精神疾病患者之自我污名、家庭功能與心理福祉之關係

The Relationship between Self-Stigma, Family Function, and Psychological Well-Being in Patients with Mental Illness

研究目的：探討精神分裂症患者與憂鬱症患者之家庭功能是否為自我污名影響心理福祉的中介因子。研究方法：研究對象經由北部某醫學中心身心科門診就診民眾招募而來，總計納入225位患者（精神分裂症患者150位、憂鬱症患者75位），收樣時間為2012年8月至2014年7月。以迴歸分析檢驗家庭功能在自我污名對其心理福祉的中介效果，其顯著程度經由拔靴法（Bootstrap）進行估計。研究結果：精神疾病患者的自我污名、家庭功能與心理福祉達顯著相關。在精神分裂症患者方面，家庭功能部分中介自我污名對自尊及憂鬱症狀的影響；在憂鬱症患者方面，家庭功能部分中介自我污名對自尊、憂鬱症狀、生活品質及無望感的影響。然而，不論精神分裂症或憂鬱症患者其自我污名對於自我效能的影響中，家庭功能均未有顯著的中介效果。研究結論：精神分裂症與憂鬱症患者的自我污名經由家庭功能進而影響其心理福祉。因此，提升精神病患的家庭功能為改善精神疾病患者心理福祉的可行介入標的。

Purpose: This study examined the mediating effect of family function on the relationship between self-stigma and psychological well-being (i.e., self-esteem, depressive symptoms, quality of life, hopelessness, and self-efficacy) in patients with schizophrenia and patients with depression. Methods: A total of 225 outpatients (150 patients with schizophrenia, 75 patients with depression) were recruited from 2012 to 2014. The mediating effect of family function on the relationship between self-stigma and psychological wellbeing was examined by regression analysis. The degree of significance of indirect effects was estimated via bootstrapping. Results: Significant correlations between self-stigma, family function, and psychological well-being were found in patients with schizophrenia and patients with depression. Family function partially mediated the relation of self-stigma to self-esteem and to depressive symptoms in patients with schizophrenia. Family function partially mediated the relation of self-stigma to self-esteem, depressive symptoms, quality of life, and hopelessness in patients with depression. However, regardless of whether the patient had schizophrenia or depression, family function did not mediate the relationship between self-stigma and self-efficacy. Conclusions: Self-stigma influenced psychological well-being via family function in schizophrenia and depression patients. Enhancing family functioning is a plausible intervention target to improve psychological well-being in patients with mental illness.