編輯的話：疫情下心理健康之守護

Editorial Remarks: Guarding Mental Health in the Pandemic

林靜蘭(Esther Ching-Lan Lin)

《精神衛生護理雜誌》 16卷2期 (2021/09) Pp. 2-5

https://doi.org/10.6847/TJPMHN.202109_16(2).00

摘要

有人說疫情是一篇發人省思的講章，讓人再次審視生命意義之所在，重新思量應被珍視的關係與價值。2019年末新冠肺炎（Coronavirus disease2019 [COVID-19]）疫情爆發，快速襲捲全球，形成世界性大流行（Habas et al.,2020），全球約超過1/10之人口確診，近四千萬人死亡（WHO, 2021）。全世界疫情爆發初期，臺灣因國家疫情指揮中心制定良好的防疫措施與邊境管控、且民眾高度配合防疫政策及戴口罩意願較高的情形下，整體疫情控制合宜，但及至2021年5月疫情加溫為三級警戒，累計病例超過14萬人，近八百人死亡（衛生福利部疾病管制署，2021）。這些確診與死傷人數為具體可計之數據，但疫情造成民眾無形的心理壓力，卻可能持續帶著負面的影響。民眾因對疾病不了解而出現恐懼、擔憂、焦慮（Talevi et al., 2020），也因疫情持續蔓延而出現混亂、憤怒與沮喪，對新聞媒體報導產生高度壓力、焦慮、憂鬱等情緒反應（Wang et al., 2020; Shah et al., 2020），並可能發展成生理或精神疾病（Duan & Zhu, 2020）。舉例而言，因應政府實施全面隔離封鎖政策，校園關閉，青少年因轉變為居家自學，大幅減少其社交活動及同儕學習的機會，僅能透過網路與他人產生連結。Zhou等人（2020）發現疫情期間43.7%的青少年出現憂鬱症狀，37.4%出現焦慮症狀，31.3%同時出現兩種症狀；Pigaiani等人（2020）亦指出：六成以上的青少年表示難以持續待在家中，三成發生與家人爭吵情形。也有研究指出青少年因學習環境的變化和有限的社交互動而產生孤獨感與社交恐懼（Chen, 2020），或對周圍成年人的情緒相當敏感、擔憂疫情產生的經濟壓力或家庭問題，而容易出現心理健康問題（Imran et al., 2020; Saurabh & Ranjan, 2020）。由此可知疫情及隔離措施對青少年影響甚鉅，衝擊其身心發展與未來的心理健康，若未及時提供適當的介入，將可能造成未來更為棘手的社會問題。本期第一篇專欄為「應用賦能於提升護理師之心理衛生照護功能」，感謝李選教授應邀撰寫，該文闡述如何應用賦能提升護理師的自我效能、心理衛生照護品質與彰顯專業角色功能之獨特價值，期待此文能為疫情下慌亂與士氣低迷的護理執業現場帶來賦能之正面影響。更且，為關注疫情下民眾的心理健康，本期增加一專欄稿，特別關注疫情下民眾心理健康問題及當前多元化線上心理健康介入之實證成效，並介紹世界衛生組織所提出之心理急救策略，藉此簡易心理介入，期能幫助臨床住院患者或身邊民眾度過疫情期間的心理危機。此外，本期有兩篇研究稿，一篇「精神科慢性病人職業復健之主觀經驗」（潘等，2021）以質性研究訪談12位參與職業復健計畫之慢性精神病人，所歸納之兩個經驗主題「內在挑戰」及「不友善的職業復健環境」，值得臨床照護團隊以此為借鏡，宜思考如何讓慢性精神病人更能受益於職業復健計畫，或為病人代言其心理需求及感受。另一篇研究稿「美沙冬替代治療患者其藥物信守之相關因素」（馬等，2021）發現－－男性、服用越久者及自主神經焦慮反應越強者，其藥物信守越好，可做為未來提高該族群藥物信守介入之實證依據。最後，專案稿「運用多元化衛教方案改善精神科慢性病人手部衛生之專案」（鄭、鄭、簡，2021）所發展多之元衛教策略，應能促進COV-19疫情下臨床精神科照護之防疫效能。最後，「平安就是福」，在此疫情下格外值得珍惜與看重身心平安！

