探討門診重鬱症患者和其伴侶的親密關係與生活品質之相關性

Abstract

背景：重鬱症影響了個案的生存意願、生活品質（quality of life）、和社會經濟等負荷，其中生活品質常被用來當作醫療處置、介入的評量標準之一，憂鬱症狀和社會支持影響了重鬱症患者的生活品質，而患者的社會支持與人際衝突主要來源是與伴侶的關係，但目前較缺乏探討與伴侶的安全依附關係和生活品質相關的研究。 目的：本研究目的為探討門診重鬱症患者與其伴侶的親密關係、性功能、憂鬱程度及生活品質之相關性。 研究方法: 本研究為橫斷式（cross-sectional）研究，以立意取樣方式（purposive sampling）於北部某醫學中心及基層醫療單位精神科門診進行收案，共收案141位服用抗憂鬱劑兩週以上、有伴侶之20到65歲門診重鬱症患者，使用自填式結構性問卷收集資料。研究工具包括：自擬人口學特性問卷、貝克憂鬱量表（BDI-II）、世界衛生組織生活品質量表－台灣簡明版（WHOQOL-BREF-TW）、親密關係量表（ECR-R）、簡版性功能變化問卷（CSFQ-14）。 研究結果：1.本研究樣本群多數為門診規律服藥者，憂鬱程度為輕度憂鬱，生活品質的生理健康、心理、社會關係範疇低於一般常模（健康與生理疾患者），焦慮依附與逃避依附傾向較一般人高，61.4%傾向有性功能障礙。2.以皮爾森積差相關係數（Pearson’s product-moment correlation）檢定發現憂鬱程度、不安全的親密關係與生活品質呈負相關，性功能與生活品質呈正相關。3.根據階層迴歸分析（hierarchical regression）結果，憂鬱程度是生活品質各範疇之主要預測因子，也是性功能除了性愉悅之外的主要預測因子，憂鬱程度越高則生活品質及性功能越差。4.與伴侶的親密關係是生活品質社會關係與環境範疇、性愉悅的主要預測因子，焦慮依附及逃避依附傾向越高則社會關係範疇的生活品質越差，焦慮依附傾向越高者環境範疇的生活品質越差。5.性功能對生活品質各範疇皆無預測力。 結論:重鬱症患者在生活品質、親密關係、性功能仍較一般人差，根據本研究結果，建議應以緩解憂鬱症狀嚴重度為優先，並包含評估與伴侶的不安全依附之親密關係於支持照護中，以改善門診重鬱症個案在生活品質及性功能的滿意度。

Background: Major depression has been recognized for its roles in influeincing the patients’ will to live, quality of life and socioeconomic burdens. Quality of life has been used to measure the outcomes of medical treatments. Depressive symptoms and social supports are related to the quality of life among the patients with major depressive disorder. The social supports and interpersonal conflicts are related to their relationships with partners. However, very few studies exist of examining the relationships between quality of life , sexual function and secure attachment with partiners. Aims: This study aims to examine the correlations of quality of life with the close relationship with partners, sexual function and depressive symptoms among the outpatients with major depressive disorder. Methods: This study adopts a cross-sectional design. The purposive sampling method was used to recruit the subjects from the outpatient department of a medical centre and the psychiatric clinic of primary care in Taipei. The criteria of the subjects include aged between 20 and 65 years old, having been receiving antidepressant medication more than two weeks and being with the repationship with the partner. The self-report measures include personal information, Beck Depression Inventory II (BDI-II), the World Health Organization’s Quality of Life assessment-brief of Taiwan (WHOQOL BREF-TW), the Experience in Close Relationships-Revised questionnaire (ECR-R), Changes in Sexual Functioning Questionnaire short-Form (CSFQ-14). Results: 1. Majority of the 114 subjects reported that they were adherence to medication treatments. With medication treatment, the averaged severity of depressive symptoms was mild. But the physical, psychological and social domains of quality of life were lower in our subjects than the general population (including healthy and those with physical diseases). The levels of anxiety and avoidance attachment styles were also higher than healthy people. The estimated numbers of sexual dysfunction were 61.4% in our subjects. 2. Pearson’s product-moment correlation test showed that the severity of depressive symptoms and insecure attachment were negatively correlated with quality of life, while sexual function was positively associated with quality of life. 3. According to the results of the hierarchical regression analysis, the severity of depressive symptoms was the main predictor for all domains of quality of life, and most domains of sexual function except for sexual pleasure. Higher severity of depressive symptoms was associated with lower quality of life and lower sexual function. 4. The close relationship with partner could predicte social and environment domains of quality of life and sexual pleasure. Higher levels of anxiety and avoidance attachment styles were associated with lower social domain of quality of life. Higher levels of avoidance attachment style were also related to lower environment domain of quality of life. 5. Sexual function was not the predictor for quality of life. Conclusions: The findings of this study conlude the lower quality of life, the close relationship and sexual function were lower among the outpatients of major depressive disorder. According to the findings, the reductions of severity of depressive symptoms need to regard as the first priority of clinical care. Meanwhile, assessments of the impacts of insecure attachment style in close relationships with partners require to be included in providing the comprehensive supportive care in order to improve quality of life and sexual function for the outpatients of major depressive disorder.