Comparison of Quality of Life for People with Schizophrenia and Mental Health of Caregivers between Community-based and Hospital-based Services

社區治療與醫院治療模式之精神分裂病患生活品質及主要照顧者情緒心理壓力之比較

曾冬勝(Dong-Sheng Tzeng) ； 龍佛衛(For- Wey Lung) ； 張永源(Yong-Yuan Chang)

《The Kaohsiung Journal of Medical Sciences》 20卷9期 (2004/09) Pp. 437-442

摘要

近年來我國極力推展精神醫療工作，並將精神分裂病患治療模式多元化與社區化。在推展這些工作的同時，醫療資源與預算緊縮，健保財務吃緊時，我們研究的目的是比較社區治療模式和以醫院為中心的治療模式，病患生活品質上的差異；了解病患主要照顧者情緒心理壓力；並預測影響精神病患安置的因素。研究對象為臺灣南部某教學醫院，診斷精神分裂病病患，急性病房出院一週內安置到慢性醫院組或社區組，各隨機抽樣 25 及 27 位，總共 52 位，年齡大於十八歲，總智商大於七十，並排除酒癮，藥癮以及器質性腦症候群者。詳細說明研究計畫，取得病患及主要照顧者之同意書，收集人口學基本資料後納入研究。施以世界衛生組識生活品質問卷；經精神科醫師評估其簡短精神症狀量表；主要照顧者之華人健康量表及個案職業狀態與社會功能等評估。測量時問分別於收案一週內及三個月，六個月，一共三次，所得量表分數經由描述性統計、資料探索分析、 t 檢定及 GEE-I ( generalized estimating equation-I）統計分析方扶進行資料分析。兩組在總智商與殘障等級上有差異（ p＝0.024，0.016 )；控制性別、年齡、病程、病情、總智商後，兩組生活品質量表，主要照顧者華人健康量表上統計學並無顯著差異；在預測出院病患安置的因素中，總智商越高者在社區組；病程愈長在醫院組。病患的生活品質及主要照顧者的情緒心理壓力受患者精神症狀顯著影響，尤其醫院組（p＜0.01 ) o 在整合性精神醫療體系的不同治療模式，醫院組病患的生活品質並未比社區組低；社區組主要照顧者的情緒心理負擔並未比醫院組高。改善精神分裂病病患的症狀，將提高病患的生活品質及降低主要照顧者的情緒心理壓力。

關鍵字

精神分裂症 ； 生活品質 ； 華人健康量表

並列摘要

This study is a comparison of the quality of life and family stress levels in community-based and hospital- based services for people with schizophrenia. Fiscal considerations of the health insurance industry in Taiwan require the evaluation of a community support program versus the traditional, hospital-centered program for reform of mental health policy concerning schizophrenia. The study involved 52 schizophrenic patients, 27 in a community-based program and 25 in a hospital-based treatment model, and was conducted from January to December 2001 in the psychiatric department of a general teaching hospital in southern Taiwan. Outcomes were determined using the World Health Organization quality of life questionnaire (WHOQoL-BREF, Taiwan version), Brief Psychiatric Rating Scale (BPRS), General Health Questionnaire (Chinese version), rate of loss to follow-up, job conditions, and social function. Comparisons of quality of life and caregiver mental health between the two groups were accomplished using descriptive analysis, independent sample t test, and the generalized estimating equation-I. No significant differences between the two groups were found in quality of life or family mental stress according to the General Health Questionnaire after controlling for sex, age, disease duration, full IQ, and total BPRS score. Long disease duration predicted a hospital setting, while a high IQ was predictive of a community setting. We found no decrease in quality of life for schizophrenic patients in a hospital-based program and no increase in family mental stress among the community-based group. To improve patients’ quality of life and the mental health of caregivers in both services, it is important to ameliorate severe symptoms associated with schizophrenia.

並列關鍵字

schizophrenia ； quality of life ； General Health Questionnaire