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系統識別號 U0026-1708201119512900
論文名稱(中文) 學齡兒童自我傷害行為心理社會模式驗證:以性別為調節變項
論文名稱(英文) Examining a psychosocial model of deliberate self-harm among elementary school-aged children: Gender as moderator
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 99
學期 2
出版年 100
研究生(中文) 叢均如
研究生(英文) Chun-Ju Tsung
學號 s8697102
學位類別 碩士
語文別 中文
論文頁數 80頁
口試委員 指導教授-柯慧貞
口試委員-黃惠玲
口試委員-鄭中平
中文關鍵字 自傷行為  憂鬱症狀  性別差異  兒童 
英文關鍵字 Deliberate self-harm  depressive symptoms  children  gender differences 
學科別分類
中文摘要 【研究背景】
自傷行為在兒童族群中是個很嚴重的問題,不論在生理或心理上均會造成負向影響,甚至會造成意外身亡的危險,因此兒童自傷行為的成因相當值得探討,其研究成果將有利於提供有效的預防及早期介入處置方案。
回顧過去文獻,兒童憂鬱症狀易導致自傷行為,但是如何產生兒童憂鬱症狀的歷程仍然未明;研究發現壓力與憂鬱症狀間的關係不穩定,且在成人及青少年群體,因應策略中的逃避因應策略可影響負向生活事件及憂鬱症狀之關係,在經驗到較多負向生活事件時,當個體使用越多逃避因應策略,可能造成憂鬱症狀的增加。目前未有研究驗證在兒童群體中此三者變項之間的關係,因此本研究欲探討在兒童群體中,逃避因應策略與負向生活事件和憂鬱症狀間的關係。
另外兒童憂鬱症狀與自傷行為間是否有其他變項影響,也是一個尚待釐清的問題。過去研究指出,自傷者缺乏適當的情緒調節策略,並多使用不適應的調節策略,因無法適當調節情緒,而使個體出現自傷行為。在不適應的情緒調節策略中,壓抑情緒表達已被證實與憂鬱症狀和自傷行為均為正相關,另外過度情緒表達與憂鬱症狀呈正相關,且是自傷行為的潛在危險因子之一,因此本研究假設憂鬱症狀可透過壓抑情緒表達、過度情緒表達的部分中介影響自傷行為。同時,考慮到過去研究發現自傷行為以及情緒表達歷程均可能有性別上的差異,故本研究亦將分開探討男性與女性的自傷行為,以澄清不同性別兒童是否在自傷行為歷程上會有所不同。
本研究試圖探討兒童自傷行為的成因與歷程,希望能夠對此臨床問題有所貢獻,並提出預防及早期介入方案的建議。

【研究目的】
1.探討負向生活事件、逃避因應策略、憂鬱症狀、壓抑情緒表達及過度情緒表達對兒童自傷行為的影響歷程,以及性別於歷程中所扮演的角色。
2.探討逃避因應策略與負向生活事件及兒童憂鬱症狀間的關係。
3.探討壓抑情緒表達及過度情緒表達在憂鬱症狀至自傷行為間所扮演的角色。

【研究方法】
1.參與者:以台南市三所國小四、五年級學生為樣本,在排除資料未填寫完全之參與者後,共454位學生納入研究分析。
2.研究工具:「基本資料問卷」、「兒童自我傷害行為問卷(Children’s Deliberate Self-harm Questionnaire, CDSQ)」、「兒童生活事件量表(Children’s Life Events Scale, CLES)」、「兒童因應策略量表(Children’s Coping Strategies Scale,CCSS)」、「兒童情緒行為檢核表(Child Behavioral and Emotional Checklist for Ages 4-16, CBECL/4-16)」、以及「兒童情緒調節量表(Children’s Emotion Regulation Scale,CERS)」。
3.研究程序:在取得人體試驗委員會同意後,取得家長及學童的同意書,以標準化施測程序於各校提供之場地分別進行團體施測,並於施測後進行資料的輸入及分析。
4.統計分析:針對研究問題,研究者將使用描述統計、相關分析、結構方程式模型來進行資料的分析。

【研究結果】
1.男性:負向生活事件與逃避因應的交互作用可預測憂鬱症狀;憂鬱症狀可透過過度情緒表達的部分中介預測自傷行為。
2.女性:負向生活事件可預測憂鬱症狀;憂鬱症狀可分別透過壓抑情緒表達及過度情緒表達的部分中介預測自傷行為。

【討論與建議】
本研究結果提供對學齡兒童自我傷害歷程之假設模式及驗證,以及其性別於歷程中所扮演的角色。研究結果顯示兒童自傷行為歷程有性別差異,建議未來發展兒童自傷行為介入方案時應考慮性別差異。此外,憂鬱症狀、壓抑情緒表達及過度情緒表達會增加自傷行為的危險性,建議應提早篩檢出憂鬱症狀程度高的兒童,將其視為高危險群提早介入,並增加自傷兒童的適應性情緒調節策略,以減少自傷行為的產生。
英文摘要 Objective. Deliberate self-harm is an important issue, especially among children, which causes physical damage and psychological suffering, and increases the risk of suicide. This study examines several risk factors for deliberate self-harm and explores how gender differences affect the relationships between each of the factors and their ability to predict deliberate self-harm.

