探討台灣乳癌女性患者生活型態防衛機制與焦慮狀態之關係

A Study of the Correlation of Anxiety State and Life Style Defense Mechanism among Women with Breast Cancer in Taiwan

李昀諠(Yun - Hsuan Li)

指導教授 ： 蕭妃秀

共同指導教授 ： 林寬佳 ； 吳志雄

臺北醫學大學/護理學院/護理學研究所/碩士(2007年)

摘要

研究背景：癌症病人的人格特質影響其所採取的防衛方式，而負向防衛型態又與癌症的發生率偏高及預後較差有關聯。國內研究著重在乳癌情緒的探討反應，尚缺乏對於乳癌患者防衛機制的研究。
研究目的：（1）了解乳癌、非乳癌婦女與社區個案於生活型態防衛機轉之差異。（2）三組個案於焦慮狀態之差異。（3）三組個案分別在生活型態防衛機轉與焦慮狀態之關係。
研究方法：本研究設計為個案對照法（case control study），以立意取樣於北區某區域教學醫院之乳房中心。經專科醫師診斷為乳癌婦女為病例組；而診斷為非乳癌之個案為對照組（一）；從未到乳房中心檢查的社區婦女為對照組（二）。樣本數共216人；其中，乳癌組48人、非乳癌組74人、社區組為94人。問卷包含個人資料、生活型態防衛機制量表和焦慮狀態量表。
研究結果：發現三組在生活型態防衛機制量表（Lifestyle Defense Mechanisms; LDM）包含次量表理性/情緒的防衛機制、（Rationality / Emotional Defensiveness; R/ED）、分量表理性的防衛機制（R/ED- rationality defensiveness; R/ED-r）和情緒的防衛機制（R/ED-emotional defensiveness; R/ED-e），次量表和諧需求（Need for Harmony）、分量表人際和諧需求（NH- harmonious related; NH-hr）和自我犧牲（NH- self sacrifice; NH-ss），結果人數都多集中在平均值右方，顯示三組都較傾向同時使用理性和情緒的壓抑，以及維持人際和諧和自我犧牲防衛方式。經One-way ANOVA 檢定僅發現乳癌比社區組個案有過多自我犧牲（t=2.05, p= .04）。生活型態防衛機制量表（LDM）與焦慮狀態量表（SAI）的相關，除了在分量表自我犧牲（NH-ss）於社區組呈現顯著正相關（r=0.22, p= .03）外，乳癌和非乳癌組在次量表及分量表皆未有顯著相關。
結論：乳癌患者或許受到人格特質及社會文化的影響，而較常使用自我犧牲的防衛機制；而過多的自我犧牲或許影響其情緒壓抑的程度。若此壓抑程度過高，個案的情緒或許會進入潛意識的防衛機制，而未能意識到焦慮情緒的狀態。生活型態防衛機制量表成功中文化後，可作為未來研究的重要工具。

關鍵字

乳癌 ； 生活型態防衛機制 ； 焦慮狀態

並列摘要

Background：Cancer patients’ personality styles have an impact on their uses of defense mechanism. The high prevalence and poor progression of cancer are related to the uses of negative defense mechanism. The focus of researches in Taiwan emphasizes the emotional distress of cancer patients. A lack of study examines defense mechanism among cancer patients.
The Purposes of The study:（1）To understand the differences in uses of life style defense mechanism among patients with breast cancer, persons without breast cancer and community people（2）To examine the differences in anxiety state among these three groups（3）To explore the relationship between life style defense mechanism and anxiety state.
Method：This study adopts case control design. The purposive sampling was used to recruit subjects from cancer centre of teaching hospital in Taipei. Patients’ problems diagnosed as breast cancer was allocated in the case group; patients’ problems diagnosed as not breast cancer in the control group 1; female persons in community never being to breast cancer in the control group 2. The total sample consists of 216 subjects; including 48 in breast cancer group, 74 in non-breast cancer group and 94 in community group. The instruments include personal information, Lifestyle Defense Mechanism (LDM) and Anxiety State Inventory (SAI).
Results：The findings indicated that the distributions of LDM and its subscales including Rationality / Emotional Defensiveness; R/ED, R/ED- rationality defensiveness; R/ED-r, R/ED-emotional defensiveness; R/ED-e, Need for Harmony, NH- harmonious related; NH-hr, NH- self sacrifice; NH-ss, appeared to concentrate on the right side of mean scores of these scales. The results suggested that subjects in three groups were likely to use defensive mechanisms of rationality, suppression, interpersonal harmony and self-sacrifice simultaneously. The One-way ANOVA test confirmed that frequency of using self-sacrifice was greater in cancer group than in community group（t=2.05, p= .04）。With regard to the relationship between LDM and SAI, there is only one positive significant relationship found on the subscale NH-ss and SAI in community group（r=0.22, p= .03）.
Conclusion：Due to impacts of personality and sociocultural factors, patients with breast cancer more frequently use defense mechanism of self-sacrifice which contributes to high emotional suppression. The extreme emotional suppressions may result in repression of emotions, as a result of not awareness of anxiety state. Development of Chinese-version LDM can be used as important instrument for the further study.

並列關鍵字

Breast cancer ； Lifestyle Defense Mechanisms (LDM) ； Anxiety State Inventory (SAI)

參考文獻

季瑋珠、黃俊升、張金堅(1997) • 台灣的乳癌 • 中華衛誌，16(1)，62-76。

郭文宏、張金堅(2006) • 乳癌 •台灣醫學，4(10)，475-481。

林惠文、顏啟華、應宗和(2006) • 乳癌的篩檢與診斷 • 基層醫學，21(12)，352-358。

黃獻樑、程劭儀(2006) • 乳癌的篩檢 • 基層醫學，21(8)，225-228。

楊宛霖、林幸慧(2006) • 乳癌高危險群評估與處置 • 基層醫學，21(3)，68-71。