台灣南部地區老年憂鬱情緒之影響因子探討

Factors of Geriatric Depression in Southern Taiwan

10.3966/168232812016062602004

何曉婷(Hsiao-Ting Ho)；劉立凡(Li-Fan Liu)；郭乃文(Nai-Wen Guo)

老年憂鬱 ； 工具性日常生活活動量表 ； 自覺健康情形 ； geriatric depression ； instrumental activities of daily living scale ； self-rated health

台灣家庭醫學雜誌

26卷2期（2016 / 06 / 01）

100 - 108

繁體中文

背景及目的：憂鬱不僅會引起負面情緒或消極心態，也會影響個人健康行為，使其罹患更多疾病或加速功能衰退，進而更加重憂鬱程度。此一身心交互影響歷程將形成惡性循環，導致醫療照護支出不斷攀升，故本研究擬從社會人口學資料和功能狀況等訊息找出和老年憂鬱相關的影響因子。方法：有效樣本為台灣南部某直轄市65歲以上居民共2,444人。以性別、年齡、教育程度、是否具低收入戶身分等社會人口學資料，與是否領有身心障礙手冊、自覺健康情形、日常生活活動功能量表(ADL)分數、工具性日常生活活動量表(IADL)分數等功能狀況訊息為獨立變項，以老年憂鬱量表(GDS-S)分數為依變項，進行相關分析與迴歸分析。結果：有效樣本中有1.8%具低收入戶身分、1.7%領有身心障礙手冊、70.3%與54.5%在ADL與IADL量表上得滿分、57.8%自覺健康情形好或很好、GDS-S量表總分平均為3.74±3.38分。相關分析發現所有社會人口學變項與功能變項都與憂鬱量表總分顯著相關，其中各功能變項的相關程度均高於各社會人口學變項。迴歸分析發現共4個變項（IADL分數、自覺健康情形、性別、年齡）達顯著解釋量(R2=0.33)，其中IADL分數具最大貢獻，可解釋22%憂鬱量表總分，自覺健康情形另增10%、女性與年齡增長相對不重要。結論：本研究發現功能變項對估計憂鬱情緒之程度遠比社會人口學變項重要，其中IADL得分和自覺健康情形與GDS-S總分變化具正相關性，此結果可用以協助提高健康照護人員對高齡長者出現憂鬱情緒的敏感力，同時可提供未來預防老年憂鬱情緒之可能介入方向，使憂鬱長者能即時獲得必要協助。

Background and Purpose: Geriatric depression, the most prevalent mental health problem among older adults, will affect one's health practice and increase the vulnerability to screen medical disease or functional decline. In turn, burden from physical illness would exacerbate consecutively. A vicious circle is expected and the usage and cost of health care services would inevitably increase. Therefore, it is necessary to identify the population at risk. Methods: Totally 2,444 adults aged 65 years or more in Southern Taiwan completed the Geriatric Depression Scale (GDS-S), the Barthel Index (ADL) and the Lawton-Brody Instrumental Activities of Daily Living Scale (IADL). The participants were also asked to rate their current health condition. Socio-demographic data were collected, including age, gender, education, as well as whether the participant has been in the status of low-income households, or certified as physically or mentally disabled. Bivariate correlation and stepwise multiple linear regression analysis were conducted to analyse these data. Results: There were 1.8% participants in the status of low-income households, 1.7% participants had the physical and mental disability handbook, 70.3% and 54.5% participants got full mark in ADL and IADL scales, and 57.8% participants had positive appraisal on their current health condition. The mean GDS-S score was 3.74±3.38. Bivariate correlation showed that all socio-demographic variables and functional status variables were significantly related to the GDS-S scores. Stepwise multiple linear regression analysis showed that four variables (the IADL score, the self-rated health, gender and age) were identified as significant explanatory factors. The four variables accounted for 33% of total variance of GDS-S score. Among them, the IADL score and the self-rated health explained 32% of the variance. Gender and age added to 1.0% of the total variance. Conclusion: For predicting the degree of negative mood, the functional status variables, especially the IADL score and the self-rated health, are more important than the socio-demographic variables. Prospective studies are warranted to confirm that enhancing independent activity of daily living and improving the health self-management skill might be helpful for preventing the geriatric depression.

