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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 潘璦琬 | |
dc.contributor.author | Yun-Ling Chen | en |
dc.contributor.author | 陳韻玲 | zh_TW |
dc.date.accessioned | 2021-06-15T00:21:17Z | - |
dc.date.available | 2009-02-17 | |
dc.date.copyright | 2009-02-17 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-02-05 | |
dc.identifier.citation | American Occupational Therapy Association. (2002). Occupational Therapy Framework: Domain and process. American Journal of Occupational Therapy, 56(609-639).
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/41512 | - |
dc.description.abstract | 研究背景與目的
在1960年代,西方開始興起去機構化運動。而國內在1980年代,亦開始推動社區的精神復健方案,包括居家治療、日間留院、社區心理衛生中心以及庇護工廠,期使心理疾患能夠回歸社區獨立生活。過去30年來,台灣罹患憂鬱症的人數逐年攀升。商志雍等人在2003年的研究發現,所有精神科門診患者中,罹患憂鬱症的比例已從1995年佔14.5%增加到2000年佔27.3%,顯示憂鬱症已成為國內心理健康領域中常見且不容忽視的議題。 憂鬱症的症狀包括憂鬱情緒、失去興趣和快樂感、有罪惡感、自我價值低落、食慾與睡眠品質降低、失去精力以及注意力不佳等。有研究指出,到了2020年,憂鬱症在全球疾病負擔的排名將躍升為第二。憂鬱症不僅具高發生率,且常慢性化並潛在地損害個案的心理社會和職能功能,嚴重的話甚至會導致死亡。過去的研究顯示,藥物治療雖能即時有效控制症狀,但對於長期促進心理社會健康的效果有限。而職能治療的目標是幫助個案參與其重視且具目的性的職能活動,勝任其職能角色,促進生活調適度,著重改善與個案相關的心理社會要素,以期提升個案的生活品質。 “生活品質” 起源於亞里斯多德提出的“追求幸福感”概念,而此專有名詞於第二次世界大戰後首次使用。自此,社會科學類的文獻漸增生活品質的研究,包括社會學、政治學、人類學和心理學。過去30年,隨著醫療評估的派典演進,醫療照顧變成以個案為中心的模式,因此個案對於本身健康狀態的觀點已被視為醫療評估的指標,而生活品質即為目前心理健康照顧領域中重要的研究和療效指標。 至今,生活品質未有統一的定義,其中世界衛生組織將生活品質定義為「個人在所生活的文化價值體系中,對於自己的目標、期望、標準、關心等方面的感受程度,其中包括一個人在生理健康、心理狀態、獨立程度、社會關係、個人信念以及環境六大方面」。且許多詞彙在文獻中常被代替為生活品質的意義,如生活滿意度、安適感、快樂感與生活狀況。不過,生活品質目前一致地被視為是一個多層面的概念,描述個人對其生理健康、心理健康、社會關係和環境的評價。 自1980年代起,開始出現心理疾患的生活品質研究,不過大多針對精神分裂症患者或異質性族群,針對憂鬱症患者的研究較為缺乏。至今,台灣在生活品質方面的文獻發表,多侷限於診斷和橫跨性方法上的研究,少有探討影響生活品質的長期追蹤研究。 國外關於憂鬱症的自然式長期追蹤研究,且探討到生活品質的預測因素,研究者搜尋到十一篇相關的文獻。在這十一篇中,追蹤次數為1到4次不等,追蹤時間長度由半年至7~8年不等。每次追蹤時的個案流失率為6%至38%,個案流失的原因包括拒絕參與追蹤研究、病情嚴重或死亡、研究者未能聯絡到個案等。在大部分的研究中,個案的平均年齡介於為40~50歲,而60%以上的個案為女性。 過去的研究一致顯示疾病相關因素與個案的生活品質變化有顯著關係,疾病相關因素包括憂鬱嚴重度、發病年齡、疾病時間長度、服用的藥物,但對其生活品質各範疇有不同的影響性。在人口學特性方面,長期追蹤的研究中發現年齡對其生活品質未有影響;性別和就業與否對生活品質的影響力不一致;而教育程度和婚姻狀況對生活品質的影響則未得到證實,另外,從橫斷式的研究中顯示個案的人口學特性,對其生活品質各範疇有不同的影響性。 在心理社會因素方面,有研究顯示,個案具有健康的生活型態與積極的因應技巧,能提升兩年後的生理與心理健康層面生活品質。另一研究顯示,個案的社會功能與其社會關係範疇的生活品質有顯著的關聯。而在橫斷式的研究中發現,個案具有較高的職能勝任感、自我掌控信念、環境支持度和社會支持滿意度,與生活品質較佳有顯著關聯。Pan (2006) 提出自覺職能表現勝任感和滿意度是生活品質的重要預測因子,亦即個案所自覺到從事職能活動的能力,以及從參與過程中所產生的滿意度,對其生活品質有正向影響。 由於目前在探討心理社會因素對憂鬱症個案生活品質的長期追蹤研究較為缺乏,且個案的人口學特性和疾病相關因素對生活品質的影響程度未明確。另外,至今較少針對台灣族群進行研究,但個案對於生活品質的觀感可能會有文化差異。因此本研究目的為以長期追蹤的觀點,探討憂鬱症個案生活品質的變化與相關的預測因子。研究問題一為生活品質四大範疇:生理健康、心理健康、社會關係和環境,是否在追蹤期間內有顯著變化。研究問題二為人口學特性、疾病相關因素與心理社會因素,是否可預測個案在綜合生活品質、綜合健康及生活品質四個範疇於追蹤期間的良莠。 研究假設 1. 個案生活品質的四個範疇,包括生理健康、心理健康、社會關係和環境,在第一次至第二次追蹤期間內皆呈現顯著改變。 2. 個案的基本背景資料,包括年齡、性別、教育程度、婚姻狀況與就業狀況,可預測台灣簡明版世界衛生組織生活品質問卷中的綜合生活品質(G1)、綜合健康(G4)、生活品質四個範疇(生理健康、心理健康、社會關係、環境)與各範疇所包含的題目,在兩次追蹤期間之良莠。 3. 個案於兩次追蹤期間的疾病相關因素,包括憂鬱嚴重度、發病年紀、生病時間長度、抗憂鬱藥物種類、服用助眠劑與否,可預測台灣簡明版世界衛生組織生活品質問卷中的綜合生活品質(G1)、綜合健康(G4)、生活品質四個範疇(生理健康、心理健康、社會關係、環境)與各範疇所包含的題目,在兩次追蹤期間之良莠。 4. 