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系統識別號 U0026-0208201915480300
論文名稱(中文) 台灣中老年人憂鬱症狀之軌跡分析及其與死亡風險之探討
論文名稱(英文) The Trajectories of Depressive Symptoms in Middle-Aged and Older Adults and Its Relationship with the Subsequent Risk of Death in Taiwan
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 107
學期 2
出版年 108
研究生(中文) 洪孟萱
研究生(英文) Meng-Hsuan Hung
電子信箱 beallsmiles123@gmail.com
學號 T86061049
學位類別 碩士
語文別 中文
論文頁數 77頁
口試委員 指導教授-胡淑貞
共同指導教授-林聖翔
口試委員-徐慧娟
中文關鍵字 憂鬱症狀  軌跡  死亡風險  世代追蹤 
英文關鍵字 Depressive symptoms  Mortality  Trajectory  Cohort study 
學科別分類
中文摘要 背景: 許多研究指出,臨床憂鬱症患者或具有憂鬱症狀的老人與較高的死亡風險相關。然而,過去有關憂鬱症狀與存活相關之社區研究,大部分僅對憂鬱症狀做一次基線或短期的測量,較少針對長期不同的憂鬱症狀變化做探討,因此憂鬱症狀的變化與死亡風險之關係仍有很大程度的未知。
目的: 透過長期追蹤臺灣中老年人之憂鬱症狀,來檢視中高齡者不同的憂鬱症狀軌跡的狀況,並探討這些不同憂鬱症狀軌跡與死亡風險之關係。
方法: 運用台灣地區中老年身心社會生活狀況長期追蹤調查 (Taiwan Longitudinal Study on Aging, TLSA) 四波資料(1996-1999-2003-2007),共3134位參與者。本研究使用Group-based Trajectory Model來建立憂鬱症狀軌跡,並追蹤不同憂鬱症狀軌跡的老人至2015年,計算其死亡風險和相關影響因子。
結果: 本研究共確立四條憂鬱症狀軌跡,分別為高憂鬱組(5.6%)、低憂鬱組(80.7%)、下降憂鬱組(5.4%)、上升憂鬱組(8.4%)。與低憂鬱組相比,僅上升憂鬱組有較高的死亡風險(HR:1.28, 95% CI=1.04-1.58),而高憂鬱組和下降憂鬱組並無顯著較高的死亡風險 (高憂鬱組HR:1.08, 95% CI=0.84-1.38;下降憂鬱組HR:1.21, 95% CI=0.93-1.57)。
結論: 本研究之貢獻為利用Group-based Trajectory Model確立台灣中老年人之憂鬱症狀軌跡種類,並瞭解不同憂鬱症狀軌跡的死亡風險,以協助提供有效的預防和治療策略。
英文摘要 Background: Various studies have indicated that both clinical depression and depressive symptoms were associated with higher risk of death in patient and in community samples. However, most previous research was crosstional or short-term design, the association between different courses of depressive symptoms and death is still largely unknown. Therefore, this study aims to explore the relationship between the trajectory of depressive symptoms and the risk of death in middle-aged and older adults in Taiwan.
Methods: A total of 3134 participants from the dataset of ‘Taiwan Longitudinal Study on Aging (TLSA)’were analyzed. The depressive symptoms (CESD) at four waves (1996-1999-2003-2007) were used to identify the depression trajectories by Group-based Trajectory Modal. Mortality rates by trajectory were calculated over a subsequent 8-years period (2007–2015).
Results: Four trajectories of depressive symptoms as high (5.6%), low (80.7%), decreasing (5.4%), and increasing (8.4%) depressive symptoms were identified. Compared with persons in the low depressive symptoms trajectory, people with a trajectory of increasing depressive symptoms (HR: 1.28, 95% CI=1.04-1.58) had a higher risk of death, but not in those with high (HR: 1.08, 95% CI=0.84-1.38) and decreasing (HR: 1.21, 95% CI=0.93-1.57) depressive symptoms.
Conclusions: This study has established the trajectories of depressive symptoms in middle-aged and older adults and examined the risk of death across these different trajectories in order to provide effective strategies for prevention and treatment.
