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Title: | 評估個體易感受性和復原力 對於青少年內化及外化問題之效應 Evaluating the effects of individual vulnerabilities and resilience on adolescent internalizing and externalizing problems |
Authors: | 羅昭宜 Chao-Yi Lo |
Advisor: | 郭柏秀 Po-Hsiu Kuo |
Keyword: | 內化行為問題,外化行為問題,感知壓力,復原力,多基因風險分數,獨立效應, internalizing problems,externalizing problems,perceived stress,resilience dimensions,polygenic risk score,PRS,main effects, |
Publication Year : | 2023 |
Degree: | 碩士 |
Abstract: | 在青少年中,內化及外化問題相當普遍。日常生活中的感知壓力被視為個人風險因素,但現今研究少調查其隨時間變化所帶來之影響。而不同面向的復原力對內化及外化問題具潛在不同保護機轉。然而,在個體易感受性的情境下,包括由多基因風險分數(Polygenic risk score; PRS)所代表的遺傳脆弱性和感知壓力,探討復原力為情緒和行為問題之保護因子的研究相當稀缺。本研究旨在(1)探討感知壓力及其變化模式對於內化及外化問題的前瞻性效應,以及復原力維度對台灣青少年內化和外化問題的獨立(補償)和調節效應(2)探索遺傳脆弱性對感興趣內化及外化問題的影響,以及不同面向的復原力的補償和調節效應,並進一步考慮感知壓力的作用。
此縱貫性研究納入999名中小學生,其中 514 名參與者的基因型數據可用可用於構建感興趣結果的PRS,並使用追蹤時家長報告的行為和情緒結果(即內化和外化問題的兩個量尺,以及五個分量尺)、基線 (T1) 和追蹤 (T2) 時的感知壓力,以及復原力的資料。利用邏輯回歸模型來分析感知壓力、復原力維度、遺傳脆弱性和內化及外化問題之間的關聯。 我們發現約十分之一的學生存在內化(10.63%)或外化問題(10.03%)。 考慮到總復原力,基線的高感知壓力是追蹤時內化問題 (OR=3.03,P 值<0.0001) 的獨立風險因素,特別是對於分量尺的焦慮(OR=3.99,P 值<0.0001) 和退縮 (OR =2.34,P 值=0.0045)問題。與持續低感知壓力組相比,持續高感知壓力組顯著增加內化問題(OR=3.1-5.73)和外化問題(OR=2.63-4.71)的風險,除了攻擊行為以外。在考慮感知壓力或其變化模式,並調整共變量後,復原力的同理心和人際互動面向對退縮問題有顯著的保護作用(OR = 0.92),而較高的情緒調節對攻擊行為有顯著的保護作用(OR=0.81-0.82)。 在 PRS 分析中,考慮到復原力和感知壓力,具憂鬱(OR=2.12, P 值=0.0433)或內化問題(OR=3.49, P 值=0.002)高遺傳脆弱性顯著增加退縮問題的風險,而遺傳脆弱性與攻擊行為具正相關(OR=2.47, P 值=0.0249)。 較高的同理心和人際互動在考慮到遺傳脆弱性的情況下對退縮問題具顯著保護作用(OR=0.91-0.93),但進一步考慮到感知壓力,相關性便不顯著。而我們的研究不支持復原力的調節作用。 總結而說,高感知壓力及其持續性和遺傳脆弱性是內化及外化問題的個體風險因素,而在個體易感受性之情境下,復原力面向,包括同理心和人際互動,以及情緒調節,對內化及外化問題是重要保護因素。本研究發現對青少年情緒和行為問題的預防及介入具重要意義。 Internalizing and externalizing problems are prevalent among adolescents. Stress perceived from daily life as an individual risk factor, but limited literature investigates the influence of changing stress levels across time. Additionally, different aspects of resilience at individual level may underlie unique protective mechanisms for internalizing and externalizing problems. However, research exploring resilience as a protective factor within the context of individual vulnerabilities, including genetic vulnerability indicated by polygenic risk score (PRS) and perceived stress is scarce. This study aims to (1) examine the prospective effects of perceived stress and its changing patterns, as well as the main (i.e. compensatory) and moderating effects of resilience dimensions on internalizing and externalizing problems among Taiwanese adolescents, and (2) further explore the impact of genetic vulnerability, and the compensatory and moderating effects of resilience dimensions on outcomes of interest while considering perceived stress. We conducted a longitudinal study with 999 elementary and junior high-school students, of which genotype data of 514 participants were available for constructing PRS for the outcomes of interest. Data of parent-reported behavioral and emotional outcomes at follow-up (i.e., two broad-band and five narrow-band measures of internalizing and externalizing problems at T2), self-reported perceived stress at baseline (T1) and T2, and resilience data, were obtained from questionnaires. Logistic regression models were used to analyze the associations between perceived stress, resilience dimensions, genetic vulnerability, and the outcomes of interest. Around one-tenth of students had broad-band internalizing (10.63%) or externalizing problems (10.03%). High perceived stress at T1 was found to be an independent risk factor for broad-band internalizing problems at T2 (OR=3.03, P-value<0.0001), particularly for anxious (OR=3.99, P-value<0.0001) and withdrawn (OR=2.34, P-value=0.0045) problems in narrow-band. Persistent high perceived stress was associated with a significantly increased risk of all internalizing (OR=3.1-5.73) and externalizing problems (OR=2.63-4.71), except for aggressive behavior, compared to the persistent low perceived stress group. After accounting for perceived stress or its changing patterns with the adjustment of covariates, resilience dimensions of empathy and interpersonal interaction showed a significant protective effect on withdrawn problem (OR=0.92), while higher emotion regulation was significantly protective against aggressive behavior (OR=0.81-0.82). In PRS analysis, high genetic risk for depression (OR=2.12, P-value=0.0433) or internalizing problems (OR=3.49, P-value=0.002) was associated with an increased risk of withdrawn problem, and genetic vulnerability for aggression was associated with aggressive behavior (OR=2.47, P-value=0.0249) while considering resilience and perceived stress. Higher empathy and interpersonal interaction of resilience (OR=0.91-0.93) showed a protective effect on withdrawn problem, accounting for genetic vulnerability but diminished further considering perceived stress. The moderating effects of resilience were not supported in our study. Our findings suggest that high perceived stress and its persistency, as well as genetic vulnerability, are individual risk factors contributing to internalizing and externalizing problems, while dimensions of resilience, including empathy and interpersonal interaction, and emotional regulation, play important protective factors in these contexts. These findings have important implications for prevention and intervention strategies targeting emotional and behavioral problems among adolescents. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90384 |
DOI: | 10.6342/NTU202303622 |
Fulltext Rights: | 同意授權(限校園內公開) |
Appears in Collections: | 流行病學與預防醫學研究所 |
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