背景：台灣有許多心理衛生倡議組織會定期或不定期舉辦“直通使用者疾病關注活動”，藉由活動提高公眾對心理衛生問題的關注。然而，由於精神疾病無法藉由明確的症狀或診斷工具而確定，加上這些活動牽涉到藥廠贊助（例如校園憂鬱症篩檢的推行），以致於這類的活動引發許多爭議。

目的：本研究目的包含兩個：首先，以台灣幾個全國性、定期介入或者持續發生影響的憂鬱症關注活動或者政策作為介入事件，並且以雙元市場擴散模型檢視這些活動所達成的效果，比較傾向疾病防治還是藥物後期市場擴散。其次，說明這些疾病關注活動可能同時帶來哪些負面的非意圖後果，並且探討其意涵。

方法與材料：使用台灣2000至2009年全民健康保險資料庫系統抽樣檔進行分析，挑選疾病診斷碼為精神疾病（ICD-9-CM 290-319）的資料，分析對象為12至18歲以及18至24歲兩組，並且以卜瓦松迴歸模式評估三個重要的介入事件（每年10月、11月全國憂鬱症篩檢日、教育部推動「校園學生憂鬱與自我傷害三級預防工作計畫」、以及衛生署公告所有抗憂鬱劑藥品仿單應加註可能會增加青少年自殺意念及行為）是否影響精神疾患的就醫行為。

結果：統計分析顯示，第一、全國憂鬱症篩檢日活動所產生的影響主要在非典型診斷上。第二、校園三級預防計畫對青少年族群可能沒有達到疾病防治作用，而對青年族群有達到疾病防治作用，但同時也可能伴隨藥物後期市場擴散。第三、黑框警語公告在台灣未減少精神疾病患者的就醫行為。

結論：研究結果顯示，台灣的憂鬱症關注活動在幾個面向上有待商榷。第一、介入雖然頻繁，但帶來的效益可能有限。第二、只能讓症狀較輕微的“病人”受益，甚至只是將可以其他非醫療方案解決的社會需求轉化為醫療需求，且對於症狀較嚴重者的幫助相當有限。第三、可能擴大低醫療需求者的需求，以及增加低效益的治療者，最終可能會產生資源排擠現象。第四、達到疾病防治作用的同時，也可能伴隨藥物後期市場擴散。第五、關注活動中藥物治療效果及副作用資訊的呈現不均衡。

Background: In Taiwan, mental health advocacy organizations periodically or occasionally conduct various “direct-to-user disease awareness campaigns” allegedly aimed to increase people’s awareness of mental health problems. However, these campaigns were controversial insofar as most campaigns are sponsored by the pharmaceutical industry and the ambiguity of diagnosis as well as necessity of treatment.

Objective: Firstly, by viewing selected disease awareness campaigns as periodical or continuing interventional events with a dual-market diffusion model, to examine whether the effect of these campaigns is disease prevention or drug late market diffusion. Secondly, to describe what undesirable unintended consequences might be caused by these disease awareness campaigns.

Methods and materials: This study utilizes National Health Insurance Research Database (2000 to 2009）and the ICD-9-CM code 290-319, all relevant patients are divided into age groups 12-18 and 18-24. Poisson Regression Model analysis follows to evaluate the seeking behavior of mental disorder patients of three significant interventional events.

Results: Statistical analyses show that, firstly, National Depression Screening Day campaigns held in October and November significantly increase atypical diagnoses. Secondly, the“tertiary prevention from depression and self-injury in school”promoted by the Ministry of Education may have no effect on disease prevention in age 12-18, while have effect on disease prevention and drug late market diffusion in age 18-24. Thirdly, announcement of required warningon the indication of antidepressant drugs does not reduce seeking behavior of mental disorder patients.

Conclusion: The results show that, in the period observed, disease awareness campaigns are questionable in several regards. First, the interventions are so frequent that their effects may be limited. Second, disease awareness campaigns in question merely benefit“patients” with mild symptom better to be treated with non-medical solution, while rarely benefit patients with relatively severe symptom. Third, campaigns may expand low-level medical needs and therefore increase patients of lower treatment effectiveness, this may cause resources crowding eventually. Fourth, the effect of disease prevention may be accompanied by that of drug late market diffusion. Fifth, uneven information of the benefit of drug treatment and side effects could be observed in disease awareness campaigns.

