青少年憂鬱情緒與多元風險因子：個別效果與累積效果的驗證

Adolescent Depressive Mood and Multiple Risk Factors: A Test of Individual and Cumulative Effects

10.30074/FJMH.201409_27(3).0001

黃昱得(Yu-Te Huang)

憂鬱情緒 ； 風險因子 ； 個別效果 ； 累積效果 ； 累積風險指數 ； depressive mood ； risk factors ； individual effect ； cumulative effect ； cumulative risk index

中華心理衛生學刊

27卷3期（2014 / 09 / 01）

327 - 355

繁體中文

研究目的：根據生態系統理論，青少年憂鬱情緒的風險因子多方面地散佈在環境中。過去的文獻除了探討個別風險因子對憂鬱情緒的解釋力外，也以累積風險指標來探究累積效果以及扣板機效應。本研究以性別、家庭經濟壓力、親子衝突、負向同儕關係以及學業期望壓力作為憂鬱情緒的風險因子，除檢視個別效果外，也以累積風險指標來驗證累積效果。研究方法：本研究對象為台灣地區就讀於高中、高職、五專一至三年級、18歲以下的青少年。經多階段叢集抽樣後，共有1,307位青少年參與團體問卷施測。考量資料的完整性，故僅針對填答完整者（N=1,196），以交叉表分析、單因子變異數分析、趨勢分析、多元邏輯迴歸及多元線性迴歸來驗證研究假設。研究結果：多元線性迴歸分析指出家庭經濟壓力、親子衝突、負向同儕關係以及學業期望壓力越高者，其憂鬱情緒得分越高。本研究也證實了風險因子具有累積效果，但扣板機效應僅展現在以累積風險指標來預測個體是否有罹患憂鬱症的風險時。研究結論：由於危險因子具有累積效果，本研究建議心理衛生專業應進行系統性的風險因子評估，並針對面臨多元風險因子的青少年進行密集性的介入協助。

Purpose: The ecological system model posits that the depressogenic risk factors that exist in a person's ecosystem exert a negative impact on an individual's mental health. Previous researchers have also proposed analysis of the cumulative effects of individual factors in order to better capture the impact of a cluster of risk factors. This study investigated the association between depressive mood and a group of risk factors that are known to be salient among adolescents in Taiwan. The risk factors investigated included gender, family economic stress, parent-adolescent conflict, negative peer relationships, and academic expectation stress. The cumulative risk index was used as a proxy for investigating the impact of multiple risk factors. Method: A multi-stage cluster sampling method was used to select respondents. Self-report questionnaires were completed by 1,307 students in high schools, vocational high schools, and junior colleges, but only 1,196 questionnaires with complete answers were entered into statistical analyses. Cross-tabulation, oneway ANOVA, trend analysis, Pearson correlation, hierarchical linear regression models, and multiple logistic regressions were used to test the hypotheses of individual and cumulative effects. Results: The linear regression analyses indicated that each risk factor was a significant predictor of the adolescents' depressive mood. Although the hypothesis of cumulative effects was verified, the findings on the triggering effect varied with the analytical approach. Conclusions: Given the evidence for cumulative effects of multiple risk factors, mental health professionals need to use the ecological perspective in assessing depressogenic risk factors and designing intensive services to address multiple risk factors.

