接受肝動脈栓塞術前肝癌病患之睡眠品質、憂鬱與生活品質間之關係

Sleep Disturbance, Depression and Quality of life in Patients with Hepatocellular Carcinoma before Receiving Transcatheter Arterial Embolization

本篇文章的目的主要是要探討肝癌病患的憂鬱情形、睡眠品質與生活品質間之關係，並測試憂鬱在睡眠障礙與生活品質間的角色。本研究利用橫斷性設計，共收集73位肝癌病患，所有病患皆完成下列問卷，包括：歐洲生活品質量表（European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30， EORTC QLQ C-30）、匹茲堡睡眠品質量表（the Pittsburgh Sleep Quality Index-Taiwan Form， PSQI-Taiwan Form），及醫院焦慮憂鬱量表－憂鬱次量表（Depression subscale of the Taiwanese version of the Hospital Depression and Anxiety Scale， HADS），資料統計分析方法包括：平均數、標準差及迴歸分析。研究結果發現：（1）睡眠障礙和憂鬱間呈現統計上顯著正相關（r=0.48， p=0.000），而睡眠障礙與憂鬱程度皆與肝癌病患之生活品質呈現顯著負相關（r=-0.310， p=0.008； r=-0.367， p=0.001）；（2）另外，憂鬱在睡眠障礙與生活品質間為完全中介的角色。這個研究結果可以了解，肝癌病患的憂鬱情形、睡眠障礙與生活品質間之關係，並進一步得知憂鬱在睡眠障礙與生活品質間所扮演的重要角色。總結來說，本研究探討肝癌病患的憂鬱及睡眠障礙症狀與生活品質間關係，且發現憂鬱症狀在睡眠障礙與生活品質間為完全中介的角色，亦即在肝癌病患治療過程中，心理因素之影響佔很重要的成分，在護理措施中是不可被忽視的一部分。The purposes of this study were to (a) explore the relationships among sleep disturbance, depression, and quality of life, and to (b) test whether depression mediates the effect of sleep disturbance on quality of life in patients with hepatocellular carcinoma (HCC). A cross-sectional study was conducted with a total of 73 patients with HCC. All participants completed questionnaires that included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ C-30), the Pittsburgh Sleep Quality Index-Taiwan Form, and the Depression subscale of the Taiwanese version of the Hospital Depression and Anxiety Scale. Path analysis was used to test the mediation role of depression. The major results were as follows. First, sleep disturbance is positively related to depression (r=0.48, p=0.000). In addition, sleep disturbance and depression are negatively interrelated with quality of life (r=-0.310, p=0.008; r=-0.367, p=0.001) in patients with HCC. Moreover, depression completely mediates the effects of sleep disturbance on quality of life. These findings suggest that depression is an important mechanism underlying the relationship between sleep disturbance and quality of life for patients with HCC. In conclusion, this is the first study to explore how the phenomenon of symptoms (sleep disturbance and depression) affects quality of life in patients with HCC and to investigate the mediating role of depression that underlies the relationship between sleep disturbance and quality of life. The current findings could be of clinical importance and imply a need to consider management of sleep disturbance and depression simultaneously.