中高齡慢性精神病患健康促進生活型態與生活品質的預測因素

Predictors In The Engagement Of Healthy Lifestyles And Quality Of Life Among Middle-Aged People With Chronic Mental Illness

鍾佳芳(Chia-Fang Chung)

指導教授 ： 苗迺芳

共同指導教授 ： 謝佳容(Chia-Jung Hsieh)

臺北醫學大學/護理學院/護理學研究所/碩士(2013年)

https://doi.org/10.6831/TMU.2013.00153

摘要

研究背景：中高齡慢性精神病患已占所有慢性精神病患的48.33％，此族群多有危害健康的生活型態及較差的生活品質，過去雖有文獻探討慢性精神病患之健康促進生活型態與生活品質，但未深入探討影響中高齡慢性精神病患健康促進生活型態與生活品質的重要因素，基於早期發現及健康促進的理念，故進行本研究。
研究目的：探討影響中高齡慢性精神病患健康促進生活型態與生活品質的預測因素。
研究方法：本研究為橫斷性設計，採立意取樣方式，以北部某精神科教學醫院四十歲（含）以上慢性精神病患為研究對象，共計173位，應用健康促進生活型態中文簡式量表及台灣簡明版世界衛生組織生活品質問卷進行資料收集，再以SPSS統計軟體18.0版進行資料分析。
研究結果：一、本研究對象健康促進生活型態平均得分屬中上程度（M=58.21±13.66），六大分量表以「營養」 平均得分最高，「運動」平均得分最低。生活品質平均得分屬中上程度（M=50.29±8.54），四大範疇以「生理健康範疇」平均得分最高，「心理範疇」平均得分最低。
二、精神症狀嚴重度與健康促進生活型態呈負相關（r= -.30；p＜.001）；自評藥物改善情形（r=.22；p＜.01）、自評藥物副作用處置滿意度（r=.20；p＜.001）與健康促進生活型態呈正相關。精神症狀嚴重度（r= -.16；p＜.05）、藥物副作用（r= -.30；p＜.001）與生活品質呈負相關；自評藥物改善情形（r=.24；p＜.001）、自評藥物副作用處置滿意度（r=.28；p＜.001）、食慾狀況（r=.16；p＜.05）與生活品質呈正相關；健康促進生活型態與生活品質呈正相關（r=.31；p＜.001）。
三、影響健康促進生活型態的預測因素有規則運動習慣、每日攝取蔬果習慣及負性症狀，共可解釋33％的變異量。影響生活品質之整體範疇預測因素有每日攝取蔬果習慣、正性症狀及藥物副作用，共可解釋32％的變異量。
研究結論：本研究結果突顯慢性精神病患建立健康促進生活型態以提升生活品質的重要性，應嚴加重視中高齡慢性精神病患規則運動與體重過重的健康問題，未來可將運動減重計畫納入病房常規活動，以做為精神科專業醫療團隊在擬定慢性精神病患健康促進計畫之策略參考。

關鍵字

中高齡 ； 健康促進生活型態 ； 生活品質

並列摘要

Background:
Middle-aged and older patients with chronic mental illness accounted for 48.33% of all chronically mentally ill patients. Most of these patients have unhealthy lifestyle and a poorer quality of life (QOL). Although previous studies have investigated the relationship between health promoting lifestyle and life quality in patients with chronic illness, the key factors affecting the association of health promoting lifestyle and QOL were not explored in depth. This study was conducted with the concept of early detection and health promoting.
Objective:
To explore the predictive factors influencing health promoting lifestyle and quality of life among middle-aged and older patients with chronic mental illness.
Methods:
This cross-sectional study was designed with a purposive sampling method. A total of 173 patients with chronic mental illness who aged over 40 years were included from a psychiatric teaching hospital located in northern Taiwan. Data was collected using the Chinese version short form of Health Promoting Lifestyle Profile (HPLP-S) and the Taiwan condensed version of the World Health Organization Quality of Life Questionnaire (WHOQOL- BREF Taiwanese version). SPSS statistical software (version 18.0) was used for analysis of the data.
Results:
The mean score of health promoting lifestyle indicated a moderate level (M=58.21±13.66). Among the six subscales, the subjects scored highest on nutrition and scored lowest on sports. The average score of QOL was at a upper-moderate level (M=50.29±8.54). The highest score was found in the physical health domain and the lowest score was the psychological domain among the four health domains.
A significant negative correlation (r = - .30; p <.001) between psychiatric symptoms severity and health promoting lifestyle was observed. Self-efficacy assessment (r = .22; p <.01) and self-assessment of satisfaction with managing drug side effects (r = .20; p <.001) were positively correlated with health promoting lifestyle. Severity of psychiatric symptoms (r = - .16; p <.05) and adverse drug reactions (r = - .30; p <.001) were negatively correlated with QOL. Self-efficacy (r = .24; p <.001), self-assessment of satisfaction with managing drug side effects (r = .28; p <.001), and appetite status
(r = .16; p <.05 ) were positively correlated with QOL. Furthermore, there was a positive correlation between health promoting lifestyle and QOL (r=.31；p＜.001).
Habits of regular exercise, daily intake of fruits and vegetables and negative symptoms were predictive factors influencing health promoting lifestyle and could explain 33% of the variance. The predictive factors affecting the domain of overall QOL included daily intake of fruits and vegetables habits, positive symptoms and side effects of drug, which were found to explain 32% of the variance.
Conclusions:
The results of this study indicated the importance of establishing health promoting lifestyle to enhance healthy lifestyle for patients with chronic mental illness. It is suggested that more attention should be paid to regular exercise and the health problems associated with overweight in middle-aged and older patients with chronic mental illness. We also recommend that weight loss plans can be included as routine activities in the ward for patient care. Our findings might be used as strategy implementation reference by psychiatric professional medical teams and medical units for the preparation of health promoting plan.

並列關鍵字

Middle-Aged ； Health promoting lifestyle ； Quality of life

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