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題名 安眠藥使用頻率的發展軌跡與其相關因子：電話追蹤研究
The Developmental Trajectories of Hypnotic Use Frequency and the Associated Factors: A phone-call follow-up research
作者 李昇晃
Lee, Shen-Kwang
貢獻者 楊建銘
Yang, Chien-Ming
李昇晃
Lee, Shen-Kwang
關鍵詞 失眠
安眠藥
群體基礎軌跡分析
BZD
BzRA
Insomnia
Hypnotics
Group-based Trajectory Modeling
BZD
BzRA
日期 2019
上傳時間 7-Aug-2019 16:33:34 (UTC+8)
摘要 研究目的：過去文獻建議短期使用安眠藥，但臨床上不難發現部分患者會發展成長期使用者，而這群人有較高的藥物副作用與依賴風險，是個不容小覷的臨床議題。過往探討安眠藥使用行為機制時，多將安眠藥使用行為簡易區分為短期或長期使用，然而，此區分方式尚不足以描述安眠藥使用者間的用藥行為個別差異，導致後續研究出現異質性。同時過往研究多採用橫斷研究進行探討，凸顯了長期追蹤資料的需求。因此，本研究目的以安眠藥使用頻率的軌跡發展切入，探索個別差異，接著透過人口變項、心理相關變項與睡眠相關變項來了解軌跡差異的可能原因，最後建立初步預測的模型，提供臨床處遇參考。

研究方法與結果： 研究受試者為144名曾經或目前正服用安眠藥的患者，待完成一份心理社會相關問卷後，便進行一年半的電話追蹤（第0、1、3、6、12和第18個月），收集其安眠藥的使用頻率。所收集的追蹤資料先進行群體基礎軌跡模型分析，將安眠藥使用頻率軌跡型態劃分成『穩定高頻使用』、『穩定低頻使用』、『快速降頻使用』、『慢速降頻使用』與『稀有使用』等，五種軌跡型態，其人數比例分別為42.6%、12.4%、12.5%、17.8%、以及14.7%。所有軌跡型態的受試者中，穩定高頻使用的年齡最高、服藥後的失眠嚴重程度最高、安眠藥渴求程度最高，與其他軌跡呈現差異；穩定低頻使用的脆弱樣貌與穩定高頻使用類似，唯有在渴求程度明顯較低。稀有使用則與穩定高頻使用明顯相反，平均年齡最低、服藥後失眠嚴重程度最低、安眠藥渴求程度最低。而下降軌跡分成快速降頻與慢速降頻兩種型態，他們皆有較高的服藥後失眠嚴重程度，不同的是快速降頻使用的平均年齡較低、渴求程度也較低，而慢速降頻使用的樣貌可與穩定高頻使用媲美，唯有在對安眠藥的失控感上明顯低於穩定高頻使用。

結論： 本研究設計以臨床情境為平台，建立了追蹤18個月的安眠藥使用頻率軌跡發展模型。此軌跡模型呈現5種不同的安眠藥使用頻率軌跡，呈現個別差異，且安眠藥渴求程度、服藥後的失眠嚴重程度，被凸顯為安眠藥使用行為相當重要的課題。
Objective: Hypnotics is recommended for short-term use but is commonly prescribed for prolonged period of time in clinical settings. However, past research suggested that there were individual differences in the pattern of hypnotic use and have not been studied over an extended time period. Therefore, the current study aims to categorize the developmental patterns of hypnotic use through trajectory analysis, and to examine the differences in the psychosocial factors associated with the different trajectories.

Methods and Results: 144 Insomnia patients with history of hypnotic use were recruited to participate in the study. They completed a package of questionnaires regarding psychosocial variables and were followed up at 6 points of time (0, 1, 3, 6, 12 and 18 months) to collect their frequency of hypnotic use. All data were used to estimate trajectories of hypnotic use frequency from group-based trajectory modeling and identified five different trajectories among users, they are “stable high users” (42.6%), “stable low users” (12.4%), “fast decline users” (12.5%), “slow decline users” (17.8%) and “rarely users” (14.7%). Among hypnotic use frequency trajectories, MANOVA results showed that “stable high users” were older, had greater insomnia severity with medication and hypnotic-urge level, meanwhile “stable low users” tend to have a similar profile with “stable high users” except for a lower hypnotic-urge level. “Rarely users” had the protective profile which were younger, had lesser insomnia severity with medication and hypnotic-urge level. Interestingly, both “fast decline users” and “slow decline users” showed greater insomnia severity with medication than the “stable low users”and “rarely users”. However, they could be differentiated by the hypnotic-urge level. Specifically, “fast decline users” were much lower and “slow decline users” were as high as “stable high users” in hypnotic-urge level except for the compelling desire to use hypnotic scores.

