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  • 學位論文

評估精神疾病患者之自我污名與對抗污名程度:使用精神疾病自我污名量表

Assessing internalized stigma and stigma resistance in individuals with mental illness: An investigation using the Internalized Stigma of Mental Illness Scale

指導教授 : 連盈如

摘要


目的: 過去研究顯示許多精神疾病患者,尤其是診斷為精神分裂症患者本身,主訴其自我污名程度偏高,上述現象會影響到疾病的預後。最近幾年以來與精神疾病相關研究逐漸將注意力轉移到與對抗污名相關課題上。所謂對抗污名指的是個體本身對抗精神疾病污名的能力。本次研究的主要目的在於評估在華人社會裡,患有精神分裂症及其他精神疾病的患者,其自我污名及對抗污名程度,以及這兩者與其他精神疾病預後相關因子之間的關連性。 方法: 本研究共計納入160位受試者,每位受試者分別是罹患不同診斷的精神疾病。在評估階段時給予受試者施測自填量表,而這些自填量表是用於評估個體本身自我污名、污名對抗,主觀污名感受、自尊、自我效能、憂鬱症狀及無望感等程度。 結果: 依據因素分析所呈現的結果顯示自我污名及對抗污名兩者本身概念是截然不同,同時另外因素分析的結果也驗證了自我污名測量的多面向性。此外,自我污名及對抗污名彼此之間呈現負相關,而且這兩者與其他精神疾病預後相關因子的相關性在統計上呈現相反的方向性。本次結果也顯示有精神病診斷與無精神病診斷的兩組患者之間其自我污名程度有明顯差異,而在對抗污名程度方面兩組之間則無顯著差異。 討論: 在從事精神疾病相關研究上,保有適當的評量工具用於評估自我污名及對抗污名程度是非常重要的。本次研究結果顯示精神疾病自我污名評估中文版量表,是一種可信賴及有效地針對精神疾病患者評估自我污名及對抗污名程度的評量工具。

並列摘要


Objective: Research has revealed that many patients with mental illness such as schizophrenia experience elevated internalized stigma (IS), which affects many recovery-related outcomes. Recently, attention moved to stigma resistance (SR), an individual’s capacity to battle against the stigma of mental illness. This study aimed to investigate the extent of internalized stigma (IS) and stigma resistance (SR) in patients with schizophrenia and other mental illness and to examine the relationship among IS, SR, and psychiatric variables in Han Chinese population. Method: A total of 160 outpatients with (n = 103) and without (n = 57) psychotic disorders were recruited and administrated with the Chinese version of the Internalized Stigma of Mental Illness Scale (ISMIS-C), which is one of the few instruments available to measure IS and SR simultaneously, and measures of perceived stigma, self-esteem, self-efficacy, depressive symptoms, and hopelessness. Results: Our factor analysis supported the concept distinction between IS and SR. The results also provided the evidence for the use of IS four subscales. IS and SR subscale scores were significantly associated with each other and with other psychiatric measures. Our data also demonstrated that the scale was ultimately found to be able to differentiate between psychotic and non-psychotic samples with different degrees of IS, but not with SR. Conclusions: Assessment of IS and SR using an appropriate instrument is a crucial aspect in the context of mental health. Our findings provided evidence supporting that the ISMIS-C is a reliable and valid measure for the assessment of IS and SR among individuals with mental illness.

參考文獻


Han DY, Chen SH (2008) Psychometric properties of the Perceived Psychiatric Stigma Scale and its short version. Formosa Journal of Mental Health 3: 273-290.
Angermeyer M, Matschinger H (2003) Public beliefs about schizophrenia and depression: similarities and differences. Social Psychiatry & Psychiatric Epidemiology 38(9): 526-534.
Assefa D, Shibre T, Asher L, Fekadu A (2012) Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study. BMC Psychiatry 12: 239.
American Psychiatric Association (2000) Diagnostic and statistical manual of mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.
Beck AT, Weissman A, Lester D, Trexler L (1974) The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology 42: 861-865.

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