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研究生:謝品瑩
論文名稱:冠狀動脈心臟病患者的D型人格、心臟自我效能、因應模式與身心健康之相關研究
論文名稱(外文):Investigating the Relationship among Type D Personality, Cardiac Self-efficacy, Coping Style and Health in Coronary Artery Disease
指導教授:王鵬智王鵬智引用關係
指導教授(外文):WANG, PENG-CHIH
口試委員:洪福建張玉萱
口試委員(外文):HUNG, FU-CHIENCHANG, YU-HSUAN
口試日期:2017-06-26
學位類別:碩士
校院名稱:輔仁大學
系所名稱:臨床心理學系碩士班
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:123
中文關鍵詞:冠狀動脈心臟病D型人格因應模式心臟自我效能身心健康
外文關鍵詞:coronary artery diseaseType D personalitycoping stylecardiac self-efficacyhealth status
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研究背景與目的 在台灣,冠狀動脈心臟病患者之死亡率逐年攀升,危害國民健康甚鉅,而過去研究證實D型人格與冠心病的不良預後及高死亡率之關聯性。然而,國內外研究針對冠心病患者較多探討生理因素,較少關注患者的心理層面,因此本研究欲探討D型人格患者的因應模式、心臟自我效能與身心健康間的心理運作機制。
研究方法 本研究採立意抽樣,研究對象為20歲以上之成人,由醫師診斷為冠心病患者,參與人數共有127位,其中D型人格組有47位,非D型人格組有 80 位。以「台灣版D型人格量表」、「因應方法量表-修訂版」、「心臟自我效能」與「西雅圖心絞痛量表」等自陳量表作為研究工具,進行問卷調查。
研究結果 D型人格患者與非D型人格患者在人口學變項上無顯著差異。D型人格患者的心臟自我效能顯著低於非D型人格患者;D型人格患者在遇到困境時,較常採用逃避因應、較少採用問題為中心、尋求社會支持的方式;而D型人格患者的心絞痛發作頻率相對較多,且較缺乏疾病認知度。心臟自我效能的維持功能向度在D型人格與疾病認知度間具有部分中介的效果。
結論與建議 本研究發現維持功能在D型人格患者的健康扮演重要的角色,D型人格會透過維持功能影響疾病認知度,當患者具有D型人格特質,其維持功能的信念及信心程度越低,會影響其知覺自我疾病的認知度。為了提升患者的身心健康,在心理介入上,可以提升患者的自我效能感,並增進自我照護的能力,釐清針對疾病的不合理信念,增加患者對於疾病或治療的可控性。

Background and Aims In Taiwan, the mortality rate of coronary artery disease (CAD) increased steadily, and endanger people’s health widely. Studies showed that the relationship among patient with Type D personality, the poor prognosis and high mortality rate of coronary artery disease were significant. However, most of related researches explored the physiological factors and less pay attention to the psychological level of patients with coronary artery disease. The purpose of the study is to investigate the psychological mechanism of the coping style, cardiac self-efficacy, social support and mental health among the CAD patients with Type D personality.
Method This study use purposive sampling. The subjects are adults over the age of 20 and diagnosed as CAD patients by cardiovascular physician. There were 127 CAD patients participanted in study; 47 Type D personality & 80 non-Type D personality patients. All participants filled out a questionnaire package including Type D Personality Scale-DS14 Taiwanese Version, Revised Ways of Coping Checklist, Cardiac self-efficacy scale, Yale Social Support Index and Seattle Angina Questionnaire.
Result The results showed no significant differences in demographic variables between Type D and non-Type D personality patients. The cardiac self-efficacy of Type D personality patients was significant lower compared to non-Type D personality patients. The results also demonstrated that Type D personality patients prefer to select avoid coping style instread of problem-focused coping and seek social support coping style, when facing a difficult situation. Moreover, Type D personality patients had frenquent angina attack and poor perception of disease. Last but not least, the maintain function of the Cardiac self-efficacy scale had a partial mediator effect between D-type personality and perception of disease of the Seattle Angina Questionnaire.
Discussion The study presented that the maintain function of the Cardiac self-efficacy scale plays an important role in the health status of Type D personality patients. Type D personality patients with lower confidence in maintain function affected their awareness of disease perception. For improving physical and mental health of patients, the psychological intervention can enhance self-efficacy, the ability of self-care and clarify the irrational beliefs of the disease to increase the controllability of disease or treatment.

