研究目的：探討精神分裂症患者與憂鬱症患者之家庭功能是否為自我污名化影響疾病預後的中介因子。研究方法：研究對象經由國軍三軍總醫院身心科門診就診民眾招募而來，總計納入225位患者（精神分裂症患者150位、憂鬱症患者75位）。以迴歸分析進行家庭功能在自我污名化對其疾病預後狀態的中介效果之檢驗，其顯著程度經由拔靴法 (bootstrap) 進行估計。研究結果：精神疾病患者的自我污名化、家庭功能與疾病預後達顯著相關。在精神分裂症患者方面，家庭功能部分中介自我污名化對自尊及憂鬱症狀的影響；在憂鬱症患者方面，家庭功能部分中介自我污名化對自尊、憂鬱症狀、生活品質及無望感的影響。然而，不論精神分裂症或憂鬱症患者其自我污名化對於自我效能的影響中，家庭功能均未有顯著的中介效果。研究結論：精神分裂症與憂鬱症患者的自我污名化經由家庭功能進而影響與臨床預後有關心理狀態。因此，提升精神病患的家庭功能為改善精神疾病患者疾病預後的可行介入標的。

Purpose : The aim of this study was to examine the mediating effect of family function on the relationship between self-stigma and prognosis (i.e., self-esteem, depressive symptom, quality of life, hopelessness and self-efficacy) in patients with schizophrenia and patients with depression. Methods : A total of 225 outpatients (150 patients with schizophrenia, 75 patients with depression) were recruited from one psychiatric outpatient of Tri-Service General Hospital. The mediating effect (also called indirect effect) of family function on the relationship between self -stigma and prognosis was examined by regression analysis. The significant degree of indirect effects was estimated via bootstrapping. Results: Significant correlations between self-stigma, family function and prognosis were found in patients with schizophrenia and patients with depression. Family function partially mediated the relation of self-stigma to self-esteem and depression symptoms, respectively, in patients with schizophrenia. Family function partially mediated the relation of self-stigma to self-esteem, depressive symptoms, quality of life, and hopelessness in patients with depression. However, regardless of the patients with schizophrenia or depression, family function did not mediate the relationship of self-stigma to self-efficacy. Conclusions: Self-stigma had influences on prognosis via family function in patients of schizophrenia and depression. Therefore, to enhance family functioning is a plausible intervention target to improve prognosis in patients with mental illness.

一、中文部分
孔繁鐘、孔繁錦（2007）。精神疾病診斷準則手冊第四版（內文革新版）。臺北：合計圖書出版社。
王美珍（2004）。台灣報紙對精神病患烙印化之初探。未出版之碩士論文，臺北：政治大學新聞研究所。
王淑清、潘璦琬、鍾麗英、熊秉荃（2011）。影響精神分裂症患者生活品質之因素－一年之追蹤研究。護理暨健康照護研究，7(1)，55-64。
吳美惠、翁儷禎、李明濱、王秀紅、熊秉荃（2006）。重鬱症病患社會支持、互惠性、衝突與憂鬱程度之相關性研究。臺灣精神醫學，20(2)，116-123。
李明濱（2006）。自殺防範指引。臺北：行政院衛生署。
李雅敏、林宏熾（2008）。成年就業精神分裂症患者康復經驗之研究。復健諮商，2，49-75。
沈淑華（2006）。精神分裂症患者出院一年後內再住院之因素探討（未出版之碩士論文）。臺南：國立成功大學護理學系護理行政組。
胡海國 （1997）。全國精神分裂一年中住院患者再住院次數分析。當代醫學，24(1)，68-74。
唐珊（2006）。門診精神分裂病患者憂鬱之相關因素探討（未出版之碩士論文）。臺北：臺北醫學大學護理學研究所，。
陳韻玲、熊秉荃、陳詞章、潘璦琬（2008）。憂鬱症個案的職能功能與生活品質。臺灣醫學，12(6)，627-634。
彭美琪、許銘能（2006）。建構社區精神病患照護網絡－以台北縣為例。長期照護雜誌，10(4)，323-332。
曾秋蓉、邱政元、顏文娟、蘇惠珍、蕭秋月（2012）。社區復健中心之精神分裂症患者其污名感受、污名因應與生活品質相關因素之探討。護理雜誌，59(4)，62-70。
黃梅羹（1987）。精神科住院病患及其家屬的心理暨社會問題探討研究。臺北：中華民國醫務社會工作協會。
黃宗正、劉智民、劉震鐘、謝明憲、簡意玲、胡海國（2011）。精神分裂症的臨床與精神病理。臺灣醫學，15(4)，365-374。
臺灣精神醫學會（2014）。Schizophrenia中文譯名由「精神分裂症」更名為「思覺失調症」的歷史軌跡。參考網址：http://www.sop.org.tw/Official/official_15.asp
鄭泰安（1985）。臺灣地區精神病患之社會文化特徵及療養結果。中華心理衛生學刊，2(1)，117-133。
