背景：憂鬱是中老年人常見的心理健康問題，隨著生命歷程的轉變，例如退休可能產生的各項變化，以及個人能否調適得當，可能會進一步影響其生理或心理的健康。然而，影響憂鬱的相關因素存在在生活中的各個層面，對退休族群而言，若能找出影響憂鬱變化的危險因子與保護因子，即可有機會協助退休者降低或改善憂鬱症狀的發生。因此，本研究目的為探討臺灣中老年退休者三年後憂鬱變化的影響因子。
目的：本研究目的有二：一是探討臺灣中老年退休者憂鬱分數變化的影響因子，包括危險因子、保護因子以及雙向因子，二是進一步分析影響臺灣中老年退休者三年後憂鬱分數惡化或改善之相關因子。
方法：本研究使用「退休規劃與退休歷程對退休後健康狀況之影響」的兩波追蹤調查資料庫，研究對象為臺灣地區50-74歲公勞保退休人員。排除條件為：ADL一題以上有困難者或六題皆未作答者、以及兩波憂鬱題目遺漏者，最終有效樣本為2379人。自變項為第一波(2015-2016年)之人口學變項(包括性別、年齡、教育程度、婚姻狀況、退休時間、退休前職業類型、退休後就業狀態、居住狀況、經濟狀況)、健康相關變項(包括抽菸、喝酒、規律運動、睡眠、疾病數、工具性日常生活活動功能(IADL)、自覺健康狀況)、以及健康心理變項(包括社會連結、參與社團組織、照顧家人或親人小孩、擔任義工或志工、參加社區活動、經歷重大生命事件等變項)。依變項為第一波及第二波的憂鬱分數變化，採用兩種結果呈現，一是分數變化，另一是分數變化之切組，切為三組：維持組、惡化組及改善組。統計方法包括描述性統計、雙變數分析、以及多變項迴歸分析，其中分數變化的部分主要以多元線性迴歸分析進行，而切組方面，則以多變項邏輯斯迴歸分析來進行。
結果：首先，在分數變化部分，經過控制相關變項後，發現教育程度為國小以下(β= 0.59，p=.010)、退休時間超過10年 (β= 0.65，p=.002)、退休前職業為非技術人員 (β= 0.81，p=.001)、獨居者 (β= 1.40，p=.002)、自覺健康狀況不好 (β= 0.82，p=.000)、有經歷重大生命事件(β= 0.52，p=.021)者，其三年後的憂鬱分數顯著較高。相反地，睡眠好 (β= -0.64，p=.002)、有擔任志工或義工(β= -0.40，p=.045)，其憂鬱分數顯著下降。
另外，若將兩波憂鬱分數之變化切成三組，經控制相關變項進行分析後，結果顯示退休時間超過10年 (OR=1.33；95% C.I.=1.04-1.70)、退休前職業為非技術人員 (OR=1.30；95%C.I.=1.04-1.71)以及經歷過重大生命事件 (OR=1.34；95% C.I.=1.03-1.76) 會促使其三年後的憂鬱分數惡化；相對地，睡眠好會阻止其三年後的憂鬱分數惡化(OR=0.70；95% C.I.=0.55-0.90)。此外，退休前職業為專業或管理人員 (OR=1.49；95% C.I.=1.02-2.20)以及擔任義工或志工 (OR=1.54；95% C.I.=1.08-2.19)會促使其三年後的憂鬱分數改善；然而，獨居 (OR=0.43；95% C.I.=0.22-0.84)以及自覺健康狀況不好 (OR=0.59；95% C.I.=0.41-0.87)會阻礙中老年退休者三年後的憂鬱分數改善。
結論：本研究發現能夠預測中老年退休者憂鬱變化的危險因子，包含教育程度較低、退休時間超過10年、獨居、自覺健康狀況不好以及經歷重大生命事件；尤其，會使憂鬱分數惡化程度較高的因子為退休時間超過10年前、經歷重大生命事件，而獨居或自覺健康不好會阻礙其憂鬱分數改善。其次，與中老年退休者憂鬱變化顯著相關的保護因子有睡眠狀況好、擔任志工或義工；其中會阻止憂鬱分數惡化的因素是睡眠狀況好，而擔任志工或義工會促使其分數改善。最後，能夠預測中老年退休者憂鬱變化的雙向因子為退休前職業類型。

Depression is a common mental health problem among middle-aged and older adults. With changes in the life course, such as the various changes that may occur in retirement and whether the individual can adjust adequately, it may further affect their physical or psychological health. The purpose of this study was to explore factors associated with the changes in depressive symptoms among retirees in Taiwan, including risk factors, protection factors, and two-way factors. This study was a two-wave follow-up survey, with a total of 2379 retirees aged 50 to 74 years old in Taiwan. Depressive symptoms were measured by the CESD 10-item scale. Results showed that, after adjusting all covariates, the risk factors related to the changes in depressive symptoms included low education, retirement for more than 10 years, living alone, poor self-related health, and experiencing major life events. In particular, retirement for more than 10 years and experiencing major life events would worsen depression symptoms. In addition, living alone or with poor health might hinder the improvement of depression. Moreover, the protective factors associated with the deterioration of depressive symptoms among retirees included sleeping well and volunteering. Lastly, but not least, the two-way factor that can predict the depression changes of retirees was the type of occupation before retirement, where the non-technical job was a risk factor, and professional occupation was a protective factor for the changes in depressive symptoms.

