探討慢性精神病患的性健康及影響因素

本研究旨在瞭解慢性精神病患的性健康，包括性功能、安全性行為、性生活滿意度和兩性互動的現況及問題；並探討個人屬性、疾病及藥物治療因素對於性健康的影響。收案場所為南部某一所醫學中心和一所教學醫院的精神科日間留院病房及居家照護單位，採橫斷性調查研究，使用自擬的結構式問卷，以訪談方式於2014年4月至6月進行資料收集，共收集182份有效問卷，有效反應率為94.8﹪，以描述性及推論性統計法進行資料分析。研究結果發現：79.1﹪的個案是單身，僅18.7﹪近半年有性交行為，而38.5﹪完全無性活動。男性有性活動的比率是女性的三倍。在自覺性功能及性生活滿意程度方面，男性滿意目前性生活有35.8﹪，女性則有59.8﹪；男性或有使用鎮靜/安眠/抗焦慮藥物的病患在性生活滿意度得分顯著偏低。個案對執行安全性行為的把握度之標準化得分為65.5分，精神症狀嚴重度分數越高在安全性行為把握度得分顯著越低；有「性」相關困擾時能尋求正確資源協助的把握度，完全無把握者有34.1﹪。兩性互動問題之調適程度標準化得分是61.2分，單身或精神症狀嚴重度分數越高在兩性互動問題之調適程度得分顯著偏低；認為「自己要交男（女）朋友是一件很困難的事」是個案最困擾的問題，同意者達42.9﹪。訪談中個案希望被協助的性健康問題以兩性互動占最多。最多個案提及精神疾病導致社會大眾對他們有異樣眼光，精神症狀讓他們社交退縮，難以交到異性朋友，也影響性生活滿意度。根據本研究結果，建議醫護人員對個案的性健康問題，應積極主動介入評估並給予個別化的照護，以提升照護品質。

關鍵字

慢性精神病患；性功能；安全性行為；性生活滿意；兩性互動；性健康照護

並列摘要

OBJECTIVE: The aim of this study was to investigate current condition in four aspects of sexual health including sexual function, safe sexual behavior, sexual satisfaction and interaction between genders in patients with chronic mental illnesses. Moreover, we explored the personal characteristic and disease history difference in sexual health. METHODS: A cross-sectional study with a self-administered structured questionnaire given in a one-to-one interview was conducted. A total of 182 patients were recruited in this study, which were from psychiatric day care units and home care units. The study data was analyzed by descriptive and inferential statistics. RESULTS: About 79﹪ of patients in the study were single. Only 18.7% had sexual behavior in the past six months, and 38.5% were totally asexual life. The proportion of male patients with regular sexual activity was three times higher than female patients. With regards to self-reported sexual function and sexual satisfaction, 35.8% of male patients and 59.8% of female patients were satisfied with their current sexual life. Males, or patients who used sedatives, hypnotics or anxiolytics, had a significantly lower score in the aspect of sexual satisfaction. Moreover, in all patients in the study, the standard score of confidence to conducting safe sexual behavior was 65.5, and the score was significantly lower with higher points of Clinical Global Impression - Severity scale (CGI-S). As for the level of confident of being able to search appropriate sources if they confronted sexual problems, 34.1% of patients absolutely no confidence. The standard score of contentment in interaction between genders was 61.2, and the single person or those with a higher CGI-S score had a significantly lower level of contentment. 42.9% of patients agreed that getting a boyfriend or girlfriend was very difficult, and it was the most frustrating problem to them. In the interview, we found that the most concerned which the patient hope to resolve was the interaction between genders. Most patients mentioned that the psychiatric disorders cause the general public to cast a disapproving eye, make the patient socially withdrawn and have difficulty to make friends, and finally affect the sexual satisfaction. CONCLUSIONS: According to our study, we recommend that the health care providers should routinely evaluate the personal sexual health problems of patients and give individualized care to promote the quality of care.