模擬幻聽於大學生對精神病患同理心、知識、社會距離及態度之成效──系統性文獻回顧暨統合分析

The Effects of Auditory Hallucination Simulation on Empathy, Knowledge, Social Distance, and Attitudes Toward Patients With Mental Illness Among Undergraduate Students: A Systemic Review and Meta-Analysis

背景：社會大眾對精神病患的負向態度將影響精神病患融入社區生活。而模擬幻聽為創新教學策略，用於改善學習者對於精神病患的觀感，然而，模擬幻聽於改善對精神病患的負向態度之實證成效仍未有定論。目的：採用系統性文獻回顧暨統合分析方法，比較與分析模擬幻聽策略於改善大學生對精神病患之同理心、精神疾病知識、社會距離及態度的成效。方法：以「幻聽」及「模擬」為關鍵字，以對精神病患的同理心、精神疾病知識、社會距離及態度為成效指標，搜尋2008至2016年間發表於Cochrane Library、EBSCO、CINAHL、MEDLINE、PsycINFO、PubMed及華藝線上圖書館共6個資料庫的實證文獻，並以修正版Jadad品質量表、牛津實證醫學中心證據等級及考科藍風險誤差工具評定文獻品質。結果：共納入11篇研究進行系統性文獻回顧，以其中具有完整數值的7篇進行統合分析。經統合分析發現，模擬幻聽可顯著改善研究對象對精神病患的同理心與精神疾病知識，綜合效量分別為0.63（95% CI [0.21, 1.05]）及0.69（95% CI [0.43–0.94]），但社會距離亦顯著增加，綜合效量為0.60（95% CI [0.01, 1.19]），對精神病患的態度則未有顯著改善，綜合效量為0.33（95% CI [-0.11, 0.77]）。結論／實務應用：模擬幻聽策略可改善大學生對於精神病患的同理心及精神疾病知識，但對於社會距離及態度的成效證據尚待累積，目前多數研究侷限於美澳地區，且研究品質仍待提升。建議未來研究宜朝向更為嚴謹的研究設計、探討其介入於不同地區或族群的實證成效。

Background: The negative attitudes of the general public toward mental illness frequently influence the integration of mental illness patients into the community. Auditory hallucination simulation may be considered as a creative teaching strategy to improve the attitudes of learners toward mental illness. However, the empirical effects of auditory hallucination simulation to change the negative attitudes toward mental illness remains uncertain. Purposes: To compare and analyze, using a systematic review and meta-analysis, the effectiveness of auditory hallucination simulation in improving empathy, knowledge, social distance, and attitudes toward mental illness in undergraduates. Methods: A search using the keywords “auditory hallucination” and “simulation” and the 4 outcome indicators of empathy, knowledge, social distance, and attitudes toward mental illness was conducted to identify related articles published between 2008 and 2016 in 6 Chinese and English electronic databases, including Cochrane Library, EBSCO-CINAHL, MEDLINE, PsycINFO, PubMed, and Airiti Library. Research quality was appraised using the Modified Jadad Scale （MJS）, the Oxford Centre for Evidence-Based Medicine Level of Evidence （OCEBM LoE）, and the Cochrane Risk of Bias tool. Results: Eleven studies were recruited, and 7 studies with sufficient data were included in the meta-analysis. The meta-analysis showed that hallucination simulation significantly improved the empathy and knowledge of participants, with respective effect sizes of 0.63 （95% CI [0.21, 1.05]） and 0.69 （95% CI [0.43-0.94]）. However, this intervention also increased social distance, with an effect size of 0.60 （95% CI [0.01, 1.19]）, and did not change attitudes toward mental illness significantly, with an effect size of 0.33 （95% CI [-0.11, 0.77]）. Conclusions/Implications for Practice: Auditory hallucination simulation is an effective teaching strategy for improving the empathy and knowledge of undergraduates. However, related evidence for the effects of social distance and attitudes toward mental illness need to be further strengthened. Most of the extant research on this subject was conducted in the United States and Australia and was of moderate quality. Future studies should use sufficiently rigorous research designs to explore the safety issues and the effectiveness of the auditory hallucination simulation intervention in different countries and ethnic populations.