臺灣博碩士論文加值系統

背景：青少年憂鬱症是台灣重要健康問題，國外研究發現大多數青少年在接受治療後會康復，這正可做為支持正向心理學的有利證據，國內缺乏已診斷憂鬱症的青少年或是縱貫性研究，所以在門診就醫的重度憂鬱症青少年，經歷哪種復原模式，仍不是很清楚。
目的：本研究目的是在探討新診斷重鬱症的青少年，在康復過程中憂鬱程度、社會支持與復原力的變化、以及心理治療、憂鬱程度、社會支持與復原力的相關性。
方法：本研究為縱貫式追蹤研究設計，在台北市一所醫學中心精神科門診進行收案，收集期間從2015年3月至2016年3月，以立意取樣的方式選取30位新診斷重鬱症青少年，年齡介於14~19歲（18.40±1.276），以結構式問卷，包括基本資料、治療方式問卷、貝克憂鬱量表、社會支持量表以及青少年復原力量表，收集新診斷時、治療後第一個月、第四個月、第七個月以及第九個月，共計五次時間點的資料。資料統計分析與處理則採取描述性統計、推論性統計，如皮爾森相關係數以及廣義估計方程式。
結果：本研究個案數雖少，但仍有重要發現：一、新診斷重鬱症的青少年，在接受完整治療後，復原力會隨著時間變化上升，形成顯著差異（p < 0.001）；二、新診斷重鬱症的青少年，在接受完整治療後，憂鬱程度會隨著時間變化而下降，形成顯著差異（p < 0.001）；三、新診斷重鬱症的青少年，在接受完整治療後，社會支持會隨著時間變化上升，形成顯著差異（p < 0.001）；四、治療期第一個月、第四個月、第七個月以及第九個月的社會支持與復原力有正相關性（r = 0.521，p = 0.003；r = 0.576，p = 0.004；r = 0.608，p = 0.002；r = 0.472，p = 0.036），其中學校支持與復原力有正相關性（p = 0.048）；五、本研究發現心理治療與復原力達到顯著差異（p = 0.004），表示心理治療在青少年康復歷程中很重要。
結論：社會支持與復原力有正相關性，其中學校支持更為重要，建議學校護理人員、專科護理師與校內外資源連結，例如與社區護理人員合作，共同擬定全面性的健康照護計畫。心理治療是新診斷重鬱症的青少年康復歷程中很重要的相關因素，所以，本研究結果建議臨床護理人員在門診提供短期心理衛生教育團體等，以協助縮短等待時間、減少疾病症狀的嚴重度、強化青少年的復原力。

Background: Major depressive disorder in adolescent is a serious health problem in Taiwan. Most adolescent will recover after therapy. And this can be a favorable evidence for positive psychology. The longitudinal research for adolescent with newly diagnosed major depressive disorder is insufficient in Taiwan. It is still unclear that what kind of recovery model adolescent, who is an outpatient, will go through.
Aim: The aim of study is to investigate the changes of the severity of depression, social support and resilience in adolescent with newly diagnosed major depressive disorder. And it also wants to investigate the relationship between the four.
Methods: The study is designed as a longitudinal research in a psychology outpatient in medical center in Taipei city. We selected 20 adolescents with newly diagnosed major depressive disorder by purposeful sampling way. Their ages were between 14 to 19 years old (18.40±1.276). Data were collected at 5 particular times by structural questionnaires which were included basic data, Beck Depression Inventory II (BDI-II), social support questionnaire and Haase adolescent resilience in illness scale.
Results: The resilience in adolescent with newly diagnosed major depressive disorder will significantly increase with time after 9-month therapy (p < 0.001). The severity of depression in adolescent with newly diagnosed major depressive disorder will significantly decrease with time after 9-month therapy (p < 0.001). The social support in adolescent with newly diagnosed major depressive disorder will significantly increase with time after 9-month therapy (p < 0.001). The social support in adolescent with newly diagnosed major depressive disorder will significantly increase with time after 9-month therapy (p = 0.000). During treatment session, social support at 1st month, 4th month, 7th month and 9th month has positive correlation with resilience (r = 0.521，p = 0.003；r = 0.576，p = 0.004；r = 0.608，p = 0.002；r = 0.472，p = 0.036). School support are positive correlated with resilience(p = 0.031). School support are positive correlated with resilience(p = 0.048). Psychology therapy is positive correlated with resilience (p = 0.004). It suggests that psychology therapy plays an important role in recovery process.
Conclusions: Social support has positive correlation with resilience, and school support is the most obvious of them all. school support is the most obvious of them all. It suggests that school nurses and nurse practitioner should give enough support to adolescent with newly diagnosed major depressive disorder and encourage adolescent with depressive disorder go back to school. Psychology treatment plays an important role in the recovery process in adolescent with newly diagnosed major depressive disorder. This study can be a resilience reference for intervention of adolescent with newly diagnosed major depressive disorder, The results suggest providing short term psycho education in outpatient group. It can shorten the waiting time, decrease the severity of symptoms, and enhance the resilience of adolescent.

正文目錄 i
「表」目錄 iv
「圖」目錄 v
「附錄」目錄 vi
中文摘要 viii
英文摘要 x
第一章　緒論 1
第一節　研究動機與重要性 1
第二節 研究問題 3
第三節 研究目的 4
第四節　名詞界定 5
第二章　文獻查證 7
第一節　青少年的發展特性 7
第二節　青少年憂鬱症 8
　　　　青少年憂鬱症的診斷 8
　　　　青少年憂鬱症之治療療程與治療方法 9
第三節 青少年復原力 12
　　　　復原力的緣起與發展 12
　　　　青少年復原力的內涵 13
　　　　青少年復原力的定義 14
　　　　青少年復原力的相關因素 14
第四節　青少年復原力在護理領域之應用 15
第三章　概念架構 19
第一節　研究假設 19
第二節 研究架構 20
第四章　研究方法 21
第一節　研究設計 21
第二節　研究對象 22
第三節 研究場所 23
第四節 研究工具 24
第五節 研究步驟 27
第六節　資料處理與統計分析方法 28
第七節　研究倫理 29
第五章　研究結果 30
第一節　研究對象問卷回收與人口學特性之描述 30
第二節　康復期間復原力變化情形 38
第三節　康復期間憂鬱程度變化情形 40
第四節　康復期間社會支持變化情形 42
第五節　康復期間各變項之分數變化 44
第六節　康復期間憂鬱程度、社會支持與復原力之相關性 45
第七節　心理治療與復原力之差異性 49
第六章　討論 51
第一節　研究對象人口學特性 51
第二節　康復期間復原力、憂鬱程度與社會支持變化 52
第三節　康復期間復原力之相關因素 55
第七章 結論與建議 57
第一節　結論 57
第二節　建議 59
第三節　限制 60
參考文獻 61

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