廣泛性焦慮疾患與憂鬱疾患共病現象的階層病理模式

A Hierarchical Model for the Comorbidity of GAD and Depressive Disorder

Clark與Watson（1991）曾提出三元模式（tripartite model）解釋焦慮疾患與憂鬱疾患的共病現象。然而過去研究發現，三元模式中的生理激發（physiological arousal or autonomic arousal）因素並無法解釋廣泛性焦慮疾患（generalized anxiety disorder, GAD）與憂鬱疾患的共病問題（Mineka, Watson, & Clark, 1998）。本研究根據文獻回顧，提出在三元模式中加入認知憂慮因素的假設模式，且認為此假設模式更有助於解釋GAD與憂鬱疾患的共病現象。本研究收集286名受試者（178名大學生及108名一般民眾），利用結構方程模式（Structural Equation Modeling, SEM）進行觀察資料與假設模式契合度考驗。結果發現，本研究之假設模式與觀察資料的契合度良好，且契合程度優於三元模式及其他兩個競爭模式。最後本研究對此結果以及未來研究方向加以討論。

Clark and Watson (1991) have proposed a tripartite model to conceptualize the relationship between anxiety and depression. Nevertheless, controversial evidence has merged, suggesting that physiological arousal might be insufficient to realize the comorbidity of generalized anxiety disorder (GAD) and depressive disorders. Furthermore, other syndrome, namely apprehension (or worry), which being strongly related to GAD, was not included in the model. Taken together, we proposed a hypothesized model which included apprehension to account for the comorbidity and specificity of GAD and depression. Two hundred and eighty six adult participants were interviewed via a battery of self-report scales. Using structural equation modeling (SEM), we tested the proposed hypothesized model. Compared to the tripartite model and other two competing models, the SEM resulted in acceptable fit of the hierarchical model to account for the comorbidity and specificity of GAD and depression. The implications of the results and future research possibilities are discussed.