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???org.dspace.app.webui.jsptag.ItemTag.dcfield??? | Value | Language |
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dc.contributor.advisor | 郭柏秀 | zh_TW |
dc.contributor.advisor | Po-Hsiu Kuo | en |
dc.contributor.author | 羅昭宜 | zh_TW |
dc.contributor.author | Chao-Yi Lo | en |
dc.date.accessioned | 2023-09-28T16:08:52Z | - |
dc.date.available | 2023-11-10 | - |
dc.date.copyright | 2023-09-28 | - |
dc.date.issued | 2023 | - |
dc.date.submitted | 2023-08-08 | - |
dc.identifier.citation | World Health, O., Guidance on ethical considerations in planning and reviewing research studies on sexual and reproductive health in adolescents.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90384 | - |
dc.description.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。 | zh_TW |
dc.description.abstract | 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. | en |
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dc.description.tableofcontents | Contents
口試委員會審定書 i 誌謝 ii 中文摘要 iii Abstract v Contents vii List of figures ix List of tables x List of supplements xi Chapter 1 Introduction 1 1.1 The epidemiology of adolescent internalizing and externalizing problems 1 1.2 Perceived stress in adolescents 2 1.3 Genetic vulnerability to internalizing and externalizing problems 3 1.4 Overview of resilience 4 1.5 Aims of this study 7 Chapter 2 Methods 8 2.1 Sample and procedure 8 2.2 Measures 9 2.2.1 Demographic variables 10 2.2.2 Child Behavioral Checklist for ages 4-18 (CBCL 4-18) 10 2.2.3 Perceived stress scale (PSS) 11 2.2.4 The Inventory of Adolescent Resilience (IAR) 12 2.3 Genotype data and quality control (QC) 12 2.3.1 DNA extraction 12 2.3.2 Genotyping and imputation 13 2.3.3 QC of post-imputation genotype data 14 2.4 Polygenic risk score (PRS) construction 15 2.5 Missing Data 16 2.6 Statistical Analysis 17 Chapter 3 Results 20 3.1 Sample characteristics 20 3.2 Main effects of PSS and resilience on internalizing and externalizing problems 22 3.3 Moderating effects of resilience on the associations between PSS and internalizing and externalizing problems 24 3.4 Main effects of PRS and resilience on internalizing and externalizing problems while considering PSS 24 3.5 Moderating effects of resilience on the associations between PRS and internalizing and externalizing problems 26 Chapter 4 Discussion 27 4.1 The proportion of internalizing and externalizing problems at T2 27 4.2 Prospective effect of PSS on internalizing and externalizing problems 29 4.3 Independent effect of genetic vulnerability on internalizing and externalizing problems 30 4.4 Specific effects of resilience dimensions on internalizing and externalizing problems 33 4.5 Strengths and limitations 38 Chapter 5 Conclusions 39 Reference 40 Figures and Tables 46 List of figures Figure 1. Study framework based on aims 46 Figure 2. Flow chart of the analytical sample 47 Figure 3. Flow chart of variant level-QC of target data 48 Figure 4. The proportions of students with internalizing problems and externalizing problems at T2 reported by parents 49 Figure 5. Forest plots for the effects of perceived stress at T1, perceived stress changing patterns, and resilience dimension on internalizing and externalizing problems at T2 50 List of tables Table 1-1 Characteristics of all students 53 Table 1-2. Distribution of demographic characteristics, perceived stress, and resilience for internalizing problems at T2 54 Table 1-3. Distribution of demographic characteristics, perceived stress, and resilience for externalizing problems at T2 56 Table 2-1. Associations between resilience dimensions, perceived stress levels at T1, and internalizing problems at T2 using multiple logistic regression 58 Table 2-2. Associations between resilience dimensions, perceived stress levels at T1, and externalizing problems at T2 using multiple logistic regression 59 Table 3-1. Associations between resilience dimensions, perceived stress changing patterns from T1 to T2, and internalizing problems at T2 using multiple logistic regression 60 Table 3-2. Associations between resilience dimensions, perceived stress changing patterns from T1 to T2, and externalizing problems at T2 using multiple logistic regression 61 Table 4-1. Associations between outcome-specific PRS, resilience dimensions, perceived stress levels at T1, and withdrawn problems at T2 using multiple logistic