過去的研究顯示，反芻為憂鬱的危險因子，對憂鬱的發展與維持扮演重要的角色。然而，並不是所有反芻型態都會對個體帶來不利的影響。Treynor, Gonzalez與Nolen-Hoeksema（2003）從反芻反應風格量表中抽取出兩個因素結構：苦惱自責式反芻與深思反省式反芻。苦惱自責式反芻能正向預測憂鬱症狀，而深思反省式則是負向預測憂鬱症狀，為較具適應性的反芻型態。然而，過去文獻在深思反省式反芻上未能獲得一致的結論，可能與研究方法及受到苦惱自責式反芻污染的影響。為釐清深思反省式反芻對乳癌患者而言是否具適應性，本研究欲探討兩類反芻與憂鬱之關聯性，並在控制初始的憂鬱症狀後，檢驗兩類反芻對一年後憂鬱症狀的預測力，最後修正Takano與Tanno（2009）的模型探索兩類反芻之路徑關係如何影響憂鬱。
本研究以立意取樣的方式，追蹤283名乳癌患者，分別於受術後一年（T1）與手術後兩年（T2）進行問卷評量。每位參與者皆需完成知情同意書、背景資料、短版反芻反應風格量表、醫院憂鬱量表。根據研究目的，以相關分析、階層迴歸分析與路徑分析進行假設考驗。
研究結果顯示，苦惱自責式反芻、深思反省式反芻與憂鬱具有同時的正向關聯性。然而，在控制時間點一的憂鬱症狀後，深思反省式反芻則會預測一年後較低的憂鬱症狀，顯示其會帶來適應性的結果，與Treynor, Gonzalez與Nolen-Hoe ksema（2003）的研究結果一致。路徑分析結果發現，苦惱自責式反芻能預測一年後較低的深思反省式反芻與增加憂鬱症狀，但能同時增加深思反省式反芻；深思反省式反芻則能抑制苦惱自責式反芻，無法預測憂鬱症狀。
本研究發現與過去研究結果一致，在乳癌患者樣本上亦能發現兩類反芻具有不同的適應性功能，尤其深思反省式反芻可能透過抑制苦惱自責式反芻來降低一年後的憂鬱症狀，進一步支持反芻反應風格應區分為兩構念進行探討。建議在臨床上可針對乳癌患者進行反芻反應篩檢，以協助判斷患者在憂鬱症狀之預後，並針對高自責式反芻的患者進行心理介入。 / Literature review has shown that rumination is one of risk factors of depression. It plays a crucial rule of developing and sustaining depressive symptoms. However, the different types of rumination may not all lead to depression. Treynor, Gonzalez and Nolen-Hoeksema (2003) have extracted two factors from Ruminative Respon -ses Scale, brooding and reflective pondering. In their study, brooding positively pre -dicts depressive symptoms, but reflective pondering negatively predicts depressive symptoms, depicting that reflective pondering is an adaptive repetitive thinking. Yet, past studies haven’t reached a consensus on reflective pondering. It is probably due to research method and not taking the contamination of brooding into account. For clarifying the possible adaptive characteristic of reflective pondering, the present study examines the relationship between reflective pondering and depression. Furthermore, after controlling T1 depression, the present study explores the prediction of rumination to T2 depression. Last, we examine the predictive paths between brooding and reflective pondering to depression.
Patients were eligible if they have been diagnosed with breast cancer. We survey 283 patients after they had completed operation for a year, and follow-up at one year later. All patients complete the informed consent, the demographic survey, the short version of Ruminative Responses Scale, the Hospital Depression Scale. Analysis are conducted using Pearson correlation analysis, multiple regression analysis and path analysis.
The result revealed that brooding and reflective pondering are positively related to depression at T1. However, after controlling T1 depression, reflective pondering negatively predicted T2 depression. This result indicates that reflective pondering may be an adaptive form of rumination, matched the result of Treynor, Gonzalez and Nolen-Hoeksema (2003). In the result of path analysis, we also found brooding predicts less reflective pondering and more depression after one year, but it concurrently predicts more reflective pondering. On the other hand, reflective pondering predicts less brooding and has no significant impact on depression.
The present study supports the finding of Treynor, Gonzalez and Nolen-Hoeksema (2003). In patients with breast cancer, reflective pondering negatively predicts depressive symptoms through reducing brooding. Brooding and reflective pondering are different forms of rumination, the former is more maladaptive and latter is adaptive. According to the study result, we suggest that clinicians screen for the high-brooder, and practice psychological interventions.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0100752003 |
| Creators | 黃荷芳, Huang, Ho Fang |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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