would feel positive perception for the meanings of life. The sense of mastery also had positive effect on the items of QOL across all the domains. Subjects with higher sense of mastery tended to feel positive perception of the performance of ADL and leisure as well as enjoy in meaningful life.
The study confirmed that severity of depression had significant impact on overall QOL and the items in the physical health, psychological health and social relationships domains. In addition, subjects with higher occupational competence and less severity of depression tended to have less demand on medical treatment and decrease the social burden. We also found that the antidepressants were the significant predictors of the items of QOL across all the domains. The subject’s demographic characteristics, including the gender, educational level, marital status and working status had different effect on the items of QOL.
The present findings provide some suggestions as to what can be done by occupational therapists in persons with depression for the QOL enhancement. In order to advance the treatment outcome for persons with chronic depression, except for symptom reduction, we should pay much more attention on the enhancement of their occupational competence and perceptions of environmental affordance as well as strengthen their sense of mastery to improve their QOL.
The study emphasized that the occupational therapists should help the subjects to design balanced lifestyle based on their different demographic backgrounds and improve the performance on roles they valued, such as the family members and workers. The educations of medication compliance were important. However, we should also take notice of the negative impact of different types of antidepressants on the subjects’ QOL, such as the SSRI’s might have negative impact on the perception of individuals’ ADL performance.
We suggested that engaging in activities clients are valued and interested in might be the suitable way to reduce their severity of depression and improve their sense of efficacy, balanced lifestyle, adaptive skills, and resulted in the positive interaction with the environment around them. Our study suggested several activities which might have positive effect on OQL in persons with depression and provided some principles to help them engaging in the activities easier. The occupation-oriented treatment programs were needed to be examined from longitudinal studies in the future.
學位考試審查表 i
致謝 ii
中文摘要 iv
ABSTRACT xiv
LIST OF TABLES xxii
LIST OF FIGURES xxiii
LIST OF APPENDICES xxiv
INTRODUCTION 1
LITERATURE REVIEW 3
Depression 3
Quality of Life (QOL) 4
Naturalistic longitudinal studies related to QOL 5
The relationships between disease-related factors and QOL 7
The relationships between demographic characteristics and QOL 10
The relationships between psychosocial factors and QOL 13
Occupational competence 14
Mastery 16
Environmental affordance 17
Social support 18
Summary of the literature review and research framework 21
METHODS 24
Subjects 24
Procedures 24
Instruments 25
The World Health Organization Quality of Life-BREF-Taiwan
version (WHOQOLBREF-TW) 25
The Occupational Self Assessment (OSA) 27
Mastery Scale 29
Social Support Questionnaire-Short Form (SSQSF) 31
Center of Epidemiology Study Depression Scale (CESD) 32
Mini-Mental State Examination (MMSE) 34
Statistical analyses 34
RESULTS 38
The characteristics of subjects 38
The follow-up duration and response 39
The differences of characteristics between the respondents and
nonrespondents 40
The subjects’ QOL in this study 41
The associations between the predictors and each domain of
QOL at T2 41
The results of Mixed-effects model 42
DISCUSSION 46
The QOL in persons with depression 46
The predictors of QOL 46
The response rate and reasons for drop-out 55
The clinical applications 56
The limitations in this study 59
Future suggestions 60
CONCLUSIONS 61
REFERENCES 64


Table 1. Characteristics of subjects at T1 (N=237) 87
Table 2. Characteristics of subjects at T2 (N=104) 88
Table 3. Characteristics of subjects at T3 (N=90) 90
Table 4. Raw scores of the assessments in this study between T1 and T3 92
Table 5. The frequency distribution in each follow-up period 93
Table 6. The differences of characteristics at T1 between the respondents and nonrespondents at T2 94
Table 7. The differences of characteristics at T1 between the respondents and nonrespondents at T3 95
Table 8. The associations between the predictive variables with each domain of QOL at T2 96
Table 9. Predictors for domains, “overall QOL” and “overall health” items of the WHOQOLBREF-TW 97
Table 10. Predictors for items in Physical Health domain of
WHOQOLBREF-TW 99
Table 11. Predictors for items in Psychological Health domain of WHOQOLBREF-TW 101
Table 12. Predictors for items in Social Relationships domain of WHOQOLBREF-TW 103
Table 13. Predictors for items in Environmental domain of
WHOQOLBREF-TW 105
Fig. 1 The framework of predictors of QOL in persons with depression 107
Fig. 2 The procedure of contacting with the subjects 108
Fig. 3 The results of the follow ups in this study 109
Fig. 4 The change of QOL in each domain among the three study test-time 110
Appendix A. Summary of the longitudinal studies related to QOL in persons with depression 111
Appendix B. The document of approval by the Institutional Review Board of the NTUH for the data at T2 117
Appendix C. The document of approval by the Institutional Review Board of the NTUH for the data at T3 118
Appendix D. The informed consent form 120
Appendix E. The basic information form 121
Appendix F. The World Health Organization Quality of Life-BREF-Taiwan version (WHOQOLBREF-TW) 122
Appendix G. The Occupational Self Assessment-Chinese version (OSA-C) 126
Appendix H. Mastery Scale-Chinese version (Mastery-C) 127
Appendix I. Social Support Questionnaire-Short Form-Chinese version (SSQSF-C) 128
Appendix J. Center of Epidemiology Study Depression Scale-Chinese version (CESD-C) 130
Appendix K. Mini-Mental State Examination-Chinese version (MMSE-C) 131
Appendix L. The permission for using the WHOQOLBREF-TW 132
Appendix M. The permission for using the OSA-C 133
Appendix N. The permission for using the Mastery-C and SSQSF-C 134
Appendix O. The permission for using the CESD-C 135
Appendix P. The permission for using the MMSE-C 136
Appendix Q. Descriptive statistics for analyzing the characteristics of subjects 138
Appendix R. The methods for analyzing the differences of variables between the respondents and nonrespondents 139
Appendix S. The methods of analyzing the associations between QOL with each predictor 140
American Occupational Therapy Association. (2002). Occupational Therapy Framework: Domain and process. American Journal of Occupational Therapy, 56(609-639).
