認知行為諮商於改善台灣地區更年期婦女情緒困擾與因應模式之成效探討

中山醫學大學機構典藏 CSMUIR > 醫學院 > 護理學系暨碩士班 > 研究計劃 > Item 310902500/2648

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Title:	認知行為諮商於改善台灣地區更年期婦女情緒困擾與因應模式之成效探討 Effects of Cognitive-Behavior Counseling to Improve the Emtional Distress and Coping of Women with Menopause in Taiwan
Authors:	李選;石芬芬;曾月霞;羅旭宜;謝明鴻;廖瓊玲 Lee, Sheuan;Shih, Fen-Fen;Tseng, Yueh-hsia;Luo, Hsu-yi;Hsieh, Ming-Hong;Liao, Chiung-ling
Contributors:	中山醫學院護理學系
Keywords:	更年期;情緒困擾;婦女心理健康 menopause;emotional distress;mental health of women's
Date:	2004
Issue Date:	2010-11-05T10:07:59Z (UTC)
Abstract:	本研究為二年期計劃，第一年研究目的旨在探討更年期婦女之停經經驗、自覺健康狀況與健康需求及心理健康反應，並瞭解上述變項之關係；研究設計以40-59歲婦女為母群體(2,877,272人)，並依照內政部公佈九十一年底台灣地區各縣市女性人口數比例分成北、中、南、東等四區，採集群抽樣法隨機抽出十個縣市與其特定行政區；再以立意取樣方式選取特定行政區所屬較大型醫療衛生機構之家醫科、婦科、身心科與衛生所之門診求診女病患及社區中年女性民眾中選取停經未滿二年者，平均年齡為49.92±4.36歲之513位婦女為對象(power=1)，以曾氏心理健康、更年期症狀困擾、停經症狀嚴重程度、自覺健康狀態、健康需求與個人基本資料為研究工具進行橫斷式問卷調查，本研究所得資料以SPSS for Windows 10.套裝軟體進行分析，統計方法包括：百分比、平均值、標準差、項目分析、皮爾森積差相關、獨立樣本t檢定、單因子變異數分析、LSD事後比較、逐步複迴歸分析等。研究結果發現：(一)症狀方面：更年期婦女其停經症狀發生頻率以腰酸背痛最常見，其次依序為健忘、關節酸痛、失眠、感覺疲倦或全身無力及對房事較不感興趣；症狀發生頻率與症狀困擾嚴重程度皆呈現地區性差異(F=8.65, 10.03, p< .001)，其中以中部地區顯著高於北部及東部，南部地區顯著高於北部；同時腰酸背痛亦是更年期婦女感受介於輕度至中度困擾之主要症狀，其序為健忘、關節酸痛與失眠。(二)健康需求方面：更年期婦女在生理需求、心理社會支持需求、訊息需求及整體健康需求上皆達顯著性差異，以區域別來分析比較發現：在生理需求方面--中部地區(21.86±11.96)顯著高於北部、南部及東部(F=8.36, p< .001)；在心理社會支持需求方面--中部地區(33.76±13.83)高於北部及東部，南部地區高於北部及東部(F=7.44, p< .001)；在訊息需求方面--中部地區(27.61±9.43)高於北部，南部高於北部，東部高於北部(F=12.30, p< .001)。在整體健康需求方面，中部部地區(87.28±32.38)仍高於北部及東部，南部高於北部(F=11.43, p< .001)；進一步分析中部地區(台中、新豐、埔里)更年期婦女在生理需求、心理社會支持需求、訊息需求及整體健康需求上皆達顯著性差異；且新豐地區在整體需求上顯著高於台中及埔里地區(F=39.06, p< .001)。(三)情緒困擾方面：四區更年期婦女在憂鬱反應上雖未達顯著性差異，但以北部及南部地區婦女呈現憂鬱反應之平均得分(51.04±10.14, 50.12±10.43)符合曾氏界定輕度憂鬱之標準；另外憂鬱反應與停經經驗未達顯著性相關，但與訊息需求、家庭滿意度及社交關係之滿意度呈顯著負相關(r=- .155, p< .05；- .212, p< .001；- .212, p< .001)。四區更年期婦女在焦慮反應方面則呈現顯著性差異(F=3.25, p< .05)，尤其以中部地區婦女顯著高於北部及東部，且焦慮反應之平均得分(50.44±10.09)亦符合曾氏心理健康標準之輕度焦慮；進一步分析中部地區更年期婦女在憂鬱反應上雖亦未達顯著性差異，但以平均得分來看新豐及埔里地區婦女皆符合曾氏輕度憂鬱(50.53±11.12, 52.09±9.40)；而焦慮反應方面亦呈現顯著性差異(F=5.14, p< .001)，其中又以新豐地區顯著高於台中及埔里地區，台中地區亦高於埔里地區，且新豐地區之婦女在焦慮平均得分(56.03±10.06)表現亦達輕度焦慮狀態。更年期婦女的焦慮情緒反應與停經經驗(症狀發生頻率，r= .709, p< .001；症狀困擾嚴重度，r= .686, p< .001)呈顯著正相關，另外焦慮反應亦與生理需求、心理社會支持需求、訊息需求及整體健康需求皆達顯著正相關(r= .503, p< .001；r=.284, P<.001；r=.185, P<.001；r=.377, P<.001)；(四)經逐步複回歸分析結果發現：更年期婦女焦慮程度之最佳預測因子為症狀發生頻率、症狀困擾嚴重度、整體健康需求、社交滿意情形，其可解釋之總變異量為70.4%。是故，由上述結果方可解釋更年期婦女之停經經驗、健康需求及社交滿意度可預測焦慮反應；文獻證實更年期婦女認知偏差、失落、低自尊等會誘發情緒困擾，因此建立正確的認知態度、發展介入模式以改善更年期情緒困擾，以激發其健康促進之自我效能，進而呈現良好的心理健康行為與生活，共同營造健康的社區，以達到全民健康之總體目標。 This study is a two- year- program. The purpose of the first year was to explore the menopause experience, emotional distress, and the statue of health, the demand of mental health and interpret the relationship between above variables. The design of this study was cross-sectional. Using cluster sampling to draw out ten counties and 513 female subjects which were recruited from north, central, south and east of Taiwan and the average age is 49.92 4.36 and they are in menopause for less than two years. ]power 100%^With the research tool of Zungs Mental Health , the disturbance of menopause, the order of seriousness of menopause, the status of health, the