精神病患復元歷程之相關性研究

A Correlational Study of the Recovery Process in Patients With Mental Illness

10.6224/JN.201804_65(2).09

黃耀輝(Yao-Hui Huang)；林幼喻(Yao-Yu Lin)；李世凱(Shih-Kai Lee)；李明峰(Ming-Feng Lee)；林靜蘭(Esther Ching-Lan Lin)

精神病患 ； 復元 ； 精神疾病污名感受 ； patients with mental illness ； recovery ； perceived psychiatric stigma

護理雜誌

65卷2期（2018 / 04 / 01）

64 - 74

繁體中文

背景：復元理念強調精神病患自主權及建立其嶄新生活型態。國內對於精神病患復元歷程以及相關性因素的實證知識仍顯不足。目的：探討精神病患的復元歷程之現況及其相關因素。方法：採橫斷面相關性研究設計，以方便取樣，選取某精神科專科醫院精神病患250位。研究工具為復元歷程、精神疾病污名感受，以及個人與社會功能量表。以描述性統計、卡方檢定、變異數及線性複迴歸統計進行資料分析。結果：研究對象多數為男性、中年、未婚、高中畢、就業中、接受居家治療及思覺失調症病患。無工作、接受康復之家照護模式及居住於社區之病患，具有較佳復元歷程表現（p ＜ .05）。病患復元歷程總分及三個次量表，與污名感受呈現顯著負相關（p ＜ .01），也與社會功能表現呈現顯著正相關（p ＜ .05）。以復元歷程為依變項進行複迴歸分析，結果發現教育程度、工作狀態、精神復健模式及污名感受為顯著的預測因素，高中（含）以上、無工作、接受康復之家照護模式及精神疾病污名感受愈低，則復元歷程表現愈佳。結論：社區精神衛生護理人員應提供就業精神病患工作壓力調適之照護，並且強化其對於污名化感受因應之策略，同時推動全民心理健康促進，提高對心理疾病的認識與接納，消弭精神疾病污名，以利病患復元。

Background: The ideology of recovery addresses the autonomy of patients with mental illness and their ability to reconstruct a normal life. Empirical knowledge of this process of recovery and related factors remains unclear. Purpose: To assess the process of recovery and related factors in patients with mental illness. Methods: This cross-sectional, correlational study was conducted on a convenience sample in a psychiatric hospital. Two-hundred and fifty patients with mental illness were recruited and were assessed using 3 instruments: Questionnaire about the Process of Recovery (QPR), Perceived Psychiatric Stigma Scale (PPSS), and Personal and Social Performance Scale (PSP). Data were analyzed using descriptive statistics, χ^2, analysis of variance, and multiple linear regression analysis. Results: Most of the participants were male, middle-aged, unmarried, educated to the senior high school level, employed, receiving home-care treatment, and diagnosed with schizophrenia. Those who were unemployed, living in a community rehabilitative house, and living in the community, respectively, earned relatively higher recovery scores (p ＜ .05). The total scores of QPR and the 3 subscales were negatively correlated with PPSS (p ＜ .01) and positively correlated with PSPS (p ＜ .01; p ＜ .05). Multiple regression analysis indicated that the factors of education, employment, having received community rehabilitative models, and stigma, respectively, significantly explained the recovery capacity of patients with mental illness. Conclusion: Community psychiatric nurses should provide care to help employed patients adapt to stresses in the workplace, strengthen their stigma-coping strategies, and promote public awareness of mental health issues by increasing public knowledge and acceptance of mental illness in order to minimize patient-perceived stigma and facilitate their recovery.

