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系統識別號 U0026-0812200915081463
論文名稱(中文) 探討HIV感染者之憂鬱症狀及其相關因素
論文名稱(英文) Factors Related to Depressive Symptoms among People Living with HIV
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 97
學期 2
出版年 98
研究生(中文) 葉美伶
研究生(英文) Mei-ling Yeh
電子信箱 mei.ling1203@gmail.com
學號 t2695104
學位類別 碩士
語文別 中文
論文頁數 78頁
口試委員 指導教授-柯乃熒
召集委員-楊延光
口試委員-柯文謙
口試委員-徐淑婷
中文關鍵字 社會歧視  人類免疫缺乏病毒  重度憂鬱症狀  CD4數目  壓力知覺感受 
英文關鍵字 social stigma  major depressive symptoms  human immunodeficiency virus  perceived stress  CD4 cell counts 
學科別分類
中文摘要 背景: 愛滋感染者因面臨病程變化及疾病相關的壓力,易誘發憂鬱症狀的發生。然而,憂鬱的情緒不易由病人的外觀察覺出,醫護人員若未能及早發現其憂鬱症狀,不僅影響其生活品質,減少對藥物的遵從性,進而使疾病病程惡化。
目的: 本研究旨在探討HIV感染者之疾病病程、壓力知覺感受、社會歧視與其憂鬱症狀之關係,及預測影響重度憂鬱症狀發生的危險因子。
方法: 研究對象來自南部某醫學中心160位固定於門診追蹤治療之HIV感染者,以結構式問卷包括:貝克憂鬱量表、壓力知覺量表、自覺社會支持的多面向量表、社會衝擊量表及病歷回顧方式搜集資料。以多元迴歸分析CD4數目、壓力知覺感受、社會歧視對憂鬱症狀之關係及邏輯式迴歸預測重度憂鬱症狀發生的危險因素。
結果: 感染者其憂鬱症狀盛行率約42.5%,重度憂鬱症狀盛行率約15.6%;感染者之CD4數目減少其憂鬱症狀強度愈高,自覺承受壓力愈大及自覺社會歧視愈嚴重其憂鬱症狀強度愈高,CD4數目、壓力知覺感受、社會歧視對憂鬱症狀之解釋力約46%;而預測感染者出現重度憂鬱症狀的主要因素為壓力知覺感受(OR:1.24, 95% CI:1.10-1.39)與社會歧視(OR:1.47, 95% CI:1.09-1.97)。
結論: 降低感染者其自覺壓力、社會歧視可作為預防HIV感染者重度憂鬱症狀之介入性措施的參考。
英文摘要 Background: People living with HIV who was faced with HIV disease progression and HIV related stress that may trigger off depressive symptom. However, depressive symptoms are difficult to detect. The depressive symptoms of patients with HIV might affect their quality of life, decrease adherence to antiretroviral therapy, and further exacerbate disease progression.
Objective: The study purposes were to examine the relationships among HIV disease progress, perceived stress, social stigma, and depressive symptoms and to investigate the predictors of depressive and major depressive symptoms among patients with HIV.
Method: Study subjects were recruited from infectious disease outpatient clinics in a university hospital in southern Taiwan. Data was collected including chart reviews and four self-administered questionnaires: Beck Depression Inventory, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, and Social Impact Scale.
Results: The prevalence rate of depressive symptoms and major depressive symptoms among patients with HIV were 42.5% and 15.6%, respectively. Multiple regression analysis indicated that CD4 cell counts, perceived stress, and social stigma were associated with depressive symptoms, accounting for 46% of the variance in depressive symptoms. The independent predictors associated with increased odds of major depressive symptoms were perceived stress (OR:1.24, 95% CI:1.10-1.39) and social stigma (OR:1.47, 95% CI:1.09-1.97).
Conclusion: People living with HIV were prone to major depressive symptoms which were affected by perceived stress and social stigma. Perceived stress and social stigma could provide reference for further intervention to prevent major depressive symptoms among people living with HIV.
論文目次 第一章 緒論 1
第一節 背景 1
第二節 研究動機與重要性 2
第三節 研究目的及假說 4
第二章 文獻查證 5
第一節 HIV感染者之憂鬱症流行病學 5
一、全球HIV病患的憂鬱症流行病學 5
二、台灣HIV病患的憂鬱症流行病學 6
第二節 憂鬱症之生物心理社會模式 7
第三節 影響HIV感染者憂鬱症之生物醫學、心理、社會因素 10
一、生物醫學層面: HIV病程進展、HIV免疫指數、抗愛滋病毒藥物治療、抗愛滋病毒藥物組合 10
二、心理層面:壓力知覺感受 15
三、社會層面:告知HIV狀態、家庭與社會支持、社會歧視 18
第三章 研究方法 22
第一節 研究設計 22
第二節 研究對象 22
第三節 研究架構 23
第四節 研究工具 27
第五節 研究步驟 30
第六節 分析方法 31
第四章 研究結果 33
第一節 人口學特性資料 33
第二節 感染者其憂鬱症狀與HIV疾病之關係 34
第三節 HIV感染者之憂鬱症狀與壓力知覺感受之關係 35
第四節 憂鬱症狀與HIV告知、家庭與社會支持、社會歧視之關係 36
第五節 預測HIV感染者其憂鬱症狀與重度憂鬱症狀之因素 37
第五章 討論 39
第一節 HIV感染者其憂鬱症狀盛行率 39
第二節 HIV感染者其憂鬱症狀與疾病進展 40
第三節 HIV感染者其憂鬱症狀與壓力感受 42
第四節 HIV感染者其憂鬱症狀與HIV告知、家庭與社會支持、社會歧視 43
第五節 HIV感染者憂鬱症狀之影響因素與預測力 45
第六章 結論與建議 46
第一節 結論 46
第二節 研究限制及未來研究的建議 46
第三節 臨床運用與未來實務的建議 47
第七章 參考文獻 49
附錄 59
表格 69
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