產後憂鬱對整個家庭發展具有不容忽視之影響,研究發現產後調適與產後憂鬱可能有關,因此本研究目的在探討北台灣地區初產婦產後九週內適應與憂鬱之相關。 本研究屬橫斷式描述相關性之研究設計。以方便取樣方式,於北部地區兩家醫院與兩家衛生所,並刊登招募廣告於孕產相關網站招募個案。問卷以郵寄方式請產婦於產後一週至九週內填答,共計取得可分析問卷186份。研究工具包括:社會人口學量表、產後適應與愛丁堡產後憂鬱量表。 結果發現:(1)產後憂鬱比率約50.5%,而有39.2 %個案達到需就醫診治的標準。(2)產後適應七個次量表評估結果,分別與產後憂鬱呈低度至中度相關。(3)若要預測產後憂鬱,「產婦有信心能處理母職工作」是最重要的因子,可解釋產後憂鬱總變異量之31%,其次為「產婦滿足生活環境」,最後為「產婦感覺配偶參與嬰兒照顧」,此3項產後適應次量表共可以解釋產後憂鬱總變異量之43.4%。(4)非計劃中生育、家中經濟狀況不足、沒有固定工作、年齡較輕與家庭型態為大家庭之初產婦,是產後適應與憂鬱高危險群。(5)約84.2%初產婦女願意接受產後心理追蹤諮詢服務。 根據本研究討論與結果提出下列建議:(1)產後適應度越差者,則其產後憂鬱情緒越高。因此產後適應狀況,應納入產後照護評估重點。(2)臨床醫護工作者,應該重視高之產後憂鬱比例問題,提供必要產後心理狀況追蹤、篩檢及介入協助。(3)提升產婦處理母職工作能力與信心,是有效改善產後憂鬱的方法。(4)相較於歐美國家,台灣初產婦有三項產後適應狀況較差,此三項分別為處理母職工作的信心、對母職與嬰兒照護的滿意和母職角色支持來自朋友、父母與其他家庭成員。因此本研究建議,對於台灣地區初產婦,可由周產期照護的政策面及護理人員的臨床能力提升來加強對於此三項議題的關注。(5)對於初產婦女中,經濟狀況較不足、產婦無固定工作、家庭型態為大家庭、非計劃性生育與年齡較輕之產後適應與憂鬱之高危險群,建議提供適當的協助。(6)本研究結果發現多數產後婦女,願意接受產後心理追蹤諮詢服務。因此建議社區衛生護理人員,可將產後適應評估量表,列入產後追蹤的項目之一,以改善目前產後照護模式之照護品質。
The purpose of this cross-sectional study was to explore the relationships between postpartum adaptation and postpartum depression among first time mothers who lived in northern Taiwan. A total of 186 first time mothers, recruited via convenience sampling methods, completed mailed questionnaires between 1 week and 2 months after giving birth. Structured questionnaires including Demographic Inventory Scale, the Postpartum Self-Evaluation Questionnaire, and the Edinburgh Postnatal Depression Scale were used. The results showed: (1) 94 (50.5%) women exhibited depressive symptoms (EPDS > 10) and 73 (39.2%) women need to seek for professional help (2) The correlation between women’s different aspects of postpartum adaptation and postpartum depression ranged from low to medium; (3) The best subsets for predicting postpartum depression were as follows: confidence in their own competence of motherhood tasks (31% of total variation), satisfaction with life circumstances, and perception of partner’s participation in child care. These three subsets explained 43.4% of total variation; (4) Women with unplanned births, low socioeconomic status, part-time employment, younger of age, and living with extended family members are at high-risk for postpartum adaptation and postpartum depression. In addotion, approximately 154 (84.2%) primiparas are willing to accept the follow-up psychology counseling. Results of this study suggest that health care providers who worked with first time mothers during the first two months after giving birth should pay much attention to the following areas: (1)conducting screening assessment and referral services on postpartum depression, (2) advocating on helping first time mothers to built confidence on motherhood tasks such as infant care (3) involving fathers in the baby care and (4) improving family and friends’ support for maternal role