以身心障礙鑑定功能量表探討思覺失調症與雙極性情感性疾患之就業預測模式

The Predictive Model of Employment status for persons with Schizophrenia and Bipolar Disorder based on ICF

呂淑貞(Shu-Jen Lu)

指導教授 ： 潘璦琬

國立臺灣大學/醫學院/職能治療研究所/博士(2017年)

https://doi.org/10.6342/NTU201700665

摘要

中文摘要
目的： 由於思覺失調症和雙極性情感性精神疾患的就業率偏低，影響這些個案獨立生活的功能與品質．為探討影響其就業與否的因子，作為未來提供服務的參考，本研究採用台灣身心障礙鑑定資料庫內的資料以研究相關因素．本研究採用世界衛生組織身心障礙鑑定功能量表第二版（ WHODAS 2.0）的向度以及總分，來探討對於就業與否的影響及其相關性．。

方法：本研究資料來自於2012年到2013年間台灣身心障礙鑑定資料庫．研究者篩選出31,793位思覺失調症或情感性思覺失調症的患者；以及15,465名雙極性情感性精神疾患之患者．並根據其就業狀況（ 就業和未就業）分為兩組。以邏輯式迴歸分析來探討與人口學特徵和功能程度之間的關係．本研究以ROC(Receiver Operative Curve)曲線來分析功能分數的閾值對於預測未來就業與否的機率．

結果：在31,793位思覺失調症患者中，排除資料不完整者，有22,168人進入分析，其中就業人口數為3,367人，未就業人口數為 18,801人。在15,465位雙極性情感性精神疾患中，排除資料不完整者,有9,886人進入分析，其中就業人口數為1,846人，未就業人口數為8,040人。ROC分析顯示思覺失調症患者的WHODAS 2.0總分若是小於25.78分，其就業機率是大於25.78分者的6倍多．而雙極性情感疾患患者的WHODAS-2總分若是小於33.57分，其就業機率是大於33.57分者的4倍多。雙極性情感疾患患者的各向度分數分別有不同的閾值，從5～39.583不等，分數低於此閾值的個案有明顯高1.6～2.3倍的機率可能就業．另外，兩群個案的年齡，性別，居住處，城市化程度，以及身心障礙等級均與就業與否有顯著相關．

結論：本研究結果提供未來進一步研究或是服務提供的參考．未來可設計相關介入方案來提升就業可能性．例如，著重行動力與自我照顧能力的訓練，確保個案具有回歸工作的基礎能力．而採用WHODAS2.0的總分來選取高於25.78分的思覺失調症個案（或是高於33.57分的雙極型情感性精神疾病個案）進入特殊職前訓練方案，則是另一個值得發展的重點．

關鍵字

國際健康功能與身心障礙分類系統(ICF) ； 身心障礙鑑定功能量表(WHODAS 2.0) ； 思覺失調症 ； 雙極性情感性精神疾患 ； 職業復健 ； 就業

並列摘要

Abstract
Purpose: This study aims to examine the relationships between the World Health Organization Disability Assessment Schedule (WHODAS 2.0) scores and the employment status using the data from the disability evaluation database in Taiwan. The findings are expected to help the allocation of the rehabilitation resources for people with schizophrenia and bipolar disorders in Taiwan.
Methods: The national disability evaluation database collected from 2012 to 2013, with 31,793 subjects with schizophrenia and 15,645 subjects with bipolar disorders were used for the current study. The subjects were dichotomized into two groups: employment and unemployment. Logistic regression analysis was used to examine the relationship among employment, the WHODAS 2.0 score, and the demographic characteristics. The Receiver Operating Characteristics (ROC) analysis was conducted to examine the probability of using the threshold score to predict the employment status.
Results: In total, 22,168 subjects with schizophrenia and 9,886 subjects with bipolar disorders were analyzed. The ROC results showed that subjects with schizophrenia who scored lower than 25.78 had about 6 times higher probability to be employed than those who scored higher than 25.78; subjects with bipolar disorders scored lower than 33.57 had about 4 times higher probability to be employed than those who scored above 33.57. Subjects with bipolar disorders demonstrated different cut-off point, ranging from 5 to 39.583, and those who scored below these cut-offs had a significantly higher probability of employment by 1.6 to 2.3 times. Demographic variables such as age, gender, residence, degree of urbanization, disability level were all significantly correlated to employment among subjects of either health conditions..
Conclusions:The study provides insight into future research as well as intervention designs to facilitate employment for people with disabilities. For instance, training focusing on mobility and self-care may enhance the ability to return to work. On the other hand, using WHODAS2.0 as an instrument to screen people with Schizophrenia and bipolar disorder for prevocational training can be another direction of development.

並列關鍵字

International Classification of Functioning, Disability and Health (ICF) ； World Health Organization Disability Assessment Schedule (WHODAS 2.0) ； Schizophreni ； Bipolar Disorder ； Vocational Rehabilitation ； Employment

參考文獻

World Health, O. (2001). International classification of functioning, disability and health (ICF). Geneva: World Health Organization.

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