乳癌病患併發心理疾患及其影響

本研究目的為(1)探討乳癌病患併發憂鬱症情形及其影響因素(2)探討乳癌病患併發焦慮症情形及其影響因素(3)探討乳癌病患併發睡眠障礙情形及其影響因素(4)探討乳癌病患併發精神疾患(憂鬱,焦慮,及睡眠障礙)是否會影響其存活情形(5)探討乳癌病患併發精神疾患(憂鬱,焦慮,及睡眠障礙)者中,有無接受精神科專科治療是否會影響其存活情形。本研究採用次級資料分析法，以回溯性縱貫性方式(Retrospective longtudinal study)進行研究，以「全民健保研究資料庫2000年百萬歸人檔」分析乳癌的病患，比較有無併發心理疾患其間的差別。收集2788位乳癌病患為研究對象，先分析心理疾患的發生率與盛行率是否在乳癌病患與對照組中有顯著差異，並分析在全民健保下乳癌病患併發心理疾患之用藥及就診情形，之後進一步以Cox proportion hazards model探討乳癌併發心理疾患對乳癌病患之存活情形。研究結果發現(1)患有乳癌的人較無乳癌的人，較容易有憂鬱的情形(hazard rate=1.1470, p=0.0929)；(2) 患有乳癌的人較無乳癌的人，容易有焦慮的情形(hazard rate=1.0951, P=0.0775)；(3) 患有乳癌的人較無乳癌的人，容易有睡眠障礙的情形(hazard rate=1.2084, P=0.0001)；(4)接受精神科專科治療對乳癌病患存活有顯著之影響(hazard rate=1.4038, P=0.0160)。本研究結果建議當確定乳癌診斷之病患，即啟動通報照會機制，及早評估及確認發生心理疾患，給予適當的指導及轉介精神科介入，做心理諮詢及診治服務，以減少心理疾患發生或進一步惡化。

關鍵字

乳癌；憂鬱；焦慮；睡眠障礙；精神科照護

並列摘要

Purpose The purpose of this study was to (1) to investigate the breast cancer patients with concurrent depression and its related factors (2) to investigate breast cancer patients with concurrent anxiety disorder situation and its influencing factors (3) to explore the breast cancer patients with concurrent sleep disorder and its related factors (4) to explore the breast cancer patients with concurrent mental disorders (depression, anxiety and sleep disorders) will affect the survival situation (5) to explore the breast cancer patients with concurrent mental disorders (depression, anxiety, and sleep disorders) who, with or without psychiatricspecialist treatment will affect the survival situation. Methods In this study, secondary data analysis study, a retrospective longitudinal approach (Retrospective longtudinal study), "National Health Insurance Research Database in 2000, one million naturalization file analysis of breast cancer patients to compare with or without concurrent mental disorders meantimedifference. Collect 2788 breast cancer patients for the study, the first analysis of the incidence and prevalence of mental disorders in breast cancer patients and control group are significantly different and concurrent psychological disorders, medication and treatment situation and analysis of breast cancer patients under the National Health Insurance Cox proportion hazards model, and then further explore the breast cancer survival situation concurrent psychological disorders of breast cancer patients. Results The results showed that (1) suffering from breast cancer than those without breast cancer, more likely to have the case of depression (hazard rate = 1.1470, p <.0929); (2) suffering from breast cancer than breast cancer, easy tothe anxiety of the situation (hazard rate = 1.0951, P <0.0775); (3) suffering from breast cancer than breast cancer, likely to have sleep disorders, (hazard rate = 1.2084, P <0.0001); (4) psychiatricspecialized in the treatment have a significant effect of survival of breast cancer patients (hazard rate = 1.4038, P <.0160). Conclusions The results of this study suggested that when determining the diagnosis of breast cancer patients start notification note mechanisms, early assessment and confirm the occurrence of psychological disorders, given the proper guidance and referral psychiatric intervention, to do psychological counseling and treatment services to reduce the occurrence of psychological disorders orfurther deterioration.