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研究生:簡士釗
研究生(外文):Shih-Chao Chien
論文名稱:接受社區復健、慢性住院與門診治療中的精神分裂症病患生活品質之比較
論文名稱(外文):Comparison of Quality of Life among Patients with Schizophrenia Receiving Community Rehabilitation, Chronic Hospitalization and Outpatient Treatment
指導教授:周碧瑟周碧瑟引用關係
指導教授(外文):Pesus Chou
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
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:87
中文關鍵詞:生活品質精神分裂症社區復健慢性住院
外文關鍵詞:quality of lifeschizophreniacommunity rehabilitationchronic hospitalization
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背景:協助精神分裂症病患適應社區生活是心理衛生的重要議題,過去二十年來有諸多研究探討去機構化與精神復健對慢性精神病患生活品質影響。本研究目的在比較接受社區復健、慢性住院與門診治療的精神分裂症病患的主觀生活品質,並探討精神復健對病患生活品質的影響。
方法: 由台灣的一所精神專科醫院之社區復健中心、慢性病房與門診以年齡性別配對設計依個案數1:2:2 比例收案三組研究對象,研究樣本為320名完成資料收集的病患。以世界衛生組織生活品質量表簡明版(World Health Organization Quality of Life- abbreviated version, WHOQOL-BREF)與12題簡短健康問卷 (Sort Form-12 Health Survey, SF-12)作為測量生活品質的工具,並以活性與負性症狀量表(Positive and Negative Symptom Scale, PANSS)測量精神症狀嚴重度。比較不同治療設施組別的病患的各範疇生活品質測量結果,以複迴歸分析在校正精神症狀嚴重度、臨床病程與社會人口學變項之下檢定治療設施與生活品質的獨立相關性,並分析工作訓練、休閒運動習慣等復健因素對生活品質的影響。
結果:在WHOQOL的生理範疇、心理範疇、社交範疇及SF-12的心理綜合分數之得分平均值皆呈現慢性住院組最高(即該範疇的生活品質最佳),社區復健中心組次之,門診組最低;然而在環境範疇得分之平均值,則以社區復健中心組最高,慢性住院組次之,門診組最低。多變項分析結果顯示:社區復健組在所有WHOQOL四個範疇得分顯著高於門診組,慢性住院組在所有WHOQOL四個範疇得分與SF-12之心理綜合得分顯著高於門診組。除了WHOQOL心理範疇慢性病房組高於社區復健組之外,社區復健與慢性住院兩組在其他所有生活品質範疇皆無顯著差異。庇護性工作與運動習慣等復健因素則與特定生活品質得分成正相關。
結論:社區復健中心與慢性病房接受復健服務的病患有較佳的生活品質,在精神分裂症病患的照護應重視提供具有支持性的環境並促進病患接受精神復健。
Background: Helping patients with schizophrenia to adapt with community living is an important issue in mental health. In the past two decades, there had been numerous studies investigating influence of de-institution and psychiatric rehabilitation on quality of life of patients with chronic mental illness. The objectives of the present study are to compare subjective quality of life (QOL) among patients with schizophrenia receiving community rehabilitation, chronic hospitalization and outpatient treatment and to explore the influence of psychiatric rehabili- tation on their QOL.
Method: Patients with clinical diagnosis of schizophrenia were recruited in community rehabilitation center, chronic ward and outpatient department in a specialty mental hospital in Taiwan by matching age and gender to form three patient groups with 1:2:2 ratio. Totally 320 patients were enrolled as our study sample. World Health Organization Quality of Life- abbreviated version (WHOQOL-BREF) and Short Form-12 Health Survey (SF-12) were used to measure subjective QOL and Positive and Negative Syndrome Scale (PANSS) was used to measure the severity of psychiatric syndrome. We compared the outcome measures of various domains of QOL among patients in different treatment settings. Multiple regression was applied to test the independent correlation of treatment setting factors with each domain of QOL while adjusting severity of psychiatric syndrome, clinical course and socio-demographic variables. Influence of rehabilitation factors such as vocational training and leisure physical activities on QOL are also analyzed.
