社區思覺失調症病人精神症狀、智謀程度與生活品質之相關性探討

中文摘要本研究旨在探討思覺失調症病人的精神症狀、智謀程度與生活品質之相關性及生活品質的預測因子。採用橫斷式研究，以方便取樣，使用結構性問卷進行資料收集，針對南部一家精神專科教學醫院之社區個案為對象，共120人。研究工具包括個案基本屬性、簡短精神症狀量表(Brief Psychiatric Rating Scale)、智謀量表(Resourcefulness scale)、世界衛生組織生活品質量表台灣簡明版(WHOQOL-BREF）四個部分。以描述性統計分析、單因子變異數分析、獨立樣本t檢定，皮爾森相關係數檢定、複迴歸分析等方法進行資料分析。研究結果顯示，120位社區思覺失調症病人之整體精神症狀平均值為8.64分(SD = 5.72)，指標分數為8分，顯示本研究對象整體精神症狀較輕微；整體智謀程度平均為95.38分(SD = 18.70)，指標分數為68.13分，顯示本研究對象智謀屬於中等程度；整體生活品質平均分數為86.42分(SD = 14.46)，指標分數為61.73分，顯示本研究對象生活品質屬於中等程度滿意。此外，年齡與精神症狀呈現正相關(r = .19, p = .04)，顯示年齡愈大，症狀愈嚴重；而工作狀態與精神症狀 (t = 2.76, p = .007)、智謀(t = -2.60, p = .011)及生活品質(t = -2.46, p = .016)有關，顯示有工作者精神症狀較不嚴重、智謀較高與生活品質較佳。精神症狀與生活品質呈現顯著負相關(r = -.40, p < .001)，表示精神症狀越輕，生活品質越好。精神症狀與整體的智謀程度呈負相關(r = -.20, p = .03)，即精神症狀越輕，整體智謀較佳。智謀程度與生活品呈現顯著正相關(r = .43, p < .001)，表示智謀程度越高者，生活品質越好。經過逐步複迴歸分析發現，精神症狀與個人智謀是生活品質的重要預測因子，其總解釋變異量為29.0%。研究結果可提供社區照護之醫療人員了解社區思覺失調症病患之精神症狀、智謀與生活品質的情形，有助於未來發展適合社區照護之方案，以降低病患精神症狀及提升智謀與生活品質。

關鍵字

思覺失調症；精神症狀；智謀；生活品質

並列摘要

Abstract Background: Because of the deinstitutionalization of mental health care has taken place in Taiwan during the decades, many patients with schizophrenia are being cared in the community. According to the Zauszniewski’s resourcefulness and quality of life theory, for the patients, the skills constituting resourcefulness should focus on self-help, or the use of one’s own efforts and resources to achieve their health. While the significant associations between resourcefulness and health have been consistently in published research, little is known about the relationship between resourcefulness and quality of life with schizophrenic patients. Objectives: The study aimed to assess the psychiatric symptoms, resourcefulness and quality of life as well as the predictors of quality of life of patients with schizophrenia living in the community. Methods: We conducted a cross-sectional study. A total of 120 patients were recruited with convenience sampling who received home care service and community rehabilitation program at the Tsyr-Huey Mental Hospital. Structured face-to-face interviews were conducted using the Brief Psychiatric Rating Scale, the Perceived Stress Scale, the Resourcefulness scale, and the World Health Organization Quality of Life Scale. Results: Statistical analysis was conducted using the IBM SPSS 19.0. The data were analyzed using one-way analysis of variance, Pearson correlation coefficients and stepwise multiple regression analysis. The results showed that average scores of psychiatric symptoms, resourcefulness, and quality of life are respectively 8.64 (SD = 5.72), 95.38(SD = 18.70), and 86.42(SD = 14.46). The unemployment status (t= -2.46, p < .05), higher level of psychiatric symptoms (r = -.40, p < .001) and lower levels of resourcefulness (r = .43, p < .001) were associated with negative perceptions of quality of life. The personal resourcefulness (β = .39) and psychiatric symptoms (β = -.32) were the predictors of quality of life and accounted for 29.0% of the variance. Conclusion: Our findings support the theory of resourcefulness. In this study, patients with less psychiatric symptoms and higher resourcefulness had better quality of life. The psychotic symptoms and personal resourcefulness are the predictors of quality of life. More research in this topic is needed in order to examine the positive factors and develop skills to promote patients’ resourcefulness and quality of life. Furthermore, the professionalisms should develop the community-based care programs to reduce patient psychotic symptoms and enhance the quality of life.