重鬱症病人身體疼痛、情緒狀態、睡眠品質與社會支持對再入院之探討

The relationships between physical pain, emotional state, sleep quality and social support among rehospitalization in major depressive disorder patients

林美蓮(Lin-Mei Lien)

指導教授 ： 陳芬如

義守大學/醫學院/醫務管理學系/碩士(2016年)

摘要

背景：憂鬱症是盛行率甚高的一種疾病，復發比率高達50%以上。重鬱症治療目
標，已逐漸趨向功能性復原與降低復發率。但病人在重返社區過程中，經常
面臨許多阻礙與困難，導致適應不良再度入院。
目的：本研究目的為探討重鬱症病人身體疼痛、情緒狀態、睡眠品質與社會支持對
再入院之相關性。
方法：採前瞻性縱貫性研究設計，以立意取樣選取南部某醫學中心，120位精神科
重鬱症住院病人為研究對象，以多種結構式問卷為工具收集資料，於出院時
進行基準點以問卷量表測試，依每位病人出院日往後追蹤五個月，記錄其再
次入院情形，並再次檢測再入院病人的身體疼痛、情緒狀態、睡眠品質與社
會支持變化。資料以卡方檢定、獨立樣本t檢定、成對樣本t檢定和二元邏
輯斯迴歸進行統計分析。
結果：研究結果顯示重鬱症病人再入院比率為46.6%，平均再入院天數為34.69天
(SD=49.94)，再入院與未再入院病人之身體疼痛強度 (p=.022) 與情緒
狀態 (p=.007) 有顯著差異；再入院病人因有較嚴重疼痛強度
(p=.012) 、惡化情緒狀態 (p<.001) 、較差睡眠品質 (p<.001) 和較
低社會支持 (p=.007) 再度入院；惡化的情緒狀態(p=.021,
OR=1.021, 95% CI=1.003~1.039) 與醫事人員所提供社會支持不足
(p=.009, OR=1.144, 95% CI=1.034~1.266) 為重鬱症病人再入院之
預測因子。
結論：出院時的情緒狀態與獲得醫事人員所提供社會支持，可預測重鬱症病人的再
入院情形，因此可成立個案管理制度或運用資訊科技互動，追蹤關懷病
人出院後的情緒變動。

關鍵字

重鬱症 ； 身體疼痛 ； 情緒狀態 ； 睡眠品質 ； 社會支持 ； 再入院

並列摘要

Background：Major Depression is a very high prevalent disease with a recurrence rate up to 50%. Main goals of depression treatment have been gradually shifted to functional recovery and reduction of the relapse rate. However, the major depression patients were often rehospitalization due to poor adaptation and mainly resulting in many obstacles and difficulties they faced when return to community.
Purpose: This study intended to investigate the correlation of physical pain, emotional state, sleep quality and social support in major depression patient rehospitalization.
Method: This study was a prospective longitudinal study, designed to purposive sampling 120 major depression inpatients in the south medical center. A designed structured questionnaires were used and the dutum point was patients discharge date, subjects were followed up for five months after discharge and rehospitalization case was record and patient physical pain, emotional state, quality of sleep and social support variety were remeasured. Data were analyzed by using the chi-square test, independent samples t-test, paired samples t-test and binary logistic regression statistical analysis.
Result: The study results showed that major depression patients' rehospitalization rate was 46.6% among five months after discharge, the average days for rehospitalization was 34.7 days (SD=49.94). There were significant differences in physical pain intensity (p=.022) and emotional state (p=.007) between patients with rehospitalization and patients without rehospitalization. The rehospitalized patients had severe pain intensity (p=.012), worse emotional state (p<.001), poor sleep quality (p<.001) and less social support (p=.007) on readmission day compared with status on discharge day. The worse emotional state (p =.021, OR=1.021,95% CI=1.003~1.039) and inadequate social support sources from medical personnel (p=.009,OR=1.144, 95% CI=1.034~1.266) predicted the patients' rehospitalization.
Conclusion: This study result showed that occurrence of major depression patients' rehospitalization related to patients' emotional status on discharge and the support from healthcare staffs. We suggested that to establish a case management syatem or using Information Technology to provide home care interaction after patient discharged to follow and evaluate the patients' emotional status.

並列關鍵字

major depression ； physical pain ； Mood disorder ； sleep quality ； social support ； rehospitalization

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