1. 陳志軒、王盈婷、徐畢卿(2017)。專業人員的反省—疾病烙印的自我覺察。護理雜誌，64(3)，12-18。
   連結：
2. 劉素芬(2011)。社會功能與社區慢性精神病患復元之相關性研究—以社區復健中心與康復之家為例。臺大社會工作學刊，23，137-180。
   連結：
3. 韓德彥、陳淑惠(2008)。精神疾病污名感受量表及其短版之心理計量特性。中華心理衛生學刊，21(3)，273-290。
   連結：
4. Ahmed, A. O.,Marino, B. A.,Rosenthal, E.,Buckner, A.,Hunter, K. M.,Mabe, P. A.,Buckley, P. F.(2016).Recovery in schizophrenia: What consumers know and do not know.Psychiatric Clinics of North America,39(2),313-330.
5. Anthony, W. A.,Cohen, M. R.,Farkas, M. D.,Gagne, C.(2002).Psychiatric rehabilitation.Boston, MA:Center for Psychiatric Rehabilitation, Boston University.
6. Baldwin, M. L.,Marcus, S. C.(2007).Labor market outcomes of persons with mental disorders.Industrial Relations: A Journal of Economy and Society,46(3),481-510.
7. Barber, M. E.(2012).Recovery as the new medical model for psychiatry.Psychiatric Services,63(3),277-279.
8. Beck, R.,Heffernan, S.,Law, H.,McCusker, M.,Bentall, R. P.,Morrison, A. P.(2012).Subjective judgements of perceived recovery from psychosis.Journal of Mental Health,21(6),556-566.
9. Browne, J.,Penn, D. L.,Meyer-Kalos, P. S.,Mueser, K. T.,Estroff, S. E.,Brunette, M. F.,Kane, J. M.(2017).Psychological well-being and mental health recovery in the NIMH RAISE early treatment program.Schizophrenia Research,185,167-172.
10. Chien, W. T.,Chan, Z. C.(2013).Chinese translation and validation of the questionnaire on the process of recovery in schizophrenia and other psychotic disorders.Research in Nursing & Health,36(4),400-411.
11. Cunningham, K. C.,Lucksted, A.(2017).Social cognition, internalized stigma, and recovery orientation among adults with serious mental illness.Psychiatric Rehabilitation Journal,40(4),409-411.
12. Deegan, P. E.(1988).Recovery: The lived experience of rehabilitation.Psychosocial Rehabilitation Journal,11(4),11-19.
13. Free Statistics Calculators. (n.d.). Post-hoc statistical power calculator for multiple regression. Retrieved from https://www.danielsoper.com/statcalc/calculator.aspx?id=9
14. Law, H.,Shryane, N.,Bentall, R. P.,Morrison, A. P.(2016).Longitudinal predictors of subjective recovery in psychosis.The British Journal of Psychiatry,209(1),48-53.
15. Lin, E. C. L.,Chan, C. H.,Shao, W. C.,Lin, M. F.,Shiau, S.,Mueser, K. T.,Wang, H. S.(2013).A randomized controlled trial of an adapted illness management and recovery program for people with schizophrenia awaiting discharge from a psychiatric hospital.Psychiatric Rehabilitation Journal,36(4),243-249.
16. Lin, E. C. L.,Kopelowicz, A.,Chan, C. H.,Hsiung, P. C.(2008).A qualitative inquiry into the Taiwanese mentally ill persons' difficulties as living in the community.Archives of Psychiatric Nursing,22(5),266-276.
17. Morosini, P. L.,Magliano, L.,Brambilla, L.,Ugolini, S.,Pioli, R.(2000).Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning.Acta Psychiatrica Scandinavica,101(4),323-329.
18. Neil, S. T.,Kilbride, M.,Pitt, L.,Nothard, S.,Welford, M.,Sellwood, W.,Morrison, A. P.(2009).The questionnaire about the process of recovery (QPR): A measurement tool developed in collaboration with service users.Psychosis,1(2),145-155.
19. Oexle, N.,Müller, M.,Kawohl, W.,Xu, Z.,Viering, S.,Wyss, C.,Rüsch, N.(2018).Self-stigma as a barrier to recovery: A longitudinal study.European Archives of Psychiatry and Clinical Neuroscience,268(2),209-212.
20. Shanks, V.,Williams, J.,Leamy, M.,Bird, V. J.,Le Boutillier, C.,Slade, M.(2013).Measures of personal recovery: A systematic review.Psychiatric Services,64(10),974-980.
21. Spaniol, L.,Wewiorski, N. J.,Gagne, C.,Anthony, W. A.(2002).The process of recovery from schizophrenia.International Review of Psychiatry,14(4),327-336.
22. Williams, J.,Leamy, M.,Pesola, F.,Bird, V.,Le Boutillier, C.,Slade, M.(2015).Psychometric evaluation of the questionnaire about the process of recovery (QPR).The British Journal of Psychiatry,207(6),551-555.
23. Wood, L.,Byrne, R.,Burke, E.,Enache, G.,Morrison, A. P.(2017).The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalized shame and self-esteem.Psychiatry Research,255,94-100.
24. Wu, B. J.,Lin, C. H.,Tseng, H. F.,Liu, W. M.,Chen, W. C.,Huang, L. S.,Lee, S. M.(2013).Validation of the Taiwanese Mandarin version of the personal and social performance scale in a sample of 655 stable schizophrenic patients.Schizophrenia Research,146(1-3),34-39.
25. Wunderink, L.,Sytema, S.,Nienhuis, F. J.,Wiersma, D.(2009).Clinical recovery in first-episode psychosis.Schizophrenia Bulletin,35(2),362-369.
26. Yam, K. K.,Lo, W. T.,Chiu, R. L.,Lau, B. S.,Lau, C. K.,Wu, J. K.,Wan, S. M.(2018).A pilot training program for people in recovery of mental illness as vocational peer support workers in Hong Kong - Job Buddies Training Program (JBTP): A preliminary finding.Asian Journal of Psychiatry,35
27. Young, D. K. W.,Ng, P. Y. N.,Pan, J.(2014).Functional recovery of consumers discharged from mental hospital and participating in a community-based psychosocial programme provided by a non-governmental organisation.East Asian Archives of Psychiatry,24(4),139-147.
28. Young, D. K. W.,Ng, P. Y. N.,Pan, J.(2017).Predictors and prevalence of recovery and remission for consumers discharged from mental hospitals in a Chinese society.Psychiatric Quarterly,88(4),839-851.
29. 宋麗玉(2013)。,未出版
30. 李淑櫻(2016)。高雄市=Kaohsiung City, Taiwan, ROC.，高雄醫學大學護理學系碩士班=Kaohsiung Medical University。
31. 林慧婷(2014)。新北市=New Taipei City, Taiwan, ROC.，國立臺北大學社會工作學系碩士班=National Taipei University。
32. 胡孟菁(2013)。臺北市=Taipei City, Taiwan, ROC.，國立政治大學社會工作研究所=National Cheng Chi University。
33. 張帥心(2015)。臺北市=Taipei City, Taiwan, ROC.，國立臺灣師範大學復健諮商研究所=National Taiwan Normal University。
34. 劉怡秀、黃綺虹(2012)。污名化對於精神疾患就業影響之初探－個案報告。臨床心理學刊，6(1)，69。
35. 蘇舜君(2014)。臺北市=Taipei City, Taiwan, ROC.，國立臺灣師範大學社會工作學研究所=National Taiwan Normal University。

