憂鬱量表之編製及其相關因素之研究

• Main Author: 劉育如
• Language: 中文
• Published: 國立政治大學
• Subjects: 憂鬱症; 全人醫治取向; 驗證性因分析; 結構方程模式; 潛在平均數; depressive disorder; the whole-person approach to healing,; confirmatory factory analysis; structural equation modeling (SEM); latent means
• Online Access: http://thesis.lib.nccu.edu.tw/cgi-bin/cdrfb3/gsweb.cgi?o=dstdcdr&i=sid=%22G0901520361%22.

本研究的主要目的是以美國全人醫治協會（American Holistic Medical Association，AHMA），提出的全人醫治取向（AHMA, 2005），發展出一份新取向的憂鬱量表，同時探討憂鬱症的相關因素。針對憂鬱症而言，全人的醫治方式需要檢視情緒、人際關係、身體和心靈等各個層面。因此，本研究所發展的自編憂鬱量表依全人醫治取向將其為分為認知取向、情緒取向、身體取向與人際取向等四個因素。 本研究量表的計分方式採用李克特式四點量表形式。原始量表共37題，依據文獻與醫院觀察所得資料編製而成。原始量表以專家效度作為刪題依據，刪題後的正式量表為22題。其計分方式，答「總是如此」得3分，「經常如此」2分，「偶爾如此」1分，「很少如此或沒有」0分。樣本分為實驗組（憂鬱症者）與效標組（非憂鬱症者），實驗組是以精神科醫師診斷為憂鬱症者共213人作為量表的填答對象，效標組是隨機抽取政大學生200人作為施測樣本，並以CES-D憂鬱量表作為效標。施測所得資料以SPSS進行描述統計、t考驗、效標關聯效度、分量表與總分之相關、區別分析、內部一致性信度的考驗；並以結構方程式模式（SEM）針對驗證性因素分析、多群組共變數結構與多群組潛在平均數結構進行考驗。 本研究的結論下： 一、本研究結果，憂鬱症好發年齡與國外25-44歲研究相符，與國內20-40歲研究結果相同。依據文獻所示，女性罹患憂鬱症的比例，為男性的2倍，本研究結果顯示與國內外研究結果是一致性。 二、各分量表與總分之間的相關從.836到.903皆為非常良好的係數值，表示本研究自編憂鬱量表具有良好的內部一致性。 三、本研究之效標關聯效度達0.939，雙尾檢定，達.01顯著水準，表示本研究所編製的量表，可測得所欲測得的特質。 四、本研究的自編量表整體內部一致性Cronbach's Alpha係數為.965，其他如刪除各單題後的總量表、校正後單題與總量表之相關、校正後單題與分量表之相關都顯示本研究自編憂鬱量表有良好的信度。 五、驗證性因素分析模式是合理適配的，表示當初四個向度假設是成立，而且這四個因素背後有一個潛在因素－「憂鬱症」存在。 六、實驗組與效標組在共變數結構上的考驗是沒有差異的，表示此自編憂鬱量表可以同時適用在實驗組與效標組。 七、分量表或總量表從t考驗值差異皆達.001顯著水準，另外區別分析Hit Ratio值為0.93，表示本研究自編之憂鬱量表具有良好之區別效度，可以有效地區別出實驗組與效標組。而在多群組潛在平均數結構上的考驗，效標組在自編憂鬱量表四個向度上的潛在平均數低於實驗組，表示本量表從潛在變項的考驗也可以有效地區辨實驗組與效標組。 === The main purpose of this study is to develop a depression scale in a new approach that reflects the whole-person approach to healing proposed by the AHMA (the American Holistic Medical Association) in the United States (AHMA, 2005), while at the same time probing into the relevant factors of depression disorders. Regarding depression disorders, a whole-person approach to healing requires the examination of multiple dimensions of the person, such as mood, interpersonal relationships, body, soul, etc. So, this study of the development of a self-establishment depression scale is divided into four dimensions: cognitive, mood, physical, and interpersonal, in accordance with the whole-person approach. The scale of this study adopts a four-item Likter scale to measure scores. The basic scale amounts to 37 items and works out according to the literature and the observing materials in hospitals. Items of the basic scale are deleted with expert validity. It is a 22- items formal scale after deleting items. Answer choices read and rate as follows: “always true” (3), “often true” (2), “true once in a while” (1), “seldom or not true” (0). Samples are separated into the experimental group (depressed person) and the criterion group (non-depressed person). In the experimental group, psychiatrists diagnosed 213 people for depressed person as the measuring target filling of the self-establishment depression scale. The criterion group consisted of 200 National Chengchi University students. CES-D was used as a criterion t. We used the program of SPSS to compute descriptive statistics, t-test, criterion-related validity, correlation of the sub-scales and the scale, discriminant, reliability of internal consistency with SPSS, and the estimations of confirmatory factory analysis, multi-sample covariance structure, multi-sample-latent-means structure with structural equation modeling (SEM). In sum, some conclusions of this research are as follows: 1. The result of this study show that depression disorder peaks during the ages of twenty-five to forty-four, consistent with in foreign and domestic research. As literature, depression disorder occurs in at double the rate in women as in men, and the result of this study is consistent with domestic and foreign studies. 2. The correlative coefficient of the sub-scales and the scale from .836 to.903 shows all as having very good coefficient value and that it has good internal consistency of the self-establishment depression scale. 3. The criterion-related validity of this research is up to 0.939, 2-tailed test reaches .01 level of significance which shows the self-establishment depression scale can examine the attributes which we want to find out. 4. The whole internal consistency Cronbach's Alpha coefficient of the self-establishment depression scale is .965, others like Cronbach's Alpha if item deleted, corrected item-total correlations single item with sub-scales and corrected item-total correlations single item with the scale all show good reliability. 5.The model confirmatory factory analysis is reasonably fit that shows four dimensions established supposing originally, and behind the back of four factors there is one latent variable – “depressive disorder” exists. 6.The estimation of covariance structure between the experimental group and the criterion group shows no difference that reveals the self-establishment depression scale can be suitable for the experimental group and the criterion group . 7.The sub-scale and the scale of the self-establishment depression scale from t-test reaches .01 level of significance, another time hit ratio value of discriminant is 0.93, both show that the self-establishment depression scale by this study can distinguish the experimental group and the criterion group efficiently. And at the estimation of multi-sample-latent-means structure shows the criterion group’s latent mean is lower than the experimental group’s, that means this scale can distinguish the experimental group and the criterion group usefully at the same time.