慢性精神病患者之主要照顧者其照顧負荷、健康控制信念、因應型態對生活品質之影響

The influence of caring burden, health locus of control and coping style of the chronic mental disorder’s primary caregivers on their quality of life.

林玫珍(Mei-Chen Lin)

指導教授 ： 黃君瑜

中原大學/理學院/心理學研究所/碩士(2013年)

https://doi.org/10.6840/cycu201300897

摘要

摘要
精神疾病的治療模式在強調去機構化及社區復健之後，照護的重擔從專業醫護人員轉嫁到家庭照顧者身上，令其產生不少照顧負荷的感受。過去的研究多聚焦於照顧者的照顧負荷與生活品質之間的關係，較少對照顧者的適應歷程做探討。因此，本研究的目的為：了解在照顧負荷之下，照顧者的健康控制信念以及因應型態對其生活品質之影響。方法：本研究以四個社區復健機構中診斷為精神分裂症以及躁鬱症之慢性精神病患之主要照顧者為研究對象，利用「照顧者負荷量表」、「簡明因應量表」、「多向度健康控握量表」、「台灣簡明版世界衛生組織生活品質問卷」為研究工具，利用問卷調查方式蒐集121位主要照顧者之資料。結果：(1)趨近型態因應以及逃避型態因應對於客觀負荷預測整體生活品質以及環境範疇生活品質具有中介的效果；對於心理範疇的生活品質而言，則只有趨近型態的因應具有中介效果。(2)趨近型態因應以及逃避型態因應二者在健康控制信念對整體生活品質以及環境範疇生活品質的預測上具有中介的效果；逃避型態因應在健康控制信念對生理健康範疇的預測上具有中介的效果。(3)趨近型態為照顧負荷與健康控制信念預測整體生活品質、生理健康範疇、心理範疇的中介變項；趨近以及逃避兩種型態的因應則為照顧負荷與健康控制信念預測社會關係範疇生活品質的中介變項。結論：慢性精神病患者之主要照顧者的照顧負荷及所持的健康控制信念均會影響其生活品質，而因應型態在其處理照顧任務的壓力過程中具有重要的角色。在臨床實務中，實務工作者可多關注主要照顧者的照顧負荷問題，協助主要照顧者覺察所持的健康控制信念，了解其健康控制信念對適應及生活品質造成的影響，並且介入教導主要照顧者學習利於適應的因應型態，處理在投入照顧患病家人的過程中所感受到的負荷、壓力，以提升其生活品質。

關鍵字

主要照顧者 ； 照顧者負荷 ； 慢性精神病 ； 因應型態 ； 健康控制信念 ； 生活品質

並列摘要

Abstract
The care burden of the chronic mental disorders is now passed from the medical profession unto the patient’s family as the psychiatric treatment models put emphasis on deinstitutionalization and community rehabilitation，and on that account, the family caregivers feel much more burdensome. The past researches focused more on the relationship of the caregiver’s care burden and the life quality than on the caregiver’s adaptation process. Therefore, the purpose of this study is: to understand the effect on the caregiver’s life quality by their health locus of control and the coping styles under the care load. The Methods: in this study, the research objects are the caregivers of the chronic mental disorders who are diagnosed as schizophrenia and bipolar disorder in four community rehabilitation agencies, and using "Caregiver Burden Scale", " Brief COPE ", " health locus of control scale ",and" WHOQOL-BREF Taiwan Version "as the research tools to collect 121 primary caregivers questionnaire information. The results: (1) there are mediating effect on the global and environmental aspects of the life quality as caregivers use the approaching and avoidant coping styles to deal with their objective care load; as to the psychological aspects of the life quality, only the approaching coping style produces the mediating effect.(2) The health locus of control’s effect on the global and environmental aspects of the life quality has been mediated by the approaching and avoidant coping styles ; as to the effect on the physical health, it only have been mediated by the avoidant coping style. (3) The effect of the care load and the health locus of control on the global and psychological aspects of the life quality and the physical health has been mediated by the approaching copying style; both the approaching and avoidant copying styles are the mediating variables as using the care load and the health locus of control to predict the life quality of the social relationship aspects. The Conclusions: The caregiver burden and health locus of control of the chronic mental patient’s family will affect their quality of life, and the coping style plays an important role in its task of handling the pressure of caring. In clinical practice, practitioners may be concerned about the caregiver burden of the family and help them to perceive their own health locus of control, and to understand the effect of their health locus of control to the quality of life. Practitioners can teach the primary caregivers to learn proper coping styles to adapt the burden of caring the illness family, and to improve their own quality of life.

並列關鍵字

caregiver burden ； chronic mental disorder ； quality of life ； coping style ； health locus of control ； primary caregivers

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