影響社區精神復健服務使用之相關因素研究——以台灣中部地區為例

The Correlates of Psychiatric Rehabilitation Service Use in Central Taiwan

對於精神疾病的處遇除了住院治療外，重新回歸社會過有品質的生活為其最高原則，社區精神復健服務即為達到此一目標的手段。許多的研究報告指出，社區精神復健服務有使用率偏低的情形。本研究乃是以照顧者的角度出發，來探討影響精神病患使用社區精神復健服務的相關因素為何。所檢視之自變項乃以Andersen Model為基礎，再加入三個預測變項：照顧者負荷、對服務的認知及獲得非正式社會支持網絡的程度。研究對象依立意取樣，針對中部地區四家醫院門診及居家治療之照顧者。以結構式問卷的面訪方式進行資料蒐集，共完成有效問卷244份。研究發現：1. 48.4%的照顧者未曾聽過四種社區復健服務中的任何一種，且只有27.0%的病患有使用過社區精神復健服務：2.社區精神復健服務的是否使用與病患的診斷、行為問題程度、照顧者求助動機、家人在照護中所獲得的支持與照顧者對服務的認識有顯著相關；3.依據Logistic迴歸分析結果，照顧者對服務的認識為病患是否使用社區精神復健服務的有力預測變項。其中尤以照顧者是否被建議及被解釋過社區精神復健服務，為最重要的相關變項。

Helping persons with mental illnesses maintain a successful community life is currently the major goal of psychiatric treatment. In order to accomplish such a goal, psychiatric rehabilitation is an essential mechanism. However, previous studies have revealed that the psychiatric rehabilitation services have been underutilized. This study aims to examine the correlates of psychiatric rehabilitation service use from the caregivers' viewpoint, Potential correlates were determined based on the Andersen Model; in addition, three variables were included: caregiver burden, knowledge about the services, and informal social support. Data was obtained from in-person interviews with 244 caregivers of mentally ill persons who were receiving psychiatric outpatient treatment or home care at four hospitals in central Taiwan, The results indicate that 48.4% of the caregivers had never heard of psychiatric rehabilitation services, and only 27% patients had used such services before. Based on the bivariate analyses, the significant correlates of psychiatric rehabilitation services were the following: patients' diagnosis, behavioral problems, motivation for help, caregiving support from family members, and knowledge about the services. Nevertheless, the multivariate analyses reveal that variables measuring knowledge about the services were the most important correlates. Caregivers who had these services explained to them and then encouraged to use them were more likely to use such services. Implications and suggestions for policy and practices are also discussed.