精神病患者家屬的壓力源、應對策略與健康狀況——時間序列的探討

Stressor, Coping Strategy and Health Status among Family Members with Psychotic Patient: A Time Process Perspective

本研究的目的在於探討精神病患者家屬：（一）最感到壓力的事件、最常使用的應對策略與最易呈現的身心症狀；（二）其壓力源與應對策略型態；（三）其壓力源型態、應對策略型態和健康狀況分別與精神病患者初次發病時間長短的關係；（四）其壓力源型態、應對策略型態和健康狀況分別與精神病患者發病次數多寡的關係；（五）其壓力源型態、應對策略型態與健康狀況彼此之間的關係。藉由調查訪談法，本研究以就診於台北市及臺灣省北、中、南部等五所教學醫院精神科門診與病房的精神病患者家屬為對象，依病患發病性質將之分為初次發病組與多次發病組二組，每組人數分別為128名與129名，並由研究者與經標準化訓練過的訪談員以家屬壓力源量表、應對策略量表與中國人健康問卷等測量工具進行會談。結果發現：1.精神病患者家屬的壓力源型態可分為四類型；精神病患者家屬的應對策略型態可分為三類型。2.初次發病患者發病時間長短或患者發病次數多寡程度不同的病患家屬在某些壓力源因素型態、應對策略因素型態與健康狀況等向度上具有組間的差異性。3.初次發病患者家屬的壓力源型態與應對策略型態間可發現二種典型相關，壓力源型態分別與健康狀況呈負相關，而應對策略型態中只有“情緒化的面對間題”與健康狀況呈負相關。本文亦就研究結果所顯示的意義、護理上的應用與未來的研究方向提出討論。

The present research studied the effects which a psychotic patient has on his(her) family members. The main emphasis was on the following five points: (1) the most stressful events, the most commonly used coping strategies and the commonly experienced symptoms, (2) the types of stressors and coping strategies, (3) the interrelationship between the duration of the first episode of psychosis and the types of stressors and coping strategies, and the health status of family members, (4) the interrelationship between the frequency of psychotic episodes and the types of stressors and coping strategies, and the health status of family members, (5) the interrelationship among stressor types, types of coping strategies, and the health status of family members. The research methods used were survey and interview which were conducted by the researcher along with trained interviewers by means of family stressor scale, coping scale, and Chinese health questionnaire. The subjects were the family members of psychotic patients being treated in the five teaching hospitals on northern, central, and southern Taiwan and were divided into two groups, those with patients of first episode and those with patients of frequent episodes. Group size was 128 and 129 respectively. The main results showed that: (1) The stressors of family members of a psychotic patient could be classified into four types; and the coping strategies into three types. (2) Concerning stressor types, types of coping strategies, and health status as realted to the duration of primary psychotic episode and the frequency of psychotic episodes, significant differences were found between the two subject groups. (3) Two kinds of canonical correlation were found between the stressor types and types of coping strategies used by family members of a psychotic patient with primary episode. (4) Stressor types were found negatively correlated with health status. Among the types of coping strategies, only ''emotional problem-solving strategy'' was found negatively correlated with health status. The application of the finding to current nursing practice and the implications for further research were also discussed.