慢性疾病的發生，容易使病患併發精神疾病,較常見的為憂鬱症以及躁鬱症。根據美國腎臟資料系統於 2013 年提出的報告，2010 年臺灣地區末期腎臟病的發生率為世界第三、亞洲第一，而盛行率則為世界第一。且民國 100 年門診以及住院前五大傷病中，慢性腎衰竭分別排名第一、第四。種種數據顯示，末期腎臟病在我國為迫切需要注意的重大傷病。本研究期望透過應用資料探勘技術於全民健康保險研究資料庫，計算國內透析患者罹患精神疾病的比率，並且建立預測模式，以得到患者接受透析之後罹患精神疾病的患者特性，達到及早預防疾病、改善醫療資源分配等目標。
利用1997年至2009年之門診處方及治療明細檔(CD)、門診處方醫令明細檔(OO)、住院醫療費用清單明細檔(DD)、住院醫療費用醫令清單明細檔(DO)、以及重大傷病證明明細檔(HV)進行分析以後，得到新發生透析患者的資料共計107,813筆，並基於病患的基本資料以及曾經被診斷出的合併症，建構出預測模型，可以幫助醫療人員未來遇到新發生的末期腎臟病患時，可以運用此決策模型初步判斷病患罹患憂鬱症或躁鬱症的可能性，進而採取相關醫療措施，以避免延誤病患的治療時程。

Depression and Bipolar disorder can easily be complicated by chronic diseases. And according to UNIRED STATES RENAL DATA SYSTEM, both of the incidence and prevalence of end-stage renal disease in Taiwan are much higher than other countries. This study will apply Data-Mining technique to National Health Insurance Research Database, and try to build a prediction model of patients who have end-stage renal disease and mental disorder.
After analyzing National Health Insurance Research Database, we found the number of end-stage renal disease patients are 107,813. Then we combined patients’ gender, age, and comorbidity data, built the prediction model, in order to help medical staff quickly predict the possibility of the patients that could have depression or bipolar, and take care of them at an early date.

目錄
第一章、 緒論 1
第一節、 研究背景與動機 1
第二節、 研究目的與問題 4
第二章、 文獻探討 6
第一節、 末期腎臟病流行病學 6
第二節、 憂鬱症病學 8
第三節、 躁鬱症 10
第四節、 透析患者罹患憂鬱症相關研究 13
第五節、 資料探勘 19
第三章、 研究方法 23
第一節、 研究架構 23
第二節、 資料選擇 24
第三節、 研究變項與操作型定義 25
第四節、 資料前處理 28
第五節、 資料探勘工具 30
第四章、 實作結果與分析 31
第一節、 實驗結果 31
第二節、 分析與評估 31
第五章、 研究結論與建議 48
第一節、 研究結論 48
第二節、 研究貢獻 48
第三節、 研究限制 49
第四節、 未來研究方向 49
參考文獻 51

圖目錄
圖 1：跨產業資料探勘標準作業程序(Cross Industry Standard Process for Data Mining, CRISP-DM) 23
圖 2：全民健康保險研究資料庫各檔案間串檔變項說明 29

表目錄
表 1：Incidence of ESRD, by year (per million population) 1
表 2：Prevalence of ESRD, by year (per million population) 1
表 3：透析患者罹患憂鬱症國外相關研究整理 14
表 4：透析患者罹患憂鬱症國內相關研究整理 17
表 5：本研究變數定義 26
表 6：採用血液透析的病患罹患憂鬱症之決策規則 32
表 7：採用腹膜透析的病患罹患憂鬱症之決策規則 35
表 8：採用血液透析的病患罹患躁鬱症之決策規則 38
表 9：採用腹膜透析的病患罹患躁鬱症之決策規則 44

中文文獻
行政院衛生署中央健康保險局. (民102). 2011年全民健康保險統計動向.
卓宜靜. (民91). 穴位指壓對末期腎臟疾病患者之疲憊感, 生活品質和憂鬱之成效探討. 國立台北護理學院護理研究所碩士論文. 未出版, 台北.
孫宜孜, 徐邦治, 楊福麟, 廖晉興, 林崇舜, & 李茹萍. (民94). 血液透析患者之憂鬱狀態及影響因素探討. 慈濟護理雜誌, 4(3), 47-55.
