台灣九二一地震災難暴露對青少年創傷後壓力反應及社會關係的影響之性別差異

Gender- Distinct Effects of Trauma Exposure on Posttraumatic Stress Reactions and Social Relations in Adolescents Following the 921 Chi- Chi Earthquake in Taiwan

本研究提出「地震暴露－社會關係－創傷後壓力反應」（ESP）假設模式，目的在探討台灣九二一地震一年後，受創區的青少年暴露於災難下的經驗，如何影響其創傷後壓力反應以及社會關係，並試圖以性別差異為切入點來呈現此一歷程。本研究採用青少年地震暴露指標量表、UCLA PTSD量表以及台灣兒童及青少年關係量表，訪問震災受創區的青少年共871人。將研究參與者區分為男生（n = 450）和女生（n = 421）兩組，分別利用結構方程式進行模式檢驗和估計。結果發現，ESP模式能適當的解釋所觀察到的現象。客觀暴露程度越嚴重者，感受到的主觀威脅程度及傷害性社會關係越強，而傷害性社會關係對創傷後壓力反應的影響非常顯著。性別差異尤其彰顯於客觀地震暴露程度對男生之創傷後壓力反應有直接顯著的影響，而主觀威脅程度則對女生的創傷後壓力反應有直接顯著的影響。研究結果建議，在協助面臨災後壓力相關問題的青少年時，應注意性別差異的影響，且應將重點放在協助改善傷害性的社會關係上。

The Earthquake Exposure- Social Relations- Posttraumatic Stress (ESP) model was proposed to clarify the relations among trauma exposure (objective and subjective), social relations (supportive and detrimental), and posttraumatic stress responses. This study recruited the adolescents who had been exposed to a large- scale natural disaster, the Taiwan 921 Chi- Chi Earthquake. Gender-distinct effects of trauma exposure on social relations and PTSD severity were evaluated using the ESP model. The Earthquake Exposure Index for Youth, UCLA- PTSD Index, and Taiwan Relationship Inventory for Children and Adolescents were given to 871 adolescents living in the epicenter one year after the earthquake. The ESP model was evaluated and cross- validated by structure equation modeling (SEM) method using the data of both boys (n = 450) and girls (n = 421) separately. Results showed that the ESP model had good overall- fit for both genders. The subjective exposure had significantly greater positive effects on supportive social relations, and objective exposure had greater positive effects on detrimental social relations (especially for girls). Both supportive and detrimental social relations had significantly greater positive effects on PTSD severity. Specifically, the more supportive and/ or detrimental social relations the individual perceived, the greater their PTSD severity. The effects of detrimental social relation were relatively larger. Gender difference was found in the paths linking exposure and PTSD severity. While objective exposure had direct positive effects on PTSD severity for boys, subjective exposure had direct positive effects on PTSD severity for girls. These findings pointed out the importance to discriminate between subjective and objective exposure as well as between supportive and detrimental social relations for studying their relations to posttraumatic stress responses. It also suggested that, in helping adolescents exposed to trauma, we should take gender into consideration, and it may be more crucial to deal with detrimental social relations for posttraumatic adjustment.