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4 ed.). Washington DC: Author.
Angermeyer, M. C., Holzinger, A., Matschinger, H., & Stengler-Wenzke, K. (2002). Depression and quality of life: results of a follow-up study. International Journal of Social Psychiatry, 48(3), 189-199.
Angst, J. (1992). Epidemiology of depression. Psychopharmacology, 106 Suppl, S71-74.
Asplund, R. (1999). Sleep disorders in the elderly. Drugs & Aging, 14(2), 91-103.
Aubin, G., Hachey, R., & Mercier, C. (1999). Meaning of daily activities and subjective quality of life in people with severe mental illness. Scandinavian Journal of Occupational Therapy, 6(2), 53-62.
Bakish, D. (2001). New standard of depression treatment: remission and full recovery. Journal of Clinical Psychiatry, 62 Suppl 26, 5-9.
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215.
Baron, K., Kielhofner, G., Iyenger, A., Goldhammer, V., & Wolenski, J. (2002). A User''s Manual for The Occupational Self Assessment (OSA) (Version 2.0). Chicago, IL: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.
Barrera, M. (1986). Distinctions between social support concepts, measures, and models. American Journal of Community Psychology, 14(4), 413-445.
Bechdolf, A., Klosterkotter, J., Hambrecht, M., Knost, B., Kuntermann, C., Schiller, S., et al. (2003). Determinants of subjective quality of life in post acute patients with schizophrenia. European Archives of Psychiatry & Clinical Neuroscience, 253(5), 228-235.
Bengtsson-Tops, A. (2004). Mastery in patients with schizophrenia living in the community: relationship to sociodemographic and clinical characteristics, needs for care and support, and social network. Journal of Psychiatric & Mental Health Nursing, 11(3), 298-304.
Berlim, M. T., Pargendler, J., Brenner, J., & Fleck, M. P. A. (2007). Significant improvement in the quality of life of Brazilian depressed outpatients 12 weeks following the start of antidepressants. Psychiatry Research, 153(3), 253-259.
Berzon, R., Hays, R. D., & Shumaker, S. A. (1993). International use, application and performance of health-related quality of life instruments. Quality of Life Research, 2(6), 367-368.
Bhat, A., Shafi, F., & El Solh, A. A. (2008). Pharmacotherapy of insomnia. Expert Opinion on Pharmacotherapy, 9(3), 351-362.
Bienenfeld, D., Koenig, H. G., Larson, D. B., & Sherrill, K. A. (1997). Psychosocial predictors of mental health in a population of elderly women. Test of an explanatory model. American Journal of Geriatric Psychiatry, 5(1), 43-53.
Birtchnell, J. (1991). Negative modes of relating, marital quality and depression. British Journal of Psychiatry, 158, 648-657.
Blackburn, I. M., & Bishop, S. (1983). Changes in cognition with pharmacotherapy and cognitive therapy. British Journal of Psychiatry Vol 143 Dec 1983, 609-617.
Blazer, D., Hughes, D. C., & George, L. K. (1992). Age and impaired subjective support. Predictors of depressive symptoms at one-year follow-up. Journal of Nervous & Mental Disease, 180(3), 172-178.
Bonicatto, S. C., Dew, M. A., Zaratiegui, R., Lorenzo, L., & Pecina, P. (2001). Adult outpatients with depression: worse quality of life than in other chronic medical diseases in Argentina. Social Science & Medicine, 52(6), 911-919.
Bowlby, J. (1969). Attachment and Loss. Vol. 1. Attachment. New York: Basic Books.
Bowlby, J. (1973). Attachment and Loss: Vol.2. Separation: Anxiety and anger. London: Hogarth Press.
Bowlby, J. (1980). Attachment and Loss. Vol. 3. Loss: Sadness and Depression. New York: Basic Books.
Brugha, T., Conroy, R., Walsh, N., Delaney, W., O''Hanlon, J., Dondero, E., et al. (1982). Social networks, attachments and support in minor affective disorders: a replication. British Journal of Psychiatry, 141, 249-255.
Buist-Bouwman, M. A., Ormel, J., de Graaf, R., & Vollebergh, W. A. M. (2004). Functioning after a major depressive episode: complete or incomplete recovery? Journal of Affective Disorders, 82(3), 363-371.
Bullinger, M. (2003). Measuring health related quality of life. An international perspective. Advances in Experimental Medicine & Biology, 528, 113-122.
Camfield, L., & Skevington, S. M. (2008). On subjective well-being and quality of life. Journal of Health Psychology, 13(6), 764-775.
Caplan, G. (1974). Support systems and community mental health. New York: Behavioral Publications.
