臺灣博碩士論文加值系統

研究背景與目的：中風病人常因失能與家庭角色改變而有適應上的困難，最常見的情緒疾患為中風後憂鬱(post stroke depression)，臨床盛行率約33%，對復健效果及社會功能造成顯著負面影響。臨床實務發現，宗教提供生命意義與心靈慰藉的功能，是中風病人常作為適應病後生活的支持資源，西方實證研究也指出，宗教、正向宗教因應策略與靈性安適感能提升個體健康及心理狀態，對慢性疾病者更是預防憂鬱情緒發生的重要因子。以民間信仰為主的臺灣本土宗教信仰長期以來融入生活，人們常藉求神問卜及祈求平安來解決生活中的疑問，與西方宗教差異甚大，基於本土宗教信仰之特性，本研究嘗試探討本土宗教信仰的中風者，其憂鬱情緒與宗教態度、宗教因應及靈性安適的關係。

研究方法：採立意取樣之問卷調查研究，以一對一晤談方式完成問卷。於醫學中心收案樣本數137人，均符合世界衛生組織之中風診斷準則。收案條件：(1)符合中風診斷；(2)中風三個月以上；(3)年齡45歲以上；(4)本土宗教信仰者(包含佛教、道教、一貫道及一般民間信仰)；(5)能使用國台語溝通，可理解並依循指令要求；(6)MMSE>20。以相關分析、多變量變異數分析與結構方程模型探討憂鬱和研究各變項(包含人口統計學變項)之關係。

研究工具：「受試者基本資料表」、「宗教態度量表」、「簡短版宗教因應量表」、「靈性安適感量表」及「貝克憂鬱量表中文版第二版」。

研究結果：(1)本土信仰中風者的宗教態度與靈性安適感有顯著正相關，宗教態度能預測較高的宗教安適感；宗教態度與憂鬱之關係不顯著；(2)正向宗教因應與靈性安適、憂鬱之關係不顯著，但負向宗教因應可預測存在安適感及憂鬱；(3)宗教態度與正向宗教因應有顯著正相關；(4)宗教安適與憂鬱之關係未達顯著，存在安適可預測憂鬱情緒；(5)宗教因應雖能預測憂鬱，對靈性安適也有直接影響，但作為中介變項之效果量未達顯著，在本研究中宗教因應並非宗教態度與靈性安適、憂鬱之中介變項。

討論：對中風患者而言，宗教態度會同時提高患者使用正向或負向宗教因應的傾向，且能預測較高的宗教安適感，較高的存在安適感則與較低程度憂鬱有顯著相關。而負向宗教因應可以預測較高的憂鬱情緒與較低的存在安適感，可能對患者帶來不利的影響。

Background and Purpose─ Stroke patients often have difficulties in adaptation due to their disability and changing roles in family. Post-stroke depression is the most common mood disturbance, and its clinical prevalence is approximately 33%. It is also associated with significant negative consequences including poor rehabilitation outcomes and social functions. In practical experiences, religious beliefs were found to have the benefits of providing meanings of life and spiritual comforts. Most stoke patients often used religions as supportive resources to help overcome life problems after stroke. Western published empirical data suggested that religions, positive religious coping strategies, and spitirual well-being had positive associations with both mental and physical health outcomes. Moreover, religious belief is an important factor in preventing chronic illness patients to have depression. Taiwan indigenous religions are predominantly based on folk beliefs, which are closely related to everyday living, and thus people often ask Gods for prophecies, or pray for safe and well when facing real-life difficulties. Based on the characteristics of the indigenous religions and the differences between Western and Eastern religions, this study investigated the relationships among stroke patients’ depression, religious attitudes, religious coping, and spirituality with a Taiwan sample.

Methods─ Participants, who were recruited by purposive sampling method, were interviewed one by one and completed the required instruments individually. All 137 patients satisfied the WHO criteria for stroke. The inclusion criteria were as follows: (1)with primary diagnosis of stroke; (2) 3 months after stroke onset; (3) older than 45 years old; (4) have Taiwan indigenous religious beliefs (including Buddhism, Taoism, I-Kuan Tao, and Taiwan Folklore Belief); (5) can communicate with Chinese or Taiwanese, understand commands and follow orders; and (6) MMSE>20. Correlation analysis, MANOVA, and structural equation model (SEM) were used to examine the relationships between depression and the other variables.

Instruments─ Religious attitudes were assessed with the Religious Attitude Scale. Religious coping was assessed with the Brief Religious Coping Scale. Spirituality was assessed with the Spiritual Well-Being Scale, and depressive symptoms were assessed with the Beck Depression Inventory-II (Chinese version).

Results─ (1) Religious attitudes had significant positive correlation with spiritual well-being. Religious attitudes predicted higher religious well-being, but no siginificant relation was found between religious attitudes and depression. (2) No significant relation was found between positive religious coping with both spiritual well-being and depression. Negative religious coping predicted lower existential well-being and higher level of depression. (3) Religious attitudes had strong positive correlation with positive religious coping. (4) Lower existential well-being predicted higher level of depression, but no significant relation was found between religious well-being and depression. (5) Although religious coping predicted depression and had direct effect on spiritual well-being, its mediating effects between religious attitudes with both depression and spiritual well-being were not significant.

