目的：基於初診斷乳癌患者的心理沮喪反應存在個別差異性之假設，本研究旨在探討乳癌患者的心理沮喪發展軌跡及其與資源變化、因應風格之間的關係，並採用動態性的壓力調適觀點來說明影響個體間發展差異與個人內變化之因素。三個主要的目的為（1）初診斷乳癌患者是否具有不同的心理沮喪發展軌跡？（2）隨時序變化的資源變化與因應風格可否區辨不同的軌跡組別；以及（3）不同軌跡組別的資源變化與因應風格對其心理沮喪之影響是否不同？
方法： 本研究採用貫時性的研究設計，共收錄200名初診斷乳癌患者。患者於診斷後的手術前一天進行評估，並於術後一個月、術後四個月、術後七個月及術後一年進行後續的追蹤。每一點的心理沮喪分數採用中文的醫院版焦慮與憂鬱量表（HADS）來測量，追蹤時間點的資源變化與癌症因應風格之分數，分別是以修編的資源改變量表（資源流失與資源獲得）與台灣版癌症心理調適量表（Mini-MAC）進行評估。
結果：潛在類別成長模式的結果顯示，相較於過去的研究，心理沮喪的變化軌跡可區辨出「韌性組」、「復原組」、「晚發組」及「慢性組」。潛在成長曲線模式的分析顯示，相較於其他三組，「韌性組」的壓力因應特性為：診斷之後維持在低資源流失、較低的初始AP，以及較低的CA成長率；相較於「韌性組」，「復原組」還具有下降較慢的FS；「晚發組」與「慢性組」又比前兩組具有更高的初始HH與較高的AP成長率，而「慢性組」比起其他三組在診斷初期具有最高的資源流失、最高的HH以及最低的FS。階層線性模式的分析顯示，四組之中的資源流失與因應風格皆可預測心理沮喪，作用的差異之處主要出現在「慢性組」的資源獲得與CA具有減緩心理沮喪之效果，以及各組之內的預測因子不同。
結論：本研究支持罹癌後的壓力反應具有個別差異性，並且指出乳癌患者的心理沮喪反應具有四種不同的發展型態。本研究也強調於連續變化的向度中考量不同的心理沮喪發展軌跡及其相關的壓力調適因子亦具有時序變化之重要性。有關的理論與實務意涵將於後作進一步地討論。 / Objectives: This study assumed the psychological distress of newly-diagnosed breast cancer (BC) patients existed the entities of the individual difference, so this study examined distinct development trajectories of psychological distress amongst BC patients and their relationship with resource changes and coping styles, and adopted a dynamic stress-coping perspective to shed light on the factors that contribute to the diversity of inter-individual development and intra-individual change. The three major purposes were (1) to determine if there are distinct development trajectories of psychological distress amongst newly-diagnosis BC patients; (2) to test whether time-varying resource changes and coping styles can distinguish the trajectory groups; (3) to explore whether the effect of time-varying resource changes and coping styles on psychological distress differ within each trajectories group.
Methods: A longitudinal reasarch study of 200 newly-diagnosed BC patients was recruited and participants were assessed at the day before surgery, and again at the 1-month, 4-month, 7-month and 1-year post-surgery follow-ups. Psychological distress was measured at the five time-points using the Chinese version of Hospital Anxiety and Depression Scale (HADS). Resource changes and cancer-specific coping were assessed at all follow-ups using the revised Resource Change Scale and the the Chinese version of Mini-MAC Scale, respectively.
Results: Latent Class Growth Analysis (LCGA) identified four latent classes of BC patients with distinct developmental trajectories of psychological distress - resilience, recovery, late onset and chronic dysfunction. Latent Growth Curve Model (LGM) revealed that the stress-coping properties of the resilience group featured a stabilized lower level of resource loss after diagnosis, a lower level of initial AP-coping and a lower growth rate of CA-coping when compared with the others. The recovery group was more likely to have a lower decrease of FS-coping than the resilience group. Moreover, the late onset group and the chronic dysfunction group were more likely to have a higher level of initial HH-coping and a higher increase in AP-coping, and the chronic dysfunction group was characterized by the highest level of initial resource loss and HH-coping, and the lowest level of initial FS-coping compared with the other groups. The Hierarchical Linear Model (HLM) indicated that resource loss and use of coping styles could significantly predict levels of psychological distress in each trajectory group. The major differences that appeared were in the positive effect of resource gain and use of CA-coping on decreasing distress symptoms amongst people in the chronic dysfunction group, as well as in the different predictors that were found in each trajectory group.
Conclusions: The present study shows that there are individual differences in cancer-specific stress responses and outlines four different developmental patterns of psychological distress amongst newly-diagnosed Taiwanese BC patients. This study also stressed the importance of considering time-serial continuity of distinct developmental trajectories with regards to psychological distress as well as the related stress-coping factors which also varies with time. Further theoretical and practical implications are discussed in depth in the content of the study.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0094752501 |
| Creators | 涂珮瓊, Tu, Pei Chiung |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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