Background. Mounting research has established child maltreatment as a significant risk factor for negative mental health outcomes in adulthood. However, the mechanisms through which childhood maltreatment exerts its detrimental effect on psychological functioning in adulthood are not well understood. Attachment theory and cognitive theory provide useful theoretical frameworks in explaining the etiology of adult psychopathology, but no prior research has tested the mediating mechanisms of insecure attachment pattern, intolerance of uncertainty (IU) and rumination within a unified model. / Objectives. There are three main objectives in the current study: (1) to explore the relationships among child maltreatment history and adult depressive and anxiety symptoms, as well as insecure attachment pattern, IU and rumination; (2) to test a etiological mediation model with distal child maltreatment predicting adult emotional outcomes via the mediating processes of insecure attachment pattern, IU and rumination; and (3) to investigate whether rumination would mediate the path between IU and adult emotional outcomes. / Method. A total of 322 adults receiving clinical psychological service in the Clinical Psychology Units of the Social Welfare Department, Hong Kong Special Administrative Region, completed the questionnaires with measures on early childhood maltreatment, attachment pattern, IU, rumination, adult emotional outcomes and proximal life stress. Structural equation modeling was conducted for data analysis. / Results. The present study showed that child maltreatment was incredibly common among clinical population and it significantly affected adult emotional outcomes as well as the three mediators (insecure attachment pattern, IU and rumination) examined. A Developmental IU Rumination-Attachment Model with good model fit and strong explanatory power was established. Two sets of etiological paths: Rumination Paths (Simple Rumination Indirect Path and IU-mediated Rumination Path) and Attachment Paths (Simple Attachment Indirect Path and IU-mediated Attachment Path) were identified. The model revealed a novel finding that IU was a common vulnerability factor for both insecure attachment pattern and rumination. Rooted from IU, insecure attachment pattern exemplified stronger influence on adult emotional outcomes when comparing with ruminative response style. Ruminative response style mediated the development from IU to adult emotional outcomes. Proximal life stress cast the least influence on adult emotional outcomes when comparing with the mediating mechanism examined. / Discussion. The Developmental IU Rumination-Attachment Model suggests that in the process of developing adult emotional problems, most of the influences stemmed from pre-existing child maltreatment history and internal psychological processes involving insecure attachment pattern, IU and ruminative response style. External proximal negative life events contribute only a relatively small proportion of influence. The current model does not only enrich our understanding to the long-term sequelae of child maltreatment, but also helps to inform important treatment components for survivors of child maltreatment and to shed light on preventive measures for child maltreatment. Implications for future research would also be discussed. / 背景：大量文獻早已確立孩童期受虐經歷是成人身心健康發展的高危因素。然而，探討孩童期受虐經歷如何影響受虐者長大後的情緒健康的研究，到目前為止卻是不多。雖然依附理論及認知理論對成人心理問題的發展進程奠定了重要的理論基礎，然而至今仍沒有任何研究同時探討當中的三個重要中介變量：依附模式，無法忍受不確定性及反芻。 / 研究目的：本研究有三個主要目的：(1) 探討孩童期受虐經歷與成人抑鬱及焦慮情緒、依附模式、無法忍受不確定性及反芻之間的關係；(2) 測試一個層次性病原模型，闡述孩童期被虐經歷的遠端因素，如何通過一系列的中介變量（依附模式、無法忍受不確定性及反芻），發展至成人期的情緒問題；(3) 研究反芻能否被確立為無法忍受不確性與成人情緒問題的中介變量。 / 研究方法：研究以問卷調查方式（調查內容包括孩童期受虐經歷、依附模式、無法忍受不確定性、反芻、成人情緒健康及近端生活壓力），於322 位在香港特別行政區社會福利署臨床心理服務課接受服務的人士所組成的樣本，使用結構方程模型進行數據分析。 / 研究結果：結果顯示，孩童期受虐經歷在臨床群體中是非常普遍，而孩童期受虐經歷也顯著地影響成人期的抑鬱及焦慮情緒，以及三個被測試的中介變量。研究所得的「發展性無法忍受不確定性反芻依附模型」（Developmental IURumination-Attachment Model）達到良好的摸型擬合度及豐富的臨床意義。模型包含了兩組病原路徑，分別為反芻路徑（單一反芻間接路徑和無法忍受不確定性中介的反芻路徑）及依附路徑（單一依附間接路徑和無法忍受不確定性中介的依附路徑）。此模型揭示了一個斬新的發現：無法忍受不確定性乃是誘發反芻及不安全依附模式的脆弱性因素。在無法忍受不確定性的情況下，依附模式較反芻對成人期的情緒問題更具影響力。除此以外，反芻被確立為無法忍受不確定性與成人情緒問題的中介變量。相對模型中的三個中介變量，近端生活壓力對成人情緒問題所構成的影響力則最弱。 / 討論：研究所得的模型有效地揭示了成人期情緒問題的發展過程中，近端外在生活壓力只構成較弱的影響力。遠端孩童期的受虐經歷，至一系列較近期的內在心理現象（依附模式、無法忍受不確定性及反芻）才是最為重要的因素。研究結果不但加深了學術界對兒童期受虐經歷長遠影響的認識，亦為預防及治療成人情緒問題提供多個臨床應用策略。最後，文未也就未來的實證研究提出了建議。 / Lam, Shui Mun Tracy. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 180-214). / Abstracts also in Chinese; appendixes in Chinese. / Title from PDF title page (viewed on 11, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.
| Identifer | oai:union.ndltd.org:cuhk.edu.hk/oai:cuhk-dr:cuhk_1291504 |
| Date | January 2015 |
| Contributors | Lam, Shui Mun Tracy (author.), Liang, Yongliang (thesis advisor.), Chinese University of Hong Kong Graduate School. Division of Psychology. (degree granting institution.) |
| Source Sets | The Chinese University of Hong Kong |
| Language | English, Chinese, Chinese |
| Detected Language | English |
| Type | Text, bibliography, text |
| Format | electronic resource, electronic resource, remote, 1 online resource (xii, 220 leaves) : illustrations, computer, online resource |
| Rights | Use of this resource is governed by the terms and conditions of the Creative Commons "Attribution-NonCommercial-NoDerivatives 4.0 International" License (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
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