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    题名: 從城鄉差異的觀點,評估台灣鄉村型社區心理衛生中心之服務需求:以社會指標分析、關鍵訊息提供者與社區居民的調查等方法研究雲林縣高農業人口地區為例
    The Needs Assessment for Rural Community Mental Health Centers in Taiwan Based on the Perspectives of Urban-Rural Differences: A Multi-Method Approach including the Social Indicators Analysis, the Survey of the Key Informants and Community Residents in the High Agricultural Areas of Yunlin County
    作者: 周才忠
    Chou, Tsai Chung
    贡献者: 陳嘉鳳
    Chen, Chia Feng
    周才忠
    Chou, Tsai Chung
    关键词: 社區心理衛生中心
    社會指標分析
    關鍵訊息提供者調查
    社區居民調查
    農業危機
    鄉村心理衛生服務
    心理衛生指標系統
    Community Mental Health Center
    Social Indicators Analysis
    Key Informants Approach
    Community Residents Survey
    Farm Crisis
    Rural Mental Health Services
    Mental Health indicators System
    日期: 2004
    上传时间: 2009-09-19 11:56:06 (UTC+8)
    摘要: 本研究以城鄉差異觀點,評估台灣鄉村型社區心理衛生中心之服務需求,具體目的有(1)分析台灣縣市及雲林縣鄉鎮與心理衛生有關之各項社會指標,以驗證社區心理衛生相關問題的城鄉差異性;(2)瞭解雲林縣及其鄉鎮關鍵訊息提供者對高度農業地區各項社區心理衛生問題嚴重程度、問題型式、地理分佈與相關在地服務資源之看法;(3)瞭解雲林縣高度農業人口鄉鎮社區居民對其村落各項相關心理衛生問題嚴重程度、問題型式、社區壓力源、因應方式與求助情形之看法;(4)由社區居民調查結果,抽取鄉村心理衛生相關問題之共同因素,並歸納諸項調查研究與指標分析結果,初步擬定出一「台灣鄉村心理衛生指標系統目錄」。

    研究方法採用多方法評估策略。社會指標分析方面,共計分析台灣地區23個縣市24項及雲林縣20個鄉鎮市16項心理衛生相關問題,以比較不同農業人口分群其發生率或盛行率之差異。關鍵訊息提供者調查方面,使用自編問卷分別調查雲林縣30位與二崙與水林兩鄉69位政府單位、民間機構或專業個人等。社區居民調查方面,二崙與水林兩鄉共發出2049份問卷,回收1074份(52.4%),有效問卷為967份(41村、97.6%)。統計方法有描述統計、集群分析、t考驗、單因子變異數分析、皮爾森積差相關分析、因素分析等。

    研究主要發現如下:(1)高度農業人口地區之老年、低教育程度、喪偶、外籍配偶、身心障礙、意外事故死亡、醫事人員平均服務人口數等比例明顯較高,離婚、全般刑案、竊盜、強盜搶奪、暴力犯罪、強制性交等比例則較低。(2)台灣縣市心理衛生相關嚴重問題社會指標之地理分佈概況不明顯,但雲林縣心理衛生相關嚴重問題比例則以高度農業人口的二崙與麥寮兩鄉明顯較高。(3)雲林縣與二崙、水林兩鄉關鍵訊息提供者皆認為人口外移與老化、老人問題(獨居、貧窮、安養等)、電話詐騙等問題比例較高。雲林縣關鍵訊息提供者主觀覺得口湖、台西與四湖為最亟需心理衛生服務的農業鄉鎮。二崙鄉關鍵訊息提供者主觀覺得大庄、楊賢與港後為該鄉最亟需心理衛生服務的村落。水林鄉關鍵訊息提供者主觀覺得水北、塭底與大山為該鄉最亟需心理衛生服務的村落。(4)二崙與水林兩鄉社區居民認為電話詐騙、人口外移、農產經營影響、人口老化、家庭經濟壓力等問題比例較高,青少女母親(含未婚懷孕)、家庭人數眾多、親友與鄰居死亡頻傳、自殺、性侵害、精神疾病、家庭暴力、家庭虐待等比例較低。(5)二崙與水林兩鄉居民認為「社區孤立與無望感」來自人口老化、多孤獨貧窮老人、人口外流嚴重、生活無聊、缺乏休閒娛樂等因素較多,「犯罪被害擔憂與恐懼」來自竊盜、詐騙、嗑藥吸毒等問題較多,「社區憂鬱現象」來自個人與家庭經濟壓力、失業、農業損害或收益等因素較多。(6)二崙與水林兩鄉居民認為其感受社會壓力源以治安惡化為主,農業壓力源以農產收益與自然災害為主,社區壓力源以治安不佳、衛生環境不良、缺乏休閒娛樂等較多,學校壓力源以城鄉差距大、教育與學習資源不足、課業或升學壓力、教育政策多變等較多,家庭壓力源以經濟收入與子女教養為主,個人壓力源以經濟收入、身體健康、工作壓力等較多。(7)二崙與水林兩鄉居民指出習慣(或主要)抒解或因應壓力方法,以「找人聊天」居首,只有6.5%曾求助於親友之外的專業人員。(8)雲林縣現有7個單位或機構(衛生局─社區心理衛生中心與長期照護管理示範中心、社會局─各課、家庭教育中心、台大醫院雲林分院精神科、雲林區心理衛生諮詢服務中心與生命線協會)共提供37個鄉村心理衛生相關服務項目。

