再住院精神分裂病患者是否住院及住院日數之社會心理因素探討
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Date
1997-04-01
Authors
吳聖良
張鳳琴
Journal Title
Journal ISSN
Volume Title
Publisher
行政院衛生署國民健康局
Abstract
本研究旨在瞭解影響精神分裂病患者是否住院及住院日數之社會心理因素。立意 選取 5 家精神科醫院並以該等醫院於民國 84 年 7 月至 11 月間之再住院精神分裂病患者 及其主要照顧者為研究樣本， 進行問卷訪問，共完成 205 名患者及其主要照顧者之問卷訪 談。研究主要發現如下：樣本患者的年齡大多集中在 20 至 39 歲間 (佔 71.1 ％ )；平均 年齡 34.7 歲；男性佔 60.5 ％；教育程度以高中畢業者最多 (佔 40.5 ％ )；婚姻狀況以 未婚居多 (佔 66.8 ％ )；過去 1 年沒有工作者佔 73.2 ％；大部份與父母同住 (佔 72.2 ％ )。 43.4 ％的精神分裂病患者在此次住院的前 1 年曾經住院過；對於前 1 年曾住院的 患者說，其平均住院次數 1.22 次，平均住院 98.7 日。研究結果發現影響患者是否住院的 因素為過去住院總次數、性別及是否看乩童；患者過去住院總次數較少、男性及沒有看過乩 童者之住院機率較高。預測住院日數的因素依次為主要照顧者之經濟負擔、是否與父母同住 、患病年數、與家屬關係之好壞、等候住院的時間長短、與家屬衝突程度、服藥劑量遵囑性 及是否獨居，以上因素能解釋住院日數 54.3 ％的變異量。另外，照顧者婚姻狀態、家屬對 患者之滿意程度、家屬對患者是否過度保護、家人支持程度與服藥劑量遵囑性亦有關，故這 些變項也間接影響住院日數。 根據結果，本研究提出兩項建議；即 (1) 精神分裂病患者之 醫療照護，除強調病患的服藥遵囑性外，亦應教育家屬如何處理其與患者相處時之情緒表露 (expressed emotion)；(2) 建立社區支持網絡，協助家屬與患者建立良好的關係。
The purpose of this multivariate correlational study is to examine the relationship between schizophrenic patients' psychosocial variables and their hospitalization, length of stay and medical compliance. We selected 205 schizophrenics rehospitalized between July and November 1995 in psychiatric hospitals and their primary caregivers (N=205). Data were gathered using a 30 item closed-ended questionnaire. Instrument test-retest reliability reached 0.93. Data were analyzed using stepwise logistic regression and multiple regression. The results revealed that sex, number of previous admissions and utilization of shaminism (folk psychiatric care) are factors related to hospitalization. Factors related to length of stay includes: whether patient is living alone, his perceived relationship with his family members, frequency of conflicts with family members, years of illness, living with parents or not, medication dosage compliance, duration of waiting for inpatient care and perceived economic burden of his family. These factors contributed to 54.3% of the total variance in length of stay. Further logistic regression analysis showed that support, over-protection, and dissatisfaction by family members and primary caregivers' marital status are related to medication dosage compliance and therefore are indirectly related to length of stay. The findings suggest that a controlled trial on psycho-educational intervention program for family members of schizophrenic patients should be implemented in hospitals to increase family members' understanding of mental illness and set up social supporting networks to enhance the relationships between patients and their family members.
The purpose of this multivariate correlational study is to examine the relationship between schizophrenic patients' psychosocial variables and their hospitalization, length of stay and medical compliance. We selected 205 schizophrenics rehospitalized between July and November 1995 in psychiatric hospitals and their primary caregivers (N=205). Data were gathered using a 30 item closed-ended questionnaire. Instrument test-retest reliability reached 0.93. Data were analyzed using stepwise logistic regression and multiple regression. The results revealed that sex, number of previous admissions and utilization of shaminism (folk psychiatric care) are factors related to hospitalization. Factors related to length of stay includes: whether patient is living alone, his perceived relationship with his family members, frequency of conflicts with family members, years of illness, living with parents or not, medication dosage compliance, duration of waiting for inpatient care and perceived economic burden of his family. These factors contributed to 54.3% of the total variance in length of stay. Further logistic regression analysis showed that support, over-protection, and dissatisfaction by family members and primary caregivers' marital status are related to medication dosage compliance and therefore are indirectly related to length of stay. The findings suggest that a controlled trial on psycho-educational intervention program for family members of schizophrenic patients should be implemented in hospitals to increase family members' understanding of mental illness and set up social supporting networks to enhance the relationships between patients and their family members.