論文目次 目錄
第壹章 前言 1
第一節 研究背景與動機 1
第二節 研究目的 2
第貳章 文獻探討 3
第一節 中老年人之憂鬱 3
第二節 中老年人憂鬱症狀軌跡 8
第三節 中老年人憂鬱症狀軌跡對死亡的影響 11
第四節 軌跡分析 15
第參章 研究方法 16
第一節 資料來源 16
第二節 研究對象 18
第三節 研究設計與研究架構 20
第四節 研究變項定義與測量 21
第五節 統計分析 25
第肆章 研究結果 26
第一節 研究樣本描述 26
第二節 憂鬱症狀軌跡分析 29
第三節 憂鬱症狀軌跡之樣本特徵性分布 32
第四節 憂鬱症狀軌跡之預測因子 38
第五節 不同憂鬱症狀軌跡分組之死亡風險 41
第六節 性別分析 46
第伍章 討論 64
第一節 主要研究發現 64
第二節 與過去研究對話 65
第三節 研究優勢與限制 69
第四節 結論與建議 70
第陸章 參考文獻 71
第柒章 附錄 76

表目錄
表2-1-1、中文版流行病學研究中心憂鬱量表(CESD) 7
表2 4-1、中老年人憂鬱症狀軌跡對死亡的影響之文獻整理 14
表3-1-1、歷次調查完訪案數、累計死亡案數、無法完成數與完訪率一覽表 17
表3-1-2、樣本世代組成 17
表3-4-1、抑鬱(CES-D)量表 21
表 3 4-2、變項定義 24
表4-1-1、2007年以前存活、死亡個案基線年(1996)社會人口學、健康相關變項之特徵性分布 27
表4-1-2、2007-2015年存活、死亡個案基線年(1996)社會人口學、健康相關變項之特徵性分布 28
表4-3-1a、存活個案憂鬱症狀軌跡基線(1996年)社會人口學變項之特徵性分布(N=3134) 34
表4-3-1b、存活個案憂鬱症狀軌跡樣本基線(1996年)健康相關變項之特徵性分布(N=3134) 35
表4-3-2a、死亡個案憂鬱症狀軌跡基線(1996年)社會人口學變項之特徵性分布(N=1389) 36
表4-3-2b、死亡個案憂鬱症狀軌跡基線(1996年)健康相關變項之特徵性分布(N=1389) 37
表4-4-1、影響存活個案不同憂鬱症狀軌跡之社會人口學以及健康相關變項* 39
表4-4-2、影響死亡個案憂鬱症狀軌跡之社會人口學以及健康相關變項* 40
表4-5-1、不同憂鬱症狀軌跡對後續8年之死亡風險估計-Cox存活分析 (N=3134) 42
表4-5-2、不同憂鬱症狀軌跡與8年後是否死亡之勝算比- logistic迴歸分析(N=3134) 44
表4-6-1、基線(1996)社會人口學、健康相關變項之特徵性分布(以性別分層) 50
表4-6-2a、男性存活個案憂鬱症狀軌跡基線(1996年)社會人口學變項之特徵性分布(N=1563) 52
表4-6-2b、男性存活個案憂鬱症狀軌跡樣本基線(1996年)健康相關變項之特徵性分布(N=1563) 53
表4-6-3a、女性存活個案憂鬱症狀軌跡基線(1996年)社會人口學變項之特徵性分布(N=1571) 54
表4-6-3b、女性存活個案憂鬱症狀軌跡樣本基線(1996年)健康相關變項之特徵性分布(N=1571) 55
表4-6-4、男性存活個案不同憂鬱症狀軌跡的死亡風險-Cox存活分析(N=1563) 56
表4-6-5、女性存活個案不同憂鬱症狀軌跡的死亡風險-Cox存活分析 (N=1571) 58
表4-6-6、男性存活個案不同憂鬱症狀軌跡的後續死亡風險- logistic迴歸分析 (N=1563) 60
表4-6-7、女性存活個案不同憂鬱症狀軌跡的後續死亡風險- logistic 迴歸分析(N=1571) 62
表附錄1、全體、存活與死亡個案1996-2007年四波憂鬱分數 76
表附錄2、存活男性、女性個案1996-2007年四波憂鬱分數 77

圖目錄
圖3-2-1、研究樣本流程圖 19
圖3 3-1、研究設計 20
圖3-3-2、研究架構 20
圖4-2-2、存活個案憂鬱症狀軌跡(3134人) 30
圖4-2-1、全樣本憂鬱症狀軌跡 (4523人) 30
圖4-2-3、死亡個案憂鬱症狀軌跡(1389人) 31
圖4 6-2、存活女性憂鬱症狀軌跡(1571人) 51
圖4-6 1、存活男性憂鬱症狀軌跡 (1563人) 51
參考文獻 Alexopoulos, G. S. (2005). Depression in the elderly. The lancet, 365(9475), 1961-1970.
