背景：生活壓力事件與憂鬱之間具有相互因果(reciprocal causation)的關係，並且對憂鬱患者接受抗鬱劑治療的結果和預後造成影響；然，過去探討生活壓力事件的研究多僅將生活事件的客觀數量加總作為壓力變項，忽略個體對生活事件主觀覺知的壓力程度。復原力(resilience)為個體面臨逆境時所需的能力，也是個體罹患一些精神疾病的保護因子，並且對憂鬱與焦慮患者的症狀減少具有預後價值。過去文獻指出短期內復原力提升與較佳的心理健康有關，也有橫斷研究發現復原力能夠調節生活壓力事件對心理健康的負面影響。目前尚缺乏以臨床憂鬱與焦慮患者為樣本，探討生活壓力事件、復原力以及心理健康的長期縱貫性追蹤研究。
目的：本研究藉由長期追蹤一群曾經接受抗鬱劑治療的門診焦慮憂鬱症患者，探討復原力、生活壓力事件以及心理健康（包含憂鬱程度、焦慮敏感性以及生活品質）之間的關係。研究假設：(1)憂鬱與生活壓力事件之間存在相互因果的關係；(2)復原力提升能夠長期預測終點較佳的心理健康狀態；(3)復原力能夠長期緩衝生活壓力事件對憂鬱的負面影響。
方法：本研究共追蹤66名曾服用抗鬱劑半年至一年間的門診焦慮憂鬱患者，基線期與終點平均間隔時間約為6年（追蹤時間介於4至8年）。參與者分別於兩次測驗中填寫Connor-Davidson彈性量表(Connor-Davidson Resilience Scale, CD-RISC)、貝氏憂鬱量表第二版(Beck depression inventory-II, BDI-II)、焦慮敏感指數(Anxiety sensitivity index, ASI)以及台灣簡明版世界衛生組織生活品質問卷(The Taiwan version of the World Health Organization Quality of Life, WHOQOL-BREF)等自陳式量表，並接受以生活事件量表(Life Events Scale, LES)為基礎的半結構式訪談。
結果：(1)終點的描述統計結果顯示66位參與者中有48位(72.7%)女性，50位(75.8%)已婚，平均教育年數為12.58年，平均年齡為53歲，有21位參與者(31.8%)BDI-II總分落於輕鬱範圍以上（總分> 13）。(2)基線期憂鬱未緩解的參與者比憂鬱緩解的參與者報告更多的生活壓力事件數量(p=.003)與主觀壓力程度(p=.002)。(3)在控制生活壓力事件總數後，復原力提升顯著預測較低的憂鬱程度(p=.014)與焦慮敏感性(p=.013)，以及較高的生活品質(p=.028)；而在控制生活壓力事件的主觀壓力後，復原力提升僅具有預測較低憂鬱程度(p=.056)與較高生活品質(p=.058)之趨勢，但能夠顯著預測較低的焦慮敏感性(p=.033)。(4)縱貫資料之調節作用分析結果發現，基線期復原力與生活壓力事件總數之二元交互作用項(p=.035)顯著預測較低的憂鬱程度，生活壓力事件總數(p=.036)顯著預測較高的憂鬱程度，基線期復原力的主要效果則不顯著(p=.388)，顯示復原力雖無法長期預測憂鬱程度，但能夠調節生活壓力事件數量對憂鬱的影響；另外生活壓力事件之主觀壓力顯著預測較高的憂鬱程度(p=.004)，但基線期復原力(p=.475)、復原力與主觀壓力的二元交互作用項(p=.088)皆無法顯著預測憂鬱程度，顯示復原力對主觀壓力的長期調節效果不存在。(5)復原力對生活壓力事件與焦慮敏感性或生活品質的關係皆不具調節作用。在考量基線期復原力的情況下，生活壓力事件總數能夠預測較低的生活品質(p=.033)與較高的焦慮敏感性(p=.055)；然在考量終點復原力的情況下，生活壓力事件總數無法顯著預測終點焦慮敏感性與生活品質，但終點復原力能夠顯著預測較低的焦慮敏感性(p=.049)與較高的生活品質(p=.013)；針對主觀壓力的分析大致得出一致結果。
總結：整體而言終點復原力與心理健康呈正相關，生活壓力事件與心理健康則呈負相關。生活壓力事件與憂鬱嚴重度之間存在相互因果的關係；復原力提升與較佳的心理健康有關。值得注意的是，復原力在生活壓力事件總數與憂鬱程度之間具有長期的調節作用；其中，生活壓力事件對憂鬱影響在原先具備較高復原力的參與者身上較小。本研究顯示復原力為焦慮憂鬱患者長期預後的保護因子，復原力的提升有機會降低生活壓力對憂鬱的影響，且復原力能幫助患者正向地適應未來的生活壓力事件。本研究結果彰顯了復原力作為介入目標的潛在價值，未來仍需療效研究證實相關介入對於焦慮憂鬱患者之復原力提升與長期預後之影響。

Several cross-sectional studies have shown that an individual’s resilience could buffer the impact of stressful life events (SLEs) on mental health, but evidence from longitudinal follow-up clinical studies is scarce. The aim of the present study was to investigate the long-term relationship between resilience, SLEs and mental health. 66 outpatients with depression and/or anxiety disorders (69.8% female) completed the Beck depression inventory-II (BDI-II), Anxiety Sensitivity Index (ASI), World Health Organization Quality of Life (WHOQOL-BREF), and Conner-Davidson Resilience Scale (CD-RISC) at baseline and the study endpoint. The Life Events Scale (LES) was used in a semistructured interview at the endpoint to investigate SLEs that patients had experienced during the follow-up period (ranging from 4-8 years). The number of SLEs was significantly associated with more severe current depressive symptom, but the main effect of the baseline resilience score on the endpoint depressive symptoms was not significant.
In addition, a significant 2-way interaction of the baseline resilience score and the number of SLEs on follow-up depressive symptoms was found. However, the 2-way interaction of the baseline resilience score and SLEs on the endpoint anxiety sensitivity and quality of life were not significant. The study findings suggested that baseline resilience was a moderator of the effect of the number of SLEs on current depressive symptoms. The effect of the number of SLEs on depressive symptoms was weaker in patients with a higher resilience. These findings highlighted the importance of interventions to improve the resilience of depressed patients.

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