乳癌婦女配偶的依附、社會支持與焦慮及生活品質關係之探討

Abstract

女性乳房惡性腫瘤為國人癌症發生率的第一名，且發生率及死亡率逐年攀升；配偶面對病患罹患威脅生命的疾病時，常是最主要的照顧者，假若配偶本身適應狀況不佳，會影響配偶在病患罹病過程中提供各項支持的能力；甚至配偶也會陷入心理社會失調的情形，對家庭造成雙重衝擊。 根據Bowlby (1969, 1973, 1982) 提出的依附理論，壓力情境會激發配偶的依附系統，而不同依附狀況的個體對於壓力事件以及社會支持的感受會有所不同。社會支持是個體適應的重要因素，感受到較多社會支持的人對於壓力事件的因應也比較正向。乳癌對配偶與病患的依附關係產生重大的衝擊，影響配偶的心理適應狀況；而配偶需要提供病患多方面的支持，因此其適應狀況極需關注。 基於以上，本研究希望透過問卷調查，了解女性乳癌患者配偶的基本資料、病患的疾病狀況，以及兩次填答時配偶感受到的壓力、配偶與病患的依附情形、配偶感受到的社會支持與配偶的焦慮情緒和生活品質的狀況以及這些變項之間的關係。 本研究的量表具有良好的信效度；研究結果顯示，不同的時間點，配偶的基本變項、壓力知覺與依附情形與焦慮和生活品質有者不同的關係，且社會支持在壓力知覺與焦慮之間發揮了緩衝的功能、在逃避依附與生活品質之間扮演了中介的角色。 最後，根據研究的結果，研究者提出研究限制與臨床實務和未來研究的建議，期望透過本研究來辨別哪些特性的配偶有較高的心理失調危機，社會工作者可以在早期提供社會支持或臨床介入，預防配偶陷入高度焦慮的情緒中，提高配偶的生活福祉，進而促進配偶有能量提供病患與家庭支持，降低乳癌對家庭帶來的衝擊。

Cancer accounts for the highest mortality in Taiwan, and female breast cancer occurs the most among all kinds of cancer. Suffering from the life-threatening disease, spouses are main caregivers most of the time. If the spouses are maladaptive, they could not provide high quality of support to the patient. Even spouses may also become maladjusted; both of the situations impact the family. According to Bowlby’s attachment theory (1969/1982, 1973), such pressure situation will arouse attachment system of individuals, and the evaluations of pressure and perceptions of social support are affected by different attachment conditions. While social support is a key attribution for adaptation, people who perceive more social support maintain better adjustment when it comes to pressure events. Breast cancer impacts the intimate relationship between the spouses and the patients. The situation will arouse spouses’ attachment system and affect their perceived social support, which could influence their adaptation. Since spouses play important roles in disease trajectory, and they suffer from breast cancer as patients do; consequently, the present study did survey at a ward of a teaching hospital in Taipei city with self-report questionnaires. These inventories were filled twice at an interval of one to three months. The inventories applied in the present study were reliable and verified. The level of education, family income, religion and level of pressure have different relationships with anxiety and quality of life at different time. Social support is a moderator between perceive pressure and anxiety, and it is a mediator between avoidant attachment and quality of life. Based on the result, the researcher discussed the limitations of the present study, suggestions for clinical practice and for future research. Professionals could identify the spouses at higher risk of psychological disorders in early stage, and provide tailored interventions to facilitate the well-beings of the spouses, patients and families, reducing the impact of breast cancer on the family.