台灣九二一地震災難暴露對青少年創傷後壓力反應及社會關係的影響之性別差異

Gender-Distinct Effects of Trauma Exposure on Posttraumatic Stress Reactions and Social Relations in Adolescents Following the 921 Chi-Chi Earthquake in Taiwan

10.6129/CJP.2008.5004.03

吳治勳(Chih-Hsun Wu)；陳淑惠(Sue-Huei Chen)；翁儷禎(Li-Jen Weng)；吳英璋(Yin-Chang Wu)

台灣九二一地震 ； 災難暴露 ； 性別差異 ； 社會關係 ； 創傷後壓力反應 ； gender difference ； PTSD symptoms ； social relation ； Taiwan 921 Earthquake ； trauma exposure

中華心理學刊

50卷4期（2008 / 12 / 01）

367 - 381

繁體中文

本研究提出「地震暴露－社會關係－創傷後壓力反應」(ESP)假設模式，目的在探討台灣九二一地震一年後，受創區的青少年暴露於災難下的經驗，如何影響其創傷後壓力反應以及社會關係，並試圖以性別差異為切入點來呈現此一歷程。本研究採用青少年地震暴露指標量表、UCLA PTSD量表以及台灣兒童及青少年關係量表，訪問震災受創區的青少年共871人。將研究參與者區分為男生(n=450)和女生(n=421)兩組，分別利用結構方程式進行模式檢驗和估計。結果發現，ESP模式能適當的解釋所觀察到的現象。客觀暴露程度越嚴重者，感受到的主觀威脅程度及傷害性社會關係越強，而傷害性社會關係對創傷後壓力反應的影響非常顯著。性別差異尤其彰顯於客觀地震暴露程度對男生之創傷後壓力反應有直接顯著的影響，而主觀威脅程度則對女生的創傷後壓力反應有直接顯著的影響。研究結果建議，在協助面臨災後壓力相關問題的青少年時，應注意性別差異的影響，且應將重點放在協助改善傷害性的社會關係上。

The Earthquake Exposure-Social Relations-Posttraumatic Stress (ESP) model was proposed to clarify the relations among trauma exposure (objective and subjective), social relations (supportive and detrimental), and posttraumatic stress responses. This study recruited the adolescents who had been exposed to a large-scale natural disaster, the Taiwan 921 Chi-Chi Earthquake. Gender-distinct effects of trauma exposure on social relations and PTSD severity were evaluated using the ESP model. The Earthquake Exposure Index for Youth, UCLA-PTSD Index, and Taiwan Relationship Inventory for Children and Adolescents were given to 871 adolescents living in the epicenter one year after the earthquake. The ESP model was evaluated and cross-validated by structure equation modeling (SEM) method using the data of both boys (n=450) and girls (n=421) separately. Results showed that the ESP model had good overall-fit for both genders. The subjective exposure had significantly greater positive effects on supportive social relations, and objective exposure had greater positive effects on detrimental social relations (especially for girls). Both supportive and detrimental social relations had significantly greater positive effects on PTSD severity. Specifically, the more supportive and/or detrimental social relations the individual perceived, the greater their PTSD severity. The effects of detrimental social relation were relatively larger. Gender difference was found in the paths linking exposure and PTSD severity. While objective exposure had direct positive effects on PTSD severity for boys, subjective exposure had direct positive effects on PTSD severity for girls. These findings pointed out the importance to discriminate between subjective and objective exposure as well as between supportive and detrimental social relations for studying their relations to posttraumatic stress responses. It also suggested that, in helping adolescents exposed to trauma, we should take gender into consideration, and it may be more crucial to deal with detrimental social relations for posttraumatic adjustment.

