嬰兒父親憂鬱狀況及相關因素、預測因素之探討

A study on paternal postpartum depression: its status, related variables and predictive variables

張瑜芳(Yu-Fang Chang)

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(2017年)

摘要

男性於配偶產後期間的身心狀況較為社會與醫療界所忽略，但目前已有研究發現男性於配偶產後期間也會呈現憂鬱情形。本研究以嬰兒父親為對象，旨在探討嬰兒父親之情緒、父嬰連結與配偶關係之狀況；其次為探索不同人口變項、孕產變項與身心狀況者於情緒、父嬰連結與配偶關係之差異；其三為了解父親憂鬱的相關變項，其四為母嬰連結、母親情緒和父嬰連結、父親焦慮對父親憂鬱之預測力，以及配偶關係於此預測路徑的中介角色。本研究以方便取樣方式收集資料，除嬰兒父親外，亦同時收集嬰兒母親之資料，以採取成對方式進行資料分析。研究工具包括貝克憂鬱量表、愛丁堡產後憂鬱量表、狀態特質焦慮量表、母嬰連結量表、配偶適應量表，有效問卷共382份（191對嬰兒父親及母親），分析方式包含描述統計、卡方檢定、差異檢定、單因子變異數分析、相關分析與多元迴歸分析。研究結果如下：
一、 嬰兒父親之情緒、父嬰連結與配偶關係狀況
憂鬱方面，於愛丁堡憂鬱量表呈憂鬱狀態者佔22.0％，於貝克憂鬱量表呈現憂鬱狀態者佔10.5％；焦慮方面，高度狀態焦慮者有21.5％，高度特質焦慮者之父親有22％；配偶關係不佳者有2.6％；父嬰連結不佳者則有9.4％。
二、 不同人口變項、孕產變項與身心狀況之嬰兒父親的情緒、父嬰連結與配偶關係之差異
（一）憂鬱：
1.愛丁堡產後憂鬱量表顯示現在�過去有憂鬱症，現在身體狀況不佳、有躁鬱症、焦慮症者，其憂鬱程度較高；懷孕意向為「計畫懷孕」者，憂鬱程度高於持「順其自然」態度者。
2.貝克憂鬱量表顯示月收入「25000元以下」的父親，憂鬱程度高於月收入「25001-50000元」者；現在�過去身體狀況不佳、有憂鬱症者，憂鬱程度較高；懷孕意向為「非計畫懷孕」者，憂鬱程度高於持「順其自然」態度者。
（二）焦慮：
1.狀態焦慮部分，現在�過去身體狀況不佳、有憂鬱症，現在有躁鬱症、焦慮症者，其狀態焦慮較高。
2.特質焦慮部分，月收入「25001-50000元」者，特質焦慮高於月收入「50001-75000元」者；現在�過去身體狀況不佳，現在有憂鬱症、躁鬱症、焦慮症者，其特質焦慮較高。
（三）父嬰連結：現在沒有躁鬱症者，父嬰連結較佳；配偶生產時妊娠週數小於37週者，父嬰連結比配偶生產時妊娠週數為37-39週者佳；懷孕意向為「順其自然」者，父嬰連結優於持「非計畫懷孕」、「計畫懷孕」態度者。
（四）配偶關係：現在身體狀況非不佳、沒有躁鬱症者，配偶關係較好；懷孕意向為「順其自然」者，配偶關係優於持「非計畫懷孕」態度者。
三、 嬰兒父親憂鬱之相關變項
在人口變項上，憂鬱父親較非憂鬱父親更為年輕；身心狀況部分，憂鬱父親現在有憂鬱症、躁鬱症、焦慮症以及過去身體狀況不佳之比例高於非憂鬱父親；孕產變項部分，憂鬱與非憂鬱父親皆無差異；父嬰連結、配偶關係部分，憂鬱父親之關係品質低於非憂鬱父親，且憂鬱父親出現負向親職行為的比例高於非憂鬱父親，焦慮程度也高於非憂鬱父親。
四、 父母親變項對嬰兒父親憂鬱之預測以及配偶關係之中介角色
除了母嬰連結之外，母親憂鬱、母親焦慮與父親焦慮對父親憂鬱皆具有正向預測力，配偶關係、父嬰連結對父親憂鬱具有負向預測力。
母親、父親觀點之配偶關係，於母親憂鬱、母親焦慮預測父親憂鬱之路徑具有完全中介之角色；父親觀點之配偶關係，於父嬰連結預測父親憂鬱之路徑具有完全中介之角色，於父親焦慮預測父親憂鬱之路徑則具有部分中介之角色。
綜合上述，本研究發現嬰兒父親出現憂鬱現象者約為一至兩成。相較於非憂鬱父親，憂鬱父親出現負向親職行為的比例較高，與嬰兒、嬰兒母親之關係較差，焦慮程度也更高。嬰兒父親憂鬱的相關變項，包括現在與過去的身心健康狀況、懷孕意向、收入及年齡。此外，母親的憂鬱與焦慮會透過配偶關係影響父親憂鬱，而父嬰連結、父親焦慮會透過父親對配偶關係的觀點而影響父親憂鬱。顯示父親憂鬱會受母親情緒、父嬰連結、父親焦慮影響，且配偶關係在其間扮演著重要的角色，因此，在預防或改善嬰兒父親之憂鬱時，應由母親情緒、父嬰連結、父親焦慮及配偶關係等面向著手。