1. 王齡竟、陳毓文(2010)。家庭衝突、社會支持與青少年憂鬱情緒：檢視同儕、專業與家外成人支持的緩衝作用。中華心理衛生學刊，23(1)，65-97。
   連結：
2. 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，55(3)，535-557。
   連結：
3. 林新沛(2005)。標準化迴歸係數的正確解釋。中山管理評論，13(2)，533-548。
   連結：
4. 陳毓文(2004)。少年憂鬱情緒的危險與保護因子之相關性研究。中華心理衛生學刊，17(4)，67-95。
   連結：
5. 黃軍義(2009)。家庭因素對少年內化與外化症狀併發的影響。中華心理學刊，51(3)，359-374。
   連結：
6. 楊孟麗(2005)。教育成就的價值與青少年的心理健康。中華心理衛生學刊，18(2)，75-99。
   連結：
7. 魏琦芳(2008)。青少年心理健康的影響因素─貫時性研究。醫護科技學刊，10(4)，251-266。
   連結：
8. 內政部(2003)：〈少年身心狀況調查報告〉。2013年4月2日，取自http://sowf.moi.gov.tw/stat/Survey/2003juvenile.doc。
9. Achenbach, T. M.(1991).Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles.Burlington, VT:University of Vermont, Department of Psychiatry.
10. Ackerman, B. P.,Izard, C. E.,Schoff, K.,Youngstrom, E. A.,Kogos, J.(1999).Contextual risk, caregiver emotionality, and the problem behaviors of six-and seven-year-old children from economically disadvantaged families.Child Development,70(6),1415-1427.
11. American Psychiatric Association(1994).Diagnostic criteria from DSM-IV.Washington, DC:American Psychiatric Association.
12. Ang, R. P.,Huan, V. S.(2006).Relationship between academic stress and suicidal ideation: Testing for depression as a mediator using multiple regression.Child Psychiatry & Human Development,37(2),133-143.
13. Ang, R. P.,Huan, V. S.(2006).Academic Expectations Stress Inventory development, factor analysis, reliability, and validity.Educational and Psychological Measurement,66(3),522-539.
14. Appleyard, K.,Egeland, B.,van Dulmen, M. H.,Sroufe, L. A.(2004).When more is not better: The role of cumulative risk in child behavior outcomes.Journal of Child Psychology and Psychiatry,46(3),235-245.
15. Arnett, J. J.(1999).Adolescent storm and stress, reconsidered.American Psychologist,54(5),317-326.
16. Biederman, J.,Milberger, S.,Faraone, S. V.,Kiely, K.,Guite, J.,Mick, E.,Reed, E.(1995).Family-environment risk factors for attention-deficit hyperactivity disorder: A test of Rutter's indicators of adversity.Archives of General Psychiatry,52(6),464-470.
17. Bosacki, S.,Dane, A.,Marini, Z.,YLC-CURA.(2007).Peer relationships and internalizing problems in adolescents: Mediating role of self-esteem.Emotional and Behavioural Difficulties,12(4),261-282.
18. Branje, S. J. T.,van Doorn, M.,van der Valk, I.,Meeus, W.(2009).Parent-adolescent conflicts, conflict resolution types, and adolescent adjustment.Journal of Applied Developmental Psychology,30(2),195-204.
19. Bronfenbrenner, U.(1979).The ecology of human development: Experiments by nature and design.Cambridge, MA:Harvard University Press.
20. Brown, B. B.,Lohr, M. J.(1987).Peer-group affiliation and adolescent self-esteem: An integration of ego-identity and symbolic-interaction theories.Journal of Personality and Social Psychology,52(1),47-55.
21. Burchinal, M. R.,Roberts, J. E.,Hooper, S.,Zeisel, S. A.(2000).Cumulative risk and early cognitive development: A comparison of statistical risk models.Developmental Psychology,36(6),793-807.
22. Chien, C. P.,Cheng, T. A.(1985).Depression in Taiwan: Epidemiological survey utilizing CES-D.Psychiatrica et Neurologica Japonica,87(5),335-338.
23. Choi, S, H. J.,Nieminen, T. A.(2013).Factor influencing the higher education of international students from Confucian East Asia.Higher Education Research and Development,32(2),161-173.
24. Compas, B. E.,Ey, S.,Grant, K. E.(1993).Taxonomy, assessment, and diagnosis of depression during adolescence.Psychological Bulletin,114(2),323-344.
25. Conger, R. D.,Conger, K. J.,Elder, G. H.,Lorenz, F. O.,Simons, R. L.,Whitbeck, L. B.(1992).A family process model of economic hardship and adjustment of early adolescent boys.Child Development,63(3),526-541.
