接受美沙冬替代療法的海洛因依賴病人之生活品質

Quality of Life among Heroin Addicts at Entry to the Methadone Maintenance Treatment

目的： 此研究調查接受美沙冬替代療法的中台灣海洛因使用者之生活品質及其相關因 子。 方法： 本研究招收 781 位在草屯療養院接受美沙冬替代療法的海洛因使用者，以世界 衛生組織生活品質問卷台灣簡明版來評估病人之生活品質。使用流行病學研究中心憂鬱量 表、貝氏衝動性量表、中文版依賴嚴重度量表、家庭功能量表來評量病人特性及共病，並抽 血檢查血液感染性疾病。以 ANCOVA 統計來尋找與較差生活品質相關的因子並去除干擾因 素。 結果： 參與者 90.9% 為男性。20.7% 病人有 HIV 感染而 90.5% 病人有 C 型肝炎病毒感 染。無業和較差的生活品質中生理、心理、社會及環境向度有明顯的關連性（p < 0.05 或 p < 0.01）。衝動性則與生活品質的較差心理向度有明顯的關係 (p < 0.01)。良好家庭支持對於 生活品質環境向度有正向明顯的關係 (p < 0.01)，而控制其他變項如人口學、物質濫用、共 病感染疾病等因子後，憂鬱與較差的所有生活品質四個向度有顯著的關係（p < 0.05 或 p < 0.01）。 結論： 帶有憂鬱症狀的海洛因使用者，有的明顯較差的生活品質。

Objective: This study was to investigate quality of life (QoL) among heroin users receiving the methadone maintenance treatment (MMT) in Taiwan, and to explore the QoL-associated factors. Method:： In this study, we enrolled 781 her-oin users who were participating in the MMT programs at Tsaotun Psychiatric Center in central Taiwan. We used the World Health Organization Quality of Life-Short Form (WHOQOL-BREF) Taiwan version for assessing their QoL. The Cen-ter for Epidemiologic Studies Depression Scale, the Barratt Impulsiveness Scale, the Chinese Version of the Severity of Dependence Scale, and the Family APGAR score were used to evaluate comorbid depressive symptoms and other characteris-tics. Blood tests for related infectious disease were also conducted. ANCOVA sta-tistics was used to identify significant associated factors independently linked to poorer QoL after adjusting for confounders. Results: The mean participant age was 36.0 years and most patients (90.9%) were men. Comorbid HIV infection was found in 20.7% of heroin-dependent patients and hepatitis C virus infection was common (90.5%). Unemployment was significantly and negatvely linked to the physical, psychological, social, and environmental domains of QoL (p< 0.05 or p < 0.01) . Needle-sharing and polysubstance abuse presented lower scores in the physical domain. Impulsivity was significantly associated with a poorer psycho-logical domain of QoL (p< 0.01). Better family support had a significant positive effect on the environmental parameters of QoL (p< 0.01). Depression was signifi-cantly associated with lower scores in all four domains of QoL after controlling demographic characteristics, drug use, and comorbid infectious disease variables (p< 0.05 or p< 0.01). Conclusion: The study findings show the associated factors of QoL among heroin users. The presence of depression was found to negatively influence QoL of heroin-dependent patients. Further studies are required to exam-ine the effect of alleviating these factors (e.g., depression) on heroin users’ QoL.