精神分裂症病患照顧者表露情緒與社會心理因素之關係－兩年追蹤研究

The Relationship for Psychosocial Factors and Expressed Emotion of Caregivers over a Two-Year Period

吳就君(Agnes Chew-Chung Wu) ； 黃梅羹(Mei-Kung Huang) ； 胡海國(Hai-Gwuo Hwu) ； 蔡春美(Chun-Mei Tsai) ； 鄭若瑟(Joseph J. Cheng) ； 張宏俊(Hung-Jung Chang) ； 鄭夙芬(Su-Fen Cheng)

《臺大社會工作學刊》 4期 (2001/06) Pp. 1+3-44

https://doi.org/10.6171/ntuswr2001.04.01

摘要

目的：本研究目的在探究精神分裂症病患照顧者表露情緒（EE）之社會心理相關因素，以作為精神病患照顧者衛生教育及家庭介入之依據。方法：以臺灣北部三大醫學中心近三年（1994－1996）住院時診斷早已精神分裂症（DSM-IV）之照顧者168名為研究對象，用「中國人五分鐘演說樣本（CFMSS）」測量照顧者的EE；另有十個社會心理因素評估量表：「社會支持」、「醫療滿意度」、「羞恥感」、「疾病歸因」、「疾病認知」、「家庭負荷」、「家庭調適」、「照顧者需求」、「生活事件」、「生活品質」等，分別於入院時、一年、二年等共三個時間點測量。統計方法援用卡方檢定、t值檢定及單因子共變數分析（ANCOVA）檢視。結果：1.高表露情緒（HEE）和低表露情緒（LEE）兩組之間的社會心理因素有顯著差異，包括：社會支持滿意度、羞恥感、對疾病歸因、家庭負荷、家庭調適及家庭需求等。2.兩年下來各組的變化，HEE組的社會心理正向驅力如社會支持滿意度及家庭調適等，以入院時最高而後下降；LEE組社會心理負向驅力如羞恥感、家庭負荷以入院時最高而後下降。3.HEE組表示對資源和支持的需求強，卻採封閉性社會調適，互為矛盾和困頓。結論：支持EE的概念是人與環境多元因素互動的動態過程，是病患與照顧者之間調適的信號；本研究發現提供HEE的家族治療及心理衛生教育之參考。

關鍵字

表露情緒 ； 社會心理因素 ； 精神分裂症

並列摘要

Objective: The purpose of this study was to examine the relationship between psychosocial factors and expressed emotion (EE) of family caregivers for schizophrenic patients. Methods: Expressed-emotion scores of the caregivers were obtained using the CFMSS when the patient was admission in the hospital, and on four subsequent occasions at three, six, 12 and 24 months after admission. A total of 161 patients and their respective family caregivers were included in the study. Psychosocial variables included social support, satisfaction for medical services, feeling of stigma, mental illness attribution, cognition of illness, family burden, family adaptation, caregivers' needs, life events and quality of life. Chi-square, t-test and ANCOVA were used to examine the relationship between psychosocial variables and the caregivers' EE. Results: (1) Significantly different scores between HEE (High Expressed Emotion) and LEE (Low Expressed Emotion) caregivers were found in psychosocial variables including: social support, satisfaction for medical services, feeling of stigma, mental illness attribution, family burden, family adaptation and caregivers needs. (2) The data of two-year follow-up demonstrated that the positive aspects of psychosocial variables in HEE caregivers, for example, the social support and family adaptation scores were significantly decreased. On the other hand, the negative aspects of psychosocial variables in LEE caregivers, for example, the feeling of stigma and family burden scores were significantly decreased. (3) the result in HEE caregivers indicated paradoxical conflicting situation which limited family life adaptation and needs for social support. Conclusion: This study presents the evidence supporting the EE concept is the result of multiple variables in a dynamic process. It is not simply cause-effect, one way relationship or an interaction between two variables. EE differs significantly according to the psychosocial variables of the caregivers.

並列關鍵字

Expressed Emotion ； Psychosocial Factors ； Schizophrenia