臺灣博碩士論文加值系統

本研究的目的是要探討心理衛教暨身心靈賦能團體對改善男性憂鬱症患者的憂鬱症狀、生活品質及門診規則返診的成效，以及了解男性憂鬱症患者對團體效果之主觀經驗。
本研究採用類實驗法(Quasi-experimental design)，自民國94年1月28日至94年7月30日以立意取樣方式將36位門診憂鬱症患者分為實驗組與控制組，實際完成者實驗組13人、控制組13人，實驗組接受8週每次約120分鐘團體治療的介入措施及精神科藥物治療，控制組僅接受精神科藥物治療，兩組成員在參與研究前後皆接受「貝克憂鬱量表」及「生活品質量表」之測量，並經由病歷確認門診規則返診之情形。實驗組個案在最後一次團體時參與半結構式會談的方式瞭解他們對團體治療效果的主觀經驗。
實驗組與控制組憂鬱症狀與生活品質之組間比較採Wilcoxon-Mann- Whitney rank sum test統計方法，結果發現兩組在減輕憂鬱症狀(Z = -3.746，p < 0.001)以及改善生活品質(Z = -3.438，p = 0.001)達顯著差異。結果顯示實驗組較控制組改善憂鬱症狀和提高生活品質。根據Fisher’s
Exact test檢定，門診規則返診在兩組間並無顯著差異(X2 = 0.688，p = 0.344)，結果顯示兩組對規則返診重要性態度接近，間接推論兩組或許對規則服藥態度也相似。個案分享自團體的獲益經質性分析可歸納為六個範疇：情緒宣洩、指導、自我瞭解、人際學習—付出、普同感及團體凝聚力，這些範疇說明團體治療療效因子的產生如何幫助男性憂鬱患者的心理及人際問題。
心理衛教暨身心靈賦能團體可改善憂鬱症狀及提升生活品質的效果，合併精神科醫師治療及心理衛教暨身心靈賦能團體治療，可以增進門診憂鬱症患者之照護品質。

Aims. This study aims to understand the effects of psychoeductional with body-mind-spirit empowerment group therapy on reducing depression and increasing quality of life among Taiwanese men with depressive disorders. In addition, this study examines group participants’ views on what aspects of group therapy worked to help their psychological and interpersonal problems.
Methods. This study is a quasi-experimental design. Subjects were recruited from outpatient department of psychiatry from 28/01/2005 to 30/07/2005. This subjects were purposively assigned into experimental group and control group. Thirteen subjects were in experimental group and thirteen subjects were in control group. The subjects in control group received usual care of physican’s treatment at the outpatient department. In addition to usual care, the subjects in experimental group received 8 sessions of weekly group therapy of 120 minutes each. The outcome variables including symptoms of depression and quality of life were evaluated at baseline (pre-treatment) and post treatment. The rate of adherence to scheduled outpatient appointment was collected through medical chart. Data were analyzed using nonparametric statistics. The subjects in experimental group were invited to participate in a semi-structured interview regarding their perceptions of the change mechanisms in the group therapy.
Results. The result of Wilcoxon-Mann-Whitney rank sum test indicated that there were significant differences in reducing depression (Z = -3.746，p < 0.001)and improving quality of life (Z = -3.438，p = 0.001) between experimental group and control group. The result suggested that subjects in experimental group appeared to have a better reduction of depression and improvement of quality of life. According to Fisher’s Exact test, there was no significant difference in rate of adherence to scheduled outpatient appointments (X2 = 0.688，p = 0.344) between two groups. The result suggested that there was a similarity of compliance to scheduled outpatient appointments. Therefore both subjects’ attitudes toward compliance of medication might be similar. The qualitative analysis yielded six domains: (1) catharsis, (2) imparting of information, (3) self understanding, (4) interpersonal output, (5) universality, and (6) group cohesiveness. These domains illustrate how the curative factors worked to help male depression patients’ psychological and interpersonal problems.
Conclusions. The psychoeductional with body-mind-spirit empowerment group therapy could improve symptoms of depression and quality of life. Combination physcian’s treatment and psychoeductional with body-mind-spirit empowerment group could improve quality of care for outpatient with depression therapy.

