素質壓力模式探討童年負向經驗與憂鬱焦慮的關係——以台灣大學生為例

Exploring the relationship between adverse childhood experience and depression and anxiety from the point of view of diathesis-stress model: taking college students in Taiwan for example

研究目的：在諸多大學生焦慮憂鬱的成因中，童年負向經驗是近年來逐漸受到矚目的議題。童年負向經驗是指兒童在生命早期所遭遇的強烈且頻繁的壓力來源，包括虐待、忽視、嚴重的家庭功能障礙以及同伴、社區和集體暴力（WHO，2018）。本研究目的即以素質—壓力模式探討童年負向經驗是否具有素質的特性，會與壓力共同作用，影響大學生的憂鬱焦慮。研究方法：招募年滿20歲的大學生284名，包括兒福相關機構及一般大學生。經中國醫藥大學暨附設醫院研究倫理中心（CRREC-111-08）審核通過，知情同意後施測童年負向經驗國際版量表ACE-IQ）及憂鬱焦慮壓力量表DASS-21）。研究結果1.素質-壓力模式得到驗證，童年負向經驗及壓力皆與憂鬱、焦慮顯著相關，且兩者的交互作用能夠顯著解釋憂鬱（t = 4.704, p < .001）焦慮（t = 8.678, p < .001）。2.童年負向經驗不同的類別對憂鬱焦慮有不同的解釋力，最佳預測憂鬱焦慮的ACE類別為「情緒疏忽」、「與患有精神疾病或有自殺傾向的家庭成員一起生活」、「性虐待」、「身體虐待」、「目睹」及「社區暴力」，綜合憂鬱焦慮的迴歸分析因子得到一個新的ACE總分ACE Brief）。3.不同性別所受到的童年負向經驗類別也有所差異，男性受試者在「身體虐待」、「霸凌」及「社區暴力」（t = 2.600、2.022、2.039, p = .011、.046、.044）的經驗較女性受試者多，而女性受試者在「身體疏忽」及「性虐待」（t = 2.123、3.068, p = .035、.002）的經驗較男性受試者多。一般大學生的ACE總分與博幼的服務對象未達顯著差異但一般大學生所感受到的焦慮（t = 2.220, p = .027）跟壓力（t = .2.786, p = .006）顯著高於博幼的服務對象。結論：童年負向經驗具有素質的特性，與壓力的交互作用能夠顯著解釋憂鬱焦慮。博幼的服務對象雖然有「貧窮」的屬性，但不見得是一種童年負向經驗。未來進行童年負向經驗與憂鬱焦慮的相關測量，ACE Brief提供了簡便的參考指標。本研究根據研究結果提出建議，以供預防性實務工作及未來研究方向參考。

Concept:
Among the causes of depression and anxiety in college students, adverse childhood experiences (ACE) have gradually attracted attention in recent years. Adverse childhood experiences refer to intense and frequently occurring sources of stress that children may suffer early in life, including abuse, neglect, serious household dysfunction and peer, community and collective violence (WHO, 2018). This study aims to test whether the adverse childhood experiences have the characteristics of diathesis, and whether it works together with stress to affect the depression and anxiety of college students.
Methods:
284 college students over age of 20 were recruited, including those who ever attended tutoring services of Boyo social welfare foundation and general college students. This study was approved by the China Medical University & Hospital Research Ethics Center (CRREC-111-085). After informed consent, the Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Depression Anxiety Stress Scale (DASS-21) were administered.
Results:
1. The diathesis-stress model has been verified. Both ACE and stress are significantly related to depression and anxiety, and the interaction between these two could significantly explain depression (t = 4.704, p < .001) and anxiety (t = 8.678, p < .001). 2. Different categories of ACE have different explanatory powers for depression and anxiety. The ACE categories that best predict depression and anxiety are ’’emotional neglect’’, ’’someone chronically depressed, mentally ill, institutionalized or suicidal’’,’’sexual Abuse,’’ ’’physical abuse’’, ’’household member treated violently’’ and ’’community violence.’’ A new index of ACE score (ACE Brief) was obtained from the regression analysis factor of depression and anxiety. 3. Gender differences of ACE are proved. Male have more experience in ’’physical abuse’’, ’’bullying’’ and ’’community violence’’ (t = 2.600, 2.022, 2.039, p = .011, .046, .044) than female, while female have more experience in ’’physical neglect’’ and ’’sexual abuse’’ (t = 2.123, 3.068, p = .035, .002) than male. There is no significant difference between general college students’ACE total score and the Boyo students’ones, but the anxiety (t = 2.220, p = .027) and pressure (t = .2.786, p = .006) of general college students are significantly higher than ones of the Boyo students.
Conclusion:
ACE has the characteristics of diathesis, and the interaction with stress can significantly explain depression and anxiety. Although the Boyo students have the charactor of ’’poverty’’, it is not necessarily meant to be an adverse childhood experience. ACE Brief provides an index for the level of depression and anxiety. Based on this study findings, recommendations for preventive practice work and future research directions were made.