Amagasa, S., Fukushima, N., Kikuchi, H., Oka, K., Takamiya, T., Odagiri, Y., & Inoue, S. (2017). Types of social participation and psychological distress in Japanese older adults: A five-year cohort study. PloS one, 12(4), e0175392.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of general psychiatry, 4(6), 561-571.
Chou, K. L., Chi, I., & Chow, N. W. S. (2004). Sources of income and depression in elderly Hong Kong Chinese: mediating and moderating effects of social support and financial strain. Aging & Mental Health, 8(3), 212-221.
Cuijpers P, van Straten A, Smit F, Mihalopoulos C, Beekman A. (2008) Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. Am J Psychiatry, 165(10), 1272-80.
Chang-Quan, H., Zheng-Rong, W., Yong-Hong, L., Yi-Zhou, X., & Qing-Xiu, L. (2010). Education and risk for late life depression: a meta-analysis of published literature. The International Journal of Psychiatry in Medicine, 40(1), 109-124.
Chan, A., Malhotra, C., Malhotra, R., & Østbye, T. (2011). Living arrangements, social networks and depressive symptoms among older men and women in Singapore. International journal of geriatric psychiatry, 26(6), 630-639.
Chiao C, Weng LJ, Botticello AL (2011). Social participation reduces depressive symptoms among older adults: an 18-year longitudinal analysis in Taiwan. BMC Public Health, 11, 292.
Chao, S. F. (2014). Functional disability and depressive symptoms: longitudinal effects of activity restriction, perceived stress, and social support. Aging & mental health, 18(6), 767-776.
Chang, S. C., Pan, A., Kawachi, I., & Okereke, O. I. (2016). Risk factors for late-life depression: a prospective cohort study among older women. Preventive medicine, 91, 144-151.
Croezen, S., Avendano, M., Burdorf, A., & van Lenthe, F. J. (2015). Social participation and depression in old age: a fixed-effects analysis in 10 European countries. American journal of epidemiology, 182(2), 168-176.
Da Costa Dias, F. L., Teixeira, A. L., Guimarães, H. C., Santos, A. P. B., Resende, E. D. P. F., Machado, J. C. B., ... & Caramelli, P. (2021). The influence of age, sex and education on the phenomenology of depressive symptoms in a population-based sample aged 75+ years with major depression: The Pieta Study. Aging & mental health, 25(3), 462-467.
Earl, J. K., Bednall, T. C., & Muratore, A. M. (2015). A matter of time: Why some people plan for retirement and others do not. Work, Aging and Retirement, 1(2), 181-189.
Förster, F., Stein, J., Löbner, M., Pabst, A., Angermeyer, M. C., König, H. H., & Riedel-Heller, S. G. (2018). Loss experiences in old age and their impact on the social network and depression–results of the Leipzig Longitudinal Study of the Aged (LEILA 75+). Journal of affective disorders, 241, 94-102.
Glass, T. A., Kasl, S. V. and Berkman, L. F. (1997). Stressful life events and depressive symptoms among the elderly. Evidence from a prospective community study. Journal of Aging and Health, 9, 70–89.
Gallo, J., Fulmer, T., Paveza, G., & Reichel, W.(2005) Handbook of geriatric assessment.
Geneva. (2017). World Health Organization, Depression and other common mental disorders: Global health estimates
Giltay, E. J., Zitman, F. G., & Kromhout, D. (2006). Dispositional optimism and the risk of depressive symptoms during 15 years of follow-up: the Zutphen Elderly Study. Journal of affective disorders, 91(1), 45-52.
García-Peña, C., Wagner, F. A., Sánchez-García, S., Espinel-Bermúdez, C., Juárez-Cedillo, T., Pérez-Zepeda, M., & Gallo, J. J. (2013). Late-life depressive symptoms: prediction models of change. Journal of affective disorders, 150(3), 886-894.
