母嬰關係、產後憂鬱與孕產期心理社會狀態之相關研究

The associations among mother-infant relationship, postpartum depression and perinatal psychosocial status

王韻婷(Yun-Ting Wang)

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系/碩士(2019年)

https://doi.org/10.6834/CSMU201900018

摘要

本研究旨在探討產後連結問卷（Postpartum Bonding Questionnaire, PBQ）（Brockington, Fraser, & Wilson et al., 2006）運用於台灣婦女之效度，及瞭解台灣孕產期婦女之心理社會狀況與產後憂鬱之間的關聯。研究對象為36位產後婦女，自台灣中部地區三間醫療院所之婦產科招募，共進行兩次資料收集，第一次於產後兩個月內，第二次則於產後兩個月至產後八個月，兩次皆使用產後連結問卷與愛丁堡產後憂鬱量表（Edinburgh Postnatal Depression Scale, EPDS）（Cox, Holden, & Sagovsky, 1987），第二次以伯明罕母性心理衛生訪談第五版（5th Edition of Birmingham Interview for Maternal Mental Health, BIMMH 5th）（Brockington, Fraser, & Wilson et al., 2006）收集孕產期心理社會因素之資料。以描述性統計、相依樣本t檢定、ROC曲線及費雪精確檢定進行資料分析。
研究結果發現以BIMMH第五版訪談結果判斷母嬰關係類型時，研究對象中母嬰連結正常者為28位（77%），母嬰連結異常者8位（22%）。母嬰連結異常者中，連結受損者有2位（5%），照顧焦慮者有2位（5%），病態性憤怒有6位（15%），潛在拒絕有1位（2%），其中3位合併有兩種異常。若以PBQ量表總分26分為「母嬰連結異常」之閾值，以BIMMH第五版為黃金標準，則PBQ之敏感性與特異性各為73%與89%。若以「因素一 ≥ 12且因素二 < 13」做為「連結受損」之閾值，敏感性與特異性各為50%與80%。若以「因素三 ≥ 10」做為「照顧焦慮」之閾值，敏感性與特異性各為67%與97%。
本研究結果發現與產後憂鬱有關的孕產期心理社會因素包括：懷孕計畫、對懷孕的反應、第二孕期適應狀況、第三孕期適應狀況、對懷孕外觀的情緒、孕期階段家人與網絡支持度、產前憂鬱、產後早期心情低落、產後夫家關係、對寶寶的情感投入、粗暴對待寶寶以及不適當搖晃寶寶。
最後，本研究結果發現各類型母嬰關係的母親在PBQ得分之平均數與其他研究有差異，無法排除受樣本組成與樣本數之影響，未來研究可擴大樣本數及以其他族群為對象建立適合台灣樣本之PBQ閾值。此外，本研究發現在第二孕期有負向適應狀況的婦女，出現產後憂鬱的情形是沒有負向適應狀況婦女的20.8倍，故建議應於懷孕初期即追蹤準媽媽的憂鬱情形，及早介入以預防憂鬱情形之持續或加重。

關鍵字

孕產期適應 ； 母嬰連結 ； 母嬰關係 ； 產後連結問卷 ； 產後憂鬱

並列摘要

The aim of this study was to examine the validity of the Postpartum Bonding Questionnaire (PBQ, Brockington, Fraser, & Wilson et al., 2006) among Taiwanese women. The associations among perinatal psychosocial status and postpartum depression were also investigated. Thirty-six participants were recruited from three Gynecology and Obstetrics clinics on middle Taiwan. All participants assessed on two time period, the first time was within two months postpartum and the second between two months to eight months postpartum. The instruments were Chinese version of Edinburgh Postnatal Depression Scale (EPDS, Cox, Holden, & Sagovsky, 1987) and PBQ. The 5th Edition of the Birmingham Interview for Maternal Mental Health (BIMMH 5th, Brockington, Fraser, & Wilson et al., 2006), a semi-structured interview, was only used on the second time. The descriptive statistics, paired-sample t test, receiver operating characteristic curve, and Fisher’s exact test were conducted.
According to BIMMH 5th, twenty-eight mothers (77%) with normal mother-infant relationship, eight mothers (22%) with mother-infant relationship disorders were noted. Among the eight mothers, there were two with mild impairment (5%), two with infant-focused anxiety (5%), six with pathological anger (15%) and one with threatened rejection (2%). Using score 26 as cutoff point, the sensitivity and the specificity of PBQ were 73% and 89% respectively. Using PBQ "factor 1 ≥ 12 and factor 2 < 13" as cutoff point for "mild impairment", the sensitivity and the specificity were 50% and 80% respectively. Using PBQ "factor 3 ≥ 10" as cutoff point for "infant-focused anxiety", the sensitivity and the specificity were 67% and 97% respectively.
The results indicated that the perinatal psychosocial factors associated with postpartum depression were pregnancy planning, response to pregnancy, adjustment on the second trimester, adjustment on the third trimester, emotions about the appearance of pregnancy, family and social support during pregnancy, prenatal depression, postpartum blue, postpartum relationship with husband's family, emotional involvement with the baby, roughly treat the baby and shaking the baby inappropriately.
Finally, the mean scores of PBQ on various types of mother-infant relationships were different from previous studies. The sample composition and the small sample size of the current study might be accounted for the difference. Further studies with larger sample size are needed to determine the appropriate PBQ cutoff point. Based on women who experienced poor adjustment on the second trimester got much higher chance of postpartum depression, it is crucial to assess depression symptom on pregnancy. Continued monitoring for postpartum depression are important as well.

並列關鍵字

Postpartum Bonding Questionnaire ； postpartum depression ； pregnancy adjustment ； mother-infant bonding ； mother-infant relationship

參考文獻

參考文獻

壹、中文部份

內政部統計處（2018）。取自106年內政部統計年報電子書。2018年12月3日取自：https://www.moi.gov.tw/files/site_node_file/7783/106%E5%B9%B4%

E5%85%A7%E6%94%BF%E7%B5%B1%E8%A8%88%E5%B9%B4%E5%A0%B1%E9%9B%BB%E5%AD%90%E6%9B%B8.pdf

白宗平、邵馨慧、蘇軒、陳智長、黃麗卿（2017）。產後婦女的家庭型態與產後照顧及憂鬱症的相關性。台灣家庭醫學雜誌，27(3)，154-163。doi:10.3966/168232812017092703003