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  • 學位論文

家屬情緒表露與智能障礙者合併精神症狀之相關研究

The Relationship between Expressed Emotion of Relatives and Intellectual Disability with Psychiatric Symptoms

指導教授 : 譚偉象

摘要


研究背景和目的:情緒表露(Expressed Emotion,簡稱EE)是透過家屬對病人所表現的情緒態度所定義出具信度及向量化的測量概念,主要包括情緒過度涉入及批評兩個因子,許多研究支持EE與精神分裂症、焦慮疾患和情感性疾患復發之間有顯著的關連,能有效地預測精神疾病患者的復發率,可做為家庭介入的治療模式,是影響精神疾患復發或病發的社會心理因子及臨床重要指標。近期研究加入歸因、文化及汙名化等因素,並拓展到許多不同診斷的族群。智能障礙者合併精神疾患診斷的可能性很高,家屬的EE和智能障礙者的行為問題之間有著雙向效應(bidirectional effects),本研究期待探討家屬EE和智能障礙者合併精神症狀之間的關係,並且加入家屬對智能障礙歸因、家庭汙名化和照顧焦慮等因素進行探索。 研究方法:本研究採橫斷性(cross-section)相關研究,立意取樣台灣北部地區的智能障礙者家屬(N=117),填寫家庭問卷(Family Questionnaire,FQ)、照顧焦慮量表、家庭汙名化問卷(Family Stigma Questionnaire,FSQ)、智能障礙歸因問卷、成人發展性障礙精神症狀檢核表(PAS-ADD Checklist),以線性回歸及結構方程模式進行統計分析。 研究結果:家屬對智能障礙的可控制、穩定性歸因,以及家庭汙名化的受沾汙因子、照顧焦慮透過的情緒表露,影響智能障礙者合併精神症狀的表現,家屬情緒表露是智能障礙者合併精神症狀的顯著預測因子(p < .001),家屬情緒表露越高,智能障礙者的精神症狀檢核表分數也越高。家庭汙名化的受沾汙對於照顧焦慮有顯著的預測力(p < .05),家屬對於智能障礙可控制歸因透過情緒過度涉入影響情緒表露,而穩定性歸因則透過批評因子影響情緒表露。依結構方程模式分析,本研究資料與研究架構具有良好的模式適配度〔χ2(38) =52.769, p > .05〕。 討論:智能障礙者家屬的情緒表露與智能障礙者合併精神症狀有顯著關連性,家庭汙名化、對智能障礙者歸因的認知因素和照顧焦慮與家屬情緒表露有著密切關連性,可作為探討智能障礙者情緒表露歸因模式的歸因因素。

並列摘要


Background and purpose: Expressed Emotion (EE) is a measurement of the emotional attitudes that a relative holds toward a particular family member, which is a reliable and dimensional concept. It includes Emotion Overinvolvement (EOI) and Critical Comments (CC). Many studies support a significant correlation between EE and relapse of schizophrenia, anxiety disorder and mood disorder. EE is an important clinical indicator of the psychosocial factor. It can effectually predict the relapse of mental disorder, and be an intervention focus in family therapy. Recent research also includes other factors such as attributions, culture, and stigma, and expands EE’s applicability into groups with different diagnoses. Individuals with intellectual disability (or mental retardation) are commly comorbid with psychiatric symptoms. Bidirectional effect may exist between the EE of the families and behavior problems of the those with intellectual disability. The purpose of this research is to investagate the relationship between the relatives’ EE and intellectual disability with psychiatric symptoms. Other research variables include relatives’ attribution toward the intellectual disability, family stigma, and care anxiety. Method: This is a cross-sectional correlation study. The participants were recruited purposefully from the relatives of individuals with intellectual disability in Northern Taiwan (N=117).They were administered the Family Questionnaire(FQ), Care Anxiety Scale, Family Stigma Questionnaire(FSQ), Attribution of Mental Retardation Questionnaire, and the Psychiatric Assessment Schedule for Adults with Developmental Disability Checklist (PAS-ADD Checklist). Linear regression and structural equation model (SEM) were applied as the method of statistical analysis in this study. Result: The effects of the families’ attribution toward the mental retardation (stability and controllability), family stigma (contamination) and care anxiety on the psychiatric symptoms of inviduals with the intellectual disability were mediated by expressed emotion (EE). The higher families’ EE, the higher was the score on PAS-ADD Checklist (p < .001). Family contamination could predict care anxiety(p < .05); the controllability attribution toward mental retardation affected EE via EOI, and stability attribution affects EE via CC. Base on the result of SEM, it suggested appropriate fit between the data and research model of this study〔χ2(38) =52.769, p > .05〕. Disscussion: There was a statistically significant correlation between the relatives’ expressed emotion and psychiatric symptoms of individuals with intellectual disability. Family stigma, attribution toward mental retardation, and care anxiety related closely with EE. They could be the factors of the EE attribution model.

參考文獻


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被引用紀錄


鄭曉儀(2011)。「重度身心障礙者診斷性評估工具第二版(DASH-II)」應用在台灣重度智能障礙者之信效度研究〔碩士論文,中原大學〕。華藝線上圖書館。https://doi.org/10.6840%2fCYCU.2011.00209

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