個案於兩次追蹤期間的心理社會因素,包括職能勝任感、自我掌控信念、環境支持度以及社會支持度,可預測台灣簡明版世界衛生組織生活品質問卷中的綜合生活品質(G1)、綜合健康(G4)、生活品質四個範疇(生理健康、心理健康、社會關係、環境)與各範疇所包含的題目,在兩次追蹤期間之良莠。 研究方法 參與者:本研究個案來自於台大醫院的精神科門診。所有個案皆經由精神科醫師根據ICD-10或DSM-IV診斷系統確認患有憂鬱症、18歲以上、有意願參與研究且認知功能足夠完成自填問卷,排除條件為具嚴重精神疾病與物質濫用問題。 研究程序:本研究於初始點的樣本(T1)來自余姓與陳姓研究者收集而得,共有237位,本研究進行兩次追蹤共歷經三年(2005/08~2008/10),第一次追蹤的個案(T2)來自於論文指導教授(潘璦琬博士)的研究計畫資料。第二次追蹤個案(T3)由研究者以電話與每位個案聯繫,說明研究目的並經個案同意參與後,約定會面的時間和地點。會面時,先請個案填寫個案基本資料表與研究參與同意書,接著進行認知功能篩檢,當個案通過簡式智能量表(>24分)後,便進行相關的自評問卷測驗,本研究的程序獲得台大醫院研究倫理委員會的同意。 工具:所有問卷皆已翻譯為中文版,並經過信、效度的驗證。除了個案的認知功能由研究者以簡式智能量表所評估外,其他皆是個案自評的中文版問卷。以下為本研究各變項所使用的工具:綜合生活品質、綜合健康、生活品質四範疇與相關層面是由台灣簡明版世界衛生組織生活品質量表進行評量;職能勝任感由職能自我評估量表的職能勝任感部份作評估;環境支持度由職能自我評估量表的環境支持度部分作評估;自覺掌控信念由自覺掌控信念量表評估;社會支持度由社會支持量表的滿意度部分作評估;憂鬱嚴重度由流行病學研究中心憂鬱量表作評估。 資料分析:將所有個案的測驗分數經由羅序測量模式轉換為羅序分數,採用的統計軟體為WINSTEPS 3.56版。羅序測量模式的特性為可將順序資料轉換為等距資料,以符合連續性資料的分析假設。接著,所有資料以SPSS 軟體15.0版及SAS 軟體9.1版進行統計分析。推論性統計方面,採用雙尾檢定且顯著水準定為α=0.05。 1. 以描述性統計分析全部個案於初始點(T1)及兩次追蹤時間點(T2, T3)時的人口統計學資料、疾病相關變項與所有測驗的原始分數。類別型資料以次數分配表及百分比呈現,而連續型資料以平均數、標準差和範圍呈現。 2. 統計每次追蹤的追蹤率和流失原因,並分析個案接受追蹤與否在人口統計學資料、疾病相關變項上的差異。連續型資料以獨立樣本t檢定(independent sample t-test)分析,類別型資料以卡方檢定(χ2 test)分析,包括從T1至T2及T1至T3兩個時間階段。 3. 統計追蹤的間隔時間長度,包括從T1至T2、T1至T3及T2至T3三個時間階段。 4. 針對研究假設,資料分析方式如下: (1) 以趨勢圖呈現參與所有測驗的個案於三次測量時間點(T1, T2, T3),生活品質各範疇原始平均分數的變化。 (2) 分析預測變項 (人口學特性、疾病相關因素與心理社會因素)與生活品質各範疇在T2時的關連,預測變項為類別變項者採用獨立樣本t檢定(Independent sample t-test)或單因子變異數分析 (One-way ANOVA),為連續變項者則採用皮爾森積差相關分析 (Pearson product-moment correlations),測驗分數皆採用其羅序分數。 (3) 在T2與T3期間,以綜合生活品質、綜合健康、生活品質四範疇及26個相關的層面為依變項,採用混合效應模式(Mixed-effect model)建立32個憂鬱症個案的生活品質預測模式,固定效應的自變項包括人口學特性、疾病相關因素、心理社會因素,而個體間在作答上的差異及隨時間的變化則視為隨機的效應。測驗分數皆採用其羅序分數 結果 所有個案在研究初始點的人口學背景與疾病相關因素特性 個案平均年齡為47.1歲(標準差=13.5,範圍=18.3~76.7歲),以女性居多(74.3%),69.6%的個案教育程度為高中以上,62.4%的個案已婚並與配偶同住,僅35.4%的個案就業中,其他個案可能待業中、身為學生、家庭主婦或已退休。91.9%的個案與家人或朋友同住,53.2%的個案月收入介於10,000~50,000之間。在疾病相關變項方面,個案的平均發病年齡為40.0歲(標準差=14.2,範圍=11.0~76.0),平均發病時間長度為7.1年(標準差=7.8,範圍=0.1~43.6),62.9%的個案有合併其他生理疾病的困擾,59.5%的個案因憂鬱症住院過,70.0%的個案正服用憂鬱劑,87.3%的個案表示生活中有受到藥物副作用的影響。 追蹤反應率、流失原因、平均追蹤時間 有104位個案參與T2的追蹤研究(反應率=43.9%),90位個案同意參與T3的追蹤研究(反應率=38.0%),未參與追蹤的原因包括個案表示不願參與研究、因居住於外地工作或求學而不方便參與以及未能聯絡上個案,最後一項原因包括個案的電話更換、聯絡期間已聯絡五次但都未能接通等原因。完整接受兩次追蹤的個案有70位。接受T2追蹤的個案中,有23位個案已停藥而有5位個案離開台大醫院就診;接受T3追蹤的個案中,有24位個案已停藥而有7位個案離開台大醫院就診。未接受追蹤的個案中,有9位個案表示已停藥與未回診而拒絕T2追蹤,有11位個案表示已停藥與未回診而拒絕T3追蹤。 本研究的總平均追蹤時間為44.9個月(標準差=5.2,範圍=36.5~54.5),T1至T2的平均追蹤時間為19.5個月 (標準差=9.8,範圍=5.8~43.6),有60.0%的個案接受追蹤的時間間距為12.1~30.0個月。T2至T3的平均追蹤時間為26.1個月 (標準差=7.4,範圍=7.8~35.9),其中75.7%的個案接受追蹤的時間間距為24.1至36.0個月。 個案接受追蹤與否之差異 個案接受追蹤與否於人口學特性與疾病相關變項的差異方面,不同追蹤階段的結果如下:個案接受T2追蹤與否,僅在其T1的婚姻狀況上有顯著差異(P=0.011);個案接受T3追蹤與否,在T1的年齡、性別、工作狀況和發病年齡上有顯著差異(P< 0.05)。另外,個案服用抗憂鬱藥物是否影響其參與度方面,兩次追蹤的結果皆發現未參與研究的個案,停用抗憂鬱藥物的比例顯著低於參與研究的個案(P≤ 0.001)。 個案的生活品質 針對70位接受兩次追蹤測驗的個案分析自初始點至兩次追蹤期間(T1~T3)在生活品質四個範疇上的平均原始分數之變化,發現到個案於環境範疇的生活品質皆最高,依序為生理範疇和社會關係範疇,而心理範疇最低。與世界衛生組織台灣版問卷發展小組所建立的健康人常模相比,發現到本研究的憂鬱症個案於生理健康、心理健康範疇的平均分數低於健康人平均分數一個標準差。