憂鬱症患者及主要照顧者健康照護與社會照顧需要之探討研究

The health care and social care needs for patients and primary caregiver with depression

吳芯慧(Hsin-Huel Wu)

指導教授 ： 葉玲玲

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

憂鬱症是長期慢性的精神疾病，造成患者身體與精神等各方面功能下降，主要照顧者在照護上也承受相當大的壓力與負擔，精神健康照護體系在提供照護時應同時考量憂鬱症患者以及主要照顧者的各層面需要。因此本研究目的在探討憂鬱症患者及主要照顧者照護患者所引發健康照護與社會照顧需要。以中部某醫學大學附設醫院身心科門診及住院憂鬱症患者及主要照顧者為研究對象，採面對面深度訪談法、觀察法及全程錄音收集資料，收案時間從2006年2月到2006年5月止，共訪談七對憂鬱症患者及主要照顧者。以質性研究方法的紮根理論研究法進行資料分析與整理。
研究結果發現照顧者面對患者發病狀況所引發健康照護需要包括24小時精神科急診、固定諮詢者與憂鬱症病房。照顧者面對患者疾病穩定時所引發健康照護需要包括日間病房、居家照護及居家附近的社區復健中心等七項；患者之健康照護需要為憂鬱症病房住院需要與居家照護服務。憂鬱症患者所接受門診醫療服務希望減少候診時間可以先報到先看診。覺得需要再長一點時間和醫師談內心的話等。憂鬱症患者所接受住院醫療服務，患者與照顧者表示曾因需要住院沒有病床要等床，或曾因想住院但沒有憂鬱症適合的病房，住院無法針對患者個別性需要作治療規劃等。
照顧者照護患者所引發社會照顧需要包括憂鬱症相關知識、照顧技巧、照護準則、支持系統、家事服務、居家喘息及機構喘息等十一項。患者之社會照顧需要包括憂鬱症相關資訊、憂鬱症相關團體、支持系統等六項。患者與照顧者表示不清楚剛發病症狀是憂鬱症徵象或症狀，不知道如何尋求協助或該看哪科，經常有求助無門的感覺。患者確診後，照顧者不能相信憂鬱症是一種疾病，覺得是患者自己胡思亂想；患者本身也不瞭解為什麼被診斷憂鬱症，覺得自己只是比較容易煩惱，好像不是罹患憂鬱症。因此民眾仍不清楚什麼是憂鬱症，對民眾憂鬱症教育與宣導不足。
依本研究結果建議規劃多元性社區照顧資源提供照顧者照顧上協助與支持。憂鬱症患者看診需要再長一點時間與醫師談內心的話，針對患者住院需要建議增設憂鬱症病房，以及對民眾提供憂鬱症相關知識衛教，提升民眾對憂鬱症的認識。對未來研究建議針對不同地理區域或年齡層探討憂鬱症患者及主要照顧者需要，以瞭解地理區域或年齡層不同需要是否有差異，以提供精神健康照護體系發展全人照護之參考。

關鍵字

憂鬱症患者、主要照顧者、需要、紮根理論、質性研究

並列摘要

Depression disorder is a chronic mental illness which will reduce functions in body and mental. The primary caregivers also have large burden and pressure in caring patients. Mental health care system should consider the need of the depression patients and the caregivers in the same time when providing services. The purpose of this research was to discuss the need of the depression patients and the primary caregivers in health care needs and social care needs. The seven couples of the depression patients and their primary caregivers were collected from a psychiatric outpatient department and hospitalization in Taichung from February to May in 2006. The data gather by face to face depth interviewing, observation and documental and was analyzed by grounded theory to get the results.
The results revealed that the health care needs were requisite including 24-hour psychiatric emergency, primary consultant and depression wards for primary caregivers in facing acute conditions. Moreover, the other services were also needed including day care center, home care and neighboring community rehabilitation center for primary caregivers in facing stable conditions. The health care needs for the patients were depression ward hospitalization and home care. However, the needs of outpatient services were to diminish the waiting time to see a doctor and more time to communicate with the doctor. The hospital could not provide personal treatment such as available hospital beds and appropriate wards for depression disorder.
The social care needs for the caregivers were 11 categories including knowledge, techniques, care principle, support system, household service and respite care. The social care needs for the patients were 6 categories including associate information, teams and support system. The patients and the caregivers usually felt helpless due to uncertain about the original symptom and how to seek help. The people get insufficient information for the depression disorder and the depression patients diagnosed were also confused this disease.
The results suggested that it is necessary to provide multiple assistances by communal service for caregivers in this study. It is also suggested that more time for patient communicating with doctors, more depression wards especially for patients, and more information for people education were needed.
The future work will focus on the different needs of the depression patients and the primary caregivers among the different areas and among the different age groups to provide information for mental health care system.

並列關鍵字

depression patient、primary caregiver、need、grounded theory、qualitative research

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