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題名 探討老化自我覺知、疾病認知及負向情緒與疾病適應結果之關係-以老年膝骨關節炎病人為例
Exploring the Relationships among Self-perception of Aging, Illness Perception, Negative Emotion and Illness Adaption - Taking Elderly Knee Osteoarthritis Patients for Example作者 邱泓達
Chiu, Hung-Ta貢獻者 吳治勳
邱泓達
Chiu, Hung-Ta關鍵詞 膝骨關節炎
老化自我覺知
疾病認知
負向情緒
憂鬱
焦慮
疾病適應
Osteoarthritis
Self-perception of aging
Illness perception
Negative emotion
Anxiety
Depression
Illness adaptation日期 2023 上傳時間 6-Jul-2023 16:58:29 (UTC+8) 摘要 研究背景:年長者如何同時經驗「老化」與「疾病」這兩個歷程,將影響其情緒與疾病適應。本研究以膝骨關節炎病人作為研究對象,探討老化自我覺知、疾病認知、及負向情緒對疾病適應之影響。研究方法:本研究為橫斷性研究,以北部某醫學中心之家醫部門診診斷有膝骨關節炎之病人為對象。請研究參與者寫台大醫院疼痛門診評估量表、國際身體活動量表(台灣短版)、短版疾病認知量表、台灣老化態度量表、台灣簡明版世界衛生組織生活品質量表、貝克焦慮量表、及貝克憂鬱量表第二版。本研究採取路徑分析,研究模式一檢驗老化自我覺知、負向情緒及疾病認知之關係,並探討疾病認知之中介效果;研究二檢驗老化自我覺知、疾病認知、負向情緒及疾病適應結果-疼痛嚴重度、身體活動程度及生活品質(生理、心理、環境及社會)-之關係,並探討負向情緒之中介效果。後續以65歲區分高、低年齡組,以多組別路徑分析檢驗年齡於各模式之調節效果。研究結果:本研究共納入66位膝骨關節炎病人。模式一路徑分析結果顯示「負向老化自我覺知」在「疾病認知各向度」中皆能正向預測「焦慮程度」,並在「個人控制感」與「理解程度」模型中可正向預測「憂鬱程度」;「正向老化自我覺知」可負向預測「疾病結果」與「情緒認知反應」;但所有中介效果均不顯著。模式二路徑分析結果顯示「正向老化自我覺知」在「疾病認知各向度」模型中皆可正向預測「心理生活品質」、「生理生活品質」及「社會生活品質」;「負向老化自我覺知」在「疾病結果、時間性、個人控制感、疾病結果、認知情緒反應」模型中可負向預測「生理生活品質」;「正向老化自我覺知」經「疾病結果」對「生理生活品質」之間接效果達正向顯著、對「近一週身體活動度」之間接效果達正向顯著、對「近期疼痛嚴重度」之間接效果達負向顯著,且皆為完全中介。因臨床觀察負向情緒確實影響膝骨關節炎病人之調適,故追加以模式三檢驗老化自我覺知、負向情緒及疾病適應結果。模式三路徑分析結果顯示「負向老化自我覺知」可正向預測「焦慮程度」;「正向老化自我覺知」可正向預測「生活品質各向度」;「負向老化自我覺知」經「焦慮情緒/憂鬱情緒」對「生理生活品質」、「心理生活品質」及「環境生活品質」之間接效果達負向顯著、對「近期疼痛嚴重度」之間接效果達正向顯著。在年齡分組上,模式二顯示低年齡組「疾病結果」對「生理生活品質」、「環境生活品質」及「社會生活品質」之預測上達負向顯著,年齡具調節效果。模式三結果顯示「正向老化自我覺知」與「憂鬱程度」在高年齡組分別對「生活品質」不同向度之預測性有顯著,而低年齡組中「負向老化自我覺知」可正向預測「負向情緒」,而「焦慮程度」可負向預測「生理生活品質」與「心理生活品質」,但無調節效果。討論:本研究發現老化自我覺知會透過疾病認知(尤其是疾病結果)或負向情緒兩種歷程影響膝骨關節炎病人的疾病適應,並且藉由年齡分組可以得知對於不同年齡層之膝骨關節炎病人,「老」與「病」影響的歷程可能有所不同,「病」對於低年齡組較有直接影響,而「老」會影響低年齡組之情緒,進而影響其適應,另一方面「老」則可能對高年齡組較有直接影響。本研究結果應有助於理解台灣膝骨關節炎病人之適應歷程,盼藉此對病人之疾病適應有所幫助,並提供探討老化自我覺知對年長病人面對疾病或生活,其潛在心理歷程之可能研究方向。
Background: When the elderly faced “aging” and “illness” at the same time, their subjective experience of the two process would influence their emotion and illness adaptation. This study chose patients with knee osteoarthritis(KOA) as research subject to explore the influence of self-perception of aging, illness perception, and negative emotions on illness adaptation.Methods: This study is a cross-sectional study. Participants in this study were patients with KOA in the department of family medicine of a medical center in north Taiwan. They filled out “the Revision of the Pain Assessment Scale Taiwan”, “the Taiwan Version of International Physical Acticity Questionnarie - Short Form”, “the Breif Illness Perception Questionnaire”, “the Taiwan Attitude toward Aging Questionnaire”, “World Health Organization Qulity of Life - BREF”, “the Beck’s Anxiety Inventory”, and “the Beck Depression Inventory II”. This study use path analysis to test the relationship among self-perception of aging, illness perception, and engative emotions and explore the mediation effect of illness perceptionin study 1. In study 2, path analysis was used to test the relatoinship among self-perception, illness