智能障礙兒童主要照顧者壓力來源對其心理健康之影響

Stress and Its Mental Health Effects toward Caregivers of Children with Intellectual Disabilities

10.30072/JDR.200809.0004

胡蓉(Jung Hu)；嚴嘉楓(Chia-Feng Yen)；林金定(Jin-Ding Lin)

心理健康 ； 主要照顧者 ； 智能障礙 ； Caregivers ； intellectual disability ； mental health ； stressors

身心障礙研究季刊

6卷3期（2008 / 09 / 01）

211 - 221

繁體中文

智能障礙者的心智發育與生理疾病多元，在成長過程的漫漫長路上必須倚靠主要照護者持續地照顧、訓練及教育，因此這些智能障礙兒童的主要照顧者所承擔的責任是長遠且辛苦的照顧工作，其心理及生理上所承受的壓力狀況是一個公共衛生上重要的社會心理課題。本文以文獻探討的方式瞭解並歸納智能障礙兒童主要照顧者可能的壓力來源與這些壓力對其心理健康產生的負面影響。在過去研究中發現造成主要照顧者壓力的因素錯綜複雜，但可歸納出主要因素之一為照顧壓力：孩子的挑戰行為問題與孩子的障礙程度以及相關併發症，前者對孩子本身或照顧者皆會產生實際性的傷害威脅；而後者則是直接造成照顧者的壓力；另外照顧者本身對於面對照顧孩子的心理調適亦會影響照顧者對壓力的感受程度，如對孩子的接納程度、自我效能等。許多研究證實智能障礙兒童照顧者相較於一般正常孩子的照顧者壓力來的更大，這些龐大的壓力所伴隨負面情緒甚至是疾病，如憂鬱、焦慮的盛行率皆高過一般正常孩子照顧者，更突顯他們在心理健康問題的嚴重性。照顧者是智能障礙者生活中最大的依靠，若照顧者本身沒有健康的生理與心理，將無法投入更多心力在智能障礙兒童的照顧工作。因此，未來如何針對照顧者的壓力來源提供適當的介入服務，減少照顧者的負面思考與情緒，並規劃如何將服務加以推廣是值得規劃的議題。

Intellectual disability is one kind of lifetime disability condition and needed to be concerned in the social welfare and health care system. The service for people with intellectual disabilities is always depending on the efforts of the caregivers who bearing hard and long-term work. The purposes of this paper were to examine the stressor of caregivers and to evaluate its influence toward the caregivers' mental health based on the current literature review. The previous studies found caregivers' stressors were varied and difficult to categorize the etiology of their mental health. However, we still can learn the generality of their mental health problems based on the literatures. Comparing with the caregivers of the general children, caregivers of children with intellectual disability received more stress. In general, the stressors among caregivers of children with intellectual disabilities come from two sources; one is the challenge behavior of children with intellectual disabilities. The challenge behavior is not only could harm children themselves but also could threaten caregivers' safety. In addition, the factors of disability level and complications of challenge behavior could cause more stressful to caregivers. Furthermore, the psychological adjustment of caregivers was also an important factor to their stress. Those psychological adjustments such as the acceptance toward children with disability and their self-efficacy of care for these children. The Caregivers were the vital service providers for children of intellectual disability in their daily living, the healthcare authority should enforce the mental health promotion for the caregivers to improve the quality of care for people with intellectual disabilities.

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