研究生: |
陳敏瑜 |
---|---|
論文名稱: |
社區精神病患之主要照顧者的照顧負荷、身心健康與照顧需求之調查研究 |
指導教授: | 林家興 |
學位類別: |
碩士 Master |
系所名稱: |
教育心理與輔導學系 Department of Educational Psychology and Counseling |
論文出版年: | 2008 |
畢業學年度: | 96 |
語文別: | 中文 |
論文頁數: | 81 |
中文關鍵詞: | 精神病患 、主要照顧者 、照顧負荷 、身心健康 、照顧需求 |
英文關鍵詞: | mental illness, primary caregiver, burden, health, need |
論文種類: | 學術論文 |
相關次數: | 點閱:1206 下載:0 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
中文摘要
本研究旨在探討社區精神病患之主要照顧者的人口變項、病患人口變項與
照顧負荷、身心健康與照顧需求三者之間的關係。本研究採立意取樣,以台灣省北中南東各區之康復之友協會、精神科門診、日間留院與社區復健中心中之精神病患的主要照顧者為研究對象,共計310名。本研究採問卷調查法進行資料收集,所使用研究工具包括「主要照顧者基本資料」、「病患基本資料」、「照顧負荷量表」、「身心健康量表」與「照顧需求量表」。調查所得資料分別以描述統計、卡方檢定、點二系列相關、積差相關與逐步迴歸分析之統計方法進行處理。本研究主要發現如下:
1. 主要照顧者以女性為主,平均年齡為57歲,與患者的關係以父母為主,教
育程度以高中職較多,多為無職業者,平均照顧病患年數為15年,每日平均相處時數為12小時,平均使用2個社會資源。
2. 精神病患的性別,男女各半,平均年紀為38歲,初次發病年齡是22歲,四
分之三為無偶者,平均生病年數為15年,平均住院次數為3次,教育程度以
高中職居多,疾病的診斷以精神分裂症佔多數,半數以上領有身心障礙手冊與
重大傷病卡。
3. 父母的照顧者有較重的烙印感,且教育程度愈高,愧疚與照顧負荷亦愈重;經濟狀況愈不足、與病患每日相處時數愈長以及自覺身體狀況愈差的照顧者,其家庭干擾程度與照顧負荷愈重。
4. 病患的住院次數愈多與復健情況愈少的照顧者,其感到家庭干擾的程度愈
重,年齡愈小與無偶的病患之照顧者,感到烙印程度愈重;病患年齡愈長,照
顧者感到較多的依賴。
5. 照顧負荷與身心不健康呈顯著正相關,而身心不健康與照顧需求呈顯著正相關,照顧負荷與照顧需求呈顯著正相關;之後以逐步迴歸分析求出最佳預測照顧需求方程式,得到6個獨變項,分別為「照顧曾使用的社會資源數」、「照顧負荷」、「住院次數」、「生病年數」、「照顧者教育程度」、「同住年數」,可以解釋照顧需求變異的27.5%。
最後,研究者針對本研究結果加以討論,並提出具體建議,以提供相關領域工作者在心理衛生服務與相關法令和政策擬訂時之參考,並提出未來研究之建議。
Abstract
The purpose of this study is to investigate the relationship among the burden, health, and need of primary caregivers of mental illness in the community in Taiwan. The samples are comprised of 310 primary caregivers from four areas across Taiwan. Instruments used in this study were“ primary caregiver data”,“ mental illness patient data”, “Caregiver Burden Scale”, ”Chinese Health Questionnaire-12”, “Caregiver need Scale”, data obtained in this study were analyzed by descriptive analysis, chi-squire, point-biserial correlation, Pearson product moment correlation and stepwise regression analysis. The main findings are as follows:
1.The characters of primary caregivers: most of them are female,their average age are 57, most of them are parents, they are unemployed, average years of taking care patients is 15, they spend about 12 hours a day to be with patients, the average number of using the social resources is 2.
2.The characters of patients: half of male and half of female, their average age are 38, the average age of their first course is 22 years old, 3/4 of them are unmarried, average years of illness is 15, average times of inpatient is 3, most of them are graduated from senior high school, most of their diagnosis is Schizophrenia.
3.Correlation among primary caregivers’ characters and burden,health, and need.
4.Correlation among mental ill patients’ characters and burden,health, and need.
5.Burden and health are significantly associated with need; burden is significantly associated with health. After Stepwise regression analysis, there are six predictive variables could predict caregivers’ need.
Finally, based on the results, implications of the study for doctors, psychologists, counselors, nurses, and social-workers and as well as suggestions for future research are proposed.
