| 摘要: | 憂鬱症為常見之精神疾患，其為造成全球人口失能之主要原因之一，亦造成了全球經濟上嚴重之負擔。惟臺灣目前仍缺乏同時控制國民中等學校、高級中等與高級職業學校等學制且使用多面向測量工具長期追蹤憂鬱症狀軌跡變化及相關風險因素之研究。故研究一之目的為控制不同學制後，青少年憂鬱症狀軌跡之變化及相關風險因素，受限於研究一之研究設計，於了解相關青少年憂鬱症狀軌跡變化與風險因素後，無法持續評估個案於青少年期銜接至成年早期後，其憂鬱核心症狀之變化與相關風險及保護因素。故研究二之目的為監測青少年銜接至成年早期階段後其失樂感之狀況，並使用病人健康問卷為黃金標準以建構Snaith-Hamilton愉悅量表於臨床和非臨床組間之截斷值及相關風險與保護因素。研究一從參與臺灣青少年至成人縱向研究的575名青少年中收集了長期追蹤之資料。統計分析方式則運用了潛在類別成長模型、單變量和多變量分析。研究二則採用橫斷相關性研究設計，並使用方便取樣法招募了來自臺灣北部三家醫院的160名患者和兩所大學的412名學生。統計分析方式則分別運用了ROC曲線分析、單變量和多變量分析。研究一之結果顯示三類軌跡成長模型「低但上升」、「中等且穩定」以及「高但下降」最符合該群體之資料。29％、38％和33％的青少年分別處於「低但上升」，「中等且穩定」和「高但下降」的軌跡中。控制相關因素後發現，霸凌經歷為憂鬱症狀的風險因素，而復原力、同儕和社會支持則為保護因素。研究二之結果顯示臨床組和非臨床組的最佳Snaith-Hamilton愉悅量表截斷值分別為29.5和23.5。臨床組良好之病識感、非臨床組之良好課程出席率及父親表現出較高關愛和保護水平的為保護因素。而非臨床組之學業滿意度較低且不願意尋求家人或朋友幫助則為風險因素。綜上所述，本研究強調了長期追蹤青少年憂鬱症狀軌跡變化的重要性，並提出了最佳化的Snaith-Hamilton愉悅量表截斷值，以期篩查出處於憂鬱風險的個體，進行早期介入。
Depression is a common mental disorder and one of the leading causes of disability worldwide, imposing a significant economic burden globally. However, in Taiwan, there is currently a lack of research that simultaneously controls for different educational systems (junior high schools, senior high schools, and vocational schools) and employs multifaceted measurement tools to track long-term changes in depressive symptom trajectories and related risk factors. Therefore, the first study aims to investigate changes in adolescent depressive symptom trajectories and related risk factors after controlling for different educational systems. Due to the limitations of the study design, it is not possible to continuously assess changes in core depressive symptoms and related risk and protective factors as adolescents transition to early adulthood. Hence, the second study aims to monitor anhedonia in adolescents transitioning to early adulthood and to establish optimal cut-off values for the Snaith-Hamilton Pleasure Scale (SHAPS) in clinical and non-clinical groups using the Patient Health Questionnaire as the gold standard and to identify related risk and protective factors. The first study collected long-term follow-up data from 575 adolescents participating in the Taiwan Adolescent to Adult Longitudinal Study. Statistical analyses included latent class growth modeling, univariate, and multivariate analyses. The second study employed a cross-sectional correlational design and recruited 160 patients from three hospitals in northern Taiwan and 412 students from two universities using convenience sampling. Statistical analyses included ROC curve analysis, univariate, and multivariate analyses. The results of the first study identified three trajectory growth models: "low but increasing," "moderate and stable," and "high but decreasing," accounting for 29%, 38%, and 33% of adolescents, respectively. Bullying experiences were identified as a risk factor for depressive symptoms, while resilience, peer, and social support were protective factors. The second study found that the optimal SHAPS cut-off values for clinical and non-clinical groups were 29.5 and 23.5, respectively. Good insight was a protective factor for the clinical group, while good class attendance and high levels of paternal care and protection were protective factors for the non-clinical group. Conversely, low academic satisfaction and reluctance to seek help from family or friends were risk factors for the non-clinical group. In summary, this research emphasizes the importance of longitudinally tracking changes in adolescent depressive symptom trajectories and proposes optimal SHAPS cut-off values to identify individuals at risk for depression for early intervention. |
