精神分裂症病人生活品質量表之建構效度

Construct Validity of the Quality of Life for Patients with Schizophrenia

目的：精神分裂症病人之健康相關生活品質漸漸成為療效指標之一。本研究的目的為建 立健康相關之生活品質量表中八個面向的建構效度。 方法：由台北市某四家精神復健機構 招募 237 位依據 DSM-IV-R 診斷為精神分裂症的病人；以 Quality of Life for Mental Disorder 測量其生活品質結果，再以結構方程式模式 (structural equation modeling) 探討該量表建構效 度。 結果：HRQoL 的最佳模式為 Chi-square = 1004.484 (df = 789), p = 0.192, GFI = 0.852, RM- SEA = 0.034, TLI = 0.940，顯示該量表的八個面向可分三個部分來詮釋；對精神分裂症病人 而言 (A) 家庭支持會直接影響其心理及身體健康 (β = 0.849 及 0.738)，也會間接影響其健康 相關生活品質（如：生活滿意、自主性、健康維護）；(B) 身體健康直接顯著地影響健康相 關生活品質 (β = 0.745 - 0.921) (p < 0.001)；以及 (C) 心理健康直接顯著地影響其身體健康 (β = 0.217) (p < 0.05)。 結論：結構方程式模式顯示健康相關生活品質量表依三個部分來詮釋精神 疾患病人的生活品質，使臨床人員更清楚了解兩者間的相關以及兩者之間之影響路徑。

Objective: Health-related quality of life (HRQoL) has become one of the most valuable indicators of treatment in patients with schizophrenia. The purpose of this study was to establish the construct validity of eight domains in a HRQoL scale. Methods: From four psychiatric rehabilitation centers, 237 patients were chosen for participation in the study. Inclusion criteria were a DSM-IV-R diagnosis of schizophrenia. Quality of life was measured using the Quality of Life for Mental Disorders (QoLMD) scale. Structural equation modeling (SEM) was chosen to investigate the construct of the QoLMD. Results:This model of HRQoL for pa- tients with schizophrenia was acceptable (Chi-square = 1004.484 (df = 789), p = 0.192, GFI = 0.852, RMSEA = 0.034, TLI = 0.940). The relationship between eight domains of the QoLMD can be interpretive into three parts: (A) under family support, patients with schizophrenia had significantly directly related to mental and physical health (β = 0.849 and 0.738) and significantly indirectly related to HRQoL (i.e., life satisfaction, autonomy, health maintenance); (B) under physical health, schizophrenia patients had significantly directly related to HRQoL (β = 0.745-0.921) (p < 0.001); and (C) under mental health had significantly directly related to physical health (β = 0.217) (p < 0.05). Conclusion:The SEM revealed that HRQoL was interpreted by the pathways between eight domains of QoLMD, and therefore it made clinical therapists understood clearly about the correlation and mutual-influential pathway between HRQoL and QoLMD.