成年智能障礙者精神徵狀量表的引進與在智能障礙機構應用

Prevalence and Factors Impacting Psychological Symptoms in Adults with Intellectual Disabilities in Taiwanese Care Institutions

智能障礙者精神徵狀盛行率為一般人四倍。雖然機構照護人員可以照護智能障礙者的生活起居以及訓練其生活能力，但不易及早察覺智能障礙者心理健康的異常，導致症狀較嚴重時才就醫。本研究的目的為引進一份適用於台灣身障機構智能障礙者心理健康量表，並運用於測量機構智能障礙者心理健康及其相關影響因素。本研究為長期研究，每3個月為一期共計4個波次調查，總觀察時間為一年的追蹤觀察研究。研究取樣涵蓋了都市、郊區、與鄉村區域具代表性的不同照顧型態的成年智能障礙者。照護型態包含24時全日型、日間以及夜間照護服務。研究工具採用結構式問卷，委請熟悉該智能障礙者6個月以上的照護員觀察填寫。統計分析方式運用單變項統計以及羅吉斯回歸分析機構成年智能障礙者個人特質、環境因素以及同儕相處情形對其精神徵狀之影響。本研究納入分析之個案共176人。精神徵狀平均盛行率為14%（25人），而一年期間盛行率為32%（56人）。精神徵狀以適應障礙、焦慮症、身體化症為前三高，累積盛行率分別為15%、16%、14%。影響機構成年智能障礙者的危險因子有：年齡較輕、精神藥物的使用、合併障礙、以及同儕相處不愉快經驗。本研究經過一年的實證觀察結果，精神徵狀一至四波平均盛行率與台灣其他研究之盛行率相近，研究結果也展示了PIMRA量表作為成年智能障礙者心理健康工具的實用性。對於PIMRA量表的應用，建議機構可依情形調整監測構面，其中焦慮症、適應障礙以及身體化症這三個構面盛行率為最高，宜定期監測。

The prevalence of psychiatric symptoms in individuals with intellectual disabilities is four times higher than in the general population. While care providers in institutions assist in daily living and training for independent skills, early detection of psychological abnormalities in these individuals is challenging, often leading to delayed medical intervention until symptoms worsen. This study aims to introduce a psychological health inventory tailored for care institutions and apply it to measure psychological well-being in individuals with intellectual disabilities and associated influencing factors. This long-term research spans four survey waves conducted every three months, totaling a year of observational tracking. The sample covers representative urban, suburban, and rural areas with diverse caregiving modalities for adults with intellectual disabilities, including 24-hour care, day programs, and overnight services. Structured questionnaires completed by caregivers familiar with these individuals for over six months constitute the research instrument. Statistical analyses involve univariate statistics and logistic regression to assess the impact of personal traits, environmental factors, and unpleasant experiences with peers on psychiatric symptoms in adult individuals within care institutions. A total of 176 participants were analyzed in the study, showing an average prevalence rate of psychiatric symptoms at 14% (25 individuals) and an annual prevalence rate of 32% (56 individuals). The most prevalent symptoms were adaptive disorders, anxiety, and somatization, with cumulative rates of 15%, 16%, and 14%, respectively. Risk factors influencing psychiatric symptoms in adult individuals in care facilities included younger age, use of psychotropic medications, comorbid conditions, and unpleasant experiences with peers. After a year of empirical observation, the average prevalence rates of psychiatric symptoms across the four waves were similar to existing prevalence rates in Taiwan, demonstrating the practical utility of the PIMRA scale as a mental health tool for adults with intellectual disabilities. Recommendations for the PIMRA scale's application suggest adjusting monitoring aspects based on the prevalence of conditions; particularly, regular monitoring is advised for anxiety disorders, adaptive disorders, and somatization, which exhibited the highest prevalence rates.