臺灣博碩士論文加值系統

本研究目的在藉由編製「兒童及青少年憂鬱篩選量表」，並探究國內兒童青少年憂鬱的相關問題之研究結果，以提供國中小學及社區諮商輔導機構作為實務上之應用；此外根據篩選量表的實施，也能了解目前國內兒童青少年憂鬱的人口學變項及臨床特徵，以作為臨床實務工作者之參酌。
研究計分為三個子研究進行，子研究一乃透過焦點訪談精神科醫師、臨床心理師、輔導老師、憂鬱個案及其家長各5名共計20名，透過紮根理論分析國內兒童青少年憂鬱的主要症狀，並以德懷術彙整意見；子研究二乃根據主要症狀類型，編制兒童及青少年憂鬱篩選量表兒童青少年版及家長版，作為評估篩選及預防之用途，研究樣本分別為兒童青少年及其家長，分作三類型樣本進行分析，兒童青少年部分包括以分層隨機叢集抽樣全國四區33所國中小一般樣本3468名學生、高危險群（受虐兒童）99名及臨床樣本98名共計3665名。家長部分則以一般樣本為2073名、高危險群90名及臨床個案81名共計2244名；子研究三則進一步針對醫院精神科轉介之臨床個案103名，分別進行人口學變項、臨床特徵及適應狀況探究其彼此間的關聯性、特徵分析及其影響。本研究資料分別以SPSS、AMOS、PARSCALE、BILOG及HLM軟體進行各種統計分析。
本研究之研究結果如下：
1. 國內兒童青少年憂鬱症狀分別依認知想法、行為、情緒及生理四個層面歸類，共有39個臨床特徵。
2. 兒童及青少年憂鬱篩選量表兒童青少年版共計34題，分作五個因素分別是1)憂鬱煩躁情緒。2)無望。3)自尊與認知功能低。4)身體抱怨與反應遲滯。5)品行-人際問題。家長版共計33題分作四個因素分別是1)憂鬱煩躁情緒、2)無望-自貶、3)品行問題、4)活力及認知功能降低。
3. 兒童及青少年憂鬱篩選量表兒童青少年版及家長版提供良好的信效度考驗。
4. 人口學變項在兒童青少年憂鬱之差異考驗，結果發現不同學程、性別、年級、手足人數、家庭結構、家庭氣氛、父與母親的管教方式、學業成績及社經地位在憂鬱上有顯著差異。
5. 量表常模建立分別依兒童青少年及家長兩部分建立。兒童青少年部分分別依總量表及五個分量表建立全國性常模、性別及年級常模；家長版部分分別依總量表及四個分量表建立全國性常模及學程常模。
6. 臨床特徵分析結果發現臨床個案出生序、學業成績及社經地位與憂鬱的嚴重程度有關聯。
7. 臨床個案的症狀特徵分析研究結果發現，臨床個案所知覺的憂鬱向度，普遍以「品行人際問題」、「自尊及認知功能低」及「憂鬱煩躁情緒」為主。
8. 臨床個案對於所知覺的適應能力在「身心發展困擾」、「人際關係困擾」、「自我關懷困擾」、「學校生活困擾」、「家庭生活困擾」五個向度的分數都顯著較一般人高。
9. 兒童青少年憂鬱與適應能力之相關之結果發現，兒童青少年憂鬱與其行為困擾有很大的相關，且臨床個案的憂鬱與行為困擾之間有顯著的典型相關存在。
10. 階層線性模式分析結果發現，臨床個案的出生序、學業成績及社經地位三個預測變項，對於臨床個案的憂鬱有顯著影響。各年級之間而言，性別是有效預測憂鬱的變項。在控制年級平均性別對憂鬱之影響後，父親管教方式對兒童青少年憂鬱有顯著之影響。
本研究根據研究結果與討論，針對量表之應用在實務上提出建議及對未來研究提出進一步具體建議，供國中小學及社區諮商輔導機構或人員參酌。