1. Chang, CF,Lin, MH,Wang, J,Fan, JY,Chou, LN,Chen, MY(2013).The relationship between geriatric depression and health-promoting behaviors among community-dwelling seniors.J Nurs Res,21,75-82.
   連結：
2. 李淑惠、蔡仲弘(2014)。台灣中老年人憂鬱症狀與新發糖尿病關聯之探討。臺灣衛誌，33，312-22。
   連結：
3. 林正祥、陳佩含、林惠生(2010)。臺灣老人憂鬱狀態變化及其影響因子。人口學刊，41，67-109。
   連結：
4. 林怡君、余豎文、張宏哲(2004)。新店地區機構和非機構老人憂鬱情形及相關因素之調查。臺灣家醫誌，14，81-93。
   連結：
5. 許志成、羅勻佐、徐瑱淳、許雅婷、羅慶徽(2007)。臺灣老人人口分佈與自覺健康之地區性差異。臺灣家醫誌，17，59-72。
   連結：
6. 衛生福利部國民健康署：民國一百年台灣地區中老年身心社會生活狀況長期追蹤（第七次）調查成果報告。2015年11月16日，取自http://www.hpa.gov.tw/Bhpnet/Portal/File/ThemeDocFile/200712270553271307/成果報告—民國100年台灣地區中老年身心社會生活狀況長期追蹤（第7次）調查.pdf
7. 內政部：內政部統計通報104年第29週。2015年11月16日，取自http://www.moi.gov.tw/chi/chi_news/news_detail.aspx?type_code=01&sn=9689
8. 衛生福利部統計處：102年國民醫療保健支出統計。2015年11月16日，取自http://www.mohw.gov.tw/cht/DOS/DM1_P.aspx?f_list_no=557&fod_list_no=365&doc_no=48453
9. Ali S,Stone, MA,Peters, JL,Davies, MJ,Khunti, K(2006).The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis.Diabet Med,23,1165-73.
10. Beekman, AT,Penninx, BW,Deeg, DJ,de Beurs, E,Geerling, SW,van Tilburg, W(2002).The impact of depression on the well-being, disability and use of services in older adults: a longitudinal perspective.Acta Psychiatr Scand,105,20-7.
11. Boey, KW(1999).Cross-validation of a short form of the CES-D in Chinese elderly.Int J Geriatr Psychiatry,14,608-17.
12. Chi, I,Yip, PS,Chiu, HF(2005).Prevalence of depression and its correlates in Hong Kong's Chinese older adults.Am J Geriatr Psychiatry,13,409-16.
13. Chiu, HC,Chen, CM,Huang, CJ,Mau, LW(2005).Depressive symptoms, chronic medical conditions and functional status: a comparison of urban and rural elders in Taiwan.Int J Geriatr Psychiatry,20,635-44.
14. Chong, MY,Tsang, HY,Chen, CS(2001).Community study of depression in old age in Taiwan: prevalence, life events and sociodemographic correlates.Br J Psychiatry,178,29-35.
15. Demakakos, P,Pierce, MB,Hardy, R(2010).Depressive symptoms and risk of type 2 diabetes in a national sample of middle-aged and older adults: the English Longitudinal Study of Aging.Diabetes Care,33,792-7.
16. Ferrari, AJ,Charlson, FJ,Norman, RE(2013).Burden of depressive disorders by country, sex, age, and year: findings from the Global Burden of Disease Study 2010.PLoS Med,10,e1001547.
17. Henry, C,M'Bailara, K,Mathieu, F,Poinsot, R,Falissard, B(2008).Construction and validation of a dimensional scale exploring mood disorders: MAThyS (Multidimensional Assessment of Thymic States).BMC Psychiatry,8,8.
