本研究為瞭解女性罹患憂鬱症及復原的歷程，與家庭系統的相互影響關係；及其復原歷程中有助於復原的因素，採質性的研究設計，以深度訪談法訪問三位20至30歲曾罹患憂鬱症、目前已復原的女性。 研究結果發現：在其生病前，家庭中皆有不穩定的夫妻次系統，充滿衝突且關係疏離的父女次系統，受訪者心理層面感到不被支持的母女次系統，疏離的手足次系統，僵化三人組的出現，以及過於糾纏或僵化的界限。她們的自我分化過低，與家中其他成員的連結薄弱，心理距離疏遠，處於一個不被支持的位置。同時，在她們心中都有很深刻、覺得難以原諒的情緒，而這些情緒在這樣的家庭互動型態中，更加無法抒解。 在她們復原後，家庭結構中不穩定的夫妻次系統，及僵化三人組的情形沒有很大的改變。而家庭系統中有助於復原的因素有：(1) 開放的系統：家庭與外界的連結增強，不論是教會或醫療體系的資源都能協助減輕家庭中的壓力。(2)個人良好的自我分化帶動系統的轉變：從生病到復原的過程中，她們經由與其他成員的互動、對話、及嘗試獨立過程，自我分化增強，開始能體會父母的心情，放下原本難以諒解的情緒，與父親的關係變得緩和，與母親或手足的連結增強。(3) 清楚的界限：與其他成員的心理距離調整到較適當的位置，不再過於疏離而無法得到支持，或過於糾纏而直接承擔太多其他次系統而來的壓力。 / The purpose of this research is to understand the process that begins from a woman having depression disorder to her recovery, the relationship between her and her family, and the factors which are good for her recovery. The method of qualitative research and in-depth interviewing are adopted to collect data. Interviewees are three unmarried women who are twenty to thirty, and they have already recovered from their depression. The results show that: Before the women get depressed, their family suffers from the unstable spouse subsystem; the father-child subsystem is distressed; the mother-child subsystem can not get support; the sibling sub-system is estranged; the rigid triad evolves, and the boundary of the family is over enmeshment or disengagement. The degree of the interviewees’ self-differentiation is low; the link between their family and they is weak. They are psychologically distant from their family so they would be unsupported in their family. At the same time, their complex emotion is even harder to be released in this family interacting pattern. After they recovered, the unstable spouse subsystem and the rigid triad would not disappear. However, the family system does change. Factors associated with recovery are: (1) open system: the link between the family and the environment are stronger. Resources from churches or medical system can moderate the pressure from the family system. (2) individual’s self-differentiation urges the change of the family structure: interacting with their family members and endeavoring to seek their independence , they undergo more complete process of self-differentiation. They began to relieve their bitter; they improve their relationship with their father; the link with their mother gets stronger. (3) clear boundary: the psychological distance between the family members and they adjust to a proper situation. The interviewees stop overly disengaging from their family, so they can get support. Meanwhile, they also don’t overly entangle with their family, so they no longer bear directly the pressure from other subsystems.