Carpiniello, B., Lai, G. L., Pariante, C. M., Carta, M. G., & Rudas, N. (1997). Symptoms, standards of living and subjective quality of life: a comparative study of schizophrenic and depressed out-patients. Acta Psychiatrica Scandinavica, 96(4), 235-241.
Chan, S. W. C., Chiu, H. F. K., Chien, W.-T., Thompson, D. R., & Lam, L. (2006). Quality of life in Chinese elderly people with depression. International Journal of Geriatric Psychiatry, 21(4), 312-318.
Chien, C. P., & Cheng, T. A. (1985). Depression in Taiwan: epidemiological survey utilizing CES-D. Seishin Shinkeigaku Zasshi - Psychiatria et Neurologia Japonica, 87(5), 335-338.
Chung, L., Pan, A. W., & Hsiung, P. C. (2008 Accepted). Quality of life for patients with depression in Taiwan: A model-based study of predictive factors. Psychiatry Research.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310-357.
Crist, P. H., Davis, C. G., & Coffin, P. S. (2000). The effects of employment and mental health status on the balance of work, play/leisure, self-care, and rest. Occupational Therapy in Mental Health, 15(1), 27-42.
de Jong, R., Treiber, R., & Henrich, G. (1986). Effectiveness of two psychological treatments for inpatients with severe and chronic depressions. Cognitive Therapy and Research, 10(6), 645-663.
Demyttenaere, K., De Fruyt, J., & Huygens, R. (2002). Measuring quality of life in depression. Current Opinion in Psychiatry, 15(1), 89-92.
Devereaux, E. (1986). Current issues in the assessment and treatment of depression. In Depression assessment and treatment update, proceedings (pp. 2-13). Rockville, MD: American Occupational Therapy Association.
Devereaux, E., & Carlson, M. (1992). The role of occupational therapy in the management of depression. American Journal of Occupational Therapy, 46(2), 175-180.
Diehr, P. H., Derleth, A. M., McKenna, S. P., Martin, M. L., Bushnell, D. M., Simon, G., et al. (2006). Synchrony of change in depressive symptoms, health status, and quality of life in persons with clinical depression. Health & Quality of Life Outcomes, 4, 27.
Doraiswamy, P. M., Khan, Z. M., Donahue, R. M. J., & Richard, N. E. (2002). The spectrum of quality-of-life impairments in recurrent geriatric depression. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 57(2), M134-137.
Doyle, J. J., Casciano, J., Arikian, S., Tarride, J. E., Gonzalez, M. A., & Casciano, R. (2001). A multinational pharmacoeconomic evaluation of acute major depressive disorder (MDD): a comparison of cost-effectiveness between venlafaxine, SSRIs and TCAs. Value in Health, 4(1), 16-31.
Eklund, M. (2007). Perceived control: how is it related to daily occupation in patients with mental illness living in the community? The American Journal of Occupational Therapy, 61(5), 535-542.
Eklund, M., & Backstrom, M. (2006). The role of perceived control for the perception of health by patients with persistent mental illness. Scandinavian Journal of Occupational Therapy, 13(4), 249-256.
Eklund, M., Backstrom, M., & Hansson, L. (2003). Personality and self-variables: important determinants of subjective quality of life in schizophrenia out-patients. Acta Psychiatrica Scandinavica, 108(2), 134-143.
Eklund, M., Hansson, L., & Bejerholm, U. (2001). Relationships between satisfaction with occupational factors and health-related variables in schizophrenia outpatients. Social Psychiatry & Psychiatric Epidemiology, 36(2), 79-83.
Endicott, J., Nee, j., Harrison, W., et. al. (1993). Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull, 29, 321-326.
Ezquiaga, E., Garcia-Lopez, A., de Dios, C., Leiva, A., Bravo, M., & Montejo, J. (2004). Clinical and psychosocial factors associated with the outcome of unipolar major depression: a one year prospective study. Journal of Affective Disorders, 79(1-3), 63-70.
Fayers, P. M., & Machin, D. (2007). Quality of life: the assessment, analysis and interpretation of patient-reported outcomes (2 ed.). Hoboken, NJ: John Wiley & Sons Ltd.
Ferrans, C. E., & Powers, M. J. (1985). Quality of life index: development and psychometric properties. Advances in Nursing Science, 8(1), 15-24.
Flaherty, J. A., Gaviria, F. M., Black, E. M., Altman, E., & Mitchell, T. (1983). The role of social support in the functioning of patients with unipolar depression. American Journal of Psychiatry, 140(4), 473-476.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
Foreman, M. D., Fletcher, K., Mion, L. C., & Simon, L. (1996). Assessing cognitive function. Geriatric Nursing, 17(5), 228-233.
Frerichs, R. R., Aneshensel, C. S., & Clark, V. A. (1981). Prevalence of depression in Los Angeles County. American Journal of Epidemiology, 113(6), 691-699.
Furukawa, T. A., Harai, H., Hirai, T., Kitamura, T., & Takahashi, K. (1999). Social Support Questionnaire among psychiatric patients with various diagnoses and normal controls. Social Psychiatry & Psychiatric Epidemiology, 34(4), 216-222.
Gecas, V. (1989). The social psychology of self-efficacy. Annual Review of Sociology Vol 15 1989, 291-316.
George, L. K., Blazer, D. G., Hughes, D. C., & Fowler, N. (1989). Social support and the outcome of major depression. British Journal of Psychiatry, 154, 478-485.