中文：
Amberg TL，2005，〈公關成功的關鍵要素〉。頁185-202，收錄於Komisarjevsky, Jernstedt R, Middleberg D, Watt R, Edelmn R, Hammond LR, Russo AJ, Amberg TL, Sachs RM, Tanaka PA, Finn D著，蔡麗蓉、李先鳳譯，《公關行銷聖經》。台北：經濟新潮社。
Moynihan R, Cassels A著、張艾茜譯、2006，《藥你生病》。台北：世潮。
Russo AJ，2005，〈公關的藝術與科學〉。頁167-183，收錄於Komisarjevsky, Jernstedt R, Middleberg D, Watt R, Edelmn R, Hammond LR, Russo AJ, Amberg TL, Sachs RM, Tanaka PA, Finn D著，蔡麗蓉、李先鳳譯，《公關行銷聖經》。台北：經濟新潮社。
Sachs RM，2005，〈小企業一鳴驚人！：計畫和啓動成公的小企業公關活動〉。頁203-233，收錄於Komisarjevsky, Jernstedt R, Middleberg D, Watt R, Edelmn R, Hammond LR, Russo AJ, Amberg TL, Sachs RM, Tanaka PA, Finn D著，蔡麗蓉、李先鳳譯，《公關行銷聖經》。台北：經濟新潮社。
王馨儀，2008，《不願面對的非理性：台灣報紙憂鬱症論述之權力運作、主體建構與社會意涵》。台北：世新大學新聞所在職班碩士論文。
江文慈，2004，〈大學生的情緒調整歷程與發展特徵〉。《教育心理學報》35(3): 249-268。
李佳霖，2009，《非營利組織與企業夥伴關係之研究：以弘道老人福利基金會為例》。嘉義：南華大學公共行政與政策研究所碩士論文。
李宗蓁，2007，《藥價政策對於處方行為及病人權益影響之研究—以抗憂鬱劑為例》。台北：國立台灣大學臨床藥理所碩士論文。
周才忠、陳嘉鳳，2007，〈兒童與青少年心理病患者：除了心理診斷與藥物治療，學校教育還能做什麼？〉。《學生輔導季刊》104: 88-93。
林正修，1997，《某醫學中心家庭醫學科門診病患憂鬱症之盛行率與相關因素的探討》。台北：台灣大學公共衛生學系碩士論文。
林怡君、余豎文、張宏哲，2004，〈新店地區機構和非機構老人憂鬱情形及相關因素之調查〉。《台灣家醫誌》14: 81-93。
林家興、陳玉芳、葉雅馨、徐佳玲、孫正大，2008，〈董氏憂鬱量表（大專版）編製研究〉。《測驗學刊》55(3): 509-533。
林惠文、楊博仁、楊宜瑱、陳俊傑、陳宣志、顏啟華、賴德仁、李孟智，2010，〈台灣地區老年人憂鬱之預測因子探討–十年追蹤結果分析〉。《台灣老誌》5(4): 257-265。
林綺雲，2002，〈從社會見構論談國人憂鬱與自殺現象的隱憂〉。《新世紀宗教研究》1(2) : 109-128。
施俊名、吳裕益，2008，〈「大學生身心健康量表」構念效度驗證之研究〉。《教育研究與發展期刊》4(4): 201-230。
洪瑞屏，2006，《初次診斷憂鬱疾患者追蹤三年之醫療利用與費用分析探討》。台中：亞洲大學健康管理研究所碩士論文。
翁秀琪，1996，《大眾傳播理論與實證》。台北：三民。
商志雍、廖士程、李明濱，2003，〈精神科門診憂鬱症患者就診率之變遷〉。《台灣醫學》7(4): 502-509。
張倍禎，2009，〈原來這是一種病 成人注意力不足過動症〉。《中國醫訊》76: 63-64。
張嘉玲，2003。《憂鬱症病友求醫經驗分析》。台北：臺灣大學衛生政策與管理研究所碩士論文。
張學善、陳凱婷、林信宏，2009，〈高危險群學生處遇方案之規劃與實施成效評估研究–以中部某大學大一新生憂鬱傾向學生為例〉。《朝陽人文社會學刊》7(2): 41-88。
陳尚彣，2006，〈企業贊助運動效果之討論〉。《輔仁大學體育學刊》5: 287-298。
陳威亨，2006，《我國非營利組織公共關係之運作現況探討-以董氏基金會為例》。彰化：國立彰化師範大學政治學研究所碩士論文。
陳若璋，1988，〈大學生憂鬱症病理發展模式的探討〉。《中華心理衛生學刊》4(1): 75-90。
陳清泉，1989，《大學生生活壓力、認知型態與憂鬱傾向相關之研究》。台北：國立台灣師範大學教育心理與輔導研究所碩士論文。
陳雪如、黃劭彥、林琦珍、蘇愛軫，2008，〈非營利組織治理機制之研究-以社會福利慈善事業基金會為例〉。《台灣企業績效學刊》2(1): 31-53。
郭鴻茹，2009，《青少年生活事件、友伴支持對憂鬱傾向的影響》。花蓮：慈濟大學社會工作學所碩士論文。
黃欣妏、曹俊德，2009，〈新生心理健康困擾之調查研究 以中部某科技大學為例〉。《朝陽人文社會學刊》7(2): 147-172。
黃惠貞，2003。《某大專院校學生靈性健康、知覺壓力與憂鬱之相關研究》。台北：國立台灣師範大學衛生教育研究所碩士論文。
楊明仁，2002，〈台灣的社會與憂鬱〉。《學生輔導》80: 53-59。
葉雅馨、林家興，2006，〈台灣民眾憂鬱程度與求助行為的調查研究〉。《中華心理衛生學刊》19(2): 125-148。
廖庭瑋，2006，《醫師，你在開什麼藥？抗憂鬱藥劑的知識生產與爭議》。台北：國立台灣大學新聞所碩士論文。
鄭雅心，2007，《探討國三青少年個人、家庭、學校因素對憂鬱情緒之影響》。台南：國立成功大學教育所碩士論文。
鄭靜明，2006，《台灣地區精神科憂鬱症醫療利用分析》。台北：國立陽明大學醫務管理所碩士論文。
謝幸燕，2005，〈藥商、醫院與醫師的處方決策：醫療制度與組織面之脈絡分析〉。《台灣社會學刊》34: 59-114。
韓德彥、陳淑惠，2008，〈精神疾病污名感受量表及其短版之心理計量特性〉。《中華心理衛生學刊》21(3): 273-290。
羅金棟，2007，〈國家治理中非政府組織的角色與政策倡議策略：以菸害防制法為例〉。《非政府組織學刊》2: 69-90。

