臺灣博碩士論文加值系統

摘要
精神疾病的治療模式在強調去機構化及社區復健之後，照護的重擔從專業醫護人員轉嫁到家庭照顧者身上，令其產生不少照顧負荷的感受。過去的研究多聚焦於照顧者的照顧負荷與生活品質之間的關係，較少對照顧者的適應歷程做探討。因此，本研究的目的為：了解在照顧負荷之下，照顧者的健康控制信念以及因應型態對其生活品質之影響。方法：本研究以四個社區復健機構中診斷為精神分裂症以及躁鬱症之慢性精神病患之主要照顧者為研究對象，利用「照顧者負荷量表」、「簡明因應量表」、「多向度健康控握量表」、「台灣簡明版世界衛生組織生活品質問卷」為研究工具，利用問卷調查方式蒐集121位主要照顧者之資料。結果：(1)趨近型態因應以及逃避型態因應對於客觀負荷預測整體生活品質以及環境範疇生活品質具有中介的效果；對於心理範疇的生活品質而言，則只有趨近型態的因應具有中介效果。(2)趨近型態因應以及逃避型態因應二者在健康控制信念對整體生活品質以及環境範疇生活品質的預測上具有中介的效果；逃避型態因應在健康控制信念對生理健康範疇的預測上具有中介的效果。(3)趨近型態為照顧負荷與健康控制信念預測整體生活品質、生理健康範疇、心理範疇的中介變項；趨近以及逃避兩種型態的因應則為照顧負荷與健康控制信念預測社會關係範疇生活品質的中介變項。結論：慢性精神病患者之主要照顧者的照顧負荷及所持的健康控制信念均會影響其生活品質，而因應型態在其處理照顧任務的壓力過程中具有重要的角色。在臨床實務中，實務工作者可多關注主要照顧者的照顧負荷問題，協助主要照顧者覺察所持的健康控制信念，了解其健康控制信念對適應及生活品質造成的影響，並且介入教導主要照顧者學習利於適應的因應型態，處理在投入照顧患病家人的過程中所感受到的負荷、壓力，以提升其生活品質。

Abstract
The care burden of the chronic mental disorders is now passed from the medical profession unto the patient’s family as the psychiatric treatment models put emphasis on deinstitutionalization and community rehabilitation，and on that account, the family caregivers feel much more burdensome. The past researches focused more on the relationship of the caregiver’s care burden and the life quality than on the caregiver’s adaptation process. Therefore, the purpose of this study is: to understand the effect on the caregiver’s life quality by their health locus of control and the coping styles under the care load. The Methods: in this study, the research objects are the caregivers of the chronic mental disorders who are diagnosed as schizophrenia and bipolar disorder in four community rehabilitation agencies, and using "Caregiver Burden Scale", " Brief COPE ", " health locus of control scale ",and" WHOQOL-BREF Taiwan Version "as the research tools to collect 121 primary caregivers questionnaire information. The results: (1) there are mediating effect on the global and environmental aspects of the life quality as caregivers use the approaching and avoidant coping styles to deal with their objective care load; as to the psychological aspects of the life quality, only the approaching coping style produces the mediating effect.(2) The health locus of control’s effect on the global and environmental aspects of the life quality has been mediated by the approaching and avoidant coping styles ; as to the effect on the physical health, it only have been mediated by the avoidant coping style. (3) The effect of the care load and the health locus of control on the global and psychological aspects of the life quality and the physical health has been mediated by the approaching copying style; both the approaching and avoidant copying styles are the mediating variables as using the care load and the health locus of control to predict the life quality of the social relationship aspects. The Conclusions: The caregiver burden and health locus of control of the chronic mental patient’s family will affect their quality of life, and the coping style plays an important role in its task of handling the pressure of caring. In clinical practice, practitioners may be concerned about the caregiver burden of the family and help them to perceive their own health locus of control, and to understand the effect of their health locus of control to the quality of life. Practitioners can teach the primary caregivers to learn proper coping styles to adapt the burden of caring the illness family, and to improve their own quality of life.

目　錄

摘要……………………………………………………………………………………………………..……………………………I
abstract…………………………………………………………………………………………………….……………………...II
致謝......................................................................................................................................IV
目錄………………………………………………………………………………………………………….………………………V
表目錄……………………………………………………………………………………………………………………….....VIII
圖目錄………………………………………………………………………………………..…………………………………….X

