運動軌跡與憂鬱情緒軌跡之關係:13-22歲之性別比較

Abstract

目的:青少年心理健康問題日益嚴重，自殺已攀升至台灣15～24歲年輕族群第二大死因。另一方面，全球近八成的青少年運動不足，有運動習慣之比例在性別中的差距逐年擴大，台灣亦只有五分之一的學生有達到世界衛生組織建議量。過去研究發現運動與憂鬱為負相關，其中不論在運動還是憂鬱情緒皆有性別差異，然台灣尚缺乏青少年運動變化與憂鬱變化同時探討之雙軌跡研究。本研究旨在釐清13-22歲學生時期，不同性別之運動軌跡與憂鬱情緒軌跡的長期發展關係。 方法:採用「兒童與青少年行為之長期發展研究」(CABLE)第一世代進行次級資料分析。本研究使用2007年至2016年間之資料，即受訪者從國中一年級追蹤至大學四年級，共有1969人。以群體基礎軌跡模型分組，再使用多元羅吉斯迴歸分析，控制家庭支持、同儕支持、父母教育程度、自覺家庭經濟、身體意象、課業壓力、電視電玩超時與重大生活事件，探究不同性別中，運動軌跡與憂鬱情緒軌跡之關係。 結果:男生課外運動軌跡分成三組:持續高運動(45.69%)、運動下降(22.43%)、持續低運動(31.88%)；女生課外運動軌跡分成持續高運動(33.30%)、運動下降(15.90%)、持續低運動(50.80%)。男生憂鬱情緒分成四組持續低憂鬱(15.58%)、憂鬱偏低(36.55%)、中等憂鬱(38.53%)、持續高憂鬱(9.35%)；女生憂鬱情緒分成五組：持續低憂鬱(5.07%)、憂鬱偏低(36.18%)、中憂鬱緩升(35.09%)、高憂鬱下降(8.95%)、持續高憂鬱(14.71%)。而課外運動軌跡與憂鬱情緒軌跡之關係，男生屬於運動下降且中等憂鬱組的聯合機率最高，為19.40%，女生則是在持續低運動且中憂鬱緩升組的聯合機率最高，為21.00%。控制背景因素後，以持續低憂鬱組為參考組，男生在持續低運動組成為憂鬱偏低與持續高憂鬱組之風險顯著較高，勝算比分別為10.19和3.56，但運動下降成為持續高憂鬱組風險顯著較低，勝算比為0.33；女生在持續低運動組成為中憂鬱緩升和持續高憂鬱組之風險顯著較高，勝算比分別為2.25和4.23。整體而言，課外運動軌跡與憂鬱情緒軌跡呈現負向關係。 結論: 不論男女，持續低運動為較高憂鬱軌跡的危險因子，學校和家庭應維持青少年的規律運動習慣，並規劃女生合適、有興趣的運動活動。此外，建議對於強化運動之介入計畫，女生介入時機應比男生早，國中為關鍵期。

Objective: Adolescents’ mental health is declining, with suicide rising to the second leading cause of death among the 15-24 age group in Taiwan. On the other hand, nearly 80% of adolescents worldwide are insufficiently active, and the gap in exercise habits between genders is widening each year. In Taiwan, only one-fifth of students meet the World Health Organization's recommended levels of physical activity. Previous studies have found a negative correlation between exercise and depression, with gender differences present in both exercise and depressive moods. However, Taiwan lacks dual-trajectory studies that simultaneously explore changes in adolescent exercise and depression. This study aims to clarify the long-term developmental relationship between exercise trajectories and depressive mood trajectories among students aged 13-22, considering gender differences. Methods: This study conducts secondary data analysis using the first-generation data from the "Child and Adolescent Behavior Longitudinal Study" (CABLE). It employs data collected from 2007 to 2016, tracking participants from their first year of junior high school to their fourth year of university, with a total of 1,969 individuals. Group-based trajectory modeling was used to classify the trajectories, followed by multiple logistic regression analysis to control for family support, peer support, parental education level, perceived family economic status, body image, academic stress, excessive TV/video game usage, and life events, and to explore the relationship between exercise trajectories and depressive mood trajectories across different genders. Results: Boys' extracurricular exercise trajectories were divided into three groups: consistently high exercise (45.69%), declining exercise (22.43%), and consistently low exercise (31.88%). Girls' extracurricular exercise trajectories were divided into consistently high exercise (33.30%), declining exercise (15.90%), and consistently low exercise (50.80%). Boys' depressive moods were divided into four groups: consistently low depression (15.58%), low depression (36.55%), moderate depression (38.53%), and consistently high depression (9.35%). Girls' depressive moods were divided into five groups: consistently low depression (5.07%), low depression (36.18%), moderate depression with a slow increase (35.09%), high depression with a decline (8.95%), and consistently high depression (14.71%). Regarding the relationship between extracurricular exercise trajectories and depressive mood trajectories, boys had the highest joint probability in the declining exercise and moderate depression group at 19.40%, while girls had the highest joint probability in the consistently low exercise and moderate depression with a slow increase group at 21.00%. After controlling for background factors, using the consistently low depression group as the reference, boys in the consistently low exercise group had significantly higher risks of low depression and consistently high depression, with odds ratios of 10.19 and 3.56, respectively. However, declining exercise significantly reduced the risk of consistently high depression, with an odds ratio of 0.33. For girls, the consistently low exercise group had significantly higher risks of moderate depression with a slow increase and consistently high depression, with odds ratios of 2.25 and 4.23, respectively. Overall, extracurricular exercise trajectories and depressive mood trajectories showed a negative relationship. Conclusion: Regardless of gender, consistently low exercise is a risk factor for higher depressive mood trajectories. Therefore, it is important to encourage students to develop regular exercise habits early on. Additionally, it is recommended that intervention programs for strength training exercises or physical activity (PA) be initiated earlier for females than for males, as middle school represents a critical developmental period.