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系統識別號 U0026-1508201710565500
論文名稱(中文) 在台灣燒燙傷後的精神性後遺症
論文名稱(英文) Psychiatric sequelae after burns in Taiwan
校院名稱 成功大學
系所名稱(中) 環境醫學研究所
系所名稱(英) Institute of Environmental and Occupational Health
學年度 105
學期 2
出版年 106
研究生(中文) 郭婉吟
研究生(英文) Wan-Yin Kuo
學號 S76041119
學位類別 碩士
語文別 英文
論文頁數 46頁
口試委員 指導教授-郭浩然
口試委員-蘇世斌
口試委員-陳柏熹
口試委員-吳政龍
中文關鍵字 精神疾病  燒燙傷  風險  發生率  住院 
英文關鍵字 psychiatric disorders  burn  risk  incidence  hospitalized 
學科別分類
中文摘要 背景: 需要住院治療的重大燒燙傷會造成患者精神上的影響,而此與燒燙傷患者不良預後有關。過去對於燒燙後精神疾病風險的研究,可能因不同的研究方法以及受限的個案數,導致其結果有很大的差異。
目的: 本研究目的為利用台灣人口族群的資料來探討燒燙傷後各種精神疾病的風險。
方法: 本研究為一利用台灣全民健康保險研究資料庫的回溯性世代研究。燒燙傷世代為2000年至2012年燒燙傷住院的個案,比較世代則為無燒燙傷者且住院接受闌尾切除術的個案。接著排除在燒燙傷住院或接受闌尾切除術前患有任何精神疾病的個案。之後追蹤每一位個案一年的時間,並藉由保險給付資料確定此追蹤期間個案之各種精神疾病的診斷。本研究利用Cox proportional hazard regression models來分析兩組得到各種精神疾病的風險。
結果: 燒燙傷世代個案數為2,231人,比較世代則為7,408人。與比較世代相比,燒燙傷世代有較高的適應障礙症、焦慮症、躁鬱症、憂鬱症、睡眠障礙、物質相關疾患以及人格障礙的發生率。而在校正干擾因子後,燒燙傷世代有較高罹患適應障礙症 (校正後風險比 [AHR]: 4.75; 95%信賴區間 [CI]: 1.26-17.92),憂鬱症(AHR: 9.91; 95% CI: 5.28-18.58), 以及物質相關疾患的風險 (AHR: 3.36; 95% CI: 1.52-7.45)。糖尿病、癌症以及較廣泛的燒傷表面積為燒燙傷後罹患精神疾病的顯著相關因子。
結論: 在一年的追蹤期間,重大燒燙傷與適應障礙症、憂鬱症以及物質相關疾患的罹病風險增加有關。對於燒燙傷患者的治療策略應包含精神疾病的監測和治療,尤以本研究辨認出的精神疾病為重點,讓燒燙傷患者得到完整的康復。
英文摘要 Background: Major burns that require hospitalizations pose psychiatric impacts on burn survivors, which are associated with poor outcomes. Studies on the risk of psychiatric disorders after burns have observed a large discrepancy, most likely because of different methodologies and limited sample sizes.
Objective: The aim of this study was to evaluate the risk of various psychiatric disorders after burns using a population-based study in Taiwan.
Methods: This retrospective cohort study used Taiwan National Health Insurance Research Database. The burn cohort included hospitalized individuals with burns diagnosed between 2000 and 2012, and the comparison cohort included hospitalized individuals for appendectomies. We excluded individuals who had any pre-existing psychiatric disorder before they had a diagnosis of burn or appendectomy. We traced each individual in the two cohorts for a one-year period and identified psychiatric disorders using insurance claims. Cox proportional hazards regression models were used to compare the risk of psychiatric disorders between the two cohorts.
Results: The burn cohort consisted of 2,231 individuals, and the comparison cohort consisted of 7,408 individuals. The incidences of many psychiatric disorders were higher in the burn cohort than in the comparison cohort including adjustment disorders, neurotic disorders, bipolar disorders, depressive disorders, sleep disorders, substance related disorders, and personality disorders. After adjusting the covariates, the burn cohort had higher risks of adjustment disorders (adjusted hazard ratio [AHR]: 4.75; 95% confidence interval [CI]: 1.26-17.92), depressive disorders (AHR: 9.91; 95% CI: 5.28-18.58), and substance related disorders (AHR: 3.36; 95% CI: 1.52-7.45). Diabetes mellitus, cancer, and more extensive of burned surface area were significant factors associated with developing psychiatric disorders after burns.

Conclusions: Major burns were associated with increased risks of adjustment disorders, depressive disorders and substance related disorders during the one-year period after the incident. Therapeutic strategy for burn survivors should include surveillance and treatment of psychiatric disorders, with an emphasis on those identified in this study, to achieve a complete recovery.
論文目次 Abstract in Chinese I
Abstract II
Acknowledgement IV
Lists of tables VII
List of figures VIII
I. Introduction 1
1. Background 1
2. Hypothesis 2
II. Literature Review 3
1. Epidemiology of burns 3
2. Physical complications after burns 4
3. Psychiatric sequelae after burns 5
3.1 Psychological responses in phases 5
3.2 Prevalence of psychiatric disorders after burns 6
3.3 Risk factors for developing psychiatric disorders after burns 7
III. Objective and Significance 8
1. Objective 8
2. Significance 8
IV. Materials and Methods 9
1. Data source 9
2. Identification of the burn cohort and the comparison cohort 9
3. Comparison of risk of various psychiatric disorders 10
4. Covariates 11
5. Statistical analyses 12
6. Ethics statement 13
V. Results 14
1. Descriptive characteristics of the study population 14
2. Incidence and risk of psychiatric disorders 14
3. Risk of psychiatric disorders stratified by characteristics of burns. 15
4. Factors associated with developing psychiatric disorders after burns. 15
5. The Kaplan-Meier curves for the cumulative risk 15
VI. Discussion 16
1. Study findings 16
2. Comparison with previous studies 16
2.1 Incidence of psychiatric disorders after burns 16
2.2 Adjustment disorders after burns 17
2.3 Depressive disorders after burns 18
2.4 Substance related disorders after burns 19
2.5 Risk factors for psychiatric disorders after burns 19
3. Strength and limitations 20
3.1 Strength 20
3.2 Limitations 21
VII. Conclusion 22
References 23
Appendix 32
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