- 學位論文
父職參與對於母親產後情緒之影響
The Link between Paternal Involvement and Maternal Postnatal Emotional Status
摘要
背景：母親懷孕和生產不論對生理、心理或是家庭社會角色上都是重大的轉變，容易引發許多產後情緒問題，如產後憂鬱和焦慮等。在台灣，女性不論就業與否，通常仍需擔負主要育兒的責任。近年來許多研究都強調產後父職參與的重要性，也就是父親在孩子出生後能參與嬰幼兒的照護，提供母親工具性的支持，此因素可能影響子女成長及發展，以及對婚姻關係有更正向的影響。父親的低支持可能是母親產後情緒問題重要的危險因子，但國內外仍缺乏父職參與對於產後憂鬱與焦慮影響之研究，以及母親工作與否在此關係中扮演的角色。 研究目的：(一) 探討大台北地區父職參與產後6個月嬰兒照護之現況，(二) 探討大台北地區產後6個月母親產後憂鬱焦慮的盛行率，(三) 探討父職參與嬰兒照護與母親產後6個月憂鬱、焦慮的影響，(四) 探討父職參與嬰兒照護對於母親產後6個月憂鬱、焦慮之關係，是否在有工作和無工作的母親間有不同的效應。 方法：本研究在台北市與新北市立意選取四所教學醫院及醫學中心，於合作的醫院婦產科門診進行產檢者邀請納入研究，亦即母親及其伴侶在孕期16週以前納入研究，在產後六個月後填寫追蹤問卷，本研究收案時間在第一次孕期問卷調查時間為2011 年7 月至2013 年6 月，產後追蹤問卷調查時間為2011 年7 月至2014 年5 月，共追蹤完成425對父母親。受訪者自填問卷包括愛丁堡產後憂鬱量表(EPDS)、情境特質焦慮量表之情境焦慮量表(STAI-S)及父職參與情形等，並使用多變項邏輯式迴歸及多元邏輯斯迴歸分析進行最後結果分析。 結果：(一) 父親花在小孩身上的時間為平均每週34.28小時、當母親不在時父親花在小孩身上時間為平均每週12.95小時、生活照顧介於每天一次至每週幾次之間、親子互動介於每週幾次至每月幾次之間;(二)母親產後高憂鬱盛行比例為21.24％、產後高焦慮盛行比例為40.77％；(三)多變項及多元邏輯斯迴歸分析顯示，在控制相關干擾因子後，相較於父親花在小孩身上時間多者，若父親花在小孩身上的時間少，母親顯著提高產後高憂鬱之風險(校正後OR=2.33, 95％CI= 1.23-4.42)，若以母親產後的憂鬱與焦慮合併而言，父親花在小孩身上時間少，可能顯著提高母親產後高憂鬱且高焦慮風險(校正後OR=2.35, 95％CI=1.09-5.05)；(四)母親沒有工作者，其父職參與較低顯著增加母親產後情緒問題(含憂鬱與焦慮)之風險，但此關係在母親有工作者則未具顯著性。 結論：國內產後情緒問題盛行率高，建議納入孕產期常規門診檢查項目中，幫助婦產科醫師快速評估孕產婦的心理情緒狀態，並且提供公共衛生及心理專業人員在母親產後持續關懷及衛教，尤其對於產後沒有工作之母親，能對其伴侶強調父職參與之重要性，以降低母親產後情緒問題風險。未來建議擴大研究範圍及長期追蹤，以較大的樣本進一步探討父職參與和母親產後情緒問題間之關聯性，並能持續追蹤探討至孩子學齡前的影響效應。
並列摘要
Background: Significant changes during prenatal and postpartum periods may affect maternal physical, mental and psychosocial health. Postnatal emotional difficulties, including depression and anxiety, are frequently observed. In Taiwan, no matter women are employed or not, childcare duties are mainly taken by mothers. Recently, more and more studies have emphasized the importance of paternal involvement (i.e., fathers are encouraged to engage in child caring work and offer instrumental support to the mothers) during perinatal periods. Paternal involvement may be positive to children’s growth and development and to the marital relationship as well. Although low paternal involvement was identified as a potentially detrimental factor, more studies are in need to further estimate the effects of paternal involvement on maternal postpartum depression and anxiety, together with the role of maternal job status in this association. Objectives: This study was aimed at investigating (1) the current picture of paternal involvement at 6 months postpartum in Taipei and New Taipei City; (2) the prevalence of maternal depression and anxiety at 6 months postpartum in Taipei and New Taipei City; (3) the association between paternal involvement and maternal postnatal depression and anxiety at 6 months postpartum; and (4) the potential modifying effects of maternal job status in the association between paternal involvement and maternal postnatal depression and anxiety. Method: Women prior to 16 gestational weeks and their partners attending the prenatal visits from July 2011 to June 2013 in four selected hospitals in Taipei City and New Taipei City were invited for participation. A total of 425 pairs of parents completed the first interview and responded the follow-up questionnaire at 6 months postpartum. Self-reported data were collected by instruments of the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory scale (STAI-S) and the paternal involvement scale. Binary and multinomial logistic regression models were performed for analyses. Result: We found that fathers spent an average of 34.28 hours a week with their child. When mothers were away, an average of 12.95 hours a week was reported. The frequencies of paternal engagement in childcare work ranged from once a day to several times a week, while those of father-child interaction ranged from several times a week to several times a month. The prevalences of maternal postnatal depression and anxiety were estimated as 21.24％ and 40.77％, respectively. In binary and multinomial logistic regression analyses, compared to higher level of paternal involvement, lower level of involvement was independently associated with increased risks of maternal postpartum depression (adjusted OR=2.33, 95％CI=1.23-4.42). If both depression and anxiety were considered, lower level of paternal involvement significantly increased the risks of maternal comorbid depression and anxiety (adjusted OR=2.35, 95％CI=1.09-5.05). For mothers without jobs, the impact of lower paternal involvement on maternal emotional difficulties was even more salient, while for employed mothers, findings did not reach the statistically significant level. Conclusion: High prevalences of maternal postpartum emotional difficulties deserve continued consideration. We suggest the need of screening perinatal depression and anxiety during routine obstetric examination to help gynecologists promptly evaluate maternal emotional status. For public health and psychological professionals, continued physical and mental care together with appropriate health education should be provided. Especially for unemployed mothers, the considerable effects of higher paternal involvement on childcare arrangements to help ameliorate maternal emotional difficulties should be emphasized. Future longitudinal studies with larger sample size are in need to further clarify the relationships between paternal involvement and maternal emotional status. Findings could also be extended to longer-term impact on children’s preschool years.