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系統識別號 U0026-1607202015113200
論文名稱(中文) 中老年社區慢性思覺失調症患者肥胖、身體意象與自尊之相關性
論文名稱(英文) Association between obesity, body image and self-esteem among middle-aged and elderly community-dwelling individuals with chronic schizophrenia
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 108
學期 2
出版年 109
研究生(中文) 劉姿伶
研究生(英文) Zi-Ling Liu
學號 TC6071010
學位類別 碩士
語文別 中文
論文頁數 119頁
口試委員 指導教授-翁慧卿
口試委員-歐陽文貞
口試委員-吳至行
中文關鍵字 思覺失調症  肥胖  代謝症候群  身體意象  自尊  老年 
英文關鍵字 schizophrenia  obesity  metabolic syndrome  body image  self-esteem  elderly 
學科別分類
中文摘要 研究背景:
思覺失調症(Schizophrenia)是一種嚴重的慢性神經精神疾病,被診斷為思覺失調症的人必須長時間服用抗精神病藥物來穩定其症狀。由於藥物的副作用、不良的飲食習慣以及封閉的居住型態,導致該族群容易誘發身體疾病,例如肥胖症、代謝症候群或是其他慢性疾病如高血壓、高血脂,上述可能會降低患者的自尊並增強自殺意念。因此,與一般人相比,他們的平均餘命通常少了10年以上。故對於此類身心障礙族群,治療上需有全人整合觀念,患者對於自覺健康的想像更是精神健康知能、持續性醫療品質與長期照顧中的重要議題之一。本研究目的為探討慢性中老年思覺失調症社區個案肥胖、身體意象與自尊間之關聯性。

研究方法:
本研究為橫斷面量性觀察的設計,資料蒐集採立意取樣(purposive sampling),已於台南某精神專科教學醫院及高雄某醫學中心附設社區精神復健中心收案111名40-65歲中年及老年符合醫師診斷DSM-5慢性思覺失調症社區患者,排除認知功能嚴重缺損以及仍有嚴重之正性症狀或精神症狀導致無法配合施測者。本研究蒐集(一)人口社會學資料(如性別、年齡、教育程度等); (二)疾病相關資料(如發病年齡、住院次數、物質濫用、身體質量指數、腰圍、血壓、其他代謝症候群相關疾病與血液檢查數據); (三)結構化問卷(如代謝症候群自我覺察量表、Rosenberg自尊量表、Stunkard身體意象量表、香港簡易認知評估量表及正性與負性症狀量表等)。統計分析將採用描述性、相關、獨立t檢定、ANOVA、卡方檢定以及階層迴歸等等來執行。

研究結果:
(1) 相較於非肥胖患者,肥胖患者的代謝症候群自我覺察程度較強(r=.40, p<.001); (2) 代謝症候群自我覺察程度強者,身體意象差距較大(M=6.5, SD=1.5); (3) 身體意象差距較大者,肥胖患者比例較多(χ²=12.39, p<.001); (4) 代謝症候群對自尊有顯著負向影響(β=-.20, p<.05)。

結論:
本研究個案在肥胖及代謝症候群中比例皆明顯過半,但相較於非肥胖的中老年慢性思覺失調症社區患者,具有肥胖問題的患者在自覺與理想意象間通常不一致,注重自身身體意象,且在代謝症候群自我覺察程度較強。而罹患代謝症候群的患者,自尊分數較低的可能性更高。

未來建議及研究方向:
根據結論,推測體重控制跟管理可能與意象息息相關且思覺失調症患者的體重增加會使患者沮喪,造成自尊心低落。期望未來提供病患本身、醫療人員及照顧者從預防醫學角度,介入並重視思覺失調患者肥胖異常及其衍伸病況及自覺健康,增加自我疾病的管理能力,促進對於自身想法的改善,養成健康行為模式。
英文摘要 For people diagnosed with Schizophrenia, they have to take antipsychotic medications for stabilizing their symptoms. Physical illness such as obesity, metabolic syndrome or other chronic diseases may be also induced because of the drug side effects and poor dietary which may lower their self-esteem. So they have a substantially reduced life expectancy compared with the ordinary people. This raise a concern and important issue of mental health literacy. The primary purposes of the cross-sectional study were to investigate the relationship between obesity, body image and self-esteem of chronic schizophrenia patients. Using purposive sampling, 111 participants were recruited from patients aged 40-65 years at psychiatric institutions in Kaohsiung and Tainan. Besides demographic data, medical history and blood test, further data were collected using the structured survey questionnaires such as Stunkard Figure Rating Scale and Rosenberg Self-Esteem Scale. Results of this study demonstrated that 1) Patients with low self-awareness of metabolic syndrome had a significantly higher percentage of obesity
(r = .40, p < .001); 2) Patients with high self-awareness of metabolic syndrome had a significantly higher percentage of distorted body image(Mean = 6.5, SD = 1.5) ;3) Patients with obvious distorted body image had a significantly higher percentage of obesity(χ² = 12.39, p < .001); 4) Metabolic Syndrome was a significant key indicator to low self-esteem among patients with schizophrenia(β = -.20, p < .05).
論文目次 中文摘要 I
Abstract III
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與問題陳述 6
第三節 研究重要性 6
第四節 名詞解釋 7
第二章 文獻探討 9
第一節 在幻覺世界中遊走:思覺失調症 9
第二節 思覺失調症之肥胖問題 17
第三節 邊緣化再邊緣化:慢性思覺失調症病患老化趨勢 31
第四節 思覺失調症病患自我意象與自尊 39
第五節 文獻小結 49
第三章 研究方法 50
第一節 研究設計 50
第二節 研究假設與研究架構 50
第三節 研究對象及收案地點 52
第四節 變項及測量工具 55
第五節 研究步驟 62
第六節 倫理考量 63
第七節 資料統計與分析 64
第四章 研究結果 65
第一節 描述性統計 65
第二節 推論性統計 71
第三節 研究假設驗證與結果統整 83
第五章 討論與建議 84
第一節 討論 84
第二節 研究限制與未來研究方向 89
參考文獻 91
附錄 113
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