研究背景
研究大災難過後，影響心理狀態之研究多為短期橫斷式研究，大部分研究為成人的創傷症候群或重度憂鬱症，少有針對青少年心理健康問題的長期追蹤研究。因此，本研究以台灣地區1999年發生之921大地震為背景追蹤青少年心理健康問題。

研究目的
本研究以曾經歷過921地震的青少年，在地震後二年及四年，探討受地震不同影響程度的國中生，對其心理健康問題的影響。

研究方法
本研究採世代追蹤研究設計，使用之次級資料以台灣教育長期追蹤資料庫進行分析，抽樣範圍涵蓋全臺灣地區2001年國中一年級學生並追蹤至2003年。資料完整之研究對象共計12,497筆，分成三組（高/中/低）：高度影響組為家中親人因921地震死亡或重傷且自評生活受到影響者、中度影響組為家中親人因921地震死亡或重傷但自評生活未受到影響者、低度影響組為家中親人沒有因921地震死亡或重傷且自評生活未受到影響者。本研究以高度影響組居住地區都市化之比例頻匹配進行隨機抽樣分為1：1：2；高度影響組255人、中度影響組255人、低度影響組510人。資料蒐集方式使用結構式問卷，其中心理健康問題包括抑鬱傾向2題，身心症傾向2題，外向行為傾向3題，各題自評分數由1至4分。使用概化估計方程式(GEE)分析時間、組別及社會人口因子對心理健康問題的影響。

研究結果
三組在社會人口學特徵上沒有顯著差異。於地震兩年後高度影響組的身心症傾向及整體心理健康問題較低、中度影響組嚴重(P＜0.01)、外向行為傾向較低度影響組嚴重(P=0.015)；地震四年後三組沒有顯著差異。
GEE統計結果顯示，影響國中生整體心理健康問題的因子為組別、性別、時間及居住都市化發展程度，高度影響組比起低影響組，在整體心理健康問題增加0.94分(p＝0.003)，女生比男生增加0.74分（p＜0.001），居住都市比居住鄉村少0.6分(p＝0.03)、地震後4年(升國三)比地震後2年(國一)增加3.04分(p＜0.001) ，時間顯著的影響整體心理健康問題的惡化，時間與高度影響組交互作用項檢定值在臨界點上(P=0.05)。
其他不同心理健康問題分析結果發現與整體心理健康問題結果一致，抑鬱傾向的影響因子為組別、性別、時間；身心症傾向的因子為組別、性別、時間及時間與組別的交互作用；外向行為傾向的因子為組別、性別、時間及時間與組別的交互作用。

研究結論
本研究發現高度影響組的國一學生在地震後2年的心理健康問題的表現都顯著的較低度影響組更為嚴重，所有國中生自國一升國三期間，心理健康問題趨勢為越來越嚴重，但高度影響組的升國三學生在這兩年段期間變嚴重的程度較少。災後的心理健康服務，例如心理輔導及支持團體，應該在2年內長期的提供。同時，心理健康問題在國中生時期有變嚴重的趨勢，學校應該推動促進心理調適的計畫，特別是介入經歷天然災害後的女性學生及鄉下學生。

Background
Previous studies on post- disaster mental status were mostly short-term or cross-sectional, and targeting adult post- traumatic stress syndrome or major depression. There was little longitudinal study for adolescents. This study examined post-earthquake mental health problems in adolescents given the context of the large earthquake on Nov 21th, 1999 in Taiwan (The 921 Earthquake).

Research Objective
This study compared mental health problems among adolescents who were impacted by the earthquake of different levels at 2 and 4 years after the 921 Earthquake.

Methods
This study was a cohort study using secondary data from the Database of Taiwan Education Panel Survey. The cohort was sampled from all seventh grade students of Taiwan in 2001, and was followed in 2003. We divided 12,497 students with complete information for study variables into 3 groups by three different impact level of the earthquake (high, medium, low). The high- impact group was students whose family died and/or injured during the earthquake and who perceived their life being affected by the earthquake. The medium- impact group was students whose family died and/or injured during the earthquake and who perceived their life being unaffected by the earthquake. The low-impact group was students whose family did not die and/or injure and whose life was unaffected by the earthquake. We included all high-impact students and then used a sampling ratio of 1: 1: 2 (from high to low) to draw samples from the medium- and low- impact groups, given urbanization level of the students’ residence were matched according to its’ frequency distribution in the high-impact group. The final samples were 255, 255, and 510 students in the high, medium, and low impact groups. The data were collected through structured questionnaires. Mental health problems included 2 questions for depressed mood, 2 questions for psychosomatics, and 3 questions for externalizing behavior. These questions were scored from 1 to 4 (low to high). Linear regression using generalized estimating equations (GEE) was used to examine the effect of time, group, and socio-demographic factors on mental health problems after the earthquake.

Results
These three groups were not significantly different in socio- demographic characteristics. At 2 years after the earthquake, the high-impact group scored significantly higher in overall mental health problems and psychosomatics than medium- and low-impact groups. The high-impact group scored significantly higher in externalizing behavior than low-impact group. But there were no significant differences at 4 years after the earthquake.
The GEE models showed that factors affected the overall mental health problems were groups, gender, time and the degree of urbanization. High-impact group scored 0.94 points (p=0.003) higher in total mental health problems than low-impact group, while females scored 0.74 points (p<0.001) higher than males, and students scored 3.04 points (p<0.001) higher at 4 years comparing to 2 years after the earthquake. Living in city scored 0.6 points (p=0.03) less than living in rural area. The interaction of time and group were borderline significant (p=0.05), in that the high-impact group increased less in mental health problems between 2 to 4 years after earthquake.
The results for different mental problem outcomes were similar to the model of overall mental health problems. Factors affected depressed mood were the groups, gender, and time. Factors affected psychosomatics were groups, gender, time, and interaction between groups and time. Factors affected externalizing behaviors were the groups, gender, time, and interaction between groups and time.