26. Conger, R. D.,Conger, K. J.,Matthews, L. S.,Elder, G. H.(1999).Pathways of economic influence on adolescent adjustment.American Journal of Community Psychology,27(4),519-541.
27. Duncan, G. J.,Brooks-Gunn, J.,Klebanov, P. K.(1994).Economic deprivation and early childhood development.Child Development,65(2),296-318.
28. Forehand, R.,Biggar, H.,Kotchick, B. A.(1998).Cumulative risk across family stressors: Short-and long-term effects for adolescents.Journal of Abnormal Child Psychology,26(2),119-128.
29. Garber, J.(2006).Depression in children and adolescents: Linking risk research and prevention.American Journal of Preventive Medicine,31(6 suppl 1),104-125.
30. Garmazy, N.(1985).Stress-resistant children: The church for protective factors.Recent research in developmental psychopathology,Oxford, UK:
31. Gerard, J. M.,Buehler, C.(2004).Cumulative environmental risk and youth maladjustment: The role of youth attributes.Child Development,75(6),1832-1849.
32. Gotlib, I. H.,Lewinsohn, P. M.,Seeley, J. R.(1995).Symptoms versus a diagnosis of depression: differences in psychosocial functioning.Journal of Consulting and Clinical Psychology,63(1),90-100.
33. Greenberg, M. T.,Speltz, M. L.,DeKlyen, M.,Jones, K.(2001).Correlates of clinic referral for early conduct problems: Variable-and person-oriented approaches.Development and Psychopathology,13(2),255-276.
34. Greenberger, E.,Chen, C.(1996).Perceived family relationships and depressed mood in early and late adolescence: A comparison of European and Asian Americans.Developmental Psychology,32(4),707-716.
35. Greenberger, E.,Chen, C.,Tally, S. R.,Dong, Q.(2000).Family, peer, and individual correlates of depressive symptomatology among U.S. and Chinese adolescents.Journal of Consulting and Clinical Psychology,68(2),209-219.
36. Grimm, L. G.(ed.),Yarnold, P. R.(ed.)(1995).Reading and Understanding Multivariate Statistics.Washington, DC:American Psychological Association.
37. Haggerty, R. J.(ed.),Sherrod, L. R.(ed.),Garmexy, N.(ed.),Rutter, M.(ed.)(1994).Stress, risk, and resilience in children and adolescents: Process, mechanisms, and interventions.Cambridge, England:Cambridge University Press.
38. Harrington, R.,Fudge, H.,Rutter, M.,Pickles, A.,Hill, J.(1990).Adult outcomes of childhood and adolescent depression: I. Psychiatric status.Archives of General Psychiatry,47(5),465-473.
39. Hilton, J. M.,Devall, E. L.(1997).The Family Economic Strain Scale: Development and evaluation of the instrument with single- and two-parents families.Journal of Families and Economic Issues,18(3),247-271.
40. Jessor, R.,Van Den Bos, J.,Vanderryn, J.,Costa, F. M.,Turbin, M. S.(1995).Protective factors in adolescent problem behavior: Moderator effects and developmental change.Developmental Psychology,31(6),923-933.
41. Jones, D. J.,Forehand, R.,Brody, G.,Armistead, L.(2002).Psychosocial adjustment of African American children in single-mother families: A test of three risk models.Journal of Marriage and Family,64(1),105-115.
42. Kent, W. M.(ed.),Rolf, J. E.(ed.)(1979).Primary prevention of psychopathology.Hanover, NH:University Press of New England.
43. Kraemer, H. C.,Stice, E.,Kazdin, A.,Offord, D.,Kupfer, D.(2001).How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors.American Journal of Psychiatry,158(6),848-856.
44. La Greca, A. M.,Harrison, H. M.(2005).Adolescent peer relations, friendships, and romantic relationships: Do they predict social anxiety and depression?.Journal of Clinical Child and Adolescent Psychology,34(1),49-61.