衛生福利部（2014）。101年度全民健康保險醫療統計年報。臺北：衛生福利部。
盧孟良、車先蕙、張尚文、沈武典（2002）。中文版貝克憂鬱量表第二版之信度和效度。臺灣精神醫學，16(4)，301-310。16
韓德彥（2001）。華人文化下污名感受、生病行為與情緒對身體化傾向之影響（未出版之碩士論文）。臺北：國立台灣大學心理學研究所。

二、英文部分
Altintas, E., Gallouj, K., & Guerrien, A. (2012). Social support, depression and self-esteem in older persons: Cluster analysis results. Annales Medico-Psychologiques, 170(4), 256-262.
Angermeyer, M. C., Beck, M., Dietrich, S., & Holzinger, A. (2004). The stigma of mental illness: Patients' anticipations and experiences. International Journal of Social Psychiatry, 50(2), 153-162.
Arboleda-Flórez, J., & Sartorius, N. (2008). Understanding the stigma of mental illness: theory and interventions. New York: John Wiley & Sons.
Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy. Developmental Psychology, 25, 729–735.
Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865.
Beck, A. T., Steer, R. A., Brown, G. K. (1996). Beck Depression Inventory II (BDI–II). Harcourt Assessment: San Antonio, TX.
Ben-Zeev, D., Young, M. A., & Corrigan, P. W. (2010). DSM-V and the stigma of mental illness. Journal of Mental Health, 19(4), 318-327.
Borecki, L., Gozdzik-Zelazny, A., & Pokorski, M. (2010). Personality and perception of stigma in psychiatric patirnts with depressive disorders. European Journal of Medical Research, 15, 10-16.
Brohan, E., Gauci, D., Sartorius, N., Thornicroft, G., & Grp, G. AMIAN-Europe Study. (2011). Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: The GAMIAN-Europe study. Journal of Affective Disorders, 129(1-3), 56-63.
Brown, Joseph H. & Christensen, Dana N. (1986). Family Therapy Theory and Practice. Belmont, CA:Brooks/ Cole Publishing.
Canive, J. M., Sanzfuentenebro, J., Vazquez, C., Qualls, C., Fuentenebro, F., & Tuason, V. B. (1995). Family environment predictors of outcome in schizophenic-patients in spain- A 9- month follow-up-study. Acta Psychiatrica Scandinavica, 92(5), 371-377.
Chiu, F. P. F., & Tsang, H. W. H. (2004). Validation of the Chinese general self-efficacy scale among individuals with schizophrenia in Hong Kong. International Journal of Rehabilitation Research, 27(2), 159-161.
Corrigan, P. W. (2005). On the stigma of mental illness. Washington, D.C.: American Psychological Association.
Corrigan, P.W. , & Watson, A.C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry Association.
Corrigan, P.W., Faber, D., Rashid, F., & Leary, M. (1999). The construct validity of empowerment among consumers of mental health services. Schizophrenia Research, 38, 77–84.
Delucchi, K. L., Tajima, B., & Guydish, J. (2009). Development of the smoking knowledge, attitude, and practices (S-KAP) instrument. Journal of Drug Issues, 39(2), 347-363.
El-Badri, S., & Mellsop, G. (2007). Stigma and quality of life as experienced by people with mental illness. Australasian Psychiatry, 15(3), 195-200.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Psychonomic Society Publications, 39(2), 175-191.
