妊娠高血糖婦女周產期間社會支持、壓力與憂鬱之重複測量研究

研究背景：妊娠高血糖婦女比較一般婦女需要承受更大的身、心、社會改變，然而有關妊娠高血糖婦女的周產期心理和社會健康之探討少見，而且橫斷性的研究設計與缺乏高級統計的資料分析，無法呈現妊娠高血糖婦女在整個周產期間心理和社會的狀態與變化的全貌。研究目的：本研究旨在探討妊娠高血糖婦女從懷孕到產後1年期間其社會支持、壓力感受與憂鬱的變化與關係。研究方法：在台灣南部一所醫學中心進行收案，以葡萄糖挑戰試驗呈陽性之妊娠高血糖婦女為研究對象，共計99人參與本研究。採用重複性研究設計，妊娠高血糖婦女在懷孕24-28週、產後1週內、4-6週、6個月以及產後1年，以社會支持量表、壓力感受量表與臺灣人憂鬱量表收集資料。使用SPSS 統計套裝軟體17.0視窗版，以混合模式分析妊娠高血糖婦女周產期間社會支持、壓力感受與憂鬱情緒之變化趨勢與彼此間的關係。研究結果：妊娠高血糖婦女的社會支持程度，除了在產後6個月比較孕期低之外，其他時段並沒有顯著改變；而壓力感受在產後1週比較孕期低，其餘時段在周產期間沒有顯著的變化；妊娠高血糖婦女在憂鬱情緒方面，除了產後4-6週相較於孕期並沒有顯著的改變之外，其他產後時段的憂鬱情形有逐漸顯著降低。本研究也發現周產期憂鬱情緒變化的重要預測因子為壓力感受變化與工作狀態；相較於家庭主婦，妊娠高血糖婦女為全職工作者，周產期間憂鬱情緒下降的程度較小；妊娠高血糖婦女周產期間壓力感受增加者，則其憂鬱情緒下降程度愈少。結論：本研究結果發現妊娠高血糖婦女周產期間的社會支持與壓力感受和憂鬱情緒有關。醫護人員應該注意及評估這群妊娠高血糖婦女周產期間的壓力與憂鬱狀態，必要時，提供她們所需要的相關護理措施與轉介，以促進其心理社會安適。

關鍵字

妊娠高血糖婦女；周產期；社會支持；壓力；憂鬱

並列摘要

Background: The perinatal period is a transitional stage for childbearing women, particularly for those hyperglycemia women because they face more dramatically physiological and psychosocial changes during the periods. Few studies were found regarding the psychosocial health status of hyperglycemia women. Moreover, a study with cross-sectional design and lack of data analysis with advanced statistics the whole picture about the patterns and changes of those women’s psychosocial status during the perinatal period were limited. Purpose: The purpose of this study was to examine changes and relationships between levels of social support, perceived stress, and depression of hyperglycemia women during their perinatal period. Method: A total of 99 participants with a positive test of 50g glucose challenge screening were recruited in a medical center in southern Taiwan. A repeated study was conducted at 5 points of time including the 24-28weeks of pregnancy for the hyperglycemia women, and 1week, 4-6 weeks, 6 months, and 1 year after their childbirths. The Social Support Scale, the Perceived Stress Scale, and the Taiwanese Depression Questionnaire were used to assess the psychosocial status of the hyperglycemia women. Data was analyzed using the Mixed Model with SPSS version 17 for Windows. Result: The significant changes of support and stress occurred at 6 months and at 1 week after childbirth, respectively. Moreover, their levels of depression decreased significantly over time, from the pregnancy to 1 week, to 6 months, and to 1 year after childbirth. This study also found that the hyperglycemia women’s employment status and stress level were predictors of the hyperglycemia women’s depression. Compared with housewives’ changes of depression, full-time employed women’s depression decreased less during the perinatal period. Hyperglycemia women who perceived a higher increase in stress levels reduced less depression. Conclusion: These results provide strong evidence that hyperglycemia women’s social support and stress are associated with depression during the perinatal period. Health care providers should pay attention to those hyperglycemia women and assess their levels of stress and depression. If they are in a status of psychosocial risk, nursing intervention and referral are needed in order to promote the hyperglycemia women’s psychological well-being.