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研究生:黃蓉蓉
研究生(外文):Rong-rong Huang
論文名稱:高雄市慢性精神病患生活品質相關因素探討
論文名稱(外文):Factors Related to Quality of Life among Chronic Mental Illness Patients in Kaohsiung City
指導教授:邱文彬邱文彬引用關係周煌智周煌智引用關係
指導教授(外文):Wen-Bin ChiouFrank Huang-Chih Chou
學位類別:碩士
校院名稱:國立中山大學
系所名稱:高階公共政策碩士班
學門:社會及行為科學學門
學類:公共行政學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:68
中文關鍵詞:生活品質慢性精神病患照顧者負荷
外文關鍵詞:Chronic mental illnessCaregiverQuality of life
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本研究旨在探討高雄市慢性精神病患的個人、疾病、家庭、社會因素與其生活品質的關係,此四層面對其生活品質的預測能力,及了解主要照顧者之需求,以為日後精神衛生政策擬定之參考依據,並做為本土化慢性精神病患者生活品質資料建立和跨文化比較研究之基礎。研究方法採橫斷面、集群取樣,曾於高雄市某精神專科教學醫院就醫之慢性精神病人,經專科醫師診斷確定,年滿十八歲,意識清楚,且能表達願意接受訪談者及家屬為對象,以結構式問卷調查法進行資料收集。內容包括生活狀況問卷、精神症狀評估表、家屬需求表、家屬負荷量表和簡式症狀量表-5(BSRS-5)及生活品質簡短量表(MOS SF- 12)。共計收案2,023人,男性52.9%,女性47.1%,平均年齡為44.99 ± 12.09歲。教育程度以高中職最多,發病年數小於10年有42.1%,11至20年的有33.7%,20年以上有24.3%。疾病分類以精神分裂症為最多(70.5%),其次為情感性精神病(19.7%)。大多數個案沒有職業、曾住院治療過。12.6%有暴力史,8.4%有自殺史,10%有物質濫用,5.4%有法律相關問題。單因子分析顯示個人因素以未婚、有工作、年齡較輕者、心理問題少、心理困擾程度低者生活品質較好,並未發現性別及教育程度與生活品質的關聯性。疾病因素方面,精神症狀、活性症狀與生活品質呈負相關;精神分裂症病患其自評生活品質較情感性精神病患為好,社區病患其自評心理層面生活品質較住院病患為差。家庭因素方面,家屬的照顧態度及家屬的照顧負荷與病患的生活品質呈負相關。社會因素方面,住屋不定及社區生活功能障礙與生活品質明顯呈負相關。將變數依社會因素、家庭因素、疾病因素、個人因素之排序進入階層迴歸分析,結果顯示個人、疾病、家庭、社會因素可顯著預測心理層面生活品質及生理層面生活品質,解釋變異量分別為48.2%及21.2%。結論:慢性精神病患生活品質是以個人因素及疾病因素為最重要的預測指標,其次在心理層面生活品質,家庭因素重於社會因素,而在生理層面生活品質,則社會因素重於家庭因素。以上這些證據支持要改善生活品質必須考量相當廣泛的因素。
The purposes of this study were 1) to explore the associations between individual factors, disease factors, family factors, social factors and quality of life ( QoL ), 2) to predict QoL in patients with chronic mental illness ( CMI ), and 3) to understand the needs of caregivers. A cross-sectional and cluster sampling was employed. Structured questionnaires, including a living conditions questionnaire and a psychotic symptom assessment scale, Caregiver Burden Scale, 5-item Brief Symptom Rating Scale ( BSRS-5 ), and the Medical Outcomes Study Short Form-12 ( MOS SF-12 ) were used to collect data. Totally, 2023 patients were recruited, males 52.9%, females 47.1%, and a mean age of 44.99±12.09. Most of these cases were high school educated, unemployed, and had been hospitalized. 12.6% had a history of violence, 8.4% had a history of attempted suicide, 10% had substance abuse, and 5.4% had legal related issues. The most common diagnoses were schizophrenia(70.5%)and affective disorder(19.7%). Single-factor analysis showed those who were unmarried, employed, younger, having less psychological problems, and low levels of psychological distress had better QOL. Besides, sex and education were not related to QOL in personal factors. Current psychotic symptoms and positive symptoms were negatively correlated with QOL. Schizophrenic patients and hospitalized patients reported higher QOL than bipolar patients and community patients in disease factors. Caregiver’s attitude and caregiver’s burden were negatively correlated with QOL in family factors. The unstable housing and community life dysfunction were negatively correlated with QOL in social factors. All significantly correlated variables were entered into hierarchical regression analysis followed the sequence of social factors, family factors, disease factors and individual factors. The results showed all four of these dimensions were significant predictors of MCS and PCS of QoL, explained variance 48.2% and 21.2%, respectively. Conclusions: Individual factors and disease factors are the most important factors in predicting QoL in CMI patients. Second, family factors are more important than social factors in MCS, and social factors are more important than family factors in PCS. The above evidence indicates a wide range of factors must be considered to improve the QoL in CMI patients.
