精神分裂症患者生活品質之追蹤研究

Abstract

本研究旨在瞭解精神分裂症患者生活品質、及其改變趨勢及探討客觀生活品質、自我概念、情感平衡狀況、精神疾病症狀與主觀生活滿意度之關聯情形並進一步分析生活品質的預測因子，搜集患者整體性生活品質及不同疾病階段的資料，以期能更真實的瞭解患者於社區生活的狀況。 本研究以立意取樣的方式，選取北部某醫學中心精神科日間留院病房及門診追蹤之社區精神分裂症患者為研究個案，與研究對象採面對面訪談蒐集第二年的資料，共收集79份有效問卷。研究工具採臺灣版精神分裂症病人生活品質評量表（Lancashire Quality of life Profile，LQOLP，以下簡稱臺灣版LQOLP）結構性訪談量表收集資料後，運用百分比、平均數、標準差、t檢定、變異數分析、皮爾森積差相關及逐步迴歸分析等統計方法進行資料整理與分析。研究結果顯示如下： （1）於一年後追蹤客觀生活品質指標，在「工作」與「休閒」兩層面之改變具統計上顯著差異，而經濟、居住狀況、法律和安全、家庭關係、社交關係和健康等層面之改變則不具顯著性。（2）個案於一年後之自我概念、情感平衡、精神症狀有改善。但在各層面主觀生活滿意度有下降之趨勢。第一年（T1）和第二年（T2）追蹤最不滿意者皆為社交關係、經濟和健康層面。（3）客觀生活品質指標與整體主觀生活滿意度相關性方面，相關強度由高到低為居住狀況、健康、法律和安全、社交關係，統計上具顯著意義，而經濟、家庭關係、休閒等層面，則皆未達統計上顯著相關。（4）整體主觀生活滿意度與正向自我概念、負向自我概念、正向情感平衡、負向情感平衡呈顯著正相關，與情緒症狀呈顯著負相關，與正性症狀、負性症狀無顯著相關。（5）以T2的十四個變項預測T2整體主觀生活滿意度之迴歸分析結果，顯示重要預測因子為：正向自我概念、負向情感和客觀生活指標中之居住狀況，影響力分別為解釋24.4%、10.8%、5.2%的變異量，總解釋變異量40.4%。（6）以T1的十四個變項預測T2整體主觀生活滿意度之迴歸分析結果，顯示唯一重要預測因子為：情緒症狀，影響力為解釋12.9%的變異量。（7）以T1七個層面之主觀生活滿意度為變項預測T2整體主觀生活滿意度之迴歸分析結果，顯示「居住狀況」和「休閒」兩層面之滿意度為重要預測因子，影響力分別為解釋31.2%、5.9%的變異量，總解釋變異量37.1%。 本研究結果可使精神醫療人員瞭解精神分裂症患者的生活品質隨時間改變之趨勢，及影響患者的生活品質之重要預測因子，提供未來在醫療及照護上之參考。

The purposes of this study were to realize the life quality of schizophrenic patients, and its tendency of transition, to explore the relationships between objective life quality, self-concept, affect balance, psychotic symptoms and subjective satisfaction of life and further analysis of the predictors for life quality, to collect the information in different stages of the disease, and to understand the patient’s life in the community ultimately. The data were collected by conducting the Taiwanese version of the Lancashire Quality of Life Profile（LQOLP）structured questionnaire with 79 subjects purposively sampled who were admitted to the rehabilitation center or outpatients at a university hospital in Taipei, and evaluated one year later. After collecting the whole data, statistical methods such as percentage, mean, standard deviation, t test, ANOVA and Pearson’s correction and linear regression were applied. The results indicated that： （1）There were changes with statistical significance in merely ”work” and ”leisure” domains of objective life conditions after 1-year follow-up; nevertheless, the changes within other domains were not significant statistically. （2）Improvements of these clients were found in self-concept, affect balance and psychotic symptoms 1 year later. But the subjective satisfaction was inclined to drift downward; the most extreme levels of relative dissatisfaction among the patients were with social relationship, finances and health domains. （3）The correlation between the objective indices and subjective satisfaction from the most high to low were living situation, health, safety, and social relationship domains; these were statistical significant. But finances, family relationship and leisure ones were not. （4）Overall subjective satisfaction with life was found to be positively correlated with positive self-concept, negative self-concept, positive affect balance and negative affect balance, and negatively correlated with mood symptoms. No significant correlation with positive or negative symptoms was noticed. （5）The most important predicting factors when using the 14 variables of the 2nd year to predict the results of multiple regression analysis about the 2nd year's overall subjective satisfaction including “positive self- concept”, “negative affect balance” and “living situation” of the objective indices explained 24.4%, 10.8% and 5.2% of the variance respectively and 40.4% of variance totally. （6）When using the 14 variables of the 1st year to predict the results of multiple regression analysis about the 2nd year's overall subjective satisfaction, we noted the only one important predictive factor was ”mood symptoms” and explained 12.9% of the variance. （7）The most important predicting factors when using the 7 domains of subjective satisfaction of the 1st year to predict the results of multiple regression analysis about the 2nd year's overall subjective satisfaction including “living situation” and ”leisure” domains explained 31.2% and 5.9% of the variance respectively and 37.1% of variance totally. The results of the study would serve as a guide toward the tendency of QOL in schizophrenic patients over time and important predictive factors, which might hold meaningful, influence on clinical care.