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研究生: 陳威霖
Chen, Wei-Lin
論文名稱: 高齡者憂鬱風險與鄰里環境相關性研究-以高雄市鹽埕區為例
Correlation between Depression Risk and Neighborhood Environment of the Elderly: A Case Study of Yancheng District, Kaohsiung City
指導教授: 趙子元
Chao, Tzu-Yuan
學位類別: 碩士
Master
系所名稱: 規劃與設計學院 - 都市計劃學系
Department of Urban Planning
論文出版年: 2024
畢業學年度: 112
語文別: 中文
論文頁數: 119
中文關鍵詞: 心理健康健康老化WHO-5 幸福指標量表二元邏輯斯迴歸模型空間自相關模型
外文關鍵詞: Mental Health, Healthy Ageing, WHO-5 well-being index, Binary logistic regression, Spatial Autocorrelation Model
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  • 人口高齡化是全球面臨的重大挑戰,台灣更是即將邁入超高齡社會,高齡化對台灣而言尤其迫在眉睫。而面對如此高齡社會的衝擊,如何使高齡者能夠在社區環境之中健康生活十分的重要,健康老化(Healthy Ageing)倡議於2020年由世界衛生組織提出,由功能能力、內在能力以及環境三個元素所組成,旨創造環境和機會,使高齡者能夠維持社會關係、保有身心能力且滿足個人需求與目標,並能夠擁有良好的健康福祉。當中心理健康對於高齡者而言十分重要,但卻也容易被忽視,全球和台灣高齡人口中患有憂鬱症的比例都相當高,但就醫率卻偏低,這對社會造成了巨大的負擔。因此了解鄰里環境對高齡者心理健康的影響,並提出相應的健康干預措施和政策,對於建構高齡友善環境和保障高齡者心理健康福祉至關重要。
    本研究透過文獻回顧的分析,梳理出各項對於高齡者心理健康與憂鬱風險可能具有影響的環境與個人因素,並以高雄市鹽埕區為實證地區,由鄰里環境的視角,探討在高齡人口佔比多且近年環境變化大的地區之中,實質環境、社會環境與個人因素各層面因素對於高齡者心理健康的影響,透過問卷調查以及地理資訊系統的運用,獲取主觀環境感受與客觀環境數據以進行全面性討論,並採用WHO-5幸福指標量表做為高齡者心理健康的量測,透過四項研究假設,以邏輯斯迴歸分析與空間自相關分析方式探討當中的關聯性。
    實證研究結果顯示,在考量個人因素的控制變量下的鄰里環境影響中,住宅類型、環境改善感知、社區治安感知以及客觀居住密度與高齡者憂鬱風險具有顯著關聯,而個人因素則是在自覺健康與高齡者憂鬱風險具有顯著關聯,然而在單一變數的迴歸分析與階層迴歸分析之下呈現出不一樣的結果,此一結果說明了鄰里環境與個人層面等因素間可能存在著交互作用,然而高齡者心理健康狀態在里別的空間尺度之下並不具有空間自相關情形。
    透過本研究之主要貢獻在於,發掘高齡者對於環境的主觀感受對於憂鬱風險具有相關性,反映出高齡社會相關政策的訂定更應該重視高齡者主觀感受,以提供契合高齡群體需求與理想的策略。此外,透過文獻回顧與實證分析結果發現,各地之間存在著極大的差異性,因此在高齡者身心健康相關決策前,應考量各地條件的不同,提出因地制宜的策略。

    With the aggravation of population aging, Taiwan is facing the challenge of how to promote healthy living among the elderly in a super-aged society. Mental health is very important to the elderly, but it is also easily overlooked. Therefore, understanding the impact of neighborhood environment on the mental health of the elderly and proposing corresponding health interventions and policies are crucial to constructing an age-friendly environment and safeguarding the mental health and well-being of the elderly. In this study, this study used Yancheng District, Kaohsiung City, as an example. The questionnaire survey included the WHO-5 well-being index and various environmental perceptions, and a secondary database was constructed to investigate the effects of neighborhood environment and personal factors on the mental health and depression risk of the elderly by means of binary logistic regression analysis and spatial autocorrelation analysis. The study found that the type of housing, perceived environmental improvement, perceived community security and living density significantly affected depression risk, while there was no significant spatial autocorrelation of the mental health status of the elderly across neighborhoods. This study emphasizes the importance of taking into account the subjective perception of the elderly in order to formulate policies that better meet their needs, and points to the need to develop strategies for the mental and physical health of the elderly that are tailored to the local context.

