初產婦產後適應及產後憂鬱之探討－以北部地區為例

• Main Author: 何巧琳
• Other Authors: 護理學研究所
• Language: Chinese; English
• Published: 2010
• Subjects: 產後適應 產後憂鬱; Norway; Webb; Lowe; St. Louis; Beck; Payne; Saunders; Mercer; Morrow; Williamson; Diaz; Borg; Goodman; Ulmer; Macpherson; McCoy; Navarro; Barros; Rubin; Birkeland; Abrams; Reece; Tarkka; Portillo; McVeigh; Carroll; Boyer; First Nations; Metis
• Online Access: http://libir.tmu.edu.tw/handle/987654321/36471

致謝 ………………………………………………………………… I 中文摘要.……………………………………………………………III 英文摘要…………………………………………………………… V 目錄…………………………………………………………………VII 附錄 …………………………………………………………………IX 圖表目次 ……………………………………………………………XI 第一章 緒論 第一節 研究動機與重要性 …………………………………………1 第二節 研究目的 ……………………………………………………4 第三節 研究問題 ……………………………………………………4 第四節 名詞界定 ……………………………………………………4 第二章 文獻查證 第一節 產後適應相關探討 …………………………………………8 第二節 產後憂鬱相關探討…………………………………………24 第三節 產後適應與產後憂鬱關係相關研究………………………29 第四節 研究架構……………………………………………………31 第五節 研究假設……………………………………………………32 第三章 研究方法 第一節 研究步驟……………………………………………………34 第二節 研究對象……………………………………………………36 第三節 研究工具……………………………………………………38 第四節 研究倫理考量………………………………………………49 第五節 資料統計分析方法…………………………………………50 第四章 分析與結果 第一節 研究對象基本資料描述 ……………………………………55 第二節 研究對象產後適應狀況描述………………………………57 第三節 研究對象產後憂鬱狀況描述………………………………58 第四節 人口學變項與初產婦產後適應之相關性 …………………61 第五節 人口學變項與初產婦產後憂鬱之相關性 …………………65 第六節 產後適應與產後憂鬱之相關分析 …………………………71 第七節 產後憂鬱的重要預測變項 …………………………………74 第五章 討論 第一節 初產婦女產後適應狀況分析…………………………………76 第二節 初產婦女產後憂鬱狀況分析…………………………………80 第三節 影響初產婦產後適應之因素…………………………………81 第四節 影響初產婦產後憂鬱之因素…………………………………82 第三節 初產婦產後適應與產後憂鬱之相關性………………………83 第四節 產後憂鬱之重要預測變項討論………………………………84 第六章 結論與建議 第一節 臨床實務方面…………………………………………………86 第二節 護理教育方面…………………………………………………87 第三節 研究限制與未來研究建議……………………………………88 參考資料 中文部分 ………………………………………………………………90 英文部分 ………………………………………………………………93 附錄 附錄一 英文版產後適應量表作者同意書 …………………………105 附錄二 英文版產後憂鬱量表作者同意書 …………………………106 附錄三 中文版產後憂鬱量表作者同意書 …………………………109 附錄四 臺北醫學大學人體試驗同意證明書 ………………………110 附錄五 萬芳醫院人體試驗同意證明書 ……………………………111 附錄六 雙和醫院護理部研究計劃初審申請表 ……………………112 附錄七 新店市衛生所研究計劃同意公文 …………………………113 附錄八 專家效度名單 ………………………………………………114 附錄九 專家效度量表 ………………………………………………115 附錄十 人體試驗主持人考試及格證明 ……………………………118 附錄十一 參與研究同意書 …………………………………………119 附錄十二 受試量表 …………………………………………………123 圖表目次 圖一 羅氏適應模式-人是一個適應的系統 ………………………12 圖二 應用羅氏適應理論於產後適應評估示意圖 …………………16 圖三 研究架構圖 ……………………………………………………31 圖四 翻譯過程流程圖 ………………………………………………43 表一 本研究各量表內在一致性分析 ………………………………48 表二 資料統計分析-描述性統計考驗方法…………………………52 表三 資料統計分析-假設之推論性考驗方法表 …………………53 表四 初產婦之社會人口學變項資料分析 …………………………56 表五 研究對象產後適應狀況資料之分布 …………………………59 表六 研究對象產後憂鬱狀況資料的分佈 …………………………60 表七 不同社會人口學變項其產後適應與產後憂鬱差異比較表… 67 表八 產後適應與產後憂鬱之相關結果 ……………………………73 表九 預測產後憂鬱之迴歸分析 ……………………………………75 表十 美國、挪威、瑞典與台灣產後適應比較表 …………………79 中文部份 孔繁鐘、孔繁錦譯（2007）‧DSM-Ⅳ精神疾病診斷準則手冊‧台北：合記。 