Keywords: mental illness , primary caregiver, burden, health, need
參考文獻
一、中文部分
孔繁鐘、孔繁錦(1998)。DSM-IV精神疾病的診斷與統計。台北:合記。
宋麗玉(1998)。精神病患社區照顧之省思-社區化或機構化,選擇或困局。中華心理衛生學刊,11卷,4期,頁73-103。
宋麗玉(1999)。精神病患照顧者之探究:照顧負荷之程度與其相關因素。中華心理衛生學刋,12卷,1期,頁1-30。
宋麗玉(2002)。精神病患照顧者負荷量表之發展與驗證-以實務應用為取向。社會政策與社會工作學刊,6卷,1期,頁61-99。
宋麗玉(2004)。台灣精神障礙者之社區照護(復健)發展。台灣精神障礙者之社區照護發展:理想與實務研討會彙編。財團法人國家衛生研究院。
宋麗玉(2005)。精神障礙者之復健與復元-一個積極正向的觀點。中華心理衛生學刊,18卷,4期,頁1-29。
吳就君(1995)。精神病患家庭照顧者的負荷研究:跨國文化比較。中華心理衛生學刊,8卷,1期,頁37-52。
吳錦喻(2006)。精神病患長期照護需求評估。行政院衛生署九十四年度科技研究計畫。
李淯琳(2005)。倫理主體的形塑、顯現與流變:以精神病患家屬為例。台灣師範大學教育心理與輔導學系碩士論文。
李建德(2005)。精神病患男性家屬的照顧經驗。國立成功大學護理學研究所碩士論文。
沈志仁、張素凰(1991)。精神病患者家屬的壓力源、應對策略與健康狀況-時間序列的探討。中華心理衛生學刊,5卷,2期,頁103-123。
沈志仁、張素凰(1993)。精神分裂病患者主要照顧家屬的需要及其相關因素。中華心理衛生學刊,6卷,1期,頁89-116。
林憲(2007)。文化精神醫學的贈物,從台灣到日本。台北:心靈工坊。
林惠琦(1998)。社區精神分裂病患主要照護者之負荷、社會支持與心理健康。高雄醫學院護理學研究所碩士論文。
林仕苾(2005)。初診精神分裂症患者及其主要照顧者的健康照護需求。國立台灣大學護理學研究所碩士論文。
社團法人台北市心生活協會(2007)。精神衛生法 96.06新法及96年秋天立法院新會期的修法行動說明。6月22日搜尋。http://www.xn--15tt31ae7f.tw/
邱啟潤,許淑敏,吳瓊滿(2002)。主要照顧者負荷、壓力與因應之國內研究文獻回顧。醫護科技學刊,4卷,4期,頁273-290。
胡海國(1996)。精神分裂症患者家屬對精神分裂症之態度。當代醫學,23卷,6期,頁90-94。
胡海國、吳就君、鄭若瑟、黃梅羹、胡小萍、黃宗正、陳珍信、葉玲玲、張宏俊(2000)。精神分裂症患者主要照顧者之負擔。台灣精神醫學,14卷,3期,頁205-217。
胡海國(2002)。精神分裂症之社區流行病學。當代醫學,29卷,9期,頁26-36。
胡海國編(2003)。台灣精神障礙者照護發展研討會彙編。財團法人國家衛生研究院。
教育部(2007)。重編國語辭典修訂本。6月22日搜尋。http://140.111.34.46/newDict/dict/index.html
張秀桃(2004)。精神分裂病患者主要照顧者的照顧負荷之探討,以某醫學中心復健和門診個案為例。高雄醫學大學行為科學研究所碩士論文。
郭峰志(譯)(2001)。現代社區精神醫療:整合式心理衛生服務體系。台北:心理。(Breakey, W. R., 1996)
莊明敏(1995)。精神病患醫療服務體系之檢討。台北:行政院研究發展考核委員會。
葉玲玲(2004)。各國精神障礙者社區照護之比較探討。台灣精神障礙者之社區照護發展:理想與實務研討會彙編。財團法人國家衛生研究院。
黃梅羮(1987)。精神科住院病患及其家屬的心理暨社會問題探討研究。中華民國醫務社會工作協會。
楊延光(2000)。杜鵑窩的春天。台北:張老師文化。
廖以誠等(2003)。Haloperidol 及Risperidone 治療精神分裂症的療效與成本比較。台灣精神醫學,17卷,4期,頁293-301。
簡以嘉編(2004)。台灣精神障礙者之社區照護發展:理想與實務研討會彙編。財團法人國家衛生研究院。
鄭泰安(1985)。台灣地區精神病患者之社會文化特徵及療養結果研究。中華心理衛生學刊,2卷,1期,頁117-133。
謝佳容等(2001)。社區精神分裂病患主要照顧者人格堅毅性與其健康狀況相關性探討。新臺北護理期刊,3卷,2期,頁89-100。
顏秀珍、楊美賞(2004)。社區精神病患之主要照顧者被病患身體攻擊後的反應。台灣醫學。8卷,6期,頁786-793。
二、英文部分
Addington J., Coldham E. L., Jones B., Ko T. & Addington D. (2003). The first episode of psychosis: the experience of relatives. Acta Psychiatrica Scandinavica, 108, 285-289.
Agitha V., Lori A. P. & Philip T. (2004). Burden in adolescent children of parents with schizophrenia: The Edmonton high risk project. Soc Psychiatry Psychiatr Epidemiol, 39, 528-535.
Bernheim K. F. & Lehman A. F. (1985). Working with families of the mentally ill. New York:W. W. Norton & Company.
