社區精神病患家屬照顧負荷及其預測因子

Burden and Predictors Among Caregivers With Mental Illness in Community

徐瑀謙(Yu-Chien Hsu) ； 黃莉萍(Li-Pin Huang) ； 徐敏芳(Min-Fang Hsu)

《健康與建築雜誌》 3卷2期 (2016/06) Pp. 64-71

https://doi.org/10.6299/JHA.2015.3.2.R7.64

摘要

背景：精神疾患是長期慢性化的疾病，在國內，絕大多數的精神疾病患者出院後和家人同住。在華人文化中的家屬、特別是患者的父母親，更扮演提供支持和照顧的重要角色，同時也形成照顧的負荷感受。目的：本研究旨在了解社區精神病患家屬的照顧負荷，並找出重要預測因子。方法：本研究為橫斷式調查法，採立意取樣，以北部某縣市精神病患家屬為收案對象，依結構式問卷以訪談方式進行資料收集，並以SPSS 18.0 統計軟體進行描述性及推論性統計分析。結果：63.7% 的家屬呈現重度負荷，而在各向度負荷感受，依序為「照顧者緊張」(2.11±0.97)、「案主依賴」(1.82±0.98)、「家庭干擾」(1.75±0.96)、「烙印」(1.52±1.16) 及「愧疚」(1.20±0.91)。經由羅吉斯迴歸模式結果顯示：1. 經濟負擔 (OR 8.459, 95% CI 2.061 - 34.719)、2. 問題行為 (OR4.534, 95% CI 1.463 - 14.055) 則是預測家屬照顧負荷的重要因子。結論/實務應用：社區精神衛生護理人員需確知家屬照顧負荷的危險因子，以利提供更適切的照護計劃並避免後續負向結果的產生。且宜針對家屬經濟照護負擔的減輕、提升病人回歸社區生活能力等政策與實務面向進行更深入的思考。

關鍵字

精神病患 ； 家屬 ； 照顧負荷

並列摘要

Background: Mental illness is a long-term chronic disease. Most of the institutionalization mental ill people live with their families in Taiwan. Families play a major role in providing care for their relatives with mental illness in Chinese culture, especially the parents. Caregivers’ burden is a complex and multidimensional construct that addresses the families perceived impacts for their caregiving tasks. Purposes: The aim of the present study was to investigate the caregivers’ burden and determine the predict factors. Methods: A cross-sectional study and purposive sampling were conducted for families who take care of mental ill people in north Taiwan. Structured questionnaires were utilized by face to face interviews to collected data. All the data was analyzed by descriptive and inferential statistics with SPSS 18.0. Results: 63.7% participants were in severe burden. The average score on family burden in each dimension, strain was the highest (2.11±0.97), followed by dependency(1.82±0.98), family disruption (1.75±0.96), stigma (1.52±1.16) and guilty (1.20±0.91). In logistic regression models, family burden predictors were economic loading (OR 8.459, 95% CI 2.061 - 34.719) and problem behaviors (OR 4.534, 95% CI 1.463 -14.055). Conclusions: Community psychiatric nurses should recognize the family burden risk factors and conduct better nursing plan for them to avoid further negative outcomes. Health care policy and practice about reduce the economic loading for family and how to enhance the function of deinstitutionalization mental ill people should be considered in more depth.

並列關鍵字

mental illness ； caregiver ； burden