醫學相關科系大學生之精神心理健康問題，可能會導致他們呈現高壓力知覺及壓力因應能力急遽降低或退化，長期下來，更可能會出現學習適應障礙、社會功能敗壞或傷害性行為等問題。學生的精神高風險狀態與其壓力知覺程度及使用的壓力因應策略，有密切的關係。因此，藉由心理社會治療的介入方法，來改變其壓力知覺程度及壓力因應策略的使用，進而改善其精神高風險的程度，是非常重要的。
本研究目的，為了解精神高風險醫學相關科系大學生的壓力知覺影響因素之現況，並探討壓力知覺管理方案介入對壓力知覺影響因素之改變成效。係採雙組前後測、單盲、隨機的研究設計，研究時間自2013年3月4日至2013年5月31日，以中部某醫學大學二年級學生為研究對象，暨以亂數表隨機分配實驗組與對照組。兩組皆提供壓力知覺管理課程的衛生教育手冊與資料，實驗組則另接受「壓力知覺管理團體」提供的教育性介入課程。
在知情同意下，願意參與本研究之精神高風險個案學生且完成前測資料收集者共50名，排除1名未完成後測資料收集者，實驗組26名，對照組23名。以自製基本資料表收集精神高風險個案學生的人口學資料，並分別在團體開始前與結束後，以中文版精神分裂人格量表簡述版、壓力知覺量表、情境特質焦慮量表Y版及壓力因應策略量表進行前、後測，並以t檢定及混合線性模式(Linear Mixed Model, LMM)進行介入措施之成效分析。
研究結果發現，精神高風險個案學生在壓力知覺影響因素變項上，皆未達統計上顯著差異。但可增加人格特性精神高風險組選擇使用情緒發洩策略與擱置問題策略的傾向(兩組後測比)，降低精神風險度程度、人際互動缺損程度、缺乏組織性程度及情境焦慮程度的成效(單一實驗組前後測比)；對焦慮特性精神高風險組的特質焦慮程度亦有降低成效(單一實驗組前後測比)。
本研究結果雖未能證實壓力知覺管理團體於精神高風險個案學生的介入成效，但確認了心理教育類型的團體介入，對人格特性精神高風險個案學生的介入效果較好，並以具前瞻性的隨機對照組研究設計方式，提供醫學教育一個改變精神高風險個案學生壓力知覺影響因素的實證證據。因此，建議未來短期介入方案研究，課程設計應單純化，且應分就不同類型精神高風險學生的特性與問題需求，調整團體的進行頻次與教育認知比重，並進行持續效果追蹤，以便進一步確認有效促進精神高風險學生心理健康之措施。

Medicine related students who were at high risk mental state is a big and important issue in recent years. The highly stressful medical training requirements made those students perceived stresses higher than ordinary students and the high pressure perception could make their symptoms of learning adaptation problems or symptoms of anxiety happen worse, resulting in their diminishing of stresses coping ability and learning ineffectiveness.
The purpose of this study aims to evaluate the effectiveness of perceived stress management intervention program to improve the mental risk, stress perception, anxiety levels, and stress coping strategies. The study design was single-blinded randomized control trial with pretest and posttest. This study subjects recruited 50 medicine related grade two undergraduate students in mid-Taiwan by convenient sampling. The study subjects were randomized assigned into experiment (n=26) and control groups (n=24). Both groups received the Perceived Stress management-related educational materials, but only the experimental group received "Perceived Stress management intervention program" as the intervention approach.
With Informed consent, 50 high-risk mental states students joined the study and completed pretest data collection and 49 subjects completed posttest. Five instruments were used for measure study variables in this study, including the demographic data, the Chinese version of Schizotypal Personality Questionnaire-Brief, the Chinese Version, Perceived Stress Scale, the Chinese mandarin of State-Trait Anxiety Inventory Y form, the Stress Coping Strategies Scale. The data were analyzed by chi-square test, independent and paired t test and Linear Mixed Model (LMM) to assess the effectiveness of intervention program.
The results showed no statistical significance at the overall scores between students in high mental risk group and the control group. However, comparing with the control group, the tendency to use coping strategies of emotional venting and problems solving increased significantly for students with personality trait of high-risk mental status. And the CSPQ-B total, interpersonal, disorganised and the state anxiety levels were also reduced for students with personality trait of high-risk mental status students with personality trait of high-risk mental status in experimental group. The scores of trait anxiety also reduced significantly in the high-risk mental status group with anxiety trait.
Although this study didn’t approve the intervention effectiveness of perceived stress management intervention program for the students with high mental risk, it did confirm that the intervention effectiveness of psycho-educational type group was better for the students with personality trait of high-risk mental status. Menawhile, the scores of study variables have decreased for students in experimental group. We recommended that the curriculum design of the short-term intervention program should be simplified for the future research. In addition, the cognitive proportion and the frequency of the group should be adjusted according to different characteristics and problems fordifferent types of mental high-risk students. Futhermore, keeping the follow-up of the management effect to evaluate long-term effects of mental health promotion is suggested for the high-risk mental state students in the future study.

標 題 頁數
中文摘要………………………………………………………… i
英文摘要………………………………………………………… iii
致謝……………………………………………………………… vi
正文目錄………………………………………………………… viii
｢表｣目錄………………………………………………………… xii
｢圖｣目錄………………………………………………………… xvii
第一章　緒論
第一節 研究動機 ……………………………………… 1
第二節 研究目的與問題 ……………………………… 4
第三節 研究架構 ……………………………………… 6
第四節 名詞定義 ……………………………………… 7
第二章　文獻探討
第一節 大學生精神心理健康狀況 …………………… 10
第二節 精神高風險醫學相關科系大學生的壓力知覺影響因素 ……………………………………… 16
第三節 壓力知覺管理方案…………………………… 23
第三章　研究方法
第一節 研究設計 ……………………………………… 27
第二節 研究對象 ……………………………………… 29
第三節 研究工具 ……………………………………… 31
第四節 研究步驟 ……………………………………… 41
第五節 研究倫理 ……………………………………… 43
第六節 資料處理與分析 ……………………………… 44
第四章　研究結果……………………………………… 46
第一節 精神高風險個案學生之基本屬性 …………… 50
第二節 精神高風險個案學生壓力知覺影響因素之前測資料分析 ………………………………… 56
第三節 壓力知覺管理方案於精神高風險個案學生之介入成效 ……………………………………… 78
第四節 壓力知覺管理方案於不同類型精神高風險個案學生之介入成效 ………………………… 107
第五章 討論與結論
第一節 精神高風險個案學生之人口學相關議題 ……………………………………………… 122
第二節 壓力知覺管理方案於精神高風險個案學生之成效……………………………………………128
第三節 壓力知覺管理方案於不同類型精神高風險個案學生之成效 …………………………………136
第四節 結論 …………………………………………… 140
第六章 研究限制與建議
第一節 研究限制 ……………………………………… 143
第二節 檢討與建議 …………………………………… 147
參考資料
中文部份………………………………………………… 151
英文部分………………………………………………… 156
附錄
附錄一 研究同意書
附錄一之1 人體試驗計畫同意書……………… 174
附錄一之2 中文版壓力知覺量表使用同意……… 175
附錄一之3 壓力因應策略量表使用同意……… 176
附錄二 研究使用問卷
附錄二之1 個人基本資料表……………………177
附錄二之2 中文版精神分裂人格量表簡述版…178
附錄二之3 中文版情境特質焦慮量表………… 179
附錄二之4 壓力知覺量表……………… 181
附錄二之5 壓力因應策略量表………………… 182

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