18. Himelhoch, S,Weller, WE,Wu, AW,Anderson, GF,Cooper, LA(2004).Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries.Med Care,42,512-21.
19. Lawton, MP,Brody, EM(1969).Assessment of older people: self-maintaining and instrumental activities of daily living.Gerontologist,9,179-86.
20. Lenze, EJ,Schulz, R,Martire, LM(2005).The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the Cardiovascular Health Study.J Am Geriatr Soc,53,569-75.
21. Mahoney, FI,Barthel, DW(1965).Functional evaluation: the barthel index.Md State Med J,14,61-5.
22. Mezuk, B,Eaton, WW,Albrecht, S,Golden, SH(2008).Depression and type 2 diabetes over the lifespan: a meta-analysis.Diabetes Care,31,2383-90.
23. Murata, C,Kondo, K,Hirai, H,Ichida, Y,Ojima, T(2008).Association between depression and socioeconomic status among community-dwelling elderly in Japan: The Aichi Gerontological Evaluation Study (AGES).Health Place,14,406-14.
24. Naranjo, DM,Fisher, L,Areán, PA,Hessler, D,Mullan, J(2011).Patients with type 2 diabetes at risk for major depressive disorder over time.Ann Fam Med,9,115-120.
25. Pan, A,Lucas, M,Sun, Q(2010).Bidirectional association between depression and type 2 diabetes mellitus in women.Arch Intern Med,170,1884-91.
26. Tsai, YF,Yeh, SH,Tsai, HH(2005).Prevalence and risk factors for depressive symptoms among community-dwelling elders in Taiwan.Int J Geriatr Psychiatry,20,1097-102.
27. Vink, D,Aartsen, MJ,Comijs, HC(2009).Onset of anxiety and depression in the aging population: comparison of risk factors in a 9-year prospective study.Am J Geriatr Psychiatry,17,642-52.
28. Williams, LM,Gordon, E(2007).Dynamic organization of the emotional brain: Responsivity, stability, and instability.Neuroscientist,13,349-70.
29. Yeh, TL,Liao, IC,Yang, YK,Ko, HC(1995).Geriatric Depression Scale (Taiwanese and Mandarin translations).Clin Gerontol,15,58-60.
30. 行政院經濟建設委員會。中華民國2012年至2060年之人口推計。
31. 林佳臻、杜明燦、陳俊傑、陳宣志、顏啟華、李孟智(2013)。台灣地區老人自覺健康狀況相關因子之探討。台灣老誌，8，75-89。
32. 林惠文、楊博仁、楊宜瑱(2010)。台灣地區老年人憂鬱之預測因子探討－十年追蹤結果分析。台灣老誌，5，257-265。
33. 凌千惠、傅光翊、黃荷瑄、姚慧萍、林宜慧、葉志嶸(2007)。老年族群之憂鬱程度、社會支持程度與醫療服務使用之相關性。中山醫學雜誌，18，201-15。
34. 廖以誠、葉宗烈、柯慧貞、駱重鳴、盧豐華(1995)。老年憂鬱量表─中譯版之信、效度初步研究。彰基醫誌，1，11-7。

1. 劉子弘,江宜庭(2023)。台灣中老年族群健康識能與憂鬱症狀之相關性研究。台灣家庭醫學雜誌，33(1)，25-35。
2. 温綵涵,阮祺文(2019)。工具性與情緒性社會支持對台灣地區中老年人憂鬱傾向關聯性探討。弘光學報，84，1-20。
3. 鄭駿樺,李百麟(2021)。社區高齡者預防跌倒、憂鬱與提升認知能力之健康促進計畫－一個10週社區據點活動成效探討。危機管理學刊，18(1)，47-58。