Goldberg, B., Brintnell, E. S., & Goldberg, J. (2002). The relationship between engagement in meaningful activities and quality of life in persons disabled by mental illness. Occupational Therapy in Mental Health, 18(2), 17-44.
Goldberg, D. P., Cooper, B., Eastwood, M. R., Kedward, H. B., & Shepherd, M. (1970). A standardized psychiatric interview for use in community surveys. British Journal of Preventive & Social Medicine, 24(1), 18-23.
Goldberg, J. F., & Harrow, M. (2005). Subjective life satisfaction and objective functional outcome in bipolar and unipolar mood disorders: a longitudinal analysis. Journal of Affective Disorders, 89(1-3), 79-89.
Gueorguieva, R., & Krystal, J. H. (2004). Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Archives of General Psychiatry, 61(3), 310-317.
Gureje, O., Harvey, C., & Herrman, H. (2004). Self-esteem in patients who have recovered from psychosis: profile and relationship to quality of life. Australian and New Zealand Journal of Psychiatry, 38(5), 334-338.
Hays, R. D., Wells, K. B., Sherbourne, C. D., Rogers, W., & Spritzer, K. (1995). Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Archives of General Psychiatry, 52(1), 11-19.
Heinrichs, D. W., Hanlon, T. E., & Carpenter, W. T., Jr. (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10(3), 388-398.
Holahan, C. J., Moos, R. H., Holahan, C. K., Cronkite, R. C., & Randall, P. K. (2004). Unipolar depression, life context vulnerabilities, and drinking to cope. Journal of Consulting & Clinical Psychology, 72(2), 269-275.
Hudson, J. I., Perahia, D. G., Gilaberte, I., Wang, F., Watkin, J. G., & Detke, M. J. (2007). Duloxetine in the treatment of major depressive disorder: an open-label study. BMC Psychiatry, 7, 43.
Hung, C. I., Liu, C. Y., Fuh, J. L., Juang, Y. Y., & Wang, S. J. (2006). Comorbid migraine is associated with a negative impact on quality of life in patients with major depression. Cephalalgia, 26(1), 26-32.
Hunt, S. M., & McKenna, S. P. (1992). The QLDS: a scale for the measurement of quality of life in depression. Health Policy, 22(3), 307-319.
Jang, Y., Haley, W. E., Small, B. J., & Mortimer, J. A. (2002). The role of mastery and social resources in the associations between disability and depression in later life. Gerontologist, 42(6), 807-813.
Judd, L. L., Akiskal, H. S., Maser, J. D., Zeller, P. J., Endicott, J., Coryell, W., et al. (1998). A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Archives of General Psychiatry, 55(8), 694-700.
Judd, L. L., Akiskal, H. S., & Paulus, M. P. (1997). The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. Journal of Affective Disorders, 45(1-2), 5-17; discussion 17-18.
Keitner, G. I., Ryan, C. E., Miller, I. W., Kohn, R., Bishop, D. S., & Epstein, N. B. (1995). Role of the family in recovery and major depression. American Journal of Psychiatry, 152(7), 1002-1008.
Keller, M. B., Klerman, G. L., Lavori, P. W., Fawcett, J. A., Coryell, W., & Endicott, J. (1982). Treatment received by depressed patients. JAMA : the Journal of the American Medical Association, 248(15), 1848-1855.
Keller, M. B., Lavori, P. W., Mueller, T. I., Endicott, J., Coryell, W., Hirschfeld, R. M., et al. (1992). Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Archives of General Psychiatry, 49(10), 809-816.
Kelly, J. G., Munoz, R. F., & Snowden, L. R. (1979). Characteristics of community research projects and the implementation process. In R. F. Munoz, L. R. Snowden & J. G. Kelly (Eds.), Social and psychological research in community settings. San Francisco: Jossey-Bass.
Kempen, G. I., Brilman, E. I., & Ormel, J. (1995). The Mini Mental Status Examination. Normative data and a comparison of a 12-item and 20-item version in a sample survey of community-based elderly. Tijdschrift voor Gerontologie en Geriatrie, 26(4), 163-172.
Kempen, G. I., Jelicic, M., & Ormel, J. (1997). Personality, chronic medical morbidity, and health-related quality of life among older persons. Health Psychology, 16(6), 539-546.
Kempen, G. I., van Heuvelen, M. J., van Sonderen, E., van den Brink, R. H., Kooijman, A. C., & Ormel, J. (1999). The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons. Social Science & Medicine, 48(9), 1161-1172.
Kendler, K. S., Thornton, L. M., & Prescott, C. A. (2001). Gender differences in the rates of exposure to stressful life events and sensitivity to their depressogenic effects. American Journal of Psychiatry, 158(4), 587-593.
Kessing, L. V., Hansen, H. V., & Bech, P. (2006). General health and well-being in outpatients with depressive and bipolar disorders. Nordic Journal of Psychiatry, 60(2), 150-156.
Kielhofner, G. (2008). A model of human occupation: theory and application (4 ed.). Philadelphia. Lippincott: Williams & Wilkins.
Kielhofner, G., & Forsyth, K. (2001). Measurement properties of a client self-report for treatment planning and documenting therapy outcomes. Scandinavian Journal of Occupational Therapy, 8(3), 131-139.
Kocsis, J. H., Zisook, S., Davidson, J., Shelton, R., & et al. (1997). Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: Psychosocial outcomes. American Journal of Psychiatry, 154(3), 390-395.
