癌症病患的主要照顧者其正念程度扮演憂鬱、生活品質與睡眠障礙之間的中介因素探討

Mindfulness levels as the Mediator between Depression, Quality of life, and Sleep Disturbance among primary caregivers of cancer patients.

邱毓瑩(Yu-Ying Chiu)

指導教授 ： 蕭妃秀

國立臺灣大學/醫學院/護理學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201702403

摘要

研究背景：幾乎有一半的癌症病患的主要照顧者表示他們經歷睡眠障礙，影響他們的生活品質身心的健康以及對生病家人的照護品質。過去研究發現憂鬱和生活品質分別為影響睡眠障礙的主要因素。目前研究尚缺乏釐清正念程度(mindfulness traitlevels)於憂鬱和生活品質與睡眠障礙關係之間所扮演的角色。
研究目的：1. 了解癌症病患的主要照顧者其睡眠障礙的現況，2. 癌症病患主要照顧者的睡眠障礙與照顧者憂鬱症狀、生活品質以及整體正念程度（觀察、描述、注意力覺察、不評價、不回應）之相關，3. 探討正念程度作為主要照顧者憂鬱及睡眠障礙相關之中介因素， 4正念程度作為主要照顧者生活品質及睡眠障礙相關之中介因素
研究方法：本研究採橫斷式描述性相關之研究設計，藉由結構式問卷收集資料，研究對象為腫瘤科病房住院的癌症住院病患的之主要照顧者。藉由結構式問卷收集資料，研究工具包含Taiwanese version of Pittsburgh Sleep Quality Index、Taiwanese version of Five Facet Mindfulness Questionnaire 、Care Giver Oncology Quality of Life questionnaire、病患及照顧者人口學之基本資料。
研究結果:200位癌症病患的主要照顧者中超過七成出現經歷睡眠障礙，照顧者有工作、合併有慢性疾病有使用精神科藥物，以及照顧時間較長者睡眠障礙程度較高。20.5%的照顧者出現憂鬱傾向，42%的照顧者生活品質滿意度偏低。在控制人口學下，憂鬱和生活品質可同時預測睡眠障礙，憂鬱程度越高、生活品質越差者，睡眠障礙的程度越高。當憂鬱程度越高，生活品質越低時，睡眠障礙越嚴重；整體正念程度無法直接預測睡眠障礙，但依據Bootstrap regression analysis，正念程度層面中的正念覺察力顯著的影響了憂鬱、生活品質對睡眠障礙的關係，產生部分中介效果，憂鬱和不良的生活品質經由影響正念覺察力的能力，而導致睡眠障礙。
結論: 睡眠障礙是癌症病患的主要照顧者不僅承受睡眠障礙常見的困擾，憂鬱症狀和生活品質為照顧者睡眠障礙的直接影響因子。正念覺察力扮演憂鬱、生活品質與睡眠障礙之間的部分中介因子，也深受憂鬱影響，不佳的生活品質讓照顧者暴露在生心理疾病的風險下，本文統計與文獻查證支持受憂鬱困擾及生活品質不佳的照顧者在面對負荷或壓力等事件時，影響傾向會以「病理性」的正念覺察的能力方式，反芻負面的思考或情緒路，而導致睡眠障礙。結果建議顯示，也許能藉由以提升正念的覺察能力的介入方案方式，能而減少於癌症住院病患的主要照顧者的睡眠障礙。

關鍵字

癌症 ； 主要照顧者 ； 正念程度 ； 憂鬱 ； 生活品質 ； 睡眠障礙

並列摘要

Background: More than half of the primary caregivers of the cancer patients experience have been through severe sleep disturbance which influences their body-mind health and care quality for their ill family members., thus they cannot get sufficient rest. The previous studies Since the researches revealedfound that depression and quality of life were the main factors associated with may be the factors affectingsleep disturbance. Up to date, there is a lack of the study examining the role of mindfulness levels as the mediator What role that mindfulness trait plays between depression, quality of life and thesleep disturbance.
become a crucial issue which we eagerly to find out.
Aims of the study: This study aims to examine 1. the sleep disturbances among the primary caregivers of the cancer patients. , 2. the associations of sleep disturbances with depression, quality of life, and mindfulness levels (including five facets: observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience), 3. mindfulness levels as the mediator between depression and sleep disturbances, and 4. mindfulness levels as the mediator between quality of life and sleep disturbances.

Methods: This study adopts cCross sectional, descriptive correlation design. The study subjects are the primary caregivers of the cancer patients at the oncology department of the general hospital. and quantitative study including 200 primary caregivers of cancer patients. The following structured Using questionnaires were used to collect data: including Taiwan version of Pittsburg Sleep Quality Index, Caregiver Oncology Quality of Life Questionnaire, Taiwan version of Five Facet Mindfulness Questionnaire, Patient Health Questionnaire and the basic information form of the primary caregivers and cancer patients.
Results: Among 200 primary caregivers of the cancer patients, over 70 per cent experienced 72%of caregivers suffered form sleep disturbance. The primary caregivers appeared to experience higher sleep disturbance if they were being employed, also suffer from chronic illness, received antidepressant and sleep pills, and spent more time in caring for ill family members. After controlling the covariates such as sociodemographic data, depression and quality of life predicted sleep disturbance. Higher sleep disturbance was correlated with higher depressive symptoms and poorer quality of life. Sleep disturbance is highly related to depression and quality of life. Overall mindfulness scores did not predict sleep disturbance. However, according to bootstrap regression analysis, among five facets of mindfulness, acting with awareness played as a partial mediator between depression, quality of life, and sleep disturbance. Mindfulness trait is a mediator influencing the relationship between sleep disturbance, depression and quality of life. The results indicated that the impacts of depression and poor quality of life on ability of acting with mindfulness were the part of the causes of sleep disturbance.

Conclusions: Sleep disturbance is the common distress among the primary caregivers of the cancer patients. The results imply that future intervention program to enhance sleep quality of caregivers of cancer patients should take mindfulness into account. Promote mindfulness may have dual benefit on emotion, quality of life and sleep quality.
Mindful awareness plays a partial mediating effect on sleep disturbance. The caregivers’ depression and poor quality of life might have the negative impacts on mindful awareness, and subsequently, contributes to sleep disturbances. The results suggest that depressed caregivers as well as those with poor quality of life might experience a “dysfunction of mindful awareness” in cognitive process pathway which result in their sleep disturbance.Depression and quality of life are the direct factors associated with sleep disturbance. Acting with awareness of mindfulness plays the partial mediator between depression, quality of life and sleep disturbance. The negative thoughts and feelings due to depression and poor quality of life might influence primary caregivers’ ability of acting with awareness of mindfulness, as a result of sleep disturbance. The intervention aiming to increase the ability of acting with awareness might be helpful in improving sleep disturbance among
Based on the findings, focusing on training mindful awareness program might be helpful to improve “dysfunction of mindful awareness” due to depression and quality of life for among primary caregivers of cancer patients at inpatient oncology unit.

並列關鍵字

cancer care givers ； mindfulness ； depression ； quality of life ； sleep disturbance

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