第五章 討論與建議
第四節 研究限制與未來研究建議
在本研究中，有兩項研究限制，(1) 本研究受限於人力、財力、時間 與受訪者之意願等因素，僅針對兩個大學，使用立意取樣的方式蒐集資 料，因此樣本的代表性及推論範圍有限；(2) 研究設計的追蹤定義為介入 的一週後，僅能確定教育介入有一週的延宕效果，無法了解此成效能維 持多久。
二、未來研究建議
本研究發現大學生可以透過教育介入改變對於精神病的認知，藉由 改變認知影響對待精神病的態度，進而影響與精神病患的社會距離，並 且介入之立即效果及延宕效果皆有降低污名化的顯著成效。奠基於此初 探研究結果，未來可擴大收案，建立具代表性的大學生樣本，其次，本 研究結果僅能確定教育介入有一週的延宕效果，因此，未來研究可將立 即後測延至一星期後測量，而追蹤可延至三個月以上測量，更能確認教 育介入對研究對象的改變成效
。
除了探討大學生之污名化教育介入成效 外，未來可探討臺灣各年齡層不同的介入教材與形式之成效評估，發展 出適當的教育內容及方案。精神疾病去污名化為精神疾病的心理衛生教 育之重要議題，臺灣目前正在進行十二年國民教育課程綱要修訂，未來 研究可檢驗是否將「精神疾病去污名化教育」融入第六個主題軸健康心 理的課程綱要或學校議題，能賦予學生更有效的社會適能與正向心理。參考文獻
73
二、英文部分
America Psychological Association. (2013). The diagnostic and statistical manual of mental disorders V. Washington: America Psychological Association.
Arboleda-Flórez, J., & Sartorius, N. (2008). Understanding the stigma of mental illness:
theory and interventions. New York: John Wiley & Sons.
Barney, L. J., Griffiths, K. M., Jorm A. F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry, 40, 51-54.
Bogardus, E.S. (1928). Immigration and race attitudes. Boston: D.C.Heath.
Branscum, P., Sharma, M., Wang, L. L., Wilson, B., & Rojas-Guyler, L. (2013). A process evaluation of a social cognitive theory-based childhood obesity prevention
intervention: the comics for health program. Health Promotion Practice, 14(2), 189-98.
Brawley, L., Rejeski, W., Gaukstern, J., & Ambrosius, W. (2012). Social cognitive changes following weight loss and physical activity interventions in obese, older Adults in poor cardiovascular health. Annals of Behavioral Medicine, 44(3), 353-364.
Carling, P. J. (1990). Major mental-illness, housing, and supports-the promise of community integration. American Psychologist, 45(8), 969-975.
Clark, A. W., & Binks, N. M. (1966). Relation of age and education to attitudes toward mental illness. Psychological Reports, 19(2), 649-50.
Corrigan, P. W., & Penn, D. L. (1999). Lessons form social psychology on discrediting psychiatric stigma. American Psychologist, 54(9), 765-776.
Corrigan, P. W., Green, A. , Lundin, R., Kubiak , M. A., & Penn, D. L. (2001). Familiarity with and social distance from people who have serious mental illness. Psychiatric Services, 52, 953-958.
Corrigan, P. W., River, L. P., Lundin, R. K., Penn, D. L., Uphoff-Wasowski, K., Campion, J., Mathisen, J., Gagnon, C., Bergman, M., Goldstein, H., & Kubiak, M. A. (2001).
Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27(2), 187-195.
Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16-20.
Corrigan, P. W., Rowan, D., Green, A., Lundin, R., River, P., Uphoff-Wasowski, K., White, K., & Kubiak, M. A. (2002). Challenging two mental illness stigmas: personal
75
responsibility and dangerousness. Schizophrenia Bulletin, 28(2), 293-309.
Corrigan, P., Thompson, V., Lambert, D., Sangster, Y., Noel, J. G., & Campbell, J. (2003).
Perceptions of discrimination among persons with serious mental illness. Psychiatric Services, 54, 1105-1110.
Corrigan, P. W. (2005). On the stigma of mental illness: practical strategies for research and social change. Washington: America Psychological Association.
