日常活動參與在憂鬱症病人之反芻型反應與生活品質間之中介效應

Mediation Effects of Daily Activity Participation between Rumination and Subjective Quality of Life in Persons with Depression

目的：本研究主要在探討參與日常重要活動之主觀感受在憂鬱症病人的反芻型反應和生 活品質間之中介效應。方法：本研究共招募 143 位來自精神科門診或日間病房且被診斷罹患 憂鬱相關疾病的受試者，並利用自填量表來收集個案資料，包括中文版反芻型反應量表 (Ruminative Response Scale - Chinese version, RRS-C)、貝克憂鬱量表二版中文版 (Beck Depression Inventory-II, BDI-II)、活動參與及限制問卷 (Activity Participation and Restriction Questionnaire, APRQ) 及台灣簡明版世界衛生組織生活品質量表 (Brief World Health Organization Quality of Life Assessment-Taiwan version, WHOQOL-BREF) 等，再透過拔靴法進行中介效應分析。結 果：本研究發現日常重要活動之參與感及憂鬱的嚴重程度，在憂鬱症病人的反芻型反應及生 活品質之間存在顯著的中介效應 (p < 0.05)。結論：本研究利用中介分析模式說明日常重要 活動參與度和憂鬱程度，在憂鬱症病人的反芻型反應和生活品質間具有顯著的中介效應，因 此臨床治療發展方向除改善病人憂鬱症狀之外，亦要著重日常活動參與型態的改善，以減輕 憂鬱症病人反芻型反應所帶來的負面效應。

Objectives: In this study, we intended to examine whether rumination negatively affects the subjective feelings while the depressed persons participating their important daily activities, and to explore the mediation effects of daily activity participation between rumination and subjective quality of life. Methods: We recruited study participants from day care centers or clinics of several hospitals in Taiwan. Study instruments included the Ruminative Response Scale-Chinese version, Beck Depression Inventory-II, Activity Participation and Restriction Questionnaire, as well as Brief World Health Organization Quality of Life AssessmentTaiwan version. We analyzed the study data for mediating correlations between study groups. Results: We enrolled 143 participants in this study and found that all the inappropriate rumination indicators significantly affected daily activity participation by decreasing the sense of involvement in engaging daily activities and worsening the severity of depression, then impacted the subjective QoL of the depressed individuals (p < 0.05). Conclusion: This study achieved a mediation model in which the severity of depression and the activity participation have mediation effects between rumination and subjective QoL in depressed people. Interventions may be developed to specifically target on improving daily activity participation in reducing negative effects of rumination in depressed patients.