目的：
中風後憂鬱症是中風的一種嚴重且常見的併發症，造成中風患者罹患憂鬱症的主因之一便是身體功能障礙，在過往的文獻中，雖然普遍接受中風發病後早期接受物理治療對功能性失能的有益影響，但對其確切最佳的介入時間、治療強度及頻率尚未有一致的研究結果，且探討中風患者接受物理治療照護對其精神健康影響的相關研究甚少，本研究以於2011年至少有三次中風診斷的新發患者，觀察其物理治療之使用情形，設定不同的觀察變項，以釐清與憂鬱傾向的關聯性。
方法：
本研究為回溯性研究，以全民健保資料庫進行次級資料分析，依據病患在初次中風診斷後五年內是否有憂鬱傾向(有至少三次憂鬱診斷或服用抗憂鬱用藥至少三個月)將其分為研究組與對照組，對照組係依研究組之性別、年齡及查爾森共病指數經傾向分數配對法(Propensity Score Matching)以1:3比例產生，以降低兩組別間干擾因素之影響。採用t檢定、卡方檢定、迴歸分析探討研究組別物理治療的使用差異。
結果：
經邏輯斯迴歸分析後發現，於2011年首次被確診之中風患者投保金額越高、中風類型為缺血性中風或未特定之中風類型、中風後六個月至一年才初次接受物理治療、中度物理治療次數越高、中風後一年內物理治療總費用越高之中風患者，其有憂鬱傾向的風險較高，且均達統計上之顯著水準(p<.05)。
結論：
期盼透過研究結果，加深政府、相關醫療單位及國民對中風患者心理健康的重視與了解，亦盼政府與醫療相關單位能針對中風患者的心理健康定期進行專業的評估檢查，亦盼中風患者不要忽視長期心情低落或心理健康影響，及早接受專業醫師正規的診斷和治療，以提升預後成效，降低腦中風復發和失能的風險。

Objective:
Post-stroke depression is a serious and common complication of stroke, and one of the main causes of patients with stroke suffering from depression is the result of physical bodily dysfunction. In the past literatures, despite the general acceptation of better benefit with early rehabilitation on functional disability, there was no consistent research result on the exact and best intervention time, treatment intensity and frequency. In this study, the new patients who had at least three stroke diagnoses in 2011 were observed under physical therapy, and different observatory variables were set to clarify the correlation with depression.
Method:
This was a retrospective study, using the national health insurance database for secondary data analysis. Patients were divided into the study group and the control group according to the tendency of having depression in a five-year period after the first stroke diagnosis (at least three times of depression diagnosis or antidepressant drug medication for at least three months). The control group was based on the sex, age and Charlson's comorbidity index by propensity score matching method in a ratio of 1:3 to reduce the influence of interference factors between the two groups. T-test, chi-square test and regression analysis were used to explore the differences in the use of physical therapy in the study group.
Result:
After logistic regression analysis, it was found that the patients with higher insurance amount, diagnosis of ischemic or unspecified stroke in 2011, accepting initial physical therapy in six months to one year after stroke, receiving higher frequency of moderate physical therapy, and higher total cost of physical therapy within one year after stroke, had a higher risk of depression, with statistical significance (p< 0.05).
Conclusion:
Hopefully, through the research result, the government, relevant medical institutions and the public will pay more attention to and understand the mental health of stroke patients, that these institutions will regularly carry out professional assessment and examination on the mental health of stroke patients, as well as allowing the patients not to ignore the long-term depression or mental health effect, with receiving proper diagnosis and treatment from professional doctors as soon as possible, to improve prognosis and reduce the risk of stroke recurrence and disability.

