研究背景
新冠肺炎疫情加劇了心理壓力。本研究探討醫院工作人員與社區居民之間心理衝擊及與產生心理衝擊相關因素的差異。基於 Lazarus 和 Folkman 的理論框架，我們應對壓力情境的兩種主要方法：問題導向的因應(problem-focused coping)與情緒導向(emotion-focused coping)的因應，這兩種方法均對心理影響有一定作用。此外，心理衝擊還與其他因素相關，包括性別、年齡、社群媒體、睡眠模式以及自我感知的健康狀況。本研究旨在深入探討產生心理衝擊與這些相關因素的關係。
研究目標
本前瞻性橫斷面研究評估了新冠肺炎疫情對台灣某社區醫院工作人員及其鄰近居民的心理衝擊（即重度憂鬱症的產生[major depression episode, MDE] 和創傷後壓力症候群 [posttraumatic stress disorder, PTSD]）及其影響因素。
材料與方法
我們使用結構性問卷進行調查，旨在評估新冠肺炎疫情爆發後高雄地區重度憂鬱症的產生和創傷後壓力症候群的發生率，同時探討影響醫院工作人員與社區居民心理衝擊的因素。研究所採用的問卷涵蓋多個面向，包括：(1) 災難相關心理症狀篩檢表（DRPST），用於評估重度憂鬱(MDE)產生和創傷後壓力症候群(PTSD)兩個心理衝擊，(2) 與新冠肺炎相關的認知、態度與行為量表，以評估因應策略，(3) 睡眠模式，及 (4) 健康相關生活品質（HRQoL），使用生活品質量表中文版（MOS SF-12）自評心理與身體健康狀況。
結果
本研究發現，在新冠肺炎疫情第一波期間，醫院工作人員的心理衝擊（MDE 和 PTSD）比社區居民更嚴重。兩組的心理衝擊均與自評身體與心理健康狀況（PCS-12 和 MCS-12）相關。而問題導向的因應與 MDE 和 PTSD 無顯著相關。情緒導向的因應及社群媒體影響與PTSD 相關在醫院工作人員與社區居民兩組都顯著，與MDE則僅在社區居民這組相關。進一步將醫院工作人員分為醫療人員與非醫療人員，並依社區居民與非醫療人員依年齡及性別傾向分數匹配後，比較三組，醫療人員的心理衝擊高於非醫療人員及社區居民。另外發現睡眠干擾對因應策略與 MDE 之間的關係具有調節作用，但對 PTSD 則無此影響。疫情爆發四年後再調查，與第一年相較，心理衝擊顯著減輕。
結論
為減輕新冠肺炎帶來的焦慮，公眾與醫療專業人員應提升韌性、採取感染預防措施、優化生活方式，並學會調適對媒體的影響。未來需進一步研究保護性因素，設計針對特定人群的有效預防措施與介入策略。

Research Background
The COVID-19 pandemic has heightened psychological distress levels. In our study, we examine the variations in psychological impacts and contributing factors between hospital staff and community residents. Drawing from Lazarus and Folkman's framework, we acknowledge two key approaches to handling stressful situations: problem-based coping and emotion-based coping, both of which play roles in shaping psychological impacts. Additionally, there exist other factors intertwined with psychological effects, including sex, age, social media, sleep patterns, and self-perceived health. Our current investigation aims to delve into these associated factors and their relationship with psychological impacts.
Research Objective
This prospective cross-sectional study assessed the psychological impacts (i.e., major depressive episode [MDE] and posttraumatic stress disorder [PTSD]) of the COVID-19 pandemic and contributing factors on the staff of a community hospital in Taiwan and nearby residents.
Materials and Methods
We conducted this survey using a structured questionnaire with the aim of identifying the incidence of major depressive episode and posttraumatic stress disorder in Kaohsiung following the COVID-19 outbreak. Additionally, we sought to investigate the contributing factors to these psychological impacts among both hospital staff and community residents. The questionnaire employed in this study assesses various dimensions, including: (1) the Disaster-Related Psychological Screening Test (DRPST) for evaluating psychological impacts, including major depression episode and posttraumatic stress disorder, (2) perceptions, attitudes, and behaviors related to COVID-19 to gauge coping strategies, (3) sleep patterns, and (4) Health-Related Quality of Life (HRQoL) measured through the Medical Outcomes Study (MOS) SF-12 to assess self-rated mental and physical health.
Results:
In this study, hospital staff experienced more severe psychological impacts (MDE and PTSD) than community residents during the first wave of COVID-19 in Taiwan. Self-rated health (PCS-12 and MCS-12) was associated with psychological impacts in both groups. However, problem-focused coping was not associated with MDE and PTSD in either group. Emotion-focused coping and social media influences were associated with PTSD in both groups and with MDE only in community residents. After dividing the group of hospital staff into medical hospital staff and non-medical hospital staff and propensity score matching, medical hospital staff had higher psychological impacts than non-medical staff and community residents. Sleep disturbances had moderating effects between coping strategies and MDE, but not with PTSD. Four years after the COVID-19 outbreaks, PTSD decreased markedly.
Conclusion:
To reduce anxiety regarding COVID-19, the public and healthcare professionals should enhance their resilience, adopt infection prevention measures, optimize their lifestyles, and cope with media influences. Future research on protective factors is needed to design effective preventive measures and interventions tailored to specific populations.

論文審定書i
致謝ii
中文摘要 iii
Abstract vi
List of Figures xii
List of Tables xiii
Introduction 1
Research background 1
Aims of the research and research questions 5
Literature Review 11
Introduction of stress theory 11
Selye stress theory 11
Lazarus and Folkman's psychological stress and coping 12
Other contributing factors to psychological impacts 15
Summary 18
Conceptual Framework and Hypotheses 19
Transactional model of stress and coping 19
Personal attributes contributing to psychological impacts 21
Situational factors contributing to psychological impacts 22
The conceptual framework 26
Study Design and Methods 27
Study Design 27
Measurement 29
Major depression episode and posttraumatic stress disorder 29
Perceptions, attitudes, and behavior towards COVID-19 30
Sleep 30
Medical Outcomes Study (MOS) SF-12 31
Data Analysis 33
Descriptive Statistical Analysis 33
Measurement model 34
Student’s t-test 34
ANOVA tests 34
Pearson Correlation 34
Multiple Linear Regression 35
Sample Size 35
Results 37
Clinical data and questionnaires 37
Measurement model 37
Correlations of variables 39
Comparison of hospital staff and community residents 40
Subgroup analysis: Medical, non-medical hospital staff and community residents 44
Moderating effects of sleep on coping and media influence 48
Four years after COVID-19 outbreak 49
Discussion 52
Conclusion 62
References 63
Appendix 1 Research Questionnaire 77
Appendix 2 IRB certification and SF-12 questionnaire consent 85

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