1. 吳治勳、吳英璋、許文耀、蕭仁釗(2008)。台灣兒童及青少年關係量表(TRICA)之編製和心理計量特性研究。測驗學刊
   連結：
2. 林耀盛、陳淑惠、洪福建、曾旭民(2005)。差異的聲音：不同性別震災受創者心理社會反應之比較分析。臨床心理學刊，2，31-40。
   連結：
3. 許文耀(2003)。資源流失、因應、社會支持與九二一地震災民的心理症狀之關係。中華心理學刊，45，263-277。
   連結：
4. Allen, J. G.(2001).Traumatic Relationships and Serious Mental Disorders.NY:Wiley.
5. American Psychiatric Association(1994).Diagnostic and statistical manual of mental disorders.Washington, DC:APA.
6. Andrews, B.,Brewin, C. R.,Rose, S.(2003).Gender, social support and PTSD in victims of violent crime.Journal of Traumatic Stress,16,421-427.
7. Barrera, M.(1986).Distinctions between social support concepts, measures, and models.American Journal of Community Psychology,14,413-445.
8. Bollen, K. A.,Long, J. S. (Eds.)(1993).Testing structural equation models.Newbury Park, CA:Sage.
9. Brewin, C. R.,Andrews, B.,Valentine, J. D.(2000).Meta-analysis of risk factors for post-traumatic stress disorder in trauma exposed adults.Journal of Consulting and Clinical Psychology,68,748-766.
10. Chao, C. C.,Wu Y. Y.,Loh, C. H.,Liao, W. I. (Eds.)(2000).Preliminary report of post-traumatic stress reactions in child survivors after the Chi-Chi earthquake.Proceedings of International Workshop on Annual Commemoration of Chi-Chi Earthquake: Vol IV Social Aspect.
11. Chen, S. H.,Hung, F. C.,Lin, Y. S.,Tseng, H. M.,C. H. Loh,W. I. Liao (Eds.)(2000).Lessons from the 921 Earthquake: Trauma, psychosocial reactions, and psychological growth.Proceedings of International Workshop on Annual Commemoration of Chi-Chi Earthquake: Vol IV Social Aspect.
12. Chen, S. H.,Lin, Y. H.,Tseng, H. M.,Wu, Y. C.(2002).Posttraumatic Stress Reactions in Children and Adolescents One Year after the 1999 Taiwan Chi-Chi Earthquake.Journal of the Chinese Institute of Engineers,25,597-609.
13. Chen, S. H.,Wu. Y. C.(2006).Changes of PTSD symptoms and school reconstruction: A two-year prospective study of children and adolescents after the Taiwan 921 Earthquake.Natural Hazards,37,225-244.
14. Cutrona, C. E.,Russell, D. W.,B. R. Sarason,I. G. Sarason,G. R. Pierce (Eds.)(1990).Social Support: An Interactional View.NY:Wiley.
15. Foa, E. B.,Ehlers, A.,Clark, D. M.,Tolin, D. F.,Orsillo, S. M.(1999).The posttraumatic cognitions inventory (PTCI): Development and validation.Psychological Assessment,11,303-314.
16. Green, B. L.,Koro, M.,Grace, M.C.,Vary, M. G.,Leonard, A. C.,Gleser, G. C.,Cohen, S. S.(1991).Children and disaster: Age, gender, and parental effects on PTSD symptoms.Journal of American Academy of Child and Adolescent Psychiatry,30,945-951.
17. Hobfall, S. E.,Stephens, M. A. P.,B. R. Sarason,I. G. Sarason,G. R. Pierce (Eds.)(1990).Social Support: An Interactional View.NY:Wiley.
18. Hu, L. T.,Bentler, P. M.(1999).Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.Structural Equation Modeling,6,1-55.
19. Kline, R. B.(2005).Principles and practice of structural equation modeling.NY:the Guilford Press.
20. La Greca, A.,Silverman, W.,Vernberg, E.,Prinstein, M.(1996).Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study.Journal of Consulting and Clinical Psychology,64,712-723.
21. Mueser, K. T.,Goodman, L. B.,Trumbetta, S. L.,Rosenberg, S. D.,Osher, F. C.,Vidaver, R.(1998).Trauma and posttraumatic stress disorder in sever mental illness.Journal of Consulting and Clinical Psychology,66,493-499.
22. Nader, K.,Pynoos, R.,Fairbanks, L.,Frederick, C.(1990).Children`s PTSD reactions one year after a sniper attack at their school.American Journal of Psychiatry,147,1526-1530.
23. National Alliance for Post-Earthquake Reconstruction(2000).Q and A: Post 921 Earthquake Reconstruction/ Q and A: Post 921 Rehabilitation 1.Taipei, Taiwan:National Alliance for Post-Earthquake Reconstruction.
24. Neria, Y.,Bromet, E. J.,Sievers, S.(2002).Trauma exposure and post-traumatic stress disorder in psychosis: Findings from a first-admission cohort.Journal of Consulting and Clinical Psychology,70,246-251.