1. Hua-Shan WU,Chi-Wen CHEN,Chiu-Yueh YANG,Chieh-Yu LIU,Chia-Chi CHANG,Chen-Jee HONG(2023).Exploring the Effectiveness of Group Cognitive Stimulation Training in People With Schizophrenia: A Randomized Controlled Trial.The Journal of Nursing Research,31(5),1-11.
2. 郭艿靈,李玉嬋(2020)。從心理學到維持心理健康與防治精神疾病的健康識能。諮商與輔導，416，40-43+29。
3. 靖永潔,吳佳芬(2020)。探究慢性思覺失調症病人復元歷程中與家人互動經驗。精神衛生護理雜誌，15(2)，6-13。
4. 謝佳容,鄭惠美,劉玟宜(2020)。社區門診思覺失調症病人復元之影響因素。榮總護理，37(4)，342-351。
5. 謝婉庭,賴芳足,楊紅玉(2021)。探討精神病患主要照顧者的關鍵需求之研究。醫務管理期刊，22(1)，23-45。
6. 楊緒穆,張雅綾,翁菁霞,吳芝儀,王奕超(2020)。從護理師的反省談烙印與解構。諮商與輔導，416，26-29。
7. 鄭淦元,劉玟宜(2023)。賦能精神病人邁向復元－以克服內在汙名化為例。護理雜誌，70(1)，23-28。
8. (2023)。《精神衛生法》修法後的電車難題。社區發展季刊，184，453-467。