英文：
Adam EB, 2007,“Costs and benefits of direct-to-consumer advertising: the case of depression.”Pharmacoeconomics 25 (6): 511-521.
Avorn J, Chen M, Hartley R, 1982,“Scientific versus commercial sources of influence on the prescribing behavior of physicians.”AmJ Med 73: 4-8.
Berndt ER, 2005,“To inform or persuade? Direct-to-consumer advertising of prescription drugs.”New Engl J Med 352(4): 325-328.
Berndt ER, Bir A, Busch SH, Frank RG, Normand SL,2002,“The medical treatment of depression, 1991-1996: Productive inefficiency, expected outcome variations, and price indexes.”J Health Econ 21: 373-396.
Chen YY, Yip P SF, 2008,“Rethinking suicide prevention in Asian countries.”Lancet 372: 1629-1630.
Coyne JC, Schwenk TL, Fechner-Bates S., 1995, “Nondetection of depression by primary care physicians reconsidered.”Gen Hosp Psychiatry 17: 3-12.
Coyne JC, Thompson R, Palmer SC, Kagee A, Maunsell E, 2000,“Should we screen for depression? Caveats and potential pitfalls.”Appl Prev Psychol 9: 101-121.
Donohue JM, Berndt ER, 2004b,“Effects of direct-to-consumer advertising on medication choic: The case of antidepressants.”J Pub Pol Marketing 23(2): 115-127.
Donohue JM, Berndt ER, Rosenthal M, Epstein AM, Frank RG, 2004a,“Effects of pharmaceutical promotion on adherence to the treatment guidelines for depression.”Med Care 42: 1176–1185.
Dowrick C, Buchan I, 1995,“Twelve month outcome of depression in general practice: Does detection or disclosure make a difference?”BMJ 311: 1274-1276.
Evans WD, Uhrig J, Davis K, McCormack L, 2009,“Efficacy methods to evaluate health communication and marketing campaigns.”J Health Commun 14: 315-330.
Ferrand Y, Kelton CML, Guo JJ, Levy MS, Yu Y, 2010,“Using time-series intervention analysis to understand U.S. Medicaid expenditures on antidepressant agents.” Res Social Adm Pharm 7: 64-80.
Gellad ZF, Lyles KW, 2007,“Direct-to-consumer advertising of pharmaceuticals.”AJM 120: 475-480.
Gilbody SM, House AO, Sheldon T, 2001,“Routinely administered questionnaires for depression and anxiety: systematic review.”BMJ 322: 406-409.
Gilbody SM, Sheldon T, Simon W, 2006,“Should we screen for depression？”BMJ 332: 1027-1030.
Hemminki E, Toiviainen HK, Vuorenkoski L, 2010,“Co-operation between patient organizations and the drug industry in Finland.”Social Science & Medicine 70: 1171-1175.
Henkel V, Mergl R, Coyne JC, Kohnen R, Moller HJ, Hegerl U, 2004,“Screening for depression in primary care: Will one or two items suffice?”Eur Arch Psychiatry Clin Neurosci 254: 215-223.
Herxheimer A, 2003,“Relationships between the pharmaceutical industry and patients’s organizations.”BMJ 326: 1208-1210.
Hickie LB, Davenport TA, Ricci CS, 2002,“Screening for depression in general practice and related medical settings.”MJA 177: S111-S116.
Highet NJ, Hickie LB, Davenport TA, 2002,“Monitoring awareness of and attitudes to depression in Australia.”MJA 176: S63-S68.
Hollon MF,2005,“Direct-to-consumer advertising: a haphazard approach to health promotion.”JAMA 293: 2030-2033.
Jureidini J, Mintzes B, Raven M, 2008,“Does direct-to-consumer advertising of antidepressants lead to a net social benefit?”Pharmacoeconomics 26(7): 557-566.
klein MC, Ciotoli C, Chung H, 2011,“Primary care screening of depression and treatment engagement in a University Health Center: a retrospective analysis.”J Am College Health 59(4): 289-295.
Kravitz RL, Epstein RM, Feldman MD, Franz CE, Azari R, Wilkes MS, 2005,“Influence of patients' requests for direct-to-consumer advertised antidepressants: A randomized controlled trial.”JAMA 293(16): 1995−2002.
