台灣南部地區老年憂鬱情緒之影響因子探討

Factors of Geriatric Depression in Southern Taiwan

背景及目的：憂鬱不僅會引起負面情緒或消極心態，也會影響個人健康行為，使其罹患更多疾病或加速功能衰退，進而更加重憂鬱程度。此一身心交互影響歷程將形成惡性循環，導致醫療照護支出不斷攀升，故本研究擬從社會人口學資料和功能狀況等訊息找出和老年憂鬱相關的影響因子。
方法：有效樣本為台灣南部某直轄市65歲以上居民共2,444人。以性別、年齡、教育程度、是否具低收入戶身分等社會人口學資料，與是否領有身心障礙手冊、自覺健康情形、日常生活活動功能量表(ADL)分數、工具性日常生活活動量表(IADL)分數等功能狀況訊息為獨立變項，以老年憂鬱量表(GDS-S)分數為依變項，進行相關分析與迴歸分析。
結果：有效樣本中有1.8%具低收入戶身分、1.7%領有身心障礙手冊、70.3%與54.5%在ADL與IADL量表上得滿分、57.8%自覺健康情形好或很好、GDS-S量表總分平均為3.74±3.38分。相關分析發現所有社會人口學變項與功能變項都與憂鬱量表總分顯著相關，其中各功能變項的相關程度均高於各社會人口學變項。迴歸分析發現共4個變項(IADL分數、自覺健康情形、性別、年齡)達顯著解釋量(R2=0.33)，其中IADL分數具最大貢獻，可解釋22%憂鬱量表總分，自覺健康情形另增10%、女性與年齡增長相對不重要。
結論：本研究發現功能變項對估計憂鬱情緒之程度遠比社會人口學變項重要，其中IADL得分和自覺健康情形與GDS-S總分變化具正相關性，此結果可用以協助提高健康照護人員對高齡長者出現憂鬱情緒的敏感力，同時可提供未來預防老年憂鬱情緒之可能介入方向，使憂鬱長者能即時獲得必要協助。

Background and Purpose: Geriatric depression, the most prevalent mental health problem among older adults, will affect one’s health practice and increase the vulnerability to screen medical disease or functional decline. In turn, burden from physical illness would exacerbate consecutively. A vicious circle is expected and the usage and cost of health care services would inevitably increase. Therefore, it is necessary to identify the population at risk.
Methods: Totally 2,444 adults aged 65 years or more in Southern Taiwan completed the Geriatric Depression Scale (GDS-S), the Barthel Index (ADL) and the Lawton-Brody Instrumental Activities of Daily Living Scale (IADL). The participants were also asked to rate their current health condition. Socio-demographic data were collected, including age, gender, education, as well as whether the participant has been in the status of low-income households, or certified as physically or mentally disabled. Bivariate correlation and stepwise multiple linear regression analysis were conducted to analysis these data.
Results: There were 1.8% participants in the status of low-income households, 1.7% participants had the physical and mental disability handbook, 70.3% and 54.5% participants got full mark in ADL and IADL scales, and 57.8% participants had positive appraisal on their current health condition. The mean GDS-S score was 3.74±3.38. Bivariate correlation showed that all socio-demographic variables and functional status variables were significantly related to the GDS-S scores. Stepwise multiple linear regression analysis showed that four variables (the IADL score, the self-rated health, gender and age) were identified as significant explanatory factors. The four variables accounted for 33% of total variance of GDS-S score. Among them, the IADL score and the self-rated health explained 32% of the variance. Gender and age added to 1.0% of the total variance.
Conclusion: For predicting the degree of geriatric depressive symptoms, the functional status variables, especially the IADL score and the self-rated health, are more important than the socio-demographic variables Prospective studies are warranted to confirm that enhancing independent activity of daily living and improving the health self-management skill might be helpful for preventing the geriatric depression.