王淑諒（2001）‧坐月子期間產婦之健康促進生活方式及其影響因素之探討‧未發表的碩士論文，臺北醫學大學，台北。 行政院勞工委員會（2009）‧98年婦女勞動統計‧臺北市：行政院勞工委員會。 何巧琳、高碧霞（2004）‧一位剖腹產初產婦遭遇哺乳困難的護理 經驗‧臺大護理，4（1），44－55。 利翠珊、陳富美（2004）‧配偶親職角色的支持與分工對夫妻恩情的影響‧本土心理學研究，21，49－83。 李小璐（2004）‧婦女之睡眠品質、疲倦及憂鬱：產後二週及四週時間序列研究‧未發表的碩士論文，國立台北護理學院，台北。 林秀娟（2004）‧縱貫性研究：孕產婦憂鬱之影響因素探討‧未發表的碩士論文，長庚大學，桃園。 林秀慧（2004）‧國內博碩士論文之婚姻滿意度研究的概況分析以民70 －92年為例‧家政教育學報，6，77－116。 邱皓政（2005）‧量化研究法（二）統計原理與分析技術－SPSS中文視窗版操作實務詳析（第9－33頁）‧臺北：雙葉。 教育部統計處（2009，6月30日）‧各級畢業生升學率‧2009年10月22日，取自http://www.edu.tw/files/site_content/B0013/98edu_108.xls 陳昭惠、林麗珠（2008，12月）‧產前教育對於產後親子關係及父母照顧嬰兒自信心的影響‧2009年12月24日，取自http://grbsearch.stpi.org.tw/GRB/result.jsp?id=RG9802-0010&plan_no=TCVGH+976502A&plan_year=0&projkey=PG9707-0058&target=report&highStr=產前教育&check=1&pnchDesc=產前教育對於產後親子關係及父母照顧嬰兒自信心的影響 陳偉任、林清華（2004）‧產後憂鬱症的回顧‧台灣醫界，47（4），163－167。 曾英芬、陳彰惠、王惠珍、蔡秋月（1994）‧比較在家中與坐月子中心坐月子婦女的產後適應‧The Kaohsiung Journal of Medical Sciences，10（8），458－468。 馮燕（1992）‧Maternal Care Utilization by Women in Taipei‧社會科學論叢，40（6），291－336。 黃久華（2003）‧產婦執行坐月子習俗遵循度與產後健康狀態之相關性研究‧未發表的碩士論文，國立陽明大學，台北。 黃月桂、林勤豐（2000）‧全民健保孕婦產檢服務初步評估‧公共衛生，27（2），115－122。 楊子慧、李明濱、張秀如（2005）‧產後憂鬱症‧北市醫學雜誌，2（7），598－604。 蔡漢賢（2000）‧社會工作辭典‧臺北市：內政部社區發展雜誌社。 鄭雅雯（2000）‧南洋到臺灣：東南亞外籍新娘在臺婚姻與生活探究──以臺南市為例‧未發表的碩士論文，國立東華大學，花蓮。 蕭昭娟（1999）‧國際遷移之調適研究：以彰化縣社頭鄉外籍新娘為例‧未發表的碩士論文，國立臺灣師範大學，台北。 英文部份 Areias, M. 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Archives of Women's Mental Health, 11(1), 1-11. 產後憂鬱對整個家庭發展具有不容忽視之影響，研究發現產後調適與產後憂鬱可能有關，因此本研究目的在探討北台灣地區初產婦產後九週內適應與憂鬱之相關。 本研究屬橫斷式描述相關性之研究設計。以方便取樣方式，於北部地區兩家醫院與兩家衛生所，並刊登招募廣告於孕產相關網站招募個案。問卷以郵寄方式請產婦於產後一週至九週內填答，共計取得可分析問卷186份。研究工具包括：社會人口學量表、產後適應與愛丁堡產後憂鬱量表。 結果發現：（1）產後憂鬱比率約50.5%，而有39.2 %個案達到需就醫診治的標準。（2）產後適應七個次量表評估結果，分別與產後憂鬱呈低度至中度相關。（3）若要預測產後憂鬱，「產婦有信心能處理母職工作」是最重要的因子，可解釋產後憂鬱總變異量之31%，其次為「產婦滿足生活環境」，最後為「產婦感覺配偶參與嬰兒照顧」，此3項產後適應次量表共可以解釋產後憂鬱總變異量之43.4%。（4）非計劃中生育、家中經濟狀況不足、沒有固定工作、年齡較輕與家庭型態為大家庭之初產婦，是產後適應與憂鬱高危險群。（5）約84.2%初產婦女願意接受產後心理追蹤諮詢服務。 根據本研究討論與結果提出下列建議：（1）產後適應度越差者，則其產後憂鬱情緒越高。因此產後適應狀況，應納入產後照護評估重點。