The purpose of this study was to explore the result of the survey by developing “Depression Screening Scale for Children & Adolescents” about domestic children & adolescents depression issue, which could provide junior high, elementary school, and community counseling & guidance institution for practical application. Otherwise, with using the Screening Scale, we could realize the variables in demography for the domestic depression children & adolescents and clinical characteristics, which can be the references to clinical workers.
This study was divided into three sub-studies, sub-study I was carried out by the focusing interviews to the groups, including psychiatrists, clinical psychologists, counselors, and outpatients. Each group had 5 persons. The total number of the participant was 20. Grounded theory was used to analyze the symptoms of domestic children & adolescents suffering from depression; Delphi compiled comments. Sub-study II was used to develop the editions of Depression Screening Scales for Children & Adolescents, which were suitable for children & adolescents and their parents, and they were provided for assessment, screening and prevention. The samples consist of children, adolescents and their parents by using cluster sampling. There were 3468 ordinary students in 4 districts of 33 junior high and elementary school, 99 high-risked (abused children) and 98 outpatients. The part for the parents contained 2244 persons, including 2073 ordinary samples, 90 high-risked and 81 outpatients. Sub-study III was to explore the correlation, characteristics analysis and effects about 103 psychiatry department outpatients by using demography variables, clinical characteristics and adjustment. The information about this research were analyzed individually in statistics by the softwares-SPSS, AMOS, PARSCALE, BILOG, and HLM.
The results were summarized as follows:
1. In accordance with cognition, behavior, emotion and physiology, there were 39 clinical characteristics in domestic children & adolescents depression.
2. There were 34 items in children & adolescents edition of Depression Screening Scale for Children & Adolescents, separated into five factors: 1) depression-dysphoric mood; 2) hopelessness; 3) low self-esteem & cognition function; 4) somatic complaints & psychomotor retardation; 5) conduct-social problems. There were 33 items in parents edition, separated into four factors: 1) depression- dysphoric mood; 2) hopelessness & self-depreciation; 3) conduct problem; 4) loss of energy & cognition function.
3. Children & adolescents and parents edition of Depression Screen Scale for Children & Adolescents provided good validity and reliability .
4. According to difference test of demography variable in children & adolescents depression, there were significant differences in different educational level, sex, grade, sibling numbers, family composition, family atmosphere, parenting styles, school performance and social-economic status.
5. Scale norms were established according to children & adolescents and parents. The children & adolescents edition was based on summarized scale and five sub-scales to establish national norms, sex norms and grade norms. The parents’ edition was based on total scale and four sub-scale to establish national norms and educational level norms.
6. According to clinical characteristics analysis, the serious degree of depression was correlated with birth order, school performance and social-economic status .
7. According to symptom characteristics of outpatients, the main depression of outpatients was conduct-social problems, low self-esteem & cognition function and depression- dysphoric mood.
8. The adjustment ability of outpatients got higher score at ”psychosomatic development disturbance”, ”social relationship disturbance”, ”self concern disturbance”, ”school life disturbance” and ”family life disturbance”.
9. According to children & adolescents depression and adjustment ability, and there was significant correlation with children & adolescents depression and behavior disturbance, and there was canonical correlation between children & adolescents depression and behavior disturbance.
10. According to Hierarchical Linear Modeling Analysis, there were significant effect on outpatient’s depression and the three prediction variables: birth order, school performance and social-economic status. Among different grades, sex was an effective predictor. By controlling the influence of grade average sex on depression, there was significant effect on father’s nurturing styles with children & adolescents depression.
This study, based on the result of study and discussion, and addressing suggestions and concrete proposals for further research in accordance with the practical application of Screening Scale, provided the references for the counselors in junior high school, elementary school and community counseling institutions for practical application.

目次 Ⅰ
表次 Ⅲ
圖次 Ⅹ
第一章 緒 論 1
第一節 問題性質與研究動機 1
第二節 研究目的 7
第三節 研究問題 7
第四節 名詞釋義 9
第二章 文獻探討 12
第一節 兒童青少年憂鬱的內涵及其臨床特徵 12
第二節 兒童青少年憂鬱相關理論 31
第三節 兒童青少年憂鬱成因之探究 42
第四節 兒童青少年憂鬱之衡鑑 61
第三章 研究方法 68
第一節 研究架構 68
第二節 各子研究之研究實施 70
研究一 兒童青少年憂鬱症狀分析 70
研究二 兒童及青少年憂鬱篩選量表編製 81
研究三 憂鬱個案臨床特徵分析 91
第四章 研究結果與討論 95
第一節 國內兒童青少年憂鬱主要症狀 95
第二節 量表發展與題目分析 183
第三節 人口學變項在憂鬱分數上的差異 257
第四節 量表常模建立及應用 296
第五節 憂鬱個案的臨床特徵分析 338
第五章 結論與建議 366
第一節 結論 367
第二節 建議 377
參考文獻 385
中文部分 385
西文部分 391
附錄一 兒童青少年憂鬱疾患焦點訪談大綱（兒童青少年版） 410
附錄二 兒童青少年憂鬱疾患焦點訪談大綱（家長與教師版） 411
附錄三 兒童青少年憂鬱疾患焦點訪談大綱（醫生、心理師） 412
附錄四 統計程式 413
附錄五 兒童及青少年憂鬱篩選量表開放式問卷 414
附錄六 第二次德懷術問卷調查內容 416
附錄七 第三次德懷術問卷調查內容 419
附錄八 專家內容效度名單（依姓氏筆劃排列） 423
附錄九 編制兒童青少年憂鬱篩選量表雙向細目表 424
附錄十 臨床個案受試同意書 425
附錄十一 預試量表 426
附錄十二 正式量表 428

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