早年不利的家庭結構對嚴重精神病人之影響

The Impact of Adverse Childhood Family Structure on Major Mental Disorders

楊連謙(Lien-Chien Yang) ； 董秀珠(Hsiu-Chu Tung)

《北市醫學雜誌》 11卷4期 (2014/12) Pp. 9-19

https://doi.org/10.6200/TCMJ.2014.11.4.02

摘要

目的：探討親代缺損（單親或繼親）和親代罹重型精神病這兩類早年不利家庭結構對重型精神疾患的影響。方法：共174對重型精神疾患及其照顧者參與。以ANOVA分析親代缺損（n =35）、親代精神病（n =17）及親代完整（n =122）三組諸多變項的關係，再以親代完整組為參照組，進行單因子虛擬化迴歸分析。結果：顯著差異的變項主要聚集在「照顧結構評量」上。相對於親代完整組，親代缺損組照顧人力少、親密度低，患者評量之生活品質量表的環境範疇得分低，顯示他們在生活資訊及醫療服務方面不足；相對於親代完整組，親代精神病組之照顧者學習成為「專業」照顧者的可塑性低，而患者評量的家庭情緒氣氛差。結論：臨床家應發展處遇策略以減緩照顧結構的衰退，甚至重建之。

關鍵字

家庭結構 ； 重型精神病 ； 生活品質 ； 照顧負擔

並列摘要

Objectives: To investigate the effects of two kinds of early life disadvantaged family structure, namely parent defect (PD group, i.e., single parent or step-family) and parent with serious mental illness (PSMI group), on offspring with serious mental illness (SMI). Methods: A total of 174 dyads of SMI patients and their care-givers participated in this study. Oneway analysis of variance was used to analyze the significance of several clinical variables between three study groups, i.e., PD (n = 35) PSMI (n = 17), and PI (parent intact, n = 122) group. And then one factorial dummy regression was used to identify the predictors, with PI group as reference. Results: Most of the variables that showed significant betweengroup difference were items of the ＂Care-giving Structural Scale＂. Compared to PI group, families of PD group had lesser manpower to care for the patient, weaker intimate relations between care-giver and their patient, and worse patients' rating scores in Environment Domain of the quality of life scale (WHOQOL-BREF), indicating inadequate daily life information and medical care among the patients; compared to PI group, caregivers of PSMI group had lesser resilience of learning to be a ＂professional＂ care-giver, and the patients rated themselves living in a worse emotional climate family. Conclusions: Clinicians should develop intervention strategies to slow down the retrogression of care-giving structure, or even to re-build it.

並列關鍵字

family structure ； serious mental illness ； quality of life ； care burden