國小學童身心抱怨影響因素之建構

Abstract

兒童的身心症狀之特徵是會反覆發生但非疾病所引起的身體抱怨症狀。諸多文獻指出學童的身心抱怨症狀隨著年齡而增加。本研究目的旨在建構國小高年級學童之身心抱怨影響因素模式。模式假設影響學童身心抱怨症狀的因子有背景因素、父母層面因素、個人社會心理因素、社會支持以及學校生活等五項因素。以2002年「台灣地區國小學童健康行為調查暨教師健康促進教學能力增長計畫」為資料來源，共有2,759位學童與其家長參與問卷調查。以線性結構方程模式（LISREL）分析進行模式建構與資料分析。 研究結果顯示：學童身心抱怨的頻率分布呈現女學童多於男學童的情形。心理症狀的發生多於身體症狀。模式驗證發現，假設模式與觀察資料間卡方檢定達到顯著水準，拒絕虛無假設，但其他評鑑指標顯示適配情形均在可接受範圍。再根據修正指標，整併觀察變項、將部分觀察變項的殘差連結後，使模式變項間的關係能有效地解釋。在所建構模式中，能顯著預測學童身心抱怨產生的因素有：學童性別、社會支持、父母的自覺健康狀態、學童個人自覺社交狀態以及家庭社經地位，可見影響學童身心抱怨是多層面的因素。 依據研究結果提出建議：一、身心抱怨影響因素再修正簡化，重新審思模式的適切性；二、未來研究方向宜採縱貫性的研究，並擴大研究對象群；三、於學童心理健康防制實務上，強化社會支持的力量，並教導學童社交技巧，藉以提昇其心理健康。Psychosomatic symptoms in children, characterized by recurrent and unidentified physical complaints, are postulated to reflect psychosocial distress and conflicts. In previous studies, the prevalence of psychosomatic complaints in schoolchildren was increasing with age. The purpose of this study was to verify the goodness of fit between empirically observed data and the factors of the psychosomatic complaints (PSC) in children. The model assumed that variables were working on background factors, the family factors, psychosocial factors, social support, and school life. The sample was selected from the school children that registered in Taiwan elementary school in the first semester of 2002. Two thousand seven hundred and fifty-nine children aged ten to 12 years and their care takers completed the self-administered questionnaires. The analysis included a multivariate analysis using the LISREL program. The results of this study indicated: (1) Mental symptoms were more common PSC in school children. The prevalence was higher in girls than boys. (2) According to other indices of overall model fit and internal structure of model fit, the observed data could be interpreted by maintained model although the value of chi-square was significant (p< .05). Adjustment was thus made, in accordance with the modification index, to delete the unsuitable paths, combine the observed variances and line the error variances of some observed variances. (3)The best predictors of PSC were gender, social support, parent health status, social competence of the schoolchildren, and social economic status. The study results thus confirm that the factors of psychosomatic complaints were multidimensional. . Based on these findings and conclusions, the suggestions for the aspects of mental health education practice and future research were proposed. Further research using other variables is needed to clarify the relationship between physiological, psychological, and socioeconomic aspects. The application of the same model will be reinvestigated in a sample of pre-schoolchild and adolescents. Longitudinal studies are needed to clarify this complex reality. We emphasize that psychological support and social relationship are necessary to reduce psychosomatic symptoms in children.