[ 摘要 ]

本研究之目的為藉由以學校為基礎的憂鬱量表篩檢、問卷及精神科醫師之診斷評估以瞭解（一）花蓮地區高中職學生之憂鬱情緒及自殺傾向現況、（二）具憂鬱情緒及自殺傾向之高危險群青少年，符合憂鬱症診斷的情形為何？、（三）高中職學生憂鬱疾患及自殺傾向之相關危險因子為何？（四）高中職學生憂鬱疾患及自殺傾向之預測因子為何？（五）追蹤一年後，高中職學生憂鬱疾患及自殺傾向之預測因子是否仍具預測力？

研究方法為以花蓮四所高中職所有學生5,259位為對象，共回收5,234份問卷，測驗工具包括台灣人憂鬱問卷（Taiwanese Depression Questionnaire, TDQ）、MINI國際神經精神科面談結構式診斷工具（the Mini International Neuropsychiatric Interview）及研究者自編青少年憂鬱及自殺危險因子檢核表（Adolescent Depression and Suicide Risk Factors Check List）。初步篩檢後TDQ分數在29分(含)以上者共有386位，由精神科醫師進行診斷，並加以追蹤。經過一年後，除已經畢業或其他原因離校的學生外，針對所追蹤之228位青少年精神科醫師再次予以診斷評估。

結果顯示所有對象TDQ總分平均為14.22分， 29分以上的學生以三年級最高（40.9%）。29分以上具自殺傾向者共129人，其中女性（65.9%）高於男性（34.1%），而以三年級最高（41.9%）；診斷憂鬱疾病者共119人，男生佔38.7%女生佔61.5%，三年級學生佔49.6﹪比例最高；有自殺傾向者共129人佔高危險群38.6%，男生44人女生85人，三年級學生佔41.9﹪為最高；符合憂鬱診斷又有自殺傾向者共76人佔高危險群19.7%。而與高中職學生憂鬱疾患相關之因子以相關係數檢定進行分析，結果顯示年級、性別、原住民身份、父母親有物質濫用、是否曾遭受虐待及身體不適症狀總和等六項達顯著；自殺傾向為憂鬱症之最佳預測因子。而與自殺傾向相關之危險因子為性別、原住民身份、父母婚姻狀況、父母親有物質濫用、家族精神疾病史、是否曾遭受虐待、有無傾吐對象、生活困擾總和、重大事件總數、負向減壓方式及身體不適症狀總和；而憂鬱症、重大事件總數、有無傾吐對象、性別及TDQ量表總分等五項因子為青少年自殺傾向之預測因子。針對追蹤一年後被診斷為憂鬱症之高中職青少年，將憂鬱症相關因子做逐步迴歸分析，結果顯示自殺傾向危險性及有無遭受過虐待兩項達顯著；而追蹤一年後高危險群青少年自殺傾向相關危險因子分析顯示，有無憂鬱症、父母婚姻狀況、生活困擾總和三項具最佳預測力。本研究結果支持憂鬱症與自殺傾向之危險因子不完全相同；在校園中以憂鬱量表篩檢出高危險群，加上自殺傾向、憂鬱症及自殺危險因子、學生特質與家庭狀況之綜合評估，可以將疑似憂鬱症及自殺危險最高之學生辨認出來轉介醫師診斷，有助於校園憂鬱及自殺防治。

[ 英文摘要 ]

The purpose of this thesis was to investigate: 1.the depression and the suicide of senior high school students in Hualien. 2.the depressive disorders among the high-risk group students with depressed mood or suicidal tendency. 3. the related risk factors of adolescent depressive disorders and suicide. 4. the predictive factors of the adolescent depressive disorders and suicide. 5.the validity of those predictive factors after one year.

In this thesis, 5,239 students of two senior high schools and two vocational high schools in Hualien were recruited. Total 5,234 students completed Taiwanese Depression Questionnaire (TDQ), and Adolescent Depression and Suicide Risk Factors Check List (designed by author). The subjects with highest cutoff scores(TDQ＞＝29, N=386)were defined as high-risk group and were interviewed by psychiatrists to decide diagnosis by the Mini International Neuropsychiatric Interview(MINI) and DSM-Ⅳ. After one-year follow-up, psychiatrists diagnosed all 228 adolescents except those who were graduated and quitted school again.

The study result showed that the overall mean of the TDQ score was 14.22, and the largest proportion of high-risk group were third graders (40.9%). The adolescents with suicidal tendency (N=129) included 85 females and 44 males, while the third graders were also the largest proportion (49.6%). Of the 119 adolescents diagnosed with depressive disorders, females (65.9%) were higher than males (38.7%).

The related risk factors of adolescent depressive disorders and suicide were analyzed by correlation. The result showed that grade, sex, and aborigine, parents with substance abuse, abused history, and physical discomforts were significant factors of adolescent depressive disorder; meanwhile, the suicidal tendency was the best predictor. Besides, the related risk factors of suicidal tendency contain sex, aborigine, parent’s married condition, parents with substance abuse, family history of psychiatric disease, abused history, unloading, annoyance in life, major negative life events, releasing pressure in negative ways and physical discomforts; and the predictors of adolescent suicide were depressive disorders, major negative life events, unloading, sex, and total scores of TDQ. One year later, the related risk factors of adolescent depressive disorder were suicidal tendency and abused history Moreover, the diagnosis of depression, parent’s married condition and the annoyance in life were the best predictors of adolescent suicidal tendency.