Lacasse JR, Leo J, 2005,“Serotonin and Depression：A Disconnect between the Advertisements and the Scientific Literature.”PLoS Med 2:1211-1216.
Lenzer J, 2004,“Bush plans to screen whole US population for mental illness.”BMJ 328: 1458.
Libby AM, Brent DA, Morrato EH, Orton HD, Allen R, Valuck R, 2007,“Decline in treatment of pediatric depression after FDA advisory on risk of suicidality with SSRIs.”Am J Psych 164(6): 884-891.
Licinio J, Wang M, 2005,“Depression, antidepressants and suicidality :a critical appraisal.”Nat rev Drug Discovery 4: 165-171.
McAlpine DD, Wilson AR, 2004,“Screening for depression in primary care: What do we still need to know?”Depress Anxiety 19: 137-145.
Mintzes B, 2006,“Disease mongering in drug promotion: Do governments have a regulatory role?”PLoS Med 3(4): 0461-0465.
Moynihan R, Heath I, Henry D, 2002,“Selling sickness: the pharmaceutical industry and disease mongering.”BMJ 324: 886-890.
Moynihan R, Henry D, 2006,“The fight against disease mongering: generating knowledge for action.”PLoS Med 3(4): 0425-0428.
O’Donovan O, 2007,“Corporate colonization of health advocacy organization’s modes of engagement with pharmaceutical corporations.”Intl J Hralth Serv 37: 711-733.
Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA, 2002,“National trends in the outpatient treatment of depression.”JAMA 287(2): 203-209.
Palmer SC, Coyne JC, 2003,“Screening for depression in medical care pitfalls, alternatives, and revised priorities.”J Psychosom Res 54: 279-287.
Paykel ES, Tylee A, Wright A, Priest RG, Rix S, Hart D, 1997,“The defeat depression campaign: psychiatry in the public arena.”Am J Psych 154(6): 59-65.
Rosenthal M, Berndt ER, Donohue JM, Frank RG, Epstein AM, 2002,“Promotion of prescription drugs to consumers.”New Engl J Med 346: 498-505.
Shiang J, 1998,“Does culture make a difference? Racial/Ethnic patterns of completed suicide in San Francisco, CA 1987-1996 and clinical applications.”Suicide Life Treat Behav 28(4): 338-354.
Simon GE, Vonkorff M, 1995,“Recognition, management, and outcomes of depression in primary care.”Arch Fam Med 4: 99-105.
Smith R, 1998,“Beyond conflict of Interest.”BMJ 317: 291-292.
Soontae An, 2008,“Antidepressant direct-to-consumer advertising and social perception of the prevalence of depression: application of the availability heuristic.”Health Communication 23(6): 499- 505.
Trivedi MH, Rush AJ, Wisniewski SR, et al, 2006,“Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.”Am J Psych 163(1): 28-40.
Vakratsas D, Kolsarici C, 2008,“A dual-market diffusion model for a new prescription pharmaceutical.”Int J Res Mark 25: 282-293.
Valuck RJ, Libby AM, Orton HD, Morrato EH, Allen R, Baldessarini RJ, 2007,“Spillover effects on treatment of adult depression in primary care after FDA advisory on risk of pediatric suicidality with SSRIs.”Am J Psych 164(8): 1198-1205.
Weissman JS, Blumenthal D, Silk AJ, Newman M, Zapert K, Leitman R, Feibelmann S, 2004,“Physicians report on patient encounters involving direct-to-consumer advertising.”Health Aff 4: 219-233.
Wolff G, Pathare S, Craig T, Leff J, 1996,“Community knowledge of mental illness and reaction to mentally ill people.”BJ Psych 168: 191-198.
Wolinsky H, 2005,“Disease mongering and drug marketing.”EMBO 6(7): 612-614.
Ziad FG, Kenneth WL, 2007,“Direct-to-consumer advertising of pharmaceuticals.”Am J Med 120: 475-480.