perception, negative emotions, and quality of life(physiological, psychological, environmental, and social domain) and explore the mediation effect of negative emotions. Furthermore, this study divided all participants into two groups by 65 ages, and multi-group path analysis was used to test the moderate effect of age between the older group and the younger group.Results: A total of 66 patients with KOA were include in this study. Path analysis in study 1 shows the following results: “Negative self-perception of aging” could positive predict “anxiety level” in all illness perception model, and could positive predict “depression level” in “personal control” and “comprehension” model; “Positive self-perception of aging” could negative predict “consequences” and “emotional representation”; There is no significant indirect effect in study 1. Path analysis in study 2 shows the following results: “Positive self-perception of aging” could positive predict “psychological quality of life”, “environmental quality of life”, and “social quality of life” in all illness perception model; “Negative self-perception of aging” could negative predict “physiological quality of life” in “consequense”, “timeline”, “personal control”, “identity” and “emtional representation” model; “Positive self-perception of aging” has positive and significant indirect effect on “physiological quality of life” and “physical activity in the past week” via “consequence”. In addition, “Positive self-perception of aging” has negative and significant indirect effect on “recent pain severity” via “consequence”. These three significant indirect effect are complete mediation. There are some phenomena that patients with KOA could be observed negative emotions affect their adaptation in clinical situation, so this study added study 3 to test the relationship among ”self-perception of aging”, “negative emotions”, and “illness adaptation”. Path analysis in study 3 shows the following results: “Negative self-perception of aging” could positive predict “anxiety level”; “Positive self-perception of aging” could positive predict all dimension of quality of life; “Negative self-preception of aging” has negative and significant indirect effect on “physiological quality of life”, “psychological quality of life”, and “environmental quality of life” via “negative emotions”. In addition, “Negative self-preception of aging” has positive and significant indirect effect on “recent pain severity” via “negative emotions”. The multi-group path analysis shows the following results:In study 2, “Consequence” could negative predict “physiological quality of life”, “environmental quality of life”, and “social quality of life” in the younger group, which means there is moderate effect by age. In study 3, “Positive self-perception of aging” and ”depression” could separately predict different domain of “illness perception” in the older group. In the younger group, “negative self-perception of aging” could positively predict “negative emotions”, and “anxiety level” could negatively predict “physiological quality of life” and “psychological quality of life”. However, there are no moderate effect in study 3.Discussion: In couclusion, self-perception of aging would affect illness adaptation of patients with KOA through illness perceptin(especially consequence) or negative emotions. Based on the multi-group path analysis, it could be known that ‘aging’ and “illness” may have different influence on the patients with KOA in different age group. In the younger group, “illness” could directly affect illness adaptation, and “aging” could affect illness adaptation via negative emotions. On the other hand, “aging” may directly affect illness adaptation in the older group. this study expands the understanding of the adapational process of patients with KOA in Taiwan, looking forward to helping patients with KOA with better illness adaptation. 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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(4), 214-215. https://doi.org/10.1093/geronb/58.4.P214 描述 碩士
國立政治大學
心理學系
108752020資料來源 http://thesis.lib.nccu.edu.tw/record/#G0108752020 資料類型 thesis dc.contributor.advisor 吳治勳 zh_TW dc.contributor.author (Authors) 邱泓達 zh_TW dc.contributor.author (Authors) Chiu, Hung-Ta en_US dc.creator (作者) 邱泓達 zh_TW dc.creator (作者) Chiu, Hung-Ta en_US dc.date (日期) 2023 en_US dc.date.accessioned 6-Jul-2023 16:58:29 (UTC+8) - dc.date.available 6-Jul-2023 16:58:29 (UTC+8) - dc.date.issued (上傳時間) 6-Jul-2023 16:58:29 (UTC+8) - dc.identifier (Other Identifiers) G0108752020 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/145913 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學系 zh_TW dc.description (描述) 108752020 zh_TW dc.description.abstract (摘要) 研究背景:年長者如何同時經驗「老化」與「疾病」這兩個歷程,將影響其情緒與疾病適應。本研究以膝骨關節炎病人作為研究對象,探討老化自我覺知、疾病認知、及負向情緒對疾病適應之影響。研究方法:本研究為橫斷性研究,以北部某醫學中心之家醫部門診診斷有膝骨關節炎之病人為對象。請研究參與者寫台大醫院疼痛門診評估量表、國際身體活動量表(台灣短版)、短版疾病認知量表、台灣老化態度量表、台灣簡明版世界衛生組織生活品質量表、貝克焦慮量表、及貝克憂鬱量表第二版。本研究採取路徑分析,研究模式一檢驗老化自我覺知、負向情緒及疾病認知之關係,並探討疾病認知之中介效果;研究二檢驗老化自我覺知、疾病認知、負向情緒及疾病適應結果-疼痛嚴重度、身體活動程度及生活品質(生理、心理、環境及社會)-之關係,並探討負向情緒之中介效果。後續以65歲區分高、低年齡組,以多組別路徑分析檢驗年齡於各模式之調節效果。研究結果:本研究共納入66位膝骨關節炎病人。模式一路徑分析結果顯示「負向老化自我覺知」在「疾病認知各向度」中皆能正向預測「焦慮程度」,並在「個人控制感」與「理解程度」模型中可正向預測「憂鬱程度」;「正向老化自我覺知」可負向預測「疾病結果」與「情緒認知反應」;但所有中介效果均不顯著。模式二路徑分析結果顯示「正向老化自我覺知」在「疾病認知各向度」模型中皆可正向預測「心理生活品質」、「生理生活品質」及「社會生活品質」;「負向老化自我覺知」在「疾病結果、時間性、個人控制感、疾病結果、認知情緒反應」模型中可負向預測「生理生活品質」;「正向老化自我覺知」經「疾病結果」對「生理生活品質」之間接效果達正向顯著、對「近一週身體活動度」之間接效果達正向顯著、對「近期疼痛嚴重度」之間接效果達負向顯著,且皆為完全中介。因臨床觀察負向情緒確實影響膝骨關節炎病人之調適,故追加以模式三檢驗老化自我覺知、負向情緒及疾病適應結果。模式三路徑分析結果顯示「負向老化自我覺知」可正向預測「焦慮程度」;「正向老化自我覺知」可正向預測「生活品質各向度」;「負向老化自我覺知」經「焦慮情緒/憂鬱情緒」對「生理生活品質」、「心理生活品質」及「環境生活品質」之間接效果達負向顯著、對「近期疼痛嚴重度」之間接效果達正向顯著。在年齡分組上,模式二顯示低年齡組「疾病結果」對「生理生活品質」、「環境生活品質」及「社會生活品質」之預測上達負向顯著,年齡具調節效果。模式三結果顯示「正向老化自我覺知」與「憂鬱程度」在高年齡組分別對「生活品質」不同向度之預測性有顯著,而低年齡組中「負向老化自我覺知」可正向預測「負向情緒」,而「焦慮程度」可負向預測「生理生活品質」與「心理生活品質」,但無調節效果。討論:本研究發現老化自我覺知會透過疾病認知(尤其是疾病結果)或負向情緒兩種歷程影響膝骨關節炎病人的疾病適應,並且藉由年齡分組可以得知對於不同年齡層之膝骨關節炎病人,「老」與「病」影響的歷程可能有所不同,「病」對於低年齡組較有直接影響,而「老」會影響低年齡組之情緒,進而影響其適應,另一方面「老」則可能對高年齡組較有直接影響。本研究結果應有助於理解台灣膝骨關節炎病人之適應歷程,盼藉此對病人之疾病適應有所幫助,並提供探討老化自我覺知對年長病人面對疾病或生活,其潛在心理歷程之可能研究方向。 