馬麗卿, 孫嘉玲, & 謝湘俐. (民99). 血液透析病患之憂鬱狀態及生活品質滿意度相關性研究. 臺灣腎臟護理學會雜誌, 9(1), 1-16.
梁定澎. (民97). 決策支援系統與企業智慧: 智盛文化事業有限
公司.
黃智英, & 楊郁. (民93). 慢性腎臟病衛教簡介. 台灣腎臟護理學會雜誌, 3(2), 81-87.
葉淑琴, 孫嘉玲, 馬麗卿, 林燕如, & 謝湘俐. (民101). 不同分期慢性腎臟疾病患者憂鬱狀態及健康相關生活品質之研究. 臺灣腎臟護理學會雜誌, 11(3), 16-32.
衛生福利部. (民102). 101年國人主要死因統計結果.
盧素真, 陳世宜, 黃淑珍, & 蘇玲華. (民99). 血液透析病患睡眠障礙, 憂鬱程度及其生活品質的分析探討. 護理暨健康照護研究, 6(1), 33-43.
魏鳳君. (民100). 臺灣末期腎臟衰竭接受透析治療者罹患憂鬱症之研究探討. 國立中山大學, 高雄市.
藺汝平. (民96). 台灣地區腎臟專科醫師對於末期腎臟病患者選擇透析模式的影響因素之看法. 國立陽明大學, 台北市.

英文文獻
About.com Bipolar Disorder. (2012). Symptoms of Mania and Hypomania in Bipolar Disorder. Retrieved November 13, 2013, from http://bipolar.about.com/od/maniahypomani1/a/mania.htm
Altman, E. G., Hedeker, D., Peterson, J. L., & Davis, J. M. (1997). The Altman Self-Rating Mania Scale. Biological psychiatry, 42(10), 948-955.
American Family Physician®. Insomnia: Assessment and Management in Primary Care. from http://www.aafp.org/afp/1999/0601/p3029.html
American Medical Network, I. Major Depressive Disorder. Retrieved November 6, 2013, from http://www.health.am/psy/major-depressive-disorder/
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV-TR: American Psychiatric Publishing.
American Psychiatric Association, & American Psychiatric Association Task Force on DSM-IV. (1994). Diagnostic and statistical manual of mental disorders : DSM-IV. Washington, DC: American Psychiatric Association.
Andreoli, T. E. (1989). Molecular aspects of endocrinology. Hospital Practice, 24(8), 11-12.
Ayuso-Mateos, & Jose Luis. (2000). Global burden of bipolar disorder in the year 2000.
Barlow, D. H., & Durand, V. M. (2011). Abnormal psychology: An integrative approach: Cengage Learning.
Ben Martin. (2006). How is Bipolar Disorder Diagnosed? Psych Central Retrieved December 18, 2013, from http://psychcentral.com/lib/how-is-bipolar-disorder-diagnosed/000512
Blair-West, G. W., & Mellsop, G. W. (2001). Major depression: does a gender-based down-rating of suicide risk challenge its diagnostic validity? Australian and New Zealand Journal of Psychiatry, 35(3), 322-328.
BMJ. (2001). Depression in developing countries: lessons from Zimbabwe. Retrieved November 6, 2013, from http://www.bmj.com/content/322/7284/482
Bowden, C. L. (2001). Strategies to reduce misdiagnosis of bipolar depression. Psychiatric Services, 52(1), 51-55.
Brachman, R. J., & Anand, T. (1996). The Process of Knowledge Discovery in Databases: A Human Centered Approach. Advances in Knowledge Discovery and Data Mining. AAAI: MIT Press.
Brekke, F. B., Amro, A., Hortemo Osthus, T. B., Dammen, T., Waldum, B., & Os, I. (2013). Sleep complaints, depression and quality of life in Norwegian dialysis patients. Clinical Nephrology, 80(2), 88-97.
Christie, K. A., Burke, J. D., Jr., Regier, D. A., Rae, D. S., Boyd, J. H., & Locke, B. Z. (1988). Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. Journal of the American Psychiatric Association, 145(8), 971-975.