工作權係為人類之基本人權，因此，各國政府莫不致力於加強身心障礙者各項權益之保障與人力資源之開發，而我國政府亦然。近年來，由於慢性精神病患人數不斷逐年的增加，且其中之憂鬱症更被視為是現代人的文明病。因此，如何面對社會上不斷加增的慢性精神病患者，並試著給予其就業權適度的保障是政府與社會大眾無法逃避的責任與情況。事實上，目前已有許多的研究顯示，諸多種類的精神疾病（例如憂鬱症）都是可以治癒且癒後良好的疾病，只要經過適當的治療，病人便能如正常人一般的正常工作與生活，更能為社會貢獻其一己之力。可惜，由於我國政府對於慢性精神疾病患者權益保障的各項措施仍感陌生，加上社會大眾普遍存有的刻板印象，造成慢性精神病患者就業率與工作待遇普遍偏低的歧視現象。因此，對於慢性精神疾病患者就業權益之保障方面，我國政府著實仍有許多需要改善之處。 本文期望藉由法規與文獻的探討，配合訪談資料的分析，來發現慢性精神病患者（特別是憂鬱症患者），在就業保障方面的問題，並試著提出改進之建議。因此，各章的內容如下：第一章安排基本的研究架構，第二章則從事相關理論的探討，第三章係整理所蒐集到的各國情況，而於第四章中進行相關個案的訪談，最後在第五章中歸納出結論，並試著提出建議。深切期望我國除了致力於經濟之發展，亦能重視弱勢團體的需要，促進慢性精神病患者回歸社區，並進而使其能在社區中有尊嚴的生活和工作。

近年來名人罹患憂鬱症，甚至因憂鬱症自殺導致死亡的消息不斷見報，使得媒體對於憂鬱症的報導大幅度增加，也引起了大眾對此類精神疾病的高度重視，但每篇新聞再現的憂鬱症樣貌似乎並不一致。故本研究欲探討在憂鬱症漸受媒體與輿論重視的大環境裡，媒體如何形塑「憂鬱症」此特定精神疾病？對於憂鬱症論述的消息來源引用為何？不一樣的消息來源呈現了什麼樣的報導輪廓？報導語氣偏向正面溫馨還是負面？呈現憂鬱症的醫學真實與社會真實的情形為何？而在不同新聞主角身分是否會導致報導方式及面貌呈現差異？ 本研究嘗試以2003年5月1日《蘋果日報》發刊為起點，至2006年12月31日止，四年內《蘋果日報》與《中國時報》的憂鬱症新聞為樣本，共取1,371則新聞，用內容分析法檢視兩報憂鬱症新聞如何呈現憂鬱症，並觀察此類新聞報導有何特性。 研究結果發現，憂鬱症新聞的版面分佈會因報別、主角身份呈現差異。《蘋果日報》憂鬱症新聞較常出現在頭版、影視娛樂版、生活消費版、論壇版，且其名人新聞亦較《中國時報》多；而《中國時報》憂鬱症新聞則較常出現在健康醫療版與地方版。在新聞性質方面，《蘋果日報》評論類新聞較《中國時報》多，但卻不因主角身份而有異。 憂鬱症新聞主要議題裡，兩報各議題排名順序雖小有差異，達統計顯著，但皆以「非以憂鬱症為主軸的議題」新聞為最多，而名人新聞有較非名人高許多的比例，新聞內文出現和憂鬱症無關聯的議題。 消息來源方面，《蘋果日報》引用憂鬱症患者本身與親友話語的比例比《中國時報》高許多，《中國時報》則仍注重「專業人士」話語的援引；名人新聞超過一半以上引用患病者話語，然而非名人新聞卻是患者與專業人士話語並重。 在生物醫學模式呈現方面，《中國時報》提供較多關於「醫師診斷」、「就醫後之果」、「非醫學治療後之果」、與「預防」的資訊；尤其是名人新聞出現「醫師診斷」與「就醫後之果」兩項目的比例，較非名人新聞低。其餘生物醫學模式呈現和憂鬱症社會真實各面向所造成的報別和主角身份差異則不大。

本研究旨在探討兒時情緒無效性、情緒抑制與心理及行為問題之結構方程模式考驗。受試樣本為國小五年級、國中二年級及高中二年級計1050人，以心理傷害量表、負向情緒社會化量表、情緒抑制量表、兒童憂鬱量表及偏差行為量表進行施測。資料分析以性別、與年齡進行多因子變異數分析及事後比較，瞭解各變項在性別及年級上之差異。並且採結構方程模式考驗兒時情緒無效性、情緒抑制與心理及行為問題間模式之適合度。 研究結果發現，子女知覺的兒時情緒無效性、憂鬱傾向及偏差行為因性別而有不同，且隨著年齡增長，個體有越高程度的兒時情緒無效經驗、情緒抑制及心理及行為問題出現。而結構方程模式考驗證實情緒抑制為兒時情緒與憂鬱傾向間之調節因子，個體形成憂鬱傾向前，會先形成長期依賴情緒抑制策略。但此模式在兒童樣本並不鎮定，顯示兒童尚處於情緒分化及成熟階段，因應情緒策略逐步在此成形，而國中和高中樣本模式皆相當穩定，顯示國中以後個體因應策略已發展完成。偏差行為則不符合模式考驗，路徑分析發現在心理傷害與偏差行為間存在直接路徑，意即可由早期心理傷害直接引發偏差行為。 最後根據研究結果及討論提出對未來研究、家庭和學校教育、以及諮商實務三方面的建議。

本研究採用一項有關青少年成長與發展調適問題的長期貫時性追蹤資料(1996-1999)，試圖突破過去討論青少年憂鬱症狀發展時，所用之横斷式資料的囿限，嘗試應用潛在成長曲線模型(Latent growth curve model, LGC Model)的分析方法，加入歷史時間的縱深，捕捉青少年憂鬱症狀的「起始狀態」、與「個別的成長軌跡發展」。以不扭曲地將所有受試青少年在三年間的內化症狀變化情形，忠實地描述出來。而後，加入「改變」因素的討論，企圖尋找能影響青少年憂鬱症狀發展軌跡的關鍵機制。 此研究主要目的即在「具象化」復原力的理論觀點，企圖加入動態的時間面向，確認負向生活事件與青少年憂鬱症狀發展軌跡之間的因果關聯，並探討來自個人、與環境脈絡中的關係運作，對青少年憂鬱症狀平均數、變化方向與速率的跨時間影響。研究結果明確回答：為什麼有些青少年在受到憂鬱症狀的負向影響之後，尚能有回復機會並「表現地比預期好」的疑問。至於針對一群憂鬱症狀發展呈現改善、或惡化的少數青少年樣本，在性別、自尊、負向生活事件、家庭親子互動、學校好朋友關係等特性上的差異，本研究亦逐一說明。 在理論層次上，本項研究結合適切的研究方法，從「靜態」到「動態」地觀察青少年的身心發展、自「個人」到「家庭系統內外」討論內外在資源對青少年復原的短暫以及長久影響效果，並以一般青少年為研究對象的作法，擴增了復原力理論的推論範疇與解釋深廣。