• 沒有找到結果。

第五章 討論

第四節 研究限制與未來建議

在本研究有幾項研究限制,首先,本研究受限於人力、財力、時間 與受訪者之意願等因素,無法採用隨機抽樣,因此樣本的代表性具有限 制。其次,本研究的樣本選取是在三軍總醫院身心科治療的門診病患,

並非全國調查,所以結果的外推性亦受到限制。第三,本研究的研究參 與者皆為經過服藥且症狀較為和緩之患者,因此在作答上可能受到藥物 的影響。最後,本研究為橫斷性的研究,在推論上是以理論與文獻為基 礎,無法檢驗時序性因果關係。

二、未來建議

本研究發現,精神分裂症與憂鬱症患者的自我污名化經由家庭功能 進而影響與臨床預後有關的不同變項,因此未來可進行提升家庭功能的 介入研究,以降低自我污名化對於疾病預後的負向影響。此外,在未來 可進行長期追蹤的研究,釐清自我污名化、家庭功能,以及疾病預後三 者間的時序性關係。

57

58

精神病理。臺灣醫學,15(4),365-374。

臺灣精神醫學會(2014)。Schizophrenia 中文譯名由「精神分裂症」更名為「思覺失 調症」的歷史軌跡。參考網址:http://www.sop.org.tw/Official/official_15.asp

鄭泰安(1985)。臺灣地區精神病患之社會文化特徵及療養結果。中華心理衛生學刊,

Altintas, E., Gallouj, K., & Guerrien, A. (2012). Social support, depression and self-esteem in older persons: Cluster analysis results. Annales Medico-Psychologiques, 170(4), 256-262.

Angermeyer, M. C., Beck, M., Dietrich, S., & Holzinger, A. (2004). The stigma of mental illness: Patients' anticipations and experiences. International Journal of Social Psychiatry, 50(2), 153-162.

Arboleda-Flórez, J., & Sartorius, N. (2008). Understanding the stigma of mental illness:

theory and interventions. New York: John Wiley & Sons.

Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy.

Developmental Psychology, 25, 729–735.

Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865.

Beck, A. T., Steer, R. A., Brown, G. K. (1996). Beck Depression Inventory II (BDI–II).

Harcourt Assessment: San Antonio, TX.

Ben-Zeev, D., Young, M. A., & Corrigan, P. W. (2010). DSM-V and the stigma of mental illness. Journal of Mental Health, 19(4), 318-327.

Borecki, L., Gozdzik-Zelazny, A., & Pokorski, M. (2010). Personality and perception of stigma in psychiatric patirnts with depressive disorders. European Journal of Medical Research, 15, 10-16.

59

Brohan, E., Gauci, D., Sartorius, N., Thornicroft, G., & Grp, G. AMIAN-Europe Study.

(2011). Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: The

GAMIAN-Europe study. Journal of Affective Disorders, 129(1-3), 56-63.

Brown, Joseph H. & Christensen, Dana N. (1986). Family Therapy Theory and Practice.

Belmont, CA:Brooks/ Cole Publishing.

Canive, J. M., Sanzfuentenebro, J., Vazquez, C., Qualls, C., Fuentenebro, F., & Tuason, V.

B. (1995). Family environment predictors of outcome in schizophenic-patients in spain- A 9- month follow-up-study. Acta Psychiatrica Scandinavica, 92(5), 371-377.

Chiu, F. P. F., & Tsang, H. W. H. (2004). Validation of the Chinese general self-efficacy scale among individuals with schizophrenia in Hong Kong. International Journal of Rehabilitation Research, 27(2), 159-161.

Corrigan, P. W. (2005). On the stigma of mental illness. Washington, D.C.: American Psychological Association.

Corrigan, P.W. , & Watson, A.C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry Association.

Corrigan, P.W., Faber, D., Rashid, F., & Leary, M. (1999). The construct validity of

empowerment among consumers of mental health services. Schizophrenia Research, 38, 77–84.

Delucchi, K. L., Tajima, B., & Guydish, J. (2009). Development of the smoking knowledge, attitude, and practices (S-KAP) instrument. Journal of Drug Issues, 39(2), 347-363.

El-Badri, S., & Mellsop, G. (2007). Stigma and quality of life as experienced by people with mental illness. Australasian Psychiatry, 15(3), 195-200.

