13-22歲憂鬱情緒軌跡與社會因素之關係

Abstract

近年來，憂鬱已成為重要的公共心理衛生議題。根據世界衛生組織(WHO)的估算，全球約有10%~20%的兒童及青少年有心理方面疾病。然而，過去的研究大多為橫斷性研究，較少的研究在於探討童年的社經地位以及青少年時期的社會因素對於青少年及成年憂鬱的長期影響。本研究透過長期追蹤樣本，探討13-22歲之憂鬱情緒發展情形，以及13-22歲憂鬱情緒軌跡之社會因素。 本研究樣本採用「兒童與青少年行為之長期發展研究計畫(Child and Adolescent Behaviors in Long-term Evolution，簡稱CABLE)」，進行次級資料分析。採用2005年至2016年之部份資料，在去除遺失值後，最後納入2382位追蹤個案進行分析。本研究以群體基礎軌跡模型(Group-based trajectory model)進行憂鬱情緒軌跡分析，最後以多元邏輯思迴歸探討軌跡類型之影響因素。 本研究樣本之憂鬱情緒趨勢呈現先上升後下降之趨勢，並以18歲(2012年)為最高峰，兩性在統計上呈現不同的憂鬱情緒軌跡。就男性而言，憂鬱情緒軌跡可分為三組: 「輕微下降組」，「中等後期下降組」以及「中等且嚴重上升組」。就女性而言，憂鬱情緒軌跡可分為四組: 「輕微下降組」，「中等後期下降組」以及「中等且嚴重上升組」以及「持續嚴重組」。在影響因素方面，不論在男性還是女性樣本，父親教育程度、國中家庭支持、國中同儕支持、高中同儕支持以及國高中重大事件在統計上對13-22歲之憂鬱情緒軌跡均有顯著關係。 本研究結論13-22歲憂鬱情緒軌跡具有性別差異，女性之憂鬱情緒分數顯著高於男性，且國高中重大事件皆會影響13-22歲之憂鬱情緒軌跡。因此建議在制定或執行心理健康政策時，應將性別差異納入考量，並加強對於壓力適應技巧之教學。

In recent years, depression has become an important public mental health issue. According to the World Health organization (WHO), about 10% to 20% of children and adolescents around the world have mental illness. However, most of studies used cross-sectional analysis, few studies explored the long-term effects of childhood socioeconomic status and social determinants of depression from adolescence to young adulthood. This study aimed to investigate the development of depressive mood in 13-22 years of age, and the social factors of the trajectory of their depressive mood with a cohort sample in Taiwan. Data used in this study were obtained from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) study. A total of 2382 participants were included in the analysis. Group-based trajectory model were used to analyze the depressive mood trajectory and the multinomial logistic regression was to explore the associated factors of the depressive mood trajectory. The trajectory of depressive mood in this study showed an inverse-u shape, while it reached its peak when the sample was 18 years old. In the male sample, the trajectory of depressive mood can be divided into three groups: a slight decline, a moderate to late decline, and a moderate and severe rise. Among female, the trajectory of depressive mood can be divided into four groups: a slight decline, a moderate to late decline group, a moderate and severely elevated group, as well as a persistent severe group. In both male and female samples, father education, family support in the middle school, family support in high school, support from colleagues in the middle school, support from high school colleagues, and negative life events in the high school are associated with the trajectory of depressive mood. This study indicated the trajectory of depressive mood in 13-22 years had gender differences. The trajectory of depressive mood in females is significantly higher than that in males, and negative life events in the high school affect the trajectory of depressive mood in 13-22 years. Therefore, when formulating or implementing mental health policies, gender differences should be taken into account and strengthen the teaching of stress coping skills.