Results: In WHOQOL physical domain, psychological domain, social domain and SF-12 mental component score, all the mean scores revealed chronic ward group being the highest (i.e. having the best QOL in that domain), community rehabilitation group being the next and outpatient group being the lowest. However, as to mean scores of WHOQOL environment domain, the community rehabilitation group was the highest, than chronic ward group and outpatients being the lowest. Multivariate analysis revealed that: Community rehabilitation group had significant higher scores than outpatient group in all four domains of WHOQOL, chronic ward group had significant higher scores in all four domains of WHOQOL and MCS of SF-12 as compared to outpatients. Besides psychological domain of WHOQOL, which shows chronic ward group had higher score than community rehabilitation group, there had been no significant difference between community rehabilitation group and chronic ward group in other QOL domains. Rehabilitation factors such as sheltered work and exercise habit were positively correlated with some of the QOL measures.
Conclusions: Patients receiving rehabilitation service in community rehabilitation center and chronic rehabilitation ward had better quality of life. Providing supportive environment and facilitating patients to receive psychiatric rehabilitation is high- lightened in caring patients with schizophrenia.
第一章 緒論.............................................1
第一節 研究背景...........................................1
第二節 研究目的...........................................3
第三節 重要名詞解釋.......................................4
第二章 文獻探討.........................................6
第一節 精神分裂症之疾病特性.............................6
第二節 精神分裂症病患的復健.............................8
第三節 精神分裂症患者之生活品質測量....................11
壹、 生活品質的概念..................................11
貳、 精神分裂症患者的生活品質測量方式................14
第四節 不同治療設施之精神分裂症患者生活品質之比較研究....20
壹、 去機構化對生活品質的影響............................20
貳、 社區與住院之精神分裂症患生活品質之比較..............22
第五節 影響精神分裂症病患生活品質的因素..................26
壹、 復健對精神分裂症病患生活品質的影響..............26
貳、 影響精神分裂症病患生活品質的其他因素............30
第三章 研究方法........................................33
第一節 研究架構........................................33
第二節 研究對象........................................34
第三節 本研究治療設施特性..............................36
第四節 測量工具........................................38
第五節 研究變項........................................43
第六節 統計分析........................................46
第四章 研究結果........................................48
第一節 研究樣本特徵與精神症狀..........................48
第二節 治療設施與生活品質的相關性......................50
第三節 精神復健因素與生活品質的相關性..................56
第五章 討論............................................60
第一節 研究結果討論....................................60
第二節 研究限制........................................63
第六章 結論與建議......................................66
參考資料.................................................68
附錄
附錄一、個案參與計畫同意書...............................78
附錄二、 個案基本資表....................................79
附錄三、台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF-TW)81
附錄四、簡短健康問卷12題(SF-12)...........................84
附錄五、休閒運動習慣量表..................................87


表目次
表2-1: 常用於精神病患研究的生活品質量表彙整..............16
表3-1: WHOQOL-BREF台灣版問卷的各個範疇所包含的題目.......42
表3-2: 研究變項彙整......................................45
表4-1: 研究樣本特徵資料..................................49
表4-2: 三組病患的WHOQOL生活品質各範疇與SF-12測量結果.....52
表4-3: 治療設施組別與各範疇生活品質相關性之多變項分析
(以門診組為對照組).......................................53
表4-4: 治療設施組別與各範疇生活品質相關性之多變項分析
(社區復健中心組為對照組).................................54
表4-5: 工作狀態、運動量與各範疇生活品質相關性之多變項分析
(組別變項未進入).........................................57
表4-6: 治療設施組別、工作狀態、運動量與生活品質相關性
之多變項分析(全部變項進入................................58
表4-7: 治療設施組別、工作狀態、運動量與生活品質相關性
之多變項分析(逐步後向刪除法..............................59
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