精神障礙家庭照顧者的照顧評價與因應方式之探討

Correlation between Caregiving Appraisal and Coping Strategies: A Study of Family Caregivers of Mental Disorders

連凱弘(LIEN, KAI-HUNG)

指導教授 ： 吳書昀

國立暨南國際大學/人文學院/社會政策與社會工作學系/碩士(2016年)

摘要

本研究目的為探討精神障礙家庭照顧者的照顧評價與因應方式為何，並分析照顧評價與因應行為之間的關係及影響因子。本研究以立意取樣為抽樣方法，共以問卷面訪100位受訪者，研究對象為接受精神障礙社區復健中心服務之精神障礙者的家庭照顧者；為豐富資料之分析，本研究也與3位受訪者進行質性訪談。
本研究發現，影響照顧評價之因子分別為年齡、照顧年數及親屬關係，照顧者年齡愈高、照顧年數愈久及為雙親，其照顧評價會愈高，進一步使用逐步迴歸分析法發現親屬關係（β=.356，p=.001）對照顧者之照顧評價具有最高顯著影響力；直接處理因應方式之影響因子分別為教育程度、親屬關係、是否尋求民俗療法及照顧評價，照顧者教育程度為研究所以上跟小學以下、有尋求過民俗療法及親屬關係為雙親者照顧評價愈高，其使用直接處理因應方式愈多，進一步使用逐步迴歸分析法發現親屬關係（β=.317，p=.001）對照顧者之直接處理因應方式具有最高顯著影響力；壓抑處理因應方式之影響因子分別為每日照顧時數及照顧評價，照顧者每日照顧時數愈久及照顧評價愈低，其使用壓抑處理因應方式愈多，進一步使用逐步迴歸分析法發現照顧評價（β=-.321，p=.002）對照顧者之壓抑處理因應方式具有最高顯著影響力。另，因應照顧精神障礙者之特殊性，本研究亦分析烙印與因應行為之關係，發現社會烙印愈多，照顧者愈常使用壓抑處理因應方式，反之，社會烙印愈少，則愈常使用直接處理因應方式。最後在檢驗中介效果時發現照顧評價在親屬關係及直接處理因應方法中存有中介效果。
本研究建議如下：（一）實務面：能多元瞭解照顧評價的內涵，在實務上更全面理解精神障礙家庭照顧者的感受。讓照顧者有機會學習不同的因應方式，並與精神醫療共同合作，以增強精神障礙者之復元；（二）政策面：首先需破除對精神障礙者之汙名，並透過教育及宣導來增加照顧者及社會大眾對精神障礙之認識，最後落實社區照顧之理念；（三）學術面：建議以不同的精神障礙型態（疾病類型、病情時期）進行研究分析，以及對精神障礙者復元之因素進行探究。

關鍵字

精神障礙 ； 家庭照顧者 ； 照顧評價 ； 因應方式

並列摘要

The purpose of this study is to investigate care appraisals and coping strategies among family caregivers of patients with mental disorders and analyze the relationship between care appraisals and coping behaviors and influential factors. First, face-to-face surveys were conducted on 100 respondents selected through purposive sampling, who were family caregivers of patients with mental disorders receiving services from community rehabilitation centers for mental disorders. To enrich data for analysis, qualitative interviews were also conducted with three of the respondents.
Findings of this study reveal that factors that affect care appraisals are age, years of caregiving and kinship. Older caregivers who give care to their parents for more years tend to have higher care appraisals. Further stepwise regression analysis finds that kinship (β=.356, p=.001) has the most significant influence on care appraisals among caregivers. Factors that affect direct coping are education, kinship, seeking folk remedies or not, and care appraisal. Caregivers who have education higher than postgraduate and lower than elementary school and give care to their parents tend to have higher care appraisals and adopt direct coping. Further stepwise regression analysis finds that kinship (β=.317, p=.001) has the most significant influence on direct coping. Factors that affect suppression coping are hours of caregiving per day and care appraisal. Caregivers who give care for more hours per day tend to have lower care appraisals and adopt suppression coping. Further stepwise regression analysis finds that care appraisal (β=-.321，p=.002) has the most significant influence on suppression coping. In response to the particularity of caregiving for patients with mental disorders, analysis was also done on the relationship between stigmas and coping behaviors. It is found that caregivers experiencing more social stigmas tend to use suppression coping while those with less social stigmas tend to use direct coping. Finally, mediation testing finds that care appraisal has a mediator effect on the relationship between kinship and direct coping.
This study offers the following suggestions. (1) Practical aspect: By finding out connotations of care appraisals from multiple angles, it is possible to have a more thorough understanding of the feelings that family caregivers of patients with mental disorders have. This gives these caregivers the opportunity to learn to cope in different ways and collaborate with mental healthcare on facilitating the recovery of patients with mental disorders. (2) Policy aspect: It is necessary to first unstigmatize patients with mental disorders by enhancing knowledge of mental disorders among caregivers and the general public through education and communication to eventually put the concept of community care into practice. (3) Academic aspect: It is suggested to conduct research and analysis on different aspects of mental disorders (types and phases of illness) and investigate factors that affect the recovery of patients with mental disorders.

並列關鍵字

Mental Disorder ； Family Caregiver ； Caregiving Appraisal ； Coping Strategies

參考文獻

一、西文部分

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Cavaye, J. (2006). Hidden carers (Vol. 3). Dunedin Academic Press.

Chakrabarti, S., Kulhara, P., & Verma, S. K. (1992). Extent and determinants of burden among families of patients with affective disorders. Acta Psychiatrica Scandinavica, 86(3), 247-252.