手足罹患思覺失調症之壓力因應模式

The Coping Style of Siblings of Persons With Schizophrenia

徐開慧(Kai-Huei Syu)

指導教授 ： 王慶福

中山醫學大學/醫學科技學院/心理學系暨臨床心理學碩士班/碩士(2015年)

摘要

過去研究中指出思覺失調症患者之主要照顧者的身心負荷對其本身健康造成影響，故除了病患本身之外，其家人也成為必須受到關注與照顧的族群。本研究目的在於了解健康手足經歷手足罹患思覺失調症所承受之壓力、採取的因應策略及其適應結果，期待透過本研究建構手足罹患思覺失調症特有的壓力因應模式。本研究以年齡介於22至30歲之間，並至少有一位手足罹患思覺失調症之健康手足為研究對象，以半結構深度訪談蒐集資料，以現象學取向進行整體描述及主題分析。
根據受訪者的整體描述，歸納了手足罹患思覺失調症的描述脈絡，包含以下共通點：華人文化的家庭關係、手足的疾病樣態及健康手足如何面對患病手足。從描述文中可發現受訪者們的家庭關係符合華人傳統觀念，面對手足罹病亦有彼此相似的心路歷程。
主題分析結果發現，手足罹患思覺失調症引起之壓力包含情緒感受、社會文化的衝擊、照顧上的壓力、擔心家人的生活、對未來的擔憂，研究者針對華人的家庭文化及疾病病程兩項重要面向將壓力加以統整說明與討論。因手足罹病而採取的因應策略包含：尋求協助、主動了解及提供協助、操之在我、無積極作為。將策略再聚焦於單純因患病手足引起的壓力之因應策略，包括：以問題解決為中心的因應、對專業人員的需求高、華人的家族觀念為認知上最重要的調適、宗教對慢性及預期的壓力有支持性。
本研究以Lazarus 與 Folkman的認知評估模式將手足罹患思覺失調症之壓力因應模式依階段性呈現，依序為：認知評估過程、因應方法、實際因應、適應結果及影響各階段之內外在資源。在上述過程中，受訪者會不斷調整現實與理想之間的差距並反思壓力本身的意義以及對自己造成的影響，足可說明壓力因應之認知評估乃是一動態交互的歷程。
本研究針對前述質性研究結果，對醫療團隊的實務工作及未來研究提出建議。

關鍵字

手足 ； 思覺失調症 ； 壓力因應模式

並列摘要

Previous studies showed that heavy burdens could influence health of schizophrenia patient’s caregiver. In this case, family members became whom should be concerned and cared about besides the patients. This study aimed to understand the stresses suffered by people whose siblings have been through having schizophrenia, their coping strategies and adjustment. We expect to construct the stress coping model specific for people whose sibling suffered from schizophrenia. The study invited subjects whose age were between 22 to 30, with at least one sibling having schizophrenia. The research data were collected by semi-structural interviews. We investigated and analyzed the qualitative data by phenomenological approach and thematic analysis. .
The result of thematic analysis indicated that the stress suffered by people whose siblings have schizophrenia included emotional effect, social culture impact, stress of taking care of the patients, the worry for the family’s life and for the future. Two important factors were integrated: Chinese family culture and disease process. The coping strategies include asking for help, find out actively, offering assistance, solving problems by oneself, and doing things passively. Focusing on the stress induced by sick siblings, we conclude four coping strategies: problem-solving coping style, reliance on professionals, adjusting cognitively themselves to Chinese family concept and supporting from religion when having chronic and predictable stress.
Basing on the Lazarus and Folkman’s cognitive appraisal model, we present the coping style that people suffered from the sibling have schizophrenia. The sequences are: the process of cognitive appraisal, coping method, adjustment result, internal and external resources. In the above process, subjects continually adjusted themselves to the gap between the reality and ideality. They try to enhance self-aware on the meanings and influences of stresses. Therefore, cognitive appraisal coping model is the dynamic process. At last, this study made suggestions for the clinical practice and future study.

並列關鍵字

sibling ； schizophrenia ； stress coping model ； thematic analysis

參考文獻

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