探討社交焦慮發展軌跡對社會性時差之影響： 以憂鬱症狀為中介變項

Abstract

背景：社交焦慮對於健康的影響廣泛且深遠，是公共衛生領域重視的議題之一。社交焦慮患者睡眠問題可謂相當普及，對於他們而言，平日的社交活動及場合如同學間互動、上台報告等，將大幅增加他們的社交焦慮症狀，進而加重失眠和睡眠不足之問題。在長期睡眠不足和睡眠品質欠佳之下，睡眠債在無形之中累積，使得社交焦慮患者不得不利用休假日進行補眠，以代償身心疲勞感。週而复始的，形成社會性時差，對身心健康造成負面影響。據文獻回顧，過去並無學者分析橫跨兒童至大學時期社交焦慮之發展軌跡，且較少討論社交焦慮對於社會性時差之關係，以及憂鬱症狀在兩者之間的中介作用。

目的：本研究以成年早期之青壯年為研究對象，以長期追蹤資料進行次級資料分析，探討兒童至大學時期社交焦慮發展軌跡對於成年早期社會性時差之關係，以及憂鬱症狀在兩者之間是否扮演中介之角色。

方法：本研究運用「兒童與青少年行為之長期發展研究計劃」(簡稱CABLE計畫) 於2001年就讀國小一年級之第一世代，且以2001年至2016年有完整追蹤資料的學生為研究樣本。以SAS 9.4進行群組化軌跡模式，二元羅吉斯迴歸，以及中介分析作為主要統計方法。

結果：本研究發現五組社交焦慮發展軌跡，分別為低下降組 (49.16%)、中上升組 (21.23%)、中下降組 (16.92%)、高穩定組 (7.34%)、高上升組 (5.35%)。進一步探討社交焦慮發展軌跡與社會性時差的關係發現，「高穩定組」者比身為「低下降組」在社會性時差 (OR=1.62, p=0.06) 達統計上邊緣性差異。憂鬱症狀在社交焦慮軌跡 (即中上升組、中下降組和高上升組) 與社會性時差之間的關係具顯著中介效果 (p<0.05)。

結論：本研究發現兒童中期至成年早期的社交焦慮發展軌跡，大部分透過憂鬱症狀，進一步影響與社會性時差的關係。研究結果凸顯早期關注社交焦慮問題之重要性，並建議相關預防措施以促進成年早期之睡眠健康。最後，建議相關單位應納入憂鬱症狀作為研究或介入方案設計之考量。

Background Social anxiety and social jetlag are major public health concerns. However, research examining the developmental trajectories of social anxiety and their relation to social jetlag is still lacking. Given the high comorbidity of depressive symptoms among socially anxious people, it is conceivable that social anxiety is associated with social jetlag indirectly through depressive symptoms. This study investigated the relationship between social anxiety trajectories and social jetlag and the mediating role of depressive symptoms on such pathways.

Methods Data were from 1,253 participants from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) project across age 7 to age 22 in northern Taiwan. Group-based trajectory modeling, binary logistic regression, and mediation analyses were applied to examine distinct social anxiety trajectories from middle childhood to young adulthood and the association between these trajectory groups and social jetlag. Mediation analyses were conducted to understand the mediating role of depressive symptoms in such a relationship.

Results Participants exhibited five patterns of social anxiety trajectory, including “low stable” (49.16%), “moderate increasing” (21.23%), “moderate to low” (16.92%), “high stable” (7.34%), and “high increasing” (5.35%). Despite marginal significance, socially anxious individuals in the “high stable” group are more likely to develop social jetlag than those in the “low stable” group (OR=1.62, p=0.06). Depressive symptoms mediated the association between the “moderate increasing” (OR=1.06), “moderate to low” (OR=0.97), and “high increasing” (OR=1.05) social anxiety trajectories and social jetlag (p<0.05).

Conclusion This study found marginal significant results on higher social jetlag risk among individuals with highly stable social anxiety trajectories. Novel findings suggest depressive symptoms mediate the association between social anxiety trajectories and social jetlag, particularly the “moderate increasing”, “moderate to low” and “high increasing” patterns. These results emphasize the need for restraining the long-term effects of social anxiety and highlighting the role of social anxiety in sleep health promotion among young adults. The presence of depressive symptoms should be considered for future research and intervention designs.