（2）臨床醫護工作者，應該重視高之產後憂鬱比例問題，提供必要產後心理狀況追蹤、篩檢及介入協助。（3）提升產婦處理母職工作能力與信心，是有效改善產後憂鬱的方法。（4）相較於歐美國家，台灣初產婦有三項產後適應狀況較差，此三項分別為處理母職工作的信心、對母職與嬰兒照護的滿意和母職角色支持來自朋友、父母與其他家庭成員。因此本研究建議，對於台灣地區初產婦，可由周產期照護的政策面及護理人員的臨床能力提升來加強對於此三項議題的關注。（5）對於初產婦女中，經濟狀況較不足、產婦無固定工作、家庭型態為大家庭、非計劃性生育與年齡較輕之產後適應與憂鬱之高危險群，建議提供適當的協助。（6）本研究結果發現多數產後婦女，願意接受產後心理追蹤諮詢服務。因此建議社區衛生護理人員，可將產後適應評估量表，列入產後追蹤的項目之一，以改善目前產後照護模式之照護品質。 The purpose of this cross-sectional study was to explore the relationships between postpartum adaptation and postpartum depression among first time mothers who lived in northern Taiwan. A total of 186 first time mothers, recruited via convenience sampling methods, completed mailed questionnaires between 1 week and 2 months after giving birth. Structured questionnaires including Demographic Inventory Scale, the Postpartum Self-Evaluation Questionnaire, and the Edinburgh Postnatal Depression Scale were used. The results showed: (1) 94 (50.5%) women exhibited depressive symptoms (EPDS > 10) and 73 (39.2%) women need to seek for professional help (2) The correlation between women’s different aspects of postpartum adaptation and postpartum depression ranged from low to medium; (3) The best subsets for predicting postpartum depression were as follows: confidence in their own competence of motherhood tasks (31% of total variation), satisfaction with life circumstances, and perception of partner’s participation in child care. These three subsets explained 43.4% of total variation; (4) Women with unplanned births, low socioeconomic status, part-time employment, younger of age, and living with extended family members are at high-risk for postpartum adaptation and postpartum depression. In addotion, approximately 154 (84.2%) primiparas are willing to accept the follow-up psychology counseling. Results of this study suggest that health care providers who worked with first time mothers during the first two months after giving birth should pay much attention to the following areas: (1)conducting screening assessment and referral services on postpartum depression, (2) advocating on helping first time mothers to built confidence on motherhood tasks such as infant care (3) involving fathers in the baby care and (4) improving family and friends’ support for maternal role