探討思覺失調症患者獨立生活信心：患者自評與代理評估比較

Abstract

背景與研究目的：獨立生活是思覺失調症患者復健的重要目標。然而，具有相同功能者未必抱有同等信心，顯示能力與信心為不同構念。此外，代理人常為個案無法自行作答時的資訊來源，但代理人的主觀感受多與個案本人不同，支持個案自陳與代理人回報的資訊應分別解讀。基於上述原因，儘管多篇研究曾探討獨立生活能力之相關因素，與個案及代理人獨立生活信心相關的因素仍大多未知，限制臨床介入之有效性。本研究旨在檢驗與思覺失調症者與代理人獨立生活信心相關的因素，以提供臨床介入之基礎。 研究方法：本次級資料分析使用臺灣身心障礙資料庫之數據。研究對象為思覺失調症患者，並排除擁有其他共病者，除大多數個案皆有失智症故未排除外。獨立生活信心以世界衛生組織身心障礙評估量表 2.0 (World Health Organization Disability Assessment Schedule 2.0) 之單題進行評估，相關因素則選自該量表的其他題項。本研究分別檢驗患者與代理人的回報資料，並採用多元逐步迴歸分析，以控制年齡與性別的影響。 研究結果：本研究分析來自 95 位患者與 108 位代理人的資料。在自陳評估組中，四項因素與獨立生活信心具顯著關聯，校正後之解釋力達 73%。這些相關的因素包括：長距離行走 (b = 0.84)、學習新事物 (b = 0.46)、參與社區活動 (b = 0.29)，以及長時間站立 (b = -0.39)。在代理人評估組中，共計八項因素與獨立生活信心相關，校正後之解釋力為 57%。關聯的因素包括：長時間站立 (b = 0.41）、交新朋友 (b = 0.63)、穿衣服 (b = 0.46）、記得重要事情 (b = 0.43)、理解言語 (b = -0.29)、專注十分鐘 (b = -0.43)、室內移動 (b = -0.22)，以及性活 動 (b = -0.23)。 結論：本研究結果顯示四項與八項活動分別與病患及代理人對個案獨立生活信心程度有關。由於這些相關因素大多不重疊，臨床評估與介入應同時考量病患與代理人考慮之相關因素，以提升準確性與實用性。

Background and Objectives: Independent living is a key goal in the rehabilitation of individuals with schizophrenia. However, similar levels of functioning do not necessarily correspond to similar levels of confidence, suggesting that confidence and ability are distinct constructs. In addition, proxies are often used as an alternative when the data cannot be directly obtained from patients, but proxies’ perceptions are likely to differ from those of patients. Thus, the patient- and proxy-reported data should be assessed and interpreted separately. While previous studies have examined factors associated with ability in independent living, those with the confidence in independent living are largely unknown, which may constrain the effectiveness of clinical interventions. This study aimed to identify factors associated with self- and proxy-reported confidence in independent living among individuals with schizophrenia, offering evidence for clinical interventions. Methods: Secondary data were extracted from the Taiwan Databank of Persons with Disabilities. Participants were patients or proxies of individuals diagnosed with schizophrenia. Those with comorbid conditions were excluded, except for dementia, as most participants had this condition. Confidence in independent living was assessed by an item of the World Health Organization Disability Assessment Schedule 2.0. Associated factors were selected from the remaining items of the same measure. Multiple regression analyses with forward selection were conducted separately for patient- and proxy-reported data to identify associated factors, controlling for age and sex. Results: Data from 95 patients and 108 proxies were analyzed. The self-reported group's confidence in independent living was associated with four factors, accounting for 73% of the variance adjusted for the model complexity. The associations were observed for long-distance walking (b = 0.84), learning new tasks (b = 0.46), joiningcommunity activities (b = 0.29), and standing for long periods (b = -0.39). In contrast, the proxy-reported group’s confidence was influenced by eight factors, explaining 57% of the variance. The associations included standing for long periods (b = 0.41), making new friends (b = 0.63), getting dressed (b = 0.46), remembering important things (b = 0.43), understanding speech (b = -0.29), concentrating for 10 minutes (b = -0.43), indoor movement (b = -0.22), and sexual activities (b = -0.23). Conclusions: Our study identified four and eight factors associated with confidence in independent living from the patient- and proxy-reported models. Given that the associated factors are largely different across patient and proxy respondents, both perspectives should be incorporated in assessment and intervention planning.