regression 62 Table 4-2. Associations between outcome-specific PRS, resilience dimensions, perceived stress levels at T1, and aggressive behavior at T2 using multiple logistic regression 63 List of supplements Supplementary figure 1. The proportions of students with internalizing problems and externalizing problems at T2 reported by parents of the normative data 52 Supplementary table 1-1. Main effects of resilience dimensions on internalizing and externalizing problems in the context of perceived stress 64 Supplementary table 1-2. Moderating effects of resilience dimensions on the associations between perceived stress and internalizing and externalizing problems 65 Supplementary table 2. Data patterns of the original cohort with 2 waves of survey 66 Supplementary table 3. Internal consistency reliability for resilience dimensions 67 Supplementary table 4. The sources of summary statistics used for constructing outcome-specific PRS in the present study 68 Supplementary table 5. The number of SNPs included at the best PRS threshold for all PRSs 69 Supplementary table 6. Correlation Matrix of the Resilience Dimensions 70 Supplementary table 7-1. Moderating effects of resilience dimensions on the association between perceived stress at T1 and internalizing problems at T2 71 Supplementary table 7-2. Moderating effects of resilience dimensions on the association between perceived stress changing patterns from T1 to T2 and internalizing problems at T2 72 Supplementary table 7-3. Moderating effects of resilience dimensions on the association between perceived stress changing patterns from T1 to T2 and externalizing problems at T2 73 Supplementary table 8. Associations between EAS Depression PRS, resilience dimensions, perceived stress levels at T1, and internalizing problems at T2 using multiple logistic regression 74 Supplementary table 9-1. Associations between outcome-specific PRS, resilience dimensions, perceived stress levels at T1, and internalizing problems at T2 using multiple logistic regression 75 Supplementary table 9-2. Associations between outcome-specific PRS, resilience dimensions, perceived stress levels at T1, and externalizing problems at T2 using multiple logistic regression 76 Supplementary table 10-1. Moderating effects of resilience dimension on the association between outcome-specific PRS and withdrawn problem at T2 77 Supplementary table 10-2. Moderating effect of resilience dimension on the association between outcome-specific PRS and aggressive behavior at T2 78 Supplementary table 11-1. Univariate associations between perceived stress from T1 to T2, resilience dimensions, and internalizing problems at T2 79 Supplementary table 11-2. Univariate associations between perceived stress from T1 to T2, resilience dimensions, and externalizing problems at T2 80 Supplementary table 12-1. Stratified analysis of resilience dimensions, perceived stress at T1, and withdrawn problem at T2 by genetic risk groups 81 Supplementary table 12-2. Stratified analysis of resilience dimensions, perceived stress at T1, and aggressive behavior at T2 by genetic risk groups 82 Supplementary table 13. Intraclass Correlation Coefficient (ICC) for resilience dimensions 83 | - |
dc.language.iso | en | - |
dc.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 | zh_TW |
dc.title | Evaluating the effects of individual vulnerabilities and resilience on adolescent internalizing and externalizing problems | en |
dc.type | Thesis | - |
dc.date.schoolyear | 111-2 | - |
dc.description.degree | 碩士 | - |
dc.contributor.oralexamcommittee | 馮嬿臻;張齡尹;楊浩然 | zh_TW |
dc.contributor.oralexamcommittee | Yen-Chen Feng;Ling-Yin Chang ;Hao-Jan Yang | en |
dc.subject.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, | zh_TW |
dc.subject.keyword | internalizing problems,externalizing problems,perceived stress,resilience dimensions,polygenic risk score,PRS,main effects, | en |
dc.relation.page | 83 | - |
dc.identifier.doi | 10.6342/NTU202303622 | - |
dc.rights.note | 同意授權(限校園內公開) | - |
dc.date.accepted | 2023-08-09 | - |
dc.contributor.author-college | 公共衛生學院 | - |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | - |
Appears in Collections: | 流行病學與預防醫學研究所 |
Files in This Item:
File | Size | Format | |
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ntu-111-2.pdf Restricted Access | 2.41 MB | Adobe PDF | View/Open |
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