目 錄
頁數
致 謝………………………………………………………… I
中文摘要………………………………………………………… II
英文摘要………………………………………………………… III
目 錄………………………………………………………… V
圖表目次………………………………………………………… VII

第一章 緒論…………………………………………………… 1
第一節 研究背景與動機……………………………………… 1
第二節 研究目的……………………………………………… 4
第三節 名詞界定……………………………………………… 5
第四節 研究假設……………………………………………… 8
第二章 文獻查證……………………………………………… 9
第一節 憂鬱症的症狀………………………………………… 9
第二節 憂鬱症對生活品質的影響…………………………… 10
第三節 憂鬱症病因……………….………………………… 12
第四節 影響男性個案就醫之因素…………………………… 17
第五節 心理衛教暨身心靈賦能團體………………………… 19
第三章 研究方法……………………………………………… 28
第一節 研究概念架構………………………………………… 28
第二節 研究設計……………………………………………… 30
第三節 團體內容……………………………………………… 31
第四節 研究對象……………………………………………… 35
第五節 研究工具……………………………………………… 36
第六節 研究步驟……………………………………………… 38
第七節 資料分析……………………………………………… 39
第四章 類實驗的結果………………………………………… 42
第一節 研究對象之基本資料……………………………… 42
第二節 實驗組與控制組在治療前後的差異……………… 45
第三節 實驗組與控制組門診規則返診的情形…………… 47
第五章 團體療效的結果……………………………………… 49
第一節 個案表達對罹患憂鬱症的原因的看法……………… 49
第二節 個案對團體療效的看法……………………………… 61
第六章 討論…………………………………………………… 79
第一節 門診憂鬱症患者之心理衛教暨身心靈賦能團體治
療成效……………………………………………… 77
第二節 心理衛教暨身心靈賦能團體治療機轉……………… 79
第七章 結論與建議…………………………………………… 88
第一節 結論………………………………………………… 88
第二節 建議………………………………………………… 89
第三節 研究限制…………………………………………… 90
參考資料
中文部分…………………………………………………… 93
英文部份…………………………………………………… 95
附錄
附錄一 基本資料問卷…………………………………… 109
附錄二 貝克憂鬱量表…………………………………… 110
附錄三 生活品質量表…………………………………… 113

圖表目次
圖一 研究概念架構………………………………………………… 29
圖二 心理衛教暨身心靈賦能團體治療療效的機轉……………… 76
表一 心理衛教團體治療的成效…………………………………… 21
表二 團體治療內容一覽表………………………………………… 33
表三 統計方法……………………………………………………… 40
表四 實驗組與控制組人口學差異分布…………………………… 43
表五 實驗組與控制組之年齡、憂鬱症狀及生活品質…………… 44
表六 實驗組與控制組憂鬱症狀與生活品質之組間比…………… 46
表七 門診規則返診實驗組與控制組之組間比…………………… 48
表八 個案對影響台灣男性憂鬱症因素的主觀看法……………… 50
表九 影響台灣男性憂鬱症的因素―個人特質範疇……………… 52
表十 影響台灣男性憂鬱症的因素―社會規範角色範疇………… 54
表十一 影響台灣男性憂鬱症的因素―調適障礙範疇…………… 57
表十二 個案對團體療效的主觀看法之範疇與主題……………… 62
表十三 個案對團體療效的主觀看法之範疇與主題―情緒宣洩 …… 64
表十四 個案對團體療效的主觀看法之範疇與主題―指導………… 66
表十五 個案對團體療效的主觀看法之範疇與主題―自我瞭解…… 68
表十六 個案對團體療效的主觀看法之範疇與主題―
人際學習―付出……………………………………………… 70
表十七 個案對團體療效的主觀看法之範疇與主題―普同感 …… 72
表十八 個案對團體療效的主觀看法之範疇與主題―
團體凝聚力…………………………………………………… 74

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