Finkelstein, J., & Lapshin, O. (2007). Reducing depression stigma using a web-based program. International Journal of Medical Informatics, 76(10), 726-734.
Gabhann, L. M., Lakeman, R., McGowan, P., Parkinaon, M., Redmond, M., Sibitz, I., . . . Walsh, J. (2010). Hear my voice: The experience of discrimination of people with mental health problems in Ireland. Dublin, Ireland :Dublin City University.
Gerlinger, G., Hauser, M., De Hert, M., Lacluyse, K., Wampers, M., & Correll, C. U. (2013). Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry, 12(2), 155-164.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
Gray, A. J. (2002). Stigma in psychiatry. Journal of the Royal Society of Medicine, 95(2), 72-76.
Hackethal, V., Spiegel, S., Lewis-Fernandez, R., Kealey, E., Salerno, A., & Finnerty, M. (2013). Towards a Cultural Adaptation of Family Psychoeducation: Findings from Three Latino Focus Groups. Community Mental Health Journal, 49(5), 587-598.
Han, D. Y., Chen, S. H., Hwang, K. K., & Wei, H. L. (2006). Effects of psychoeducation for depression on help-seeking willingness: Biological attribution versus destigmatization. Psychiatry & Clinical Neurosciences, 60(6), 662-668.
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York Londen: Guilford.
Helweg-Larsen, M., Sadeghian, P., & Webb, M. S. (2002). The stigma of being pessimistically biased. Journal of Social and Clinical Psychology, 21(1), 92-107.
Hill, Kimberley, & Startup, Mike. (2013). The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: The mediating role of self-efficacy. Psychiatry Research, 206(2/3), 151-157.
Holmes, E. P., & River, L. P. (1998). Individual strategies for doping with the stigma of severe mental illness. Cognitive and Behavioral Practice, 5(2), 231-239.
Hsiung, P. C., Pan, A. W., Liu, S. K., Chen, S. C., Peng, S. Y., & Chung, L. (2010). Mastery and Stigma in Predicting the Subjective Quality of Life of Patients With Schizophrenia in Taiwan. Journal of Nervous and Mental Disease., 198(7), 494-500.
Kao, Y. C (2013).Assessing internalizedstigma and stigma resistance inindividuals with mental illness: an investigation usingthe Internalized Stigma ofMental Illness Scale (unpublish thesis). Taipei：National Taiwan University.
Kao, Y.-C., Liu, Y.-P., & Lu, C.-W. (2012). Beck Hopelessness Scale: Exploring its Dimensionality in Patients with Schizophrenia. Psychiatric Quarterly, 83(2), 241-255.
Keitner, G. I., Ryan, C. E., Miller, I. W., Kohn, R., Bishop, D. S., & Epstein, N. B. (1995). Role of the family in recovery and major depression. American Journal of Psychiatry, 152(7), 1002-1008.
Kessler, R. C., Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G., & Leaf, P. J. (1996). The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry, 66(1), 17-31.
Koyama, A., Akiyama, T., Miyake, Y., & Kurita, H. (2004). Family functioning perceived by patients and their family members in three Diagnostic and Statistical Manual-IV diagnostic groups. Psychiatry and Clinical Neurosciences, 58(5), 495-500.
Kuehner, C., & Huffziger, S. (2013). Factors predicting the long-term illness course in a cohort of depressed inpatients. European Archives of Psychiatry and Clinical Neuroscience, 263(5), 413-423.
Kuo, Po-Ju, Ma, Hui-Ing, Kuo, Chien-Cheng, Huang, Wei-Che, & Chung, Ming-Shun. (2009). Factor analysis of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese version and related factors. International Journal of Psychiatry in Clinical Practice, 13(4), 278-284.
Lam, C. S., Tsang, H. W. H., Corrigan, P. W., Lee, Y. T., Angell, B., Shi, K., . . . Larson, J. E. (2010). Chinese Lay Theory and Mental Illness Stigma: Implications for Research and Practices. Journal of Rehabilitation, 76(1), 35-40.
