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研究生:余春娣
研究生(外文):Chun-Ti Yu
論文名稱:門診重鬱症病患生活品質及其相關因素之探討
論文名稱(外文):Quality of life and its related factors of outpatients with Major Depressive Disorder
指導教授:熊秉荃熊秉荃引用關係
指導教授(外文):Ping-Chuan Hsiung
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:151
中文關鍵詞:重鬱症生活品質
外文關鍵詞:Major Depressive DisorderQuality of Life
相關次數:
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本研究之目的是探討重鬱症病患生活品質現況及其相關因素影響,係為一橫斷式研究,採立意取樣(Purposive Sampling)方式,樣本來自於台北市某醫學中心之精神部門診病患,共收案120位,以結構式問卷收集資料,本研究使用的工具包括:一、人口學特性;二、簡式健康量表;三、憂鬱程度量表;四、社會支持行為量表;五、台灣簡明版世界衛生組織生活品質問卷。資料分析以SPSS(Statistical Package for the Social Science)10.0版電腦軟體進行描述性分析,包括:次數分配、平均值(mean)、標準差(standard deviation)及百分比(﹪)。以獨立樣本t檢定(t-test)、皮爾森積差相關係數(Pearson’s product-moment correlation)、單因子變異數分析(one way ANOVA)及多重性逐步迴歸分析(stepwise multiple regression)等方法檢定人口學特性、憂鬱程度、社會支持與生活品質之相關性。經研究結果發現:

一、重鬱症病患之生活品質現況,以各範疇總分在4-20分之間,於生理健康範疇方面:平均值總分是11.54;於心理範疇方面:平均值總分是10.46;於社會關係範疇方面:平均值總分是11.61;於環境範疇方面;平均值總分是12.82,其結果是以『環境範疇』得分最高,感到最有品質,而以『心理範疇』得分最低,感到品質最差。

二、重鬱症病患人口學特性、憂鬱程度、社會支持與生活品質之相關性結果是:
(一)生理健康範疇:有顯著線性相關的自變項有:年齡、第一次發病年齡、職業型態、居住狀況、經濟狀況、健康狀況、憂鬱程度、情緒支持。
(二)心理範疇:有顯著線性相關的自變項有:年齡、第一次發病年齡、職業型態、居住狀況、經濟狀況、健康狀況、憂鬱程度、社會支持總分、情緒支持、實質支持、訊息及價值觀支持。
(三)社會關係範疇:有顯著線性相關的自變項有:年齡、第一次發病年齡、婚姻狀況、職業型態、經濟狀況、健康狀況、憂鬱程度、社會支持總分、情緒支持、實質支持、訊息及價值觀支持。
(四)環境範疇:有顯著線性相關的自變項有:年齡、第一次發病年齡、婚姻狀況、經濟狀況、憂鬱程度、社會支持總分、情緒支持。

三、重鬱症病患之生活品質最佳預測逐步迴歸模式分析結果如下:
(一)生理健康範疇方面:最佳預測因子是憂鬱程度,其可解釋總變異量是60.30﹪。
(二)心理範疇方面:最佳預測因子是憂鬱程度、社會支持總分、第一次發病年齡及年齡的大於等於71歲,其可解釋總變異量是76.50﹪。
(三)社會關係範疇方面:最佳預測因子是憂鬱程度、第一次發病年齡、社會支持的訊息及價值觀支持、職業型態的無業者及年齡的大於等於71歲,其可解釋總變異量是53.80﹪。
(四)環境範疇方面:最佳預測因子是憂鬱程度、經濟狀況的小於10萬、經濟狀況的大於等於11萬及年齡的51-70歲,其可解釋總變異量是53.50﹪。
本研究結果有助於瞭解重鬱症病患之生活品質狀況,同時可提供未來相關研究、發展本土性資料及衛生行政之參考依據。
The purpose of this study was to explore the quality of life and its related factors of patients with major depressive disorder. This study adopted cross-sectional research design. Purposive sampling was used to collect data from 120 patients came from the psychiatric outpatient departments of a medical center and a psychiatric hospital in northern Taiwan. Data were collected through structured questionnaires, which included:(1) demographic data sheet, (2) 5-item Brief Symptom Rating Scale (BSRS-5), (3) the Center For Epidemiologic Studies Depression Scale(CES-D), (4) Inventory of Socially Supportive Behaviors(ISSB), (5) World Health Organization’s Questionnaire on Quality of Life:BREF-Taiwan Version 100(WHOQOL-BREF). Data were analyzed by using SPSS/Windows 10.0 statistical software. The descriptive statistics methods included frequency distribution, arithmetic mean, standard deviation, and percentage. Data were analyzed by using independent t-test, Pearson’s product-moment correlation, one way ANOVA and stepwise multiple regression and so on, with which we can examine the demographic, degree of depression, social support and their links to the quality of life. Through the research, we found out the following results:

1.The condition of major depressive disorder patients’ quality of life is score range of each subtitle from 4-20. A sum from the following subtitles:physical domain is 11.54, psychological domain is 10.46, social domain is 11.61 and environmental domain is 12.82. The quality of life results is higher of environmental domain, which is poorer of psychological domain.