Dean, K., Walsh, E., Morgan, C., Demjaha, A., Dazzan, P., Morgan, K., et al. (2007). Aggressive behaviour at first contact with services: findings from the AESOP First Episode Psychosis Study. Psychological Medicine, 37(4), 547-557.
Erik L. Goldman. (1999). Clinical Psychiatry News. Retrieved November 13, 2013, from http://www.angelfire.com/fl5/bipolarnoise/News/WarningSignals1.html
Fayyad, U. (1997). Data mining and knowledge discovery in databases: implications for scientific databases. Paper presented at the Ninth International Conference on Scientific and Statistical Database Management.
Fayyad, U., Piatetsky-Shapiro, G., & Smyth, P. (1996). From data mining to knowledge discovery in databases. AI magazine, 17(3), 37.
Furukawa, T. A. (2010). Assessment of mood: guides for clinicians. Journal of Psychosomatic Research, 68(6), 581-589.
Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: bipolar disorders and recurrent depression (Vol. 1): New York: Oxford University Press.
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.
Hedayati, S. S., Minhajuddin, A. T., Toto, R. D., Morris, D. W., & Rush, A. J. (2009). Prevalence of Major Depressive Episode in CKD. [Article; Proceedings Paper]. American Journal of Kidney Diseases, 54(3), 424-432.
Ibrahim, N., Chiew-Thong, N. K., Desa, A., & Razali, R. (2013). Depression and coping in adults undergoing dialysis for end-stage renal disease. Asia-Pacific Psychiatry, 5 Suppl 1, 35-40.
Judd, L. L., & Akiskal, H. S. (2003). The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. Journal of Affective Disorders, 73(1-2), 123-131.
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLOS Medicine, 5(2), e45.
Kurasaki, K., Okazaki, S., & Sue, S. (2002). Asian American mental health: Assessment theories and methods: Springer.
Levey, A. S., Coresh, J., Balk, E., Kausz, A. T., Levin, A., Steffes, M. W., et al. (2003). National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Annals of internal medicine, 139(2), 137-147.
Mansell, W., & Pedley, R. (2008). The ascent into mania: a review of psychological processes associated with the development of manic symptoms. Clinical Psychology Review, 28(3), 494-520.
Margarita Tartakovsky. (2009). Bipolar Disorder Fact Sheet. Psych Central Retrieved December 18, 2013, from http://psychcentral.com/lib/bipolar-disorder-fact-sheet/0001561
Merikangas, K. R., Akiskal, H. S., Angst, J., Greenberg, P. E., Hirschfeld, R. M., Petukhova, M., et al. (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Archives of General Psychiatry, 64(5), 543-552.
Monczor, M. (2010). Bipolar disorder in the elderly. Vertex, 21(92), 275-283.
Muzina, D. J., Kemp, D. E., & McIntyre, R. S. (2007). Differentiating bipolar disorders from major depressive disorders: treatment implications. Annals of Clinical Psychiatry, 19(4), 305-312.
National Institute of Mental Health. (2008). Depression.
Neitzer, A., Sun, S., Doss, S., Moran, J., & Schiller, B. (2012). Beck Depression Inventory-Fast Screen (BDI-FS): An efficient tool for depression screening in patients with end-stage renal disease. Hemodialysis International, 16(2), 207-213.
NIMH: Bipolar Disorder. (2008). Introduction: Bipolar Disorder. Retrieved November 13, 2013, from http://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml
NSW Health Department. (2001). Consensus Guidelines for Assessment and Management of Depression in the Elderly.
Oquendo, M. A., Bongiovi-Garcia, M. E., Galfalvy, H., Goldberg, P. H., Grunebaum, M. F., Burke, A. K., et al. (2007). Sex differences in clinical predictors of suicidal acts after major depression: a prospective study. The American Journal of Psychiatry, 164(1), 134-141.
Palmer, S. C., Vecchio, M., Craig, J. C., Tonelli, M., Johnson, D. W., Nicolucci, A., et al. (2013). Association between depression and death in people with CKD: a meta-analysis of cohort studies. American Journal of Kidney Diseases, 62(3), 493-505.