Conclusions
We found that the students who were impacted highly by the earthquake had higher mental health problems at 2 years after the earthquake. All students deteriorated in mental health problems from 7th to 9th grades, but the high-impact students deteriorated to a lesser extent comparing to others. Post-disaster mental health services such as counseling or supportive groups should be provided for at least 2 years. Since mental health problems become severe through junior high school years, schools should provide programs promoting mental well-being among students. More attention should be given to female and rural students, as well as students who were impacted by nature disasters.

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誌謝…………………………………………………………………… i
中文摘要……………………………………………………………… ii
英文摘要……………………………………………………………… iv
目錄…………………………………………………………………… vi
圖目錄…………………………………………………………………viii
表目錄………………………………………………………………… ix
第一章 緒論………………………………………………………………1
第一節 研究動機及重要性 ……………………………………… 1
第二章 文獻探討…………………………………………………………5
第一節 青少年的心理問題發展……………………………………5
第二節 地震災害對心理健康狀態的衝擊…………………………7
第三節 青少年心理健康問題探討…………………………………10
第四節 社會人口學因子在心理健康的影響………………………13
第三章 研究方法 ………………………………………………………17
第一節 研究設計 …………………………………………………17
第二節 研究目的與架構 …………………………………………18
第三節 研究對象……………………………………………………21
第四節 研究工具……………………………………………………29
第五節 資料處理與分析……………………………………………36
第四章 研究結果 ………………………………………………………40
第一節 三組受921大地震不同影響程度之社會人口學變項分布情形…40
第二節 國中生於大地震後2年及4年各組心理健康問題之得分情形…43
第三節 大地震後影響國中生心理健康問題之組別及社會人口學變項…51
第五章 討論……………………………………………………………58
第一節 三組不同影響程度之國中生於大地震後2年及4年心理健康問題討論 ……………………………………………………………58
第二節 大地震後2年至4年間影響國中生心理健康問題之討論…63
第六章 結論與建議 ……………………………………………………67
第一節 結論與建議…………………………………………………67
第二節 研究限制與優勢……………………………………………71

參考文獻…………………………………………………………………74
附錄………………………………………………………………………81
附錄一 第一波(2001)國中學生問卷 …………………………………81
附錄二 第一波(2001)國中家長問卷 …………………………………98
附錄三 第二波(2003)國中學生問卷…………………………………113
附錄四 第二波(2003)國中家長問卷…………………………………127

圖目錄

圖2.1 青少年13歲至23歲憂鬱軌跡發展情……………………………6
圖3.1 921地震時間點及心理健康問題資料蒐集進程………………17
圖3.2 集集大地震等震圖 ……………………………………………18
圖3.3 研究架構圖 ……………………………………………………20
圖3.4 研究樣本篩選流程 ……………………………………………28
圖5.1 三組抑鬱傾向在震後2~4年的改變……………………………61
圖5.2 三組身心症傾向在震後2~4年的改變…………………………61
圖5.3 三組外發行為傾向在震後2~4年的改變………………………62
圖5.4 三組心理健康問題在震後2~4年的改變………………………62


表目錄

表2.1 青少年/孩童族群地震後心理健康問題研究一覽……………12
表3.1 台灣教育長期追蹤資料庫(TEPS)資料蒐集進程表 …………21
表3.2 台灣教育長期追蹤資料庫(TEPS)完訪數量說明 ……………23
表3.3 排除個案與追蹤個案之卡方檢定 ……………………………26
表3.4 研究族群社會人口學背景描述性統計(n=12,497) …………27
表3.5 心理健康問題之信度考驗(n=1,020)…………………………35
表4.1 三組之社會人口學背景分布情形(n=1,020)…………………42
表4.2 地震後2年國中生受影響程度之心理健康問題差異(n=1,020)……………………………………………………………………………48
表4.3 地震後4年國中生受影響程度之心理健康問題差異(n=1,020)……………………………………………………………………………49
表4.4 地震後2年及4年各組影響程度之國中生心理健康問題差異…………………………………………………………………………50
表4.5 模式一：探討抑鬱傾向之概化估計方程式…………………………………………………………………………54
表4.6 模式二：探討身心症傾向之概化估計方程式 ………………54
表4.7 模式三：探討外發行為傾向之概化估計方程式 ……………54
表4.8 模式四：探討心理健康問題之概化估計方程式 ……………55
表4.9 模式五：加入時間及時間*組別交互作用於抑鬱傾向之概化估計方程式…………………………………………………………………55
表4.10 模式六：加入時間及時間*組別交互作用於身心症傾向之概化估計方程式………………………………………………………………56
表4.11模式七：加入時間及時間*組別交互作用於外發行為傾向之概化估計方程式……………………………………………………………56
表4.12模式八：加入時間及時間*組別交互作用於心理健康問題之概化估計方程式 …………………………………………………………57

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