增進憂鬱症患遵從醫囑因素之研究

The Components of Adherence for Depression Patients

研究目的：為了解憂鬱症門診患者遵從抗憂鬱劑治療情形及對於醫病關係期待的內容，以提供身心科門診醫師、心理及醫療照護人員鼓勵患者能遵從醫囑及接受完整治療之參考。研究方法：於臺灣東部地區一家綜合醫院身心科門診實施，共計有年齡介於20～75歲之150患者（男性40位及女性110位，平均齡48.51歲）匿名填答。參與者匿名填答由研究者編譯包含患者對醫病關係的知覺、保留個人自主性、對抗鬱劑的正向信念、友伴認同等四項因素之抗鬱劑遵從調查問卷（ADCQ），並簡述其遵從或阻礙醫囑服用抗鬱劑的原因、對於醫病關係的期待及醫護人員如何覺察病患需求等。研究結果：多數患者正向評估其抗鬱劑治療的遵從醫囑情形有正面的期待，且年長者在醫病關係及對抗鬱劑的治療有較正向的知覺。身心出現明顯的不適、希望病情獲得控制能恢復健康及信任醫師等，是持續門診及遵從醫囑的主要理由；然而，對於藥物副作用的負面印象或依賴藥物的緩解效果、生活環境的影響及未採取積極正確的健康管理行動等，則是阻礙患者遵從抗憂鬱劑治療的主要原因。患者們也期待醫師能多傾聽患者說話、多瞭解和關心其病情的發展、能從多項的非語言資料，察覺患者對於病情治療的需求，並提供專業諮詢與衛教服務等鼓勵的支持行動以穩定情緒。研究結論：從研究結果可以反映憂鬱症患者，對於穩定且積極的支持關係、自主性及正向的醫療效果，有很高的心理需求，建議醫護人員多運用傾聽、同理心的諮商要素，指導正確的用藥資訊，以提昇對醫囑的遵從性。

Purpose: This research examined the factors and reasons that support depression patients in maintaining their antidepressants. Methods: Participants were 150 psychiatric out-patients (40 men and 110 women, age 20-75 with mean age of 48.51) at a regional hospital in Taiwan. The Antidepressant Compliance Questionnaire (ADCQ) and open-ended questions were used to gain an understanding of the circumstances that support patients in taking their antidepressants as well as their expectations regarding treatment. Results: More than 90% of the patient-respondents had a positive evaluation of the treatment. Younger participants had lower perceptions of their relationships with their doctors and lower beliefs about efficacy of antidepressants than elders. The main reason for patients continuing acceptance of both the treatment and out-patient service was the hope that taking antidepressants would lead to a significant reduction of their mental and physical symptoms. The main factors that hindered patients’ willingness to take antidepressants were a negative impression of the side effects, fear of reliance on pharmaceuticals, circumstantial influences, and the lack of a rigorous health-management plan. Conclusions: This study indicated that depression patients have very high expectations for supportive relationships and a positive therapeutic outcome. Patients expected medical personnel to be able to understand their needs by making use of their non-verbal information. The clinical implications of the findings suggest that healthcare practitioners should engage in empathic listening and provide accurate information about the use of antidepressants to increase patients’ compliance with prescriptions.