中文摘要----------------------------------------------------------------------------------------------- i
英文摘要---------------------------------------------------------------------------------------------- ii
目次-----------------------------------------------------------------------------------------------------iii
圖表目次-----------------------------------------------------------------------------------------------v
第一章緒論----------------------------------------------------------------------------------------1
第一節研究背景與重要性--------------------------------------------------------------------1
第二節研究目的--------------------------------------------------------------------------------3
第二章文獻探討-----------------------------------------------------------------------------------5
第一節個人因素--------------------------------------------------------------------------------5
第二節疾病及精神病理因素-----------------------------------------------------------------7
第三節家庭因素--------------------------------------------------------------------------------9
第四節社會環境因素------------------------------------------------------------------------ 10
第三章研究方法--------------------------------------------------------------------------------- 13
第一節概念架構與研究問題--------------------------------------------------------------- 13
第二節研究對象------------------------------------------------------------------------------ 14
第三節研究工具------------------------------------------------------------------------------ 15
第四章研究結果--------------------------------------------------------------------------------- 19
第一節慢性精神病患在不同治療模式的差異比較----------------------------------- 19
第二節慢性精神病患的生活品質、心理困擾及照顧者負荷、心理困擾-------- 21
一、慢性精神病患的生活品質------------------------------------------------------ 21
二、慢性精神病患及家屬的心理困擾程度--------------------------------------- 22
三、慢性精神病患的照顧者負荷--------------------------------------------------- 23
第三節個人、疾病、家庭及社會因素與慢性精神病患生活品質的關係-------- 24
一、個人因素與慢性精神病患生活品質的關係--------------------------------- 24
二、疾病因素與慢性精神病患生活品質的關係--------------------------------- 26
三、家庭因素與慢性精神病患生活品質的關係--------------------------------- 28
四、社會因素與慢性精神病患生活品質的關係--------------------------------- 29
第四節從個人、疾病、家庭及社會層面來探討預測慢性精神病患之生活品質31
一、從個人、疾病、家庭及社會層面來預測慢性精神病患之心理層面生活
品質--------------------------------------------------------------------------------- 31
二、從個人、疾病、家庭及社會層面來預測慢性精神病患之生理層面生活
品質--------------------------------------------------------------------------------- 32
第五節慢性精神病患家屬的需求-------------------------------------------------------- 34
第五章討論---------------------------------------------------------------------------------------- 35
第六章結論及建議----------------------------------------------------------------------------- 41
第一節結論------------------------------------------------------------------------------------ 41
第二節建議------------------------------------------------------------------------------------ 41
參考文獻--------------------------------------------------------------------------------------------- 44
中文部份---------------------------------------------------------------------------------------- 44
英文部份---------------------------------------------------------------------------------------- 45
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