心衰竭病患復原力、憂鬱、自我照護行為與生活品質之關係

研究背景與目的：慢性心衰竭病患因生理功能損傷以及擔心預期預後，常伴有憂鬱情緒，進而影響生活品質。自我照顧行為可以改進慢性心衰竭預後，亦是對自我健康負責的關鍵，而病患的心理狀態，會影響自我照顧行為。復原力則是個體在面對負向壓力或生理疾病時，成功適應改變或恢復心理、情緒健康的正向情緒；良好的復原力，可以有較佳精神狀態來面對疾病、改善生活品質。因此，本研究目的為探討慢性心衰竭病患復原力、憂鬱、自我照顧與生活品質的相關，此外本研究探測以下假說（1）憂鬱在復原力與生活品質心理構面的關係中扮演中介變項角色；（2）自我照顧行為的自信心在復原力與生活品質生理構面的關係中扮演中介變項角色；（3）控制干擾變項後，復原力會獨立影響生活品質的心理構面；（4）控制干擾變項後，復原力會獨立影響生活品質的生理構面。方法：本研究採橫斷式描述性相關性研究設計，收取住院與門診慢性心衰竭病患共86位個案，採問卷調查方式進行資料收集。研究工具包括中文版復原力量表、中文版貝克憂鬱量表第二版、臺灣繁體中文版心衰竭自我照顧量表第六版與SF-36臺灣版生活品質評估量表。結果：復原力（r＝ .35, p＜ .001）、憂鬱（r＝- .57, p＜ .001）、自我照顧行為維持（r＝ .26, p＝ .015）與生活品質心理構面呈顯著相關，復原力（r＝.37, p＜ .001）、自我照顧行為自信（r＝ .26, p＝ .015）與生活品質生理構面呈顯著相關；控制憂鬱，復原力與生活品質心理構面淨關係下降（r： .09, p＝ .4）；控制自我照顧行為自信，復原力與生活品質生理構面淨關係些微下降（r： .29, p＝ .006）；控制干擾變項後，復原力可獨立影響生活品質心理構面（β＝ .26, p＝ .011）與生理構面（β＝ .22, p＝ .038）。結論：憂鬱是復原力與生活品質心理構面關係的中介變項；自我照顧行為自信在復原力與生活品質生理構面中扮演部分中介角色；復原力可以獨立影響生活品質心理與生理構面。

關鍵字

復原力；憂鬱；自我照顧行為；生活品質

並列摘要

Background and Purpose：Chronic heart failure (CHF) patients may experience poor quality of life (QOL) and various degrees of depression due to impaired physical functioning and uncertainty of prognosis. Self-care management can improve the prognosis of CHF patients. Resilience is a positive mood and can help an individual successfully adapt to changes and restore mental health in face of stress or physical illness. It also would improve patients’ QOL. Presently, there are few studies examining the relationships among resilience, depression, self-care and health-related QOL in patients with CHF. The purpose of this study was to examine the relationship among resilience, depression, self-care, and QOL in CHF patients. The hypotheses of this study were：1. Depression is a mediator in the relationship between resilience and the mental aspect of QOL; 2. Confidence of self-care is the mediator in the relationship between resilience and the physical aspect of QOL; 3. When confounding variables are controlled, resilience would independently affect the mental aspect of the QOL; and 4. When confounding variables are controlled, resilience would independently affect the physical aspect of QOL. Methods：This study used a cross-sectional, correlational design. In total, 86 CHF inpatients and outpatients were recruited. Participants filled out the Resilience Scale, Beck Depression Inventory-II, Self-care of Heart Failure Index, 36-item Short Form Health Survey. Results：The results showed that resilience (r= .35, p< .001), depression (r=- .57, p< .001) and maintenance of self-care (r= .26, p= .015) were significantly associated with the mental aspect of QOL. Resilience (r=.37, p< .001), confidence of self-care (r= .26, p= .015) were significantly associated with the physical aspect of QOL. When depression was controlled, the relationship between resilience and the mental aspect of QOL was obliviated (r= .09, p= .4). When confidence of self-care was controlled, the relationship between resilience and the physical aspect of QOL was slightly decreased (r= .29, p= .006). When confounding variables was controlled, resilience independently predicted the mental (β= .26, p= .011) and physical ( β= .22, p= .038) aspects of QOL. Conclusion：Depression was a mediator in the relationship between resilience and the mental aspect of QOL. Confidence of self-care partially mediated the relationship between resilience and the physical aspect of QOL. Resilience independently predicted both the mental and the physical aspects of QOL.