精神分裂症患者之烙印與差別待遇經驗調查研究

Survey of stigma and discrimination experiences among people with schizophrenia

張志誠(Chih-Cheng Chang)

指導教授 ： 呂宗學

國立成功大學/醫學院/公共衛生研究所/碩士(2010年)

摘要

研究背景：儘管精神分裂症患者深受精神疾病烙印的影響，但過去台灣本土的相關研究甚少。同時，我們對於影響病患負面差別待遇的因子並不清楚。

研究目的：針對台灣精神分裂症患者的烙印與差別待遇經驗盛行現況進行研究，並找出可能影響患者負面差別待遇經驗的社會人口及臨床特性因子。
研究材料與方法：我們使用差別待遇與烙印量表來進行橫斷面調查，總共有205位某綜合醫院精神科的精神分裂症患者完成面對面的問卷訪談。

研究結果：有超過八成的精神分裂症患者受到烙印與差別待遇的影響。最常發生的負面差別待遇經驗為刻意迴避(20%)、交友方面(18.5%)、鄰里之間(17.6%)。最常見的預期差別待遇依序為隱瞞精神健康問題不被他人發現(48.8%)、放棄擁有親密關係(28.3%)、放棄應徵工作(24.4%)。超過八成的患者認為自己無法使用個人技巧來應付烙印與差別待遇。患者的精神症狀嚴重度會影響患者的負面差別待遇經驗，而性別、年齡、教育程度、工作狀態、宗教信仰、居住狀態、居住地區都市化程度、婚姻狀態、過去是否有精神科強制住院經驗、是否了解自己診斷、目前精神科治療型態、抗精神病藥物使用種類、抗精神病藥物使用途徑等對患者的負面差別待遇經驗皆無顯著的影響。

結論：臨床工作人員必須將精神疾病烙印影響列入病患的常規評估內，並幫助患者減少烙印的影響。未來研究應該再進一步探討精神症狀嚴重度和負面差別待遇經驗的因果關係及影響患者預期差別待遇及克服烙印程度的因子。

關鍵字

精神分裂症 ； 精神疾病 ； 烙印 ； 差別待遇 ； 台灣

並列摘要

Background: Although mental illness stigma has a strong impact on people with schizophrenia, we had little related studies in Taiwan. Also, the factors associated with negative experienced discrimination were not clear.

Objective: We did a prevalence study of stigma and discrimination experiences among people with schizophrenia in Taiwan. We also investigated the relationship between sociodemographic and clinical characteristics and negative experienced discrimination.

Materials and methods: We used discrimination and stigma scale (DISC-12) to do a cross-sectional survey. A total of 205 participants with schizophrenia from general hospitals were interviewed by face-to-face.

Results: More than 80% of people with schizophrenia were influenced by mental illness stigma and discrimination. The most common situations of negative experienced discrimination were being avoided or shunned (20%), making or keeping friends (18.5%), and treating unfairly by people in the neighborhood (17.6%). The most common situations of anticipated discrimination were concealing mental health problems from others (48.8%), stopping to have a close personal relationship (28.3%) and stopping to apply for work (24.4%). More than 80% of people with schizophrenia were unable to use personal skills or abilities in coping with stigma and discrimination. The severity of psychiatric symptoms, but not other demographic and clinical characteristics such as gender, age, education level, current employment status, religious belief, current living situation, urbanization level of living area, marital status, past history of psychiatric compulsory treatment, knowing the diagnosis, current type of mental health care, the type of antipsychotic treatment and the route of antipsychotic were associated with negative experienced discrimination.

Conclusions: Clinicians should assess the effect of mental illness stigma as part of the routine work-up for patients with mental illness, and help patients reduce the effect of stigma ontheir lives. Further research should investigate the causal relationship between the severity of psychiatric symptoms and negative experienced discrimination and assess the factors related to anticipated discrimination and overcoming stigma.

並列關鍵字

schizophrenia ； mental illness ； stigma ； discrimination ； Taiwan

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