The Relationship between Sleep Problems and Substance Use in Adolescents

「睡眠問題」和「物質使用」是目前青少年最常見的兩種精神疾患，且與其他精神疾患有群聚現象，但是過去的文獻中，較少有系統地同時討論，為了促進青少年的健康，有必要進一步瞭解兩者間的關係。青少年的睡眠問題包括：睡眠時間不足、入睡困難、睡眠持續問題、睡眠周期不規律、日間疲倦等，可能會導致他們使用各種物質。反之，青少年的物質使用包括：飲酒、吸菸、使用含咖啡因物質、吸食大麻、使用古柯鹼、使用含安非他命物質、使用鎮靜安眠藥物、使用含鴉片類物質藥物、使用俱樂部用藥等，對他們的睡眠也有影響；嚼檳榔和使用吸入劑對睡眠的影響則不確定。本文藉由文獻回顧，證實青少年「睡眠問題」和「物質使用」之間可能有互為因果的關係，但台灣學者探討兩者因果關係的不多，並發現「睡眠問題」導致「物質使用」的研究多以心理及行為層面為主，而「物質使用」導致「睡眠問題」的研究則涵蓋生理、心理和行為等層面，因此未來在青少年健康促進的研究，除了要注重本土特色外，也應該同時顧及多元觀點，才能將研究成果轉譯為具體的政策。Sleep problems and substance use are the most prevalent mental health issues in adolescents. Moreover, individuals with these two problems may also be susceptible to other psychiatric disorders. A lack of systematic understanding of the relationship between sleep problems and substance use hinders our ability to promote health in adolescents. Sleep problems, such as inadequate total sleep time, difficulty in falling sleep and in maintaining sleep, irregular sleep patterns, and excessive daytime fatigue, may subsequently contribute to substance use in adolescents. Conversely, the use of substances, such as alcohol, tobacco, coffee or caffeine, marijuana, cocaine, amphetamines, sedatives or hypnotics, opioid containing prescriptions, and club drugs, affects sleep in adolescents. The effects of betel nut chewing and administration of inhalants on sleep are undermined. This review suggests a bidirectional relationship between sleep problems and substance use. The paucity of causal studies in Taiwan and the lack of biological evidence for sleep problems leading to substance use should prompt further research among native adolescents from multidimensional perspectives in order to determine practical policies to address both problems

Caregivers’ Burden in Individuals with Cognitive Impairment in Taiwan

老人及其照顧的相關問題隨著人口老化而成為衛生政策的主要焦點，但認知障礙老人與其照顧提供者的議題卻在本土研究和實務中相對被忽略。鑒於過去的研究中，少有以一般失能老人為研究主體，針對認知障礙與否的照顧者提供負荷為主題，且又有具代表性樣本的本土化研究，對於衛生政策的評估及制定不無缺憾。故本研究的目的在於了解我國老年失能個案家庭照顧者的負荷的概況，以及「老年個案認知障礙」與「照顧者各構面負荷」之間的關係。析資料來自2001年1月至2002年12月行政院衛生署執行的「全國長期照顧需要評估」研究計畫調查資料中，65歲以上有長期照顧需求且有家庭照顧者的個案和照顧者的資料，研究樣本共有7,630對個案及照顧者。究結果顯示，家庭照顧者的整體負荷為低度負荷者最多（佔53.8%），高度負荷者最少（佔5.7%），分別來看，身體負荷（低度佔55.2%，高度佔17.4%）、情緒負荷（低度佔62.1%，高度佔2.9%）、關係負荷（低度佔83.1%，高度佔1.7%）、時間負荷（低度佔45.0%，高度佔21.5%）、財務負荷（低度佔59.9%，高度佔15.6%）的比例也都是低度負荷者最多、中度負荷者其次，高度負荷者較少；其中身體負荷、時間負荷和財務負荷的為高度負荷者比例較高。利用multinomial logistic regression分析個案的認知障礙是否影響照顧者的負荷，發現不論是身體、情緒、關係、時間、財務、整體負荷等構面，相較於個案的無認知障礙，個案認知障礙確實為顯著的影響因子，其勝算比分別為1.925、1.661、2.538、2.009、1.258和1.926，其他影響照顧者（整體）負荷的因素還包括個案年齡、個案慢性疾病數、個案失能程度、個案干擾行為、照顧者職業狀況、照顧者健康狀況、照顧者工作衝突、照顧者支持程度、照顧者照顧競爭、照顧者每日照顧時數、照顧者每月額外支出等。言之，對於「個案有認知障礙、男性、65-69歲、家庭月收入介於10萬到20萬之間、慢性疾病數5種以上、輕度以上ADL失能、有干擾行為」；「照顧者為女性、初／國中畢業、與個案關係為配偶、健康狀況略差或很差、有工作衝突、支持程度很低、有照顧競爭、總照顧時間在1年以內、每日照顧時數超過8小時、每月額外支出在1,000元以上」者，應力求減少家庭照顧者的身體負荷。對於「個案有認知障礙、男性、65-69歲、中度以上ADL失能、有干擾行為」；「照顧者健康狀況略差或很差、有工作衝突、支持程度很低、每月額外支出在5,000至10,000元之間」者，應力求減少家庭照顧者的情緒負荷。對於「個案認知障礙、男性、65-69歲、家庭月收入在1萬元以下、中度以上ADL失能、有干擾行為」；「照顧者有配偶、與個案關係為非配偶、健康狀況略差或很差、有工作衝突、支持程度很低、總照顧時間在1年以內、每日照顧時數超過8小時」，應力求減少家庭照顧者的關係負荷。對於「個案有認知障礙、65-69歲、教育程度為初／國中與高中／職、慢性疾病數在5種以上、輕度以上ADL失能、有干擾行為」；「照顧者教育程度為小學（含）以上、無職業、健康狀況略差或很差、有工作衝突、支持程度很低、有照顧競爭、總照顧時間在1年以內、每日照顧時數超過8小時、每月額外支出在1,000元以上」者，應力求減少家庭照顧者的時間負荷。對於「個案有認知障礙、男性、65-74歲、家庭月收入在10,000元以下、慢性疾病數3-4種以上、輕度以上ADL失能、有干擾行為」；「照顧者未受教育、無配偶、無職業、健康狀況略差或很差、有工作衝突、支持程度很低、每日照顧時數超過8小時、每月額外支出在1,000元以上」者，應力求減少家庭照顧者的財務負荷。對於「個案有認知障礙、男性、65-74歲、家庭月收入在10,000元以下、慢性疾病數5種以上、輕度以上ADL失能、有干擾行為」；「照顧者有配偶、與個案的關係為非配偶、健康狀況略差或很差、有工作衝突、支持程度很低、照顧時間在1年以內、每日照顧時數超過8小時、每月額外支出在1,000元以上」者，應力求減少家庭照顧者的整體負荷。