中風者之憂鬱與宗教態度、宗教因應及靈性的關係：以本土宗教為例

The relationsphips of stroke patiens’ depression with religious attitudes, religious coping , and spirituality: A study on indigenous religions.

蔡馥好(Fu-Hao Tsai)

指導教授 ： 譚偉象

中原大學/理學院/心理學研究所/碩士(2013年)

https://doi.org/10.6840/CYCU.2013.00104

摘要

研究背景與目的：中風病人常因失能與家庭角色改變而有適應上的困難，最常見的情緒疾患為中風後憂鬱(post stroke depression)，臨床盛行率約33%，對復健效果及社會功能造成顯著負面影響。臨床實務發現，宗教提供生命意義與心靈慰藉的功能，是中風病人常作為適應病後生活的支持資源，西方實證研究也指出，宗教、正向宗教因應策略與靈性安適感能提升個體健康及心理狀態，對慢性疾病者更是預防憂鬱情緒發生的重要因子。以民間信仰為主的臺灣本土宗教信仰長期以來融入生活，人們常藉求神問卜及祈求平安來解決生活中的疑問，與西方宗教差異甚大，基於本土宗教信仰之特性，本研究嘗試探討本土宗教信仰的中風者，其憂鬱情緒與宗教態度、宗教因應及靈性安適的關係。

研究方法：採立意取樣之問卷調查研究，以一對一晤談方式完成問卷。於醫學中心收案樣本數137人，均符合世界衛生組織之中風診斷準則。收案條件：(1)符合中風診斷；(2)中風三個月以上；(3)年齡45歲以上；(4)本土宗教信仰者(包含佛教、道教、一貫道及一般民間信仰)；(5)能使用國台語溝通，可理解並依循指令要求；(6)MMSE>20。以相關分析、多變量變異數分析與結構方程模型探討憂鬱和研究各變項(包含人口統計學變項)之關係。

研究工具：「受試者基本資料表」、「宗教態度量表」、「簡短版宗教因應量表」、「靈性安適感量表」及「貝克憂鬱量表中文版第二版」。

研究結果：(1)本土信仰中風者的宗教態度與靈性安適感有顯著正相關，宗教態度能預測較高的宗教安適感；宗教態度與憂鬱之關係不顯著；(2)正向宗教因應與靈性安適、憂鬱之關係不顯著，但負向宗教因應可預測存在安適感及憂鬱；(3)宗教態度與正向宗教因應有顯著正相關；(4)宗教安適與憂鬱之關係未達顯著，存在安適可預測憂鬱情緒；(5)宗教因應雖能預測憂鬱，對靈性安適也有直接影響，但作為中介變項之效果量未達顯著，在本研究中宗教因應並非宗教態度與靈性安適、憂鬱之中介變項。

討論：對中風患者而言，宗教態度會同時提高患者使用正向或負向宗教因應的傾向，且能預測較高的宗教安適感，較高的存在安適感則與較低程度憂鬱有顯著相關。而負向宗教因應可以預測較高的憂鬱情緒與較低的存在安適感，可能對患者帶來不利的影響。

關鍵字

靈性 ； 中風 ； 中風後憂鬱 ； 宗教性 ； 宗教因應 ； 宗教 ； 中風後情緒適應

並列摘要

Background and Purpose─ Stroke patients often have difficulties in adaptation due to their disability and changing roles in family. Post-stroke depression is the most common mood disturbance, and its clinical prevalence is approximately 33%. It is also associated with significant negative consequences including poor rehabilitation outcomes and social functions. In practical experiences, religious beliefs were found to have the benefits of providing meanings of life and spiritual comforts. Most stoke patients often used religions as supportive resources to help overcome life problems after stroke. Western published empirical data suggested that religions, positive religious coping strategies, and spitirual well-being had positive associations with both mental and physical health outcomes. Moreover, religious belief is an important factor in preventing chronic illness patients to have depression. Taiwan indigenous religions are predominantly based on folk beliefs, which are closely related to everyday living, and thus people often ask Gods for prophecies, or pray for safe and well when facing real-life difficulties. Based on the characteristics of the indigenous religions and the differences between Western and Eastern religions, this study investigated the relationships among stroke patients’ depression, religious attitudes, religious coping, and spirituality with a Taiwan sample.

Methods─ Participants, who were recruited by purposive sampling method, were interviewed one by one and completed the required instruments individually. All 137 patients satisfied the WHO criteria for stroke. The inclusion criteria were as follows: (1)with primary diagnosis of stroke; (2) 3 months after stroke onset; (3) older than 45 years old; (4) have Taiwan indigenous religious beliefs (including Buddhism, Taoism, I-Kuan Tao, and Taiwan Folklore Belief); (5) can communicate with Chinese or Taiwanese, understand commands and follow orders; and (6) MMSE>20. Correlation analysis, MANOVA, and structural equation model (SEM) were used to examine the relationships between depression and the other variables.

Instruments─ Religious attitudes were assessed with the Religious Attitude Scale. Religious coping was assessed with the Brief Religious Coping Scale. Spirituality was assessed with the Spiritual Well-Being Scale, and depressive symptoms were assessed with the Beck Depression Inventory-II (Chinese version).

Results─ (1) Religious attitudes had significant positive correlation with spiritual well-being. Religious attitudes predicted higher religious well-being, but no siginificant relation was found between religious attitudes and depression. (2) No significant relation was found between positive religious coping with both spiritual well-being and depression. Negative religious coping predicted lower existential well-being and higher level of depression. (3) Religious attitudes had strong positive correlation with positive religious coping. (4) Lower existential well-being predicted higher level of depression, but no significant relation was found between religious well-being and depression. (5) Although religious coping predicted depression and had direct effect on spiritual well-being, its mediating effects between religious attitudes with both depression and spiritual well-being were not significant.

Conclusion─For the stroke patients who had indigenous religious beliefs, religious attitudes enhanced the tendency of using both positive and negative religious coping as coping strategy. Higher level of religious attitudes predicted higher religious well-being, and higher existential well-being was correlated with lower level of depression. On the other hand, negative religious coping predicted higher level of depression and lower existential well-being, which might bring negative outcomes to patients.

並列關鍵字

religion ； stroke ； post-stroke depression ； religious attitudes ； depression. ； indigenous religions ； spiritual well-being ； religious coping

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