研究顯示，青少年的「改善」或「惡化」憂鬱症狀發展軌跡，確實在環境脈絡的節制之下，存在著個別差異。此外，青少年起始的憂鬱狀態並不影響憂鬱症狀軌跡發展的變化率。家庭經濟不利這項負向生活事件，對於青少年憂鬱症狀的預測，只呈現短暫的初始影響。自尊和好朋友關係皆是青少年可以主動建構與可為之舉，為兩個最重要能影響青少年憂鬱症狀變化的關鍵因素。至於學校脈絡，則可視為在家庭脈絡之外，能提供青少年憂鬱症狀改變效果的新路徑，以及讓青少年可以順利「轉大人」之雙重機會的結構因素。 / Using data derived from a panel study (1996-1999) of long-term Taiwanese adolescent development and adaptation, this study intended to break through the limitations of cross-sectional studies, which plagued past studies of adolescents’ developing depressive symptoms. By employing the Latent Growth Curve Model (LGC Model), this study mainly attempted to feature the individual initial status and the trajectory of every adolescent’s developmental depressive symptoms, which concerned about the important functions of the dynamic historical time and space on youth internalizing symptoms, for the research purpose to reflect the real resilient outcome each adolescent displayed. Besides, in order to understand the key factors that were taken as positive and effective mechanisms to influence the initial status and rates of changes on youth trajectories of depressive symptoms, several latent constructs such as self-esteem and protective factors developed from family and school contexts were taken into accounts. Further, specified characteristics were noted to highlight the basic differences gradually showed between resilient improved adolescents and worsen ones. A positive-psychological stance was taken as the leading research perspective in this study. The results shows that familial economic hardship only affects the initial status of adolescent depressive symptoms, implying that this negative event just had a short-term effect on youth’s psychological well beings. Those who were initially vulnerable to familial negative event had opportunity to become resilient over time. As to the protective factors, self-esteem and cohesive good-friendship were two crucial facets adolescents could actively construct and make efforts for further resilient performances to be better than expected. The analyzing results indicated, interestingly, that parent-child relationship early obtained in family context and adolescent’s satisfaction with parenting merely counted for the initial impact on adolescent trajectories of depressive symptoms. Concerns and cohesive relationships acquired in school contexts, especially in classes, provided dual chances for adolescents to become resilient in a long run.