zh_TW dc.description.abstract (摘要) Background: When the elderly faced “aging” and “illness” at the same time, their subjective experience of the two process would influence their emotion and illness adaptation. This study chose patients with knee osteoarthritis(KOA) as research subject to explore the influence of self-perception of aging, illness perception, and negative emotions on illness adaptation.Methods: This study is a cross-sectional study. Participants in this study were patients with KOA in the department of family medicine of a medical center in north Taiwan. They filled out “the Revision of the Pain Assessment Scale Taiwan”, “the Taiwan Version of International Physical Acticity Questionnarie - Short Form”, “the Breif Illness Perception Questionnaire”, “the Taiwan Attitude toward Aging Questionnaire”, “World Health Organization Qulity of Life - BREF”, “the Beck’s Anxiety Inventory”, and “the Beck Depression Inventory II”. This study use path analysis to test the relationship among self-perception of aging, illness perception, and engative emotions and explore the mediation effect of illness perceptionin study 1. In study 2, path analysis was used to test the relatoinship among self-perception, illness perception, negative emotions, and quality of life(physiological, psychological, environmental, and social domain) and explore the mediation effect of negative emotions. Furthermore, this study divided all participants into two groups by 65 ages, and multi-group path analysis was used to test the moderate effect of age between the older group and the younger group.Results: A total of 66 patients with KOA were include in this study. Path analysis in study 1 shows the following results: “Negative self-perception of aging” could positive predict “anxiety level” in all illness perception model, and could positive predict “depression level” in “personal control” and “comprehension” model; “Positive self-perception of aging” could negative predict “consequences” and “emotional representation”; There is no significant indirect effect in study 1. Path analysis in study 2 shows the following results: “Positive self-perception of aging” could positive predict “psychological quality of life”, “environmental quality of life”, and “social quality of life” in all illness perception model; “Negative self-perception of aging” could negative predict “physiological quality of life” in “consequense”, “timeline”, “personal control”, “identity” and “emtional representation” model; “Positive self-perception of aging” has positive and significant indirect effect on “physiological quality of life” and “physical activity in the past week” via “consequence”. In addition, “Positive self-perception of aging” has negative and significant indirect effect on “recent pain severity” via “consequence”. These three significant indirect effect are complete mediation. There are some phenomena that patients with KOA could be observed negative emotions affect their adaptation in clinical situation, so this study added study 3 to test the relationship