臺灣博碩士論文加值系統

本研究採用前瞻式逐日記錄的資料收集方式，探討婦女經前期之身心變化與其生活壓力感受的關聯。文獻資料顯示，5%至90%的婦女在經前期經驗嚴重程度不等之情緒低落、緊張焦慮、激躁不安、注意力無法集中、疲勞、食慾與睡眠改變，以及身體部位腫脹等症狀干擾。一般相信，荷爾蒙與神經內分泌物質的改變、人格特質、壓力因應能力，以及社會文化相關之態度與信念等多重變項，皆可能影響經前期的症狀表現。本研究以Rubinow（1989）提出之「經前症候群是一種狀態調節的疾病」的概念架構為基礎，並假設：月經週期性的身心變化，使一些易感性較高的婦女產生知覺、認知和情緒等各方面之狀態依賴的變化；反映在其對生活壓力的評估明顯改變，在經前期感受到更大的壓力。
本研究受試者為一般生育期婦女，排除目前懷孕、哺育、手術或長期服用藥物等情況。受試者在42天記錄期間逐日填答「經前症狀量表」與「生活壓力事件量表」。本研究篩選之症狀組，須符合DSM-Ⅳ「經前期心情沮喪疾患」之診斷準則，且其症狀嚴重度在經前期明顯大於經後期30％以上。本研究結果顯示：
（1） 在開始逐日記錄的前幾天，經前症狀與生活壓力得分傾向於顯著高於之後的其他日子。
（2） 在本研究年齡介於18至43歲的樣本中，受試者年齡越大，其經前症狀越嚴重。此外，受試者週期變動程度越大，其年齡越小、月經週期天數越長或是月經來潮持續天數越長。
（3） 不同教育背景的受試者，其經前症狀與生活壓力略有差異。專科生（護專生）之「身體部位腫脹敏感」症狀顯著高於研究生或大學生；而大學生之「疲倦/性慾改變」則顯著高於專科生。此外，研究生與大學生之「成就表現」壓力顯著高於專科生。
（4） 本研究估計經前症狀之盛行率為34.2％。
（5） 症狀組或非症狀組在經前期皆有部分症狀增加的現象，然而，只有症狀組在經前期有明顯大幅提升之情緒症狀（煩躁不安、沮喪鬱悶和對人不友善）。
（6） 症狀組在經前期感受到生活壓力增加，且以「一般人際衝突」的改變最為明顯。
最後，根據研究結果，本研究討論前瞻式逐日記錄之評量偏向效果、受試者特性的影響，以及「狀態依賴的變化」之假設概念在探討經前期變化的可行性，進一步提出未來的研究方向與可能的臨床應用。

Previous studies revealed that 5-90 % of women have more or less experienced premenstrual symptoms of low mood, tension, irritability, poor concentration, fatigues, changed appetite and sex drive, and physical discomforts. Hormonal fluctuations, per-sonality, stress-coping styles, and sociocultural factors are postulated to explain such a problem. As noted, psychological approach to Premenstrual Syndrome has been growing as an important area of research on women''s mental health. In attempting to verify the link of menstrual cycle with daily stress perception as well as physical and psychological symptoms, the present study, based on the presumption suggested by Rubinow (1989) that premenstrual syndrome is a disorder of state regulation, was thus designed with a prospective, daily rating manner.
In this study, 117 menstruating women recruited from various settings in Taipei Metropolitan completed Premenstrual Symptom Scale (PSS) and Life Stress Scale (LSS) at a daily rating basis in 42 consecutive days. Of 117 women, 34.2 % women (N = 40) were identified as PMS group and the rest as non-PMS group. The PMS group consists of those who not only met the DSM-IV diagnostic criteria of Premen-strual Dysphoric Disorder (DSM-IV) but also presented at least 30 % more symptoms at premenstrual phase in comparison to postmenstrual phase. MANOVA and t-test were utilized in data analyses. The results indicate that: 1) a significant drop of scores in daily rating approach was noted, in that scores of PSS and LSS were significantly greater in the first couples of days than of the following days; 2) age is positively cor-related with severity of premenstrual symptoms; 3) education level plays a role in experience of premenstrual symptom (on PSS) and daily stress perception on LSS, in that students from nursing college reported more “body swelling”, undergraduates more “fatigue-changed sexual drive”, and graduate and undergraduate students more “achievement-related stress”; 4) in terms of the relationship between symptom mani-festation and menstrual cycle, while both PMS and non-PMS groups reported signifi-cantly more PMS symptoms at premenstrual phase, only PMS group experienced mo-re negative affects at premenstrual phase; and 5) in terms of the relationship between daily stress perception and menstrual cycle, only PMS reported significantly more stress in general at premenstrual phase, and more “non-specific interpersonal con-flicts” in particular.
Results of the present study suggest a possible relationship among daily stress perception, premenstrual symptoms, and menstrual cycle. Utilization of prospective daily rating approach, screening procedure for potential PMS cases, and the concept of PMS as state-dependent changes are thus discussed. Implication for future research in this line and clinical applications are also suggested.

目 次
表目次iii
圖目次iv
中文摘要v
英文摘要vi
第一章 緒論1
第一節 經前症候群的定義1
第二節 經前症候群之流行病學研究4
壹、經前症候群之盛行率4
貳、經前症候群之嚴重程度與年齡的關係6
參、經前症候群與其他精神疾病的關係6
第三節 經前症候群之可能致病病因8
壹、生物層面病因9
貳、心理層面病因10
參、社會文化病因11
第四節 研究目的與假設12
第二章 量表編製與其相關研究15
第一節 量表編製15
壹、經前症狀量表的編製15
貳、生活壓力事件量表的編製17
第二節 量表特性與分量表之建立18
壹、經前症狀量表的特性與分量表19
貳、生活壓力事件量表的特性與分量表21
第三章 研究方法23
第一節 受試者23
第二節 測量工具24
壹、經前症狀量表25
貳、生活壓力事件量表25
第三節 研究程序26
壹、資料收集26
貳、干擾變項檢驗27
參、篩選症狀組29
肆、研究假設驗證29
第四章 研究結果31
第一節 前瞻式逐日記錄方式的得分偏向之檢驗31
壹、經前症狀31
貳、生活壓力32
第二節 開始記錄與月經來潮之星期日期分佈的檢驗33
第三節 受試者基本資料變項在量表得分上的差異比較33
壹、經前症狀33
貳、生活壓力35
第四節 症狀組之篩選結果35
第五節 症狀組與非症狀組之量表得分的差異比較37
壹、經前症狀37
貳、生活壓力37
第六節 在月經週期之不同時期的量表得分差異比較39
壹、全部有效樣本39
貳、症狀組40
第五章 討論42
第一節 前瞻式逐日記錄方式之評量偏向效果42
第二節 受試者基本資料變項與其量表得分的關係44
第三節 症狀組與非症狀組在量表得分的差異45
第四節 月經週期之不同時期的生活壓力感受的變化47
第五節 本研究之限制與未來改進的方向48
壹、受試樣本49
貳、測量工具50
參、研究程序51
第七節 本研究結果之應用53
參考文獻56
表61
圖91
附錄一 經前症狀量表101
附錄二 生活壓力事件量表102
附錄三 記錄紙103
附錄四 研究對象同意書與個人基本資料104
附錄五 經前症狀量表與生活壓力事件量表之答題情形106
附錄六 「平日之經前症狀嚴重度」與「症狀組之比例」112
附錄七 改善經前期症狀的方法113

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