2.The results of quality of life related to demographic, degree of depression, social support were as followed:
(1)Physical domain:the independent variables of significant linear correlation is age, the age of early-onset, type of occupation, living arrangements, economic status, health status, the degree of depression and emotional support.
(2)Psychological domain:the independent variables of significant linear correlation is age, the age of early-onset, type of occupation, living arrangements, economic status, health status, the degree of depression, the sum of social support, emotional support, instrumental support, informational and appraisal support.
(3)Social domain:the independent variables of significant linear correlation is age, the age of early-onset, marital status, type of occupation, economic status, health status, the degree of depression, the sum of social support, emotional support, instrumental support, informational and appraisal support.
(4)Environmental domain:the independent variables of significant linear correlation is age, the age of early-onset, marital status, economic status, the degree of depression, the sum of social support and emotional support.

3.The best stepwise regression models of predicting major depressive disorder patients’ quality of life were as followed:
(1)Physical domain:the best predicting factor is the degree of depression, and accounted for explained 60.30﹪of the variance.
(2)Psychological domain:the best predicting factors are the degree of depression, the sum of social support, the age of early-onset, age more than 71 years old, and accounted for explained 76.50﹪of the variance.
(3)Social domain:the best predicting factors are the degree of depression, the age of early-onset, informational and appraisal support, unemployment and age more than 71 years old, and accounted for explained 53.80﹪of the variance.
(4)Environmental domain:the best predicting factors are the degree of depression, income less than one hundred thousand, income more than one hundred ten thousand and more than 71 years old, and accounted for explained 53.50﹪of the variance.
The results of this study could understand major depressive disorder patients’ quality of life condition and provide related research in the future, develop local data and health administration reference of foundation.
致謝…………………………………………………………………… I
中文摘要……………………………………………………………… III
英文摘要……………………………………………………………… VI
目錄…………………………………………………………………… IX
圖表目錄……………………………………………………………… XI
第一章 緒論………………………………………………………… 1
第一節 研究動機…………………………………………………… 1
第二節 研究目的………………………………………………… 4
第三節 研究問題………………………………………………… 5
第四節 名詞界定…………………………………………………… 6
第二章 文獻查證…………………………………………………… 7
第一節 重鬱症…………………………………………………… 7
第二節 生活品質之概念………………………………………… 15
第三節 重鬱症病患生活品質之相關研究……………………… 29
第三章 研究設計與方法…………………………………………… 36
第一節 研究架構…………………………………………………… 36
第二節 研究對象…………………………………………………… 37
第三節 研究工具………………………………………………… 38
第四節 研究工具信度與效度之測定…………………………… 44
第五節 研究過程…………………………………………………46
第六節 資料分析與方法…………………………………………… 49
第七節 研究倫理考量……………………………………………… 54
第四章 研究結果…………………………………………………… 55
第一節 重鬱症病患基本人口學特性之現況…………………… 56
第二節 重鬱症病患憂鬱程度與社會支持之現…………………… 58
第三節 重鬱症病患生活品質之現況……………………………… 69
第四節 重鬱症病患生活品質之相關因素………………………… 71
第五節 重鬱症病患之基本人口學特性、憂鬱程度、社會支持對生活品 質之預測分析………………………………………………………… 76
第五章 討論………………………………………………………… 97
第一節 重鬱症病患之基本人口學特性、憂鬱程度、社會支持與生活品質之現況………………………………………………………… 97
第二節 重鬱症病患基本人口學特性與生活品質之相關性……… 105
第三節 重鬱症病患憂鬱程度與生活品質之相關………………… 112
第四節 重鬱症病患社會支持與生活品質之相…………………… 113
第五節 重鬱症病患生活品質之重要預測因子…………………… 115
第六章 結論與建議………………………………………………… 119
第一節 結論……………………………………………………… 119
第二節 應用及建議……………………………………………… 121
第三節 研究限制及建議…………………………………………… 124
第七章 參考資料…………………………………………………… 126
中文部分…………………………………………………………… 126
英文部分……………………………………………………………… 131
附錄一 研究問卷…………………………………………………… 142
附錄二 研究工具使用同意函……………………………………… 151


