失智症照顧者支持團體之統合分析研究

Caregiver Support Groups in Patients With Dementia: A Meta-Analysis

簡伶育(Ling-Yu Chien)

指導教授 ： 周桂如

臺北醫學大學/護理學院/護理學研究所/碩士(2010年)

摘要

目的：評值支持團體對於失智症照顧者的成效，並探討支持團體研究的特徵對效果量的影響。
樣本來源：廣泛蒐集西元1998至2009年間以英文發表之研究，電子資料庫包含Cochrane Library、Medline、PUBMED、PsycARTICLES、PsycINFO、ERIC、Ageline、CINAL及Psychology and Behavioral Sciences Collection。
樣本選擇：支持團體包含相互支持團體、教育心理團體及教育訓練團體，針對失智症非專業照顧者成效評值之英文量性文獻，共篩選出30篇（真實驗與類實驗）控制試驗研究。成效指標為照顧者之心理健康、憂鬱、負荷及社會結果。
資料登錄：由兩位評分者分別獨立進行文章篩選及資料登錄，登錄特徵包含方法特徵、介入特徵及參與者特徵，並進行研究的品質評估，檢視統合分析的結果是否受到研究品質的影響。
結果：整體來說，支持團體對於照顧者之心理健康（Hedge’s g＝-0.44；95％CI＝-0.73，-0.15）、憂鬱（Hedge’s g＝-0.40；95％CI＝-0.72，-0.08）、負荷（Hedge’s g＝-0.23；95％CI＝-0.33，-0.13）或社會結果（Hedge’s g＝0.40；95％CI＝0.09，0.71）都有其正面且顯著的效果。有無使用理論、團體期程與總時數的不同會顯著影響心理健康及憂鬱效果量的大小；女性參與比例（為心理健康、憂鬱）、平均年齡（為社會結果）的顯著預測變項。支持團體特徵變項經組間的比較，在心理健康及憂鬱結果上有相似的發現：隨機抽樣方法、高品質研究、教育心理團體、有使用理論、團體大小6∼10人、有使用團體手冊、團體期程≧8週且團體總時數≧16小時、有進行追蹤測量、中度失智症患者的照顧者、多專業背景領導者的特徵可獲得顯著且較高的改善效果；而在負荷結果上：教育訓練團體、團體期程≧8週且團體總時數＜16小時的特徵可獲得顯著且較高的改善效果，其餘特徵與心理健康及憂鬱有一致性的結果。
結論：支持團體對照顧者「心理健康」、「憂鬱」、「負荷」及「社會結果」是有助益的，可以作為未來臨床工作者及研究者進行介入時的參考指引。

關鍵字

失智症 ； 照顧者 ； 支持團體 ； 統合分析

並列摘要

Objectives: To evaluate the efficacy of such intervention and identify characteristics associated with intervention efficacy.
Data Sources: Nine peer reviewed databases including Cochrane Library, Medline, PUBMED, PsycARTICLES, PsycINFO, ERIC, Ageline, CINAL, and Psychology and Behavioral Sciences Collection, were searched for controlled trials, preferably randomized, published in English from 1998 to 2009 inclusive.
Study Selection: Studies on dementia caregiver support groups including mutual support groups, psychoeducational groups, as well as education and training programs were included. Thirty (20 randomized and 10 nonrandomized) controlled trials from English quantitative journal literatures that met inclusion criteria were selected.
Data Extraction: Two reviewers independently identified trials, reviewed relevant articles, extracted data and compiled tables of intervention and participant characteristics and results associated with intervention efficacy, appraised the methodological quality of the trials, and summarized results. The outcome indicators of intervention include caregiver’s psychological well-being, depression, burden, and social outcomes.
Results: All in all, support groups have a positive and significant effect on psychological well-being (Hedge’s g = -0.44; 95%CI = -0.73, -0.15), depression (Hedge’s g = -0.40; 95%CI = -0.72, -0.08), burden (Hedge’s g = -0.23; 95%CI = -0.33, -0.13), and social outcomes (Hedge’s g = 0.40; 95%CI = 0.09, 0.71) of dementia caregivers. The effects of psychological well-being and depression is significantly influenced by different factors, including theories, and duration and intensity in support groups. The proportion of female participant is an obvious predictor for psychological well-being and depression, while mean age predicts social outcomes. By comparing the characteristics of support groups, our analysis indicated that psychological well-being and depression of caregivers benefit significantly under the condition of random sampling, high quality research, psychoeducational groups, the use of theories and manual, the group size limitation of six to ten members, intensity and duration of no less than 16 hours and lasting longer than 8 weeks of the support group, patients with moderate dementia, and the leader with interdisciplinary background. On the other hand, support groups can also have a greater and obvious effect on caregivers’ burden under the condition of education and training programs, intensity and duration of no more than 16 hours and lasting more than 8 weeks of the support group. Other characteristics have identical influences on psychological well-being and depression of caregivers.
Conclusions: Support groups are beneficial to caregivers of dementia patients in terms of psychological well-being, depression, burden and social outcomes. Our result provides future clinical workers and researchers with a useful reference.

並列關鍵字

Dementia ； Caregiver ； Support group ； Meta-Analysis

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