精神疾病患者生活品質及其測量

Quality of Life in Psychiatric Patients and Its Assessment

10.29478/TJP.200509.0003

鄭若瑟(Joseph J. Cheng)；高家常(Chia-Chan Kao)

生活品質 ； 治療結果測量 ； 精神疾病患者 ； 量表 ； quality of life ； outcome measurement ； psychiatric patients ； scale

台灣精神醫學

19卷3期（2005 / 09 / 01）

179 - 191

繁體中文

傳統上對精神疾病患者預後研究之指標多為「症狀消除」與「功能恢復」的價值評斷模式，不能完全反應病人的狀態。健康相關生活品質的概念由於反應以病人為中心之治療目標和消費者觀點，逐漸廣泛地被引用。但其定義至今未有共識，測量方式和範疇亦有不同看法。在精神疾病患者由於受症狀或人格特質影響，其測量容易出現天花板或地板效應。綜合文獻可歸納出：生活品質是測量病人「健康相關的身心和生活狀態」，是多向度測量，包括病人對生活良好感（生活感受）、過得如何（生活功能）、擁有些什麼（生活標準）三大範疇之主客觀測量。其量表分為：一般，廣用型及特定疾病三種。應依研究目的、對象、社會文化之特性、信效度、概念範圍、反應度、敏感度、解讀性及負荷選擇適當量表。生活品質可應用在：（一）預後指標，（二）臨床試驗及治療結果測量指標，（三）成本效果或效益評估，（四）需求調查與政策資源配置，（五）治療方案規劃。生活品質研究有其社會和文化特異性，國內相關研究不多，值得進一步探索。

In contemporary psychiatric research, outcome measurement is no longer limited to the classical concepts of symptom elimination and recovery of function. Health related quality of life (HRQOL) has become an increasingly important assessment which represents both patient centered value and consumer perspectives. However, the definition of HRQOL in psychiatric research has yet to be standardized, and many issues about measurement methodology including objective versus subjective measurements, and the adequacy of coverage of life domains remain controversial. HRQOL is an inherently multidimensional assessment, and its measurement should therefore cover different constructs and perceptions in life domains. In brief, HRQOL covers patients' sense of well being (perception of life), how they are doing (functional status), what they have (standard of living), with both subjective and objective measurements treated as equally important. There are three types of QOL scales: general QOL, generic HRQOL, and disease-specific HRQOL. For selecting a scale, in addition to validity and reliability, the conceptual model, responsiveness, sensitivity, interpretability and burden should be considered under the context of the research purpose, patient characteristics and culture. HRQOL assessment is useful in: (1) prognosis and risk factors research, (2) as an outcome measure in clinical trials and health services research, (3) as an index of cost effectiveness and benefit research, (4) for health needs assessments of populations and resources allocation, (5) for the planning of clinical care of individual patients. HRQOL research is socially and culturally specific. The limited number of studies from Taiwan that have investigated HRQOL suggests the need for further emphasis of this important measure.

