鄭泰安陳秀熙臺灣大學：王聲昌Wang, Sheng-ChangSheng-ChangWang2007-11-282018-06-292007-11-282018-06-292005http://ntur.lib.ntu.edu.tw//handle/246246/59182背景：社交焦慮症為好發於青少年之常見精神疾病，其病程常為慢性化，且多合併憂鬱症、物質濫用及單純畏懼症、廣泛性焦慮症等其他焦慮疾患；對患者之生活品質、人際關係及職業功能等影響甚鉅，但易為患者與臨床醫師所忽視。因此，目前之防治策略多指向針對社區的青少年進行篩檢，並確立診斷，以便及早介入。 本研究之目的即為設計並修訂中文版之青少年自填社交畏懼症評量表，作為篩檢台灣青少年社交焦慮症之工具。 方法：於三所五年制專科學校抽取一至三年級學生共369名完成自填「台灣青少年社交畏懼症評量表」，其中333名再經由精神科醫師以中文版神經精神醫學臨床評估表(簡稱SCAN)進行會談，確立是否符合DSM-IV或ICD-10-DCR之社交畏懼症診斷，並依據檢測結果進行各種信度與效度評估。 結果：無論是17或22題版的「台灣青少年社交畏懼症評量表」都有良好的內在一致性與效標效度。就DSM-IV診斷系統而言，區別社交畏懼症患者與正常對照組之最佳臨界點分別為23 (17題版)與26 (22題版)分。鑑別分析結果顯示「害怕團體活動」、「避免演講」、「在別人面前會發抖、晃動」、「害怕自我介紹」、「害怕與陌生人以電話交談」及等五題有最佳鑑別力。另方面，就ICD-10-DCR診斷系統而言，其最佳臨界點與前述僅有些微差異，但以「會因臉紅而困擾」、「逃避尷尬情境」、「害怕與陌生人交談」及「在別人面前會發抖、晃動」等四題最具鑑別力。 結論：「台灣青少年社交畏懼症評量表」為信效度良好之篩檢工具。Background: Social phobia (SP) is a common mental disorder with onset in adolescence. Most of the cases have a chronic course and are frequently comorbid with other mental disorders, such as depressive disorders, substance disorders and anxiety-spectrum disorders. In spite of the great impact on quality of life, interpersonal relationships and occupational functioning, the patients and clinicians usually neglect SP. To prevent the disorder, it is crucial to screen the susceptible subjects in the community and provide prompt intervention. Aims of the present study are to design and modify the self-administered Chinese Social Phobia Inventory for screening SP among Taiwanese adolescents. Method: Three hundred and sixty-nine subjects were recruited from the junior grades of three vocational colleges and completed the self-administered questionnaire. Diagnostic interviewing was conducted for 333 of the total participants by a psychiatrist with the Chinese version of Schedules of Clinical Assessment in Neuropsychiatry (SCAN) to identify the social phobic cases. Then, the psychometric properties were examined. Result： Good internal consistency and criterion validity were obtained for both of the 17-item and 22-item versions of SPIN-TA. The optimal cut-off scores were 23 and 26 for DSM-IV definition, respectively. The items with best discrimination power were “fear of group activities”, “avoidance of speech”, “distressed by trembling or shaking”, ”fear of introducing oneself”, and ”fear of talking to strangers on phone”. There were similar cut-off points for cased defined by ICD-10-DCR, but the items with best discrimination were “bother by brushing”, “avoidance of embarrassment”, “fear of talking to strangers” and “distressed by trembling or shaking". Conclusions： SPIN-TA has been demonstrated to have satisfactory psychometric properties and can be employed as a screening tool for the detection of social phobia among Taiwanese adolescents in the community.誌謝 iii 中文摘要 iv Abstract v List of Tables and Figures vii 1. Introduction 1 1.1. General Background 1 1.2. Design and development of a self-administered social phobia screening questionnaire for Taiwanese adolescents 3 1.3. Aims of the present study 3 2. Literature Review 5 2.1. Methodological issues in studies of social phobia5 2.1.1. The influence from case identification 5 2.1.2. The influence from socio-cultural factors 7 2.2. Social phobia in adolescents 8 2.2.1. Social anxiety symptoms in adolescents 8 2.2.2. The nature of social phobia in adolescents 9 2.2.3. Social phobia among adolescents in Taiwan 9 2.3. Psychometric properties of social phobia inventory - Self-reported questionnaires versus standardized diagnostic interview 9 2.3.1. Self-reported questionnaires versus standardized diagnostic interviews 10 2.3.2. Psychometric properties and clinical application of the SPIN 10 3. Material and Method 13 3.1. Development of the Taiwanese Adolescent version of the SPIN (SPIN-TA) 13 3.2. Study subjects 13 3.3. Study Procedure 14 3.4. Diagnostic interview 14 3.5. Data analysis 15 4. Results 17 4.1. Socio-demographic characteristics of the study subjects 17 4.2. Identification of social phobia 17 4.3. Psychometric properties of the SPIN-TA 17 4.3.1. Construct validity- factor analysis 17 4.3.2. Mean scores of SPIN-TA 19 4.3.3. Internal consistency 20 4.3.4. Criterion validity 20 4.4. Discriminant function analysis 21 4.5. Comparisons among subgroups of subjects with SP 22 5. Discussion 24 5.1. Psychometric properties of the SPIN-TA 24 5.1.1. Factorial structure 24 5.1.2. Internal consistency 24 5.1.3. Criterion (concurrent) validity 25 5.2. Discriminant function analysis of the SPIN-TA 25 5.3. Comparisons of the results between DSM-IV and ICD-10-DCR 26 5.4. Gender differences of social phobia in Taiwanese adolescents 27 5.5. Strength and Limitation 28 6. Conclusion 30 References 31 Tables 37 Figures 58 Appendix 1: Social Phobia Inventory 63 Appendix 2: 台灣青少年社交畏懼症評量表 65411756 bytesapplication/pdfen-US青少年社交畏懼症台灣青少年社交畏懼症評量表adolescentssocial phobiaSPIN-TA[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/59182/1/ntu-94-R91846009-1.pdf