子女罹癌之母親的成人依附、親子親密情感及親職壓力之關係探討

The Relationships among Adult Attachment, Parent-Child Intimacy and Parenting Stress in Mothers of Children with Cancer

蔡宇涵(Yu-Han Tsai)

指導教授 ： 王郁茗

中山醫學大學/醫學院/心理學系暨臨床心理學碩士班/碩士(2021年)

https://doi.org/10.6834/csmu202100124

摘要

研究目的：本研究旨在了解子女罹癌之母親的親職壓力，並探討母親的成人依附、親子親密情感與親職壓力之間的關係。
研究方法：本研究採橫斷式調查法，以立意取樣，於中部兩間醫學中心之兒童血液腫瘤科招募癌症患者之母親為研究對象，納入條件為子女確診癌症時年齡小於18歲者、與罹癌子女同住負擔養育照顧之責、能獨立閱讀填寫問卷；排除條件為有嚴重精神疾病或認知障礙者、非本國籍、罹癌子女患有癌症之外的慢性疾病。以結構式自填問卷收集資料，內容包含：罹癌子女及母親的人口學資料、子女疾病史、社經背景與家庭支持等；中文版成人依附量表修訂版，包含焦慮、逃避分量表；親子關係量表之恩情依附分量表；親職壓力量表，包含父母困擾、親子失功能互動、困難兒童分量表。總計發出158份問卷，回收131份有效問卷，回收率為82.91%。所得資料以統計套裝軟體進行分析，統計方法包括獨立樣本t檢定、單因子變異數分析、皮爾森積差相關、階層迴歸分析。
研究結果：
(一) 子女罹癌之母親的親職壓力量表總分及其父母困擾、親子失功能互動、困難兒童三個分量表分數，對照健康者常模均屬正常壓力範圍。
(二) 子女罹癌之母親的親子親密情感與成人依附、親職壓力量表及其父母困擾程度、親子失功能互動、困難兒童三個分量表分數均無相關；母親的焦慮與逃避依附傾向越高，整體親職壓力、父母困擾、親子失功能互動分數越高。
(三) 子女罹癌年數在親職壓力量表總分、親子失功能互動分量表分數、困難兒童分量表分數呈顯著差異；罹癌年數越高，母親的親職壓力量表總分、親子失功能互動分量表分數、困難兒童分數均較低。
(四) 罹癌子女年齡與治療類型，在父母困擾分量表分數呈顯著差異；罹癌子女年紀越大，母親的父母困擾較低，採取門診追蹤之治療類型者，其母親的父母困擾較低。
(五) 罹癌子女之母親的職業在親子失功能互動分量表上呈顯著差異；母親職業為家管者，其親子失功能互動的親職壓力較高。
(六) 階層迴歸分析結果顯示：控制罹癌子女年齡、罹癌年數、父親支持度等背景變項後，焦慮依附可預測親職壓力量表總分，且達顯著水準；控制發病年齡之背景變項後，焦慮依附可預測父母困擾分量表分數，且達顯著水準；控制罹癌年數、母親年齡、父親支持度等背景變項後，焦慮依附可預測親子失功能互動分量表分數；而逃避依附、親子親密情感對於親職壓力總分及其分量表均無顯著解釋力。
結論：子女罹癌之母親的焦慮依附傾向影響其親職壓力，包括擔任母職的困擾、親子失功能互動與困難兒童。本研究結果可作為臨床照護專業人員提供子女罹癌之母親在心理協助與親職諮詢之參考。

