慢性精神障礙者社會支持與活動參與之相關研究

Abstract

「社會支持」可協助個人維持良好健康狀態，降低疾病造成的失能,幫助個人在康復過程獲得安適感，增加社會功能以及生活適應性，可說是促進復健成功重要因素。 世界衛生組織（WHO）賦予「健康」新意函主張衡量健康狀態應時考量應身體功能(Body function and structure)、活動(Activity)及參與(Participation)三大功能，「活動參與」成為重要且客觀之健康衡量指標。在許多實證研究發現藉由主動參與有意義的活動過程，可幫助個人滿足內在需求，增進獨立性和自我效能，因此「活動參與」不僅是ㄧ個健康衡量指標，還可協助患者改善病情，重新建構規律生活，增加社會適應的功用。 本研究主要在探討慢性精神障礙者社會支持強度、來源以及活動參與狀況，探討慢性精神障礙者的社會支持與活動參與的相關性，以及社會支持之強弱是否可預測慢性精神障礙者活動參與度。期待研究結果的發現能夠作為照顧者及精神醫療復健的臨床工作者提供服務、照護之參考。 本研究採量化方式，選取300位年齡介於18~65 歲的生活於社區之慢性精神障礙者接受結構問卷調查，回收問卷286份，共238份有效樣本進行分析。根據抽樣問卷之統計分析結果，本研究共有六點發現： 一、慢性精神障礙者主要「社會支持」來源為機構人員為主，其次為家人，親友最少。感受到的社會支持類型多為情緒支持和評價支持。 二、慢性精神障礙者主要「活動參與」困難為與「他人相處」、「生活活動」、「社會參與」。 三、不同年齡、家庭狀況之慢性精神障礙者，其「社會支持」感受與來源以及「活動參與」狀況有顯著差異。較年輕、非獨居社會支持感受較佳，活動參與較無困難。 四、不同之藥物副作用影響程度之慢性精神障礙之在活動參與度上有顯著差異。不同診斷之慢性精神障礙者，其社會支持感受與來源有顯著差異。 五、「情緒性支持」、「評價性支持」、「訊息性支持」、「協助性支持」以及「整體支持」皆和「生活自理」、「與他人相處」、「社會參與」及「活動參與整體」 達負顯著相關，而與「認知」、 「四處走動」無顯著相關。 六、「家人整體社會支持」和「機構情緒性支持」對「生活自理能力」有顯著預測力。「親友評價性支持」對「與他人相處」有顯著預測力。“Social support” is an important factor in the rehabilitation of people with chronic mental illness and in keeping them healthy. With social support, the extent of disabilities caused by illness is lowered. In addition, social support is known to provide the well-being in the recovery process, and increase patients’ ability to adapt to social life. In their new definition of health, the World Health Organization (WHO) suggests that body function and structure, and activities and participation be considered in general health assessment of patients as well since “Activity Participation” has become an important and objective part of health assessment in other areas of medicine. This recommendation follows the many empirical studies which have proven that a person gets inner satisfaction and increased independency and self-ability by participating purposely and actively in some activity. Activity Participation, therefore, is not only a health assessment indicator but an important factor in helping patients improve their health status, re-structure their lives and increase their ability to adapt to the wider society. The purpose of this study is to clarify the correlations between social support and activity participation for people with chronic mental illness. Our working hypothesis is that: the more social support a patient receives, the less difficulty he perceives in activity participation. We hope the findings of this study will be helpful references for rehabilitation, care-center clinicians and Patients' families. The design of this study was as follows: 300 persons between the ages of 18 and 65, and previously diagnosed with chronic mental illness, were recruited from community rehabilitation centers in Taiwan and each person was provided with a structure-designed questionnaire. The data collected on the 238 questionnaires were then analyzed. The major findings of this study are summarized below: 1.People with chronic mental illness tend to receive more emotional and appraisal support, from rehabilitation agencies than from families. 2.The main difficulty for people with chronic mental illness in engaging in “Activity Participation” is the need to get along with others, deal with life activities and social participation. 3.There are significant variations based on ages, family backgrounds and the diagnos-tic status within people with chronic mental illness who are receiving social support. 4.There are significant differences in how medicinal side-effects affect activity par-ticipation of individuals with chronic mental illness. Patients with different clinical diagnosis status have significantly different perception of social support and re-sources. 5.Those dependent factors, such as self-care, getting along with others, social partici-pation, activities participation, have significant and negative correlation with the emotional support, the appraisal support, the assistant support, whole support. It means the higher score on the emotional support, the appraisal support, the assistant support, whole support, less difficulty on self-care, getting along with others, social participation, and activities participation. 6.Independent factors of family social support, emotional support from rehabilitation agencies can predict the effect of self-care. 7.Independent factors of relatives appraisal support can predict the effect of getting along with others.