Assari, S., & Lankarani, M. M. (2016). Chronic medical conditions and negative affect; racial variation in reciprocal associations over time. Frontiers in psychiatry, 7, 140.
Aziz, R., & Steffens, D. C. (2013). What are the causes of late-life depression? Psychiatric Clinics, 36(4), 497-516.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of general psychiatry, 4(6), 561-571.
Blazer, D. G. (2003). Depression in late life: review and commentary. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(3), M249-M265.
Bogner, H. R., Morales, K. H., Reynolds III, C. F., Cary, M. S., & Bruce, M. L. (2012). Course of depression and mortality among older primary care patients. The American Journal of Geriatric Psychiatry, 20(10), 895-903.
Bryk, A. S., & Raudenbush, S. W. (1987). Application of hierarchical linear models to assessing change. Psychological bulletin, 101(1), 147.
Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B., & Bruce, M. L. (2010). High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication. Archives of general psychiatry, 67(5), 489-496.
Carrière, I., Farré, A., Proust-Lima, C., Ryan, J., Ancelin, M.-L., & Ritchie, K. (2017). Chronic and remitting trajectories of depressive symptoms in the elderly. Characterisation and risk factors. Epidemiology and psychiatric sciences, 26(2), 146-156.
Chachamovich, E., Fleck, M., Laidlaw, K., & Power, M. (2008). Impact of major depression and subsyndromal symptoms on quality of life and attitudes toward aging in an international sample of older adults. The Gerontologist, 48(5), 593-602.
Chang, K.-F., & Weng, L.-J. (2013). Screening for depressive symptoms among older adults in Taiwan: Cutoff of a short form of the Center for Epidemiologic Studies Depression Scale. Health, 5(03), 588.
Chen, C.-M., Mullan, J., Griffiths, D., Kreis, I. A., Lan, T.-Y., & Chiu, H.-C. (2011). Trajectories of depression and their relationship with health status and social service use. Archives of Gerontology and Geriatrics, 53(2), e118-e124.
Chiu, C.-J., Tseng, Y.-H., Hsu, Y.-C., & Wu, S.-T. (2017). Depressive symptom trajectories in the first 10 years of diabetes diagnosis: antecedent factors and link with future disability in Taiwan. Social psychiatry and psychiatric epidemiology, 52(7), 829-836.
Cuijpers, P., & Smit, F. (2002). Excess mortality in depression: a meta-analysis of community studies. Journal of affective disorders, 72(3), 227-236.
Cuijpers, P., Smit, F., Oostenbrink, J., De Graaf, R., Ten Have, M., & Beekman, A. (2007). Economic costs of minor depression: a population‐based study. Acta Psychiatrica Scandinavica, 115(3), 229-236.
Cuijpers, P., Vogelzangs, N., Twisk, J., Kleiboer, A., Li, J., & Penninx, B. W. (2013). Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both. The British journal of psychiatry, 202(1), 22-27.
Cuijpers, P., Vogelzangs, N., Twisk, J., Kleiboer, A., Li, J., & Penninx, B. W. (2014). Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. American journal of psychiatry, 171(4), 453-462.
de Winter, C. d., Bastiaanse, L., Hilgenkamp, T., Evenhuis, H., & Echteld, M. (2012). Overweight and obesity in older people with intellectual disability. Research in Developmental Disabilities, 33(2), 398-405.