憂鬱症是盛行的精神疾病之一。慢性疼痛或是處在長期壓力情境的患者常與憂鬱症產生共病。在動物研究中，類鴉片delta受體制效劑能產生抗憂鬱效果，並且在發炎性疼痛的研究也指出類鴉片delta受體制效劑能展現抗痛覺過敏的效果。本研究主要利用大白鼠腦室內給予類鴉片delta受體制效劑SNC80以及三環抗憂鬱劑amitriptyline，來探討並比較其所產生的抗憂鬱效果在發炎性疼痛或長期壓力情境下與正常情境下的異同。大白鼠強迫游泳試驗被用來比較測試藥物的抗憂鬱效果；佛氏完全佐劑經由皮下注射至大白鼠右後腳掌底板來產生發炎性疼痛；腎上腺皮質酮經由皮下注射且持續21天來產生長期性壓力；西方墨點法用來檢驗在發炎性疼痛或長期壓力下，類鴉片delta受體蛋白質在大白鼠海馬迴的細胞膜上的改變。另外，拮抗劑實驗則用來確認類鴉片delta受體所產生的抗憂鬱效果。實驗結果顯示，大白鼠在正常情境下，SNC80及amitriptyline皆能產生抗憂鬱效果；然而在發炎性疼痛下，SNC80所產生的抗憂鬱效果有提高的表現，並且類鴉片delta受體蛋白質的數量在海馬迴的細胞膜上也隨著疼痛的時間增長而增加，amitriptyline則跟正常情境下的效果相似。另外，大白鼠在長期性壓力下，SNC80的抗憂鬱效果則沒有提高的表現，並且類鴉片delta受體蛋白質的數量在海馬迴的細胞膜上也未受到改變。本研究透過行為實驗提出類鴉片delta受體制效劑的藥理特性，並用分子生物學的方法來對應行為實驗的結果。本研究可做為未來類鴉片delta受體制效劑在治療慢性疼痛的憂鬱症患者上，可能發展為抗憂鬱藥的一個證據。 / Depression is one of the most prevalent mental illnesses all over the world. Patients with chronic pain or stress often have depression. Previous studies have shown that delta opioid receptor (DOR) agonists produced antidepressant-like effects in animal models and that antihyperalgesic effects of DOR agonists can be enhanced in rats under inflammatory pain. The aim of the study was to investigate and compare the antidepressant-like effects of a DOR agonist, SNC80, and a tricyclic antidepressant, amitriptyline, following intracerebroventricular (i.c.v.) administration in rats under different states. The forced swim test was used to determine the antidepressant-like effects of test compounds. Complete Freund’s adjuvant was injected subcutaneously into the right hind paw of rats to elicit inflammatory pain. Corticosterone was injected subcutaneously once per day for 21 days to induce chronic stress. The western blot was used to quantify the levels of DOR protein on plasma membrane in the hippocampus of rats under inflammatory pain or chronic stress. In addition, antagonist experiment was conducted to verify the receptor mechanism underlying the antidepressant-like effects of DOR agonist. Results indicated that i.c.v. SNC80 and amitriptyline dose-dependently produced antidepressant-like effects in rats under normal state. More importantly, the potency of SNC80-induced antidepressant-like effects, but not amitriptyline, was enhanced in rats under inflammatory pain. In addition, up-regulation of supraspinal DORs was time-dependently associated with enhanced antidepressant-like effects of SNC80 in rats under inflammatory pain. On the other hand, SNC80 did not produce enhanced antidepressant-like effects, and DOR density was not changed in rats under chronic stress. This study provides evidence of the DOR agonist’s state-dependent effects and suggests that DOR agonists may be more effective as potential antidepressants for patients with depression comorbid with chronic pain.