研究結果充實個案認知障礙與家庭照顧者負荷相關性的實證資料，可作為長期照顧政策研議提供認知障礙家庭照顧者資源的參考。未來針對家庭照顧者提供支持的方案，也應特別考量認知障礙個案的照顧者，對於不同的照顧負荷亦應給予妥適的支持。Due to the increase in the number of elderly people, the aging process and age-related issues have been the focus of public health policies across the world. However, cognitive impairment in the elderly and the difficulties faced by their caregivers have been relatively neglected in native research and have always been given less priority in national health policy making. The objectives of this thesis are as follows: (1) to understand burdens of family caregivers of the disabled elderly population in Taiwan, and (2) to clarify the association between care recipients’ cognitive impairment and their family caregivers’ burden.ata from the Department of Health, Executive Yuan (Jan. 2001 to Dec. 2002), were collected for analyses and a two-stage survey was conducted. A total of 7,630 pairs of care recipients and family caregivers were included for analysis.nalysis of the entire burden experienced by family caregivers suggests that more family caregivers experienced light burden (53.8%) while a smaller proportion suffered from serious burden (5.7%). This trend was also observed separately in physical burden, emotional burden, relational burden, burden of time, and financial burden. More caregivers suffered from serious physical burden (17.4%), burden of time (21.5%), and financial burden (15.6%) than other types of burden. A multinomial logistic regression analysis of the influence of care recipients’ cognitive impairment on the family caregivers’ burden reveals statistically significant results. The odds ratio of care recipients’ cognitive impairment to their cognitive non-impairment are 1.925, 1.661, 2.538, 2.009, 1.258, and 1.926 for serious burden to light physical burden, emotional burden, relational burden, burden of time, financial burden, and entire burden, respectively. Other statistically significant factors are age of the patient, number of chronic illnesses of the patient, degree of impairment of activity of daily living (ADL), disturbing behavior of the patient, occupational status of the caregiver, health status of the caregiver, occupational conflict of the caregiver, perceived support from the caregiver, conflict among the caregivers, daily hours of care provided by the caregiver, and the additional monthly expenditure of the caregiver.or males aged 65–69 years with cognitive impairment, a monthly household income between NTD 100,000 to 199,999, more than 5 chronic illnesses, more than mild ADL impairment, and exhibiting disturbing behaviors, and their family caregivers who are typically female graduates from junior high school, involved in a relationship of couple, with poor health status, occupational conflicts, poor support systems, and care conflicts, with a total care period of less than 1 year, daily care period of more than 8 hours, and an additional monthly expenditure of more than NTD 1,000, relieving the family caregivers of their physical burden is mandatory. n the case of males aged 65–69 years with cognitive impairment, moderate to severe ADL impairment, and disturbing behaviors, and their family caregivers who have poor health status, occupational conflicts, poor support systems, and an additional monthly expenditure of NTD 5,000 to 100,000, relieving the family caregivers of their emotional burden is mandatory.or males aged 65–69 years with cognitive impairment, a monthly household income of less than NTD 9,999, moderate to severe ADL impairment, and