Kuehner, C. (2002). Subjective quality of life: validity issues with depressed patients. Acta Psychiatrica Scandinavica, 106(1), 62-70.
Kuehner, C., & Buerger, C. (2005). Determinants of subjective quality of life in depressed patients: the role of self-esteem, response styles, and social support. Journal of Affective Disorders, 86(2-3), 205-213.
Lefcourt, H. M. (1983). The locus of control variables as a moderator variable: Stress. In H. M. Lefcourt (Ed.), Research with the locus of control construct (Vol. 2, pp. 253-268). New York: Academic Press.
Lehman, A. F. (1983). The well-being of chronic mental patients. Archives of General Psychiatry, 40(4), 369-373.
Lehman, A. F. (1996). Measures of quality of life among persons with severe and persistent mental disorders. Social Psychiatry & Psychiatric Epidemiology, 31(2), 78-88.
Linacre, J. M. (2006). WINSTEPS Rasch measurement computer program. Chicago: Winsteps.com.
Lloyd, C., Kanowski, H., & Maas, F. (1999). Occupational therapy in mental health: challenges and opportunities. Occupational Therapy International, 6(2), 110-125.
Marshall, G. N., & Lang, E. L. (1990). Optimism, self-mastery, and symptoms of depression in women professionals. Journal of Personality & Social Psychology, 59(1), 132-139.
McCabe, R., & Priebe, S. (2002). Focussing on quality of life in treatment. International Review of Psychiatry, 14(3), 225-230.
McCall, W. V., Cohen, W., Reboussin, B., & Lawton, P. (1999). Effects of mood and age on quality of life in depressed inpatients. Journal of Affective Disorders, 55(2-3), 107-114.
McCall, W. V., Reboussin, B. A., Cohen, W., & Lawton, P. (2001). Electroconvulsive therapy is associated with superior symptomatic and functional change in depressed patients after psychiatric hospitalization. Journal of Affective Disorders, 63(1-3), 17-25.
McKenna, S. P., & Hunt, S. M. (1992). A new measure of quality of life in depression: testing the reliability and construct validity of the QLDS. Health Policy, 22(3), 321-330.
Meeberg, G. A. (1993). Quality of life: a concept analysis. Journal of Advanced Nursing, 18(1), 32-38.
Mendes de Leon, C. F., Gold, D. T., Glass, T. A., Kaplan, L., & George, L. K. (2001). Disability as a function of social networks and support in elderly African Americans and Whites: The Duke EPESE 1986-1992. Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 56B(3), S179-S190.
Mercier, C., Peladeau, N., & Tempier, R. (1998). Age, gender and quality of life. Community Mental Health Journal, 34(5), 487-500.
Miller, I. W., Keitner, G. I., Whisman, M. A., Ryan, C. E., Epstein, N. B., & Bishop, D. S. (1992). Depressed patients with dysfunctional families: description and course of illness. Journal of Abnormal Psychology, 101(4), 637-646.
Mitchell, R., & Neish, J. (2007). The use of a ward-based art group to assess the occupational participation of adult acute mental health clients. British Journal of Occupational Therapy, 70(5), 215-217.
Murphy, G. E., Simons, A. D., Wetzel, R. D., & Lustman, P. J. (1984). Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression. Archives of General Psychiatry, 41(1), 33-41.
Murray, C. J., & Lopez, A. D. (1997a). Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet, 349(9064), 1498-1504.
Murray, C. J., & Lopez, A. D. (1997b). Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet, 349(9063), 1436-1442.
Nagtegaal, J., Laurant, M., Kerkhof, G., Smits, M., van der Meer, Y., & Coenen, A. (2000). Effects of melatonin on the quality of life in patients with delayed sleep phase syndrome. Journal of Psychosomatic Research, 48(1), 45-50.
Naughton, M., Shumaker, S., Anderson, R., & Czajkowski, S. (1996). Psychological aspects of health-related quality of life measurements: tests and scales. In Quality of Life and Pharmacoeconomics in Clinical Trials (2 ed., pp. 117-131). Philadelphia, PA: Spilker B. Lippincott-Raven.
Nuijten, M. J. (2001). Assessment of clinical guidelines for continuation treatment in major depression. Value in Health, 4(4), 281-294.
Omvik, S., Sivertsen, B., Pallesen, S., Bjorvatn, B., Havik, O. E., & Nordhus, I. H. (2008). Daytime functioning in older patients suffering from chronic insomnia: Treatment outcome in a randomized controlled trial comparing CBT with Zopiclone. Behaviour Research and Therapy, 46(5), 623-641.
Orley, J., Saxena, S., & Herrman, H. (1998a). Quality of life and mental illness. Reflections from the perspective of the WHOQOL. British Journal of Psychiatry, 172, 291-293.
Orley, J., Saxena, S., & Herrman, H. (1998b). Quality of life and mental illness. Reflections from the perspective of the WHOQOL.[see comment]. British Journal of Psychiatry, 172, 291-293.
Oxman, T. E., Berkman, L. F., Kasl, S., Freeman, D. H., Jr., & Barrett, J. (1992). Social support and depressive symptoms in the elderly. American Journal of Epidemiology, 135(4), 356-368.
Pan, A. W., Chan, P. Y. S., Chung, L., Chen, T. J., & Hsiung, P. C. (2006). Quality of life in depression: predictive models. Quality of Life Research, 15(1), 39-48.
