乳癌婦女的身體心像、性功能與憂鬱症狀之關聯性

Abstract

背景：乳癌是台灣女性癌症發生率第一位，雖然早期乳癌存活率高，但治療副作用導致身體心像改變與性功能障礙，使乳癌婦女面臨心理與社會壓力產生憂鬱症狀。即使進入追蹤存活期，仍持續受憂鬱症狀困擾著。憂鬱症狀除影響治療遵從性，嚴重更可能危及生命。近年以乳癌婦女為研究對象，針對身體心像、性功能與憂鬱症狀間關係及其內在關聯之研究欠缺，因而引發本研究進一步探究乳癌婦女身體心像、性功能與憂鬱症狀的影響並釐清其影響路徑。 目的：本研究旨在探討乳癌婦女身體心像、性功能與憂鬱症狀之關聯及其中介效應。 方法：為橫斷式研究設計。於北部某醫學中心之乳房醫學中心門診招募完成乳癌治療的0至III A期別病人。測量工具以身體心像(Body Image Scale，BIS)、性功能(Female Sexual Function Index，FSFI)和憂鬱症狀(Centre for Epidemiological Studies Depression Scale，CES-D)問卷資料。以描述性統計分析資料庫中社會人口學、疾病特性、身體心像、性功能與憂鬱症狀的分布；線性迴歸分析社會人口學、疾病特性、身體心像、性功能與憂鬱症狀之關聯性及中介效應。 研究結果：本研究收案的191位乳癌婦女中，有175位（91.6%）出現性功能障礙（≦ 26.5分），53位（27.7%）發生憂鬱症狀。經單變項線性迴歸統計顯示年齡(β = 0.18, p < 0.05)、身體心像(β = 0.46, p < 0.001)及性功能(β = 0.15, p < 0.05) 與憂鬱症狀具顯著關聯；多元線性迴歸顯示，在控制年齡與性功能後，身體心像與憂鬱症狀具高度顯著關聯(β = 0.44, p < 0.001)；中介效應分析結果，在控制年齡後，性功能障礙與憂鬱症狀具顯著正向關聯(β = 0.15, p < 0.05)，在身體心像納為中介變項後，性功能障礙對憂鬱症狀之直接效應降至不顯著(β = 0.03, p > 0.05)，證實身體心像為性功能障礙與憂鬱症狀間之「完全中介因子」，顯示性功能障礙透過身體心像影響憂鬱症狀。 結論：乳癌存活期婦女仍有近三成面臨憂鬱症狀。身體心像是性功能障礙與憂鬱症狀間之完全中介因子。因此，臨床照護除了生理層面的性功能評估外，更應加強身體心像的評估與重建，以降低憂鬱症狀的發生。於治療與追蹤期間，整合病友團體與心理諮商等資源，協助病患建立正向身體心像，以減緩性功能障礙對心理健康的衝擊，促進其身心靈之整體健康。

Background: Breast cancer has the highest incidence rate among women in Taiwan. Although the survival rate for early-stage breast cancer is high, the side effects of treatment often lead to change in body image and sexual dysfunction. These change subject women with breast cancer to significant psychological and social stress, resulting in depressive symptoms. Persistent depressive symptoms remain evident even during the follow-up survival period. Depressive symptoms not only affect treatment adherence but, in severe cases, may also endanger life. Recent studies investigating women with breast cancer have paid limited attention to the relationships among body image, sexual function, and depressive symptoms, as well as the underlying mechanisms linking these variables. Therefore, this study aimed to further investigate the effects of body image and sexual function on depressive symptoms among women with breast cancer and to clarify the pathways through which these effects occur. Aim: This study aimed to investigate the associations of body image and sexual function with depressive symptoms and to examine the mediation of body image among women with breast cancer. Methods: This study adopts a cross-sectional design. Patients with stage 0 to IIIA breast cancer who have completed treatment will be recruited from the Breast Medical Center outpatient clinic of a medical center in Northern Taiwan. Data were collected using the Body Image Scale (BIS), the Female Sexual Function Index (FSFI), and the Centre for Epidemiological Studies Depression Scale (CES-D) questionnaires. Descriptive statistics were used to analyze the distributions of sociodemographic characteristics, disease- characteristics , body image, sexual function, and depressive symptoms. Linear regression analyses were performed to investigate the associations among sociodemographic characteristics, disease characteristics, body image, sexual function, and depressive symptoms, and to test whether body image mediates the relationship between sexual function and depressive symptoms. Results: Among the 191 women with breast cancer enrolled in this study, 175 (91.6%) experienced sexual dysfunction (≤ 26.5 points), and 53 (27.7%) exhibited depressive symptoms. Univariate linear regression analysis showed that age (β = 0.18, p < 0.05), body image (β = 0.46, p < 0.001), and sexual dysfunction (β = 0.15, p < 0.05) were significantly associated with depressive symptoms. Multiple linear regression analysis demonstrated that, after adjusting for age and sexual function, body image remained highly significantly associated with depressive symptoms (β = 0.44, p < 0.001). Mediation analysis revealed that, after controlling for age, sexual dysfunction was significantly positively associated with depressive symptoms (β = 0.15, p < 0.05). After body image was included as a mediator, the direct effect of sexual dysfunction on depressive symptoms was reduced to a non-significant level (β = 0.03, p > 0.05), confirming that body image fully mediated the relationship between sexual dysfunction and depressive symptoms. Overall, the results indicated that sexual dysfunction influenced depressive symptoms indirectly through body image. Conclusion: Nearly one-third of breast cancer survivors continued to experience depressive symptoms. Body image was identified as a key full mediator between sexual dysfunction and depressive symptoms. Therefore, in addition to assessing sexual function from a physiological perspective, clinical care should place greater emphasis on the assessment and reconstruction of body image to reduce the risk of depressive symptoms. During treatment and follow-up care, healthcare professionals are encouraged to integrate supportive resources, such as peer support groups and psychological counseling, to help patients develop a positive body image, thereby mitigating the psychological impact of sexual dysfunction and promoting their overall physical, psychological, and spiritual well-being.