由趨勢圖觀察顯示在兩次追蹤期間 (T2, T3),個案於生理健康和心理健康範疇上有稍微下降的趨勢,而在社會關係與環境範疇上則相對穩定。個案於社會關係範疇上的平均分數較健康人常模稍低(介於平均值與負一個標準差之間),但環境範疇的平均分數稍高於健康人常模。 個案的生活品質預測因素 由詳盡的混合效應模式的分析結果顯示,門診憂鬱症個案在兩年追蹤期間的四個生活品質範疇未隨時間呈現顯著變化,但由生活品質範疇各自包含的題目來看,發現個案雖然醫療需求隨時間顯著減少,但個案的活力與對生命正面意義的觀感也隨之顯著降低。個案的年齡、發病年紀、生病時間長度皆未能顯著預測個案的生活品質。不過,個案的職能勝任感、環境支持度、自我掌控信念、憂鬱嚴重度、服用抗憂鬱藥物、一些人口學因素是個案生活品質的重要預測因子。 本研究證實心理社會因素對於個案生活品質的長期影響。個案自覺具有較高的職能勝任感與環境支持度傾向感受到較好的綜合生活品質。再者,職能勝任感對於生活品質四個範疇的諸多題項有正面的效果。個案具有較高的職能勝任感傾向滿意自己在日常生活活動、工作和休閒方面的效能感,並對於社會支持和人際關係具有正面的觀感。而環境支持度高除了能提升個案在環境範疇上的滿意度,亦能對心理範疇上的題項有正面的效果。個案具有較高的環境支持度,傾向對於自己的生命意義有正面觀感。個案的自我掌控信念較高,傾向對於自己在日常生活和工作上的表現較為滿意,並享受於有意義的生活。 憂鬱嚴重度對於個案的綜合生活品質、綜合健康以及在生理健康、心理健康和社會關係範疇上的生活品質的諸多題項具有影響。個案具有較高的職能勝任感與較輕的憂鬱嚴重度傾向對於健康照護的需求較少,而可能降低社會負擔。另外,我們也發現到抗憂鬱藥物的種類對於個案在生活品質四個範疇上有所影響。而個案的性別、婚姻狀況、教育程度和工作狀況也對於生活品質不同層面有所影響。 結論 經本研究三年的長期追蹤結果顯示,門診憂鬱症個案在環境範疇的生活品質最高,心理健康範疇最低。對於居住於台灣的慢性憂鬱症個案而言,我們建議臨床處置應更積極,且著重於提升個案在生理健康、心理健康和社會關係範疇的生活品質。經由詳盡的研究分析方法,本研究確認全面性的生活品質預測模式,作為職能治療針對憂鬱症個案處置的參考。 本研究證實憂鬱嚴重度、服用抗憂鬱劑對於個案的生活品質有顯著長期效應。因此,臨床治療人員應加強教育憂鬱症個案藥物順從性的重要,以降低其憂鬱嚴重度,但也須同時注意不同種類的抗憂鬱劑對於個案在生活品質之影響。例如,選擇性血清素再吸收抑制劑 (SSRI)可能會使個案對於自己在日常生活表現上的觀感有負面的影響。性別、教育程度、婚姻狀況與工作狀況等人口學特性能對個案生活品質的不同層面有所影響,因此,臨床治療人員應該根據個案不同的人口學背景建立適合個案的生活型態。 除了改善憂鬱程度的處置,也應該著重提升個案的職能勝任感與環境支持度,並強化其自我掌控信念,以提升與維持個案的生活品質。本研究強調職能治療師應該幫助個案設計均衡的生活型態,有效地表現其重視的職能角色,如家庭成員與工作者。我們建議使個案投入其重視與有興趣的職能活動可能是一個適當的方法,以降低其憂鬱嚴重度,並促進自我效能感、均衡生活型態、調適能力,以及與環境產生正向互動。另外,本研究也提供一些或可幫助提升個案生活品質的活動,與幫助他們更容易投入活動的原則。我們建議未來應以長期追蹤研究,驗證以職能為基礎的治療模式在憂鬱症個案生活品質上的成效。 | zh_TW |
dc.description.abstract | Background
The number of persons with depression has been increasing in the recent 30 years in Taiwan (商志雍, 廖士程, & 李明濱, 民92). Depression is a chronic disorder that substantially impairs a client’s psychosocial and occupational functioning, as well as resulted in significant morbidity and mortality (Bakish, 2001; Trivedi et al., 2006; World Heath Organization, 2007). Although many longitudinal studies have investigated the predictors of Quality of Life (QOL) in persons with depression (Pyne et al., 2003; Ruggeri, Bisoffi, Fontecedro, & Warner, 2001), few of these studies have emphasized on the contribution of psychosocial factors. Results from the longitudinal studies have demonstrated that healthy lifestyle and active coping skills are strong predictors of QOL in physical health and psychological health domain, respectively (Sherbourne, Hays, & Wells, 1995). A study by Goldberg and Harrow (2005) found a significant relationship between objective social functioning and social aspect of QOL among persons with depression (J. F. Goldberg & Harrow, 2005). Several cross-sectional studies suggested that occupational competence, mastery, environmental affordance and social support may have contribution to enhance QOL for persons with depression (Carpiniello, Lai, Pariante, Carta, & Rudas, 1997; Chan, Chiu, Chien, Thompson, & Lam, 2006; Chung, Pan, & Hsiung, 