父母重病可能衝擊家庭經濟，也是造成子女內化行為問題的危險因子。過去研究對父母重病和子女內化行為的關係，傾向從個體心理層面因子尋找問題成因，對於連結兩者關係的路徑機制，以及結構面的社會經濟脈絡因素的探討不多。因此，本研究目的除了分析父母重病事件對臺灣青少年子女內化行為發展軌跡的影響外，也著重於探討家庭收入在父母重病和子女內化行為關係間的中介效果。

本研究為世代追蹤研究，使用「臺灣教育長期追蹤資料庫(Taiwan Education Panel Survey, TEPS」2001、2003和2005年三波調查進行次級資料分析。統計分析使用多元填補法處理遺漏值；以潛在成長模式分析青少年內化行為和家庭收入發展軌跡；採用潛在成長平行過程模型和拔靴法驗證家庭收入對父母重病和青少年內化行為關係的中介效果。

研究結果發現:1.臺灣青少年的內化行為問題隨時間的變動有增加的趨勢，但初始階段內化問題程度較高的青少年，後續內化行為問題成長的速率會變慢。2.父母曾重病的青少年，初始階段內化行為問題程度高於其他青少年，但波段成長速率相對較慢。所以父母曾重病對青少年內化行為問題程度的負面影響，有隨著時間慢慢減弱的趨勢。3.父母曾重病的青少年，初始階段家庭收入相對較低，但後續成長速率較快。青少年家庭收入起始值較高和成長速率越快，青少年的內化行為分數的成長速率會越慢，亦即經濟資源有延緩青少年內化行為問題惡化的效果。4.父母重病對於青少年內化行為的影響效果中，家庭收入發展軌跡的中介效果只存在於初始階段，長期中介效果並不明顯。

基於上述研究發現，本研究提出之政策建議為:1.建議《兒童及少年生活狀況調查報告》將「父/母重病」視為兒童及青少年發展過程的風險因子，列入調查問項中。2.整合相關扶助管道，於父母重病事件發生初期，針對家庭遭遇的經濟衝擊，包括醫療費用需要和家庭收入減少等困境提供醫療補助和生活津貼。3.於父母重病事件發生初期，提供青少年心理健康方面的支持性服務。

Parent's serious illness may have impact on family income and become the risk factor of adolescent internalizing behavior problems. However, previous researches on the relationship between parent's serious illness and adolescent internalizing behaviors intend to search causal factors from individual mental domain. Only few researches explored the influences of socio-economic factors and the connecting mechanisms.

The purposes of this study are to explore the effects of parent’s serious illness on the developmental trajectories of internalizing behavior problems of Taiwanese adolescent and to test the mediated effects of family income on the relationships between parent's serious illness and adolescent internalizing behaviors.

This is a longitudinal cohort study. Secondary data analysis was conducted from three-wave survey data of Taiwan Education Panel Survey (TEPS) in 2001, 2003 and 2005. Statistical methods are multiple imputation to deal with missing values; latent growth model (LGM) to analyze the developmental trajectories of adolescent behavior and family income; the parallel process latent growth model (PPLGM) and bootstrap method to verify mediated effect of family income on the relationship of parent's serious illness and adolescent internalizing behaviors.
Three research results were founded. First, trajectory of Taiwan adolescents’ seemed to be growing in a non-linear incremental curve. However, the higher the degree of problems at initial stage, the slower the growth rate of internalized problems of adolescent.

Second, adolescent whose parent had serious illness had higher degree of internalizing behavior problems than other adolescent at the initial status. However, the growth rate of internalizing behavior was relatively lower than others. Therefore, the negative effect of parent’s serious illness on the adolescent internalizing behavior problems decreased gradually as time goes by.

Third, adolescent whose parent had serious illness had relatively lower family income at the initial status. However, the growth rate of their family income was slightly higher than others. The higher the initial status and growth rate of family income of adolescent, the lower the growth rate of adolescent internalizing behaviors. This means economics resources may delay the deterioration of adolescent internalizing behavior problems.

Fourth, the mediate effect of developmental trajectory of family income on the relationship between parent’s serious illness and adolescent internalizing behavior problems was significant only at the initial status. It is not significant in the long term.

