疼痛對癌症病患焦慮與憂鬱之影響

The Impact of Pain on the Anxiety and Depression of Cancer Patients

本研究主要探討有無疼痛對癌症病患心理困擾之影響，為橫斷式相關性研究，採立意取樣(Purposive Sampling)方式，以北部某醫學中心之腫瘤科的癌症病患為對象，共選取90位病患，疼痛組和無痛組各45位。以「疼痛評估表」、「Karnofsky Performance Scale」(KPS)、「多層面健康控制重心量表」、「醫院焦慮與憂鬱量表」等問卷收集資料，比較分析有痛及無痛癌症病患焦慮與鬱的情況。結果顯示：(1)在焦慮與憂鬱的樣本盛行率及嚴重度上，疼痛組皆高於無痛組(P<.05)。(2)小學或小學程度以下者有較高的憂鬱程度(P<.05)。(3)身體功能狀態和焦慮、憂鬱之間呈顯著負相關(P<.01)。(4)「機運控制」和焦慮、憂鬱呈正相關(P<.01)。(5)在其它影響焦慮與憂鬱的因素被控制後，疼痛組及無痛組在焦慮的程度上是沒有顯著差異的，但在憂鬱方面則疼痛組的憂鬱程度顯著高於無痛組(P<.05)。在預測因素方面，「機運控制」能顯著預測焦慮，身體功能狀態及教育程度能顯著預測憂鬱。本研究再度證實「疼痛」是影響癌症病患心理困擾重要的因素，尤其是在憂鬱方面的影響。護理人員應協助癌症病患達到最佳的疼痛緩解，以減少癌症病患焦慮與憂鬱的發生，使患者生理、心理均達到安適狀態，進而提昇生活品質。

Aim of Investigation：To compare the anxiety and depression between cancer patients with and without pain. Methods：Ninety hospitalized cancer patients,45 wit pain and 45 without pain, were assesed for anxiety and depression using Hospital Anxiety and Depression Scale(HADS).Patients' demographic information, functional status, and health locus of control were also assessed. Results: The prevalence of both anxiety and depression in pain group were significantly higher than that in the pain free group. After controlling the effect of covariates (functional status, and chance control), the pain patients tended to have higher anxiety level than the pain free patients although the difference was not statistically significant (p=.110). However, when the effect of covariates (functional status, chance control, and educational level) was controlled, the pain patients still showed a significantly higher level of depression (p = .032). Conclusions: Depression and anxiety of cancer patients are related to their functional status, educational level, and health locus of control. When these factors are controlled, pain status still has significant impact on patients' depression. This study confirms the association between cancer pain and depression. Nurses should help patients to reach optimal pain relief and therefore decrease their anxiety and depression.