1. 蔡冠逸、周煌智、歐陽文貞、蘇東平、林昌億(2004)。地震後罹患精神疾病患者於生活品質之關係。台灣精神醫學，18，108-118。
   連結：
2. Atkinson M,Zibin S,Chuang H(1997).Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology.Am J Psychiatry,154,99-105.
3. Award AG(1992).Quality of life of schizophrenic patients on medications and implications for new drug trials.Hospital & community psychiatry,43,262-265.
4. Bastiaansen D,Koot HM,Ferdinand RF,Verhulst FC(2004).Quality of life in children with psychiatric disorders: self-, parent, and clinician report.J Am Acad Child Adolesc Psychiatry,43,221-230.
5. Becker M(1995).Quality of life instruments for severe chronic mental illness: implications for pharmacotherapy.Pharmacoeconomics,7,229-237.
6. Browne S(1999).Rehabilitation programmers and quality of life in severe mental illness.The International Journal of Social Psychiatry,45,302-309.
7. Cheater F(1998).Quality of life measures for the health-care environment.Nurse Res,5,17-30.
8. Das AK,Olfson M,Gameroff MJ(2005).Screening for bipolar disorder in a primary care practice.JAMA,293,956-963.
9. Epstein RS,Sherwood LM(1996).From Outcomes Research to Disease Management: A Guide for the Perplexed.Ann Intern Med,124,832-837.
10. Ettigi P,Meyerhoff AS,Chirban JT,Jacobs RJ,Wilson RR(1997).The quality of life and employment in panic disorder.J Nerv Ment Dis,185,368-372.
11. Evans JD,Wright DE,Svanum S,Bond GR(2004).Psychiatric disorder and unmet service needs among welfare clients in a representative payee program.Community Ment Health J,40,539-548.
12. Fayers PM,Machin D(2000).Quality of Life: Assessment, Analysis and Interpretation.New York:John Wiley & Sons.
13. Felce D(1997).Defining and applying the concept of quality of life.J Intellect Disabil Res,41,126-135.
14. Fitzgerald PB,Williams CL,Corteling N(2001).Subject and observer-rated quality of life in schizophrenia.Acta Psychiatr Scand,103,387-392.
15. Hass BK(1999).Clarification and integration of similar quality of life concept.J Nurs Scholarsh,31,215-220.
16. Heiurichs DW,Hanlon TE,Carpenter WT(1984).The quality of life scale: an instrument for rating the schizophrenic deficit syndrome.Schizophr Bull,10,388-398.
17. Holcomb WR,Morgan P,Adams NA,Ponder H,Farrel M(1993).Development of a structured interview scale for measuring quality of life of the severity mentally ill.J Clin Psychol,49,830-840.
18. Hupper J,Smith T(2001).Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor.J Nerv Ment Dis,189,669-675.
19. Huxley P,Warner R(1992).Case management, quality of life, and satisfaction with services of long-term psychiatric patients.Hospital & Community Psychiatry,43,799-802.
20. Kaplan HI,Sadock BJ(1998).Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry.Baltimore:Williams & Wilkins.
21. Katschnig H(1997).How useful is the concept of quality of life in psychiatry?.Current Opinion in Psychiatry,10,337-345.
22. Katschnig H,Freeman H,Sartorius N(1999).Quality of Life in Mental Disorders.New York:John Wiley & Sons.
23. Katschning H(2000).Schizophrenia and quality of life.Acta Psychiatr Scand,102,33-37.
24. Kelly S,McKenna H,Parahoo K(2001).The relationship between involvement in activities and quality of life for people with severe and enduring mental illness.Journal of Psychiatric and Mental Health Nursing,8,139-146.
25. Kravetz S,Faust M,David M(2000).Accepting the mental illness label, perceived control over the illness, and quality of life.Psychiatr Rehabil J,23,323-332.
26. Lehman AF(1983).The well-being of chronic mental patients.Arch Gen Psychiatry,40,369-373.
27. Lehman AF(1996).Measures of quality of life among persons with severe and persistent mental disorders.Soc Psychiatry Psychiatr Epidemiol,31,78-88.
28. Lehman AF,Ward NC,Linn LS(1982).Chronic mental patients: the quality of life issue.Am J Psychiatry,139,1271-1276.
29. Lima AF,Pechansky F,Fleck MP,De Boni R(2005).Association between psychiatric symptoms and severity of alcohol dependence in a sample of brazilian men.J Nerv Ment Dis,193,126-130.
30. Malm U,May PRA,Denker SJ(1981).Evaluation of the quality of life of the schizophrenic outpatient: a checklist.Schizophr Bull,7,477-487.
31. Mendlowicz MV,Stein MB(2000).Quality of life in individuals with anxiety disorders.Am J Psychiatry,157,669-682.
32. Muldoon MF,Barger SD,Flory JD,Manuck SB(1998).What are quality of life measurements measuring?.BMJ,316,542-545.
33. Naber D,Karow A,Lambert M(2002).Psychosocial outcomes in patients with schizophrenia: Quality of life and reintegration.Current Opinion in Psychiatry,15,31-36.
