產後婦女社會支持、憂鬱與健康相關生活品質:一項重複測量研究設計

Postpartum Women’s Social Support, Depression, and Health-related Quality of Life: A Repeated-Measure Study Design

李麗君(Li-Chun Lee)

指導教授 ： 洪志秀

高雄醫學大學/護理學院/護理學系博士班/博士(2018年)

摘要

研究背景：產後期婦女處在一個變動、多重壓力的適應階段。過去的研究顯示婦女的社會支持為憂鬱的預測因子，社會支持和憂鬱對於產後婦女的健康相關生活品質的影響尚未有定論。而且多數為橫斷式研究，並未探討產後婦女的憂鬱和健康相關生活品質變化與其影響因素。
研究目的：因此本研究目的在於探討(一)產後第一、三與六個月婦女的社會支持、憂鬱及健康相關生活品質的趨勢變化；(二)產後婦女憂鬱影響因素及憂鬱變化的影響因素；(三)產後婦女健康相關生活品質及其變化的影響因素。
研究方法：採用單組重複測量之縱貫性研究設計，於台灣南部某區域醫院，以立意取樣婦女在產後第一、三、六個月進行面對面方式的結構式問卷調查。共有282位產婦參與本研究，271人完成資料追蹤，流失率為4.26%。研究工具包括基本屬性問卷、社會支持量表（Social Support Scale, SSS）、愛丁堡産後憂鬱量表（Edinburgh Postnatal Depression scale, EDPS）與簡明版世界衛生組織生活品質量表（World Health Organization Quality of Life- Bref, WHOQoL-Bref）。採用軌跡分析與廣義估計方程式以分析婦女產後六個月期間社會支持、憂鬱與健康相關生活品質的變化趨勢，以及影響憂鬱、健康相關生活品質的因子。
研究結果: 婦女產後第三與第六個月的社會支持相較於產後第一個月顯著減少；婦女產後第三和第六個月的憂鬱風險比產後第一個月分別增加1.88倍（95％CI = 0.25,1.01）和 1.53倍（95％CI = 0.03,0.82）；產後憂鬱的預測因子為婦女所處的家庭型態與所感受到的社會支持；產婦的年齡、移民婦女以及社會支持的改變量可以預測婦女產後憂鬱變嚴重機率。婦女在產後六個月期間健康相關生活品質並無顯著差異；產後婦女健康相關生活品質的預測因子包括移民婦女、職業、家庭型態、社會支持以及憂鬱；社會支持的改變量可預測婦女產後健康相關生活品質改變量；產後憂鬱變嚴重者比產後憂鬱未改變或改善者，健康相關生活品質增加量顯著減少。　
結論:本研究發現產後社會支持、憂鬱和健康相關生活品質的變化與其影響因素。護理人員應重視產後婦女社會支持與憂鬱的評估，針對欠缺社會支持或產後憂鬱的高危險婦女，宜及早提供支持照護，以降低婦女憂鬱發生率並促進產後婦女健康相關生活品質。未來可以探討台灣週產期的照護文化、婦女職業與家庭型態對產後婦女社會支持、憂鬱、健康相關生活品質的影響。

關鍵字

社會支持 ； 憂鬱 ； 健康相關生活品質 ； 產後期變化

並列摘要

Background: Women experienced dynamically and stressfully adaptive process during the postpartum period. Previous studies demonstrated that women's social support was a predictor of depression. However, the impact of social support and depression on postpartum women’s health-related quality of life had not been determined. Moreover, most studies were cross-sectional design and studies on the evolution of depression, changes of health-related quality of life, and it’s influencing factors for postpartum women were not found.
Aim: Thus, the aims of this study were to explore (a) the trend of social support, depression, and health related quality of life for women at the 1st, 3rd and 6th month postpartum period; (b)influencing factors of postpartum women’s depression and the variation in depression; (c) influencing factors for the level and variation of postpartum women’s health-related quality of life.
Methods: With a single group and repeated measure study design. A total of 282 participants were recruited from a regional hospital in southern Taiwan. Data were collected with structured questionnaires including the demographic questionnaire, the Social Support Scale , Edinburgh Postnatal Depression scale and the World Health Organization Quality of Life- Bref at women’s 1st, 3rd, and 6th month postpartum period. There were 271 participants completed the questionnaires for the three points of time. The attrition rate was 4.26%. Data were analyzed by trajectories analyses and generalized estimating equation for the trends and influencing factors among women’s social support, depression and health-related quality of life during the six months postpartum period.
Results: Women's social support decreased significantly at the 3rd and 6th months postpartum compared to the 1st month postpartum. Women's depression increased, 1.88 (95% CI=0.25,1.01) and 1.53 times (95% CI=0.03,0.82) respectively, at the 3rd and 6th month postpartum compared to 1st month postpartum. Predictors of postpartum depression were the family type and social support. Women’s age, immigrant women, and the change level of social support predict the risk of women’s depression being worse. Women's health-related quality of life did not differ significantly during the six months postpartum period. The predictors of women’s health-related quality of life were immigrant women, occupation, family type, social support, and depression. The change levels of social support predict the change levels of health-related quality of life. Postpartum women, whose depression became worse, had significantly lower increment of health-related quality of life than those women whose depression were unchanged or improved.
Conclusions: This study showed the variability and influencing factors of postpartum women’s social support, depression, and health-related quality of life. Health care providers should pay more attention to postpartum women's levels of social support and depression. For women who lacked social support or had high risk of postpartum depression, supportive care should be provided as early as possible to reduce the risk of women's depression and to enhance their health-related quality of life. Future study may explore the impact of Taiwan's perinatal culture, women's occupation, and family type on their social support, depression, and health-related quality of life.

並列關鍵字

Social Support ； Depression ； Health-related Quality of Life ； Postpartum period variation

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