母親的原生依附、產後憂鬱與母嬰連結之相關研究

Relationships among parental attachment, postpartum depression and the mother-infant bonding

蔡宗延(Tsung-Yen Tsai)

指導教授 ： 謝珮玲

中山醫學大學/醫學科技學院/心理學系暨臨床心理學碩士班/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00023

摘要

本研究探討母嬰連結、產後憂鬱、原生依附的展現情形、相關變項，以及三者之間的關係，並探討原生依附與產後憂鬱以何種方式對母嬰連結產生影響。研究對象為260名產後兩週至七個月的成年婦女，研究工具為產後連結問卷（Postpartum Bonding Questionnaire）、愛丁堡產後憂鬱量表（Edinburgh Postnatal Depression Scale）、雙親教養態度量表（Parental Bonding Instrument）。以描述統計、相關、t檢定、變異數分析及結構方程模式進行資料分析。研究結果為：（一）母嬰連結輕度異常者為27.7%，潛在拒絕者為1.5%。與母嬰連結不佳有關的因子，包括對夫妻關係滿意度低、懷孕未滿37週生產、孕期憂鬱、寶寶性別不如預期，以及完全交由他人帶寶寶就醫等。（二）產後憂鬱者為26.2%（EPDS ≥ 13）。與產後憂鬱有關的因子，包括對夫妻關係滿意度低、懷孕未滿37週生產、孕期憂鬱、孕期焦慮、過去有憂鬱症病史，以及年紀輕等。（三）原生父親為理想教養、疏忽教養、無情控制、情感束縛的教養類型之比例分別為32.7%、21.5%、32.7%及13.1%；原生母親為理想教養、疏忽教養、無情控制、情感束縛的教養類型之比例分別為35.4%、21.2%、35.4%及8.1%。原生依附經驗中，關懷或過度保護因素在原生父母之間呈現高度相關。（四）母嬰連結與產後憂鬱有高度相關性（r = .47）；原生依附與產後憂鬱、原生依附與母嬰連結之間有中低度相關性（依序為r = .16 ~ .21、r = .15 ~ .21）。（五）原生依附經驗會透過產後憂鬱間接影響到母嬰連結，亦即產後憂鬱在原生依附與母嬰連結的關係中扮演中介變項的角色。（六）原生依附與產後憂鬱之交互作用對母嬰連結沒有影響，亦即產後憂鬱在原生依附與母嬰連結的關係中未扮演調節變項的角色，以及原生依附在產後憂鬱與母嬰連結的關係中亦未扮演調節變項的角色。由於產後連結問卷乃在國內首次運用，建議未來研究應探討其效標關聯效度。在臨床應用上，母親的原生依附經驗除了直接影響母嬰連結，也會透過產後憂鬱間接影響到母嬰連結，因此，原生依附、產後憂鬱均是影響母嬰連結的重要因素。實務工作者可透過與母親討論原生依附經驗或改善產後憂鬱等方式，來促進母親對嬰兒的正向連結。

關鍵字

中介變項 ； 母嬰連結 ； 原生依附 ； 產後憂鬱 ； 結構方程模式 ； 調節變項

並列摘要

The purpose of this study was to investigate the mother-infant bonding, postpartum depression, parental attachment, their related variables, and the correlations between them. How did parental attachment and postpartum depression influence mother-infant bonding was also addressed.　Two hundred and sixty adult women at their 2 weeks to 7 months postpartum were included. The Postpartum Bonding Questionnaire (PBQ), Edinburgh Postnatal Depression Scale (EPDS) and Parental Bonding Instrument (PBI) were administered to each participant. Descriptive analysis, correlations, t test, ANOVA, and structural equation modeling were applied in the data analysis. The results showed that: (1) 27.7% of the mothers reported mild bonding disturbances and 1.5% threatened rejection of their infants. Mothers with mother-infant difficulties had lower levels of marital satisfactions, given birth at less than 37 weeks of gestational ages, prenatal depression, disappointed with the gender of their babies, or dependency on others to take their babies to hospitals. (2) 26.2% of the mothers reported depression symptoms above cut-off points (EPDS ≥ 13). Mothers with depression symptoms had lower levels of marital satisfactions, given birth at less than 37 weeks of gestational ages, prenatal depression, prenatal anxiety, history of previous depression, or were younger in ages.　(3) The percentages of optimal parenting, neglectful parenting, affectionless control and affectionate constraint of participants’ fathers were 32.7%, 21.5%, 32.7%, 13.1%, respectively, and participants’ mothers were 35.4%, 21.2%, 35.4%, 8.1%, respectively. Within the mothers’ parental attachment experiences, the caring or overprotection sub-scale score was strongly correlated in between parents. (4) A strong correlation between mother-infant bonding and postpartum depression was found (r = .47). Correlations between parental attachment and postpartum depression, parental attachment and mother-infant bonding were mild to moderate (r = .16 ~ .21, r = .15 ~ .21, respectively). (5) Postpartum depression mediated the relationship between parental attachment and mother-infant bonding. (6) Not only postpartum depression did not moderate the relationship between parental attachment and mother-infant bonding, but also parental attachment did not moderate the relationship between postpartum depression and mother-infant bonding. Since this was the first application of PBQ in Taiwan, the author suggested that the exploration of its criterion-related validity is needed. Based on the result, mothers’ parental attachment experiences were associated with mother-infant bonding, and these relationships were mediated by postpartum depression. The author suggested that clinician may either discuss about parental attachment experiences or postpartum depression to facilitate better mother-infant bonding.

並列關鍵字

mediator variable ； moderator variable ； mother-infant bonding ； parental attachment ； postpartum depression ； structural equation modeling ； SEM

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