乳癌患者的反芻類型、因應之中介對憂鬱的關係

Rumination Subtypes and Coping as Pathways to Depressive Symptoms in Patients with Breast Cancer

研究目的：本研究提出深思反省是否有利於乳癌患者的心理適應需要考量憂鬱、苦惱自責與不同因應的影響—深思反省會透過趨近因應之中介，負向預測憂鬱；透過逃避因應之中介，正向預測憂鬱；反之，苦惱自責會干擾問題解決或增加負向因應，因此預測苦惱自責會負向預測趨近因應，正向預測逃避因應，進而增加憂鬱。研究方法：本研究於2010-2013年間在中部一所醫學中心的癌症門診募集304位初診斷、手術後三個月的乳癌患者，並於三個月後追蹤，於兩個時間點參與者均填答反應風格量表短版、簡明因應量表與醫院焦慮與憂鬱量表的憂鬱量尺。研究結果：以結構方程模式檢驗，發現模式適配度良好。苦惱自責與深思反省需透過因應而影響憂鬱，無法直接預測憂鬱。苦惱自責會增加逃避因應，而提高憂鬱；深思反省會因採用不同的因應，而對憂鬱有不同的影響。研究結論：有關癌症患者的反芻研究，深思反省是否為適應性反芻，也就是可否降低憂鬱？就本研究的結果來看，需考量其苦惱自責的程度，以及因應的中介，而非僅考量深思反省與憂鬱的關係。

Purpose: Research investigating the relationship between reflective pondering (RP) and depression has produced conflicting results. We propose that the type of coping utilized and the frequent co-occurrence of RP and brooding may account for these contradictory findings. Our longitudinal study extends previous work by including brooding and different types of coping. We hypothesized that RP is adaptive with approach coping, but maladaptive with avoidant coping. Brooding may interfere with problem solving. Thus, we also expect that brooding corresponds to increased avoidant coping and decreased approach coping, resulting in increased depressive symptoms. Methods: Breast cancer survivors (N = 304) were assessed longitudinally at 3 months and 6 months after surgery. Participants completed surveys assessing RP, brooding, approach and avoidant coping, and depressive symptoms. Results: We used structural equation modeling to assess the proposed mediation model. The data fit the model well. RP predicted reduced depressive symptoms through the use of approach coping, and increased depressive symptoms through the use of avoidant coping. Brooding predicted greater depressive symptoms through the pathway of avoidant coping. Conclusion: The current study fills gaps in the literature by demonstrating that, independent of brooding, RP differentially influences depressive symptoms through the pathways of approach and avoidant coping.