    第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 3 第三節 研究內容與流程 3 第二章 文獻回顧 5 第一節 老年憂鬱症探討 5 第二節 健康城市與健康老化 11 第三節 影響高齡者心理健康之因素 14 第三章 研究設計 20 第一節 研究假設 20 第二節 研究範圍與對象 21 第三節 研究方法 29 第四章 實證分析 45 第一節 客觀環境資料庫 45 第二節 問卷調查 49 第三節 信效度分析 51 第四節 敘述性統計分析 52 第五節 迴歸分析 64 第六節 空間自相關分析 82 第七節 討論 85 第五章 結論與建議 89 第一節 結論 89 第二節 研究建議與限制 90 參考文獻 93 附錄 104 附錄一:問卷內容 104

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    Vink, D., Aartsen, M. J., & Schoevers, R. A. (2008). Risk factors for anxiety and depression in the elderly: a review. J Affect Disord, 106(1-2), 29-44. https://doi.org/10.1016/j.jad.2007.06.005
    Vujcic, M., Tomicevic-Dubljevic, J., Grbic, M., Lecic-Tosevski, D., Vukovic, O., & Toskovic, O. (2017). Nature based solution for improving mental health and well-being in urban areas. Environmental Research, 158, 385-392. https://doi.org/10.1016/j.envres.2017.06.030
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    Wang, S., Cai, W., Tao, Y., Sun, Q. C., Wong, P. P. Y., Huang, X., & Liu, Y. (2023). Unpacking the inter- and intra-urban differences of the association between health and exposure to heat and air quality in Australia using global and local machine learning models. Sci Total Environ, 871, 162005. https://doi.org/10.1016/j.scitotenv.2023.162005
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    (二)專書論著
    Hill, T. D., & Maimon, D. (2013). Neighborhood Context and Mental Health. In C. S. Aneshensel, J. C. Phelan, & A. Bierman (Eds.), Handbook of the Sociology of Mental Health (pp. 479-501). Springer Netherlands. https://doi.org/10.1007/978-94-007-4276-5_23
    Narrow, W. E. (2007). Age and gender considerations in psychiatric diagnosis. American Psychiatric Association.
    Sarkar, C., Webster, C. J., & Gallacher, J. (2014). Healthy cities : public health through urban planning. Cheltenham.
    WHO. (2001). The World health report : 2001 : Mental health : new understanding, new hope. World Health Organisation.
    WHO. (2007). Global age-friendly cities: a guide. World Health Organisation.
    WHO. (2015). World report on ageing and health. World Health Organisation.
    WHO. (2017a). Depression and other common mental disorders: global health estimates. World Health Organisation.
    WHO. (2020). UN Decade of Healthy Ageing: Plan of Action 2021–2030. World Health Organisation.
    WHO. (2021). Decade of healthy ageing: baseline report. World Health Organisation.
    WHO. (2022c). Mental health and Climate Change: Policy Brief. World Health Organisation.
    WHO. (2022d). World mental health report: Transforming mental health for all - executive summary. World Health Organisation.
