身心壓力諮商門診患者之特性分析

Analysis of the Characteristics of Stress Clinic Patients in Primary Care

張琦郁(Chi-Yu Chang) ； 鄭逸如(Yih-Ru Cheng) ； 呂碧鴻(Bee-Horng Lue) ； 陳秀蓉(Hsiu-Jung Chen) ； 洪福建(Fu-Chien Hung)

《臺灣家庭醫學研究》 7卷2期 (2009/04) Pp. 70-80

https://doi.org/10.29475/TFMR.200904.0003

摘要

背景：近年來全人醫療模式衝擊傳統的生物醫學模式，心理社會因素對於身體疾病和症狀的影響不容小觀，臨床心理師加入基層醫療(primary care)之服務團隊，在台大醫院已有二十多年的歷史。本研究之目的在分析身心壓力諮商門診患者的特性，並探討影響後續治療動機的可能因素，以作為提升全人醫療品質與持續發展身心壓力諮商工作的重要指引。方法：以2009年3月至9月臺大醫院家庭醫學部門診照會需接受身心壓力諮商的70名患者為樣本。本研究運用貝克焦慮量表、貝克憂鬱量表第二版，以及短式華人敵意量表來評估患者的焦慮、憂鬱和敵意的情緒狀態，並且運用自編的「身心壓力衡鑑與治療晤談表」來進行半結構式的身心壓力晤談。結果：(1)接受身心壓力諮商患者平均年齡為43.45歲，女性居多，已婚者較多，教育水準主要為高中到大學。最常見的身體症狀是失眠，73%的患者有焦躁的情緒困擾，69%的患者有憂鬱的情緒困擾，49%的患者有行為的困擾，64%的患者有社交的困擾，以及51%患者的壓力源來自於家庭者，為最多。(2)本研究發現有接受身心壓力治療與僅接受身心壓力評估兩組患者，在有無失眠症狀上、在恐慌發作經驗上，以及在呼吸系統症狀總數有顯著差異。(3)生理症狀總數、貝克焦慮量表總分、貝克憂鬱量表總分，以及短式華人敵意量表總分對於接受身心壓力治療的療程總數無顯著的預測力。結論：身心壓力反應的症狀若其威脅生命感受愈高，主觀焦慮感愈高，症狀總數愈多，身體症狀的困擾程度愈高者，愈傾向接受後續的身心壓力治療。本研究發現，僅接受一次服務的病患為眾，病患的主觀痛苦感受愈高者，接受諮詢的次數也愈多。影響後續是否接受身心壓力治療的因素多且複雜，本研究所整合的變項過於廣泛，若欲更有效地預測，可能需將各變項更細緻化。

並列摘要

Background: The long-existing traditional biomedical model was recently clashed with newer model of whole person care, i.e. biopsychosocial healthcare. The fact that the psychosocial factors affect physical diseases and symptoms should not be ignored. Acknowledging this trend, the clinical psychologists have joined primary care professionals in healthcare for more than 20 years at the National Taiwan University Hospital, Taiwan. The purpose of this study is to analyze the characteristics of patients who consulted stress clinic, to explore the possible factors motivating patient's acceptance to ensuing psychotherapy in order to promote comprehensive healthcare and provide guidance for continuing development of stress counseling.Methods: A total of 70 outpatients with psychosomatic symptoms referred from the department of family medicine for psychological assessment in March to September, 2009 were the study subjects. The Beck Anxiety Inventory (BAI), Beck Depression Inventory-2nd version (BDI-Ⅱ), and the short-form hostility scale were conducted to evaluate the emotional states. The Stress Assessment Scale was developed and used in the semi-structure interview in this study.Results: (1) The average age of the patients was 43.45. Most of them were female, married, with education level from high school to university. The most common physical complaint was insomnia, and 73% of patients had anxiety, 69% had depression, 49% had behavioral problems, 64% had social problems, and 51% complained stress coming from family. (2) There were significant differences in insomnia, total number of respiratory symptoms, and panic attack experiences between patients under psychotherapy treatment and patients receiving psychological assessment only but without treatment. (3) The sum of physical symptoms, BAI scores, BDI-Ⅱ scores, and hostility scores could not predict the number of psychotherapy sessions.Conclusions: Patients with life-threatening physical symptoms higher anxiety, more total symptom numbers, and more somatic symptoms had higher motivation to seek help and accept further psychotherapy. In this study, most patients received one-session service. Patients perceived more threats and sufferings seemed to receive more psychotherapy sessions but multivariate analysis failed to establish such a relationship. One explanation is that the variables in this study were too rough to reveal the relationships among the variables. Further studies should redefine and specify these variables.

並列關鍵字

stress ； psychotherapy ； primary care