孕產期間父親的情緒問題與生活品質:比較胎次的差異性

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Title:	孕產期間父親的情緒問題與生活品質:比較胎次的差異性 Paternal Emotional Status and Quality of Life from Maternal Early Pregnancy to 6-months Postpartum: Parity Differences and Effects
Authors:	陳怡涵 Chen, Yi-Han
Contributors:	陳怡樺
Keywords:	父親孕產期憂鬱;父親孕產期焦慮;父親孕產期生活品質;胎次 paternal depression;paternal anxiety;paternal quality of life;parity
Date:	2015-06-10
Issue Date:	2020-08-19 11:53:00 (UTC+8)
Abstract:	背景：「父親」在家庭發展中是一個不容忽略的重要角色。過去研究在探討男性的健康問題之中，發現當男性成為「父親」可能會因為角色責任帶來的壓力而對自身健康造成影響。而第一個小孩的出生促使家庭系統改變，角色轉換，帶來家庭危機，是家庭的第一個危險期；但是家庭有新成員加入時，對於家庭其實都屬於一種壓力源，因為此時的家庭成員，必須重新調整彼此的角色、分工、經濟的分配。但目前對於父親在伴侶孕產期間情緒問題與生活品質的探討仍較母親不足，且大多數對於父親調適情形會放在初為人父的狀況。研究目的：本研究目的為(一)探討父親在伴侶孕產期憂鬱焦慮的盛行現況與變化情形，(二)探討父親在伴侶孕產期間的生活品質的變化情形，(三)探討胎次對父親孕產期憂鬱焦慮與生活品質是否有影響，(四)探討胎次對父親孕產期憂鬱焦慮與生活品的影響，是否因教育程度的不同而有不同的效應。方法：本研究在台北市與新北市立意選取五所教學醫院及醫學中心，於合作的醫院婦產科門診進行產檢的婦女，邀請夫妻一同參與調查，亦即在孕期16週前納入基線測量研究，在懷孕中期、懷孕後期、小孩出生後一個月、小孩出生後六個月填寫共五次追蹤問卷，本研究收案時間在第一次調查為2011年7月至2014年5月，追蹤時間為2011年9月至2015年4月，共納入631名父親進行分析。受訪者自填問卷包含愛丁堡產後憂鬱量表(EPDS)、情境特質焦慮量表之情境焦慮量表(STAI-S)及世界衛生組織生活品質問卷台灣簡明版(WHOQOL-BREF)等，並使用廣義估計方程式(Generalized Estimate Equation,GEE)進行最後結果分析。結果：本研究發現(一)父親在伴侶孕產期間高憂鬱盛行比例為15.22%至18.74%，在伴侶懷孕時期高憂鬱比例最高，小孩出生後一個月高憂鬱比例最低。(二)父親在伴侶孕產期間高焦慮盛行比例為14.06%至17.81%，在伴侶懷孕初期高焦慮比例最低，小孩出生後六個月高焦慮比例最高。(三)父親在伴侶孕產期間生活品質滿意度差之比例為43.33%至51.41%，在伴侶懷孕後期比例最低，小孩出生後一個月比例最高；父親在孕產期間生理範疇、社會關係範疇及環境範疇之生活品質均在小孩出生後有顯著變差，但心理範疇之生活品質沒有隨著時間有顯著變化。(四)在伴侶懷孕時期，控制相關因子後，非新手父親較新手父親有較高憂鬱風險(校正後OR= 1.67，95%CI= 1.17~2.39)，有較差生活品質滿意度(校正後 OR=1.44，95%CI=1.12~1.84)、有較低生理範疇分數(校正後ß= -0.33，95%CI= -0.56~ -0.09)、有較低社會關係範疇分數(校正後ß=-0.36，95%CI= -0.67~ -0.05)；而在伴侶產後時期，在控制相關因子後，非新手父親比新手父親有較低生理範疇分數(校正後ß=-0.34，95%CI= -0.62~ -0.07)，其他則未具顯著性。(五)父親教育程度在研究所以上者，其非新手父親比新手父親有更高孕產期憂鬱風險及較差的生活品質，而此關係在父親教育程度為大學(專)以下者則未具顯著性。結論：國內父親孕產期憂鬱焦慮盛行率高，特別孕期憂鬱是產後憂鬱的重要危險因子，建議在伴侶孕產期衛教納入情緒篩檢項目，並鼓勵父親連同伴侶一同參與課程，幫助醫護人員快速評估父母親的心理健康狀態，尤其是對非新手父母親做更進一步的了解及衛教。未來建議擴大研究範圍及追蹤時間，以進一步探討胎次對父親孕產期間情緒問題及生活品質之影響，及其後續對嬰幼兒成長發育之影響。 Background: Fathers do play an important role in family. According to previous studies investigating men’s health problems, becoming a father may be stressful for men and may have negative impact on health. The literature has highlighted the birth of a first child as a crisis moment and a difficult transition for first-time parents. Nevertheless, even for experienced parents, adjustment during maternal perinatal period in order to incorporate a new member into a preexisting system could be more stressful. While most of previous studies have focused on transitional difficulties and quality of life among mothers, paternal adjustment during maternal perinatal period has not been adequately studied. Additionally, studies targeting on men’s condition during maternal perinatal period considered mainly first-time fathers. Objectives: This study was aimed at investigating (1) the prevalence and change of paternal depression and anxiety from maternal early pregnancy to 6-months postpartum; (2) the change of paternal quality of life during maternal perinatal period; (3) the effects of parity on paternal emotional status and quality of life during maternal perinatal period; and (4) the potential modifying effects of paternal education on the association between parity and paternal perinatal emotional status and quality of life. Method: Men and his pregnant partners (less than 16 gestational