| 摘要: | 孕期憂鬱和焦慮是常見的孕期情緒問題，並且會對小孩及母親造成負面影響，例如早產、低出生體重、增加剖腹產及產後憂鬱風險等。過去研究顯示孕期憂鬱相關的因子，例如:年齡、教育程度、社經地位、吸菸習慣、社會支持、婚姻關係等，然而在本土研究中探討孕期焦慮相關因素的文獻較缺乏，也較少研究著重於懷孕期間的工作壓力和親職壓力對憂鬱焦慮的影響。因此，本研究目的為探討職場壓力、親職壓力及家庭關係與孕期憂鬱焦慮的影響，另外想了解壓力對孕期情緒問題之影響在三個孕期間是否有差異。
本研究招募大台北地區共712位孕婦為研究樣本，招募時間從2011年8月至2012年3月，立意選取台北市兩所醫院，在這兩家醫院婦產科門診進行產檢的婦女為收案對象，研究工具為自填式問卷，孕期憂鬱及焦慮的篩檢工具分別為愛丁堡憂鬱量表(EPDS)、情境焦慮量表(STAI)，其他孕期壓力的測量工具分別為職場壓力量表、親職壓力量表、婚姻調適量表，並以邏輯式迴歸模型分析探討。
研究結果顯示孕期憂鬱、焦慮的盛行率分別為19.08%、35.67%，而在多變項邏輯式迴歸分析中，相較於職業婦女，無工作的孕婦顯著提升孕期憂鬱的風險(OR=2.20, 95%CI=1.36-3.57)；但是職業狀態與孕期焦慮的相關性並不顯著。在調整相關干擾因子後，職場壓力大(OR=2.91,95%CI= 1.55- 5.46)、親職壓力大(OR=2.07,95%CI= 1.26-3.41)、整體家庭關係差(OR= 1.92, 95%CI=1.17-3.14)、婚姻調適差(OR=1.62,95%CI=0.99 -2. 65)及家人關係差(OR=1.99,95%CI=1.24-3.22)都顯著增加孕期憂鬱的風險。另外，在調整相關干擾因子後，針對孕期焦慮的部分，職場壓力大(OR=3.20, 95%CI= 1.82- 5.85)、親職壓力大(OR= 2.69,95%CI=1.70-4.25)、整體家庭關係差(OR=2.64, 95%CI=1.70-4.10)、婚姻調適差(OR=2.03,95%CI=1.32-3.14)及家人關係差(OR=2.71,95%CI= 1.76 - 4.19)也會顯著增加孕期憂鬱的風險。而三個孕期之間憂鬱焦慮程度沒有顯著差異，在各個孕期間壓力對孕期情緒問題之關係是有差異的。整體而言，職場壓力及親職壓力對第二孕期婦女之憂鬱焦慮影響較大，而整體家庭關係對第一孕期婦女的情緒問題影響較大。
綜合以上，孕期憂鬱及焦慮是普遍存在的，值得後續繼續關注。雖然有職業是保護因子，然而工作壓力大會增加孕期憂鬱和焦慮的風險，此外較高的親職壓力與整體家庭關係較差是孕期情緒問題的危險因子，而三個孕期間影響情緒問題較大之因素不同。本研究探討孕期憂鬱焦慮之相關危險因子，可提供醫護人員進行孕婦心理健康篩檢，並儘早提供諮詢與介入措施，以預防可能的孕期憂鬱和焦慮。
Prenatal depression and anxiety are common emotional problems during pregnancy, with a negative impact on children and mothers e.g., premature birth, low birth weight, caesarean section and postpartum depression. Previous studies identified risk factors for prenatal depression, such as age, educational level, socioeconomic status, smoking behaviors, social support, and marital relationship. However, fewer focused on prenatal anxiety. The effects of workplace stress and parental stress during gestation also remained indefinite. This study was thus aimed to examine the effects of workplace stress, parental stress, and family relationship on prenatal depression and anxiety. How these associations were veried by three trimesters would futher be investigated.
A total of 712 pregnant women who had their prenatal visits from August 2011 to March 2011 in two selected hospitals in Taipei City were recruited for participation. Self-reported data were collected in the hospitals using questionnaires of the Edinburgh Postnatal Depression Scale (EPDS), State- Trait Anxiety Inventory (STAI), the Workplace Stress Scale, the Parental Stress Scale, and Locke-Wallace Marital Adjustment Test. Multivariate logistic regression model was used for analysis.
The prevalence of prenatal depression and anxiety were 19.08% and 35.67%, respectively. Compared with employed women, those without a job significantly had an increased risk for prenatal depression (OR=2.20, 95%CI= 1.36-3.57).Yet occupational status was not association with prenatal anxiety. Higher workplace stress (OR=2.91,95%CI= 1.55- 5.46), higher parental stress (OR= 2.07,95%CI= 1.26-3.41), and poorer family relationship (OR= 1.92, 95%CI= 1.17-3.14) were independently associated with antenatal depression. Additionally, women with higher workplace stress (OR=3.20, 95%CI= 1.82- 5.85) , higher parental stress (OR= 2.69,95%CI=1.70-4.25), and poorer family relationship (OR=2.64, 95%CI=1.70-4.10) further experienced significantly increased risks for antenatal anxiety. The prevalence of depression and anxiety did not differ significantly in the three trimesters. In the second trimester, the workplace stress and parenting stress made a greater impact on prenatal depression and anxiety, while in the third trimester the family relationship had greater effects on women’s emotional problems.
Prenatal depression and anxiety are prevalent and deserve continued attention. Although having a job was protective, increased workplace stress was associated with higher risks for antenatal depression and anxiety. Furthermore, higher parental stress and poorer family relationship were risk factors for gestational emotional ailments. The effects of stresses on gestational emotional problems differed among trimesters. It is thus important to consider negative impact of stress, from both family and workplace, during pregnancy and to offer intervention services as early as possible to offset possible progression into prenatal depression and anxiety. |