Corrigan, P. W., Lurie, B. D., & Goldman, H. H. (2005). How adolescents perceive the stigma of mental illness and alcohol abuse. Psychiatric Services, 56, 544-550.
Corrigan, P. W., Watson, A., & Barr, L. (2006). The self-stigma of mental illness:
implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25(8), 875-884.
Corrigan, P. W, & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30(8), 907–922.
Corrigan, P. W., Rafacz, J. D., Hautamaki, J., Walton, J., Rüsch, N., Rao, D., Doyle, P., O’Brien, S., Pryor, J., & Reeder, G. (2010). Changing stigmatizing perceptions and recollections about mental illness: the effects of NAMI’s in our own voice.
Community Mental Health Journal, 46, 517-522.
Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012).
Challenging the public stigma of mental illness: a meta-analysis of outcome studies.
Psychiatric Services, 63(10), 963-73.
Druss, B. G., & Rosenheck, R. A. (1997). Use of medical services by veterans with mental disorders. Psychosomatics, 38(5), 451-458.
Druss, B. G., & Rosenheck, R. A. (1998). Mental disorders and access to medical care in the United States. American Journal of Psychiatry, 155(12), 1775-1777.
Druss, B. G., Bradford, D. W., Rosenheck, R. A., Radford, M. J., & Krumholz, H. M.
(2000). Mental disorders and use of cardiovascular procedures after myocardial infarction. Journal of the American Medical Association, 283(4), 506-511.
Desai, M. M., Rosenheck, R. A., Druss, B. G., & Perlin, J. B. (2002a). Mental disorders and quality of care among postacute myocardial infarction outpatients. Journal of Nervous and Mental Disease, 190(1), 51-53.
Desai, M. M., Rosenheck, R. A., Druss, B. G., & Perlin, J. B. (2002b). Mental disorders and quality of diabetes care in the veterans health administration. American Journal of Psychiatry, 159(9), 1584-1590.
Desforges, D. M., Lord, C. G., Ramsey, S. L., Mason, J. A., Van Leeuwen, M. D., West, S.
C., & Lepper, M. R. (1991). Effects of structured cooperative contact on changing negative attitudes toward stigmatized social groups. Journal of Personality and Social Psychology, 60(4), 531-544.
Fabrega, H. Jr. (1991). Psychiatric stigma in non-western societies. Comprehensive Psychiatry, 32(6), 534-51.
Faul, F., Erdfelder, E., Lang, A. G., & Buchmer, A. (2007). G*Power 3: a flexible
statistical power analysis program for the social, behavioral, and biomedical sciences.
Behavior Research Methods, 39(2), 175-91.
Fink, P. J. (1986). Dealing with psychiatry's stigma. Hospital and Community Psychiatry, 37(8), 814-818.
Fu, T. S., Lee, C. S., Gunnell, D., Lee, W. C., Cheng, A. T. (2013). Changing trends in the prevalence of common mental disorders in Taiwan: a 20-year repeated cross-sectional survey. Lancet, 381(9862), 235-41.
Gabbard, G. O., & Gabbard, K. (1992). Cinematic stereotypes contributing to the
stigmatization of psychiatrists. In P. J. Fink & A. Tasman (Eds.), Stigma and mental illness (pp. 113-126). Washington, DC: American Psychiatric Press.
Gallagher, B. G. (1995). The sociology of mental of mental illness (3rd). New Jersey:
Prentice-Hall.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York:
Simon & Schuster
Gonzalez, J. M., Perlick, D. A., Miklowitz, D. J., Kaczynski, R., Hernandez, M., Rosenheck, R. A., Culver, J. L., Ostacher, M. J., Bowden, C. L., & the STEP-BD Family Experience Study Group. (2007). Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study. Psychiatric Services, 58(1), 41-48.
Goode, W. J. (1978). The celebration of heroes: prestige as a control system. Berkeley:
University of California Press.
Hatchett, A., Hallam, J. S., & Ford, M. A. (2013). Evaluation of a social cognitive theory-based email intervention designed to influence the physical activity of survivors of breast cancer. Psycho-Oncology, 22(4), 829-836.
