憂鬱症患者其青少年手足的生活經驗

Abstract

全球憂鬱症的罹患人口逐漸攀升，憂鬱症相關議題的研究亦隨之增加。檢視台灣近年來有關於憂鬱症家庭的研究，發現多將研究重心置於患者或是成年的主要照顧者身上，手足同樣身為家庭的一份子，相形之下卻鮮少獲得學術研究的關注，在憂鬱症患者家屬的文獻資料中，常常不包括手足的身影，健康手足成為了家中的隱形人物。<br> 研究目的在於探討憂鬱症患者的青少年手足，在患者從罹病開始到就醫治療的過程中，個人主觀經驗的覺察、適應以及和患者之間手足關係的轉變。以質性研究為方法，採取一對一訪談的形式來收集資料，共訪問了四位憂鬱症患者的青少年手足，受訪者年齡介於19-21歲且尚在學。研究結論分為以下五個主題：<br> 1.健康手足從「未知」到「知後」受到影響：手足受到正負面的影響，正面影響包括是自覺成熟、懂得包容、有耐心。而負面影響較直接反應在個人心理情緒上，包括：壓力、難過、想哭、愧疚等等。生理方面出現易醒、睡眠中斷和身體疲勞狀況。受訪者多選擇以向家人、朋友傾訴來增進適應，但未必得到良好調適。 2.家庭功能無法有效運作：家庭氣氛顯得凝重、衝突漸多、家庭規則逐漸被打破、家庭溝通模式間接且侷限、資源取得單一化，並且手足在醫療方面參與率低，整體變化影響了家庭功能的正常發展與運作。 3.健康手足的社會發展危機：為了陪伴、教導患者，健康手足漸無暇參與同儕社交性的聚會或活動。對於患者的病情，手足會選擇性地告知朋友，交友模式改變。 4.社會烙印感受不深：手足並未因患者的罹病而感受到高程度的社會烙印。 5.手足關係可能增進也可能拉遠：發病前的手足互動關係牽連著發病後的關係，父母對待的態度和健康手足的認知交互作用後產生影響。<br> 最後依據結論與討論提出建議，呼籲家庭加強衛生教育，並促進良好家庭溝通。專業人員之間結合運作，主動提供憂鬱症患者、健康手足及整體家庭服務。

More research has been conducted to address depressive disorders, as the number of people afflicted with the disorder around the world is rising. Going through recent studies in Taiwan, however, one can easily find the focus is rarely on the siblings of patients. Most studies only pay attention to patients and the main caregivers, often disregarding the role of healthy siblings, who in turn become ‘invisible’ in the family.<br> The purpose of this research is to better understand the subjective experience of healthy adolescent siblings, how they adapt to the reality that their sisters or brothers have been ill, and how the relations among siblings change. This research adopted the qualitative research method to collect information through one-on-one interviews. The participants were between 19-21 years old, and still students. The research findings were divided into five themes:<br> 1.Adolescents are affected after knowing their siblings are afflicted with depressive disorders: Influences are both positive and negative. In terms of positive impacts, some consider themselves more mature, tolerant, and patient. On the other hand, the negative ones are mostly related to personal emotions and feelings, including huge stress, sadness, the inclination to cry, and feeling sorry for ill siblings. Some participants also admit they wake up more easily, tend to suffer from sleep discontinuance, and often feel exhausted. To get more adapted, most participants choose to talk to their family or friends, which only works in some cases. 2.The family cannot function well: The whole family is affected by the stressful atmosphere. Conflicts become usual and rules are broken. The communication within family members is limited and indirect. Resources are few, and participants rarely take part in any facet of the treatment that their ill siblings have been through. 3.Adolescents face social development crises: Participants tend to spend time accompanying and teaching ill siblings at the expense of their opportunities to take part in social activities. In addition, adolescents are inclined to hide part of the information about their ill siblings when talking to friends. 4.Only a slight stigma is perceived: Participants do not feel a heavier stigma attached to them, even after their siblings were diagnosed with depressive disorders. 5.The relations among siblings can improve or worsen: How siblings get along before one of them has depressive disorder and parents’ attitude towards the illness will affect how the relations among siblings change afterwards.<br> In conclusion, this research calls for the reinforcement of health education, direct communication among family members, and cooperation among professionals in different fields to actively provide services and advice for patients with depressive disorders, healthy siblings, and the whole family.