背景：國外對於末期腎臟衰竭病患可能罹患的各種合併症已有相當多的研究，近來國外也發現末期腎臟衰竭患者在長期進行透析治療後會對其心理狀態產生影響或出現憂鬱情緒，可能影響其醫療資源使用或是增加死亡率，因此逐漸成為備受重視的議題。
目的：欲探討台灣末期腎臟衰竭罹患憂鬱症之盛行率，並探討末期腎臟衰竭有無罹患憂鬱症者在人口學特質上、共病、透析治療、醫療資源利用(含門診就醫次數與門診就醫費用)是否具統計上的顯著相關或差異。最後，探討末期腎臟衰竭罹患憂鬱症之重要因子。
方法：利用健保資料庫內2000年、2002年、2004年與2006年之『醫事機構基本資料檔』、『重大傷病證明明細檔』『醫事機構基本資料檔』進行次級資料分析。由『重大傷病證明明細檔』自內挑出末期腎臟衰竭病患，再以病患之身份證統一編號將『重大傷病證明明細檔』與『門診處方及治療明細檔』進行串檔合併再由其診斷碼中挑選出罹患憂鬱症者，利用利用卡方檢定、獨立樣本t檢定與邏輯斯回歸進行資料分析。
結果： 2000年、2002年、2004年與2006年末期腎臟衰竭病患罹患憂鬱症之年盛行率為0.47%、0.73%、1.27%與1.34%。證實末期腎臟衰竭罹患憂鬱症與性別、透析治療方式、透析持續時間、就醫機構區域性、就醫醫院層級、就醫科別具有顯著相關(p < 0.0001)。年齡、共病、就醫科別、透析治療持續之時間、門診就醫次數、門診就醫費用為末期腎臟衰竭病患罹患憂鬱症之共同影響因子。
結論：末期腎臟衰竭罹患憂鬱症者之危險因子包括性別、年齡、共病、透析治療、透析持續時間與門診就醫費用。本研究雖採用健保資料庫而擁有大量的樣本數以進行分析，但由於未能深入了解臨床醫師實際上如何診斷憂鬱症，或是在健保給付限制之下，診斷碼與實際挑選出來之病患與實際狀況可能仍有差異，因此建議未來可以採用問卷調查以彌補健保資料庫不足之處。

Background:Various amalgamation diseases which the ESRD patient of may suffer from have already had quite a lot of research to latter stage abroad .Recently, Abroad research find The ESRD patient in carry on extended dialysis can exert an influence or appear melancholy mood to psychological condition their treat .Extended dialysis may influence its medical resource to use or increase mortality.It gradually become to a topic.
Objectives：This study explores the prevelance of ESRD with melancholia and finds out if there are any significant difference upon demography status, comorbodities, dialysis
therapy, utilization of health care between ESRD with melancholia and without melancholia.As well as we will discuss the risk factors of ESRD patient with melancholia.
Methods：We conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and melancholia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression.
Result：The prevelance of ESRD with melancholia were 0.47%(2000), 0.73%(2002),1.27%(2004), 1.34%(2008)；ESRD patients with and without melancholia was significant difference (p < 0.0001) between sex, dialysis therapy, dialysis duration, and the regions of hospital organizations, class of hospital organizations. ESRD patients with and without melancholia was significant difference (p < 0.0001) between age, comorbidities, dialysis duration, outpatient visits and expenditures.
Conclusion：The study was benefited by large sample of adminstative data, but there were some limitation of precision of diagnoses and payment issue of health care system, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.

目錄
論文審定書----------------------------------------------------------------------------------------ii
誌謝------------------------------------------------------------------------------------------------iii
中文摘要------------------------------------------------------------------------------------------iv
英文摘要-------------------------------------------------------------------------------------------v
目錄-----------------------------------------------------------------------------------------------vii
表目錄---------------------------------------------------------------------------------------------ix
名詞解釋-------------------------------------------------------------------------------------------x
第一章 緒論------------------------------------------------------------------------------------1
第一節 研究背景與動機---------------------------------------------------------------1
第二節 研究目的------------------------------------------------------------------------2
第二章 、文獻探討---------------------------------------------------------------------------3
第一節 末期腎臟衰竭疾病分級------------------------------------------------------3
第二節 憂鬱症的概念------------------------------------------------------------------5
第三節 憂鬱症的測量工具------------------------------------------------------------7
第四節 末期腎臟衰竭病患罹患憂鬱症之情形------------------------------------8
第五節 人口學特性與憂鬱症之關係----------------------------------------------10
第六節 末期腎臟衰竭罹患共病症(Comorbidity)之影響-----------------------11
第七節 末期腎臟衰竭之透析治療方式-------------------------------------------12
第八節 末期腎臟衰竭之相關醫療資源利用-------------------------------------13
第三章 研究方法與進行步驟-------------------------------------------------------------15
第一節 研究架構及研究假設-------------------------------------------------------15
第二節 研究樣本與資料來源-------------------------------------------------------17
第三節 研究流程----------------------------------------------------------------------18
第四節 測量變項----------------------------------------------------------------------20
第五節 分析方法----------------------------------------------------------------------24
第四章 結果分析----------------------------------------------------------------------------27
第一節 描述性統計-------------------------------------------------------------------27
第二節 推論性統計-------------------------------------------------------------------36
第五章 討論----------------------------------------------------------------------------------60
第一節 末期腎臟衰竭者罹患憂鬱症之盛行率----------------------------------60
第二節 末期腎臟衰竭者罹患憂鬱症之人口學特質----------------------------61
第三節 末期腎臟衰竭者罹患憂鬱症之共病-------------------------------------62
第四節 末期腎臟衰竭者罹患憂鬱症之透析治療與透析持續時間----------63
第五節 末期腎臟衰竭者罹患憂鬱症之醫療資源利用----------------------------64
第六節 末期腎臟衰竭者罹患憂鬱症之影響因子-------------------------------65
第六章 結論與建議-------------------------------------------------------------------------67
第一節 研究結論----------------------------------------------------------------------67
第二節 研究限制----------------------------------------------------------------------68
第三節 研究建議----------------------------------------------------------------------68
參考文獻-------------------------------------------------------------------------------------69

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