本研究的主要目的是以美國全人醫治協會（American Holistic Medical Association，AHMA），提出的全人醫治取向（AHMA, 2005），發展出一份新取向的憂鬱量表，同時探討憂鬱症的相關因素。針對憂鬱症而言，全人的醫治方式需要檢視情緒、人際關係、身體和心靈等各個層面。因此，本研究所發展的自編憂鬱量表依全人醫治取向將其為分為認知取向、情緒取向、身體取向與人際取向等四個因素。 本研究量表的計分方式採用李克特式四點量表形式。原始量表共37題，依據文獻與醫院觀察所得資料編製而成。原始量表以專家效度作為刪題依據，刪題後的正式量表為22題。其計分方式，答「總是如此」得3分，「經常如此」2分，「偶爾如此」1分，「很少如此或沒有」0分。樣本分為實驗組（憂鬱症者）與效標組（非憂鬱症者），實驗組是以精神科醫師診斷為憂鬱症者共213人作為量表的填答對象，效標組是隨機抽取政大學生200人作為施測樣本，並以CES-D憂鬱量表作為效標。施測所得資料以SPSS進行描述統計、t考驗、效標關聯效度、分量表與總分之相關、區別分析、內部一致性信度的考驗；並以結構方程式模式（SEM）針對驗證性因素分析、多群組共變數結構與多群組潛在平均數結構進行考驗。 本研究的結論下： 一、本研究結果，憂鬱症好發年齡與國外25-44歲研究相符，與國內20-40歲研究結果相同。依據文獻所示，女性罹患憂鬱症的比例，為男性的2倍，本研究結果顯示與國內外研究結果是一致性。 二、各分量表與總分之間的相關從.836到.903皆為非常良好的係數值，表示本研究自編憂鬱量表具有良好的內部一致性。 三、本研究之效標關聯效度達0.939，雙尾檢定，達.01顯著水準，表示本研究所編製的量表，可測得所欲測得的特質。 四、本研究的自編量表整體內部一致性Cronbach's Alpha係數為.965，其他如刪除各單題後的總量表、校正後單題與總量表之相關、校正後單題與分量表之相關都顯示本研究自編憂鬱量表有良好的信度。 五、驗證性因素分析模式是合理適配的，表示當初四個向度假設是成立，而且這四個因素背後有一個潛在因素－「憂鬱症」存在。 六、實驗組與效標組在共變數結構上的考驗是沒有差異的，表示此自編憂鬱量表可以同時適用在實驗組與效標組。 七、分量表或總量表從t考驗值差異皆達.001顯著水準，另外區別分析Hit Ratio值為0.93，表示本研究自編之憂鬱量表具有良好之區別效度，可以有效地區別出實驗組與效標組。而在多群組潛在平均數結構上的考驗，效標組在自編憂鬱量表四個向度上的潛在平均數低於實驗組，表示本量表從潛在變項的考驗也可以有效地區辨實驗組與效標組。 / The main purpose of this study is to develop a depression scale in a new approach that reflects the whole-person approach to healing proposed by the AHMA (the American Holistic Medical Association) in the United States (AHMA, 2005), while at the same time probing into the relevant factors of depression disorders. Regarding depression disorders, a whole-person approach to healing requires the examination of multiple dimensions of the person, such as mood, interpersonal relationships, body, soul, etc. So, this study of the development of a self-establishment depression scale is divided into four dimensions: cognitive, mood, physical, and interpersonal, in accordance with the whole-person approach. The scale of this study adopts a four-item Likter scale to measure scores. The basic scale amounts to 37 items and works out according to the literature and the observing materials in hospitals. Items of the basic scale are deleted with expert validity. It is a 22- items formal scale after deleting items. Answer choices read and rate as follows: “always true” (3), “often true” (2), “true once in a while” (1), “seldom or not true” (0). Samples are separated into the experimental group (depressed person) and the criterion group (non-depressed person). In the experimental group, psychiatrists diagnosed 213 people for depressed person as the measuring target filling of the self-establishment depression scale. The criterion group consisted of 200 National Chengchi University students. CES-D was used as a criterion t. We used the program of SPSS to compute descriptive statistics, t-test, criterion-related validity, correlation of the sub-scales and the scale, discriminant, reliability of internal consistency with SPSS, and the estimations of confirmatory factory analysis, multi-sample covariance structure, multi-sample-latent-means structure with structural equation modeling (SEM). In sum, some conclusions of this research are as follows: 1. The result of this study show that depression disorder peaks during the ages of twenty-five to forty-four, consistent with in foreign and domestic research. As literature, depression disorder occurs in at double the rate in women as in men, and the result of this study is consistent with domestic and foreign studies. 2. The correlative coefficient of the sub-scales and the scale from .836 to.903 shows all as having very good coefficient value and that it has good internal consistency of the self-establishment depression scale. 