    (三)電子資源
    Anselin, L. (2020). Global Spatial Autocorrelation (1)Visualizing Spatial Autocorrelation. GeoDa. Retrieved April from https://geodacenter.github.io/workbook/5a_global_auto/lab5a.html
    WHO. (2017b). Mental health of older adults. World Health Organisation. Retrieved September from https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
    WHO. (2022a). Ageing and health. World Health Organisation. Retrieved September from https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
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    二、中文文獻
    (一)期刊文獻
    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 [Predictive Factors of Geriatric Depression in Taiwan: A Ten-Year Longitudinal Study]。 台灣老年醫學暨老年學雜誌, 5(4), 257-265。 https://doi.org/10.29461/tgg.201011.0003
    彭建文、 李美杏、陳冠儒 (2020)。 台灣地區居住滿意度影響因素之實證分析 [Determinants of Residential Satisfaction: An Empirical Study in Taiwan]。 都市與計劃, 47(3), 243-270。 https://doi.org/10.6128/CP.202009_47(3).0003
    曾憲洋、 陳正生、 唐子俊、 張明永、 鄭泰安 (2000)。 老人憂鬱自我評量表 (Self-CARE[D]) 的效度研究。 台灣精神醫學。
    劉慕恩、 楊誠弘 (2017)。 老年憂鬱症回顧。 臨床醫學月刊, 79(2), 69-71。 https://doi.org/10.6666/ClinMed.2017.79.2.012
    盧俊吉、 蕭崑杉、 林如森、 王春熙 (2011)。 高齡者社會支持、休閒活動與心理健康關係之研究。 農業推廣文彙(56輯), 101-110。 https://doi.org/10.29743/aea.201112.0031
    (二)專書論著
    Association原著、台灣精神醫學會譯 (2014)。 DSM-5精神疾病診斷準則手册 合記圖書。
    王濟川、 郭志剛 (2004)。 Logistic迴歸模型 : 方法及應用 = Logistic regression models : Methods and application / 王濟川, 郭志剛著 (二版 ed。)。 五南。
    米勒、 雷諾三世、 李淑珺 (2007)。 老年憂鬱症完全手冊。 心靈工坊文化。
    周俊 (2018)。 問卷資料分析 : 破解SPSS的六類分析思路 / 周俊著 (初版 ed。)。 博碩文化。
    林震岩 (2018)。 多變量分析 : SPSS的操作與應用 = Multivariate analysis : SPSS operation and application / 林震岩編著 (三版 ed。)。 智勝文化。
    國家發展委員會 (2022)。 中華民國人口推估(2022 年至 2070 年)。 國家發展委員會。
    國家發展委員會國土區域離島發展處 (2022)。 都市及區域發展統計彙編。 中華民國111年。 國家發展委員會。
    黃正平 (2011)。 臨床老年精神醫學。 合記。
    葉雅馨 (2019)。 老年憂鬱不是老化 : 別讓藍色風暴遮蔽年邁旅程 / <大家健康>雜誌採訪整理 ; 葉雅馨總編輯 (初版)。 董氏基金會大家健康雜誌。
    衛生福利部 (2024)。 中華民國 111 年老人狀況調查報告。
    衛生福利部委託國立臺灣大學醫學院附設醫院精神醫學部編製 (2015)。 認識憂鬱 面對憂鬱 擺脫憂鬱—憂鬱情緒障礙自助手冊。 衛生福利部。
    衛生福利部國民健康署 (2022)。 民國一百零八年中老年身心社會生活狀況長期追蹤調查成果報告。 臺北市: 衛生福利部國民健康署
    (三)學位論文
    許智宏 (2006)。 都市混合土地使用形態及其影響因素之研究—以台南市為例
    (四)電子資源
    林惠琴 (2022)。 中高齡憂鬱症盛行率16.3% 國衛院研究發現7成未就醫。 自由時報。 Retrieved September from https://health.ltn.com.tw/article/breakingnews/4055375
    劉嘉韻、 李樹人、 陳婕翎、 吳文琪、 曾玉玲、 林志強、 許珮珍、 高博彥、 黃琬淑 (2019)。 聰明就醫×健保大數據。 聯合報。 Retrieved September from https://topic.udn.com/event/health_depression
    衛生福利部國民健康署 (2015)。 消弭臺灣健康不平等之行動策略。 Retrieved May from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1089&pid=6416

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