憂鬱之概念分析

Depression: A Concept Analysis

10.6142/VGHN.33.2.204

黃淑儀(Shu-Yi Huang)；宋惠娟(Huei-Chuan Sung)

憂鬱 ； 概念分析 ； 護理 ； depression ； concept analysis ； nursing

榮總護理

33卷2期（2016 / 06 / 01）

204 - 211

繁體中文

世界衛生組織(World Health Organization, WHO)指出，2020年憂鬱症將是造成人類失能(disability)的第二大原因，因而被稱為「二十一世紀的癌症」。美國國家心理衛生研究院(National Institute of Mental Health, NIMH)前主席Lewis Judd亦指出憂鬱症是新世紀的黑死病(depression as the plague of the modern era)。憂鬱症的病因包含生物性、心理性、社會性三個層面，據臨床上推論，憂鬱症是由腦中神經傳導物質，如血清素(serotonin)、正腎上腺素(norepinephrine)或多巴胺(dopamine)不平衡所造成，而生活壓力事件、體質的脆弱性、支持系統功能不彰及性格因素等皆扮演一定的角色。憂鬱症不僅提高社會經濟成本，人類痛苦的代價更是無法估計，嚴重憂鬱症可以摧毀一個家庭以及患者的生命。本篇文章依據Walker及Avant (2011)的概念分析法，界定憂鬱症的定義性特徵及其發生的前因後果，列舉典型案例、邊緣案例、相關案例及相反案例，並介紹多個具信效度的測量工具以提供醫護人員即早篩檢憂鬱，透過概念分析，可有助於專業人員更瞭解憂鬱的概念及臨床運用。

The World Health Organization started that depression will be the second major cause of human disability by 2020. This condition has thus been called ＂the cancer of the 21st century.＂ Lowis Judd, the former chairman of the National Institute of Mental Health, confirmed depression to be the plague of the modern era. The causes of depression include biological, psychological, and social factors. Clinical inferences have indicated that depression results mainly from imbalances among neurotransmitters in the human brain, such as serotonin, norepinephrine, and dopamine. Several factors, such as stressful life events, physical vulnerability, dysfunctional support systems and personality also play crucial roles. Depression involves not only social and economic costs but also causes tremendous human suffering. Serious depression can destroy a family as well as the lives of patients. Using the concept analysis (CA) method developed by Walker and Avant (2011), we defi ned the characteristics of depression and the causes and effects of its occurrence. Typical, marginal, relevant, and opposite cases were also described and analyzed. Several valid and reliable screening tools were introduced to help health professionals conduct early screenings for depression in clinical settings. This concept analysis may assist health professionals in improving their understanding of depression and clinical application.

1. 余民寧、黃馨瑩、劉育如(2010)。台灣憂鬱症量表心理計量特質分析報告。測驗學刊，58(3)，497-500。
   連結：
2. Kovacs, M. (1983). The Children's Depression Inventory: A self-rating depression scale for school-aged youngsters. Unpublished manuscript. (Available from Maria Kovacs, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15261).
3. Abramson, L. Y.,Seligman, M. E.,Teasdale, J. D.(1978).Learned helplessness in humans: Critique and reformulation.Journal of Abnormal Psychology,87(1),49-74.
4. American Psychiatric Association(2013).Diagnostic and statistical manual of mental disorders.Washington, DC:Author.
5. Bay, E.,Hagerty, B. M.,Williams, R. A.,Kirsch, N.,Gillespie, B.(2002).Chronic stress, sense of belonging, and depression among survivors of traumatic brain injury.Journal of Nursing Scholarship,34(3),221-226.
6. Beck, A. T.,Ward, C. H.,Mendelson, M.,Mock, J.,Erbaugh, J.(1961).An inventory for measuring depression.Archives of General Psychiatry,4,561-571.
7. Boelby, J.(1988).A secure base: Parent-child attachment and health human development.New York:Basic Books.
8. Cox, J. L.,Holden, J. M.,Sagovsky, R.(1987).Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale.The British Journal of Psychiatry,150(6),782-786.
9. Hamilton, M. A. X.(1967).Development of a rating scale for primary depressive illness.British Journal of Social and Clinical Psychology,6(4),278-296.
10. Lépine, J. P.,Briley, M.(2011).The increasing burden depression.Neuropsychiatric Disease Treatment,7(Suppl 1),3-7.
11. Longman group(1992).Longman dictionary of English language and culture.Britain:Suffolk.
12. Montgomery, S. A.,Asberg, M.(1979).A new depression scale designed to be sensitive to change.British Journal of Psychiatry,134(4),382-389.
13. Radloff, L. S.(1977).The CES-D scale: A selfreport depression scale for research in the general population.Applied Psychological Measurement,1(3),385-401.
14. Stansbury, K.,Gunnar, M. R.(1994).Adrenocortical activity and emotion regulation.Monographs of the Society for Research in Child Development,59(2-3),108-134.
15. Walker, L.,Avent, K.(2011).Strategies for theory construction in nursing.London:Applenton Lange.
16. Yesavage, J. A.,Sheikh, J. I.(1986).Geriatric depression scale (GDS): Recent evidence and development of a shorter version.Clinical Gerontology,5(1-2),165-173.
17. Zung, W. W.,Richards, C. B.,Short, M. J.(1965).Self-rating depression scale in an outpatient clinic: Further validation of the SDS.Archives of General Psychiatry,13(6),508-515.
18. 張芳杰編(2000)。國際英漢大辭典。台北市:遠東圖書。
19. 張春新(1989)。張氏心理學辭典。台北市:東華出版社。
20. 陳淑惠(2008)。台灣版兒童青少年憂鬱量表指導手冊。台北市:心理出版社。
21. 鄭泰安(2012)。近20 年台灣焦慮與憂鬱症盛行率倍增。當代醫學，40(2)，91-94。
22. 盧孟良、車先蕙、張尚文、沈武典(2002)。中文版貝克憂鬱量表第二版之信度和效度。台灣精神醫學，16(4)，301-310。

1. 陳淑女(2017)。乳癌婦女的睡眠障礙與焦慮、憂鬱症狀及生活品質相關因素之探討。義守大學醫務管理學系學位論文。2017。1-69。
2. 林淑芬(2017)。脊椎壓迫性骨折病人經皮穿刺椎體成形術後之健康相關生活品質探討。義守大學管理碩博士班學位論文。2017。1-84。
3. 林芷亘(2017)。晚期非小細胞肺癌病人於首療標靶藥物期間生活品質之縱貫性研究。長榮大學醫務管理學系(所)學位論文。2017。1-150。
4. 劉瑞靈(2018)。結直腸癌病人在化療期間症狀困擾、焦慮與憂鬱預測因子之探討。義守大學護理學系學位論文。2018。1-72。
5. 劉芝萓(2018)。支持性關懷對口腔癌病人接受治療後憂鬱情緒與社會互動之成效。義守大學護理學系學位論文。2018。1-115。