身心症狀家庭功能與疾病的關係

THE RELATIONSHIP AMONG PSYCHOSOMATIC SYMPTOMS FAMILY FUNCTION AND ILLNESS

本研究係以生物心理社會模式（陳慶餘與吳英璋，民76年）探討於台大醫院家庭醫學科建立家庭檔案病患之身心狀況、自我支持、家庭功能、家庭生活事件、心理困擾等各變項及對病情嚴重程度之間的關係。結果顯示在65名病人中，在半年內有身心症狀的類數為7.05類，症狀出現較頻繁的是「失眠」、「頭暈」、「腰酸背痛」以及「四肢無力」。對治療效果的評估中，認為病情改善的佔61%，而有7%認為反而較差。最常遭遇的生活事件依項為「家庭中人口減少」、「家庭經濟改變」、「為子女婚事操心」、「夫妻爭執厲害」、「喪偶」等。多數病人的自我支持與家庭功能是正向的，而最常出現的心理困擾為「我覺得自己很神經質」、「我會有一段時間心情不好容易生氣」和「有一段時間心情低落憂鬰鬱悶」。相關分析發現「健康自評」與「身心症狀數」、「生活事件煩惱程度」以及「心理困擾」三項成正相關，而與「自我支持」、「家庭功能評量」兩項成負相關。廻歸分析中則發現解釋「健康自評」的主要變項為「身心症狀總強度」、「自我支持」和「沮喪憂鬱反應」。

A biopsychosocial model was applied to investigate and define the relationship among somatic symptoms, self support, family function, psychologic reaction and illness. Patients were recruited from the family file registered at the Family Medicine Clinic, National Taiwan University Hospital. There were 65 patients cared by one family physician receiving interview using a structurized investigation form during their visits. The results were summarized as follows: the mean number of somatic symptoms was 7.05 in the past half year; the common symptoms were ''Insomnia'', ''dizziness'', ''back pain'', and ''weakness of extremities''. On the evaluation of treatment effect, improvement was told by 61% of patients but 7% considered as worse than before. The common life events were ''decrease of family members'', ''change of family economic status'', ''worried about children's marriage'', ''quarrelling with spouse'', ''death of spouse''. Positive support from themselves and family was found in most of patients. The common psychologic reactions were ''I feel very nervous'', ''I am easily angry sometimes'' and ''I feel very depressed occasionally''. Variable of ''health self-assessment'' was positively correlated with ''somatic symptoms'' and ''emotional disturbance'', but negatively correlated with ''self support'' and ''family function''. Regression analysis revealed that ''the strength of somatic symptoms'', ''self support'' and ''depression reaction'' as the main variables to explain the outcome of ''health self-assessment''.