disturbing behaviors, and their family caregivers who are married, non-couples, with poor health status, occupational conflicts, poor support systems, total care period of less than 1 year, and daily care period of more than 8 hours, relieving the family caregivers of their relational burden is mandatory. n the case of males aged 65–69 years, who are graduates from junior or senior high school, with cognitive impairment, more than 5 chronic illnesses, more than mild ADL impairment, and disturbing behaviors, and their family caregivers are jobless, with more than 6 years of education, poor health status, occupational conflicts, poor support systems, care conflicts, a total care period of less than 1 year, daily care period of more than 8 hours, and an additional monthly expenditure of more than NTD 1,000, relieving the family caregivers’ burden of time is mandatory. or males aged 65–74 years, with cognitive impairment, a monthly household income of less than NTD 10,000, more than 3–4 chronic illnesses, more than mild ADL impairment, and disturbing behaviors, and their family caregivers who are illiterate, without couple, jobless, with poor health status, occupational conflicts, poor support systems, daily care period of more than 8 hours, and an additional monthly expenditure of more than NTD 1,000, relieving the family caregivers of financial burden is mandatory. n the case of males aged 65–74 years with cognitive impairment, a monthly household income of less than NTD 10,000, more than 5 chronic illnesses, more than mild ADL impairment, and disturbing behaviors, and their family caregivers who are married, non-couple, and have poor health status, occupational conflicts, poor support systems, total care period of less than 1 year, daily care period of more than 8 hours, and an additional monthly expenditure of more than NTD 1,000, relieving the family caregivers of the entire burden is mandatory. his study provides evidence of the association between care recipients’ cognitive impairment and the family caregivers’ burdens in the disabled elderly population in Taiwan. Based on the results of this study, we suggest that the public health policy makers should consider the care recipients’ cognitive impairment so as to provide appropriate support systems for various dimensions of a family caregiver’s burden.第壹章、前言–––––––––––––––––––––––––––––––––––––––––– 1一節、研究背景及動機–––––––––––––––––––––––––––––––– 1二節、研究目的–––––––––––––––––––––––––––––––––––––– 5貳章、文獻回顧及探討–––––––––––––––––––––––––––––––– 6一節、台灣地區家庭照顧者的特質及提供照顧的內容概觀–– 6二節、照顧者負荷的定義與測量–––––––––––––––––––––––– 7三節、影響失能老人照顧者負荷的因素–––––––––––––––––– 10四節、影響認知障礙個案或失智症患者照顧者負荷的因素–– 15五節、比較認知障礙與否與照顧者負荷的研究–––––––––––– 25叄章、材料與方法–––––––––––––––––––––––––––––––––––– 27一節、研究架構–––––––––––––––––––––––––––––––––––––– 27二節、資料來源–––––––––––––––––––––––––––––––––––––– 28三節、研究變項之操作型定義及測量–––––––––––––––––––– 29四節、資料處理與分析–––––––––––––––––––––––––––––––– 33肆章、結果–––––––––––––––––––––––––––––––––––––––––– 35一節、各變項描述–––––––––––––––––––––––––––––––––––– 35二節、個案特質與照顧者負荷、照顧者特質分照顧者負荷之交叉列表分析-----------------------------------------------40三節、以照顧者負荷為依變項的多變項資料分析–––––––––– 76伍章、討論與結論–––––––––––––––––––––––––––––––––––– 94一節、討論–––––––––––––––––––––––––––––––––––––––––– 94二節、政策意涵–––––––––––––––––––––––––––––––––––––– 105三節、研究限制與未來研究方向–––––––––––––––––––––––– 108表–––––––––––––––––––––––––––––––––––––––––––––––––– 111考文獻–––––––––––––––––––––––––––––––––––––––––––––– 174、中文文獻–––––––––––––––––––––––––––––––––––––––––– 174、外文文獻–––––––––––––––––––––––––––––––––––––––––– 17