Preljevic, V. T., Osthus, T. B., Os, I., Sandvik, L., Opjordsmoen, S., Nordhus, I. H., et al. (2013). Anxiety and depressive disorders in dialysis patients: association to health-related quality of life and mortality. Gen Hosp Psychiatry, 35(6), 619-624.
Preljevic, V. T., Osthus, T. B., Sandvik, L., Opjordsmoen, S., Nordhus, I. H., Os, I., et al. (2012). Screening for anxiety and depression in dialysis patients: comparison of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory. [Comparative Study
Research Support, Non-U.S. Gov't]. Journal of Psychosomatic Research, 73(2), 139-144.
Psychiatric Times. (2006). Bipolar Disorder: Particle or Wave? DSM Categories or Spectrum Dimensions? Retrieved November 13, 2013, from http://www.psychiatrictimes.com/bipolar-disorder/bipolar-disorder-particle-or-wave-dsm-categories-or-spectrum-dimensions
Psychiatric Times. (2008). Medical Comorbidities in Late-Life Depression. Retrieved November 6, 2013, from http://www.psychiatrictimes.com/articles/medical-comorbidities-late-life-depression
Psychiatric Times. (2009). Cognitive Difficulties Associated With Depression What Are the Implications for Treatment? Retrieved November 6, 2013, from http://www.psychiatrictimes.com/articles/cognitive-difficulties-associated-depression-what-are-implications-treatment
PsychiatryOnline.com. (2006). Practice Guideline for the Treatment of Patients With Bipolar Disorder Second Edition.
Psychology Today. (2010). Bedfellows: Insomnia and Depression. Retrieved November 6, 2013, from http://www.psychologytoday.com/articles/200307/bedfellows-insomnia-and-depression
Quinlan, J. R. (1986). Induction of decision trees. Machine learning, 1(1), 81-106.
Reckert, A., Hinrichs, J., Pavenstadt, H., Frye, B., & Heuft, G. (2013). [Prevalence and correlates of anxiety and depression in patients with end-stage renal disease (ESRD)]. Z Psychosom Med Psychother, 59(2), 170-188.
Santos, P. R., & Arcanjo, F. P. (2013). Social adaptability and substance abuse: predictors of depression among hemodialysis patients? BMC Nephrol, 14, 12.
Santos, P. R., Capote, J. R., Jr., Cavalcanti, J. U., Vieira, C. B., Rocha, A. R., Apolonio, N. A., et al. (2013). Sexual dysfunction predicts depression among women on hemodialysis. International Urology and Nephrology.
Sezer, S., Uyar, M. E., Bal, Z., Tutal, E., & Ozdemir Acar, F. N. (2013). The influence of socioeconomic factors on depression in maintenance hemodialysis patients and their caregivers. Clinical Nephrology, 80(11), 342-348.
Silva Junior, G. B., Daher, E. F., Buosi, A. P., Lima, R. S., Lima, M. M., Silva, E. C., et al. (2013). Depression among patients with end-stage renal disease in hemodialysis. Psychol Health Med.
Srivastava, S., & Ketter, T. A. (2010). The link between bipolar disorders and creativity: evidence from personality and temperament studies. Current Psychiatry Reports, 12(6), 522-530.
Sumanathissa, M., de Silva, V. A., & Hanwella, R. (2011). PREVALENCE OF MAJOR DEPRESSIVE EPISODE AMONG PATIENTS WITH PRE-DIALYSIS CHRONIC KIDNEY DISEASE. [Article]. International Journal of Psychiatry in Medicine, 41(1), 47-56.
U.S. National Institutes of Health. (1995). Bipolar Disorder: NIH Publication No. 95-3679. Retrieved November 13, 2013, from http://web.archive.org/web/20080429204140/http://www.pueblo.gsa.gov/cic_text/health/bipolar/bipolar.htm
UNITED STATES RENAL DATA SYSTEM. (2013). 2013 USRDS ANNUAL REPORT. 2.
Web M.D. Bipolar II Disorder Symptoms and Signs. Retrieved November 13, 2013
WebMD.com. (2010). Hypomania and Mania in Bipolar Disorder. Retrieved November 13, 2013, from http://www.webmd.com/bipolar-disorder/guide/hypomania-mania-symptoms
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429-435.