日間型及住宿型精神復健機構中思覺失調症個案之生活功能、社會功能及生活品質探討

研究背景與目的：思覺失調症對個案的生活功能、社會功能及生活品質造成很大的影響，而社區精神復健為減緩症狀和失能對個人影響，使個案盡可能如常地生活在社區中的治療模式。台灣的社區精神復健機構分為社區復健中心(日間型)及康復之家(住宿型)兩類，國內外目前缺乏探討不同類型精神復健機構中個案特性、功能及生活品質的研究，本研究目的為瞭解並比較社區復健中心及康復之家思覺失調症個案之人口學、臨床特徵、生活功能、社會功能及生活品質，並探討影響社區精神復健機構中思覺失調症個案生活功能、社會功能及生活品質的影響因素，以作為建議較佳安置，及提升社區復健機構服務品質之參考。研究方法：研究對象為台北市、新北市、宜蘭縣等地2015至2017年評鑑合格且督導考核甲等以上6家社區復健中心及康復之家中，79位思覺失調症個案（社區復健中心40位，康復之家39位）。由機構專業人員填寫個案基本資料表、簡短精神症狀評量表(The Brief Psychiatric Rating Scale, BPRS)、巴氏量表(Barthel Index)、工具性日常生活功能量表(The Lawton Instrumental Activities of Daily Living (IADL) Scale)及精神病患社會功能量表(The Social Function Scale-Taiwan short form, SFST)等，另由研究人員評估台灣簡明版世界衛生組織生活品質問卷(WHO Quality of Life-BREF, WHOQOL-BREF)及簡短智能測驗(Mini-Mental State Examination, MMSE)。資料蒐集完成後，比較兩類型機構個案在人口學、臨床特徵與表現、生活功能（巴氏量表、工具性日常生活量表）、社會功能、及生活品質(WHOQOL-BREF)等之差異，並以多變項迴歸分析，探討影響思覺失調症社區個案生活功能、社會功能及生活品質之相關因素。研究結果：社區復健中心的個案平均年齡較康復之家個案輕、發病年齡較早、罹病年數較短(p<0.001)，且受教育年數較久(p<0.01)，但家庭支持度較差、慢性疾病的罹患率較高(p<0.05)，均達顯著差異。評量結果中，社區復健中心組的精神症狀程度較重(p<0.01)、但認知功能較佳(p<0.05)，社會功能較好(p<0.05)，均達顯著差異，但兩組在生活功能和生活品質兩個層面則沒有顯著差異。迴歸分析結果顯示：IADL功能與社會功能量表總分(β=0.07, p < 0.001)呈顯著正相關；而社會功能的迴歸分析結果顯示與IADL量表總分呈顯著正相關(β=5.01, p < 0.001)；在各範疇之生活品質迴歸分析結果顯示，BPRS總分愈高（精神症狀愈嚴重）其在生理健康、心理、社會關係、環境等四個範疇的生活品質愈差(p<0.05)。結論：本研究為首篇比較社區復健中心與康復之家兩類機構中思覺失調症個案功能與生活品質的研究。社區復健中心與康復之家雖同屬精神復健機構，但角色功能定位不同康復之家可能因人力緊縮，難以提供顧及個案獨立性和個別性的復健服務。期望本研究的初步結果可提供未來政策擬定和服務提供的參考。另本研究發現精神症狀的嚴重程度是影響不同面向生活品質的重要因子，因此加強個案的疾病管理是社區精神復健機構非常重要的服務內容。

關鍵字

思覺失調症；社區復健；精神復健機構；生活功能；生活品質

並列摘要

Background and aims: Schizophrenia has a great impact on the individual on the daily function, social function, and quality of life. Community psychiatry rehabilitation is one of the interventions which remit the impact of symptoms and disability on the individual and allows the individual to live in the community as normal as possible. There are two kinds of community psychiatry rehabilitation institutions in Taiwan: community rehabilitation centers (daycare type) and half-way houses (accommodation type). Currently, researches to explore the characteristics, functions, and quality of life of the individual from the different types of community psychiatry rehabilitation institutions in Taiwan are insufficient. The purposes of this study were to understand and compare the demographic, clinical characteristics, daily functions, social functions, and quality of life of the individuals with schizophrenia from the community rehabilitation centers and the half-way houses, and to explore the correlated factors of their daily function, social function and quality of life. Methods: The subjects in this study were 79 people with schizophrenia from Taipei City, New Taipei City, Yilan County, who receive services from 6 community rehabilitation centers and half-way houses which have been rated as A-level and above accreditation from 2015 to 2017 (40 staying in community rehabilitation centers and 39 living in the half-way houses). The general information form, Brief Psychiatric Rating Scale (BPRS), Barthel Index, Lawton Instrumental Activities of Daily Living (IADL) Scale, and Social Function Scale - Taiwan Short Form (SFST) were completed by the staffs of the institutions, and the researcher assessed the WHO Quality of Life-BREF, WHOQOL-BREF and Mini-Mental State Examination (MMSE). After the data collection was completed, comparing the differences between the subjects of the two types of institutions in demographics, clinical characteristics, daily function (Barthel Index, The Lawton Instrumental Activities of Daily Living (IADL) Scale), social function(SFST), and quality of life (WHOQOL-BREF). Multivariate regression analysis was used to explore the factors that influence the life function, social function, and quality of life of subjects. Results: Compare to those living in the half-way houses, the average age of the subjects staying in community rehabilitation centers was younger, the age of onset was earlier, the number of rickets is shorter (p < 0.001), and the number of years of education was longer (p <0.01), but family support was poorer, the chance of suffering from chronic disease was higher (p < 0.05), and all the differences were significant. Among the assessment results, the community rehabilitation center group had a higher severity of psychotic symptoms (p <0.01), but better cognitive and social function (p<0.05), , and all the differences are significant. But there were no significant differences in daily function and quality of life between the two groups. The results of regression analysis showed that the IADL function was positively correlated to the total score of SFST (β = 0.07, p < 0.001), and the regression analysis results of social function showed a positive correlation with the total score of the IADL scale (β = 5.01, p < 0.001). The regression analysis of quality of life in each category showed that the higher the total score of BPRS (the more severe psychosis symptoms), the worse quality of life in physiological, psychological, social relationships and environment (p < 0.05). Conclusions: This study was the first to compare the function and quality of life of people with schizophrenia between the community rehabilitation centers and the half-way houses. The half-way houses may be manpower-tightened and it is difficult to provide rehabilitation services that take into account the individual’s independence and individuality. It is expected that the preliminary results of this study will provide a reference for future policy development and service delivery. In addition, this study found that the severity of psychotic symptoms is an important impact factor to the quality of life in all aspects. Therefore, strengthening clients’ ability of illness management is a very crucial in the community psychiatry rehabilitation institutions.