關鍵字

兒童癌症 ； 母親 ； 成人依附 ； 親子親密情感 ； 親職壓力

並列摘要

Purpose: This study aimed to explore the parenting stress of mothers whose children were suffering from cancer, and the relationships among mother's adult attachment, parent-child intimacy, and parenting stress.
Method: This study adopted a cross-sectional survey method, with purposive sampling, and recruited mothers of cancer patients in the Children's Hematology-Oncology Department of two medical centers in Taichung City. Inclusion conditions were those who were younger than 18 when the child was diagnosed with cancer, live with the child with cancer and bear the responsibility of nurturing and care, and can read and fill out the questionnaire independently; exclusion conditions were those with severe mental illness or cognitive impairment, non-nationality, children with cancer suffering from chronic diseases other than cancer. Use structured self-reported questionnaires to collect data, including demographic data of children with cancer and mothers, children's disease history, socioeconomic background, and family support, etc; a Chinese version of revised adult attachment scale, including anxiety and avoidance subscales; The parent-child relationship scale has a subscale attached to the graciousness dependency scale; The parenting stress index includes a subscale for parental distress, parent-child dysfunction interaction, and difficult child. A total of 158 questionnaires were sent out and 131 valid questionnaires were retrieved, with a response rate of 82.91%. A statistical package software were used. The statistical methods included independent sample t-test, analysis of variance, Pearson product-moment correlation coefficient, and hierarchical regression analysis.
Result:
(1) The total scores of the parenting stress index for mothers with children with cancer and the three subscales scores of parental distress, parent-child dysfunction interaction, and difficult child, compared with the normal norm of healthy people were within the normal pressure range.
(2) There was no correlation between the parent-child intimacy, adult attachment, parenting stress index, and three subscales of parental distress, parent-child dysfunction interaction, and difficult child; The higher the mother's anxiety and avoidance tendency, the higher the parenting stress index, parental distress, and parent-child disability interaction scores.
(3) There was a significant difference in the total scores of the parenting stress index, the parent-child dysfunction interaction subscale, and the difficult child subscale for the number of years of children with cancer; the higher the number of years of cancer, the total parenting stress index, parent-child dysfunction interaction, and difficult child were lower.
(4) The age and treatment type of children with cancer showed significant differences in the scores of the parental distress subscale; the older the children with cancer, the lower the parental distress, and those who adopted the outpatient follow-up treatment type had lower parental distress.
(5) The occupation of the mother of a child suffering from cancer had a significant difference in the degree of parent-child dysfunction interactions subscale; the mother's occupation was a household manager, and the parent-child dysfunction interaction was higher.
(6) The results of the hierarchical regression analysis showed that after controlling for background variables such as the age of children with cancer, the number of years of cancer, and the degree of support of the father, anxiety dependence could predict the total score of the parental stress scale, and reached a significant level; After controlling for background variables such as the age of onset, anxiety attachment could predict parent-child disability subscale scores and reached a significant level; After controlling for background variables such as cancer years, mother's age, and father support, anxiety attachment could predict parent-child dysfunction interaction subscale scores and reached a significant level; However, avoidance of attachment and parent-child intimacy had no significant explanatory power for the total score of parenting stress index and its subscales.
Conclusion: The anxiety style of adult attachment of mothers whose children suffer from cancer affected their parenting stress, included the troubles of motherhood, parent-child disability interaction, and difficult children. The results of this study might help clinical professionals to provide mothering counseling and counsult for mothers with children with cancer.

並列關鍵字

Childhood Cancer ； Mother ； Adult Attachment ； Parent-Child Intimacy ； Parenting Stress

參考文獻

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陳富美、利翠珊（2004）。夫妻的育兒經驗：親職分工與共親職的探討。中華心理衛生學刊，17(4)，1-28。

中文部分

中華民國兒童癌症基金會（2020）。2019年度報告。取自https://www.ccfroc.org.tw/sites/default/files/inline-files/%E5%85%92%E7%99%8C2019%E5%B9%B4%E5%A0%B1%E9%9B%BB%E5%AD%90%E7%89%88%281%29.pdf。

方恩真（2011）。東南亞籍新移民母親照顧癌症子女之生活經驗（未出版之碩士論文）。國立台北護理健康大學護理系，台北市。