among ”self-perception of aging”, “negative emotions”, and “illness adaptation”. Path analysis in study 3 shows the following results: “Negative self-perception of aging” could positive predict “anxiety level”; “Positive self-perception of aging” could positive predict all dimension of quality of life; “Negative self-preception of aging” has negative and significant indirect effect on “physiological quality of life”, “psychological quality of life”, and “environmental quality of life” via “negative emotions”. In addition, “Negative self-preception of aging” has positive and significant indirect effect on “recent pain severity” via “negative emotions”. The multi-group path analysis shows the following results:In study 2, “Consequence” could negative predict “physiological quality of life”, “environmental quality of life”, and “social quality of life” in the younger group, which means there is moderate effect by age. In study 3, “Positive self-perception of aging” and ”depression” could separately predict different domain of “illness perception” in the older group. In the younger group, “negative self-perception of aging” could positively predict “negative emotions”, and “anxiety level” could negatively predict “physiological quality of life” and “psychological quality of life”. However, there are no moderate effect in study 3.Discussion: In couclusion, self-perception of aging would affect illness adaptation of patients with KOA through illness perceptin(especially consequence) or negative emotions. Based on the multi-group path analysis, it could be known that ‘aging’ and “illness” may have different influence on the patients with KOA in different age group. In the younger group, “illness” could directly affect illness adaptation, and “aging” could affect illness adaptation via negative emotions. On the other hand, “aging” may directly affect illness adaptation in the older group. this study expands the understanding of the adapational process of patients with KOA in Taiwan, looking forward to helping patients with KOA with better illness adaptation. Furthemore, this study could provide a potential psychological process which influence the elderly’s illness or life adaptation. en_US dc.description.tableofcontents 謝誌摘要 iii目錄 viii圖目錄 xiii第一章、前言 1第二章、文獻回顧 4第一節、骨關節炎 4一、 骨關節炎特性與適應 4二、 老化態度與疾病認知對膝骨關節炎病人之影響 7三、 骨關節炎病人的情緒困擾 8第二節、老化自我覺知 11一、 老化 11二、 老化態度 – 刻板印象與自我覺知 13三、 老化自我覺知與負向情緒之關係 20第三節、疾病認知 24一、 疾病認知心理模型 24二、 老化與疾病認知 26三、 疾病認知與負向情緒 28第四節、小結 30第五節、研究架構及假設 32一、 模式一:老化自我覺知、負向情緒與疾病認知之關係 33二、 模式二:老化自我覺知、疾病認知與負向情緒三者與疾病適應結果之關係 35第三章、研究方法 37第一節、研究參與者與研究流程 37第二節、研究工具 38第三節、資料分析 42一、 資料與遺漏值處理 42二、 描述統計 43三、 量表信度檢測 43四、 路徑分析 43第四章、研究結果 46第一節、樣本概述與各變項描述統計 46第二節、量表信度檢驗 49第三節、控制變項之檢驗 50一、 獨立樣本t檢定 50二、 單因子獨立樣本變異數分析 54三、 年齡與BMI之皮爾森積差相關分析 59第四節、全樣本路徑分析 62一、 模式一之全樣本路徑分析 62二、 模式二之全樣本路徑分析 69三、 老化自我覺知、負向情緒及疾病適應結果之全樣本路徑分析 86第五節、年齡分組路徑分析 97一、 模式二之年齡分組路徑分析 97二、 模式三之年齡分組路徑分析 126第五章、討論與結論 134第一節、老化自我覺知、疾病認知及負向情緒的關係 134第二節、老化自我覺知、疾病認知、負向情緒及疾病適應結果 137一、 老化自我覺知、疾病認知及疾病適應結果 137二、 老化自我覺知、負向情緒及疾病適應結果 144第三節、年齡對老化自我覺知、疾病認知、負向情緒及疾病適應結果之調節效果 149一、 