2008 Accepted; Kuehner & Buerger, 2005; Pan, Chan, Chung, Chen, & Hsiung, 2006; 陳韻玲, 熊秉荃, 陳詞章, & 潘璦琬, 民97). The severity of depression and the demographic characteristics have been proposed to predict clients’ long-term QOL but the results of studies investigating these factors have been inconsistent. To date, there are few internationally published studies on the factors affecting QOL for Taiwanese or eastern people with depression and these studies delineated the predictors of QOL were restricted in using the cross-sectional study design (Chan et al., 2006; Hung, 2006; Pan et al., 2006; 陳韻玲 et al., 民97). As QOL in depression may have cultural differences, we deemed it worthwhile to conduct a study in Taiwan (Berzon, Hays, & Shumaker, 1993).Thus, the aim of this study is to examine the change in QOL and predictive factors of QOL in persons with depression from longitudinal perspective. Methods The study is a naturalistic longitudinal study and the subjects were adult outpatients with depression recruited from the psychiatric outpatient clinic of the National Taiwan University Hospital (NTUH) in Taipei, Taiwan. All subjects met the ICD-10 system (F32, F33, F34) (World Health Organization, 1992) or DSM-IV system (296.2, 296.3, 300.4, 311) (American Psychiatric Association, 1994) for a diagnosis of Depressive Disorder. Diagnosis was established by an attending psychiatrist during the subject’s first visit to the clinic. A total of 237 subjects agreed to participate in the study at baseline (T1) that obtained from the studies of Yu and Chen by purposive sampling method (余春娣, 民94; 陳靜紋, 民94). The subjects were followed up twice during the period of three years. The data from the 1st follow up (T2) were existing data from a previous project of my advisor Dr. Pan (潘璦琬, 民94a, 民94b). The data from the 2nd follow up (T3) were collected by the principal researcher of this study. Subjects were contacted by telephone and assessed using a standardized procedure. Ethical clearance for this study was approved by the Institutional Review Board of the NTUH. Following consent to participate in the study, subjects were screened for cognitive function using the Mini-Mental State Examination-Chinese version (MMSE-C) and were excluded from the study if they had a score of 24 or below. Afterwards, they were administered other self-rated questionnaires to examine their QOL, occupational competence, sense of mastery, environmental affordance, social support, and severity of depression. The measures included The World Health Organization Quality of Life-BREF-Taiwan version (WHOQOLBREF-TW), the Occupational Self Assessment-Chinese version (OSA-C), Mastery scale-Chinese version (Mastery-C), Social Support Questionnaire-Chinese version (SSQ-C), Center of Epidemiology Study-Depression Scale-Chinese version (CESD-C). Raw