Conclusion─For the stroke patients who had indigenous religious beliefs, religious attitudes enhanced the tendency of using both positive and negative religious coping as coping strategy. Higher level of religious attitudes predicted higher religious well-being, and higher existential well-being was correlated with lower level of depression. On the other hand, negative religious coping predicted higher level of depression and lower existential well-being, which might bring negative outcomes to patients.

目錄
摘要…………………………………………………………………….I
Abstract……………………………………………………………………II
誌謝………………………………………………………………………...IV
目錄…………………………………………………………………………V
表目錄……………………………………………………………………VIII
圖目錄……………………………………………………………………..IX
第一章 序論……………………………………………………………….1
第一節 研究動機與目的…………………………………………….1
第二節 中風後憂鬱概念及相關研究…………………….…………5
一、中風後憂鬱的定義與診斷………………..…..………………5
二、中風後憂鬱的發生……………………………………………7
三、中風後憂鬱的衡鑑與評估工具……………………………..11
四、中風後憂鬱的高危險因子及預測因子……………………..13
五、中風後憂鬱的治療…………………………………………..18
六、中風後憂鬱的預防…………………………………………..21
七、小結…………………………………………………………..24
第三節 宗教、宗教因應、靈性安適與健康………………………..25
一、宗教之定義與測量…………………………………………..25
二、宗教因應之定義與測量……………………………………..35
三、宗教、宗教因應與健康相關研究…………….……….……40
四、靈性安適概念與相關研究………………………………….45
五、宗教性、宗教因應、靈性安適感與中風、失能及障礙之關
係探討………..……………………………………………..49
六、 小結………………………………………………………...51
第四節 研究架構、問題與假設………….…………………….…..53
第二章 研究方法………………………………………………………...55
第一節 研究對象與程序……..……………………………………..55
第二節 研究工具……………………………………………………56
一、基本資料表….……………….……………………………..56
二、宗教態度量表……………………….….……………...……56
三、宗教因應量表…………………………..……………….…..57
四、靈性安適感量表……..……………………………………...59
五、貝克憂鬱量表…………..…………………………………...61
第三節 統計分析……………………………………………………62
第三章 研究結果………………………………………………………...64
第一節 研究樣本結構之描述性統計分析…………………………64
第二節 信效度分析…….…………………………………………...67
一、 宗教態度量表……………………………………………..67
二、 宗教因應量表……………………………………………..69
三、 靈性安適感量表…………………………………………..69
第三節 各變項描述性統計分析……………………………………70
第四節 人口學變項與研究變項各構面之關係……………………72
第五節 研究架構檢驗………………………………………………74
第六節 研究假設檢驗………………………………………………75
第四章 討論……………………………………………………………...77
第一節 研究結果摘要…………………………………..…..............77

一、 宗教態度與靈性安適感、憂鬱之關係………………...77
二、 宗教因應與靈性安適感及憂鬱之間的關係……...……77
三、 宗教態度與宗教因應之關係…………………………...77
四、 靈性安適感與憂鬱之關係………………………………78
五、 宗教因應與宗教態度、靈性安適、憂鬱程度之關聯…78
第二節 綜合討論…………………………………………………..78
一、 本土宗教信仰之中風者，其宗教態度與靈性安適感、憂鬱之關係78
二、 本土宗教信仰中風者，其宗教因應與靈性安適、憂鬱之關係…...79
三、 本土宗教信仰中風者其宗教態度與宗教因應之關係……………...80
四、 人口學變項與研究各變項之關係…………………………81
第三節 研究限制、研究方向與研究貢獻………………………….81
一、 研究限制…………………………………………………..81
二、 未來研究方向………………………………………………82
三、 研究貢獻……………………………………………………83

參考文獻………………………………………………………………………84
中文部份…………………………………………………………………84
英文部分…………………………………………………………………87
附錄一：本研究問卷………………………………………………………….95
附錄二：量表授權同意使用書與電子郵件………………………………….96
表目錄
表1-1：評估中風後憂鬱情感性疾患問卷整理.……………...………………12
表3-1：受試者基本資料概況…………………………………………………65
表3-2：受試者疾病概況………………………………………………………66
表3-3：受試者宗教信仰概況…………………………………………………67
表3-4：宗教態度量表之因素分析結果………………………………………68
表3-5：宗教因應量表驗證性因素分析之模型適配度指標檢核表…………69
表3-6：靈性安適量表驗證性因素分析之模型適配度指標檢核表…………70
表3-7：各研究變項之描述統計量……………………………………………71
表3-8：受試者憂鬱概況分布…………………………………………………71
表3-9：研究各變項之相關……………………………………………………72
表3-10：受試者人口統計學連續變項與研究各變項之相關………………..73
表3-11：研究架構結構方程模式分析摘要…………………………………..75
表3-12：研究架構之模型適配度指標檢核表………………………………..75
表3-13：路徑關係檢定表……………………………………………………..76
表3-14：整體模型影響效果表………………………………………………..76

圖目錄
圖1-1：研究假設之架構圖…………………….……………...………………53
圖3-1：本研究架構圖之修正…………………………………………………74

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