Paykel, E. S., Ramana, R., Cooper, Z., Hayhurst, H., Kerr, J., & Barocka, A. (1995). Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine, 25(6), 1171-1180.
Pearlin, L. I., Lieberman, M. A., Menaghan, E. G., & Mullan, J. T. (1981). The stress process. Journal of Health & Social Behavior, 22(4), 337-356.
Pearlin, L. I., Nguyen, K. B., Schieman, S., & Milkie, M. A. (2007). The life-course origins of mastery among older people. Journal of Health & Social Behavior, 48(2), 164-179.
Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health & Social Behavior, 19(1), 2-21.
Portney, L. G., & Watkins, M. P. (2000). Foundations of clinical research: applications to practice (2 ed.). Upper Saddle River, New Jersey: Prentice-Hall, Inc.
Pukrop, R., Schlaak, V., Moller-Leimkuhler, A. M., Albus, M., Czernik, A., Klosterkotter, J., et al. (2003). Reliability and validity of Quality of Life assessed by the Short-Form 36 and the Modular System for Quality of Life in patients with schizophrenia and patients with depression. Psychiatry Research, 119(1-2), 63-79.
Pyne, J. M., Bullock, D., Kaplan, R. M., Smith, T. L., Gillin, J. C., Golshan, S., et al. (2001). Health-related quality-of-life measure enhances acute treatment response prediction in depressed inpatients. Journal of Clinical Psychiatry, 62(4), 261-268.
Pyne, J. M., Sieber, W. J., David, K., Kaplan, R. M., Hyman Rapaport, M., & Keith Williams, D. (2003). Use of the quality of well-being self-administered version (QWB-SA) in assessing health-related quality of life in depressed patients. Journal of Affective Disorders, 76(1-3), 237-247.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.
Ritsner, M., Kurs, R., Gibel, A., Hirschmann, S., Shinkarenko, E., & Ratner, Y. (2003). Predictors of quality of life in major psychoses: a naturalistic follow-up study. Journal of Clinical Psychiatry, 64(3), 308-315.
Ritsner, M., Modai, I., Endicott, J., Rivkin, O., Nechamkin, Y., Barak, P., et al. (2000). Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients. Journal of Clinical Psychiatry, 61(11), 880-889; quiz 890.
Roberts, B. L., Dunkle, R., & Haug, M. (1994). Physical, psychological, and social resources as moderators of the relationship of stress to mental health of the very old. Journal of Gerontology, 49(1), S35-43.
Rosenfield, S. (1989). The effects of women''s employment: personal control and sex differences in mental health. Journal of Health & Social Behavior, 30(1), 77-91.
Rosenfield, S. (1992). Factors contributing to the subjective quality of life of the chronic mentally ill. Journal of Health & Social Behavior, 33(4), 299-315.
Roth, T. (2005). Prevalence, associated risks, and treatment patterns of insomnia. Journal of Clinical Psychiatry, 66 Suppl 9, 10-13; quiz 42-13.
Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs, 80(1), 1-28.
Rudolf, H., & Priebe, S. (1999). Subjective quality of life in female in-patients with depression: a longitudinal study. International Journal of Social Psychiatry, 45(4), 238-246.
Ruggeri, M., Bisoffi, G., Fontecedro, L., & Warner, R. (2001). Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach: The South Verona Outcome Project 4. British Journal of Psychiatry, 178, 268-275.
Rush, A. J., Beck, A. T., Kovacs, M., Weissenburger, J., & Hollon, S. D. (1982). Comparison of the effects of cognitive therapy and pharmacotherapy on hopelessness and self-concept. American Journal of Psychiatry, 139(7), 862-866.
Saarijarvi, S., Salminen,J.K., Toikka, T., & Raitasalo, R. (2002). Health-related quality of life among patients with major depression. Nordic Journal of Psychiatry, 56(261-264).
Sarason, B. R., Shearin, E. N., Pierce, G. R., & Sarason, I. G. (1987). Interrelations of social support measures: Theoretical and practical implications. Journal of Personality and Social Psychology, 52(4), 813-832.
Sarason, I. G., Levine, H. M., Basham, R. B., & Sarason, B. R. (1983). Assessing social support: The Social Support Questionnaire. Journal of Personality and Social Psychology, 44(1), 127-139.
Sarason, I. G., & Sarason, B. R. (1986). Experimentally provided social support. Journal of Personality and Social Psychology, 50(6), 1222-1225.
Sarason, I. G., Sarason, B. R., Potter, E. H., & Antoni, M. H. (1985). Life events, social support, and illness. Psychosomatic Medicine, 47(2), 156-163.
Sarason, I. G., Sarason, B. R., Shearin, E. N., & Pierce, G. R. (1987). A Brief Measure of Social Support: Practical and Theoretical Implications. Journal of Social and Personal Relationships, 4(4), 497-510.
Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychology, 4(3), 219-247.
Schieman, S., & Turner, H. A. (1998). Age, disability, and the sense of mastery. Journal of Health & Social Behavior, 39(3), 169-186.
Sechter, D., Troy, S., Paternetti, S., & Boyer, P. (1999). A double-blind comparison of sertraline and fluoxetine in the treatment of major depressive episode in outpatients. European Psychiatry: the Journal of the Association of European Psychiatrists, 14(1), 41-48.
Shephard, R. J. (1997). Exercise and relaxation in health promotion. Sports Medicine, 23(4), 211-217.