demand of health and the personal information to survey transversely . The data of this study was statistics with the software of SPSS for Window 10.0 and the methods of statistic include percentile , mean, SD, Item Analysis, Pearsons Correlations, Independent-t-test, one way ANOVA, LSD, Posterior, Comparisons Stepwise Multiple Regression, etc. The result indicated that (A) the disturbance of climacteric symptoms of sore waist and backache are the most common and the next ones are obliviousness, joint ache, insomnia, feeling tired and uninterested in sex activities. The number of the cases in the central areas is obviously larger than the north and the east and the number of south is obviously larger than the north (F=10.03,p<.001) (B) In the aspect of the demand of health, the menopause women in the central has the highest score in physiology demand(21.8611.96), the demand of the social support in psychology, the demand of the message(27.619.43), and the demand of the whole health (87.2832.38). The discrepancy of the physiology demand, the demand of the social support in psychology, the demand of message and the demand of the whole health is very obvious and especially in physiological demand, the number of the central is larger than the north, the south and the east. (F=8.36, p<.001) In he demand of the social support in psychology, the number of the central is larger than the north and the south and the north is larger than the north and the east (F=7.44,p<.001). In the demand of message, the number of the central is larger than the north, the south is larger than the north and the east is also larger than the south. in the demand of the whole health, the number of the central is larger than the north and the east, the south is larger than the north (F=11.43,p<.001) To analysis further, the discrepancy of the menopause-woman- subjects of the central (Taichung, Hsinfeng and Puli) is obvious in the physiological demand , the demand of the social support in psychology, the demand of message(27.619.43) and the demand of the whole health. (C) In the aspect of disturbance of the mood, the menopause women in Taiwan are not anxious but cases in the central area get higher score in melancholy tool of Zungs Mental Health than the north and the east. The frequency of anxiety and the climacteric symptoms is correlative with the degree of disturbance. (r=.709, P<.001Fr=.686, P<.001) Anxiety and the demand of social support in psychology, the demand of message and the demand of the whole health are correlative. (r=.284, P<.001Fr=.185, P<.001Fr=.377, P<.001) The average score of the menopause women in the south area is 52.03116.12 in Zungs Mental Health which belongs to the reaction of mild depression. The menopause women in the other areas are not considered to be depressed. Depression and the frequency and disturbance and having climacteric symptoms are not correlative. (D) According the progressive analysis, we find out the best predictable facts of the menopause women in Taiwan are the frequency, the degree of depression, the seriousness of disturbance of symptoms
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