社區精神病人網路遊戲成癮、經驗網路霸凌、與失眠之相關以及焦慮扮演的中介角色

Abstract

中文摘要 背 景: 研究指出患有精神障礙病人的網路使用率並不低於一般人，而隨著網路使用項目的多元，網路遊戲成癮也成為當前要研究的主題，近年的研究發現，對於人們的生理、心理上都帶來了負面影響，尤其是在睡眠及網路互動上的網路霸凌議題，在青少年及兒童族群的研究上有日漸嚴重的趨勢，許多的研究都顯示已是刻不容緩要關切的現象，然而較少關注於相較已是脆弱族群的精神疾患病人進行探討。 目 的: 本研究探討社區精神病病人網路遊戲成癮現況，經驗網路霸凌、與失眠之相關性，並分析焦慮在其中扮演的中介角色。 方 法: 本研究採橫斷式描述性相關設計(cross-section correlation study)，以北部某醫學中心精神科門診之青壯年患者，以18歲以上至40歲為對象，診斷涵蓋思覺失調症、雙相情緒障礙症、憂鬱症為研究對象，採立意取樣並透過結構式問卷收集110份有效樣本，工具包括自擬問卷「基本資料量表」、「中文版網路遊戲成癮量表」「中文版手機遊戲成癮量表（短版）」、「社群網站網路霸凌和網路攻擊辨識量表: 網路霸凌和網路攻擊受害者辨識」、「中文版失眠嚴重度量表」、「廣泛性焦慮症量表(GAD-7)」。資料以SPSS 29.0 for windows版本統計套裝軟體進行資料分析，根據本研究變項性質及目的進行分析。 結 果: 本研究收案共110位社區精神病患病人，年齡為18-40歲青壯年人口，其網路遊戲成癮比例佔20.9%，手機遊戲成癮比例佔10.9%、遭受網路受害的比例言語霸凌佔13.6%、霸凌關係佔10.9%、影像佔4.5%，而失眠比例高達 55.5%，焦慮嚴重度比例占50.9%，皆是超過半數，在控制主要變項:宗教、不同診斷別、每日上網時數後，多元迴歸結果發現每日上網時數、網路遊戲成癮可達顯著預測睡眠障礙嚴重程度，而診斷別、宗教信仰、手機遊戲成癮、網路霸凌關係行為則無達到顯著水準；在中介路徑中發現焦慮在網路遊戲成癮及失眠之間起中介作用，表示網路遊戲成癮會透過焦慮增加了失眠的風險和嚴重程度.檢視手機遊戲成癮透過焦慮影響失眠嚴重度、或是網路遊戲及手機遊戲成癮會經由經驗網路霸凌而造成失眠則無見中介效果。 結 論: 社區精神病人影響失眠的主要因素為網路使用時間長和網路遊戲成癮程度，且網路遊戲成癮也會透過焦慮影響失眠。社區精神疾患本身因為疾病的脆弱性、社交需求可能導致在虛擬網路世界中使用時間過長，進而發展出新的互動產生焦慮問題，或延伸出其他的傷害，研究發現因為網路霸凌的社交創傷直接對睡眠系統造成衝擊，可能具有直接的生理影響。建議在評估社區精神病人的失眠問題或病史時，網路使用習慣及成癮項目都應列為評估指標之一，盡早處理焦慮問題以減緩成癮及失眠問題的困擾。 關鍵字：網路遊戲成癮、網路霸凌、失眠、焦慮、社區精神病人

Abstract Background: Research indicates that internet usage among patients with psychiatric disorders is as prevalent as in the general population. With the diversification of online activities, Internet Gaming Disorder (IGD) has emerged as a critical research topic. Recent studies have highlighted its negative impacts on physical and psychological health, particularly regarding insomnia and cyberbullying. While research on cyberbullying has increased among children and adolescents, there remains a significant gap in understanding this phenomenon among the vulnerable population of adult psychiatric patients. Objectives: This study aims to explore the current status of IGD, experiences of cyberbullying, and insomnia among community psychiatric patients, and to analyze the mediating role of anxiety in these relationships. Methods: A cross-sectional correlational design was employed. Using purposeful sampling, 110 valid samples were collected from young adult outpatients (aged 18–40) at a psychiatric department of a medical center in Northern Taiwan. The sample included individuals diagnosed with schizophrenia, bipolar disorder, and depressive disorder. Data were collected via structured questionnaires, including a Demographic Scale, the Chinese version of the Internet Gaming Disorder Scale, the Mobile Gaming Addiction Scale (Short Form), the Cyberbullying and Cyber-aggression Identification Scale, the Insomnia Severity Index (ISI), and the Generalized Anxiety Disorder Scale (GAD-7). Statistical analysis was performed using SPSS 29.0. Results: The study enrolled 110 community psychiatric patients aged 18–40 years. The prevalence rates were 20.9% for Internet Gaming Disorder (IGD) and 10.9% for mobile gaming addiction. Regarding cyber-victimization, verbal bullying was the most frequent (13.6%), followed by relational bullying (10.9%) and visual bullying (4.5%). Notably, more than half of the participants suffered from insomnia (55.5%) and significant anxiety (50.9%). After controlling for major covariates—including religion, psychiatric diagnosis, and daily internet usage—multiple regression analysis revealed that daily internet hours and IGD severity were significant predictors of insomnia severity. In contrast, diagnosis, religious beliefs, mobile gaming addiction, and relational cyberbullying did not reach statistical significance. Mediation analysis further confirmed that anxiety plays a significant mediating role between IGD and insomnia, indicating that IGD elevates the risk and severity of insomnia through the pathway of anxiety. No significant mediating effects of anxiety were found for mobile gaming addiction, nor did cyberbullying mediate the relationship between gaming addiction and insomnia. Conclusion: The primary factors driving insomnia among community psychiatric patients are prolonged internet usage and the severity of IGD, with IGD also exerting an indirect effect on sleep through anxiety. Due to their inherent vulnerability and unmet social needs, individuals with psychiatric disorders may spend excessive time in virtual environments, leading to interaction-based anxiety or further digital harms. This study highlights that social trauma from cyberbullying directly impacts the sleep system, potentially exerting immediate physiological disruptions. It is recommended that clinical assessments for insomnia or psychiatric history include internet usage habits and addiction severity as key indicators. Early intervention targeting anxiety is essential to mitigate the cycle of addiction and sleep disturbances. Keywords: Internet Gaming Disorder, Cyberbullying, Insomnia, Anxiety, common mental disorders