長者衰弱與憂鬱之關聯：以心理效能素養與接納行動為中介

Abstract

臺灣進入高齡社會後，健康老化、老年憂鬱與自殺成了相當重要的議題。本研究目的為理解臺灣老年人身體老化與憂鬱中，心理效能素養與接納行動在其中的影響機制。因此將探討身體老化因素（包含衰弱、工具性日常生活活動功能與基本日常生活功能）、心理效能素養與憂鬱之間的相關、預測與中介機制。 本研究之研究方法採問卷法，針對社區長者進行收案，共回收251份有效問卷。研究工具包含：衰弱、工具性日常生活活動功能、基本日常生活活動功能、自編老年心理效能素養問卷、接納行動問卷、老年憂鬱量表。收案後進行量表項目分析、因素分析、相關、預測與雙變項中介路徑分析。 研究結果發現： (1) 衰弱、日常生活活動功能、老年憂鬱之間呈顯著正相關；長者心理效能素養、接納行動兩者間呈現正相關，但與憂鬱呈現負相關。 (2) 在控制背景變項（年齡層、目前婚姻有無與社會支持）後，衰弱、工具性日常生活活動功能與基本日常生活活動功能皆對憂鬱有顯著之正向預測力，長者心理效能素養當中之連結性、以及接納行動皆對憂鬱有顯著的負向預測力。 (3) 雙中介分析當中，以衰弱作為獨變項，老年憂鬱作為依變項進行分析時，長者心理效能素養、接納行動之雙變項中介效果為顯著；將長者心理效能素養三個分量表分開討論時，自主性與接納行動、連結性與接納行動、抱持性、接納行動之雙中介效果皆顯著。 (4) 以工具性日常生活活動功能（IADL）作為獨變項，老年憂鬱作為依變項進行分析時，長者心理效能素養、接納行動之雙中介效果皆顯著；將長者心理效能素養三個分量表分開討論時，自主性與接納行動、連結性與接納行動之雙中介效果皆顯著；但扶持性與接納行動之雙中介效果未顯著。 (5) 以基本日常生活活動功能（BADL）作為獨變項，老年憂鬱作為依變項進行分析時長者心理效能素養、接納行動之雙中介效果皆顯著；將長者心理效能素養三個分量表分開討論時，自主性與接納行動、連結性與接納行動之雙中介效果皆顯著；但扶持性與接納行動之雙中介效果未顯著。 依據研究結果，本研究發現長者心理效能素養包括:自主性、連結性與抱持性三項重要成分，其中連結性與憂鬱之間的關聯最為顯著；而抱持性因在中介分析中皆無顯著效果，因此推測抱持性可能與長者更高層次的幸福感有關。另外，提示在身體老化受限時，可經由心理效能素養影響接納行動，進而減低憂鬱程度，因此建議未來在心理治療當中，接納承諾治療或正念相關的介入，可能對長者產生保護與預防的效果。After becoming a senior society, healthy aging, depression and suicide in late life has become an important issue in Taiwan. The present research aims to understand how the psychological efficacy literacy and acceptance action affect the mechanism of Taiwanese elders’ physical aging and depression. Therefore, this research will examine the correlations, prediction and mediation among physical aging factors (including frailty, activity daily life and basic activity daily life), psychological efficacy literacy, acceptance action and geriatric depression. The present study is based on a collection of questionnaires distributed to a sample of community dwelling elders from Taipei Metropolitan Area in Taiwan. The measurements included: Taiwanese Fried Frailty Index, Barthel Index (BADL), Instrumental Activities of Daily Living Scale (IADL), elders’ psychological efficacy literacy, Acceptance and Action Questionnaire – II (AAQ), Geriatric Depression Screening scale (GDS). The data was analyzed by items analysis, factor analysis, correlation, regression and serial multiple mediation analysis. The major findings of the present study were as follow: 1. Frailty, activities of daily living were significantly positively correlated to geriatric depression; elders’ psychological efficacy literacy were significantly positively correlated to acceptance, which negatively correlated to geriatric depression. 2. After controlling the background variable (age groups, marriage, social support), frailty, instrumental activities of daily living and basic activities of daily living could positively predict geriatric depression. Connecting subscale of elders’ psychological efficacy literacy and acceptance could negatively predict geriatric depression. 3. In the mediation analysis, elders’ psychological efficacy literacy and acceptance has serial multiple mediation effect when frailty as independent variable and geriatric depression as dependent variable. And all the subscales of the elders’ psychological efficacy literacy (including autonomy, connecting and holding) and acceptance has serial multiple mediation effect. 4. Elders’ psychological efficacy literacy and acceptance and action has serial multiple mediation effect when instrumental activities of daily living as independent variable and geriatric depression as dependent variable. In the subscales of the elders’ psychological efficacy literacy, autonomy and acceptance, connecting and acceptance has serial multiple mediation effect, however, holding and acceptance doesn’t have serial multiple mediation effect. 5. Elders’ psychological efficacy literacy and acceptance and action has serial multiple mediation effect when basic activities of daily living as independent variable and geriatric depression as dependent variable. In the subscales of the elders’ psychological efficacy literacy, autonomy and acceptance, connecting and acceptance has serial multiple mediation effect, however, holding and acceptance doesn’t have serial multiple mediation effect. According to the research findings, the elders’ psychological efficacy literacy have 3 important elements including autonomy, connecting and holding, and connecting was the most significant relation with the geriatric depression; however, holding didn’t play the mediating effect between physical aging factors and depression, we speculate that holding may relate to higher well-being in elderly. In addition, we propose that when elders limited by physical aging, we could alleviate depression by the way of improving psychological efficacy literacy, and further influencing their acceptance and action. Thence, we recommend Acceptance and Commitment Therapy and Mindfulness based intervention could be a good choice of psychotherapy to provide protection and prevention for elders in the future.