失智症患者之照顧者照顧負荷、反芻思考與創傷後成長的關係探討

研究目的：本研究旨在描述參與本研究之失智症患者之照顧者的照顧負荷、反芻思考與創傷後成長，探討其間之關聯性，並暸解反芻思考在照顧負荷與創傷後成長之中介效果。研究方法：採橫斷性調查法，以立意取樣分別於北部與南部共二家診所及二家長期照顧服務機構，招募失智症患者之照顧者為研究對象。研究工具包含照顧負荷量表（Caregiver Burden Inventory, CBI），全量表共24題，採李克特式五點量尺給予0-4分作答；多向度反芻焦點量表（Multidimensional-Focused Rumination Scale, MFRS），全量表共20題，包含情緒、評價與意義焦點反芻分量表，採李克特式六點量尺給予1-6分作答；加長版創傷後成長量表（Expanded Posttraumatic Growth Inventory, PTGI-X）進，全量表共25題，採李克特式六點量尺給予0-5分作答。統計方法採用皮爾森積差相關、ANOVA、獨立樣本t檢定、羅吉斯回歸、多元線性回歸及階層迴歸。研究結果：本研究共招募165名失智症患者之照顧者，照顧者女性多於男性，照顧負荷平均數及標準差為55.90±18.88；情緒、評價及意義焦點反芻之題平均數與標準差分別為32.32±9.12、20.34±8.22及23.70±7.26；PTG平均數及標準差為69.87±30.30。研究結果發現失智症患者之照顧者照顧負荷越高，情緒、評價及意義焦點反芻程度越高，PTG程度亦越高。經控制照顧者性別、每日照顧小時及生活影響程度後，照顧負荷與情緒及意義焦點反芻可預測PTG。檢驗情緒及意義焦點反芻對照顧負荷及PTG之中介效果，並使用Sobel test驗證，結果顯示情緒及意義焦點反芻在照顧負荷及PTG間具有完全中介效果。研究討論：本研究結果有助於臨床工作者了解失智症患者之照顧者經歷照顧負荷下出現PTG的樣貌，並暸解情緒及意義尋找之層面的反芻思考在照顧負荷與PTG關係扮演重要角色，提供臨床工作者催化照顧者PTG之心理介入參考。

Purpose：The purpose of this study was to describe the burden of care, regurgitation and post-traumatic growth of the caregivers of dementia patients in this study, to investigate the correlation between them, and to find out the mediating effect of regurgitation on the burden of care and post-traumatic growth.Methods：A cross-sectional survey was conducted to recruit dementia caregivers from two clinics and two long-term care organizations in the north and south of the country. The instruments used in the study included the Caregiver Burden Inventory (CBI), a 24-question scale with a Likert-type five-point scale ranging from 0-4; the Multidimensional-Focused Rumination Scale (MFRS), a 20-question scale with questions on emotion, appraisal and evaluation; and the Multi-Rumination Scale (MFRS), a 20-question scale with questions on emotion, appraisal and appraisal. The Multidimensional-Focused Rumination Scale (MFRS), a full scale with 20 questions, includes emotion, evaluation and meaning focus regurgitation subscales, which are scored 1-6 on a 6-point Likert-type scale; and the Expanded Posttraumatic Growth Inventory (PTGI-X), a full scale with 25 questions, which is scored 0-5 on a 6-point Likert-type scale. The statistical methods used were Pearson's cumulative correlation, ANOVA, independent t-test, Rogers regression, multivariate linear regression, and hierarchical regression.Result：A total of 165 caregivers of dementia patients were recruited in this study. There were more females than males in this study, and the mean and standard deviation of caregiving load was 55.90±18.88; the mean and standard deviation of regurgitation of emotion, appraisal, and meaning were 32.32±9.12, 20.34±8.22, and 23.70±7.26 respectively; and the mean and standard deviation of PTG were 69.87±30.30. The study found that the higher the caregiving load of the dementia caregivers, the higher the regurgitation of emotions, evaluations and meaning, and the higher the PTG level. After controlling for the caregiver's gender, hours of care per day, and degree of life influence, care load and ruminant for emotion and meaning could predict PTG. The mediating effect of ruminant for emotion and meaning on care load and PTG was examined by using the Sobel test, and the results showed that ruminant for emotion and meaning had a complete mediating effect between care load and PTG.Discussion：The results of this study can help clinicians to understand how the caregivers of dementia patients experience PTG under the burden of caregiving, and to understand that regurgitation of emotions and meaning-seeking plays an important role in the relationship between caregiving and PTG, which can provide a reference for clinicians to catalyze the caregiver's psychological intervention of PTG.