聚焦於青少年生活品質且於社區進行的心智健康服務

Mental Health Service Focused on Quality of Life Conducted in Community for Adolescents

葉啟斌(Chin-Bin Yeh)

指導教授 ： 戚樹誠

國立臺灣大學/管理學院/商學組/碩士(2015年)

https://doi.org/10.6342/NTU.2015.11288

摘要

背景：通常傳統的精神衛生服務中，執行工作的場所是在臨床的機構，而不是在社區工作。另外，臨床醫師常常只注意精神疾病的嚴重程度，而不是他們的內心感受。因此，常見的問題是，青少年不願意前往精神科門診，本研究的目的是建立在社區進行的精神衛生服務模式，並把服務的焦點放在青少年內心的感受上，可能有助於服務滿意度。
方法：注意力缺陷/過動障礙（ADHD）是一個青少年最常見的精神障礙，在青春期不易被辨認，因為這種疾病的症狀往往解釋為由於生活這個階段的發育情感風暴。因為這個疾病的持續性、嚴重度和與ADHD在成年相關的繼發性疾病的風險，因此有必要發展出一套可靠篩檢工具，以檢測過動症青少年和為他們提供治療。在我們的研究的第一步是因此進行了台灣高中生樣本中過動症的篩查工具的心理特性評量。有2873位15至18歲青少年完成了成人ADHD自評量表（ASRS），文德猶他州評定量表（WURS），衝動量表（IS），貝克抑鬱量表（BDI）和貝克焦慮量表（BAI）。其中的八十四位於接受測試兩週後，再次被評估重測信度。兩次測量之間的關係以皮爾遜相關（r）和重測信度與類內相關（ICC）做檢驗。另外，在以ASRS預測的過去孩童時期的行為問題和現在的危險行為的嚴重程度則以logistic迴歸分析。這項前瞻性研究的第二個步驟是追蹤並且使用世衛組織生活質量量表，測定過動症青少年的第二年的受損的生活品質。我們研究的另一個目的在探討過動症和生活品質受損之間的關係中背後的機制，調查憂鬱和焦慮症狀作為這兩者之間中介變項的角色。這可能有助於設計新的治療措施，以改善他們的生活質量。
結果：ASRS分量表的再測信度具有良好的一致性（ICC = 0.81），且與WURS和IS也有良好的一致性，並且可以顯著預測童年時期的破壞性問題和現在併發危險行為，結果顯示華人版ASRS是一個可靠和有效的工具，以協助篩查ADHD的青少年。同時，患有過動症的青少年在第二年被發現有較差的生活質量。同時我們發現憂鬱和焦慮症狀顯著地中介過動症和生活質量之間的關係。
結論：在學校使用的精神衛生服務工作，用自我報告的問卷有助於早期辨識高危險群。這將解決過動症青少年的被延遲轉診和被汙名化的問題。此外，治療的重點是生活質量和憂鬱/焦慮症狀，而不只是過動症的症狀嚴重程度，這樣可能有助於服務滿意度，為這些青少年成長為成年人後，防止他們伴隨或發展出精神障礙或影響他們的生活質量。

關鍵字

心理健康服務 ； 生活質量 ； 服務滿意度 ； 青少年 ； 注意力缺失/過動症 ； 焦慮/憂鬱

並列摘要

Background: Traditional mental health service usually works in clinic rather than in community. In addition, the adolescent is not willing to visit psychiatric clinic since the clinicians pay attention to the adolescents’ severity of mental illness rather than their well-being. Therefore, the aim of this proposal was to establish the mental health service model conducted in the community and focused on the well-being of these adolescents which might help service satisfaction.
Methods: Attention-deficit/hyperactivity disorder (ADHD) is a most prevalent mental disorder in adolescents and is not easily recognized in adolescence, as the symptoms of the disorder are often interpreted as due to the developmental emotional turmoil of this phase of life. Given the high persistence, severity, and risk of secondary disorders associated with ADHD in adulthood, it is important to have reliable tools to detect ADHD in adolescents and provide treatment for them. The first step in our study was consequently carried out to examine the psychometric properties of a screening measure of ADHD in a sample of Taiwanese senior high school students. There were 2,873 adolescents aged 15-18 administered the Adult ADHD Self-report Scale (ASRS), Wender Utah Rating Scale (WURS), Impulsivity Scale (IS), Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) . Eighty-four of them were retested two weeks later to evaluate test-retest reliability. Relationships among the scales were examined with Pearson correlations (r) and test-retest reliability with intra-class correlations (ICC). Scale values in predicting severity of behavioral problems and risky behaviors were analyzed with logistic regression. The second step of this prospective study was to follow-up the impaired quality of life measured with WHO-QoL BREF among the adolescents with ADHD in the second year. We also aimed to investigate the mechanisms underlying the relationship between ADHD and impaired quality of life by the ways of investigating the role of depression and anxiety as mediators. It might help design new interventions to improve their quality of life.
Results: ASRS subscales showed good concordance (ICC = .81). A significant correlation with the WURS and IS, and the ability to predict childhood disruptive problems and concurrent risky behaviors, results suggest that the Chinese ASRS is a reliable and valid instrument to assist in screening for ADHD in adolescents. Meanwhile, the impaired quality of life was found in the adolescents with ADHD in the second year. The depression and anxiety significantly mediated the relationship between ADHD and quality of life.
Conclusion: The mental health service working at school and used self-reported questionnaire help early recognition of the at risk group. It will solve the delayed referral and stigmatization of the adolescents with ADHD. In addition, the treatment focuses on the quality of life, and depression/anxiety rather than ADHD symptoms severity only might help service satisfaction and prevent the development of comorbid mental disorders or impaired quality of life as those adolescents grow into adults.

並列關鍵字

Mental Health Service ； Quality of Life (QoL) ； Service satisfaction ； Adolescents ； Attention-deficit/hyperactivity disorder (ADHD) ； Anxiety/Depression

參考文獻

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Barkley, R. A., Anastopoulos, A. D., Guevremont, D. C., & Fletcher, K. E. 1991. Adolescents with ADHD: patterns of behavioral adjustment, academic functioning, and treatment utilization. J Am Acad Child Adolesc Psychiatry, 30(5): 752-761.

Barkley, R. A., Anastopoulos, A. D., Guevremont, D. C., & Fletcher, K. E. 1992. Adolescents with attention deficit hyperactivity disorder: mother-adolescent interactions, family beliefs and conflicts, and maternal psychopathology. J Abnorm Child Psychol, 20(3): 263-288.

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