3. The criterion-related validity of this research is up to 0.939, 2-tailed test reaches .01 level of significance which shows the self-establishment depression scale can examine the attributes which we want to find out. 4. The whole internal consistency Cronbach's Alpha coefficient of the self-establishment depression scale is .965, others like Cronbach's Alpha if item deleted, corrected item-total correlations single item with sub-scales and corrected item-total correlations single item with the scale all show good reliability. 5.The model confirmatory factory analysis is reasonably fit that shows four dimensions established supposing originally, and behind the back of four factors there is one latent variable – “depressive disorder” exists. 6.The estimation of covariance structure between the experimental group and the criterion group shows no difference that reveals the self-establishment depression scale can be suitable for the experimental group and the criterion group . 7.The sub-scale and the scale of the self-establishment depression scale from t-test reaches .01 level of significance, another time hit ratio value of discriminant is 0.93, both show that the self-establishment depression scale by this study can distinguish the experimental group and the criterion group efficiently. And at the estimation of multi-sample-latent-means structure shows the criterion group’s latent mean is lower than the experimental group’s, that means this scale can distinguish the experimental group and the criterion group usefully at the same time.

本論文根據無望感的相關理論，以三種方式探討貝氏無望感量表內的正負向期待為一個概念的兩面，或是表徵兩種不同的概念。首先，本論文進行探索性與驗證性因素分析，以考驗一與二因素模式的模式適合度。再者，MacLeod與Byrne（1996）認為兩類未來思考對憂鬱症狀的影響是相互獨立運作，但可能有過於簡化的限制，故本論文提出四種的可能模式並加以檢驗。最後，根據Trew（2011）所提出的整合性模式，提出行為抑制與激發系統導致憂鬱症狀之兩種競爭模式，檢驗無望感或正負向未來思考在此模式中所扮演的中介角色，以及兩個系統之機制間有互動的可能性。主要的研究結果如下：（1）探索性與驗證性因素結果均支持貝氏無望感量表的二因素結構，並以正負向未來思考加以命名；（2）支持模式二的假設，負向未來思考為正向未來思考與憂鬱症狀間的部分中介變項，但正向未來思考並非是負向未來思考與憂鬱症狀間的部分中介變項；（3）競爭模式二具備較佳的模式適合度，支持Trew（2011）認為憂鬱症時須同時注意BAS與BIS各自不同影響途徑的觀點，亦彰顯正向未來思考的保護因子角色；（4）更重要的是，支持無望感量表中正負向期待內容應被視為兩種不同且各自存在的概念。最後並提出本論文研究限制與對憂鬱症的臨床理論與實務上之建議。 / This study investigated the relation between the positive and negative expectations assessed in Beck Hopelessness Scale (BHS) by three ways. First, exploratory and confirmatory factor analysis were used to test the goodness of fit of one-factor and two-factor models. Besides, MacLeod and Byrne (1996) stated that two kinds of future thinkings influenced the depressive symptoms independently, but this statement had some limitations. Therefore, this study proposed four models to test the hypotheses. Based on Trew ‘s (2011) integrated model, two competing models illustrating the relations among BAS, BIS and depression were proposed to examine the mediation effect of hopelessness or future thinkings. The main results were: (1) the two-factor model of BHS was supported in exploratory and confirmatory factor analyses; (2) the second model was supported that negative future thinking was the partial mediator between depression and positive future thinking; (3) the competing model 2 had the better goodness of fit, supporting that BAS and BIS had important but different pathways to influence the development of depression, and positive future thinking played the protective role in this process; (4) Most importantly, the perspective that the positive and negative expectations assessed in BHS should be treated as two different kinds of constructs respectively was supported. Finally, the limitations of this study and the suggestions for the theories and clinical treatment of depression were discussed.