認知障礙症患者之照顧者的照顧負荷、依戀關係、孝道信念與心理幸福感之關係研究

研究目的：認知障礙症患者由於認知功能逐漸退化，隨著病程進展導致日常生活功能經常需要他人協助，加上行為精神症狀干擾，照顧者需花費大量時間協助患者，因此經常感到照顧負荷，並對身心健康造成威脅。而在華人的文化社會中，孝順父母是普遍的價值觀，子女對孝順父母抱持的態度也與幸福感有關，此外照顧者與接受照顧者的依戀品質也會影響其幸福感。因此本研究旨在探討認知障礙症患者之照顧者，照顧負荷、依戀關係、孝道信念與心理幸福感之間的關聯。研究方法：本研究採橫斷研究設計，採用立意取樣，於長照機構、失智社區服務據點、網路社群，使用調查法以結構式問卷進行資料蒐集。研究對象為認知障礙症患者之照顧者，共取得99份有效問卷。研究工具包含照顧負荷量表、雙元孝道量表、親密關係體驗量表、心理幸福感量表。研究資料以描述性統計、t檢定、變異數分析、皮爾森積差相關、階層回歸分析進行統計分析。研究結果：本研究結果顯示，認知障礙症患者之照顧者自評經濟條件較差、每日照顧時數較高、非採用輪流照顧方式的照顧者有較高的照顧負荷。照顧負荷、依戀焦慮與心理幸福感呈現低度負相關；依戀迴避與心理幸福感呈現中度負相關；相互性孝道與心理幸福感呈現中度正相關。在控制照顧者年齡、婚姻情況、經濟條件後，僅有依戀迴避、相互性孝道可以預測照顧者整體心理幸福感。依戀迴避程度越高，心理幸福感越低；相互性孝道認同程度越高，心理幸福感越高。結論與建議：相較於照顧負荷，依戀迴避與相互性孝道認同程度對照顧者整體心理幸福感更具預測效果，因此在探討認知障礙症患者之照顧者身心健康議題時，照顧者與接受照顧者關係親密程度、照顧者對侍奉父母所抱持的價值觀會是更需要關注的焦點。

關鍵字

認知障礙症；照顧負荷；依戀關係；孝道信念；心理幸福感

並列摘要

Purpose: Neurocognitive disorder patients often need assistance from others for their daily living, due to the progress of the disease and the degenerative of cognitive functions. Additionally, the interference of behavioral and psychological symptoms to the patients requires caregivers spend extra time to assist them. Therefore, feeling the burden of care often poses a threat to the caregivers’ physical and mental health. In Chinese culture, filial piety is a universal value. The attitude of adult children towards filial piety is also related to their well-being. In addition, the quality of attachment between caregivers and the care recipients also affects their well-being. In this instance, this study aims to investigate the relationships between caregiver burden, attachment relationships, filial piety, and well-being, in the cases of caregivers of patients with neurocognitive disorder. Method: This study adopted a cross-sectional design and utilized structured questionnaires to collect data from long-term study facilities, dementia community service sites, and an online community. A total of 99 valid questionnaires were collected from caregivers of patients with neurocognitive disorders. The measurement includes Chinese Version of the Caregiver Burden Inventory, Dual Filial Piety Scale, Chinese Version of the Experiences in Close Relationships Scale, and the Psychological Wellbeing Scale. The data were analyzed by descriptive statistics, t-tests, one-way ANOVA, Pearson Correlation, and hierarchical regression analysis. Result: This study showed that caregivers of patients with neurocognitive disorders had lower self-rated economic status, higher care hours per day, and caregivers who did not alternatively look after their parents had a higher degree of burden. Furthermore, caregiver burden, attachment anxiety was negatively correlated with psychological well-being. Attachment avoidance showed a moderate negative correlation with psychological well-being. Reciprocal filial piety also showed a moderate positive correlation with psychological well-being. After caregivers' age, marital status and economic condition were controlled, attachment avoidance and reciprocal filial piety are able to predict caregivers' psychological well-being. Caregivers with higher attachment avoidance showed lower psychological well-being, while caregivers with higher reciprocal filial piety showed higher psychological well-being. Conclusion: Compared to caregiver burden, the degrees of attachment avoidance and reciprocal filial piety are more predictive of the psychological well-being for caregivers. In this case, when considering the physical and mental health of caregivers of patients with neurocognitive disorders, the experiences in a close relationship between the caregiver and care recipients, and the caregiver's value for serving their parents should be taken into account.