台灣青少年憂鬱的性別特定模式之前瞻式研究： 憂鬱與壓力、自我掌控信念、反芻風格之關聯

Abstract

前言：憂鬱疾患的性別差異於 12 至 15 歲青少年時期產生變化，過去研究指 出壓力事件、自我掌控信念、憂鬱反芻於此差異中扮演重要的角色；卻少有研究 做整合性的分析與模式的建立。本研究除了分析上述變項各自的性別差異外，亦 藉由壓力歷程模式統整變項，模式中壓力歷程被剖析為主要壓力、調節資源，和 心理健康結果－憂鬱。於研究中，主要壓力分為人際/非人際壓力，調節資源包 括了自我掌控信念與憂鬱反芻，其中憂鬱反芻又分為苦惱自責式/深思反省式反 芻。探討不同類型的壓力、調節資源會如何互動、影響不同性別青少年的憂鬱症 狀為本研究重點。目的：藉由整合影響憂鬱性別差異的重要變項，了解男女憂鬱 背後各自的認知機制，除了進一步推論憂鬱者與非憂鬱者之差別外，亦可藉此思 索未來臨床的介入途徑。方法：研究一和研究二共採用 466 名國中生為樣本，旨 在建立中文版自我掌控信念量表修訂版和台灣版兒童青少年憂鬱量表第二版的 心理計量特性與因素結構。研究三採用 399 名國中生為樣本，以驗證本研究由壓 力歷程模式延伸的青少年憂鬱之性別特定模式，初探男女各自在人際/非人際壓 力、深思反省/苦惱自責式反芻、自我掌控信念彼此的關聯與其對憂鬱症狀之影 響。結果：（1）中文自我掌控信念量表修訂版和台灣版兒童青少年憂鬱量表第二 版具有良好的心理計量特性，且兩者呈顯著負相關。（2）女生在非人際壓力、苦 惱自責/深思反省反芻、憂鬱症狀均顯著高於男生；人際壓力和自我掌控信念未 有差異。（3）女生的苦惱自責式反芻顯著預測憂鬱症狀；不論男女，深思反省式 反芻對憂鬱症狀雖未達顯著但有正面效益。（4）不論男女，自我掌控信念均顯著 預測憂鬱症狀，掌控感越高，憂鬱症狀越下降。（5）面對壓力時，困擾程度影響 女生反芻策略的選擇，困擾程度越高，會同時使用苦惱自責/深思反省反芻；壓 力類型影響男生反芻策略的選擇，人際壓力預測苦惱自責式反芻的頻率，非人際 壓力預測深思反省式反芻的頻率。討論：最後比對憂鬱性別特定模式與Nolen-Hoeksema 等人（1999）提出的性別差異假說，整合其支持與未支持部分。 接著，說明研究結果在臨床應用上的啟示，與未來可行的實行治療與研究方向。

Introduction: Change of gender differences of depression arises prominently in adolescents from 12-15 years old. Previous research points out that stressors, mastery, and rumination play important roles in this phenomenon; but few studies try to integrate the relationship among above-mentioned variables and build a concrete model. The present study will not only analyze gender differences in stressors, mastery, rumination and depression symptoms, but also integrate these variables into a stress process model. The stress process model used to dissect stress into three categories including primary stressors, moderating resources and mental health outcomes—depression. In present study, primary stressors will be divided into interpersonal and non-interpersonal categories; moderating resources include mastery and rumination, which will be divided into brooding and reflection. The study will focus on exploring the interplay between different types of stressors and moderating resources, and examining how they will affect adolescents’ depression symptoms. Purpose: By integrating above-mentioned variables that play important roles in affecting the gender difference of depression, the present study aims to understand the mechanisms behind depression of boys and girls. It may help further infer the difference between depressed and non-depressed persons, and as a springboard, may then help to develop adequate clinical intervention. Method: Study 1 and Study 2 examined psychometric properties of the Mastery Scale Chinese version (MS-C) and Children’s Depression Inventory 2 nd Inventory_Taiwan Version (CDI2_TW) with a sample of 466 junior high school students. Study 3 examined the relationships among stress (i.e., interpersonal/non-interpersonal stressors), rumination (brooding/reflection), mastery and depression symptoms in different gender to validate the Gender-Differentiated Model of Depression which was developed from stress process model. Results: The results indicate that: (1) The MS-C and CDI2_TW yielded good psychometric properties. Moreover, the MS-C scores correlated significantly and negatively with CDI2_TW. (2) Girls’ non-interpersonal stressor, brooding/reflection rumination, depression symptoms were significantly higher than boys’, but there was no significant difference in interpersonal stressor and mastery. (3) Girls’ brooding rumination significantly predicted depression symptoms. Regardless of gender, reflection rumination negatively but not significantly predicted depression symptoms. (4) Regardless of gender, mastery significantly negatively predicted depression symptoms. (5) If the stressor was more annoyed, girls would simultaneously use brooding/reflection rumination in response to stress; and boys would take different types of rumination to cope with stress dependent on the types of stressors, i.e., coping with interpersonal stress by brooding rumination. Discussion: Based on the above findings, the Gender-Differentiated Model of Depression will be compared to Nolen-Hoeksema et al’s gender different hypothesis. Possible applications and future directions are also addressed.