조현병 환자의 내재화된 낙인, 사회적지지 및 약물이행과의 관계

Abstract

The purpose of this study was to analyze the relations among schizophrenia patient perceived internalized stigma, social support and medication adherence and thereupon, provide for some basic data useful to exploration of an effective nursing intervention to encourage their medical adherence and improve their health. For this purpose, this study sampled the schizophrenia patient who had been treated at the department of mental health of 'J' University Hospital in 'J' region, and thereby, conducted a questionnaire survey for them for the period from May 30 through July 30, 2019. For this survey, this study used the questionnaire developed by Ritsher(2004) and translated and modified by Hwang Tae-yeon(2006) (Korean version of Internalized Stigma of Mental Illness Scale, K-ISMI) and that developed by Zimet(1988) and translated by Lee Ok-seon(2000) (Multidimensional Scale of Perceived Social Support, MSPSS) and that developed by Hwang Myong-sook(1998) and modified by Shin Kyoung-sook(2001) (Medication Adherence Scale). The collected data were processed using the SPSS/WIN 22.0 for Chronbach's Alpha, descriptive statistical analysis, independent t-test, ANOVA, Pearson's correlation coefficients and multiple regression analysis. The results of this study can be summarized as follows; 1) Subjects' internalized stigma scored 2.18(±0.55) on the 4-point scale. To be specific, the Stigma resistance scored highest or 2.49(±0.65), followed by Alienation 2.25(±0.71), Social withdrawal 2.14(±0.71), Discrimination experience 2.07(±0.71), and Stereotype endorsement 2.01(±0.59) in their order. The social support scored 3.18(±0.86) on the 5-point scale. To be specific, the Family support scored highest or 3.57(±0.89), followed by Significant other support 3.14(±1.02), and Friends support 2.84(±1.06). Their medication adherence scored 3.84(±0.78), a higher point than average on the 5-point scale. 2) As a result of analyzing the differences of subjects' medication adherence depending on their demographic variables, it was found that their medication adherence differed significantly depending on the demographic variables: age(F=3.79, p=.012), education level (F=5.67, p=.004), occupation(t=-2.53, p=.012), monthly household income(F=4.37, p=.014), religion(t=-2.44 p=.016) and experience of relapses(t=-2.63, p=.009). 3) Subjects' medication adherence was negatively correlated with their internalized stigma(r=-.39, p<.001), while being positively correlated with the social support(r=.52, p<.001). 4) The factors affecting subjects' medication adherence were internalized stigma(β=-.18, p=.022) and social support(β=.35, p<.001), both of which explained about 30.4% of the total variances. Since it was confirmed by this study that the schizophrenia patient's medication adherence would be affected by their internalized stigma and social support, it is deemed necessary to make efforts to help them relieved of their internalized stigma and gain more social support, while encouraging them to adherence medication. All in all, it is also required to explore a nursing intervention to educate them continuously to help them to surmount their difficulties. Key words: Schizophrenia patient, Internalized stigma, Social support, Medication adherence