Lan, C. M., Yang, C.Y., Huang, J. Y., & Shiau, S,J. (2004). The relationship of drug alliance behaviors of schizophrenic outpatients with the characteristics of key persons and family function. Chang Gung Nursing, 15(1),1-14.
Lewis, A. J., Bertino, M. D., Skewes, J., Shand, L., Borojevic, N., Knight, T., . . . Toumbourou, J. W. (2013). Adolescent depressive disorders and family based interventions in the family options multicenter evaluation: study protocol for a randomized controlled trial. Trials, 14.
Liberman, R. P., Glynn, S., Blair, K. E., Ross, D., & Marder, S. R. (2002). In vivo amplified skills training: promoting generalization of independent living skills for clients with schizophrenia. Psychiatry-Interpersonal and Biological Processes, 65(2), 137-155.
Lin, H.-C., Tang, T.-C., Yen, J.-Y., Ko, C.-H., Huang, C.-F., Liu, S.-C., & Yen, C.-F. (2008). Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan. Psychiatry and Clinical Neurosciences, 62(4), 412-420.
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363-385.
Link, B. G., Struening, E., Cullen, F. T., Shrout, P. E., & Dohrenwend, B. P. (1989). A modified labeling theory appoach to mental -disorders - An enpirical - assessment. American Sociological Review, 54(3), 400-423.
Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150-2161.
Lysaker, P. H., Vohs, J., Hasson-Ohayon, I., Kukla, M., Wierwille, J., & Dimaggio, G. (2013). Depression and insight in schizophrenia: Comparisons of levels of deficits in social cognition and metacognition and internalized stigma across three profiles. Schizophrenia Research, 148(1-3), 18-23.
McGrath, J., Saha, S., Chant, D., & Welham, J. (2008). Schizophrenia: a concise overview of Incidence, prevalence, and mortality. Epidemiologic Reviews, 30(1), 67-76.
Mojalefa, S. R. (2003). The impact of schizophrenia on family functioning: a social work perspective. 63, ProQuest Information & Learning, US.
Murray, C. J. L., & Lopez, A. D. (1996). The global burden of disease : a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press.
Nasser, E. H., & Overholser, J. C. (2005). Recovery from major depression: the role of support from family, friends, and spiritual beliefs. Acta Psychiatrica Scandinavica, 111(2), 125-132.
Oliver, M. (1996). Defining impairment and disability : Issues at stake. In C. Barnes & G. Mercer (Eds.), Exploring the Divide. Leeds: The Disability Press.
Oxford Outcomes Ltd. (2004). The Revised Schizophrenia Quality of Life Questionnaire (SQLS-R4): User manual for the SQLS-R4. Cassington: Oxford Outcomes.
Perlick, D., Miklowitz, D., Link, B., Struening, E., Kaczynski, R., Gonzalez, J., et al (2007). Perceived stigma and depression among caregivers of patients with bipolar disorder. British Journal of Psychiatry, 190, 535–536.
Phelan, J. C., Link, B. G., Stueve, A., & Pescosolido, B. A. (2000). Public conceptions of mental illness in 1950 and 1996: What is mental illness and is it to be feared? Journal of Health and Social Behavior, 41(2), 188-207.
Pompili, Maurizio, Innamorati, Marco, Gonda, Xenia, Serafini, Gianluca, Sarno, Stefania, Erbuto, Denise, . . . Girardi, Paolo. (2013). Affective temperaments and hopelessness as predictors of health and social functioning in mood disorder patients: A prospective follow-up study. Journal of Affective Disorders, 150(2), 216-222.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879-891.
Pukrop, R., Schlaak, V., Möller-Leimkühler, A. M., Albus, M., Czernik, A., Klosterkötter, J., & Möller, H. J. (2003). Reliability and validity of quality of life assessed by the short-form 36 and the modular system for quality of life in patients with schizophrenia and patients with depression. Psychiatry Research, 119(1-2), 63-79.
Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research, 121(1), 31-49.
Rosenberg, M. (1989). Determinants of self -esteem- a citation classic commentary on society and adolescent self image by Rosenberg, M. Current Contents/Arts & Humanities(6), 14-14.
Salyers, M. P., & Mueser, K. T. (2001). Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia. Schizophrenia Research, 48(1), 109-123.
