| 摘要: | 台灣少子化嚴重且婦?總生育?全球最低，關心及促進?孕症族群健康成為政府甚 為重要課題。?孕使個案經?相當之心?壓?，可能導致憂鬱與焦慮症，惟台灣結構 化分析此壓?因子、壓?程?與情緒反應模式之文獻闕如；國內外也未??孕症診斷 至患者出現??疾病之時間間隔及相對風險之研究。結果可供衛生單位於預防醫學措 施之?考。 以關??孕族群健康差距為出發點，本研究欲達目的如下：驗證?孕患者壓?因 子、壓?程?與憂鬱、焦慮之測?與結構模式；估計於?同風險因子下，?孕者出現 ??疾病之相對風險；探??孕症及之後出現??疾病之潛在風險因子。 初級資?擬為?中南三區共 3 家醫學中心?孕症門診患者(人工與非人工生殖)360 位，以結構式問卷進?橫斷調查；回溯縱貫性次級資?擬採全民健保資?庫2002-2009 ?承保抽樣歸人檔中診斷為?孕症患者（男-606.x，?-628.x）約13,640 位。分析方法 包括以AMOS 17 驗證結構方程模式（SEM）、SAS 9.2 進?存活分析(Cox 對比涉險模 式)、及PASW Modeler 13 進?資?探勘。 預期結果為促進?孕患者壓?因子與程?及?孕症確診後??疾病風險差?之瞭 解，協助提供?孕症照護可能發展方向，包括?孕壓?與情緒反應篩檢，有效衛教、 心?諮商與社工介入之時機，以嘗試預防??疾病發生。
As the total fertility rate (TFR) in Taiwan has been ranked the lowest in the world, the issue of the fewer children trend becomes extraordinarily severe. Therefore, the authorities face a significant challenge in caring and treating infertile patients in the implications of health promotion and, hopefully, can elevate the TFR eventually. Previous research has asserted that the infertile individuals experience substantially psychological stress during the disease course and are at higher risks of depression and anxiety. However, there is a dearth of analyses on the structural model of stressors, stress level, and emotional reactions among Taiwan infertile patients; moreover, there is no literature on the time interval between diagnoses of infertility and mental disorders onset as well as on the relative hazards. Hence, timely, preventive intervention to the infertile is deserved. Study results may serve as a reference for formulating the policy measures of preventive medicine in psychologically appropriate ways for this vulnerable yet important group. Initialized by a concern for health disparities among the infertility patients, the present study seeks to: 1. Establish the measurement and structural models of infertile stressors, stress level, and depression and anxiety; 2. Estimate the interval between the diagnosis of infertility and the diagnosis of mental disorder and relative hazards; and 3. Explore the potential risk factors of infertility and infertility related mental disorders. Data source is two-fold. In the cross-sectional design, primary data of 360 outpatients will be obtained using structured questionnaires at infertility clinics at three medical centers of northern, central, and southern Taiwan. Longitudinal, secondary data analysis will be conducted by utilizing the data extracted from 1,000,000 randomly sampled beneficiaries recorded in the 2002-2009 Taiwan National Health Insurance Research Database, which include approximately 13,640 women and men with infertility (ICD-9-CM 628.x and 606.x, respectively). Analysis methods include Structural Equation Modeling (SEM) conducted in AMOS 17, survival analysis (Cox Proportional Hazard Model) in SAS 9.2, and data mining using PASW Modeler 13. The present study expects to contribute towards the advancement in understanding infertile stressors, stress level, and disparities in mental disorders onset. Furthermore, the results can provide valuable information for the development of possible directions in infertility healthcare. A reliable screening instrument for identifying stressful patients with higher emotional risks and effective timing of intervention involving patient instructions, psychological counseling, and social works may be obtained, all in the attempt to prevent mental illness among patients with the patient-centered healthcare framework. |