Sherbourne, C. D., Hays, R. D., & Wells, K. B. (1995). Personal and psychosocial risk factors for physical and mental health outcomes and course of depression among depressed patients. Journal of Consulting & Clinical Psychology, 63(3), 345-355.
Silver, E. J., Heneghan, A. M., Bauman, L. J., & Stein, R. E. K. (2006). The relationship of depressive symptoms to parenting competence and social support in inner-city mothers of young children. Maternal and Child Health Journal, 10(1), 105-112.
Skaff, M. M., Pearlin, L. I., & Mullan, J. T. (1996). Transitions in the caregiving career: effects on sense of mastery. Psychology & Aging, 11(2), 247-257.
Skarsater, I., Baigi, A., & Haglund, L. (2006). Functional status and quality of life in patients with first-episode major depression. Journal of Psychiatric & Mental Health Nursing, 13(2), 205-213.
Skarsater, I., Langius, A., Agren, H., Haggstrom, L., & Dencker, K. (2005). Sense of coherence and social support in relation to recovery in first-episode patients with major depression: a one-year prospective study. International Journal of Mental Health Nursing, 14(4), 258-264.
Skevington, S. M., & Wright, A. (2001). Changes in the quality of life of patients receiving antidepressant medication in primary care: validation of the WHOQOL-100. British Journal of Psychiatry, 178, 261-267.
Smith, N. R., Kielhofner, G., & Watts, J. H. (1986). The relationships between volition, activity pattern, and life satisfaction in the elderly. American Journal of Occupational Therapy, 40(4), 278-283.
Sobocki, P., Ekman, M., Agren, H., Krakau, I., Runeson, B., Martensson, B., et al. (2007). Health-related quality of life measured with EQ-5D in patients treated for depression in primary care. Value in Health, 10(2), 153-160.
STAKES, M. H. G. (2006). MINDFUL Project Recommendations for the European Health Interview Survey (EHIS) Health Determinants Module. Helsinki, Finland: STAKES (National Research and Development Centre for Welfare and Health).
Stansbury, J. P., Ried, L., & Velozo, C. A. (2006). Unidimensionality and bandwidth in the center for epidemiologic studies depression (CES-D) scale. Journal of Personality Assessment, 86(1), 10-22.
Stein, M. B., & Barrett-Connor, E. (2002). Quality of life in older adults receiving medications for anxiety, depression, or insomnia: findings from a community-based study. American Journal of Geriatric Psychiatry, 10(5), 568-574.
Taylor, J. E., Poston, W. S., Haddock, C. K., et al. (2003). Psychometric characteristics of the General Well-Being Schedule(GWB) with Aferican-American women. Quality of Life Research 12, 31-39.
Thoits, P. A. (1987). Gender and marital status differences in control and distress: common stress versus unique stress explanations. Journal of Health & Social Behavior, 28(1), 7-22.
Torng, P.-L., Chang, W.-C., Hwang, J.-S., Hsu, W.-C., Wang, J.-D., Huang, S.-C., et al. (2007). Health-related quality of life after laparoscopically assisted vaginal hysterectomy: is uterine weight a major factor? Quality of Life Research, 16(2), 227-237.
Trivedi, M. H., Rush, A., Wisniewski, S. R., Warden, D., McKinney, W., Downing, M., et al. (2006). Factors Associated With Health-Related Quality of Life Among Outpatients With Major Depressive Disorder: A STAR*D Report. Journal of Clinical Psychiatry, 67(2), 185-195.
Turner, N., & Lydon, C. (2008). Psychosocial programming in Ireland based on the Model of Human Occupation: a program evaluation study. Occupational Therapy in Health Care, 22(2-3), 105-114.
Turner, R., Lloyd, D. A., Roszell, P. (1999). Personal resources and the social distribution of depression. American Journal of Community Psychology, 27(5), 643-672.
Unger, J. B., McAvay, G., Bruce, M. L., Berkman, L., & Seeman, T. (1999). Variation in the impact of social network characteristics on physical functioning in elderly persons: MacArthur Studies of Successful Aging. Journals of Gerontology Series B-Psychological Sciences & Social Sciences, 54(5), S245-251.
Verbeke, G., & Molenberghs, G. (2000). Linear Mixed Models for Longitudinal Data. New York, NY: Springer.
Versiani, M., Moreno, R., Ramakers-van Moorsel, C. J. A., Schutte, A. J., & Comparative Efficacy Antidepressants Study, G. (2005). Comparison of the effects of mirtazapine and fluoxetine in severely depressed patients. CNS Drugs, 19(2), 137-146.
Wang, W.-C., Yao, G., Tsai, Y.-J., Wang, J.-D., & Hsieh, C.-L. (2006). Validating, improving reliability, and estimating correlation of the four subscales in the WHOQOL-BREF using multidimensional Rasch analysis. Quality of Life Research, 15(4), 607-620.
Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473-483.
Weber, M. (1946). Max Weber: Essays in Sociology. Oxford: Oxford University Press.
Weiss, R. S. (1974). The provisions of social relations. In Z. Rudin (Ed.), Doing unto others. Englewood Cliffs, N. J.: Prentice-Hall.
Wethington, E., & Kessler, R. C. (1986). Perceived support, received support, and adjustment to stressful life events. Journal of Health and Social Behavior, 27(1), 78-89.
Whisman, M. A., Sheldon, C. T., & Goering, P. (2000). Psychiatric disorders and dissatisfaction with social relationships: does type of relationship matter? Journal of Abnormal Psychology, 109(4), 803-808.