data obtained from all self-rated instruments was transformed for Rasch analysis using WINSTEPS 3.56 (Linacre, 2006). All data was analyzed using SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA) and Statistical Analysis System (SAS), version 9.1 (SAS Institute, Cary, NC). The level of significance was set at two-tailed with an alpha level of 0.05. The measured scores in the overall QOL, overall health, 4 domains of QOL and related 26 items between T2 and T3 were fitted with linear mixed-effects model with covariates, including 5 demographic variables, 5 disease-related variables and 4 psychosocial variables. We chose the random intercept and slope model to establish these 32 predictive models of QOL. Results The average length of involvement in this study was 44.9 months (SD=5.2, range=36.0-54.5). The average length from T1 to T2 was 19.5 months (SD=9.8, range=5.8-43.6) and the average length from T2 to T3 was 26.1 months (SD=7.4, range=7.8-35.9). 104 subjects (response rate: 43.9%) were assessed at T2 and 90 subjects (response rate: 38.0%) were assessed at T3. The most significant differences of variables at T1 between respondents and nonrespondents were subjects’ demographic characteristics, including marital status, gender, age, employment and onset age. In addition, the subjects who had not taken antidepressants tended to participate in the follow-up study. The results of this 3-year longitudinal study of QOL among adults with chronic depression suggested that the majority of subjects were satisfied with their environmental domain of QOL, followed by the physical health, social relationships and the psychological health was the least satisfied aspect. The subjects’ QOL in the physical health and psychological health domains were poorer than that of the healthy populations in Taiwan. Also, there were slightly decreasing in these two domains of QOL between T2 and T3. The persons with depression had slightly poorer QOL in the social relationships domain than the healthy populations but had better QOL in the environmental domain but the changes in these two domains were relative stable. For the persons with chronic depression lived in Taiwan, we suggested that our treatments should be more intensive and pay much more attention on the enhancement of their QOL in the physical health, psychological health and social relationships domains than in the environmental domain. The present study provides a broad but detailed inquiry to understand the predictors of QOL longitudinally in persons with chronic depression in Taiwan. After the analyses on the domains and items of QOL with mixed-effects model, we found that the subjects’ age, onset age and onset duration had no significant effect on the QOL in persons with depression. Rather, occupational competence, environmental affordance, sense