Correlates of Rehospitalization in Depressive Disorder

　　目的：探討影響憂鬱症患者再住院的相關危險因素，以為將來介入處置的參考依據。方法：以1996年12月1日至1999年5月31日，在南部某醫學中心『壓力病房』住院的憂鬱症病人為研究對象，進行回溯之個案對照研究。研究組為曾經在壓力病房重複住院兩次或兩次以上者有90名，再以隨機選樣的方法於318名非重複住院者中選取90名對照組。資料分析的主要來源為病歷回顧，及以「家庭關懷度APGAR問卷」作為家庭功能評估之訪談結果。結果：分析發現，婚姻狀況、過去是否曾因憂鬱症住院以及家庭功能等變項，與重複住院有顯著相關；換句話說，已婚、過去是否曾因憂鬱症住院、以及家庭功能不佳者有較高重複住院的可能性。結論：已婚、中年、婦女為憂鬱症住院患者的人口統計學三大特點；家庭功能為憂鬱症患者重複住院之重要相關因素。建議應重視家庭與精神疾病之關聯，憂鬱症治療層面應該擴及於家庭，針對家庭互動關係進行介入處遇，不僅可減輕照顧者之負擔，亦將可降低憂鬱症患者再住院可能性。
　　Objective: The purpose of this study was to investigate the family function and the risk-factors associated with repeated hospitalization among patients with depressive disorder. Material and Methods: A case control study design was used. Patients with depressive disorder admitted to a medical-psychiatric ward at a medical center in southern Taiwan during the period from December 1996 to May 1999 were recruited for participation. A total of 90 cases were selected by the criteria of diagnosis of depressive disorders with a history of two or more hospitalizations during the study period. On the other hand, another 90 subjects with depressive disorders were selected as the control group from 318 patients with non-repeated admissions by random sampling. Data were collected by chart review. Family function was evaluated with the Family APGAR (adaptability, partnership, growth, affection, resolve) Questionnaire by telephone interviews. Results: Most of the research subjects were unemployed (65,00%) married (77.78%) middle-aged (50.43, SD ＝ 14,03) women (67.78%). Among them, 18,89% had a history of psychiatric admission before being admitted at this medical-psychiatric ward. Their average Family APGAR score was 14.33 (SD = 3.94, range 6-20). Statistical analysis showed that marital status (X&sup2; = 9.40, p<0.05), history of another psychiatric admission for depressive disorder (X&sup2; =11.75, p<0.05), and family function (t=2.24, p<0.05) were significantly associated with repeated admission. Those who were married, had a history or another psychiatric admission, and had poor family function, were more likely to utilize psychiatric admission rep eatedly, Conclusion: Women, married, and middle aged, were the demographic characteristics of admitted patients with depressive disorders, and family function was significantly associated with repeated admission, This finding indicates that family function assessment should be considered as a mandatory procedure for the treatment of depressive disorders. Intervention to improve family function may help prevent rehospitalization in patients with depressive disorders. (Full Text in Chinese)