Satcher, D. (1999). Mental health: A report of the surgeon general Department of Health and Human services. Washington: DC.
Scheff. (1974). The labelling theory of mental illness. American sociological review.
Schwarzer, R., & Mueller, J. (1999). Assessment of perceived general self-eftlcacy on the internet: Data collection in cyberspace. Anxiety. Stress, and Coping, 12, 145-161.
Segalovich, J., Doron, A., Behrbalk, P., Kurs, R., & Romem, P. (2013). Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. [Article]. Archives of Psychiatric Nursing, 27(5), 231-234.
Sibitz, I., Amering, M., Unger, A., seyringer, M. E., Bachmann, A., Schrank, B., . . . Woppmann, A. (2011). The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. European Psychiatry, 26(1), 28-33.
Smilkstein, G. (1978). The family APGAR: A proposal for a family function test and its use by physicians. Journal of family practice, 6(6), 1231.
Urizar, A. C., & Giraldez, S. L. (2008). Quality of life and family functioning in schizophrenia patients. Psicothema, 20(4), 577-582.
Valdez, C. R., Padilla, B., Moore, S. M., & Magana, S. (2013). Feasibility, acceptability, and preliminary outcomes of the fortalezas familiares intervention for Latino families facing maternal depression. Family Process, 52(3), 394-410.
Vauth, R., Kleim, B., Wirtz, M., Corrigan, P., 2007. Self-efficacy and empowerment as outcomes of self-stigmatizing and coping schizophrenia. Psychiatry Research, 150, 71–80.
Vega, W. A., Rodriguez, M. A., & Ang, A. (2010). Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry, 32(2), 182-191.
Vlassoff, C., & Ali, F. (2011). HIV-related stigma among South Asians in Toronto. Ethnicity & Health, 16(1), 25-42.
Vogel, D. L., Bitman, R. L., Hammer, J. H., & Wade, N. G. (2013). Is Stigma Internalized? The Longitudinal Impact of Public Stigma on self-Stigma. Journal of Counseling Psychology, 60(2), 311-316.
Wagner, G. J., Holloway, I., Ghosh-Dastidar, B., Kityo, C., & Mugyenyi, P. (2011). Understanding the influence of depression on self-efficacy, work status and condom use among HIV clients in Uganda. Journal of Psychosomatic Research, 70(5), 440-448.
Watson, A. C., Corrigan, P., Larson, J. E., & sells, M. (2007). Self-stigma in people with mental illness. Schizophrenia Bulletin, 33(6), 1312-1318.
Waraich, P., Goldner, E. M., Somers, J. M., & Hsu, L. (2004). Prevalence and incidence studies of mood disorders: a systematic review of the literature. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 49(2), 124-138.
Werner, P., Stein-Shvachman, I., & Heinik, J. (2009). Perceptions of self-stigma and its correlates among older adults with depression: a preliminary study. International Psychogeriatrics, 21(6), 1180-1189.
Wilkinson, G., Hesdon, B., Wild, D., Cookson, R., Farina, C., Sharma, V., . . . Jenkinson, C. (2000). Self-report quality of life measure for people with schizophrenia: the SQLS. British Journal of Psychiatry, 177, 42-46.
Yang, Y. H., Yeh, E. K., & Hwu, H. G. (2012). Prevalences of Schizophrenia, Bipolar Disorder, and Depressive Disorders in Community between Taiwan and Other Countries. Taiwanese Journal of Psychiatry, 26(2), 77-87+72.
Yildiz, M., Ozten, E., Isik, S., Ozyildirim, I., Karayun, D., Cerit, C., & Ucok, A. (2012). Self-stigmatization among patients with schizophrenia, their relatives and patients with major depressive disorder. Anadolu Psikiyatri Dergisi-Anatolian Journal of Psychiatry, 13(1), 1-7.
Yen, C. F., Chen, C. C., Lee, Y., Tang, T. C., Ko, C. H., & Yen, J. Y. (2009). Association between quality of life and self-stigma, insight, and adverse effects of medication in patients with depressive disoreers. Depression and Anxiety, 26(11), 1033-1039.