政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/145913

政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/145913

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題名:	探討老化自我覺知、疾病認知及負向情緒與疾病適應結果之關係－以老年膝骨關節炎病人為例 Exploring the Relationships among Self-perception of Aging, Illness Perception, Negative Emotion and Illness Adaption - Taking Elderly Knee Osteoarthritis Patients for Example
作者:	邱泓達 Chiu, Hung-Ta
貢獻者:	吳治勳邱泓達 Chiu, Hung-Ta
關鍵詞:	膝骨關節炎老化自我覺知疾病認知負向情緒憂鬱焦慮疾病適應 Osteoarthritis Self-perception of aging Illness perception Negative emotion Anxiety Depression Illness adaptation
日期:	2023
上傳時間:	2023-07-06 16:58:29 (UTC+8)
摘要:	研究背景：年長者如何同時經驗「老化」與「疾病」這兩個歷程，將影響其情緒與疾病適應。本研究以膝骨關節炎病人作為研究對象，探討老化自我覺知、疾病認知、及負向情緒對疾病適應之影響。研究方法：本研究為橫斷性研究，以北部某醫學中心之家醫部門診診斷有膝骨關節炎之病人為對象。請研究參與者寫台大醫院疼痛門診評估量表、國際身體活動量表（台灣短版）、短版疾病認知量表、台灣老化態度量表、台灣簡明版世界衛生組織生活品質量表、貝克焦慮量表、及貝克憂鬱量表第二版。本研究採取路徑分析，研究模式一檢驗老化自我覺知、負向情緒及疾病認知之關係，並探討疾病認知之中介效果；研究二檢驗老化自我覺知、疾病認知、負向情緒及疾病適應結果－疼痛嚴重度、身體活動程度及生活品質（生理、心理、環境及社會）－之關係，並探討負向情緒之中介效果。後續以65歲區分高、低年齡組，以多組別路徑分析檢驗年齡於各模式之調節效果。研究結果：本研究共納入66位膝骨關節炎病人。模式一路徑分析結果顯示「負向老化自我覺知」在「疾病認知各向度」中皆能正向預測「焦慮程度」，並在「個人控制感」與「理解程度」模型中可正向預測「憂鬱程度」；「正向老化自我覺知」可負向預測「疾病結果」與「情緒認知反應」；但所有中介效果均不顯著。模式二路徑分析結果顯示「正向老化自我覺知」在「疾病認知各向度」模型中皆可正向預測「心理生活品質」、「生理生活品質」及「社會生活品質」；「負向老化自我覺知」在「疾病結果、時間性、個人控制感、疾病結果、認知情緒反應」模型中可負向預測「生理生活品質」；「正向老化自我覺知」經「疾病結果」對「生理生活品質」之間接效果達正向顯著、對「近一週身體活動度」之間接效果達正向顯著、對「近期疼痛嚴重度」之間接效果達負向顯著，且皆為完全中介。因臨床觀察負向情緒確實影響膝骨關節炎病人之調適，故追加以模式三檢驗老化自我覺知、負向情緒及疾病適應結果。模式三路徑分析結果顯示「負向老化自我覺知」可正向預測「焦慮程度」；「正向老化自我覺知」可正向預測「生活品質各向度」；「負向老化自我覺知」經「焦慮情緒／憂鬱情緒」對「生理生活品質」、「心理生活品質」及「環境生活品質」之間接效果達負向顯著、對「近期疼痛嚴重度」之間接效果達正向顯著。在年齡分組上，模式二顯示低年齡組「疾病結果」對「生理生活品質」、「環境生活品質」及「社會生活品質」之預測上達負向顯著，年齡具調節效果。模式三結果顯示「正向老化自我覺知」與「憂鬱程度」在高年齡組分別對「生活品質」不同向度之預測性有顯著，而低年齡組中「負向老化自我覺知」可正向預測「負向情緒」，而「焦慮程度」可負向預測「生理生活品質」與「心理生活品質」，但無調節效果。討論：本研究發現老化自我覺知會透過疾病認知（尤其是疾病結果）或負向情緒兩種歷程影響膝骨關節炎病人的疾病適應，並且藉由年齡分組可以得知對於不同年齡層之膝骨關節炎病人，「老」與「病」影響的歷程可能有所不同，「病」對於低年齡組較有直接影響，而「老」會影響低年齡組之情緒，進而影響其適應，另一方面「老」則可能對高年齡組較有直接影響。本研究結果應有助於理解台灣膝骨關節炎病人之適應歷程，盼藉此對病人之疾病適應有所幫助，並提供探討老化自我覺知對年長病人面對疾病或生活，其潛在心理歷程之可能研究方向。 Background: When the elderly faced “aging” and “illness” at the same time, their subjective experience of the two process would influence their emotion and illness adaptation. This study chose patients with knee osteoarthritis(KOA) as research subject to explore the influence of self-perception of aging, illness perception, and negative emotions on illness adaptation. Methods: This study is a cross-sectional study. Participants in this study were patients with KOA in the department of family medicine of a medical center in north Taiwan. They filled out “the Revision of the Pain Assessment Scale Taiwan”, “the Taiwan Version of International Physical Acticity Questionnarie - Short Form”, “the Breif Illness Perception Questionnaire”, “the Taiwan Attitude toward Aging Questionnaire”, “World Health Organization Qulity of Life - BREF”, “the Beck’s Anxiety Inventory”, and “the Beck Depression Inventory II”. This study use path analysis to test the relationship among self-perception of aging, illness perception, and engative emotions and explore the mediation effect of illness perceptionin study 1. In study 2, path analysis was used to test the relatoinship among self-perception, illness perception, negative emotions, and quality of life(physiological, psychological, environmental, and social domain) and explore the mediation effect of negative emotions. Furthermore, this study divided all participants into two groups by 65 ages, and multi-group path analysis was used to test the moderate effect of age between the older group and the younger group. Results: A total of 66 patients with KOA were include in this study. Path analysis in study 1 shows the following results: “Negative