Conclusions: The results of the current study suggested that the heterogeneous practice among sleep medication users. At the same time, the predicting model raised the importance of insomnia severity and hypnotic craving as important issues in hypnotic use behavior.
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描述 碩士
國立政治大學
心理學系
104752023
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0104752023
資料類型 thesis
dc.contributor.advisor 楊建銘zh_TW
dc.contributor.advisor Yang, Chien-Mingen_US
dc.contributor.author (Authors) 李昇晃zh_TW
dc.contributor.author (Authors) Lee, Shen-Kwangen_US
dc.creator (作者) 李昇晃zh_TW
dc.creator (作者) Lee, Shen-Kwangen_US
dc.date (日期) 2019en_US
dc.date.accessioned 7-Aug-2019 16:33:34 (UTC+8)-
dc.date.available 7-Aug-2019 16:33:34 (UTC+8)-
dc.date.issued (上傳時間) 7-Aug-2019 16:33:34 (UTC+8)-
dc.identifier (Other Identifiers) G0104752023en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/124860-
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) 104752023zh_TW
dc.description.abstract (摘要) 研究目的：過去文獻建議短期使用安眠藥，但臨床上不難發現部分患者會發展成長期使用者，而這群人有較高的藥物副作用與依賴風險，是個不容小覷的臨床議題。過往探討安眠藥使用行為機制時，多將安眠藥使用行為簡易區分為短期或長期使用，然而，此區分方式尚不足以描述安眠藥使用者間的用藥行為個別差異，導致後續研究出現異質性。同時過往研究多採用橫斷研究進行探討，凸顯了長期追蹤資料的需求。因此，本研究目的以安眠藥使用頻率的軌跡發展切入，探索個別差異，接著透過人口變項、心理相關變項與睡眠相關變項來了解軌跡差異的可能原因，最後建立初步預測的模型，提供臨床處遇參考。

研究方法與結果： 研究受試者為144名曾經或目前正服用安眠藥的患者，待完成一份心理社會相關問卷後，便進行一年半的電話追蹤（第0、1、3、6、12和第18個月），收集其安眠藥的使用頻率。所收集的追蹤資料先進行群體基礎軌跡模型分析，將安眠藥使用頻率軌跡型態劃分成『穩定高頻使用』、『穩定低頻使用』、『快速降頻使用』、『慢速降頻使用』與『稀有使用』等，五種軌跡型態，其人數比例分別為42.6%、12.4%、12.5%、17.8%、以及14.7%。所有軌跡型態的受試者中，穩定高頻使用的年齡最高、服藥後的失眠嚴重程度最高、安眠藥渴求程度最高，與其他軌跡呈現差異；穩定低頻使用的脆弱樣貌與穩定高頻使用類似，唯有在渴求程度明顯較低。稀有使用則與穩定高頻使用明顯相反，平均年齡最低、服藥後失眠嚴重程度最低、安眠藥渴求程度最低。而下降軌跡分成快速降頻與慢速降頻兩種型態，他們皆有較高的服藥後失眠嚴重程度，不同的是快速降頻使用的平均年齡較低、渴求程度也較低，而慢速降頻使用的樣貌可與穩定高頻使用媲美，唯有在對安眠藥的失控感上明顯低於穩定高頻使用。

結論： 本研究設計以臨床情境為平台，建立了追蹤18個月的安眠藥使用頻率軌跡發展模型。此軌跡模型呈現5種不同的安眠藥使用頻率軌跡，呈現個別差異，且安眠藥渴求程度、服藥後的失眠嚴重程度，被凸顯為安眠藥使用行為相當重要的課題。		zh_TW
dc.description.abstract (摘要) Objective: Hypnotics is recommended for short-term use but is commonly prescribed for prolonged period of time in clinical settings. However, past research suggested that there were individual differences in the pattern of hypnotic use and have not been studied over an extended time period. Therefore, the current study aims to categorize the developmental patterns of hypnotic use through trajectory analysis, and to examine the differences in the psychosocial factors associated with the different trajectories.