of mastery, severity of depression, the antidepressants and several demographic characteristics were the important predictors of QOL over time and the predictive model of QOL in persons with chronic depression was validated. Importantly, we proved the positive effect of psychosocial factors, including occupational competence, sense of mastery and environmental affordance, on the QOL in different aspects over time. When a person perceived higher occupational competence and environmental affordance, he or she tends to feel better overall QOL. In addition, the occupational competence had positive effect on the items of QOL across all the domains. Subjects with higher occupational competence tended to have the sense of capacity and efficacy in personal performance on the ADL, work and leisure as well as have positive perceptions of social support and interpersonal relationships with others. Except for the environmental domain of QOL, environmental affordance also had positive effect on the item of the psychological health domain. Subjects with higher environmental affordance would feel positive perception for the meanings of life. The sense of mastery also had positive effect on the items of QOL across all the domains. Subjects with higher sense of mastery tended to feel positive perception of the performance of ADL and leisure as well as enjoy in meaningful life. The study confirmed that severity of depression had significant impact on overall QOL and the items in the physical health, psychological health and social relationships domains. In addition, subjects with higher occupational competence and less severity of depression tended to have less demand on medical treatment and decrease the social burden. We also found that the antidepressants were the significant predictors of the items of QOL across all the domains. The subject’s demographic characteristics, including the gender, educational level, marital status and working status had different effect on the items of QOL. The present findings provide some suggestions as to what can be done by occupational therapists in persons with depression for the QOL enhancement. In order to advance the treatment outcome for persons with chronic depression, except for symptom reduction, we should pay much more attention on the enhancement of their occupational competence and perceptions of environmental affordance as well as strengthen their sense of mastery to improve their QOL. The study emphasized that the occupational therapists should help the subjects to design balanced lifestyle based on their different demographic backgrounds and improve the performance on roles they valued, such as the family members and workers. The educations of medication compliance were important. However, we should also take notice of the negative impact of different types of