Based on the above findings, three suggestions to the government are as follows. First, should organize all supportive resources related to various medical subsidies and living allowances at the initial stage of parent’s serious illness to reduce the economic impact of high medical expenses on the reduction of family income. Second, should provide adolescence supportive services on mental health at the initial stage of parent’s serious illness. Third, should follow-up adolescent who do not seek further education to explore whether the factors are related to family negative life events or obstacles generated from internalizing behavior problems of the adolescent.

論文目錄
誌謝 I
摘要 II
Abstract III
目錄 V
表目錄 VII
圖目錄 VIII
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 4
第三節 研究重要性 5
第二章 文獻回顧 6
第一節 父母重病對青少年內化行為影響的實證研究 6
第二節 父母重病對青少年內化行為影響的家庭收入中介模型 24
第三節 父母重病對青少年內化行為影響中介模式之論證 36
第三章 研究方法 43
第一節 研究設計與研究架構 43
第二節 研究假說 45
第三節 研究對象及資料來源 46
第四節 變項定義與測量 47
第五節 資料處理與分析方法 53
第四章 研究結果 63
第一節 樣本基本特性 63
第二節 青少年內化行為發展軌跡的分析 70
第三節 父母曾重病對青少年內化行為發展軌跡的影響 74
第四節 家庭收入發展軌跡及其對青少年內化行為的影響 79
第五節 家庭收入的中介效果 84
第五章 討論 89
第一節 研究方法討論 89
第二節 研究結果討論 92
第三節 研究限制 95
第六章 結論與建議 96
第一節 研究結論 96
第二節 對衛生福利政策的建議 97
第三節 對未來研究的建議 99
參考文獻 100

表目錄
表2-1父母重病類型及相關研究 7
表2-2父母重病對未成年子女內化行為影響相關之量化研究 19
表2-3相關研究提及之父母重病對未成年子女影響的中介與調節因子 27
表2-4與父母重病有關之補助法規及其子法 34
表2-5 M-plus提供之常用模式適合度指標的數值範圍及理想數值 42
表3-1 TEPS 國中樣本第一至三波資料蒐集進程表 46
表3-2家庭收入的構念測量 47
表3-3內化行為的構念測量 48
表3-4內化行為測量項目參數估計結果 49
表3-5親子關係的構念測量 51
表3-6變項編碼或計分方式一覽表 52
表3-7第三波樣本分析變項含遺漏值之人數分布 55
表3-8 本研究操作化模型 57
表3-9本研究主要使用之統計方法 62
表4-1 TEPS不同波段樣本研究變項描述性統計和樣本差異檢定 64
表4-2青少年人口學變項分布與內化行為分數之組別差異 68
表4-3青少年內化行為潛在成長模型適配度指標摘要 71
表4-4 青少年內化行為非線性成長曲線模型參數估計結果 73
表4-5「父母曾重病」對青少年內化行為影響的有條件潛在成長模型分析摘要 77
表4-6青少年內化行為中介效果模式相關潛在成長模型分析摘要 80
表4-7家庭收入對父母重病與青少年內化行為的中介效果拔靴法估計結果 85
表4-8單一填補樣本的中介效果拔靴法估計結果 88
表5-1研究假說驗證結果摘要 92

圖目錄
圖2-1父母重病影響青少年內化行為的家庭收入中介模式 30
圖2-2兩變項簡單模式 38
圖2-3單一中介變項模式 39
圖3-1研究架構 44
圖3-2本研究資料處理流程圖 54
圖3-3 模型1青少年內化行為線性潛在成長測量模式概念性路徑關係 58
圖3-4模型2非線性潛在成長測量模式概念性路徑關係 59
圖3-5模型3有條件潛在成長模型的概念性路徑關係 60
圖4-1青少年第一波內化行為分數人數分布圖 65
圖4-2青少年第二波內化行為分數人數分布圖 66
圖4-3青少年第三波內化行為分數人數分布圖 66
圖4-4青少年內化行為分數發展軌跡─父/母曾重病分組 67
圖4-5模型1線性潛在成長模型參數估計結果 70
圖4-6模型2非線性潛在成長模型參數估計結果 72
圖4-7模型4父母重病對青少年內化行為影響的參數估計結果 78
圖4-8模型5父母重病對家庭收入發展軌跡影響的參數估計結果 81
圖4-9模型6 家庭收入對青少年內化行為發展軌跡影響的參數估計結果(省略控制變項之簡化圖) 83
圖4-10模型7家庭收入中介效果模型參數估計結果(省略控制變項之簡化圖) 86

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