34. Narud K,Mykletun A,Dahl AA(2005).Quality of life in patients with personality disorders seen at an ordinary psychiatric outpatient clinic.BMC Psychiatry,5,10.
35. Norman RMG,Malla AK,Mclean T,Voruganti LPN,Cortese L,McIntosh E,Cheng S,Rickwood A(2000).The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the quality of life scale.Acta Psychiatr Scand,102,303-309.
36. Oliver JP,Huxley PJ,Priebe J(1996).Measuring the quality of life of severity mentally ill people using the Lancashire Quality of Life Profile.Soc Psychiatry Psychiatr Epidemiol,32,76-83.
37. Orley J,Saxena S,Herrman H(1998).Quality of life and mental illness: Reflections from the perspective of the WHOQOL.Br J Psychiatry,172,291-293.
38. Pickard AS,Johnson JA,Penn A,Lau F,Noseworthy T(1999).Replicability of SF-36 summary scores by the SF-12 in stroke patients.Stroke,30,1213-1217.
39. Pinkney AA,Gerber GJ,Lafave HG(1991).Quality of life after psychiatric rehabilitation: the clients' perspective.Acta Psychiatr Scand,83,86-91.
40. Rabkin J,Wagner G,Griffin KW,American Psychiatric Association (eds.)(2000).Handbook of Psychiatric Measurement.Washington, DC:American Psychiatric Association.
41. Rosenfield S(1992).Factors contributing to the subjective quality of life of the chronic mentally ill.J Health Soc Behav,33,299-315.
42. Rudnick A,Kravetz S(2001).The relation of social support-seeking to quality of life in schizophrenia.J Nerv Ment Dis,189,258-262.
43. Ruesch P,Graf J,Meyer PC,Rossler W,Hell D(2004).Occupation, social support and quality of life in persons with schizophrenic or affective disorders.Soc Psychiatry Psychiatr Epidemiol,39,686-694.
44. Sainfort F,Becker M,Diamond R(1996).Judgments of quality of life of individuals with severe mental disorders: patient self-report versus provider perspectives.Am J Psychiatry,153,497-502.
45. Shu BC,Lung FY,Lu YC,Cary A,Pan P(2001).Care of patients with chronic mental illness: comparison of home and half-way house care.The International Journal of Social Psychiatry,47,52-62.66.
46. Sousa KH(1999).Description of a health-related quality of life conceptual model.Outcomes Management for Nursing Practice,3,78-82.
47. Staniszewska S(1999).Patient expectations and health-related quality of life.Health Expect,2,93-104.
48. Staniszewska S(1998).Measuring quality of life in the evaluation of health care.Nurs Stand,12,36-39.
49. Sullivan G,Wells KB,Leake B(1992).Clinical factors associated with better quality of life in a seriously mentally ill population.Hospital & Community Psychiatry,43,794-798.
50. Testa MA,Simonson DC(1996).Current Concepts: Assessment of Quality-of-Life Outcomes.N Engl J Med,334,835-840.
51. Townsend MC(2000).Psychiatric Mental Health Nursing: Concepts of Care.Philadelphia:F.A. Davis.
52. UK Group(1999).Predictors of quality of life in people with severe mental illness: study methodology with baseline analysis in the UK 700 trial.Br J Psychiatry,175,426-432.
53. Voruganti L,Heslegrave R,Awad AG,Seeinan MV(1998).Quality of life measurement in schizophrenia: reconciling the quest for subjectivity with the question of reliability.Psychol Med,28,165-172.
54. Ware JE,Sherbourne CD(1992).The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection.Med Care,30,473-483.
55. WHOQOL group(1998).Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment.Psychol Med,28,551-558.
56. Wiersma D,Katschnig H(eds.),Freemen H(eds.),Sartorius N (eds.)(1999).Quality of Life In Mental Disorders.New York:John Wiley & Sons.
57. Yanos PT,Rosenfield S,Horwitz AV(2001).Negative and supportive social interaction and quality of life among persons diagnosed with severe mental illness.Community Ment Health J,37,405-419.
58. Zatzick DF,Marmar CR,Weiss DS(1997).Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.Am J Psychiatry,154,1690-1695.
59. Zissi A,Barry MM,Cochrane R(1998).A mediational model of quality of life for individuals with severe mental health problems.Psychol Med,28,1221-1230.
60. 成和玲、楊美賞(1997)。門診與社區復健精神分裂病人者生活品質之比較及影響生活品質之因素。高雄醫學科學雜誌，13，748-756。
61. 余伍洋、成和玲、龍佛衛、陳明哲、林清華(1995)。精神病人者生活品質量表之發展。公共衛生，22，29-40。
62. 林進嘉、殷建智、李添誠、謝秀幸(2001)。日間留院及居家治療之精神分裂症患者生活品質之比較。台灣精神醫學，15，226-236。
63. 姚開屏(2001)。世界衛生組織生活品質問卷台灣版問卷發展小組：台灣版世界衛生組織生活品質問卷之發展及使用手冊。台北市:世界衛生組織生活品質問卷台灣版問卷發展小組。
64. 梁玉雯、蔣欣欣、李從業、吳玫勳、嚴小燕、崔翔雲(1997)。慢性精神病人者客觀生活品質之探討。護理研究，5，212-222。
65. 臺灣版世界衛生組織生活品質問卷發展小組(2000)。臺灣版世界衛生組織生活品質問卷之發展簡介。中華公共衛生雜誌，19，315-324。
66. 鄭若瑟、陳小慈、黃瑞珠(1995)。八十四年度衛生處醫學與公共衛生研究獎助金研究報告八十四年度衛生處醫學與公共衛生研究獎助金研究報告,未出版

1. 丘小丹(2016)。探討思覺失調症病人充權感受與健康相關生活品質之關係。長榮大學護理學系(所)學位論文。2016。1-93。