在照顧中長大：臺灣兒少家庭照顧者照顧精神疾病父母的回溯性研究

Growing up with Caregiving: A Retrospective Study of Being Young Carers of Parents with Mental Illness in Taiwan

對孩子來說出於愛、義務與責任照顧父母及滿足家庭的需求是非常自然的。孩子參與照顧父母的事實，大多被隱藏在社區中。自90年代，西方文獻對於兒少家庭照顧者的弱勢處境，特別是在照顧父母已有相當多的研究。然而，臺灣對於兒少承擔照顧者的角色，未被理解的需求仍顯相對缺乏。此研究目的在探討臺灣參與者童年時期照顧精神疾病父母的經驗。研究架構以社會排除理論為主，融合社會建構理論，著重在兒少家庭照顧者和他們的家庭，所感受精神疾病的社會汙名，導致他們身處在被忽視與社會隔絕的環境。本研究採用質性—回溯研究方法，了解兒少家庭照顧者成長、陪伴精神疾病父母的完整童年經驗。十九位參與者參與半結構式的深人訪談，以主題式分析方法完成研究結果分析，呈現四大主題。主題一：探討孩子成為兒少家庭照顧者的經驗，伴隨四個次主題：覺察父母的精神疾病、承擔照顧責任、家人關係和學校生活。主題二：了解精神疾病父母對其影響，伴隨五個次主題：苦樂參半的記憶、感覺童年生活分崩瓦解、健康與福祉、因應策略和長期照顧的承諾。主題三：兒少家庭照顧者所期望的社會支持，伴隨三個次主題：醫療資訊、心理暨社會服務、學校支持和公共教育。主題四：昔日兒少家庭照顧者給予現在兒少家庭照顧者的忠告。最後，統璐硏究發現如何回應研究問題，與相關文獻對話討論，呈現本研究的獨特觀點，並提出研究發現對於實務和政策的建議及未來研究方向。

It is natural for children to support their parents’care out of love, reciprocity, responsibility as well as family demands. Incidents of children being involved in parental care are often in hidden contexts within the community. The vulnerabilities of young carers, in particular engaging parental mental care, have been well-documented in Western countries since the 1990s. However, research on young carers assuming a caring role alone with unrecognized needs seems relatively limited in Taiwan. This study aims to explore the experiences of participants who had cared for a parent with mental illness during childhood in Taiwan. The research framework is mainly constructed by social exclusion in addition to social constructionism, in light of young carers and their families and their perceptions of social criticisms attached to mental illness, as a result of living in hidden contexts. The study is based on the qualitative methods, and taking a retrospective stance to ascertain the comprehensive experiences of young carers growing up with a mentally ill parent through childhood. A total of nineteen participants took part in the semi-structured interviews, which emerged four themes analyzed by thematic analysis. Theme 1 discusses about the experiences of children becoming young carers with four subthemes emerging from research data: the awareness of the parent’s mental illness, undertaking caring responsibilities, family relationships, and school life. Theme 2 investigates the impact of having a parent with mental illness with five subthemes emerging: bittersweet memories, feelings of childhood life falling apart, health and well-being, coping strategies, and a long-term caring commitment. Theme 3 underlines young carers’wishes for social support with three subthemes: medical information, mental health and social services, and school support and public education. Theme 4 sheds light on former young carers’advice for current young carers. Finally, the study concludes with a discussion of the study findings in relation to the research questions and previous literature, and provides the unique insights into the experiences of these populations. The implications of the study findings for practice and policy contexts, and suggestions for further research are also indicated.