weeks) attending the prenatal visits from July 2011 to June 2014 in five selected hospitals in Taipei and New Taipei City were invited for participation. A total of 631 fathers completed the initial baseline survey and responded the follow-up questionnaires at maternal mid-pregnancy, late-pregnancy, 1-month postpartum and 6-months postpartum during September 2011 to April 2015. Self-reported data were collected using instruments of Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory scale (STAI-S) and the World Health Organization Quality of Life (WHOQOL-BREF, Taiwan version). This study used the Generalized Estimate Equation (GEE) approach to analyze correlated data. Result: We found that the prevalence of paternal depression ranged from 15.22% to 18.74% during maternal perinatal period, with the highest level being observed in mid-pregnancy. The prevalence of paternal anxiety ranged from 14.06% to 17.81%, with the levels increasing slightly from maternal early pregnancy to 6-months postpartum. We also found that about 43.33% to 51.41% of men had poor quality of life during maternal perinatal period. The physical health, social relationships and environment domains of quality of life displayed worse scores in the postpartum period than during maternal pregnancy. In our GEE analyses, compared to first-time fathers, those with two or more children experienced increased risks of depression (adjusted OR=1.67, 95%CI=1.17~2.39) and poor quality of life (adjusted OR=1.44, 95%CI=1.12~1.84) during maternal pregnancy. They also displayed lower scores on the physical health (adjust beta=-0.33, 95%CI=-0.56~ -0.09) and the social relationships domains (adjust beta=-0.36, 95%CI=-0.67~ -0.05) of quality of life. In maternal postpartum period, we found that compared to first-time fathers, experienced fathers further had lower scores on the physical health domain of quality of life (adjust beta=-0.34, 95%CI=-0.62~ -0.07). Insignificant findings were observed for other domains of quality of life. Finally, in stratified analyses by education, for fathers with higher education (attending graduate school), the impact of parity on paternal perinatal depression and quality of life reached the statistically significant levels. Nevertheless, no significant result was observed for fathers with lower education. Conclusion: High prevalence of paternal emotional difficulties during maternal perinatal period deserves full concern. Based on our findings, we suggest the need to screen emotional status during obstetric examination for both mothers and fathers, so that healthcare providers may adequately evaluate parental emotional status and promptly intervene for amelioration. In addition, the intervention should be tailored for experienced and inexperienced parents to meet their specific need. Future longitudinal studies with larger sample size and prolonged follow-up are imperative to further clarify the change of the effects of parity on paternal perinatal emotional status and quality of life. How paternal emotional status, together with maternal difficulties, may impact on children’s growth and development would further be elucidated.
Description:	碩士指導教授:陳怡樺委員:李思賢委員;莊坤洋
Data Type:	thesis
Appears in Collections:	[School of Public Health] Dissertations/Theses

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