Holmes, E. P., Corrigan, P. W., Williams, P., Canar, J., & Kubiak, M. A. (1999). Changing attitudes about schizophrenia. Schizophrenia Bulletin, 25(3),447-456.
77
Judd, C. M., & Park, B. (1993). Definition and assessment of accuracy in social stereotypes. Psychological Review, 100(1), 109-28.
Komiya, M., Good, G. E., & Sherrod, N. B. (2000) . Emotional openness as a predictor of college students’ attitudes toward seeking psychological help. Journal of Counseling Psychology, 47(1),138-143.
Lee, M. B., Lee, Y. J., Yen, L. L., Lin, M. H., & Lue, B. H. (1990). Reliability and validity of using a brief psychiatric symptom rating scale in clinical practice. Journal of The Formosan Medical Association, 89(12), 1081-7.
Lee, S. (2005). Experience of social stigma by people with schizophrenia in Hong Kong.
British Journal of Psychiatry, 186, 153-157.
Lee, S., Chiu, M. Y. L., Tsang, A., Chui, H., & Kleinman, A. (2006).Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong. Social Science and Medicine, 62, 1685-1696.
Levinson, R. M., & Zan York, M. (1974). The attribution of "dangerousness" in mental health evaluations. Journal of Health and Social Behavior, 15(4), 328-35.
Li, S., & Phillips, M. (1990). Witch doctors and mental illness in mainland China: a preliminary study. American Journal of Psychiatry, 147(2), 221.
Li, X., Zhang, L., Mao, R., Zhao, Q., & Stanton, B. (2011). Effect of social cognitive theory-based HIV education prevention program among high school students in Nanjing, China. Health Education Research, 26(3), 419-431.
Lin, T., & Lin, M. (1981). Love, denial and rejection: responses of Chinese families to mental illness. In A. Kleinman & T. Y. Lin (Eds.), Normal and abnormal behavior in Chinese culture (pp. 387-401). Boston, MA:D. Reidel.
Link, B. G., & Cullen, F. T. (1986). Contact with the mentally ill and perception of how dangerous they are. Journal of Health and Social Behavior, 27, 289-303.
Link, B. G. (1987). Understanding labelling effects in the area of mental-disorders-an assessment of the effects of expectations of rejection. American Sociological Review, 52(1), 96-112.
Link, B. G., Cullen, F. T., Frank, J., & Wozniak, J. F. (1987). The social rejection of former mental patients: understanding why labels matter. American Journal of Sociology, 92(6), 1461-1500.
Link, B. G., Cullen, F. T., Struening, E., Shrout, P. E., & Dohrenwend, B. P.(1989). A modified labeling theory approach to mental disorder: an empirical assessment.
American Sociological Review, 54, 400-423.
Link, B. G., Mirotznik, J., & Cullen, F. T.(1991). The effectiveness of stigma coping orientations: can negative consequence of mental illness labeling be avoided? Journal of Health and Social Behavior, 32(3), 302-320.
Link, B. G., & Phelan, J. C. (2001). Stigma and its public health implications. Lancet, 367, 528-529.
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 and Medicine, 71, 2150-2161.
Lysaker, P. H., Vohs, J., Hasson-Ohayonc, I., Kukla, M., Wierwillee, J., & Dimaggiof, 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.
Mak, W. W. S., & Cheung, R. Y. M. (2008). Affiliate stigma among caregivers of people with intellectual disability or mental illness. Journal of Applied Research in
Intellectual Disabilities, 21, 532-545.
Mehta, P., & Sharma, M. (2012). Evaluation of a social cognitive theory-based yoga intervention to reduce anxiety. International Quarterly of Community Health Education, 32(3), 205-17.
Mehta, S. I., & Farina, A. (1988). Associative stigma-perceptions of the difficulties of college-aged children of stigmatized fathers. Journal of Social and Clinical Psychology, 7(2-3), 192-202.
Mittal, D., Sullivan, G., Chekuri, L., Allee, E., & Corrigan, P. W. (2013). Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatric Services, 63(10), 974-981.
Monahan, J. (1992). Mental disorder and violent behavior: perceptions and evidence.
