親職壓力與兒童內外化行為問題之關係：探討睡眠問題的中介影響

The Associations of Parenting Stress with Internalizing and Externalizing Problems in Children : The Mediating Role of Sleep Problems

林筱雅(Hsiao-Ya Lin)

指導教授 ： 張齡尹

國立臺灣大學/公共衛生學院/健康行為與社區科學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202102017

摘要

背景：「親職」是人生中的重大改變與挑戰，而親職壓力不只影響父母心理健康，亦導致兒童行為發展不良。研究發現，親職壓力可有效預測兒童內化及外化行為問題之發生，但其影響機制現仍大多著重於父母養育行為。根據睡眠生態系統理論和雙歷程假說，親職壓力會透過兒童睡眠影響其行為發展，故推測兒童睡眠問題應是兩者關係的中介因子。同時，兒童睡眠問題中介作用亦可能受到先天性心臟病之調節。
目的：分析親職壓力對於兒童內外化行為問題之影響，並探討兒童睡眠問題於親職壓力與內外化行為問題之中介作用，進一步了解兒童睡眠問題中介作用是否受到先天性心臟病調節。
方法：採次級資料庫分析，源自「臺灣先天性心臟病童父母親職壓力以及兒童發展問題之探討」計畫的第一年資料。研究樣本自民國106至107年的臺大兒醫小兒心臟科招募，年齡 1.5至5歲的兒童和其父母。共納入420名兒童（337名先天性心臟病病童；83名健康兒童）。以兒童行為檢核表和親職壓力量表測量主要變項：親職壓力、兒童睡眠問題、兒童內化及外化行為問題。使用SAS 9.4統計軟體的PROCESS模組分析中介作用與調節式中介作用。
結果：兒童睡眠問題於親職壓力對兒童內外化行為問題的中介作用顯著（內化行為問題：間接效果值=0.02, 95% CI= [0.01, 0.03]；外化行為問題：間接效果值0.02, 95% CI= [0.01, 0.03]），即表示當父母親職壓力越高，兒童的睡眠問題會越多，進而導致其產生內外化行為問題的可能性增加。但兒童的先天性心臟病罹病狀態無法調節此中介作用（內化行為問題：調節式中介作用指標= –0.02, 95% CI= [–1.41, 0.02]；外化行為問題：調節式中介作用指標= –0.02, 95% CI= [–1.60, 0.02]），即親職壓力透過兒童睡眠問題影響其內外化行為問題的中介作用強度不會因有無先天性心臟病而有所差異。
結論：兒童睡眠問題為父母親職壓力影響兒童內外化行為問題關係的中介因子。藉本研究結果，建議未來可發展親職壓力調適之相關計畫或課程，以促進兒童睡眠健康及行為發展。

關鍵字

親職壓力 ； 內化行為問題 ； 外化行為問題 ； 睡眠問題 ； 先天性心臟病 ； 調節式中介作用

並列摘要

Background: “Parenting” is one of the most challenge phases of the family life cycle. Parenting stress not only affects parents’ mental health but also leads to poor behavioral outcomes of the child. Many studies have indicated that parenting stress may predict the probability of internalizing and externalizing problems among children. However, the mechanisms through which parenting stress leads to internalizing and externalizing problems remain understudied. According to the ecological model of sleep and the two process model of sleep regulation, parenting stress may affect the behavioral development of the child via child sleep. In addition, the mediation of sleep may differ according to the disease condition of the child (e.g., congenital heart disease).
Aims: To investigate the association of parenting stress with internalizing and externalizing problems in children, assess whether child sleep problems mediate this association, and examine whether congenital heart disease moderates this mediation.
Methods: A secondary data analysis was conducted from the baseline data of “Parenting Stress and Developmental Problems in Children with Congenital Heart Disease” project. The study sample included 420 children (337 with congenital heart disease and 83 healthy children) in Taiwan. Participants were recruited by referral from pediatric physicians in the National Taiwan University Hospital from 2017 to 2018. The Child Behavior Checklist were used to assess children’s internalizing problems, externalizing problems, and sleep problems. The Parenting Stress Index-Short Form was used to assess parenting stress of the parents. A series of multiple regression models was conducted using the SAS 9.4 PROCESS procedure to test the mediating role of child sleep problems and the moderating role of congenital heart disease in the mediation process.
Results: Child sleep problems mediated the association between parenting stress and internalizing problems (indirect effect = 0.02, 95% CI= [0.01, 0.03]) and between parenting stress and externalizing problems (indirect effect = 0.02, 95% CI= [0.01, 0.03]). However, these mediations were not moderated by congenital heart disease (index of internalizing problems= –0.02, 95% CI of internalizing problems= [–1.41, 0.02], index of externalizing problems= –0.02, 95% CI of externalizing problems=
[–1.60, 0.02]). Specifically, we found that regardless of the disease condition of the child, higher parenting stress was associated with more sleep problems in children, which in turn, lead to more internalizing and externalizing problems.
Conclusion: The association between parenting stress and child’s behavioral problems may in part due to sleep problems of the child. Interventions to decrease behavioral problems of children resulted from parenting stress may be more effective by targeting sleep problems.

並列關鍵字

Parenting stress ； Internalizing problems ； Externalizing problems ； Sleep problems ； Congenital heart disease ； Moderated mediation

參考文獻

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