Galatzer-Levy, I. R., & Bonanno, G. A. (2014). Optimism and death: Predicting the course and consequences of depression trajectories in response to heart attack. Psychological Science, 25(12), 2177-2188.
Gallo, J., Fulmer, T., Paveza, G., & Reichel, W. (2000). Mental status assessment. Handbook of geriatric assessment, 50-56.
Gatz, M., & Hurwicz, M.-L. (1990). Are old people more depressed? Cross-sectional data on Center for Epidemiological Studies Depression Scale factors. Psychology and aging, 5(2), 284.
Guralnik, J. M., de Leon PhD, C. F. M., Pahor, M., Maria-Chiara Corti MD, M., & Wallace, R. B. (1998). Cardiovascular events and mortality in newly and chronically depressed persons> 70 years of age. The American journal of cardiology, 81(8), 988-994.
Hamilton, M. (1960). A rating scale for depression. Journal of neurology, neurosurgery, and psychiatry, 23(1), 56.
Helmchen, H., & Linden, M. (2000). Subthreshold disorders in psychiatry: clinical reality, methodological artifact, and the double-threshold problem. Comprehensive Psychiatry, 41(2), 1-7.
Hsu, H. C. (2012). Group‐based trajectories of depressive symptoms and the predictors in the older population. International journal of geriatric psychiatry, 27(8), 854-862.
Kendler, K. S., Gardner, C. O., & Prescott, C. A. (2006). Toward a comprehensive developmental model for major depression in men. American journal of psychiatry, 163(1), 115-124.
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS medicine, 5(2), e45.
Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D depression symptoms index. Journal of aging and health, 5(2), 179-193.
Kuchibhatla, M. N., Fillenbaum, G. G., Hybels, C. F., & Blazer, D. G. (2012). Trajectory classes of depressive symptoms in a community sample of older adults. Acta Psychiatrica Scandinavica, 125(6), 492-501.
Kwon, E., Kim, B., Lee, H., & Park, S. (2018). Heterogeneous trajectories of depressive symptoms in late middle age: Critical period, accumulation, and social mobility life course perspectives. Journal of aging and health, 30(7), 1011-1041.
Laborde‐Lahoz, P., El‐Gabalawy, R., Kinley, J., Kirwin, P. D., Sareen, J., & Pietrzak, R. H. (2015). Subsyndromal depression among older adults in the USA: Prevalence, comorbidity, and risk for new‐onset psychiatric disorders in late life. International journal of geriatric psychiatry, 30(7), 677-685.
Lee, G. R., DeMaris, A., Bavin, S., & Sullivan, R. (2001). Gender differences in the depressive effect of widowhood in later life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56(1), S56-S61.
Lee, J., Jang, S.-N., & Cho, S.-I. (2017). Gender differences in the trajectories and the risk factors of depressive symptoms in later life. International Psychogeriatrics, 29(9), 1495-1505.
Lenze, E. J., Schulz, R., Martire, L. M., Zdaniuk, B., Glass, T., Kop, W. J., . . . Reynolds III, C. F. (2005). The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the Cardiovascular Health Study. Journal of the American Geriatrics Society, 53(4), 569-575.
Lino, V. T. S., Portela, M. C., Camacho, L. A. B., Atie, S., Lima, M. J. B., Rodrigues, N. C. P., . . . de Noronha Andrade, M. K. (2014). Screening for depression in low-income elderly patients at the primary care level: use of the patient health questionnaire-2. PloS one, 9(12), e113778.
Lohman, M., Dumenci, L., & Mezuk, B. (2016). Depression and Frailty in Late Life: Evidence for a Common Vulnerability. The Journals of Gerontology: Series B, 71(4), 630-640. doi:10.1093/geronb/gbu180
Mackinnon, A., McCallum, J., Andrews, G., & Anderson, I. (1998). The center for epidemiological studies depression scale in older community samples in Indonesia, North Korea, Myanmar, Sri Lanka, and Thailand. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 53(6), P343-P352.
