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研究生:王昶智
研究生(外文):Chang-ChihWang
論文名稱:社團組織參與對老年憂鬱症狀之影響:政治團體與一般團體之比較
論文名稱(外文):The effect of social organization participation on depressive symptoms in older adults: A comparison between political groups and general groups
指導教授:胡淑貞胡淑貞引用關係
指導教授(外文):Susan C. Hu
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:107
中文關鍵詞:政治參與老年憂鬱中老年人長期追蹤研究混合效果模型
外文關鍵詞:social participationpolitical participationlater-life depressionlongitudinal studymixed-effect model
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背景:憂鬱症是老年人常見的心理問題,老年憂鬱不僅造成日常生活功能受損也是自殺的危險因子。然而,過去文獻很少討論老年人社會參與的某一種類─也是歐盟活躍老化指標(Active Aging Index, AAI)社會參與面向其中之一的政治參與對老年憂鬱的影響,可能會錯失老年憂鬱預防時機。
目的:本研究目的為了解台灣55歲以上中老年人參與政治性團體以及一般性社團參與的狀況,以及政治性團體與一般性社團參與對其後續憂鬱狀態的影響,並進一步分層分析社團組織參與在不同特質族群(包含性別、基線年齡組、基線憂鬱程度)中的後續憂鬱影響。
方法:資料來源為「台灣地區中老年身心社會生活狀況長期追蹤調查」,本研究使用1999年、2003年及2007年三波資料,進行1999年55歲以上族群固定樣本長期追蹤研究。依序排除未滿55歲、居住在機構、代答者、ADL分數大於1、2003年死亡以及1999年和2003年重要變項遺漏者,最終研究樣本為2922人。本研究結果變項是憂鬱分數,測量工具為CES-D10,總分0分至30分,分數越高越嚴重,為連續變項;自變項根據1999年和2003年樣本的社會組織參與類別進行分組,分成兩類進行後續分析:社團組織參與類別以及社團組織參與波數。社團組織參與類別為以下3組:曾政治參與、曾一般參與以及兩波皆無參與;社團組織參與波數分為以下5組:兩波政治參與、一波政治參與、兩波一般參與、一波一般參與、兩波皆無參與。控制變項包含人口學變項(包含性別、教育程度)、時間、健康狀態(自覺健康、慢性疾病數)、健康行為(抽菸、飲酒、運動)、基線憂鬱分數。統計分析使用描述性統計進行樣本基本特質描述,包含卡方檢定、ANOVA檢定等;推論性統計使用Mixed effect model進行分析,探討1999年與2003年的社團組織參與類別和社團組織參與波數對後續憂鬱的影響,並使用社團組織參與類別進行分組分析。此外,在整體樣本及分層樣本進行模型分析時,皆會進一步分層分析觀看各組的時間效應。
結果:在2922人中,男性比例為52.6%,基線平均年齡為67.98±7.89歲,23.61%教育程度為國中以上。樣本的社團組織參與類別的情形為:曾政治參與1023人(35.01%)、曾一般參與880人(30.12%)以及兩波皆無參與1019人;而社團組織參與波數的情形為:兩波政治參與283人(9.69%)、一波政治參與740人(25.33%)、兩波一般參與414人(14.17%)、一波一般參與466人(15.95%)、兩波皆無參與1019人(35.04%)。在社團組織參與類別放入所有控制變項的模型中,相較於兩波皆無參與者,曾政治參與(β=-0.540,p〈0.05)、曾一般參與(β=-0.962,p〈0.001)顯著較低的憂鬱分數;在時間效應的部份,相較於第二波,曾政治參與(β=0.732,p〈0.001)以及兩波皆無參與(β=0.537,p〈0.05)會在第三波顯著增加憂鬱平均分數。在分層分析的部份,不同的社團組織參與類別在不同性別、不同基線年齡層以及不同基線憂鬱有不一樣的效果,例如曾政治參與僅在男性有顯著效果(β=-0.752,p〈0.05),但女性則無。在社團組織參與波數放入所有控制變項的模型,相較於兩波皆無參與者,兩波政治參與已無顯著較低的後續憂鬱狀態。
結論:台灣中老年人不同種類的社團組織參與對其後續憂鬱狀態有不同的影響。整體而言,社團組織參與者皆有較低的後續憂鬱狀態,但是政治參與者似乎有隨著時間增加憂鬱的情形。另外,社會組織參與在不同特質的族群身上有不同的影響。本研究發現政治參與似乎對心理健康有其獨特的效果。
The purpose of this longitudinal study is to examine the effect of social organization participation on depressive symptoms in Taiwanese older adults, including political groups and general groups. A nationally representative dataset “Taiwan Longitudinal Study on Aging (TLSA)” collected in 1999, 2003 and 2007 was used. Data from the fixed cohort of 2922 participants aged 55 years and over in 1999 was recruited. Depressive symptoms were measured by ten-item Chinese version of Center for Epidemiologic Studies Depression Scale (CES-D10). Social organization participation in 1999 and 2003 was categorized into two types: participation category and participation wave. The former was divided into three groups: (1) ever political participation, (2) ever general participation, and (3) no participation. Mixed effect model was used to examine the effect of social organization participation on subsequent depressive symptoms.
After controlling confounders, compared with no participation group, those with ever political participation(β=-0.540,p〈0.05) and ever general participation(β=-0.962,p〈0.001) predicted significantly lower CES-D10 mean score. However, participants in the groups of ever political participation seemed to increase the score of CES-D10 over time, whereas the group of ever general participation didn't do so. This result may indicate different tendency to the average depression scores between the groups of ever political participation and ever general participation, and future research is needed.
第壹章 前言 1
第一節 研究背景 1
第二節 研究目的 3
第三節 研究假說 4
第四節 名詞定義 4
第貳章 文獻回顧 6
第一節 老年憂鬱的影響 6
第二節 老年人社會參與的重要性 15
第三節 社會參與和老年憂鬱 25
第四節 現有社會參與文獻不足之處 31
第參章 研究設計與方法 34
第一節 資料來源與研究對象 34
第二節 研究架構與研究設計 37
第三節 變項測量 39
第四節 統計分析 46
第肆章 研究結果 50
第一節 研究樣本描述及社團組織參與分組情形 51
第二節 社團組織參與類別之雙變項分析 57
第三節 社團組織參與類別之多變項模型分析結果 63
第四節 社團組織參與類別之模型分層分析結果 68
第五節 社團組織參與波數之雙變項分析 82
第六節 社團組織參與波數之多變項模型分析 87
第伍章 討論 92
第一節 主要研究發現 92
第二節 與過去研究結果之討論 94
第三節 本研究優勢與限制 97
第四節 結論與建議 98
第陸章 參考文獻 101
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