第一章 緒論………………………………………………………………………………………………………………………1
第二章 文獻回顧…………………………………………………………..………………………………………………4
第一節 照顧者負荷…………………………………………….…………………………………………………4
　　壹　照顧者負荷的概念……………………………………………………………………………………4
　　貳　照顧者負荷的測量………………………….………………..………………………………………5
　　參　照顧者負荷的相關研究………….…………………………………..……………………………7
第二節 生活品質…………………………………………………………………………..………………………8
　　壹　生活品質的定義…………………………………………………….…………………………………8
　　貳　健康相關生活品質的測量……………………………………………………………………..10
　　參　照顧者負荷與生活品質之間的關係……………………………….……………………..13
第三節 壓力與因應之相關探討…..…………………………………..………………………………..14
　　壹　壓力的概念……………………………………………………………..……………………………..14
　　貳　因應的概念及測量…………………………………………….…………………………………..15
　　參　因應與生活品質...…………………………………………….…………………………………...21
第四節 健康控制信念與生活品質……………………………………………………………………..23
　　壹　健康控制信念的概念與測量………………………………..………………………………..23
　　貳　健康控制信念與生活品質之間的關係…………………………..……………………..25
　　參　健康控制信念與因應策略之間的關係………………………………..………………..26
　　肆　因應策略對健康控制信念與生活品質之間關係的中介效果…………..…..27
第五節 研究架構與研究假設…………………………………………………………..………………..28
第三章 研究方法……………………………………………………………………………………..………………..30
第一節 研究對象……………………………………………………………..………………………………..30
第二節 研究工具…………………………………………………………..…………………………………..34
一、 人口統計變項及臨床變項……………………………………..……………………………..34
二、 照顧者負荷量表…………………………………………………….……………………………..35
三、 簡明因應量表………………………………………………………………………………………..36
四、 健康控握量表………………………………………………………………………………………..37
五、 台灣簡明版世界衛生組織生活品質問卷……………………………………………..38
　　第三節　研究程序………………………………………………………………………………………………..39
第四節　資料分析………………………………………………………………………………………………..40
第四章 研究結果……………………………………………..………………………………………………………..41
　　第一節　基本人口變項與研究變項之關係…………………………….…………………………. 41
第二節 　各重要研究變項間之相關………………………………………..…………………………..46
第三節 多元迴歸分析結果………………………………………………………………………………..52
　　壹　因應型態在照顧負荷預測生活品質所具有的中介效果……………….……..52
　　貳　因應型態在健康控制信念預測生活品質所具有的中介效果….…………..58
　　參　因應型態在照顧負荷與健康控制信念預測生活品質所具有的
　　　　中介效果……………………………………………………………..………………………………..66
第五章 討論…………………………………………………………………………….………………………………..77
第一節 主要照顧者的照顧負荷與生活品質……………………………..……………………..77
第二節 因應型態與照顧負荷、健康控制信念、生活品質的關係………..………..78
第三節 中介效果之檢驗……………………………………………………………….…………………..79
第四節 人口變項及臨床變項在研究變項上的差異…….…………………….……………..81
第五節 研究貢獻與臨床應用…………………………….………………………….…………………..82
第六節 研究限制與未來研究建議……………….…………………….……………………………..83
參考文獻……………………………………………………………….……………………………………….……………..84
附錄（問卷）………………………………………………………….…………….……………………………………..96
　　附件一　健康控握量表………………………………….……………..……………………………………..97
　　附件二　簡明因應量表……………………………….…………………………………….…………….....98
　　附件三　照顧者負荷量表…………………………………………….……………..…….…………….....99
　　附件四　台灣簡明版世界衛生組織生活品質問卷…………………………...………………100
附件五　簡明因應量表（Brief COPE）中文版使用授權書…………………..…………..102
附件六　照顧負荷量表使用授權書………………………………………………………..………….103
附件七　臺灣版世界衛生組織生活品質問卷（WHOQOL-BREF臺灣簡
　　　　　　明版）使用授權書……………………………………………………………………………….104





















表目錄

表2-2-1　各健康相關生活品質量表所測量的內容概要………………….……….………………….11
表2-2-2　台灣簡明版世界衛生組織生活品質問卷之範疇與層面架構………….……..…….12
表2-4-1　Holahan, Moos & Schaefer因應分類表………………………………………………………….16
表2-4-2　十三種常見的因應群…………………………………………………………………………….………18
表2-4-3　常見的因應測量工具……………………………………………………………………………….……20
表3-2-1　患者及照顧者之人口變項及臨床變項特性………………………………………………….34
表3-1　照顧者負荷量表簡短版之整體量表及各向度之信度整…………………….……………36
表3-2　台灣簡明版世界衛生組織生活品質問卷的心理計量特性簡述……………..………39
表3-4-1　研究問題與統計方法…………………………………………………………………………………….40
表4-1-1　基本人口變項與研究變項之間的關係………………………………………………………….43
表4-2-1　年齡以及各研究變項之間的相關………………………………………………..……………….50
表4-3-1　因應型態在照顧負荷預測整體生活品質所具有的中介效果……………..……….52
表4-3-2　因應型態在照顧負荷預測生理健康範疇所具有的中介效果………………..…….54
表4-3-3　因應型態在照顧負荷預測心理範疇所具有的中介效果…………………..………….55
表4-3-4　因應型態在照顧負荷預測社會關係範疇所具有的中介效果…………………..….56
表4-3-5　因應型態在照顧負荷預測環境範疇所具有的中介效果…………………..………….57
表4-3-6　因應型態在健康控制信念預測整體生活品質所具有的中介效果……………….58
表4-3-7　因應型態在健康控制信念預測生理健康範疇所具有的中介果……………….….60
表4-3-8　因應型態在健康控制信念預測生理健康範疇所具有的中介效果……………….62
表4-3-9　因應型態在健康控制信念預測社會關係範疇所具有的中介效果……………….64
表4-3-10　因應型態在健康控制信念預測環境所具有的中介效果……………….…………...65
表4-3-11　因應型態在照顧負荷與健康控制信念預測生活品質總分範疇所
具有的中介效果..………………………………………………….…………………………………….67
表4-3-12　因應型態在照顧負荷與健康控制信念預測生理健康範疇所具有
的中介效果……………………………………………..……………………………………...…...……69
表4-3-13　因應型態在照顧負荷與健康控制信念預測心理範疇所具有的中
介效果………………………………………………………………………………………………...………71
表4-3-14　因應型態在照顧負荷與健康控制信念預測社會關係範疇所具有
的中介效果………………………………………………………………………………………………...73
表4-3-15　因應型態在照顧負荷與健康控制信念預測環境範疇所具有的中
介效果…………………………………………………………………………………………..……..……75





圖目錄

圖9-1　研究架構圖………………………………………………………….……………………………………………28

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