創傷後壓力症、憂鬱及網路成癮之共病模型：以無法忍受不確定性為中介變項

Abstract

經歷創傷事件者除了經常出現創傷後反應，亦可能進一步發展出創傷後壓力症（Posttraumatic Stress Disorder, PTSD），以及其他精神疾患的共病，如憂鬱症、物質成癮等。經驗到PTSD與其他疾病症狀之受創者，往往有較嚴重的心理困擾、較差的預後等，因此瞭解PTSD與其他疾病之間的共病機制，澄清其中的可能影響因子，進而研擬相關的介入方針，以提供倖存個體更適切的照護，在理論及臨床實務上皆有其重要性。本研究嘗試探索PTSD症狀、憂鬱症狀及網路成癮之間的共病關係，並且從創傷事件之重要特性之一──不確定性──出發，以無法忍受不確定性（intolerance of uncertainty, IU）此個人傾向為中介因子，探討其與前述變項之間的關聯。研究參與者為394位曾經歷創傷事件的成人，透過網路問卷進行收集資料，先檢驗並確立無法忍受不確定性量表的心理計量適切性與結構特性，然後，以結構方程模型、路徑分析驗證所有資料及不同性別之模型。研究結果指出，首先，無法忍受不確定性量表具有良好的心理計量特性，同時，雙因子模型（bifactor model）最適合用來表述之。接著，共病模型之分析結果發現模型適配良好，IU部分中介PTSD症狀至憂鬱症狀、完全中介PTSD症狀至網路成癮傾向；PTSD症狀愈嚴重，IU愈高，憂鬱症狀與網路成癮傾向皆愈嚴重。男性組中，憂鬱症狀正向影響網路成癮傾向，女性組中兩者則無顯著關聯。綜整結果顯示，無法忍受不確定性傾向可能是影響個體受創後發展出創傷、憂鬱、網路成癮之共病現象的影響因子；此模型有助於研究者與實務工作者瞭解創傷後的共病機制，並且為創傷治療提供不同的切入角度，以減輕受創者的心理困擾，增進其後續整體身心適應。

People who experienced traumatic events often display posttraumatic reactions, and may further develop posttraumatic stress disorder (PTSD), as well as other mental disorders, such as depression and addiction. Victims who have experienced symptoms of PTSD and other diseases often have more serious psychological distress and poor prognosis. Therefore, understanding the comorbidity mechanism between PTSD and other diseases, clarifying the possible influencing factors, and providing interventions with more appropriate care for surviving individuals are of great importance both in theory and clinical practice. This study aimed to explore the comorbid relationship among PTSD symptoms, depression symptoms and Internet addiction, starting from the perspective of uncertainty, one of the important characteristics of traumatic events, and taking intolerance of uncertainty (IU) as a mediator, which is a kind of individual tendency. Participants were 394 adults who had experienced traumatic events. Data were collected through online questionnaires. The psychometric properties and structure of the intolerance of uncertainty scale (IUS) were first examined and confirmed. Data were then analyzed by structural equation modeling and path analysis for different gender groups. Results indicate that, first, IUS had good psychometric properties, and bifactor model was the most suitable solution. Second, the analysis of comorbidity model showed a well-fit model, in that IU partially mediated the link from PTSD symptoms to depression symptoms, completely mediated the link from PTSD symptoms to Internet addiction. The more severe the PTSD symptoms, the higher the IU, and the more severe the depression symptoms and Internet addiction. For male group, depression symptoms positively predicted Internet addiction tendency, while for female group there was no significant association between them. In conclusion, IU may influence the development of comorbidity of PTSD, depression, and Internet addiction for traumatized individuals. This model may help researchers and practitioners to understand the comorbidities after traumatic events, and provides different perspectives for trauma therapy to reduce the psychological distress and improve mental health of the survivors.