精神疾病患者之自我污名化、家庭功能與 疾病預後之關係

Abstract

研究目的：探討精神分裂症患者與憂鬱症患者之家庭功能是否為自我污名化影響疾病預後的中介因子。研究方法：研究對象經由國軍三軍總醫院身心科門診就診民眾招募而來，總計納入225位患者（精神分裂症患者150位、憂鬱症患者75位）。以迴歸分析進行家庭功能在自我污名化對其疾病預後狀態的中介效果之檢驗，其顯著程度經由拔靴法 (bootstrap) 進行估計。研究結果：精神疾病患者的自我污名化、家庭功能與疾病預後達顯著相關。在精神分裂症患者方面，家庭功能部分中介自我污名化對自尊及憂鬱症狀的影響；在憂鬱症患者方面，家庭功能部分中介自我污名化對自尊、憂鬱症狀、生活品質及無望感的影響。然而，不論精神分裂症或憂鬱症患者其自我污名化對於自我效能的影響中，家庭功能均未有顯著的中介效果。研究結論：精神分裂症與憂鬱症患者的自我污名化經由家庭功能進而影響與臨床預後有關心理狀態。因此，提升精神病患的家庭功能為改善精神疾病患者疾病預後的可行介入標的。

Purpose : The aim of this study was to examine the mediating effect of family function on the relationship between self-stigma and prognosis (i.e., self-esteem, depressive symptom, quality of life, hopelessness and self-efficacy) in patients with schizophrenia and patients with depression. Methods : A total of 225 outpatients (150 patients with schizophrenia, 75 patients with depression) were recruited from one psychiatric outpatient of Tri-Service General Hospital. The mediating effect (also called indirect effect) of family function on the relationship between self -stigma and prognosis was examined by regression analysis. The significant degree of indirect effects was estimated via bootstrapping. Results: Significant correlations between self-stigma, family function and prognosis were found in patients with schizophrenia and patients with depression. Family function partially mediated the relation of self-stigma to self-esteem and depression symptoms, respectively, in patients with schizophrenia. Family function partially mediated the relation of self-stigma to self-esteem, depressive symptoms, quality of life, and hopelessness in patients with depression. However, regardless of the patients with schizophrenia or depression, family function did not mediate the relationship of self-stigma to self-efficacy. Conclusions: Self-stigma had influences on prognosis via family function in patients of schizophrenia and depression. Therefore, to enhance family functioning is a plausible intervention target to improve prognosis in patients with mental illness.