臺灣青少年腦瘤存活者復原力及生活適應之研究

Abstract

復原力是探究青少年成功適應逆境的重要概念，但是目前研究很少比較青少年腦瘤存活者與健康青少年復原力之差異。本研究目的有三項：1.比較青少年腦瘤存活者與健康青少年的復原力之差異，以澄清青少年復原力的高低差異是受健康問題影響或是受腦瘤診斷的影響；2.將復原力視為危險因子與保護因子互動的結果，以檢驗青少年腦瘤存活者的復原力與情緒型健康問題、生活目的與社會支持之間的關係；3.將復原力視為正向適應的過程，以檢驗青少年腦瘤存活者的復原力在情緒型健康問題與生活適應之間所扮演的角色。本研究依據三個理論─生命發展理論、Frankl存在分析、Haase青少年復原力理論─以形成本研究的架構與研究假設。 本研究設計是橫斷式個案控制/配對研究，青少年腦瘤存活者的樣本是自某醫學中心以方便取樣方式獲得，選樣條件如下：1.現年13-18歲；2.已完成腦瘤治療，或經醫生診治不需治療而持續追蹤者；3.目前規律到校上課。而健康青少年的樣本是與青少年腦瘤存活者進行性別、就讀學校的類別與就學年級、居住地等配對後，隨機抽樣自國中、高中、高職學校而得。經收案醫院倫理委員會審定後， 並取得家長與青少年同意後，以郵寄結構式問卷收集個案資料。資料分析是以SPSS 12.0版及LISREL 8.8（學生版）統計軟體進行，包括描述性統計、推論性統計與路徑分析。 本研究收案時間自2006年11月至2007年4月，共收集60位青少年腦瘤存活者以及120位健康青少年的問卷資料。兩組青少年的平均年齡約15歲，63.3%是男性，55%是國中生。藉由統計分析與測試研究假說，本研究結果如下：1.在控制人口學變項後，兩組青少年的復原力沒有差異，情緒型健康問題都是兩組青少年復原力的危險因子。但對於青少年腦瘤存活者而言，其情緒型健康問題對於復原力的負向影響較健康青少年為大（Beta= -0.34, p < .05）。2.對青少年腦瘤存活者而言，只有情緒型健康問題會對復原力造成負面影響（Beta = 0.43, p < .01, R-square = .27），疾病史與基本資料都不是其復原力的危險因子。3.有情緒型健康問題的青少年腦瘤存活者，須經由家庭支持才能產生復原力（R-square = .57）。4.青少年腦瘤存活者的生活目的，可減少情緒型健康問題對其復原力的負面影響約達51.3%（R-square = .49）。5.透過路徑分析可知，醫療人員的支持能直接增強青少年腦瘤存活者的復原力，或是間接透過與家人支持並共同訂定生活目的後，其復原力才得以提升。6.青少年腦瘤存活者的復原力可減少情緒型健康問題對於其生活適應的負面影響約達48.7%（R-square = .56）。 本研究依據上述研究結果作出以下五點結論：1.造成青少年復原力產生差異的原因是情緒型健康問題而非單純受腦瘤診斷的影響。2.青少年腦瘤存活者的情緒型健康問題對復原力之危害，較健康青少年甚巨。3.不管是青少年腦瘤存活者或是健康青少年，其情緒型健康問題是復原力的危險因子。4.青少年腦瘤存活者的生活目的、家庭支持、醫療人員的支持都是其復原力的保護因子。5.青少年腦瘤存活者的復原力可調節情緒型健康問題對於其生活適應的負面影響。本研究結果也提供醫療人員能早期發現青少年腦瘤存活者的情緒型健康問題、加強其支持系統、實踐其生活目的，進而提升復原力且達到正向的生活適應。

Background. Resilience is an important concept in the positive psychosocial adjustment of adolescents to adversity. However, few studies have compared differences in resilience and its influence among adolescent survivors of brain tumors (ASBT) with that among healthy adolescents. The researcher hypothesized that resilience is influenced by emotion-related health problems, purpose in life, and perceived social support. Purpose. The aims were 1) to clarify normative development and impact of illness in ASBT by comparing them to healthy adolescents in terms of resilience and the effect of types of health problems on resilience, 2) to test the relationship among resilience and influences on resilience in ASBT, when resilience is an outcome, and 3) to examine the effect of resilience on the relationships between emotion-related health problems and life adaptation in ASBT, when resilience is a process. Theory and Method. The theoretical framework was based on life-span developmental theory, Haase’s Adolescent Resilience Model, and Frankl’s existential analysis. This study used a cross-sectional, case-control design. Convenience sampling was used to recruit participants who were ASBT and 13 to 18 years old. Random sampling was used to recruit healthy adolescents matched with ASBT by school level, gender and living area. Data were collected by a structured questionnaire (a demographic questionnaire and 7 scales). Analysis. Four of the 7 scales were translated and back-translated from English to Mandarin according to principles of instrument translation. Descriptive statistics were used to illustrate the distribution of variables. T-test was used to analyze differences in group means for independent and dependent variables. Multiple regression was used to analyze the contribution of each predictor to explaining total variance in the ASBT group. Path analysis was used to identify the process of forming resilience in ASBT. Results. The study participants included 60 ASBT and 120 healthy adolescents. ASBT and healthy adolescents were on average 15.4 years (SD = 1.56) and 15.17 years (SD = 1.65), respectively. Participants in both groups were predominantly male (63.3%) and studying in junior high school (55%). The findings were as follows. 1) ASBT and healthy adolescents did not differ significantly in resilience. However, resilience was more strongly and negatively affected by emotion-related problems (Beta value = -0.34, p < .05) in ASBT than in healthy adolescents with emotion-related health problems. 2) Except for emotion-related problems, medical history and demographics were not risk factors for resilience in ASBT. The negative effect of emotion-related health problems on resilience (Beta = 0.43, p < .01) in ASBT accounted for 26.9% of the variance in resilience. 3) ASBT with emotion-related health problems didn’t develop their resilience until they perceived support family support (R-square = .57). 4) “Purpose in life” reduced the effect of emotion-related health problems on resilience up to 51.4% (R-square = .49). 5) Path analysis showed that health care providers’ support not only directly enhanced resilience in ASBT, but also indirectly nurtured their resilience by assisting them and their families to achieve purpose in life by themselves. 6) Regarding resilience as a process of life adaptation, resilience reduced the effect of emotion-related health problems on life adaptation up to 48.7% (R-square = .56). Conclusions. This study’s results can be summarized by five conclusions after considering limitations of the study. 1) Differences in resilience between ASBT and healthy adolescents were due to emotion-related health problems, not “having a brain tumor” only. 2) The impact of emotion-related health problems on resilience was more severe in ASBT than in healthy adolescents. 3) Emotion-related health problems were identified as a risk factor for resilience in both ASBT and in healthy adolescents. 4) Perceived family support, perceived support from health care providers, and purpose in life were identified as protectors of resilience in ASBT. 5) For ASBT, resilience mediated between emotion-related health problems and life adaptation. These results suggest that health care professionals could foster resilience in ASBT by screening them soon after diagnosis for emotion-related health problems, strengthening their family support system, and supporting their purpose in life.