antidepressants on the subjects’ QOL, such as the SSRI’s might have negative impact on the perception of individuals’ ADL performance. We suggested that engaging in activities clients are valued and interested in might be the suitable way to reduce their severity of depression and improve their sense of efficacy, balanced lifestyle, adaptive skills, and resulted in the positive interaction with the environment around them. Our study suggested several activities which might have positive effect on OQL in persons with depression and provided some principles to help them engaging in the activities easier. The occupation-oriented treatment programs were needed to be examined from longitudinal studies in the future. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T00:21:17Z (GMT). No. of bitstreams: 1 ntu-98-R95429008-1.pdf: 2123269 bytes, checksum: 7e8b2d48828078f8c245050c2b9a3ec8 (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 學位考試審查表 i
致謝 ii 中文摘要 iv ABSTRACT xiv LIST OF TABLES xxii LIST OF FIGURES xxiii LIST OF APPENDICES xxiv INTRODUCTION 1 LITERATURE REVIEW 3 Depression 3 Quality of Life (QOL) 4 Naturalistic longitudinal studies related to QOL 5 The relationships between disease-related factors and QOL 7 The relationships between demographic characteristics and QOL 10 The relationships between psychosocial factors and QOL 13 Occupational competence 14 Mastery 16 Environmental affordance 17 Social support 18 Summary of the literature review and research framework 21 METHODS 24 Subjects 24 Procedures 24 Instruments 25 The World Health Organization Quality of Life-BREF-Taiwan version (WHOQOLBREF-TW) 25 The Occupational Self Assessment (OSA) 27 Mastery Scale 29 Social Support Questionnaire-Short Form (SSQSF) 31 Center of Epidemiology Study Depression Scale (CESD) 32 Mini-Mental State Examination (MMSE) 34 Statistical analyses 34 RESULTS 38 The characteristics of subjects 38 The follow-up duration and response 39 The differences of characteristics between the respondents and nonrespondents 40 The subjects’ QOL in this study 41 The associations between the predictors and each domain of QOL at T2 41 The results of Mixed-effects model 42 DISCUSSION 46 The QOL in persons with depression 46 The predictors of QOL 46 The response rate and reasons for drop-out 55 The clinical applications 56 The limitations in this study 59 Future suggestions 60 CONCLUSIONS 61 REFERENCES 64 Table 1. Characteristics of subjects at T1 (N=237) 87 Table 2. Characteristics of subjects at T2 (N=104) 88 Table 3. Characteristics of subjects at T3 (N=90) 90 Table 4. Raw scores of the assessments in this study between T1 and T3 92 Table 5. The frequency distribution in each follow-up period 93 Table 6. The differences of characteristics at T1 between the respondents and nonrespondents at T2 94 Table 7. The differences of