圖表目錄
圖3-1-1 研究架構……………………..……………………………………….. 36
圖4-2-1 重鬱症病患心理困擾程度各題得分百分比分佈折線圖…………… 59
圖4-5-1 重鬱症病患生活品質之生理健康範疇架構圖……………………….. 93
圖4-5-2 重鬱症病患生活品質之心理範疇架構圖…………………………….. 94
圖4-5-3 重鬱症病患生活品質之社會關係範疇架構圖……………………….. 95
圖4-5-4 重鬱症病患生活品質之環境範疇架構圖…….………………………. 96
表2-3-1 國外重鬱症病患之生活品質相關研究……………………………...... 32
表3-4-1 各量表之Cronbach’s α值狀況表………….………………………… 45
表3-6-1 描述性統計分析表………………………..…………….……………... 52
表3-6-2 生活品質之相關性統計分析表…..…………………….……………... 53
表4-1-1 重鬱症病患基本人口學特性……………..…………….……………... 56
表4-2-1 重鬱症病患心理困擾程度得分情形…………………….……………. 59
表4-2-2 重鬱症病患憂鬱程度得分情形……...………………………………... 61
表4-2-3 重鬱症病患憂鬱程度各題得分百分比分佈狀況…….……………..... 62
表4-2-4 重鬱症病患社會支持各層面得分…………………………………….. 63
表4-2-5 重鬱症病患社會支持網絡各題得分百分比分佈狀況….……………. 66
表4-2-6 重鬱症病患社會支持量表各層面及各題得分排序…….……………. 67
表4-2-7 重鬱症病患社會支持功能各題得分百分比分佈狀況….……………. 68
表4-3-1 重鬱症病患生活品質各範疇得分…………………………………….. 69
表4-3-2 重鬱症病患生活品質量表各範疇及各題得分排序…...……………... 70
表4-4-1 重鬱症病患人口學特徵各組間與生活品質之相關性….……………. 73
表4-4-2 重鬱症病患憂鬱程度與生活品質之相關性………………………….. 72
表4-4-3 重鬱症病患社會支持與生活品質之相關性…………….……………. 75
表4-5-1 重鬱症病患生活品質之生理健康範疇共線性診斷…….……………. 77
表4-5-2 重鬱症病患生活品質之生理健康範疇初步逐步迴歸結果………….. 78
表4-5-3 重鬱症病患生活品質之生理健康範疇刪除影響模式個案後逐步迴歸結果………………………………………………………………. 79
表4-5-4 重鬱症病患生活品質之心理範疇共線性診斷……………………….. 80
表4-5-5 重鬱症病患生活品質之心理範疇初步逐步迴歸結果……………….. 81
表4-5-6 重鬱症病患生活品質之心理範疇刪除影響模式個案後逐步迴歸結果…………………………………………………………………..... 82
表4-5-7 重鬱症病患生活品質之社會關係範疇共線性診斷…….……………. 83
表4-5-8 重鬱症病患生活品質之社會關係範疇初步逐步迴歸結果………….. 85
表4-5-9 重鬱症病患生活品質之社會關係範疇刪除影響模式個案後逐步迴歸結果……………………………………………...……………… 86
表4-5-10 重鬱症病患生活品質之環境範疇共線性診斷………….…………… 88
表4-5-11 重鬱症病患生活品質之環境範疇初步逐步迴歸結果……………….. 89
表4-5-12 重鬱症病患生活品質之環境範疇刪除影響模式個案後逐步迴歸結果………………………………………………………………….… 90
表4-5-13 重鬱症病患生活品質各範疇之最佳逐步迴歸結果…….…………… 92
表5-1-1 重鬱症與其他相關研究之生活品質四大範疇排序狀況……………. 104
表5-1-2 重鬱症與台灣WHOQOL小組之生活品質四大範疇平均得分狀況.. 104
表5-1-3 重鬱症與其他相關研究之生活品質四大範疇總平均得分狀況……. 104
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王秀紅(2003,4月10日).社會支持與健康的相關性.2003年5月20日取自http://biometrics.sinica.edu.tw//nsc/v17_04.htm。
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朱德容(2001).類風濕性關節炎病患憂鬱與日常活動狀況對生活品質影響之探討.未發表碩士論文.台北:國立台北護理學院護理研究所。
吳佳珍、林秋菊(1997).生活品質的概念分析.榮總護理,14(1),102-107。
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李明濱(2001).新世紀精神醫療的回顧與展望.精神醫學通訊,20,513-514。
李惠玲、顧乃平、竇維正、白璐(2001).乳癌化學治療病人生活品質及其相關因素之研究.護理研究,9(3),57-68。
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姚開屏(2000).台灣版世界衛生組織生活品質問卷之發展簡介.中華公共衛生雜誌,19(4),315-324。
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姚開屏(2002).台灣版世界衛生組織生活品質問卷之發展與應用.台灣醫學,6,193-200。
柯舜娟(2002).社區老人生活品質測量-以SF-36台灣版及WHOQOL-BREF台灣版為例.未發表的碩士論文.台北:國立台北護理學院護理研究所。
洪莉竹(1996).憂鬱個案及輔導策略之探討.諮商與輔導,121,13-17.
胡海國(1999).精神醫學診斷手冊.台北:健康文化。
胡海國、林信男(1996).精神與行為障礙之分類-診斷指引.台北:中華民國精神醫學會。
倪麗娟(1998).內外科病房護理人員生活品質及其相關因素之探討.未發表的碩士論文.台北:國立台灣大學醫學院護理研究所。
徐淑貞(2001).社區獨居老人其內在資源對憂鬱與生活品質影響之探討.未發表的碩士論文.台北:國立台北護理學院護理研究所。
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