Biegel D. E., Milligan S. E., Putnam P. L., Song L.Y. (1997). Predictors of burden among lower socioeconomic status caregivers of persons with chronic mental illness. Community Mental Health Journal.30, 473-494.
Cheng T.A. & Williams P. (1986). The design and development of a screening questionnaire(CHQ) for use in community studies of mental disorders in Taiwan. Psychological Medicine.16, 415-422.
Chong M.Y. & Wilkinson G. (1989). Validation of 30- and 12-item versions of the Chinese Health Questionnaire(CHQ) in patients admitted for general health screening. Psychological Medicine.19, 495-505.
Cheng T.A., Wu J. T., Chong M.Y., Williams P. (1990). Internal consistency and factor structure of the Chinese Health Questionnaire. Acta Psychiatr Scand. 82, 304-308.
Chen P. S., Yang Y. K., Liao Y. C., Lee Y. D., Yeh Y. L. & Chen C. C. (2004). The psychological well-being and associated factors of caregivers of outpatients with schizophrenia in Taiwan. Psychiatry and Clinical Neurosciences. 58, 600-605.
Chen F. P., Greenberg J. S. (2004). A positive aspect of caregiving: the influence of social support on caregiving gains for family members of relatives with schizophrenia. Community Mental Health Journal, 40(5), 423-435.
Duffy K. G. & Wong F. Y. (2003). Community psychology. Boston :Allyn and Bacom.
Hunt C. K. (2003). Concepts in caregiver research. Journal of Nursing Scholarship. 35(1), 27-32.
Hazel N. A., Mcdonell M. G., Short R. A., Berry C. M., Voss W. D., Rodgers M.L. et al. (2004). Impact of multiple-family groups for outpatients with schizophrenia on caregivers’ distress and resources. Psychiatric Services. 55(1), 35-41.
Hatfield A.B. & Lefley H. P. (2005). Future involvement of siblings in the lives of persons with mental illness. Community Mental Health Journal. 41(3), 327-338.
Jewell T. C. & Stein C. H. (2002).Parental influence on sibling caregiving for people with severe mental illness.Community Mental Health Journal. 38(1), 17-33.
Lefley H. P. (1987). Aging parents as caregivers of mentally ill adult children: A emerging social problem. Hospital and Community Psychiatry. 38(10), 1063-1070.
Lefley H. P. (1996). Family caregiving in mental illness. Thousand Oaks, CA:Sage Publications.
Lefley H. P. & Hatfield A. B. (1999).Helping parental caregivers and mental health consumers cope with parental aging and loss.Psychiatric Services. 50(3), 369-375.
Lee C., Thomas H., McGlashan & Scott W. W. (2005).Prevention of Schizophrenia. Can it Be Achieved. CNS Drugs, 19(3), 193-206.
Magliano L., Marasco C., Fiorillo A., Malangone C., Guarneri M., Maj M., & the working group of the Italian national study on families of persons with schizophrenia (2002).The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy.Acta Psychiatrica Scandinavica.106, 291-198.
Meijer K., Schene A., Koeter M., Knudsen H. C., Becker T., Thornicroft G., et al. (2004). Needs for care of patients with schizophrenia and the consequences for their informal caregivers: results from the EPSILON multi centre study on schizophrenia. 39, 251-258.
Mak W. W. S. (2004). Integrative model of caregiving: How macro and micro factors affect caregivers of adults with severe and persistent mental illness. American Journal of Orthopsychiatry. 75(1), 40-53.
Murray-Swank A. B., Lucksted A., Medoff D.R., Yang Y., Wohlheiter K. & Dixon L.B. (2006).Religiosity, psychosocial adjustment, and subjective burden of persons who care for those with mental illness.Psychiatry Service.57(3), 361-365.
Ohaeri J. U.(2003). The burden of caregiving in families with a mental illness: a review of 2002. Current Opinion in Psychiatry. 16, 457-465.
Ritu N., Subho C., Paramanand K. & Rajni S. (2005).Caregiver-coping in bipolar disorder and schizophrenia: A reexamination. Soc Psychiatry Psychiatr Epidemiol.40, 329-336.
Solomon P. & Draine J. (1995).Subjective burden among family members of mentally ill adults: relation to stress, coping, and adaptation. Amer J Orthopsychiat. 65(3), 419-427.
Schwartz C. and Gidron R.(2002). Parents of mentally ill adult children living at home: rewards of caregiving. Health and Social Work.27(2), 145-154.
Saunders J. C. (2003).Families living with severe mental illness: a literature review. Issues in Mental Health Nursing.24, 175-198.
Savage S., Bailey S. (2004). The impact of caring on caregivers’ mental health: a review of the literature. Australian Health Review. 27(1), 111-117.
Wehmeier S. (2000).Advanced Learner’s dictionary. New York:oxford university.
World Health Organization. Retrieved June 22, 2007, from http://www.who.int/mental_health/en/
Zipple A. M., Langle S., Spaniol L., Fisher H. (1990). Client confidentiality and the family’s need to know: strategies for resolving the conflict. Community Mental Health Journal, 26, 533-545.