並列摘要

Some people describe the pandemic as an inspiring speech that helps people review the significance of life and reconsider the relationships and values that merit attention. At the end of 2019, the pandemic of coronavirus disease 2019 (COVID-19) broke out and rapidly spread across the world, causing global outbreak (Habas et al., 2020). Approximately more than 1/10 of the global population were contracted, which caused death of nearly 40 million people (WHO, 2021). At the initial stage, Taiwan Centers for Disease Control (CDC) developed appropriate pandemic prevention and border control measures. With the people highly cooperative to pandemic prevention policies and their high willingness to wear masks, Taiwan properly controlled the overall pandemic within its territory. However, in May 2021, the pandemic aggravated in Taiwan, reaching level 3 alert. The cumulative number of confirmed cases exceeded 140,000 and nearly 800 died of the disease (CDC of the Ministry of Health and Welfare, 2021). The confirmed cases and death tolls were concrete and calculable, but the pandemic caused invisible psychological stress to the public may continue its negative effects. The public experienced fear and concern out of their unfamiliarity with the disease (Talevi et al., 2020). The continuous spread of the pandemic also caused people's chaos, anger, and distress, thereby leading to emotional reactions, such as high stress, anxiety, and depression, to news reports (Wang et al., 2020b; Shah et al., 2020b), and may develop into physiological or psychiatric disorders (Duan & Zhu, 2020). For example, under the total lockdown policy implemented by the government, campuses are closed. Teenagers must learn at home by themselves and considerably reduce their social activities and peer learning opportunities. The Internet is the only approach they can use to associate with others. Zhou et al. (2020) reported that during the pandemic, 43.7% of teenagers exhibited depression symptoms, 37.4% had anxiety symptoms, and 31.3% had both depression and anxiety symptoms. Pigaiani et al. (2020) indicated that more than 60% of the teenagers expressed that they had difficulty in staying home continuously; 30% quarreled with their family members. Studies have shown that teenagers felt a sense of loneliness and social fear because of the change in learning environments and limited social interaction (Chen, 2020) or became highly sensitive to surrounding adults' emotions and concerned of the economic pressure or family problems resulting form the pandemic; thus, the teenagers were at risk of developing mental health problems (Imran et al., 2020; Saurabh & Ranjan, 2020). Accordingly, the pandemic and quarantine measures tremendously affect teenagers and impact their physical and psychological development as well as their future mental health. If appropriate intervention cannot be provided timely, more difficult social problems may arise in the future. To address mental health of the public under the pandemic, the current issue added a column, in which the author reviewed mental health problems of the general public under the pandemic and evidence-based online interventions on mental health. The Psychological First Aid proposed by World Health Organization was also introduced as a practical and simple mental intervention for assisting clinical inpatients or people around us to weather the mental crisis during the pandemic. Another column titled "Use of Empowerment to Increase Nurses' Mental Health Care Functions" was composed by Professor Li Sheuan, whom we are indebted. It described how to use empowerment to increase nurses' self-efficacy and mental health care quality and to manifest the unique value of their professional role functions. Through empowerment, it is expected to positively affect clinical nurses, baffled and dispirited by the pandemic. The current issue contained two research articles. First, "Subjective Experience of Vocational Rehabilitation of Patients with Chronic Psychiatric Diseases" using a qualitative inquiry to interview 12 patients with chronic psychiatric illness in a vocational rehabilitation program. Two kinds of experience, namely, "internal challenge" and "unfriendly vocational rehabilitation environment" could inform healthcare teams to help those patients to benefit from vocational rehabilitation programs or advocate for them. Second, "Correlation Factors of Medication Adherence among Patients Receiving Alternative Treatment of Methadone" indicated that greater medication adherence was observed in men, patients on long-term medication, and patients with strong anxiety. The results will provide for designing interventions to improve medication adherence in the future. A project article titled "Use of Diverse Health Education Projects to Improve Hand Hygiene of Patients with Chronic Psychiatric Diseases" promoted the pandemic-prevention performance in clinical psychiatry care through multiple health education strategies, which might be useful during the COVID-19 pandemic. Lastly, "safety is blessing"; physical and psychological health is worthy of special attention during this pandemic.