目錄
論文審定書 i
中文摘要 ii
Abstract iii
圖次 vi
表次 vii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻查證 4
第一節 腦中風疾病的診斷定義、分類、流行病學及復健治療方式 4
一、腦中風診斷定義、分類及流行病學 4
二、腦中風復健治療方式及目的 5
第二節 憂鬱症診斷定義、流行病學、治療方式及抗憂鬱藥物種類 8
一、憂鬱症診斷定義及流行病學 8
二、憂鬱症治療方式 9
三、抗憂鬱藥物種類 10
第三節 中風後憂鬱症診斷定義、流行病學及治療方式 12
一、中風後憂鬱症診斷定義及流行病學 12
二、中風後憂鬱症的危險因子 15
三、中風後憂鬱症的治療方式 15
第四節 物理治療的定義、目的及對中風患者的應用 22
一、物理治療的定義與目的 22
二、物理治療在中風患者的應用 22
第五節 小結 24
第三章　研究方法 25
第一節 研究假設與架構 25
第二節　資料來源與研究樣本 27
第三節 研究測量變項與定義 31
第四節 研究流程 33
第五節 資料處理與分析方法 37
第四章 研究分析與結果 38
第一節 研究樣本之描述性統計分析 38
第二節 各變項對各依便項組及物理治療使用、費用之影響 49
第三節 研究假設 87
第五章 討論 88
第一節 台灣腦中風患者憂鬱傾向的人口特性 88
第二節 影響台灣腦中風病患使用物理治療之因素 90
第六章 研究結論與建議 92
第一節 研究結論 92
第二節 研究限制 93
第三節 研究建議 94
第四節 研究貢獻 95
參考文獻 96
附錄 107
圖次
圖3-1 研究架構圖 26
圖3-2 研究對象篩選流程圖 30
圖3-3 資料庫合併流程圖 36
表次
表2-1 中風後憂鬱症診斷定義之研究整理 14
表2-2 中風患者接受物理治療與心理健康之相關文獻整理 23
表3-1 本研究所使用之全民健保資料庫資料檔案及欄位 29
表3-2 研究測量變向與定義—自變項及共變項 31
表3-3 研究測量變項與定義—依變項 32
表3-4 查爾森共病症嚴重度指標(CCI)與ICD-9-CM對照表 32
表3-5 腦中風國際疾病分類碼第九版前三碼(ICD-9) 33
表3-6 憂鬱症國際疾病分類碼第九版前三碼(ICD-9) 34
表3-7 抗憂鬱藥品ATC代碼前五碼 34
表3-8 物理治療診療項目代碼 35
表4-1 憂鬱傾向組與對照組經過配對後之樣本分佈情形 40
表4-2 憂鬱傾向組與對照組在不同單一變項之分佈情形 40
表4-3 中風患者有無憂鬱症診斷在不同單一變項之分佈情形 43
表4-4 中風患者有無服用抗憂鬱藥物在不同單一變項之分佈情形 46
表4-5 各變項對中風後兩個禮拜內物理治療使用頻率之線性複迴歸分析 50
表4-6 各變項對中風後兩個禮拜至三個月內物理治療使用頻率之線性複迴歸分析 51
表4-7 各變項對中風後三個月至六個月內物理治療使用頻率之線性複迴歸分析 52
表4-8 各變項對中風後六個月至一年物理治療使用頻率之線性複迴歸分析 53
表4-9 各變項對中風後兩個禮拜內接受簡單治療次數之線性複迴歸分析 54
表4-10各變項對中風後兩個禮拜至三個月內接受簡單治療次數之線性複迴歸分析 55
表4-11 各變項對中風後三個月至六個月內接受簡單治療次數之線性複迴歸分析 56
表4-12 各變項對中風後六個月至一年接受簡單治療次數之線性複迴歸分析 57
表4-13 各變項對中風後兩個禮拜內接受中度治療次數之線性複迴歸分析 59
表4-14 各變項對中風後兩個禮拜至三個月內接受中度治療次數之線性複迴歸分析 60
表4-15 各變項對中風後三個月至六個月內接受中度治療次數之線性複迴歸分析 61
表4-17 各變項對中風後兩個禮拜內接受複雜治療次數之線性複迴歸分析 65
表4-18 各變項對中風後兩個禮拜至三個月內接受複雜治療次數之線性複迴歸分析 66
表4-19 各變項對中風後三個月至六個月內接受複雜治療次數之線性複迴歸分析 67
表4-20 各變項對中風後六個月至一年接受複雜治療次數之線性複迴歸分析 68
表4-21 各變項對中風後兩個禮拜內物理治療平均費用之線性複迴歸分析 70
表4-22 各變項對中風後兩個禮拜至三個月內物理治療平均費用之線性複迴歸分析 71
表4-23 各變項對中風後三個月至六個月內物理治療平均費用之線性複迴歸分析 73
表4-24 各變項對中風後六個月至一年物理治療平均費用之線性複迴歸分析 74
表4-25 各變項對中風後兩個禮拜內總費用之線性複迴歸分析 76
表4-26 各變項對中風後兩個禮拜至三個月內總費用之線性複迴歸分析 78
表4-27 各變項對中風後三個月至六個月內總費用之線性複迴歸分析 79
表4-28 各變項對中風後六個月至一年總費用之線性複迴歸分析 80
表4-29 與中風患者有無憂鬱傾向相關因素之複邏輯斯迴歸分析 81
表4-30 與中風患者有無憂鬱症診斷相關因素之複邏輯斯迴歸分析 83
表4-31 與中風患者有無服用抗憂鬱藥物相關因素之複邏輯斯迴歸分析 85
表4-32 研究假設驗證 87

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