Methods and Results: 144 Insomnia patients with history of hypnotic use were recruited to participate in the study. They completed a package of questionnaires regarding psychosocial variables and were followed up at 6 points of time (0, 1, 3, 6, 12 and 18 months) to collect their frequency of hypnotic use. All data were used to estimate trajectories of hypnotic use frequency from group-based trajectory modeling and identified five different trajectories among users, they are “stable high users” (42.6%), “stable low users” (12.4%), “fast decline users” (12.5%), “slow decline users” (17.8%) and “rarely users” (14.7%). Among hypnotic use frequency trajectories, MANOVA results showed that “stable high users” were older, had greater insomnia severity with medication and hypnotic-urge level, meanwhile “stable low users” tend to have a similar profile with “stable high users” except for a lower hypnotic-urge level. “Rarely users” had the protective profile which were younger, had lesser insomnia severity with medication and hypnotic-urge level. Interestingly, both “fast decline users” and “slow decline users” showed greater insomnia severity with medication than the “stable low users”and “rarely users”. However, they could be differentiated by the hypnotic-urge level. Specifically, “fast decline users” were much lower and “slow decline users” were as high as “stable high users” in hypnotic-urge level except for the compelling desire to use hypnotic scores.

Conclusions: The results of the current study suggested that the heterogeneous practice among sleep medication users. At the same time, the predicting model raised the importance of insomnia severity and hypnotic craving as important issues in hypnotic use behavior.		en_US
dc.description.tableofcontents 第一章 緒論 1
第一節 研究動機 1
第二章 文獻探討 5
第一節 安眠藥物治療的定義、盛行率以及延伸的問題 5
第二節 安眠藥使用行為之個別差異與不同歷程之可能性 9
第三節 安眠藥使用頻率之軌跡型態的可能影響因子 14
第四節 研究問題 23
第三章 研究方法 24
第一節 研究受試者 24
第二節 研究流程 25
第三節 測量工具 27
第四節 統計分析 34
第四章 研究結果 37
第一節 受試者人口背景資料與特性 37
第二節 不同安眠藥使用頻率軌跡之軌跡模型建立 38
第三節 安眠藥使用頻率軌跡型態之間的相關因子 46
第五章 綜合討論 59
第一節 研究受試者的樣本類型 59
第二節 安眠藥物使用頻率軌跡型態的概述與探討 59
第三節 安眠藥使用頻率軌跡型態在相關變項的表現 62
第四節 預測安眠藥使用頻率軌跡型態之因素與臨床應用 66
第五節 與過往研究的對應 68
第六節 研究限制與對研究未來發展的建議 69
參考文獻 70		zh_TW
dc.format.extent 2941553 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0104752023en_US
dc.subject (關鍵詞) 失眠zh_TW
dc.subject (關鍵詞) 安眠藥zh_TW
dc.subject (關鍵詞) 群體基礎軌跡分析zh_TW
dc.subject (關鍵詞) BZDzh_TW
dc.subject (關鍵詞) BzRAzh_TW
dc.subject (關鍵詞) Insomniaen_US
dc.subject (關鍵詞) Hypnoticsen_US
dc.subject (關鍵詞) Group-based Trajectory Modelingen_US
dc.subject (關鍵詞) BZDen_US
dc.subject (關鍵詞) BzRAen_US
dc.title (題名) 安眠藥使用頻率的發展軌跡與其相關因子：電話追蹤研究zh_TW
dc.title (題名) The Developmental Trajectories of Hypnotic Use Frequency and the Associated Factors: A phone-call follow-up researchen_US
dc.type (資料類型) thesisen_US
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dc.identifier.doi (DOI) 10.6814/NCCU201900310en_US