僵直性脊椎炎患者的童年逆境經驗、復原力與其健康狀態之關係探討

研究目的：童年逆境經驗(Adverse Childhood Experiences, ACE)是一種長期的負面壓力反應，可能會觸發疾病風險因子，使僵直性脊椎炎(Ankylosing Spondylitis, AS)患者的症狀惡化，而復原力可能為其重要的保護因子。然而，當前尚無針對三者關係進行探討，因此本研究旨在探討僵直性脊椎炎患者童年逆境經驗、復原力與其健康狀態三者之間的關聯性。研究方法：本研究採橫斷性調查法，以立意取樣於中山醫學大學附設醫院風濕免疫門診招募僵直性脊椎炎成年患者為研究對象。以結構式自填問卷收集資料，包括中文版童年逆境經驗國際調查問卷(The Taiwan-Version of Adverse Childhood Experiences Questionnaire)、中文版Connor-Davidson復原力量表(Connor-Davidson Resilience Scale)、脊椎關節炎健康指數(ASAS Health Index, ASAS HI)、脊椎關節炎健康指標相關環境因子量表(Environmental factors related to ASAS Health Index)。統計方法包括Pearson積差相關、ANOVA、ANCOVA、獨立樣本t檢定、多元線性迴歸、二元羅吉斯迴歸以及多項式羅吉士迴歸。本研究通過中山醫學大學第一人體研究倫理審查委員會審查(編號：CS1-20182)。研究結果：本研究共招募120名AS患者，其中男性多於女性；依ASAS HI分類，以正常健康功能者居多，其次依序為中度健康功能障礙者、重度健康功能障礙者；有童年逆境經驗的AS患者佔79.2%，其中首次發生童年逆境經驗的平均年齡為10.35 ± 4.17歲；研究樣本中，高復原力者居多，其次依序為低復原力、中復原力者。研究發現AS患者之童年逆境經驗分數越高，其健康狀態顯著越差，而復原力越好，其健康狀態則顯著較佳；當控制疾病持續時間、運動頻率、服用免疫調節或生物制劑頻率、近一個月壓力知覺程度等變項後，童年逆境經驗仍可預測其健康狀態，且童年逆境經驗分數越高，中重度健康功能障礙的風險越高。經統計排除復原力的影響後，童年逆境經驗和首次發生童年逆境經驗的年齡對AS患者的健康狀態未具有交互作用之影響；在控制與復原力和脊椎關節炎健康指數的相關變項後，復原力於AS患者的童年逆境經驗和其健康狀態間具有中介效果，並使用Sobel test和PROCESS macro model 4皆顯示具中介效果。研究結論：僵直性脊髓炎患者的健康狀態與其童年逆境經驗、復原力有關；童年逆境經驗可預測AS患者的健康狀態；復原力於AS患者的童年逆境經驗和其健康狀態具有中介效果。本研究結果有助於臨床專業了解童年逆境經驗、復原力對AS患者產生的影響，並為臨床專業提供患者相關協助與心理治療之參考，同時本研究亦強調了解童年逆境經驗造成的結果以及跨領域間創傷知情合作的重要性。

關鍵字

僵直性脊椎炎；童年逆境經驗；復原力；脊椎關節炎健康指數

並列摘要

Purpose Adverse Childhood Experience (ACE) is long-term distress that may trigger disease risk factors that worsen symptoms in patients with Ankylosing Spondylitis (AS), and resilience may be an important protective factor. However, there is currently no research on the relationship between the three; Therefore, this study aimed to explore the relationship among childhood adverse experiences, resilience, and health status in patients with Ankylosing Spondylitis. Methods A cross-sectional study with purposive sampling was adopted. One hundred and twenty adult patients with Ankylosing Spondylitis were recruited from the Immunology Rheumatology of Chung Shan Medical University Hospital. Data were collected by structured self-report questionnaire, including the Chinese-Version of Adverse Childhood Experiences Questionnaire, Connor-Davidson Resilience Scale, an ASAS Health Index (ASAS HI), and Environmental factors related to ASAS Health Index. Statistical methods include Pearson Correlation, ANOVA, ANCOVA, Independent t-test, Multiple regression, Binary Logistic Regression, and Multinomial Logistic Regression. This study was approved by the Institutional Review Board of Chung Shan Medical University Hospital. Results A total of 120 AS patients were recruited in this study, among whom there were more males than females; according to ASAS HI classification, those with normal health function were the majority, followed by moderate impairment of functioning, and severe impairment of functioning. AS patients with childhood adversity experience accounted for 79.2%, and the average age of the first childhood adversity experience was 10.35 ± 4.17 years old; in the research sample, most of the patients had high resilience, followed by low resilience and moderate resilience. The study found that the higher the adverse childhood experience score of the research sample, the worse the health status; the better the resilience of the research sample, the better the health status. After controlling for disease duration, exercise frequency, frequency of taking immunosuppressive agents or biopharmaceuticals, and stress perception in the past month, the adverse childhood experience in AS patients can predict their health status, and the risk of impairment of functioning increases with an increasing number of ACE. After excluding the effect of resilience. The adverse childhood experience and the age of first exposure to adverse childhood experiences didn't have an interaction with the health status of AS patients. Resilience was partial mediation between adverse childhood experience and health status in AS patients after controlling for variables associated with resilience and ASAS health index, using Sobel test and version 4.1 of the PROCESS macro model showed that the mediation effect was also significant. Discussion Adverse childhood experience and resilience of AS patients are significantly correlated with their health status; adverse childhood experience can predict the health status of AS patients; resilience has a mediating effect on AS patients' adverse childhood experience and their health status. The results presented in this study aid will provide clinical professionals with an understanding of the impact of adverse childhood experiences and resilience on AS patients. Meanwhile, it provides clinical professionals with a reference for patient assistance and psychotherapy. The result also emphasizes the importance of understanding the consequences of adverse childhood experiences and trauma-informed collaboration across domains.