關鍵字

中介變項 ； 父親憂鬱 ； 父親焦慮 ； 母親憂鬱 ； 母親焦慮 ； 親嬰連結 ； 配偶關係

並列摘要

The mental health of fathers is often overlooked during the postpartum period, however, researchers found that some fathers were also depressed during this period. The first aim of this study is to explore the status of depression, anxiety, bonding, and dyadic interaction in infant's father. The second aim is to find the differences of the above variables regarding to the demographic, physical, mental health, and perinatal status. The third aim is to investigate the related factors of paternal depression. The fourth aim is whether paternal depression could be predicted by bonding, mother’s emotion and father's anxiety. Finally, whether dyadic interaction was a mediator between paternal depression and the other variables. A total of 191 postnatal Taiwanese dyads participated in this study. Five questionnaires were employed, including the Beck Depression Inventory-Second Edition (BDI-II), Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory, Mother-Infant Bonding Scale, and Dyadic Adjustment Scale. Data were analyzed using the SPSS 20.0 for descriptive statists, chi-square test, t-tests, one way ANOVA, Pearson's correlation, and multiple regression analysis. The following results were obtained:
A. Twenty-two percent of participants were classified as depressed group by EPDS, and 10.5% in BDI-II. There were 21.5% of fathers had high state anxiety and 22% had high trait anxiety. There were 2.6% of fathers were in poor relationships with their wives and 9.4% in low bonding with their infants.
B. The differences in depression, anxiety, bonding, and dyadic interaction regarding to demographic, physical, mental health, and perinatal status were:
a) Depression
1.EPDS: Fathers who were diagnosed as depression now or before, who were in poor physical condition, who were diagnosed as bipolar/anxiety disorder, and who “pregnant with plan” were more depressed than other fathers.
2.BDI-II: Fathers who got income less than 25000 NTD, who had poor physical condition, who were diagnosed as depression now or before, and who “pregnant not in plan” were more depressed than other fathers and fathers who had income between 25001-50000 NTD and who "pregnant then accept".
b) Anxiety
1.State anxiety: Fathers who had poor physical condition now or before, who were diagnosed as depressive disorder now or before, who were diagnosed as bipolar or anxiety disorder experienced higher state anxiety than the other fathers.
2.Trait anxiety: Fathers who got income between 25001-50000 NTD, who were in poor physical condition now or before, and who were diagnosed as depressive/bipolar/anxiety disorder had higher trait anxiety than the others and who had income between 50001-75000 NTD.
c) Paternal-infant bonding
When fathers were not diagnosed as bipolar disorder, when their spouses’ gestation period less than 37-39 weeks, and when they “pregnant then accept”, they had better paternal-infant bonding than the other fathers.
d) Dyadic interaction
Fathers who were not in poor physical condition, who were not diagnosed as bipolar disorder, and who "pregnant then accept" had better dyadic interaction than the other fathers.
C. In terms of the related factors of paternal depression, depressed fathers were younger, had poorer dyadic interaction and bonding, had higher rate in mental disorders and existing physical problem, more anxious, and displayed more negative parenting behaviors.
D. In terms of the predictive power of parental variables, mediating effects of dyadic interaction on parental variables and paternal depression, all variables could predict paternal depression except the mother-infant bonding variable. Maternal anxiety, maternal depression, and paternal anxiety could positively predict paternal depression; dyadic interaction and paternal-infant bonding could negatively predict paternal depression. In maternal variables, both parents’ perception of dyadic interaction could completely mediate the relationship between mother’s emotion and paternal depression; in paternal variables, father’s view of dyadic interaction could completely mediate the relationship between paternal-infant bonding and paternal depression; furthermore, father’s view of dyadic interaction could partially mediate the relationships between paternal anxiety and paternal depression.
In summary, 10.5-22% of infants' fathers were classified as depressed in this study. Depressed fathers had poorer relationships with their infants, wives and were more anxious than their non-depressed counterparts; moreover, they also demonstrated more negative parenting behaviors. The related variables of paternal depression were the current and past physical and mental health, the intention of pregnancy, income and age. Additionally, we found that mother’s negative mood affected paternal depression through both parents’ view of the dyadic interaction, whereas paternal-infant bonding and paternal anxiety affected paternal depression through the father’s view of dyadic interaction.
These results suggest that paternal depression were influenced by the emotion of spouses, father-infant bonding and paternal anxiety. Dyadic interaction plays a crucial role between those variables and paternal depression. On the prevention or intervention of paternal depression, we should focus on the emotion of spouses, father-infant bonding, paternal anxiety and dyadic interaction.

並列關鍵字

mediator ； dyadic interaction ； anxiety ； depression ； parent-infant bonding ； parenting behaviors

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