American Psychologist, 47, 511-521.
Murphy, B. M., Black, P., Duffy, M., Kieran, J., & Mallon, J. (1993). Attitudes towards the mentally ill in Ireland. Irish Journal of Psychological Medicine, 10(2), 75-79.
National Alliance on Mental Illness. (2003). Results of a national survey of NAMI members living with mental illnesses and their families. From:
http://www.nami.org/Template.cfm?section=Search&Template=Search/SearchDisplay .cfm
79
New Freedom Commission on Mental Health. (2002). Mental health commission releases interim report. From:
http://govinfo.library.unt.edu/mentalhealthcommission/press/nov1_rpt.htm
Pearson, V. (1993). Families in China: an undervalued resource for mental health? Journal of Family Therapy, 15(2), 163-185.
Penn, D., Gaynan, K., Daily, T., Spaulding, W., Garbin, C., & Sullivan, M.(1994).
Dispelling the stigma of schizophrenia: what sort of information is best?
Schizophrenia Bulletin, 20(30), 567-574.
Penn, D., Kohlmaier, J., & Corrigan, P. (2000). Interpersonal factors contributing to the stigma of schizophrenia: social skills, perceived attractiveness, and symptoms.
Schizophrenia Research, 45(1-2), 37-45.
Perlick, D. A., Miklowitz, D. J., Link, B. G., Struening, E., Kaczynski, R., Gonzalez, J., Manning, L. N., Wolff, N., & Rosenheck, R. A. (2007). Perceived stigma and depression among caregivers of patients with bipolar disorder. British Journal of Psychiatry, 190, 535-6.
Phelan, J. C., Bromet, E. J., & Link, B. G. (1998). Psychiatric illness and family stigma.
Schizophrenia Bulletin, 24(1), 115-26.
Sartorius, N., & Schulze, H. (2005). Reducing the stigma of mental illness: a report from a global association. New York: Cambridge University Press.
Scheff, T. J. (1966). Being mentally ill: a sociological theory. Chicago: Aldine.
Scheff, T. J. (1974). The labeling theory of mentally ill. American Sociological Review, 39(3), 444-452.
Shannon, M., & David, L. (2003). Interpersonal contact and the stigma of mental illness: a review of the literature. Journal of Mental Health, 12, 291-305.
Song, L. Y., Chang, L. Y., Shih, C. Y., Lin, C. Y., & Yang, M. J. (2005). Community attitudes towards the mentally ill: the results of a national survey of the Taiwanese population. International Journal of Social Psychiatry, 51(2), 162-76.
Steadman, H. J. (1981). Critically reassessing the accuracy of public perceptions of the dangerousness of the mentally ill. Journal of Health and Social Behavior, 22(3), 310-6.
Sturm, R., Gresenz, C. R., Pacula, R. L., & Wells, K. B. (1999). Datapoints: labor force participation by persons with mental illness. Psychiatric Services, 50(11), 1407.
Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the self-stigma associated with
seeking psychological help. Journal of Counseling Psychology, 53, 325-337.
Wahl, O. F., & Harman, C. R. (1989). Family views of stigma. Schizophrenia Bulletin, 15(1), 131-9.
Wahl, O. F. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25(3), 467-478.
World Health Organization. (2001a). Final report on world health day 2001 activities.
Geneva: World Health Organization.
World Health Organization. (2001b). 2001: mental health: stop exclusion - dare to care.
Retrieved from: http://www.who.int/world-health-day/previous/2001/en/index.html World Health Organization. (2012). Depression is a common illness and people suffering
from depression need support and treatment. Retrieved from:
http://www.who.int/mediacentre/news/notes/2012/mental_health_day_20121009/en/
World Psychiatric Association. (2000). The WPA programme to reduce stigma and discrimination because of schizophrenia (Vols 1-5).Geneva: World Psychiatric Association.
World Psychiatric Association. (2005). The WPA global programme to reduce stigma and discrimination because of schizophrenia. Geneva: World Psychiatric Association.
World Psychiatric Association. (2013). Local action groups-United States. Retrieved from:
http://www.openthedoors.com/english/01_05_21.htm
Yamaguchi, S., Wu, S. I., Biswas, M., Yate, M., Aoki, Y., Barley, E. A., & Thornicroft, G.
