不同憂鬱傾向、年齡之糖尿病患者其風險覺知與情緒狀態的特徵

Abstract

本文探討不同憂鬱傾向和年齡屬性糖尿病患者的風險覺知和情緒狀態因素結構差異比較，嘗試釐清風險覺知和情緒狀態的正負向表徵，進而建立憂鬱傾向作為患者「生理－心理」互動關係情緒衡鑑指標的可能性，以提供臨床心理介入健康照顧方案之參考。 方法：以北部某醫院家庭醫學部糖尿病門診病必為樣本，進行相關量表測量，共抽取145名有效樣本。其中男性75名（佔51.7%），女性70名（佔48.3）受測樣本的男性與女性比例相當。受測樣本的平均年齡為58.61歲（標準差為12.2），罹患糖尿病的持續時間平均為7.37年（標準差為6.05）。 結果：本研究顯示，在「風險覺知」因素結構方面呈現多元陸，即「知行不一」、「慣常踐行」、「不切實際」和「順其自然」。經控制「罹患糖尿病持續時間」與「是否尚有其他慢性病」變項後，相對低憂鬱組患者傾向「不切實際」風險覺知，雖可緩和憂鬱情緒，具功能性後果，但也可能是一種虛幻式控制。至於相對高齡組，傾向「順其自然」風險覺知，可能基於因應效率的策略。情緒狀態的因素結構，分成「鬱灼無助」和「達觀福份」。「高憂鬱組」傾向持有「鬱灼無助」情緒，「低憂鬱組」傾向保有「達觀福份」情緒。 結論：(1)相對低憂鬱患者傾向不切實際風險覺知，包含功能性和虛幻式後果。(2)順其自然的風險覺知，較為符合高齡患者的因應效率。(3)對於慢性病患者的身心諮商服務，若能從憂鬱傾向的情緒衡鑑作為初級資料的建立，篩選出高憂鬱傾向族群，加強其自我效能和改變動機，當可減緩個案陷入「鬱灼無助」的情緒。若個案屬於低憂鬱族群，雖持存達觀福份情緒狀態，但傾向「不切實際」的風險覺知，需評估其非理性信念，提昇遵從醫囑行為。如此，當可逐步落實「生物心理社會」健康照護模式的臨床實踐觀點。

The study aimed to assess the differences of risk appraisal and emotional states between high and low depressive disposition groups, and between young and old persons with diabetes. Method: 145 persons (75 males; mean age 58.61±12.27 years) with diabetes were recruited form the department of family medicine of the university`s affiliated hospital in northern Taiwan, and were administered rating scales. Self-report measures included demo-graphic variable, risk appraisal scale, emotional state checklist and the depressive disposition reaction to chronic illness scale. Results: Four factors of risk appraisal were identified, namely, inconsistency, routine, Pollyanna and undoing. Two factors of emotional state consisted of positive and negative manifestations. After controlling for the covariance of the illness onset and other chronic illness diagnosis variables within the samples, the high depressive disposition group tended to adopt the Pollyanna risk appraisal. The older age group was found to have a tendency to adopt the undoing risk appraisal. The high depressive disposition group showed a tendency to be helpless, and the low depressive disposition group tended to be optimistic. Conclusion: The Pollyanna risk appraisal was thought to serve as a buf fer for negative emotions, and presents as an illusory coping strategy for the high depressive group. The undoing risk appraisal adopted by the older persons with diabetes is interpreted as an ef ficient coping style consistent with the min-max principle, The above findings provide a psychological-physical link index of depression reaction to chronic illness. It is suggested that an emotional assessment be administered to persons with diabetes prior to conducting psychotherapy. This will allow tailoring of interventions to prevent sense of helplessness in the high depres sive disposition group and unrealistic optimism in the low depressive group, and may improve overall medical com-p lance. Implications of the current findings in light of the clinical practice of the biopsy chosocial health model are discussed.