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系統識別號 U0026-1308201811385500
論文名稱(中文) 比較康樂活動與懷舊治療對社區老人憂鬱狀態及社會支持之成效
論文名稱(英文) Comparing the effects of recreational activities and reminiscence therapy on depression and social support among community-dwelling elders
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 106
學期 2
出版年 107
研究生(中文) 張嘉秀
研究生(英文) Chia-Hsiu Chang
電子信箱 chiahsiu@gmail.com
學號 TA8991042
學位類別 博士
語文別 英文
論文頁數 73頁
口試委員 指導教授-陳彰惠
口試委員-黃英修
口試委員-葉淑惠
口試委員-陳美燕
口試委員-李淑芳
中文關鍵字 憂鬱  社會支持  康樂活動  懷舊活動  社區老人 
英文關鍵字 depression  social support  reminiscence therapy  recreational therapy  community-dwelling elderly 
學科別分類
中文摘要 背景
憂鬱是世界各國共同的心理健康問題,臺灣的老年憂鬱人口也越來越多。本研究目的為了解老年憂鬱症的盛行率,憂鬱和社會支持變項的相關性,以及檢視康樂活動與懷舊治療對社區憂鬱老人的介入成效。
研究方法
本研究採類實驗性設計,以「心情溫度計」(BSRS-5) 為研究工具,在一鄉鎮中的社區衛生所進行65歲老人以上的老人進行調查,然後召募BSRS-5中得分6至9分具有輕度憂鬱傾向的高齡者,分配至團康組及懷舊組,各組都由10至15位高齡者所組成,參與十週的介入措施。所有參與之社區老人皆在前測、後測I (十週後)及後測II (18個月後)接受簡易老人憂鬱量表和社會支持量表檢測。
研究結果
共有38位長輩加入此研究,懷舊組有14位,康樂組有13位,居家訪視組有11位。本研究採用單因子共變數分析,以居住地與社會支持前測分數為控制變項,結果為懷舊組在活動前比康樂組擁有較多的社會支持(p = 0.02)。在無母數成對性比較分析中,介入活動成效方面,懷舊組在簡易老人憂鬱量表後測 II與前測的比較中,呈現顯著性差異(p < 0.01);康樂組在社會支持量表中後測I呈現顯著差異,結果為整體社會支持、家人支持、朋友的支持及對社會支持的滿意度此四項達到統計上的效益 (p = 0.02, p = 0.03, p = 0.03, and p = 0.02)。結果顯示,團康組在介入活動後,能有效地得到社會支持,懷舊療法在改善老人憂鬱程度上,具有長期效益。
結論
老年憂鬱盛行率高和日漸增加的自殺率是當今臺灣急迫處理的心理健康問題,有效的預防、覺察和監測憂鬱症患者的照護模式是極為關鍵的管理機制。採取康樂活動的介入措施能立即提升憂鬱老人社會支持度的效果,但無法持續其效益;懷舊療法則具有降低老人憂鬱程度的長期效果;本研究結果希冀能提供政策制定者預防社區老人憂鬱症策略之參考。
英文摘要 BACKGROUND AND OBJECTIVE
Depression is a common worldwide mental disorder. The number of elderly Taiwanese with depression is growing. This study examined, in rural community-dwelling elderly (≥ 65 years old) people in southern Taiwan, the prevalence of depression and its association with social support variables, and compared the effects of recreational activity and reminiscence therapy on the signs and symptoms of depression.

METHODS
In this quasi-experimental research, the Brief Symptom Rating Scale (BSRS-5) was used to screen the mental health status of community-dwelling Taiwanese elderly in a community healthcare center. Participants with BSRS-5 scores of 6-9 were assigned to the Recreational, Reminiscence, or Home-Visit group. Each group had 10-15 members with mild depression. Ten-week interventions were done, and the Geriatric Depression Scale Short Form (GDS-SF) and Social Support Inventory (SSI) were the main instruments used to examine the differences in the pretest, posttest 1 (10 weeks later), and posttest 2 (18 months later) scores.

RESULTS
Thirty-eight participants were recruited for this study: 14 in the Reminiscence group, 13 in the Recreational group, and 11 in the Home-Visit group. Analyses using inhabitancy and SSI pretest scores as covariants showed that the Reminiscence group had higher pretest mean scores of social support than did the Recreational group (p = 0.02). Wilcoxon signed-rank tests were used to compare the differences in the three groups. The mean difference between the GDS-SF posttest 2 and the pretest was significant (p < 0.01) in the Reminiscence group; the mean difference between the SSI posttest 1 and the pretest was significant in total social support (p = 0.03), family support (p = 0.03), support from friends (p = 0.02), and satisfaction with social support (p = 0.02) after intervention in the Recreational group. Depression attenuation was prolonged in the Reminiscence group.

CONCLUSIONS
The high prevalence of depressive elderly and the rising incidence of suicide by the elderly are urgent mental health problems in Taiwan. These problems must be monitored, detected, and prevented. Recreational therapy had a good but short-term effect on increasing social support but not on relieving depression; reminiscence therapy slightly attenuated the signs and symptoms of depression over the long term. With this information, perhaps effective new strategies can be developed to make old age more enjoyable for the elderly.
論文目次 Literature Review.......................1
Methodology............................ 8
Method of Investigation................…8
Participants……………………………………………………………………….9
Instruments………………………………………………………………...………10
Interventions……………………………………………………………………..11
Procedure and Ethical Consideration………………27
Data Analysis............................33
Results..................................34
Discussion...............................51
Limitation and Suggestions...............55
Conclusions..............................57
References...............................58
Appendix I.
Approval of NCKU Institutional Review Board………………………...67
Appendix II.
Short Portable Mental State Questionnaire, SPMSQ.......69
Appendix III.
Brief Symptom Rating Scale (BSRS-5)....................71
Appendix IV.
Geriatric Depression Scale Short Form (GDS-SF).........72
Appendix V.
Social Support Inventory...............................73
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