WHOQOL Group. (1994). Development of the WHOQOL: Rationale and current status. International Journal of Mental Health, 23(3), 24-56.
WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychological Medicine, 28(3), 551-558.
Wilkins, K., & Beaudet, M. P. (1998). Work stress and health. Health Reports, 10(3), 47-62 (ENG); 49-66 (FRE).
Winefield, H. R. (1979). Social support and the social environment of depressed and normal women. Australian & New Zealand Journal of Psychiatry, 13(4), 335-339.
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders. Geneva, Switzerland: WHO.
World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization.
World Heath Organization. (2007). Depression [online]. Retrieved 10 November, 2007
Wright, B. D., & Mok, M. M. C. (2004). An Overview of the Family of Rasch Measurement Models. In E. V. S. Smith, R. M. (Ed.), Introduction to Rasch Measurement: Theory, models and Applications. Maple Grove, Minnesota: JAM Press.
Yao, G., Chung, C.-W., Yu, C.-F., & Wang, J.-D. (2002). Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. Journal of the Formosan Medical Association, 101(5), 342-351.
Zhan, L. (1992). Quality of life: conceptual and measurement issues. Journal of Advanced Nursing, 17(7), 795-800.
Zlotnick, C., Shea, M. T., Pilkonis, P. A., Elkin, I., & Ryan, C. (1996). Gender, type of treatment, dysfunctional attitudes, social support, life events, and depressive symptoms over naturalistic follow-up. American Journal of Psychiatry, 153(8), 1021-1027.
丁思惠, & 陳喬琪. (民95). 憂鬱症的婚姻與家庭治療. 北市醫學雜誌, 3(10).
方麗華, 陳昭姿, & 陳純誠. (民87). 憂鬱症的治療. 台灣醫學, 2(4), 456-463.
王淑敏. (民93). 中文版「職能自我評估」之心理計量品質研究 --以台灣精神分裂症個案為例 國立臺灣大學醫學院職能治療研究所碩士論文, 未出版, 台北市.
世界衛生組織生活品質問卷台灣版問卷發展小組. (民91). 台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊 (第二版).
余春娣. (民94). 門診重鬱症病患生活品質及其相關因素之探討. 國立台灣大學醫學院護理學研究所碩士論文, 未出版, 台北市.
吳美惠, 翁儷禎, 李明濱, 王秀紅, & 熊秉荃. (民95). 重鬱症病患社會支持、互惠性、衝突與憂鬱程度之相關性研究. 台灣精神醫學, 20(2), 116-123.
吳家碧, & 劉兆達. (民96). 憂鬱症的運動治療. 大專體育, 90, 170-176.
巫珍宜, & 郭麗安. (民96). 憂鬱症患者的婚姻權力關係:以傳統家務分工為例. 本土心理學研究, 28, 199-255.
周勵志、鄭舒方. (民96). 精神科門診憂鬱症病人之處遇模式與治療配合度. 台灣精神醫學, 21(2), 107-116.
胡幼慧. (民79). 性別、社會角色與憂鬱症狀. 婦女與兩性學刊, 2, 1-18.
商志雍, 廖士程, & 李明濱. (民92). 精神科門診憂鬱症患者就診率之變遷. 台灣醫學, 7(4), 502-509.
郭乃文, 劉秀枝, 王珮芳, 廖光淦, 甄瑞興, 林恭平, et al. (民74). 「簡短式智能評估」之中文施測與常模建立. 中華民國復健醫學會雜誌, 16, 52-59.
陳慧雅, 丘亮, & 林忠順. (民93). 憂鬱症. 基層醫學, 19(11), 264-269.
陳靜紋. (民94). 憂鬱症病患自我掌控信念、社會支持與憂鬱程度之相關性及影響因素探討. 國立台灣大學醫學院護理學研究所碩士論文, 未出版, 台北市.
陳韻玲, 熊秉荃, 陳詞章, & 潘璦琬. (民97). 憂鬱症個案的職能功能與生活品質. 台灣醫學 12(6), 627-634.
彭鈺人, & 張淑玲. (民86). 有氧運動與無氧運動對焦慮與憂鬱的影響. 大專體育, 34, 46-50.
黃隆正, & 李明濱. (民92). 憂鬱症與自殺. 台灣醫學, 7(6), 929-934.
潘璦琬. (民94a). 憂鬱症患者數位化評量系統之發展與建置: 行政院衛生署專題研究成果報告(編號:DOH94-TD-M-113-005).
潘璦琬. (民94b). 職能治療遠距服務系統之研發-精神障礙者之復健: 行政院國家科學委員會專題研究成果報告(編號:NSC94-2516-S-002-010).
潘璦琬, & 王淑敏. (民96). 職能自我評估中文版使用手冊(第二版). 台北市: 國立台灣大學醫學院職能治療學系.
潘璦琬, 陳韻玲, 熊秉荃, & 鍾麗英. (民97). 應用羅序測量模式驗證中文版社會支持量表的測量品質. Paper presented at the 第八屆職能治療學術研討會.
鄭若瑟, & 高家常. (民94). 精神疾病患者生活品質及其測量. 台灣精神醫學, 19(3), 179-191.
羅昭瑛, 李錦虹, & 詹佳真.(民92). 女性憂鬱症患者性別角色之內在經驗. 中華心理衛生學刊, 16(1), 51-69.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top