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.

Psychonomic Society Publications, 39(2), 175-191.

Finkelstein, J., & Lapshin, O. (2007). Reducing depression stigma using a web-based program. International Journal of Medical Informatics, 76(10), 726-734.

Gabhann, L. M., Lakeman, R., McGowan, P., Parkinaon, M., Redmond, M., Sibitz, I., . . . Walsh, J. (2010). Hear my voice: The experience of discrimination of people with mental health problems in Ireland. Dublin, Ireland :Dublin City University.

Gerlinger, G., Hauser, M., De Hert, M., Lacluyse, K., Wampers, M., & Correll, C. U.

(2013). Personal stigma in schizophrenia spectrum disorders: a systematic review

60

of prevalence rates, correlates, impact and interventions. World Psychiatry, 12(2), 155-164.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.

Gray, A. J. (2002). Stigma in psychiatry. Journal of the Royal Society of Medicine, 95(2), 72-76.

Hackethal, V., Spiegel, S., Lewis-Fernandez, R., Kealey, E., Salerno, A., & Finnerty, M.

(2013). Towards a Cultural Adaptation of Family Psychoeducation: Findings from Three Latino Focus Groups. Community Mental Health Journal, 49(5), 587-598.

Han, D. Y., Chen, S. H., Hwang, K. K., & Wei, H. L. (2006). Effects of psychoeducation for depression on help-seeking willingness: Biological attribution versus

destigmatization. Psychiatry & Clinical Neurosciences, 60(6), 662-668.

Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York Londen: Guilford.

Helweg-Larsen, M., Sadeghian, P., & Webb, M. S. (2002). The stigma of being

pessimistically biased. Journal of Social and Clinical Psychology, 21(1), 92-107.

Hill, Kimberley, & Startup, Mike. (2013). The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: The mediating role of self-efficacy. Psychiatry Research, 206(2/3), 151-157.

Holmes, E. P., & River, L. P. (1998). Individual strategies for doping with the stigma of severe mental illness. Cognitive and Behavioral Practice, 5(2), 231-239.

Hsiung, P. C., Pan, A. W., Liu, S. K., Chen, S. C., Peng, S. Y., & Chung, L. (2010).

Mastery and Stigma in Predicting the Subjective Quality of Life of Patients With Schizophrenia in Taiwan. Journal of Nervous and Mental Disease., 198(7), 494-500.

Kao, Y. C (2013).Assessing internalizedstigma and stigma resistance inindividuals with mental illness: an investigation usingthe Internalized Stigma ofMental Illness Scale (unpublish thesis). Taipei:National Taiwan University.

Kao, Y.-C., Liu, Y.-P., & Lu, C.-W. (2012). Beck Hopelessness Scale: Exploring its Dimensionality in Patients with Schizophrenia. Psychiatric Quarterly, 83(2), 241-255.

Keitner, G. I., Ryan, C. E., Miller, I. W., Kohn, R., Bishop, D. S., & Epstein, N. B. (1995).

Role of the family in recovery and major depression. American Journal of

61

Psychiatry, 152(7), 1002-1008.

Kessler, R. C., Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G., & Leaf, P. J.

(1996). The epidemiology of co-occurring addictive and mental disorders:

Implications for prevention and service utilization. American Journal of Orthopsychiatry, 66(1), 17-31.

Koyama, A., Akiyama, T., Miyake, Y., & Kurita, H. (2004). Family functioning perceived by patients and their family members in three Diagnostic and Statistical Manual-IV diagnostic groups. Psychiatry and Clinical Neurosciences, 58(5), 495-500.

Kuehner, C., & Huffziger, S. (2013). Factors predicting the long-term illness course in a cohort of depressed inpatients. European Archives of Psychiatry and Clinical Neuroscience, 263(5), 413-423.

Kuo, Po-Ju, Ma, Hui-Ing, Kuo, Chien-Cheng, Huang, Wei-Che, & Chung, Ming-Shun.

(2009). Factor analysis of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese version and related factors. International Journal of Psychiatry in Clinical Practice, 13(4), 278-284.

Lam, C. S., Tsang, H. W. H., Corrigan, P. W., Lee, Y. T., Angell, B., Shi, K., . . . Larson, J.

