1, 4 1, 2 3 1 4 1, 2 1977 E n g e l 1999 5 1 ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 ) 2003 1 2 2-32 stress model, stress analysis [ 1 ] ( p s y c h o g e n e s i s ) (holism) (biomedical model) ( r e d u c t i o n i s m ) ( f a c t o r- E n g e l [ 1, 2 ] analytic approach) ( p a r t (biopsychosocial model) ( i m p e r s o n a l ) ( h i e r a r c h i c a l ) ( c o n t i n u o u s ) 1 2 3 4 92 8 29 92 1 0 2 0 7 22 2003
( s y s t e m ) ( s t r e s s ) (stress model) ( s y s t e m ) [ 4 1980 ] [ 5 ] C o x [ 3 ] 1 [ 1, 2 ] [ 6-8 ] [ 9 ] Tw Fam Med Res 2003 Vol.1 No.1 23
[ 10 ] 1 991 2 [ 11 ] [ 11, 12 ] 24 2003
1 987 1 994 ( 1 ) ( 2 ) 1999 1 ~ 12 149 ( 1 ) - 3 + 3 ( 2 ) 1 3 ( 3 ) - 3 + 3 ( 4 ) ( 1 ) ( 2 ) ( 5 ) Tw Fam Med Res 2003 Vol.1 No.1 25
( ( 2 ) 1 ) 0 5-3 149 118 31 + 3 3. 8 37. 3 1 2. 7 1 9 03. 65 % 1 49 2 3 1 92 1 51 42 9 36. 04 11. 40 ( 1 ) ( 2 ) 149 ( 3 ) 51 2 2 = 3.953 p=.412 2 = 3. 843 p =.698 ( 4 ) 2 = 2. 704 p =.845 4. 7 26 2003
51 2. 6 1. 5 9 17. 6 % 0 0. 6. 3 2 7 52. 9 % 3 ~ 6 15 29. 5 % 2 1. 2 0. 9 7 1. 0 0. 8 Tw Fam Med Res 2003 Vol.1 No.1 27
38 74. 5 % 10 19. 6 % 3 5. 9 ( 1 ) ( 2 ) 28 2003
4 4 1 23 7. 8 % 4 7 9 2. 2 % 1. 86 2 ~ 5 12 4 7 1 0. 87 ( 3 ) 1. 69 46 90. 2 % 1. 41 ( 2 ) 5 9. 8 % ( 4 ) 33 64. 7 % 20 39. 2 % 2 8 15. 7 % 3. 9 % 10 19. 6 % 29 56. 9 % 1 2. 0 % 1 1 1 2 1. 6 % 8 7 13. 7 % 2 ~ 4 1 5. 7 % 11 21. 6 % 11 11 1 0 21. 6 % 2 1. 6 % 19. 6 % 5 6 7 5 4 2 4 1. 2 % 9 7. 8 %. 8 % 3. 9 % 51 52. 9 % 2 1 2. 6 1. 2 51 6 11. 8 % 1 8 3 5. 3 % 1 5 2 9. 4 % 9 1 7. 6 % 3 5. 9 % 2. 71 1. 08 1 0. 0. 8 ( 1 ) Tw Fam Med Res 2003 Vol.1 No.1 29
K a n t o r ( f i e l d ) [ 11 L e w i n ] [ 13, 14 ] 51 51 9 0. 2 % NSC 89-2413-H-002-050 30 2003
1. Engel GL: The clinical application of the 4 31-40 biopsychosocial model. Am J Psychiatry 9. 1980; 137: 535-44. 2. Engel GL: The need for a new medical 1991 5 23-34 model: a challenge for biomedicine. 10. -- S c i e n c e 1977; 196: 129-36. 3. Cox T: S t re s s. New York: Magmillan 1 3-16 27-94 93 1 Press, 1978: 1-25. 11. 4. -- 1 3 4 16-29 9 94 a 1 2 6 49 8-35 5 12. 5. 1 1 23 29 59 11 4 b- 6 13. Ellis A, Dryden W: The Practice of Rational-emotive Therapy (RET). N e w 1 987 3 89-105 York: Springer, 1987: 1-27. 6. 14. Blackburn IM, Davidson KM: C o g n i t i v e Therapy for Depression and Anxiety-a 1987 3 117-36 practitioner's guide. Oxford: Blackwell 7. Science, 1990. 1 9 8 7 3 1 5 5-7 0 8. 1994 Tw Fam Med Res 2003 Vol.1 No.1 31
Original Article The Application of Stress Model and Stress Analysis in Patients of the Department of Family M e d i c i n e : a Preliminary Study Yih-Ru Cheng 1,4, Bee-Horng Lue 1,2, Hsiu-Jung Chen 3, Yu-Fan Lee 1, En-Chang Wu 4, Ching-Yu Chen 1,2 Along with the development of psychosomatic medicine and the changes of disease pattern, George Engel's biopsychosocial model has been emphasized in medical health care. In Taiwan, researchers started to develop the stress model from the biopsychosocial perspective since about ten years ago. Furthermore, the clinical application of stress assessment and management based on the stress model also showed its effectiveness in patient care. For better patient care and to fulfill the social need, we set up a special clinic for stress assessment and counseling in the Department of Family Medicine in a medical center in J a n u a r y, 1999. We conducted this study by analyzing 51 patients' assessment records for the purpose of investigating the nature and related factors of their stresses as well as the applicability of the stress model. The results were as follows: (1) Stress model is appropriate for analyzing phenomenon of stress. (2) Most of the cases had psychosomatic symptoms; all of them had negative emotions; half of them did not or rarely express emotions; more than half of them did not resolve or even worsen the problems. (3) There were no cases of stress maladaptation purely ensued from the externalenvironmental or personal- characteristic factors. Stress adjustment problems were the results of these two factors. Department of Family Medicine 1, National Taiwan University Hospital; Department of Family Medicine 2, College of Medicine, National Taiwan University; Department of Psychology 3, Fu-Jen Catholic University; Department of Psychology 4, National Taiwan University, Taipei, Taiwan, R.O.C. Received: August 23, 2003; Accepted: October 20, 2003. 32 2003