慢性精神障礙者活動參與和就業現況之相關性探討

The study of the correlation between activity participation and employment for persons with chronic mental illness in Taiwan

陳雅玲

指導教授 ： 吳亭芳

國立臺灣師範大學/教育學院/復健諮商研究所/碩士(2009年)

摘要

世界衛生組織在2001年提出國際功能、障礙、健康分類(International Classification of Functioning, disability, and Health，簡稱ICF )，將「活動參與」列為描述健康的要素之一。本研究以ICF的「活動參與」為架構發展「慢性精神障礙者活動參與和就業現況」問卷，內容包括基本技能與一般任務、自我照顧與居家生活、溝通與人際互動、社區生活等4大活動領域。以其「參與」和「困難」程度來預測就業現況。
研究者運用問卷調查法，以台灣北、中、南部的精神醫療機構或社區復健中心與康復之友協會之慢性精神障礙者為主要對象，共回收194份問卷。其中82位為過去一年有工作的就業組和112位超過一年無工作的未就業組。以描述統計、獨立樣本t檢定和邏輯式回歸分析進行資料處理。其研究結果如下：

1. 就業組在4項活動參與顯著高於未就業組，就業組在4項活動困難程度也顯著低於未就業組。
2. 有工作之慢性精神障礙者，其薪資普遍較一般人低。再比較不同安置模式，其平均薪資和工作時間，都是競爭性就業高於支持性和庇護性；但在工作維持時間部份，雖呈現庇護性大於支持性，再大於競爭性，然此差異並未達顯著。
3. 中度障礙程度的慢性精神障礙較易獲得工作，但多安置在支持度高的庇護性就業。
4. 慢性精神障礙者的「活動參與程度」和「活動困難程度」呈現顯著中度負相關。
5. 以「活動參與程度」和「困難程度」預測就業因子，其中有4項具有預測力，最佳預測力為「社區生活參與程度」，其次是「社區生活困難程度」、「溝通與人際關係參與程度」和「溝通與人際關係困難程度」。

建議未來精神復健專業人員從事慢性精神障礙者在職業重建時除了參考精神症狀及自我照顧能力外，應參考其社區生活、溝通與人際關係來增加其有效安置。

關鍵字

慢性精神障礙者 ； ICF ； 活動參與 ； 就業現況

並列摘要

The World Health Organization has recently focused attention on activity participation with the development of the new International Classification of Functioning, Disability and Health (ICF; WHO, 2001).In this framework, activity participation has been considered as an important concept of health. The purpose of this study is to understand the correlation between activity participation and employment for persons with chronic mental illness in Taiwan.
194 persons with chronic mental illness, age between 18 – 64 years, from psychiatric outpatients, day care centers, sheltered workshops, community rehabilitation centers and half-way houses participated this study. A self-designed questionnaire based on ICF framework, including four activity participation subscales and four activity limitation subscales was used to collect data. Among all the participants, 82 persons with chronic mental illness were in a paid job recently, and 112 were unemployed in the pass year. Data was analyzed by SPSS 12.0. The results indicated the flowerings:
1. Participants who were employed had significantly greater scores in activities participations than those unemployed.
2. The salaries of persons with chronic mental illness were lower than the legally minimal salaries. Among three different job placement models, the average salaries and working hours per week of persons who were hired in competitive employment were highest followed by supported employment, and sheltered employment.
3. Persons with moderate degree of mental illness were easier to get a job than persons with mild degree or with the insurers for a major injury/illness and usually were placed in sheltered workshops.
4. The scores of “activity participation” and” activity limitation” were significantly negative correlation in moderate degree.
5. Among four activity participation scores and 4 activity limitation scores, as the predictors, only 4 significantly predicts to work conditions. The community paticipation is the best predictor, followed by limitation of community participation, participation of communication and social interaction, and limitation of communication and social interaction.
Vocational rehabilitation practitioners should consider self-care skills, communication and social interaction skills, and community participation of clients with chronic mental illness when making the decision of job placement.

並列關鍵字

persons with chronic mental illness ； ICF ； activity participation ； work

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