(2013). Effects of short-term interventions to reduce mental health-related stigma in university or college students: a systematic review. Journal of Nervous and Mental Disease, 201(6), 490-503.
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.
Yoshioka, K., Reavley, N. J., MacKinnon, A. J., & Jorm, A. F. (2014). Stigmatising
attitudes towards people with mental disorders: results from a survey of Japanese high school students. Psychiatry Research, 215(1), 229-36.
I
附錄一：教育內容
附錄二：教育內容專家效度名單
職稱 專家姓名
三軍總醫院身心科主治醫師 王聖強 三軍總醫院臨床心理師 呂倩文 三軍總醫院臨床心理師 林淑鐘 三軍總醫院社會工作師 游奕霖
三軍總醫院護理師 劉玫伶
III
附錄三：研究問卷
研究問卷（預試）
同學，您好：
這份調查問卷的目的是想了解您對精神病的看法，調查結果絕對不做個別 資料之陳述且一律保密，請您安心填寫。研究結果將做為推展精神病去污名化 教育之參考。您所填答的資料對本研究調查極具價值，所以衷心期望能獲得您 的協助，懇請您依據最直觀的想法填答。
如果您在填寫問卷中遇到任何問題，可以詢問研究人員或由研究人員協助 您們填寫，請您於填寫完畢後，將問卷交給研究人員。
謝謝您的合作！祝您 學業順利
國立臺灣師範大學健康促進與衛生教育學系（碩士班）
指導教授：連盈如博士 研究生：陳依煜
一、基本資料
1. 姓名：
2. 性別：□男 □女
3. 學院：□教育學院 □文學院 □理學院 □科技學院 □藝術學院 □運動與休閒學院 □國際與僑教學院 □音樂學院
□管理學院 □社會科學學院
4. 教育程度：□大學一年級 □大學二年級 □大學三年級 □大學四年級 5. 宗教信仰：□無 □佛教 □道教 □基督教 □天主教 □其他
6. 身心適應狀況：
請您仔細回想在最近一星期中（包括今天），以下這些問題使您感到困擾或苦
惱的程度，然後圈選一個您認為最能代表您感覺的答案。
完全 沒有
輕微 中等
程度
厲害 非常
厲害
1. 感覺憂鬱、心情低落。 □ □ □ □ □
2. 為了一些小事，而責備自己。 □ □ □ □ □
3. 覺得寂寞。 □ □ □ □ □
4. 對一般的事物失去了興趣。 □ □ □ □ □
5. 覺得自己沒有價值。 □ □ □ □ □
6. 覺得將來沒有希望。 □ □ □ □ □
7. 有自殺的想法。 □ □ □ □ □
V
14. 「精神病」患者在接受足夠的治療後（藥物、心理、家 族治療），隨著病情逐漸緩和，他們也漸漸回歸到正常 的生活。
□ □ □ □ □
15. 「庇護性工廠」是一個協助「精神病」患者就業的復健 機構。「精神病」患者在病情穩定下來後，可先去這類 機構接受復健，建立就業的相關技能。
□ □ □ □ □
16. 「精神病」發病初期的症狀通常較輕微，若能在早期即 進行治療，一般來說，都能減緩病情發展，達到「預防 惡化」的效果。
□ □ □ □ □
17. 不論任何疾病，都是越早治療效果越好，「精神病」也
不例外。 □ □ □ □ □
VII
四、態度量表與距離量表
以下的敘述請您依照最直觀的想法勾選答案。答案並無好壞之分，資料內容僅供研究 使用，絕對保密。
非常
同意 同意 不同意
非常 不同意
1. 我認為要與精神病患談話是件困難的事。 □ □ □ □
2. 我認為大部分的精神病患有暴力傾向。 □ □ □ □
3. 我認為精神病患的智能較弱。 □ □ □ □
4. 我認為精神病患的行為是不可預期的。 □ □ □ □
5. 我認為精神病是能康復的。 □ □ □ □
5. 我認為精神病是能康復的。 □ □ □ □