不良睡眠品質中介Facebook成癮對台灣國中生憂鬱症狀之影響：九個月追蹤研究

[[abstract]]研究背景與目的 青少年在Facebook 成癮、睡眠品質不佳、憂鬱的問題日益增加，且文獻指出Facebook成癮、憂鬱及不良睡眠品質三者間有關聯性，故釐清三者之間的因果關係成為重要議題。雖然近年兩篇橫斷研究發現，網路成癮透過不良睡眠品質而與憂鬱相關，另一篇文獻結果更支持不良睡眠品質透過網路成癮而與憂鬱相關，但受限於橫斷研究，顯示兩條路徑仍有待以縱貫式研究加以驗證。是故，本研究使用九個月縱貫研究設計的方式，擬釐清上述路徑假設，即Facebook成癮會透過不良睡眠品質而影響憂鬱症狀，或不良睡眠品質會透過Facebook成癮而影響憂鬱症狀。 研究假設 假設一：在控制性別、T1&T2憂鬱症狀及T1不良睡眠品質下，T1 Facebook成癮會透過T2不良睡眠品質的中介，預測T3憂鬱症狀。 假設二：在控制性別、T1&T2憂鬱症狀及T1Facebook成癮下，T1不良睡眠品質會透過T2 Facebook成癮的中介，預測T3憂鬱症狀。 方法 1.資料來源：柯慧貞教授之「國中生網路成癮現象、成因及預防教育」系列計畫之部分資料進行分析；本研究之執行通過校內醫學研究倫理委員會之審查通過後始執行。 2.參與者：本研究採縱貫研究設計，進行九個月的追蹤，以叢集取樣台南與台中各一所國中一、二年級學生1001名學生，於 2014年九月進行施測，刪除問卷填答不佳者有815名學生完成前測(T1)；729名學生於 2015 年一月進行第二次施測(T2)；613名學生於2015年六月完成最後施測(T3)，追蹤率75.2%。 3.研究工具：Facebook 成癮量表、中文版匹茲堡睡眠品質量表以及 SCL-90-R 憂鬱分量表進行施測。 4.研究程序：施測前取得學生家長的同意後，於施測日向受試者說明施測目的及流程，強調問卷的保密性後，簽署施測同意書。回收問卷後，在以SPSS 22.0版進一步進行資料建檔、除錯後進行分析。 5.統計分析：採用描述性統計、卡方考驗、獨立樣本t檢定、皮爾森績差相關分析、Bootstrap 分析。 結果 1.以皮爾森績差相關分析，發現在T1、T2、T3三個時間點的「不良睡眠品質」、「Facebook成癮」及「憂鬱症狀」兩兩皆呈顯著正相關。 2.由Bootstrap法檢驗中介效果驗證假設一與假設二，其結果如下： (1)假設一：在控制性別、T1&T2憂鬱症狀及T1不良睡眠品質下，T1 Facebook成癮可以透過T2不良睡眠品質的中介，預測T3憂鬱症狀。 (2)假設二：在控制性別、T1&T2憂鬱症狀及T1 Facebook成癮下，T1不良睡眠品質無法透過T2 Facebook成癮的中介，顯著預測T3憂鬱症狀。 結論與建議 1.結論：本研究結果支持假設一，即Facebook成癮透過不良睡眠品質的完全中介影響憂鬱症狀；Facebook 成癮分數越高的國中生，睡眠品質越差，而憂鬱症狀也越嚴重。 2.研究限制： (1)本研究以自陳式問卷調查蒐集資料，缺乏客觀資料，建議未來可採用多種衡鑑工具進行。(2)本研究未釐清受試者使用Facebook的時間，如白天、晚上或睡前等。 3.建議：有鑑於Facebook 成癮、不良睡眠品質與憂鬱症狀對青少年危害影響甚鉅，建議未來進一步探討降低Facebook 成癮對改善不良睡眠品質的介入成效，以及改善不良睡眠品質預防憂鬱症狀的介入成效。 Background The poor sleep quality, Facebook addiction and depression are highly prevalent among adolescents worldwide. It is interesting to investigate the pathways among poor sleep quality, Facebook addiction and depression in adolescent students. Previous research revealed that Facebook addiction was associated with depression, and there was a high correlation between poor sleep quality and depression. In recent years, two cross-sectional studies found the two mediation pathways, one study indicated that internet addiction was a mediator between poor sleep quality and depression, and another study showed poor sleep quality was a mediator between internet addiction and depression. Therefore, the pathways among poor sleep quality, Facebook addiction and depression remained controversial. Consequently, the aim of this study was to illuminate the role of poor sleep quality and Facebook addiction on depression among junior high students in a longitudinal design. Hypotheses After controlling for gender and other confounding variable, the study hypotheses were as follows: (1) T2 poor sleep quality would be a mediator between T1 Facebook addiction and T3 depression. (2) T2 Facebook addiction would be a mediator between T1 poor sleep quality and T3 depression. Methods This study was conducted by a three-wave longitudinal study designed in 613 adolescents in grades 7 and 8. All participants were invited to join this study after gaining parents and student informed consent. They completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), Facebook Addiction Scale (FAS), and the Chinese version of the Symptoms Check List-90R (SCL-90-R). Data analysis was performed by using SPSS version 22.0, and the PROCESS was used to exam the hypothesized model. Results Two main results were identified. First, after controlling for baseline levels of depression and gender, the effect of T1 Facebook addiction on T3 depression was significant, which was fully mediated by T2 poor sleep quality. Second, T1 poor sleep quality could not predict T3 depression mediated through T2 Facebook addiction. Discussion These findings from the current study suggest that poor sleep quality is probably an important factor in explaining the development of depression in adolescents with Facebook addiction. Further study may examine whether educational intervention to reduce Facebook use and maintain healthy sleep habits will help to improve adolescent depression