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研究生:孟欣宏
研究生(外文):Shin-Hung Meng
論文名稱:退休對心理健康之影響
論文名稱(外文):The Effect of Retirement on Mental Health
指導教授:林文德林文德引用關係
指導教授(外文):Wen -der Lin
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫務管理學系(所)
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2011
畢業學年度:100
語文別:中文
論文頁數:77
中文關鍵詞:退休心理健康鎮靜安眠藥傾向分數法重複測量
外文關鍵詞:retirementmental healthantidepressanthypnoticanxiolyticpropensity scorerepeated measures
相關次數:
  • 被引用被引用:1
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中文摘要
目的:探討退休者與未退休者在退休者之退休日期前後鎮靜安眠藥使用之變化情形以瞭解退休對心理健康的影響。
方法:本研究採回溯性世代研究之設計,利用全民健康保險資料庫2005年版 100萬抽樣歸人檔(LHID2005),分析50-64歲之退休與未退休者在退休者之退休日期前三年及後六年的鎮靜安眠藥每年利用量變化情形,安眠藥年利用量以每日標準劑量(defined daily doses, DDDs)計算,並將樣本依退休前鎮靜安眠藥年平均用量依大於及低於30DDDs分為用藥量高低兩組,分別進行探討。此外,本研究利用樣本之各項特性,以傾向分數配對法(PS, propensity score)進行配對,以減少樣本之選樣偏誤。隨後,以Wilcoxon無母數分析法,比較退休與未退休者於退休者退休日期後每年鎮靜安眠藥使用量之差異;最後,將樣本依鎮靜安眠藥年利用量依高於30DDDs與否分為二類,並利用廣義估計方程式(GEE)估計退休與未退休者間用藥是否較高之勝算比(OR, odds ratio)。
結果:去除極端值後,本研究退休樣本共9,687人,用藥量高低兩組退休樣本人數分別為4,650人及5,037人;配對後,兩組退休樣本為3,282人及3,057人。在控制退休前鎮靜安眠藥使用情形及樣本特性後,低利用與高利用之退休者在退休後之鎮靜安眠藥用量與未退休者未有顯著差異。GEE分析結果發現,低利用退休者退休後鎮靜安眠藥使用並未增多(勝算比1.00, 信賴區間為0.99-1.02),高利用退休者退休後鎮靜安眠藥使用則顯著下降(勝算比0.97, 信賴區間為0.95-0.99,P<0.01)。
結論:退休對於退休前使用鎮靜安眠藥較少之工作者而言,鎮靜安眠藥利用的影響不大,但對於退休前鎮靜安眠藥用量較高之工作者而言,退休似能減少其對鎮靜安眠藥之依賴。因此,退休似對心理健康有正面的影響。


Abstract
Objective: This study aimed to investigates the impact of retirement on the mental health measured by the utilization of antidepressant, hypnotic, and anxiolytic drugs.
Methods: We used a longitudinal, retrospective cohort study design to analyze the data came from Taiwan’s Longitudinal Health Insurance Dataset in 2005 (LHID 2005) which consisted of 1 million of representative samples. The dosages of the antidepressant, hypnotic, and anxiolytic drugs analyzed the retirees and employees age 50-64 for up to 3 years prior, and followed up for 6 years after. The samples were classified into two groups according to their pre-retirement utilization of these drugs. Their counterparts who were not retired but had similar drugs used were selected by a greedy matching algorithm based on propensity score. We used Wilcoxon nonparametric methods to test the retirees and employees with the variance using amount of hypnotic drugs for every year. Data using repeated-measures logistic regression is to analyze the binary outcome with generalized estimating equations (GEE).
Results: This sample has 9,687 retirees. After matching, we separated two matched groups into 3,282 and 3,057 retirees. According to repeated-measures logistic-regression analysis with generalized estimating equations estimation, the odds ratio (OR) for low-dosages retirees compared to their counterparts was 1.00 (95% confidence interval 0.99-1.02), and the high-dosages retirees was 0.97 (95% confidence interval 0.95-0.99).
Conclusion: For each year of observation, prevalence of drugs use are sustained decrease that retirement is beneficial for mental health.


目錄
中文摘要 II
Abstract III
第一章 緒論 1
第二章 文獻探討 3
第一節 我國的退休制度與現況 3
第二節 退休與心理健康相關研究之心理測量 5
第三節 退休與心理健康相關研究現況與結果 7
第四節 影響退休後心理健康變化之因素 16
第五節 文獻總結 19
第三章 研究方法 20
第一節 研究設計 20
第二節 研究材料 21
第三節 分析方法 33
第四章 研究結果 38
第一節 個人特性與健康狀態 38
第二節 影響退休之因素 42
第三節 配對後樣本特性與健康狀況 44
第四節 退休前後對鎮靜安眠藥利用情形之變化 47
第五章 討論 60
第一節 研究方法 60
第二節 研究結果 64
第六章 結論與建議 67
第一節 結論 67
第二節 建議 69
參考文獻 71


表目錄
表2.5:退休與心理健康相關文獻彙整表 11
表2.6:影響退休後心理健康相關文獻彙整表 18
表3.1:資料庫內容使用說明 22
表3.2:操作型定義一覽表 30
表3.3:疾病分類一覽表 32
表4.1:退休前個人特性與健康狀態 41
表4.2:影響退休因素之羅吉斯迴歸分析 43
表4.3:退休前個人特性與健康狀態-配對後 46
表4.4:配對前退休前後對鎮靜安眠藥使用量之變化 49
表4.5:配對後退休前後對鎮靜安眠藥使用量之變化 50
表4.6:配對前退休前後對鎮靜安眠藥使用人數之變化 55
表4.7:配對後退休前後對鎮靜安眠藥使用人數之變化 56
表4.8:傾向分數模型分析退休前後鎮靜安眠藥使用與否之勝算比 59
附表一:鎮靜安眠藥-藥品分類表 76


圖目錄
圖3.1:研究架構圖 20
圖3.2:精神科相關藥品篩選流程圖 23
圖3.3:退休樣本之研究期間 25
圖3.4:退休樣本篩選流程圖 26
圖3.5:統計分析流程圖 37
圖4.1:配對前退休前後鎮靜安眠藥使用量之變化-低利用者 51
圖4.2:配對後退休前後鎮靜安眠藥使用量之變化-低利用者 51
圖4.3:配對前退休前後鎮靜安眠藥使用量之變化-高利用者 52
圖4.4:配對後退休前後鎮靜安眠藥使用量之變化-高利用者 52
圖4.5:配對前退休前後對鎮靜安眠藥使用率之變化-低利用者 57
圖4.6:配對後退休前後對鎮靜安眠藥使用率之變化-低利用者 57
圖4.7:配對前退休前後對鎮靜安眠藥使用率之變化-高利用者 58
圖4.8:配對後退休前後對鎮靜安眠藥使用率之變化-高利用者 58



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