憂鬱傾性、親密關係與乳癌術後婦女身體意象關係之探討

To Explore the Relationship of Depressive Disposition, Intimacy Relation, and Postmastectomy Breast Cancer Women’s Body Image

胡至家(Chih-Chia Hu)

指導教授 ： 張娟鳳 ； 林耀盛

高雄醫學大學/健康科學院/行為科學研究所/碩士(2005年)

摘要

本論文的目的在探討乳房切除術後乳癌婦女身體意象、憂鬱傾性、親密關係方面的現況，及諸變項之間的相關性，以及其重返生活世界後的生命經驗。
本論文由三個子研究所構成；研究對象為南部某醫學中心乳房切除術後的乳癌婦女。以研究一所自編之「身體意象量表」，暸解國內乳房切除術後的乳癌婦女身體意象的狀況；同時以美國「流行病學中心－憂鬱量表」的中文版本，評估乳癌術後復婦女的憂鬱傾性；研究二並以「成年早期婚姻親密量表」，探討乳癌術後婦女目前的親密關係。本論文之量化研究以描述性統計、獨立樣本t檢定、單因子變數分析、雪費氏事後比較、卡方檢驗、邏輯迴歸分析、路徑分析等統計方式進行資料分析。本論文之研究三，採質性訪談的方式，暸解乳癌術後婦女的生命經驗。
本論文之研究結論，綜述如下：（一）研究一共蒐集到214份有效問卷。「身體意象量表」中「未重建組題項」之量表信度達.9331，量表切截分數為58.35分；而「重建組題項」之信度達.9594，切截分數為72.60分。超過量表切截分數表示「身體意象差」。（二）「身體意象量表」共可抽出四個因素結構：整全的身體、性化的身體、私密的身體、社會的身體。而質性的訪談資料，則將「身體意象」的內涵層次概念，從「徵候的身體」到「自我的身體」，再到「他者的身體」，最後推向為「生活世界的身體」。（三）研究二共蒐集到88份有效問卷。在未重建組的研究樣本中，「身體意象差」佔39.00％（16人）；而重建組的研究樣本中，則佔31.90％（15人）。（四）乳癌術後婦女身體意象的表現，會受到自覺疾病嚴重度與害怕復發程度的影響；而與患者的年齡、乳房切除術後的時間，及是否施行乳房重建等變項較無關。（五）研究二中「高憂鬱傾性」者佔37.50％（33人），且「高憂鬱傾性」的患者有較不好的身體意象。除了憂鬱情緒之外，從訪談資料可以看到許多更為複雜的情緒。（六）「成年早期婚姻親密量表」共可抽取五個因素：精神的親密、身體的親密、性慾的親密、社會的親密與情感的親密。研究二中「低婚姻親密」者佔47.73％（42人），且「低婚姻親密」的患者有較不好的身體意象。乳癌術後婦女，在生活中經驗到親密關係的轉變。有些訪談個案表述疾病對於性生活的直接衝擊。（七）經邏輯迴歸分析後發現，高憂鬱傾性、低婚姻親密及低社會的親密等變項，為乳癌術後婦女身體意象差的重要預測變項。（八）路徑分析的結果顯示，不論是透過直接或是間接的方式，「憂鬱傾性」對於乳癌術後婦女身體意象的形成，皆具重要的影響力。

關鍵字

親密關係 ； 憂鬱傾性 ； 乳房切除術後乳癌婦女 ； 身體意象

並列摘要

The purpose of this paper was to explore the condition of the postmastectomy breast cancer women’s body image, depressive disposition, and intimacy relation, and the relationship among each variable, and the live experience after return to their live world.
The research of this paper was constituted by three parts. Participants of this research were the postmastectomy breast cancer women of one hospital center in Southern Taiwan. In order to evaluate the depressive emotion, marital intimacy, and the body image that postmastectomy breast cancer women presently perceived. “Body Image Scale(BIS)” which build by researcher, the American “Center of Epidemiology Study- Depression Scale(CES-D)” Chinese edition, and “Marital Intimacy Inventory(MII)” were been used. Descriptive statistics, Independence t Test, One-Way ANOVA, Scheffe Post Hoc Tests, Chi-Square Test, Logistic Regression, and path analysis were utilized to analysis quantitative data. The third study used the method of qualitative research to explore the live experience of the postmastectomy breast cancer women.
The conclusions of this paper revealed that (1)There were 214 valid questionnaires been collected in the first study. In BIS, the reliability of “No Reconstruction Item” is .9331; the cut-off point of scale is 58.35. The reliability of “Reconstruction Item” is .9594; the cut-off point of scale is 72.60. The score over cut-off point means “poor body image”. (2)The BIS could be extracted four factors: whole body, sexualize body, privacy body, and social body. The qualitative interview data let the concept of “body image” from “symptom body” to “self body”, then to “others body”, at lastly to “live world body”. (3)There were 88 valid questionnaires been collected in the second study. Participants of no reconstruction group had 39.00% (16 persons) were “poor body image”, and of reconstruction group were 31.90% (15 persons). (4)Subjective extent of severity and the fear of recurrence show significantly difference in the performance of the postmastectomy breast cancer women. But it would be less relation about the variables as the patient’s age, the time after the mastectomy, and they accepted the breast reconstruction or not. (5) In the second study, there had 37.50% (33 persons) participants were "high depressive disposition", they had the more poor body image. Besides the depressive emotion, the qualitative interview data revealed much more complicated emotions. (6)The MII could be extracted five factors: spiritual intimacy, physical intimacy, sexual intimacy, social intimacy, and affection intimacy. There had 47.73% (42 persons) participants were “low marital intimacy”, and they had the more poor body image. The postmastectomy breast cancer women experienced the change of intimacy relation in the live. There were some interviewees narrated the directly impact of the illness to sexuality. (7)By the Logistic Regression analysis, high depressive disposition, low marital intimacy, and low social intimacy are the most important variables to predict poor body image in postmastectomy breast cancer women. (8)The result of path analysis indicated that whether through directly or indirectly effect, “depressive disposition” have important impact to body image in postmastectomy breast cancer women.

並列關鍵字

depressive disposition ； body image ； intimacy relation ； postmastectomy breast cancer women

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