健康照護學生心理健康素養結構方程模型之研究

Abstract

研究背景：健康照護學生精神疾病盛行率高，然而患病學生大多不願尋求心理健康專業協助。尋求心理健康專業協助為心理健康素養的面向之一，雖然心理健康素養的概念具有多面向性，尚未提出以理論為基礎的心理健康素養建構。研究目的：探討健康照護學生維持正向心理健康、精神疾病辨識與認識、精神疾病污名態度、求助效能與尋求心理健康專業協助的路徑關係，依據尋求協助相關理論發展具理論基礎的心理健康素養建構，並利用健康照護學生樣本進行驗證，檢驗心理健康素養不同面向在尋求專業協助過程扮演的角色為何。研究方法：本研究根據尋求協助理論、尋求心理健康協助模型及健康信念模式提出心理健康素養建構的多重中介模型。本研究資料來自2018年健康照護學生心理健康素養調查研究，最終有效樣本共計1294份 (醫學生970名，公衛系學生324名)。研究工具分為兩個部分：第一部份為社會人口學變項；第二部分是健康照護學生心理健康素養量表，該量表分成維持正向心理健康、精神疾病辨識與認識、精神疾病污名態度、求助效能及求助態度五個分量表。本研究使用描述性統計瞭解樣本分布狀況；皮爾森相關係數檢定雙變項之間相關情形；結構方程模型檢驗各變項間的直接效果及間接效果。研究結果：受訪者以男性 (55.8%)、大三至大四 (81.9%)、無特定宗教信仰 (51.5%) 及家庭月收入10萬元以上，20萬元 (含) 以下 (27.1%) 學生較多。結構方程模型顯示精神疾病辨識與認識對於求助效能及維持正向心理健康具有正向的直接效果，意即具備較佳精神疾病辨識與認識者，較瞭解心理健康照護管道及維持正向心理健康的相關知識。本研究提出精神疾病辨識與認識及求助態度的多重中介模型，其中僅求助效能具有中介效果，意即較佳的精神疾病辨識與認識，有助於提升瞭解心理健康專業服務資訊，進一步促進求助態度。研究結論：本研究為第一個奠基於理論基礎而提出心理健康素養五個面向的多重中介因子架構，有助於瞭解健康照護學生尋求心理健康專業協助的影響過程。提升醫學生及公衛領域學生的精神疾病辨識與認識能力有助於改善其求助效能，進一步促進尋求心理健康專業協助態度，產生實際求助行為，因而有助於心理健康發展，對於未來其從事醫療照護以及健康促進工作具有正向影響。

Background: There is a high prevalence of mental illness in healthcare students, while most students with mental health problems are reluctant to seek help from mental health professionals. Help-seeking is one of the components of mental health literacy (MHL). Although MHL is conceptualizing as multi-dimensional, a theory-based multi-construct of MHL is still lacking to date.Objective: The present study aimed to build a theory-based multi-construct of MHL and then to explore the pathways of help seeking. A sample of healthcare students was used to verify the proposed construct.Methods: Based on help-seeking theory, model for mental health help seeking, and the health belief model, we established a parallel mediation model of MHL. The data were from the survey of MHL among healthcare students in 2018 (N=1294). Sociodemographic data were recorded and Mental Health Literacy Scale for Healthcare Students was used to measure maintenance of positive mental health, recognition of mental illness, mental illness stigma attitude, help-seeking efficacy, and help-seeking attitude. Descriptive analysis, Pearson’s correlation, and structural equation modeling (SEM) was conducted in this study.Results: More than half of the participants were male (55.8%) and had no specific religion (51.5%). Most of the participants were junior and senior undergraduates (81.9%), and 27.1% of the students had a household monthly income between 100,000 and 200,000 Taiwan dollars. The findings of the SEM model indicated recognition of mental illness had positive direct effects on both help-seeking efficacy and maintenance of positive mental health. Additionally, help-seeking efficacy fully mediated the relationship between recognition of mental illness and help-seeking attitude.Conclusions: The present study proposed a theory-based multi-construct of MHL for understanding the process of help-seeking for mental health concerns among healthcare students. Help-seeking efficacy plays a significant role in healthcare students’ willingness to seek professional help when mental health care is needed. Accordingly, improving help-seeking efficacy strategies would increase the use of mental health services and contribute to the prevention of mental health problems.