self-perception of aging” could positive predict “anxiety level” in all illness perception model, and could positive predict “depression level” in “personal control” and “comprehension” model; “Positive self-perception of aging” could negative predict “consequences” and “emotional representation”; There is no significant indirect effect in study 1. Path analysis in study 2 shows the following results: “Positive self-perception of aging” could positive predict “psychological quality of life”, “environmental quality of life”, and “social quality of life” in all illness perception model; “Negative self-perception of aging” could negative predict “physiological quality of life” in “consequense”, “timeline”, “personal control”, “identity” and “emtional representation” model; “Positive self-perception of aging” has positive and significant indirect effect on “physiological quality of life” and “physical activity in the past week” via “consequence”. In addition, “Positive self-perception of aging” has negative and significant indirect effect on “recent pain severity” via “consequence”. These three significant indirect effect are complete mediation. There are some phenomena that patients with KOA could be observed negative emotions affect their adaptation in clinical situation, so this study added study 3 to test the relationship among ”self-perception of aging”, “negative emotions”, and “illness adaptation”. Path analysis in study 3 shows the following results: “Negative self-perception of aging” could positive predict “anxiety level”; “Positive self-perception of aging” could positive predict all dimension of quality of life; “Negative self-preception of aging” has negative and significant indirect effect on “physiological quality of life”, “psychological quality of life”, and “environmental quality of life” via “negative emotions”. In addition, “Negative self-preception of aging” has positive and significant indirect effect on “recent pain severity” via “negative emotions”. The multi-group path analysis shows the following results:In study 2, “Consequence” could negative predict “physiological quality of life”, “environmental quality of life”, and “social quality of life” in the younger group, which means there is moderate effect by age. In study 3, “Positive self-perception of aging” and ”depression” could separately predict different domain of “illness perception” in the older group. In the younger group, “negative self-perception of aging” could positively predict “negative emotions”, and “anxiety level” could negatively predict “physiological quality of life” and “psychological quality of life”. However, there are no moderate effect in study 3. Discussion: In couclusion, self-perception of aging would affect illness adaptation of patients with KOA through illness perceptin(especially consequence) or negative emotions. Based on the multi-group path analysis, it could be known that ‘aging’ and “illness” may have different influence on the patients with KOA in different age group. In the younger group, “illness” could directly affect illness adaptation, and “aging” could affect illness adaptation via negative emotions. On the other hand, “aging” may directly affect illness adaptation in the older group. this study expands the understanding of the adapational process of patients with KOA in Taiwan, looking forward to helping patients with KOA with better illness adaptation. Furthemore, this study could provide a potential psychological process which influence the elderly’s illness or life adaptation.
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描述:	碩士國立政治大學心理學系 108752020
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