E. (2010). Chinese Lay Theory and Mental Illness Stigma: Implications for Research and Practices. Journal of Rehabilitation, 76(1), 35-40.

Lan, C. M., Yang, C.Y., Huang, J. Y., & Shiau, S,J. (2004). The relationship of drug alliance behaviors of schizophrenic outpatients with the characteristics of key persons and family function. Chang Gung Nursing, 15(1),1-14.

Lewis, A. J., Bertino, M. D., Skewes, J., Shand, L., Borojevic, N., Knight, T., . . . Toumbourou, J. W. (2013). Adolescent depressive disorders and family based interventions in the family options multicenter evaluation: study protocol for a randomized controlled trial. Trials, 14.

Liberman, R. P., Glynn, S., Blair, K. E., Ross, D., & Marder, S. R. (2002). In vivo

amplified skills training: promoting generalization of independent living skills for clients with schizophrenia. Psychiatry-Interpersonal and Biological Processes, 65(2), 137-155.

Lin, H.-C., Tang, T.-C., Yen, J.-Y., Ko, C.-H., Huang, C.-F., Liu, S.-C., & Yen, C.-F. (2008).

Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan. Psychiatry and Clinical

Neurosciences, 62(4), 412-420.

Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology,

62

27, 363-385.

Link, B. G., Struening, E., Cullen, F. T., Shrout, P. E., & Dohrenwend, B. P. (1989). A modified labeling theory appoach to mental -disorders - An enpirical - assessment.

American Sociological Review, 54(3), 400-423.

Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150-2161.

Lysaker, P. H., Vohs, J., Hasson-Ohayon, I., Kukla, M., Wierwille, J., & Dimaggio, G.

(2013). Depression and insight in schizophrenia: Comparisons of levels of deficits in social cognition and metacognition and internalized stigma across three profiles.

Schizophrenia Research, 148(1-3), 18-23.

McGrath, J., Saha, S., Chant, D., & Welham, J. (2008). Schizophrenia: a concise overview of Incidence, prevalence, and mortality. Epidemiologic Reviews, 30(1), 67-76.

Mojalefa, S. R. (2003). The impact of schizophrenia on family functioning: a social work perspective. 63, ProQuest Information & Learning, US.

Murray, C. J. L., & Lopez, A. D. (1996). The global burden of disease : a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press.

Nasser, E. H., & Overholser, J. C. (2005). Recovery from major depression: the role of support from family, friends, and spiritual beliefs. Acta Psychiatrica Scandinavica, 111(2), 125-132.

Oliver, M. (1996). Defining impairment and disability : Issues at stake. In C. Barnes & G.

Mercer (Eds.), Exploring the Divide. Leeds: The Disability Press.

Oxford Outcomes Ltd. (2004). The Revised Schizophrenia Quality of Life Questionnaire (SQLS-R4): User manual for the SQLS-R4. Cassington: Oxford Outcomes.

Perlick, D., Miklowitz, D., Link, B., Struening, E., Kaczynski, R., Gonzalez, J., et al (2007). Perceived stigma and depression among caregivers of patients with bipolar disorder. British Journal of Psychiatry, 190, 535–536.

Phelan, J. C., Link, B. G., Stueve, A., & Pescosolido, B. A. (2000). Public conceptions of mental illness in 1950 and 1996: What is mental illness and is it to be feared?

Journal of Health and Social Behavior, 41(2), 188-207.

Pompili, Maurizio, Innamorati, Marco, Gonda, Xenia, Serafini, Gianluca, Sarno, Stefania, Erbuto, Denise, . . . Girardi, Paolo. (2013). Affective temperaments and

hopelessness as predictors of health and social functioning in mood disorder

63

patients: A prospective follow-up study. Journal of Affective Disorders, 150(2), 216-222.

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879-891.

Pukrop, R., Schlaak, V., Möller-Leimkühler, A. M., Albus, M., Czernik, A., Klosterkötter, J., & Möller, H. J. (2003). Reliability and validity of quality of life assessed by the short-form 36 and the modular system for quality of life in patients with

schizophrenia and patients with depression. Psychiatry Research, 119(1-2), 63-79.

Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness:

psychometric properties of a new measure. Psychiatry Research, 121(1), 31-49.

Rosenberg, M. (1989). Determinants of self -esteem- a citation classic commentary on society and adolescent self image by Rosenberg, M. Current Contents/Arts &

Humanities(6), 14-14.

