本研究旨在探索乳癌病人之睡眠困擾、壓力、失志與心理幸福感之間的關係，並進一步以心理幸福感作為適應指標，了解睡眠困擾、壓力與失志三者的影響路徑。本研究採橫斷式設計，以問卷調查方式收集以下資料：個人基本資料、匹茲堡睡眠品質量表、初診斷乳癌病人之壓力感受量表、害怕惡化量表短版、失志量表、心理幸福感量表。研究對象來源以中部某醫學中心的門診病人為主，以病友團體、親友協助為輔，受試者為平均年齡52歲、診斷後2年且罹患I、II期的乳癌病人，回收有效樣本共208筆。以相關、階層迴歸及結構方程模式進行統計分析，結果顯示：（1）乳癌病人的睡眠困擾、壓力、失志與心理幸福感之間為負相關；（2）乳癌病人的睡眠困擾會影響心理幸福感，壓力和失志在兩者之間扮演中介角色；（3）乳癌病人的壓力和睡眠困擾會同時透過失志的完全中介影響其心理幸福感。因此，建議臨床人員在乳癌病人照護上，須多加留意壓力與睡眠困擾對心理健康的影響，尤其對病人情緒低落的現象加以關注，必要時提供情緒支持或其他心理治療的介入。藉此提昇乳癌病人之心理幸福感，進而有效促進乳癌之疾病適應。
This research is aimed to the patients with breast cancer, exploring their relationship between Sleep Disturbances、Stress (including pressure perception and fear of recurrence)、Demoralization and the Psychological Well-Being. Regarding the Psychological Well-Being as the outcome variable, and understand the influential pathway of Sleep Disturbances、Stress and Demoralization. This research was design for Cross-Sectional survery, collecting data by questionnaire. Sleep Disturbance was assessed by Pittsburg Sleep Quality Inventory (Taiwan form version). Stress were assessed by Scale of Newly Diagnosed Breast Cancer Stress and Fear of Progression Questionnaire (short form version). Demoralization was assessed by Demoralization Scale (Chinese, Mandarin version). Psychological Well- Being was assessed by Ryff’s Psychological Well-Being Scale (Chinese, short form version). The 208 subjects mainly are outpatients, and the rest of them came from the supporting group. The average age of the subjects were 52-years old, post-diagnosed by 2 years and with I、II stages breast cancer. This research using the bivariate correlation, hierarchical regression and structural equation modeling for statistics and analysis, and the results show: (1) Negative correlation between Psychological Well-Being and Sleep Disturbance、Stress and Demoralization; (2) Sleep Disturbance affect the Psychological Well-Being, while Stress and Demoralization plays the role as mediator; (3) Stress and Sleep Disturbance simultaneously affect the Demoralization, then influence the Psychological Well-Being. This discovery suggest that clinical staffs must keep an eye on the influence for psychological health affected by stress and sleep disturbance of breast cancer patients, applying the emotional support and other psychological therapies if necessary.