characteristics at T1 between the respondents and nonrespondents at T3 95 Table 8. The associations between the predictive variables with each domain of QOL at T2 96 Table 9. Predictors for domains, “overall QOL” and “overall health” items of the WHOQOLBREF-TW 97 Table 10. Predictors for items in Physical Health domain of WHOQOLBREF-TW 99 Table 11. Predictors for items in Psychological Health domain of WHOQOLBREF-TW 101 Table 12. Predictors for items in Social Relationships domain of WHOQOLBREF-TW 103 Table 13. Predictors for items in Environmental domain of WHOQOLBREF-TW 105 Fig. 1 The framework of predictors of QOL in persons with depression 107 Fig. 2 The procedure of contacting with the subjects 108 Fig. 3 The results of the follow ups in this study 109 Fig. 4 The change of QOL in each domain among the three study test-time 110 Appendix A. Summary of the longitudinal studies related to QOL in persons with depression 111 Appendix B. The document of approval by the Institutional Review Board of the NTUH for the data at T2 117 Appendix C. The document of approval by the Institutional Review Board of the NTUH for the data at T3 118 Appendix D. The informed consent form 120 Appendix E. The basic information form 121 Appendix F. The World Health Organization Quality of Life-BREF-Taiwan version (WHOQOLBREF-TW) 122 Appendix G. The Occupational Self Assessment-Chinese version (OSA-C) 126 Appendix H. Mastery Scale-Chinese version (Mastery-C) 127 Appendix I. Social Support Questionnaire-Short Form-Chinese version (SSQSF-C) 128 Appendix J. Center of Epidemiology Study Depression Scale-Chinese version (CESD-C) 130 Appendix K. Mini-Mental State Examination-Chinese version (MMSE-C) 131 Appendix L. The permission for using the WHOQOLBREF-TW 132 Appendix M. The permission for using the OSA-C 133 Appendix N. The permission for using the Mastery-C and SSQSF-C 134 Appendix O. The permission for using the CESD-C 135 Appendix P. The permission for using the MMSE-C 136 Appendix Q. Descriptive statistics for analyzing the characteristics of subjects 138 Appendix R. The methods for analyzing the differences of variables between the respondents and nonrespondents 139 Appendix S. The methods of analyzing the associations between QOL with each predictor 140 | |
dc.language.iso | en | |
dc.title | 憂鬱症生活品質的長期追蹤研究 | zh_TW |
dc.title | A Longitudinal Study of Quality of Life in Persons with Depression | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 王榮德,鍾麗英 | |
dc.subject.keyword | 職能治療,憂鬱症,生活品質,藥物, | zh_TW |
dc.subject.keyword | Occupational therapy,Depression,Quality of life,Medication, | en |
dc.relation.page | 140 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2009-02-06 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 職能治療研究所 | zh_TW |
顯示於系所單位: | 職能治療學系 |
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