Salyers, M. P., & Mueser, K. T. (2001). Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia.

Schizophrenia Research, 48(1), 109-123.

Satcher, D. (1999). Mental health: A report of the surgeon general Department of Health and Human services. Washington: DC.

Scheff. (1974). The labelling theory of mental illness. American sociological review.

Schwarzer, R., & Mueller, J. (1999). Assessment of perceived general self-eftlcacy on the internet: Data collection in cyberspace. Anxiety. Stress, and Coping, 12, 145-161.

Segalovich, J., Doron, A., Behrbalk, P., Kurs, R., & Romem, P. (2013). Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. [Article]. Archives of Psychiatric Nursing, 27(5), 231-234.

Sibitz, I., Amering, M., Unger, A., seyringer, M. E., Bachmann, A., Schrank, B., . . .

Woppmann, A. (2011). The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. European Psychiatry, 26(1), 28-33.

Smilkstein, G. (1978). The family APGAR: A proposal for a family function test and its use by physicians. Journal of family practice, 6(6), 1231.

Urizar, A. C., & Giraldez, S. L. (2008). Quality of life and family functioning in schizophrenia patients. Psicothema, 20(4), 577-582.

Valdez, C. R., Padilla, B., Moore, S. M., & Magana, S. (2013). Feasibility, acceptability,

64

and preliminary outcomes of the fortalezas familiares intervention for Latino families facing maternal depression. Family Process, 52(3), 394-410.

Vauth, R., Kleim, B., Wirtz, M., Corrigan, P., 2007. Self-efficacy and empowerment as outcomes of self-stigmatizing and coping schizophrenia. Psychiatry Research, 150, 71–80.

Vega, W. A., Rodriguez, M. A., & Ang, A. (2010). Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry, 32(2), 182-191.

Vlassoff, C., & Ali, F. (2011). HIV-related stigma among South Asians in Toronto.

Ethnicity & Health, 16(1), 25-42.

Vogel, D. L., Bitman, R. L., Hammer, J. H., & Wade, N. G. (2013). Is Stigma Internalized?

The Longitudinal Impact of Public Stigma on self-Stigma. Journal of Counseling Psychology, 60(2), 311-316.

Wagner, G. J., Holloway, I., Ghosh-Dastidar, B., Kityo, C., & Mugyenyi, P. (2011).

Understanding the influence of depression on self-efficacy, work status and condom use among HIV clients in Uganda. Journal of Psychosomatic Research, 70(5), 440-448.

Watson, A. C., Corrigan, P., Larson, J. E., & sells, M. (2007). Self-stigma in people with mental illness. Schizophrenia Bulletin, 33(6), 1312-1318.

Waraich, P., Goldner, E. M., Somers, J. M., & Hsu, L. (2004). Prevalence and incidence studies of mood disorders: a systematic review of the literature. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 49(2), 124-138.

Werner, P., Stein-Shvachman, I., & Heinik, J. (2009). Perceptions of self-stigma and its correlates among older adults with depression: a preliminary study. International Psychogeriatrics, 21(6), 1180-1189.

Wilkinson, G., Hesdon, B., Wild, D., Cookson, R., Farina, C., Sharma, V., . . . Jenkinson, C.

(2000). Self-report quality of life measure for people with schizophrenia: the SQLS.

British Journal of Psychiatry, 177, 42-46.

Yang, Y. H., Yeh, E. K., & Hwu, H. G. (2012). Prevalences of Schizophrenia, Bipolar Disorder, and Depressive Disorders in Community between Taiwan and Other Countries. Taiwanese Journal of Psychiatry, 26(2), 77-87+72.

Yildiz, M., Ozten, E., Isik, S., Ozyildirim, I., Karayun, D., Cerit, C., & Ucok, A. (2012).

Self-stigmatization among patients with schizophrenia, their relatives and patients with major depressive disorder. Anadolu Psikiyatri Dergisi-Anatolian Journal of

65

Psychiatry, 13(1), 1-7.

Yen, C. F., Chen, C. C., Lee, Y., Tang, T. C., Ko, C. H., & Yen, J. Y. (2009). Association between quality of life and self-stigma, insight, and adverse effects of medication in patients with depressive disoreers. Depression and Anxiety, 26(11), 1033-1039.