Gong, F., Zhao, D., Zhao, Y., Lu, S., Qian, Z., & Sun, Y. (2018). The factors associated with geriatric depression in rural China: stratified by household structure. Psychology, health & medicine, 23(5), 593-603.
Hamilton, M. (1960). A rating scale for depression. Journal of neurology, neurosurgery, and psychiatry, 23(1), 56.
Himmelfarb, S., & Murrell, S. A. (1983). Reliability and validity of five mental health scales in older persons. Journal of gerontology, 38(3), 333-339.
Hershey, D. A., & Henkens, K. (2014). Impact of different types of retirement transitions on perceived satisfaction with life. The Gerontologist, 54(2), 232-244.
Hou, L. H., Zhang, C. C., Lu, J., Zhao, H. N., & Chang, Y. Q. (2019, September). Association of Marital Affection, Depression, Anxiety and Stress among Chinese Elderly: The Moderating Role of Social Support. In Journal of The American Geriatrics Society (Vol. 67, pp. S672-S672). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY.
Jang, S. N., Cho, S. I., Chang, J., Boo, K., Shin, H. G., Lee, H., & Berkman, L. F. (2009). Employment status and depressive symptoms in Koreans: results from a baseline survey of the Korean Longitudinal Study of Aging. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 64(5), 677-683.
Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D depression symptoms index. Journal of aging and health, 5(2), 179-193.
Kraaij, V., Arensman, E., & Spinhoven, P. (2002). Negative life events and depression in elderly persons: a meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57(1), 87-94.
Katsumata, Y., Arai, A., Ishida, K., Tomimori, M., Lee, R. B., & Tamashiro, H. (2012). Which categories of social and lifestyle activities moderate the association between negative life events and depressive symptoms among community-dwelling older adults in Japan?. International psychogeriatrics, 24(2), 307-315.
Kuroda, A., Tanaka, T., Hirano, H., Ohara, Y., Kikutani, T., Furuya, H., ... & Iijima, K. (2015). Eating alone as social disengagement is strongly associated with depressive symptoms in Japanese community-dwelling older adults. Journal of the American Medical Directors Association, 16(7), 578-585.
Livingston, G., Watkin, V., Milne, B., Manela, M. V., & Katona, C. (2000). Who becomes depressed? The Islington community study of older people. Journal of Affective Disorders, 58(2), 125-133.
Li, N., Pang, L., Chen, G., Song, X., Zhang, J., & Zheng, X. (2011). Risk factors for depression in older adults in Beijing. The Canadian Journal of Psychiatry, 56(8), 466-473.
Lim LL, Chang WN, Yu X, Chiu H, Chong MY, Kua EH. (2011). Depression in Chinese elderly populations. Asia-Pacifi c Psychiatry, 3, 46-53.
Lee, E., Cho, H. J., Olmstead, R., Levin, M. J., Oxman, M. N., & Irwin, M. R. (2013). Persistent sleep disturbance: a risk factor for recurrent depression in community-dwelling older adults. Sleep, 36(11), 1685-1691.
Liu, X., Wang, C., Qiao, X., Si, H., & Jin, Y. (2020). Sleep quality, depression and frailty among Chinese community-dwelling older adults. Geriatric Nursing,42(3), 714-720.
Miss, C. W. (2020). Modifiable Protective and Risk Factors for Depressive Symptoms among Older Community-dwelling Adults: A Systematic Review. Journal of Affective Disorders.
Morikawa, M., Okamoto, N., Kiuchi, K., Tomioka, K., Iwamoto, J., Harano, A., & Kurumatani, N. (2013). Association between depressive symptoms and metabolic syndrome in Japanese community‐dwelling older people: a cross‐sectional analysis from the baseline results of the Fujiwara‐kyo prospective cohort study. International journal of geriatric psychiatry, 28(12), 1251-1259.
Min, J., Ailshire, J., & Crimmins, E. M. (2016). Social engagement and depressive symptoms: do baseline depression status and type of social activities make a difference?. Age and Ageing, 45(6), 838-843.
Misawa, J., & Kondo, K. (2019). Social factors relating to depression among older people in Japan: analysis of longitudinal panel data from the AGES project. Aging & mental health, 23(10), 1423-1432.
Noone, Jack H.; Christine Stephens and, Fiona M. Alpass. 2009. Preretirement Planning and Well-Being in Later Life: A Prospective Study. Research on Aging. 31(3): 295-317.
Ng, C. W., Tan, W. S., Gunapal, P. P., Wong, L. Y., & Heng, B. H. (2014). Association of Socioeconomic Status (SES) and social support with depressive symptoms among the elderly in Singapore. Ann Acad Med Singapore, 43(12), 576-587.
Petkoska, J., & Earl, J. K. (2009). Understanding the influence of demographic and psychological variables on retirement planning. Psychology and aging, 24(1), 245.