45. Ladd, G. W.,Troop-Gordon, W.(2003).The role of chronic peer difficulties in the development of children's psychological adjustment problems.Child Development,74(5),1344-1367.
46. Laursen, B.,Coy, K. C.,Collins, W. A.(1998).Reconsidering changes in parent-child conflict across adolescence: A meta-analysis.Child Development,69(3),817-832.
47. Lee, M.,Larson, R.(2000).The Korean 'examination hell': Long hours of studying, distress, and depression.Journal of Youth and Adolescence,29(2),249-271.
48. Lewis, M.(ed.),Feiring, C.(ed.)(1998).Families, risk, and competence.Mahwah, NJ:Erlbaum.
49. Lima, J.,Caughy, M.,Nettles, S. M.,O'Campo, P. J.(2010).Effects of cumulative risk on behavioral and psychological well-being in first grade: Moderation by neighborhood context.Social Science & Medicine,71(8),1447-1454.
50. Lin, H. C.,Tang, T. C.,Yen, J. Y.,Ko, C. H.,Huang, C. F.,Liu, S. C.,Yen, C. F.(2008).Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan.Psychiatry and Clinical Neurosciences,62(4),412-420.
51. Lopez, C.,DuBois, D. L.(2005).Peer victimization and rejection: Investigation of an integrative model of effects on emotional, behavioral, and academic adjustment in early adolescence.Journal of Clinical Child and Adolescent Psychology,34(1),25-36.
52. Luthar, S. S.(1993).Methodological and conceptual issues in research on childhood resilience.Journal of Child Psychology and Psychiatry,34(4),441-453.
53. Mistry, R. S.,Benner, A. D.,Tan, C. S.,Kim, S. Y.(2009).Family economic stress and academic well-being among Chinese-American youth: The influence of adolescents' perceptions of economic strain.Journal of Family Psychology,23(3),279-290.
54. Newman, P. R.,Newman, B. M.(1976).Early adolescence and its conflict: Group identity versus alienation.Adolescence,11(42),261-274.
55. Pedhazur, E. J.(1997).Multiple Regression in Behavioral Research.Orlando, FL:Harcourt Brace.
56. Pelkonen, M.,Marttunen, M.,Kaprio, J.,Huurre, T.,Aro, H.(2008).Adolescent risk factors for episodic and persistent depression in adulthood: A 16-year prospective follow-up study of adolescents.Journal of Affective Disorders,106(1-2),123-131.
57. Petersen, A. C.,Compas, B. E.,Brooks-Gunn, J.,Stemmler, M.,Ey, S.,Grant, K. E.(1993).Depression in adolescence.American Psychologist,48(2),155-168.
58. Pinquart, M.,Silbereisen, R. K.(2002).Changes in adolescents' and mothers' autonomy and connectedness in conflict discussions: An observation study.Journal of Adolescence,25(5),509-522.
59. Sameroff, A. J.,Seifer, R.,Baldwin, A.,Baldwin, C.(1993).Stability of intelligence from preschool to adolescence: The influence of social and family risk factors.Child Development,64(1),80-97.
60. Szatmari, P.,Shannon, H. S.,Offord, D. R.(1994).Models of multiple risk: Psychiatric disorder and poor school performance.International Journal of Methods in Psychiatric Research,4(4),231-240.
61. Veiel, H. O. F.(1987).Buffer effects and threshold effects: An alternative interpretation of nonlinearity in the realtionship between social support, stress, and depression.American Journal of Community Psychology,15(6),717-740.
62. Yang, H. J.,Soong, W. T.,Kuo, P. H.,Chang, H. L.,Chen, W. J.(2004).Using the CES-D in a two-phase survey for depressive disorders among nonreferred adolescents in Taipei: A stratum-specific likelihood ratio analysis.Journal of Affective Disorders,82(3),419-430.
63. Yi, C. C.,Wu, C. I.,Chang, Y. H.,Chang, M. Y.(2009).The psychological well-being of Taiwanese youth: School versus family context from early to late adolescence.International Sociology,24(3),397-429.
64. 王淑卿(2004)。碩士論文(碩士論文)。國立嘉義大學家庭教育研究所。
65. 王齡竟(2008)。碩士論文(碩士論文)。國立臺灣大學社會工作研究所。

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