    本研究由社區居民調查結果,共抽取出七個因素構面並分別命名為「一般社區心理衛生問題」、「農業社區心理衛生問題」、「環境污染」、「經濟壓力」、「居住生活風險」、「犯罪」與「家庭婚姻特性」,並歸納諸項調查研究與指標分析結果,初步擬定出一「台灣鄉村心理衛生指標系統目錄」(5大指標向度,14個指標項目)。

    文末,研究者並根據研究結果與國內外相關文獻,分別提出鄉村居民心理健康政策、鄉村心理衛生指標系統、農業危機服務、老人心理衛生、社區孤立與無望感、犯罪被害恐懼、環境污染心理影響、鄉村性別與族群心理議題、鄉村學校之預防功能、鄉村心理衛生服務模式等10項建議。
    The purposes of this thesis were: (1) to analyze the differences of some social indicators related to mental health of Taiwan (23 cities/counties) and Yunlin county (20 townships). (2) to understand the opinions of the key informants about community mental health problems. (3) to survey community residents of agricultural areas about the subjective perceptions of their mental health. (4) to set up a summative index of Taiwan Rural Mental Health indicators System.

    This research used a multi-method strategy. Data collected in the spring of 2005 included 24 social indicators of 23 cities/counties in Taiwan, and 16 social indicators of 20 cities/township in Yunlin, and questionnaires of 99 key informants and 967 community members of Erh-lun and Shui-lin Township of Yunlin County.

    Major findings of this study were as follows:

    (1)Significant differences were found in the social indicators about the numbers of older population, the lower educational status, the widowed, the foreign spouse, and the disabled, the accidental injury-related deaths in agricultural counties. In contrast, urbanized areas had higher rates of the divorced, all criminal case, larceny, robbery and forceful taking, violent crime, rape, and the average number of people serviced by per medical personnel .

    (2)The geographic analysis in terms of the mental health status and service needs of residents revealed no significant differences among 23 cities/counties, but significant differences among 20 cities/township (Yunlin County), Erh-lun and Mailiao had much more problems.

    (3)Yunlin County’s key informants indicated that the areas of Kou-hu, Tai-si and Sih-hu have high needs for mental health services. Erh-lun’s key informants indicated that 3 villages have high needs for mental health services. Shui-lin’s key informants indicated that 3 villages have high needs for mental health services.

    (4)Most respondents of resident sample ranked the following mental health problems as serious: fraudulent telephone calls, out-migrant, farm crisis, being elderly, and family economic hardship.

    (5)Most respondents of resident sample employed “chatting with others” as stress-relieving or coping method. Besides “family and friends”, only about 6.5% of respondents reported that they sought help from mental health professionals or specialists.

    (6)To set up the initial rural mental health indicator systems of Taiwan: a summative index consists of 14 items and is divided into five dimensions

    The recommendations for rural mental health policies, indicator systems, program strategies and rural mental health service delivery issues were also suggested.
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