年齡對老化自我覺知、疾病認知及疾病適應結果之影響 149二、 年齡對老化自我覺知、負向情緒及疾病適應結果之影響 156第四節、結論 161一、 研究貢獻與應用 161二、 研究限制與未來方向 164中文參考文獻 166英文參考文獻 168附錄 182一、 基本資料與膝骨關節炎疼痛評估 182二、 IPAQ台灣活動量調查短版問卷 183三、 短版疾病認知量表 186四、 台灣老化態度量表之老化自我覺知分量表 187五、 台灣簡明版世界衛生組織生活品質量表 188 zh_TW dc.format.extent 10076998 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0108752020 en_US dc.subject (關鍵詞) 膝骨關節炎 zh_TW dc.subject (關鍵詞) 老化自我覺知 zh_TW dc.subject (關鍵詞) 疾病認知 zh_TW dc.subject (關鍵詞) 負向情緒 zh_TW dc.subject (關鍵詞) 憂鬱 zh_TW dc.subject (關鍵詞) 焦慮 zh_TW dc.subject (關鍵詞) 疾病適應 zh_TW dc.subject (關鍵詞) Osteoarthritis en_US dc.subject (關鍵詞) Self-perception of aging en_US dc.subject (關鍵詞) Illness perception en_US dc.subject (關鍵詞) Negative emotion en_US dc.subject (關鍵詞) Anxiety en_US dc.subject (關鍵詞) Depression en_US dc.subject (關鍵詞) Illness adaptation en_US dc.title (題名) 探討老化自我覺知、疾病認知及負向情緒與疾病適應結果之關係-以老年膝骨關節炎病人為例 zh_TW dc.title (題名) Exploring the Relationships among Self-perception of Aging, Illness Perception, Negative Emotion and Illness Adaption - Taking Elderly Knee Osteoarthritis Patients for Example en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 行政院主計總處(2021年12月6日):〈國情統計通報(第231號)109年65歲以上高齡者健保費用占39.8%〉。2022年8月23日取自:https://www.stat.gov.tw/News.aspx?n=2661&sms=11020&_CSN=0&page=12&PageSize=20車先蕙、盧孟良、陳錫中、張尚文、李宇宙(2006):〈中文版貝克焦慮量表之信效度〉。《台灣醫學》,10(4),449-454。https://doi.org/10.6320/FJM.2006.10(4).05吳治勳(2010):《對老的刻板印象、老化自我覺知及最適老化》(博士論文,國立台灣大學心理學系暨研究所),臺灣博碩士論文知識加值系統,https://hdl.handle.net/11296/sgnqf7。https://doi.org/10.6342/NTU.2010.01398吳政龍(2018):〈長期以蹲跪姿勢工作引起之膝關節骨關節炎認定參考指引〉。勞動部職業安全衛生署。2022年12月10日取自:https://tmsc.osha.gov.tw/news1cont.asp?kk=204姚開屏(2002):〈台灣版世界衛生組織生活品質問卷之發展與應用〉。《台灣醫學》,6(2),193-200。https://doi.org/10.6320/FJM.2002.6(2).09陳毓璟(2011):〈退化性膝關節炎中老年病人之疾病認知與因應〉。《健康促進與衛生教育學報》,(36),1-30。https://doi.org/10.7022/JHPHE.201112.0001國家發展委員會人口推估查詢系統(無日期):〈三階段人口(占總人口比率)〉。2022年8月23日取自:https://pop-proj.ndc.gov.tw/dataSearch.aspx?r=5&uid=2104&pid=59衛生福利部國民健康署(2004年11月):〈民國一百年台灣地區中老年身心社會生活狀況長期追蹤(第七次)調查成果報告〉。民111年8月31日取自:https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=242&pid=1282衛生福利部國民健康署(2018年6月):〈民國一百零四年台灣地區中老年身心社會生活狀況長期追蹤調查成果報告〉。民111年8月31日取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=242&pid=1282衛生福利部國民健康署(2022年3月):〈民國一百零八年台灣地區中老年身心社會生活狀況長期追蹤調查成果報告〉。2022年8月31日取自:https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=242&pid=1282衛生福利部統計處(2019年):〈民國106年老人狀況調查〉。2022年8月16日取自:https://dep.mohw.gov.tw/DOS/lp-5095-113.html衛生福利部中央健康保險暑(2022年8月16日):〈109年全民健保就醫疾病資訊〉。2022年8月23日取自:https://www.nhi.gov.tw/Content_-List.aspx?n=D529CAC4D8F8E77B&topn=23C660CAACAA159D衛生福利部(2021年6月12日):〈109年合計門診就診率〉。2022年8月13日取自:https://www.mohw.gov.tw/dl-16436-98bb24c0-2a16-4bf8-a482-579815cbd586.html衛生福利部(2018年1月3日):〈IPAQ台灣活動量調查短版及長版問卷研究工具使用申請注意事項及問卷〉。2022年11月20日,取自:https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=876&pid=4900劉影梅(2004):《國際身體活動量表台灣中文版之發展與信效度驗證》(博士論文,國立台灣大學護理學研究所),臺灣博碩士論文知識加值系統,https://hdl.handle.net/11296/e9v6vm。盧孟良、車先蕙、張尚文、沈武典(2002):〈中文版貝克憂鬱量表第二版之信度和效度〉。《台灣精神醫學》,16(4),301-310。Abramoff, B., & Caldera, F. 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