摘要 ii
Abstract iii
致謝 v
目錄 vii
圖目錄 ix
表目錄 x
第一章、 緒論 1
第二章、 文獻回顧 4
第一節 冠狀動脈心臟病 4
第二節 D型人格之冠狀動脈心臟病 10
第三節 自我效能 13
第四節 因應模式 19
第五節 身心健康 25
第三章、 研究方法 33
第一節 研究架構 33
第二節 研究問題與假設 34
第三節 研究程序 36
第四節 研究對象 37
第五節 研究工具 40
第六節 資料分析 50
第四章、 研究結果 52
第一節 人口學背景變項分析 54
第二節 研究變項間的差異分析 55
第三節 各反應變項間的相關分析 61
第四節 變項之中介效果分析 67
第五章、 綜合討論 71
第一節 研究假設之驗證 72
第二節 冠心病患者特性的描述性資料 74
第三節 研究變項間之相關分析討論 76
第四節 研究模式之平行中介效果討論 83
第五節 總結與建議 85
參考文獻 89
附錄一、IRB核准證明 101
附錄二、台灣D型人格量表修訂版之使用同意書 104
附錄三、中文版西雅圖心絞痛問卷之使用同意書 105
附錄四、基本資料表 106
附錄五、台灣版D型人格量表 107
附錄六、心臟自我效能量表 108
附錄七、因應模式量表-修訂版 109
附錄八、西雅圖心絞痛問卷(中文版) 112


圖目錄
圖2-3-1 自我效能架構圖………………………………………………………………13
圖3-1-1 研究架構圖……………………………………………………………………33
圖4-3-1 假設 2-1:「D型人格」與「心臟自我效能」達顯著的負相關…….……61
圖4-3-2 假設 2-2:「D型人格」與「因應模式」達有意義的顯著相關………….62
圖4-3-3 假設 2-3:「D型人格」與「身心健康」達顯著的負相關………….……62
圖4-3-4 假設 2-4:「因應模式」與「身心健康」達有意義的顯著相關………….63
圖4-3-5 假設 2-5:「心臟自我效能」與「身心健康」達顯著的正相關…….……63


表目錄
表3-4-1 研究受試者人口學基本資料………………………………………………………38
表3-5-1 負向情感……………………………………………………………………………41
表3-5-2 社交抑制……………………………………………………………………………42
表3-5-3 問題導向因應策略…………………………………………………………………43
表3-5-4 尋找社會支持因應策略……………………………………………………………44
表3-5-5 自責因應策略………………………………………………………………………44
表3-5-6 願想因應策略………………………………………………………………………45
表3-5-7 逃避式因應策略……………………………………………………………………45
表3-5-8 症狀控制……………………………………………………………………………47
表3-5-9 維持功能……………………………………………………………………………47
表4-1-1 研究受試者人口學背景變項分析…………………………………………………54
表4-2-1 兩組於台灣版D型人格量表修訂版之差異檢定…………………………………55
表4-2-2 兩組於心臟自我效能總分之差異檢定……………………………………………56
表4-2-3 兩組於心臟自我效能向度之差異檢定……………………………………………57
表4-2-4 兩組於因應方法量表總分之差異檢定……………………………………….…...58
表4-2-5 兩組於因應方法量表向度之差異檢定……………………………………………59
表4-2-6 兩組於西雅圖心絞痛量表之差異檢定……………………………………………60
表4-3-1 D型人格、心臟自我效能、因應模式及身心健康之相關分析表……………..65
表4-4-1 維持功能平行中介D型人格對疾病認知度影響的迴歸摘要表…………………68
表4-4-2 維持功能平行中介D型人格對疾病認知度影響的總效果、直接效果及間接效果………………………………………………………………………………………………70
表5-1-1 研究假設之驗證結果………………………………………………………………72

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