25. Norris, F. H.,Foster, J. D.,Weisshar, D. L.,R. Kimerling,P. Ouimette,J. Wolfe (Eds.)(2002).Gender and PTSD.New York:Guilford Press.
26. Norris, F. H.,Kaniasty, K.(1996).Received and perceived social support in times of stress: A test of the social support deterioration deterrence model.Journal of Personality and Social Psychology,71,498-511.
27. Ozer, E. J.,Best, S. R.,Lipsey, T. L.,Weiss, D. S.(2003).Predictors of posttraumatic stress disorder and symptoms in adults: A meta analysis.Psychological Bulletin,129,52-73.
28. Pynoos, R.,Frederick, C.,Nader, K.,Arroyo, W.,Steinberg, A.,Eth, S.(1987).Life threat and posttraumatic stress in school-age children.Archive of General Psychiatry,44,1057-1063.
29. Pynoos, R.,Goenjian, A.,Tashjian, M.,Karakashian, M.,Manjikian, R.,Manoukian, G.(1993).Post-traumatic stress reactions in children after the 1988 Armenian earthquake.British Journal of Psychiatry,163,239-247.
30. Pynoos, R.,Rodriguez, N.,Steinberg, A.,Stuber, M.,Frederick, C.(1998).The UCLA PTSD reaction index for DSM IV.Los Angeles:UCLA Trauma Psychiatry Program.
31. Pynoos, R.,Steinberg, A.,Wraith, R.,D. Cicchetti,D. J. Cohen. (Eds.)(1995).Developmental Psychopathology.NY:John Wiley & Sons, Inc..
32. Rook, K. S.(1984).The negative side of social interaction: Impact on psychological well-being.Journal of Personality and Social Psychology,46,1097-1108.
33. Rook, K. S.,B. H. Spitzberg,W. R. Cupach (Eds.)(1998).The dark side of close relationships.Mahwah, NJ:Erlbaum.
34. Sarason, B. R.,Shearin, E. N.,Pierce, G. R.,Sarason, I. G.(1987).Social support as an individual difference variable: Its stability, origins and relational aspects.Journal of Personality and Social Psychology,49,469-480.
35. Schuster, T. L.,Kessler, R. C.,Aseltine, R. H.(1990).Supportive interactions, negative interactions, and depressed mood.American Journal of Community Psychology,18,423-438.
36. Silver, R. C.,Wortman, C. B.,Crofton, C.,B. R. Sarason,I. G. Sarason,G. R. Pierce (Eds.)(1990).Social support: An interactional view.NY:Wiley.
37. Soong, W. T.,Lee, Y. C.,Huang, R. R.,Liu, Y. S.,Yu, W. C.,Chen, Y. S.,C. H. Loh,W. I. Liao (Ed.)(2000).A comparative study of post-traumatic symptoms between students living at Yu-Chih and relocation to Kaohsiung after the Chi-Chi earthquake.Proceedings of International Workshop on Annual Commemoration of Chi-Chi Earthquake: Vol IV Social Aspect.
38. Taylor, S. E.(2003).Health Psychology.NY:McGraw-Hill.
39. Tolin, D. F.,Foa, E. B.(2006).Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research.Psychological Bulletin,132,959-992.
40. Tolin, D. F.,Foa, E. B.,R. Kimerling,P. Ouimette,J. Wolfe (Eds.)(2002).Gender and PTSD.New York:Guilford Press.
41. Vernberg, E. M.,La Greca, A. M.,Silverman, W. K.,Prinstein M. J.(1996).Prediction of posttraumatic stress symptoms in children after hurricane Andrew.Journal of Abnormal Psychology,105,237-248.
42. Wu, Y. C.,Hung, F. C.,Chen, S. H.(2002)."Change or Not" is the question: The meaning of posttraumatic stress reactions one year after the Taiwan Chi-Chi Earthquake.Journal of the Chinese Institute of Engineers,25,611-620.
43. Zautra, A. J.,Burleson, M. H.,Matt, K. S.,Roth, S.,Burrows, L.(1994).Interpersonal stress, depression, and disease activity in rheumatoid arthritis and osteoarthritis patients.Health Psychology,13,139-148.
44. Zlotnick, C.,Warshaw, M.,Shea, M. T.,Keller, M. B.(1997).Trauma and chronic depression among patients with anxiety disorders.Journal of Consulting and Clinical Psychology,65,333-336.
45. 洪福建(2003)。博士論文(博士論文)。國立台灣大學心理學研究所。
46. 許文耀(2000)。921地震災區學生的因應型態與心理症狀的關係。中華心理衛生學刊，13，35-39。

1. 賴彥合,張子健(2021)。通訊心理諮商應用於災難與創傷治療。諮商與輔導，421，29-32。
2. 劉季宇、詹忠翰、葉錦勳、張宜君、胡伯維、林冠慧、林宗弘(2017)。地震、屋毀與傷亡：集集地震風險的因果分析。都市與計劃，44(1)，83-112。
3. 劉志如,游雅婷,王沂釗(2023)。COVID-19事件下，社會支持、創傷後壓力症狀、創傷後成長與心理健康的關係。輔導與諮商學報，45(2)，67-101。
4. 張維真、林耀盛(2017)。八八水患災後心理療癒：排灣族受災者存有經驗的現象探索。哲學與文化，44(8)，85-102。
5. 鄭淑利,葉翠玉,孫慧芳,周雨青(2016)。軍校生心理健康與適應狀態於性別因素之探討。源遠護理，10(1)，34-44。
6. (2016)。「救急」的媒介溝通效果：以災難新聞為例。傳播與社會學刊，38，37-82。