Method. A comprehensive survey was conducted in a sample of 454 (218 boys, 236 girls) 4th- and 5th-grade Taiwanese children (mean age 10.19). The negative life events, avoidant coping, depressive symptoms, inhibited and disinhibited emotional expression, and deliberate self-harm were collected by self-report questionnaires.

Results. Structural Equation Modeling revealed that avoidant coping moderated the relationship between negative life events and depressive symptoms in boys only. Furthermore, the ability of depressive symptoms to predict deliberate self-harm was partially meditated by disinhibited emotional expression in both genders. However, the partial mediating effect of inhibited emotional expression to the relationship of depressive symptoms and deliberate self-harm were only existed in girls.

Conclusions. Results indicated that the process of deliberate self-harm was affected by genders among middle age children. Therefore, we should develop different treatment plans for deliberate self-harm for boys and girls. Furthermore, depressive symptoms and inadequate emotional expression might increase the risk of deliberate self-harm. Efforts should be made to detect high risk children who have depressive symptoms, and improved adaptive emotional regulation strategies of children.
論文目次 【目錄】
第一章 緒論-----------------------------------------------1
第一節 自傷行為--------------------------------------------1
壹、兒童自傷行為的嚴重性----------------------------------1
貳、自傷行為的盛行率-------------------------------------2
參、自傷行為的性別差異------------------------------------3
肆、小結-----------------------------------------------4
第二節 自傷行為之相關性探討:憂鬱症狀--------------------------4
壹、兒童憂鬱之定義與臨床表現-------------------------------5
貳、憂鬱症狀對自傷行為的影響-------------------------------6
參、過去研究尚待釐清之問題--------------------------------6
第三節 憂鬱症狀相關因素:負向生活事件與憂鬱症狀的關係-------------7
第四節 憂鬱症狀相關因素:逃避因應於負向生活事件與憂鬱症狀之
間扮演的角色----------------------------------------9
第五節 自傷行為之相關性探討:壓抑情緒表達及過度情緒表達-----------10
壹、憂鬱症狀、壓抑情緒表達與自傷行為之間的關係---------------11
貳、憂鬱症狀、過度情緒表達與自傷行為之間的關係---------------13
參、情緒表達之性別差異-----------------------------------13
肆、小結----------------------------------------------14
第六節 研究目的與假設--------------------------------------15
壹、過去研究缺失與未解決的問題----------------------------15
貳、研究目的-------------------------------------------15
參、研究假設-------------------------------------------16
第二章 研究方法-------------------------------------------17
第一節 研究參與者------------------------------------------17
第二節 研究工具-------------------------------------------17
壹、基本資料問卷----------------------------------------17
貳、兒童自我傷害行為問卷---------------------------------17
參、兒童生活事件量表------------------------------------18
肆、兒童因應策略量表------------------------------------18
伍、兒童情緒行為檢核表-----------------------------------19
陸、兒童情緒調節量表------------------------------------19
第三節 研究程序-------------------------------------------20
第四節 統計方法-------------------------------------------21
第三章 研究結果-------------------------------------------23
第一節 自傷組與非自傷組人口學變項與各研究變項之分析--------------23
第二節 各研究變項之相關分析---------------------------------23
第三節 假設模式驗證----------------------------------------24
壹、女性模式-------------------------------------------24
貳、男性模式-------------------------------------------24
第四章 討論----------------------------------------------26
第一節 本研究之主要發現與解釋-------------------------------26
第二節 本研究之限制與未來研究方向----------------------------29
第三節 本研究之應用價值------------------------------------30
壹、學術貢獻-------------------------------------------30
貳、臨床貢獻-------------------------------------------31
參考文獻 --------------------------------------------------32

【表目錄】
表一、『有效分析樣本』與『無效樣本』在基本人口學變項及各
量表得分分析-------------------------------------42
表二、『未自傷組』與『自傷組』在基本人口學變項及各量表得
分析-------------------------------------------43
表三、各研究變項之相關矩陣(女生)---------------------------44
表四、各研究變項之相關矩陣(男生)---------------------------45
表五、女生分析模式適配度評估摘要表--------------------------46
表六、男生分析模式適配度評估摘要表--------------------------47

【圖目錄】
圖一、兒童自傷行為歷程之假設模式圖--------------------------48
圖二、女生自傷行為歷程之驗證模式圖--------------------------49
圖三、男生自傷行為歷程之驗證模式圖--------------------------50

【附錄目錄】
附錄一、個人基本資料表-------------------------------------51
附錄二、兒童生活事件量表-----------------------------------52
附錄三、兒童因應策略量表-----------------------------------55
附錄四、兒童情緒行為檢核表---------------------------------57
附錄五、兒童情緒調節量表-----------------------------------65
附錄六、童自我傷害行為問卷---------------------------------70
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