Park, H., Hwangbo, Y., Lee, Y. J., Jang, E. C., & Han, W. (2016). Employment and occupation effects on late-life depressive symptoms among older Koreans: a cross-sectional population survey. Annals of occupational and Environmental Medicine, 28(1), 1-8.
Qiu, Q. W., Qian, S., Li, J. Y., Jia, R. X., Wang, Y. Q., & Xu, Y. (2020). Risk factors for depressive symptoms among older Chinese adults: A meta-analysis. Journal of Affective Disorders, 277, 341-346.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied psychological measurement, 1(3), 385-401.
Roh, H. W., Hong, C. H., Lee, Y., Oh, B. H., Lee, K. S., Chang, K. J., ... & Chung, Y. K. (2015). Participation in physical, social, and religious activity and risk of depression in the elderly: a community-based three-year longitudinal study in Korea. PloS one, 10(7), e0132838.
Roudsari, M. S., Nedjat, S., Foroughan, M., Shahboulaghi, F. M., Rashedi, V., Haghi, M. & Mansouri, T. (2018). Protective psychosocial factors of geriatric depression in community dwelling older adults: A review article. Iranian journal of psychiatry and behavioral sciences, 12(2).
Steunenberg, B., Beekman, A. T., Deeg, D. J., & Kerkhof, A. J. (2006). Personality and the onset of depression in late life. Journal of affective disorders, 92(2-3), 243-251.
Spinhoven, P., Elzinga, B. M., Hovens, J. G. F. M., Roelofs, K., Van Oppen, P., Zitman, F. G., & Penninx, B. W. J. H. (2011). Positive and negative life events and personality traits in predicting course of depression and anxiety. Acta Psychiatrica Scandinavica, 124(6), 462-473.
Seung Hee, L. E. E., & Kim, Y. B. (2014). Which type of social activities decrease depression in the elderly? An analysis of a population-based study in South Korea. Iranian Journal of Public Health, 43(7), 903.
Tsai, Y. F., Yeh, S. H., & Tsai, H. H. (2005). Prevalence and risk factors for depressive symptoms among community‐dwelling elders in Taiwan. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 20(11), 1097-1102.
Uemura, K., Makizako, H., Lee, S., Doi, T., Lee, S., Tsutsumimoto, K., & Shimada, H. (2018). Behavioral protective factors of increased depressive symptoms in community‐dwelling older adults: A prospective cohort study. International journal of geriatric psychiatry, 33(2), e234-e241.
Vink, D., Aartsen, M. J., & Schoevers, R. A. (2008). Risk factors for anxiety and depression in the elderly: a review. Journal of affective disorders, 106(1-2), 29-44.
Vyas, C. M., & Okereke, O. I. (2020). Late-Life Depression: A Narrative Review on Risk Factors and Prevention. Harvard Review of Psychiatry, 28(2), 72-99.
World Health Organization. (2018). Depression.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of psychiatric research, 17(1), 37-49.
Yunming, L., Changsheng, C., Haibo, T., Wenjun, C., Shanhong, F., Yan, M. & Qianzhen, H. (2012). Prevalence and risk factors for depression in older people in Xi′ an China: a community‐based study. International journal of geriatric psychiatry, 27(1), 31-39.
Yeung, Dannii Y. (2013). Is pre-retirement planning always good? An exploratory study of retirement adjustment among Hong Kong Chinese retirees. Aging & mental health, 17(3), 386-393.
Yoo, J. S., Chang, S. J., & Kim, H. S. (2016). Prevalence and predictive factors of depression in community-dwelling older adults in South Korea. Research and theory for nursing practice, 30(3), 200-211.
Zung, W. W. (1965). A self-rating depression scale. Archives of general psychiatry, 12(1), 63-70.
林正介, 李燕鳴, & 劉樹泉. (1995). 影響新店社區老人憂鬱情緒之因素. 中華家醫誌 (5), 1(10).
廖以誠, 葉宗烈, 柯慧貞, 駱重鳴 & 盧豐華. (1995). 老年憂鬱量表--中譯版之信, 效度初步研究. 彰基醫誌, 1, 11-7.
呂寶靜. (1997). 台灣地區民眾從事老年準備之初探. 社會工作學刊, 4, 27-53.
周玉慧, 楊文山, & 莊義利. (1998). 晚年生活壓力, 社會支持與老人身心健康.人文及社會科學集刊, 10(2), 227-265.
李庚霖, 區雅倫, 陳淑惠, & 翁儷禎. (2009). “臺灣地區中老年身心社會生活狀況長期追蹤調查” 短版 CES-D 量表之心理計量特性. 中華心理衛生學刊, 22(4), 383-410.