Malgaroli, M., Galatzer-Levy, I. R., & Bonanno, G. A. (2017). Heterogeneity in trajectories of depression in response to divorce is associated with differential risk for mortality. Clinical Psychological Science, 5(5), 843-850.
Mathers, C. D., & Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS medicine, 3(11), e442.
McArdle, J. J., & Epstein, D. (1987). Latent growth curves within developmental structural equation models. Child development, 110-133.
Meeks, T. W., Vahia, I. V., Lavretsky, H., Kulkarni, G., & Jeste, D. V. (2011). A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. Journal of affective disorders, 129(1-3), 126-142.
Moazen-Zadeh, E., & Assari, S. (2016). Depressive symptoms predict major depressive disorder after 15 years among whites but not blacks. Frontiers in public health, 4, 13.
Murphy, R. A., Hagaman, A. K., Reinders, I., Steeves, J. A., Newman, A. B., Rubin, S. M., . . . Ayonayon, H. N. (2015). Depressive trajectories and risk of disability and mortality in older adults: longitudinal findings from the health, aging, and body composition study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 71(2), 228-235.
Muthén, B. (2001). Second-generation structural equation modeling with a combination of categorical and continuous latent variables: New opportunities for latent class–latent growth modeling.
Nagin, D. S., & NAGIN, D. (2005). Group-based modeling of development: Harvard University Press.
Nagin, D. S., & Odgers, C. L. (2010). Group-based trajectory modeling in clinical research. Annual review of clinical psychology, 6.
Olfson, M., Broadhead, W. E., Weissman, M. M., Leon, A. C., Farber, L., Hoven, C., & Kathol, R. (1996). Subthreshold psychiatric symptoms in a primary care group practice. Archives of general psychiatry, 53(10), 880-886.
Penninx, B. W., Deeg, D. J., van Eijk, J. T. M., Beekman, A. T., & Guralnik, J. M. (2000). Changes in depression and physical decline in older adults: a longitudinal perspective. Journal of affective disorders, 61(1-2), 1-12.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied psychological measurement, 1(3), 385-401.
Rote, S., Chen, N. W., & Markides, K. (2015). Trajectories of depressive symptoms in elderly Mexican Americans. Journal of the American Geriatrics Society, 63(7), 1324-1330.
Saeed, M. S., Ikram, M., Freak-Poli, R., Hofman, A., Rizopoulos, D., & Tiemeier, H. (2018). 12 Year Trajectories of Depressive Symptoms in Community-Dwelling Older Adults and the Subsequent Risk of Death Over 13 Years. The journals of gerontology. Series A, Biological sciences and medical sciences, 73(6), 820.
Seitz, D., Purandare, N., & Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22(7), 1025-1039.
Soysal, P., Veronese, N., Thompson, T., Kahl, K. G., Fernandes, B. S., Prina, A. M., . . . Tseng, P.-T. (2017). Relationship between depression and frailty in older adults: A systematic review and meta-analysis. Ageing research reviews, 36, 78-87.
Stafford, M., Antonucci, T. C., & Zaninotto, P. (2019). Joint trajectories of spousal social support and depressive symptoms in older age. Journal of aging and health, 31(5), 760-782.
Vaughan, L., Corbin, A. L., & Goveas, J. S. (2015). Depression and frailty in later life: a systematic review. Clinical interventions in aging, 10, 1947.
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry, 72(4), 334-341.
Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V., & Vos, T. (2015). The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PloS one, 10(2), e0116820.
Wilcox, M. E., Freiheit, E. A., Faris, P., Hogan, D. B., Patten, S. B., Anderson, T., . . . Maxwell, C. J. (2016). Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC psychiatry, 16(1), 277.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of psychiatric research, 17(1), 37-49.
李庚霖、區雅倫、陳淑惠、翁儷禎(2009)。「臺灣地區中老年身心社會生活狀況長期追蹤調查」短版 CES-D 量表之心理計量特性。中華心理衛生學刊。22(4),383-410。
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。1,11-17。
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