台灣家醫誌民國 06 年 27 卷 3 期白宗平邵馨慧蘇軒等 55 20% [] 9-6% [2,3] [4,5] 40.3% [6] 2% [7] [8] [9] [0,] [2] [0] 研究對象研究方法 0 0

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1 54 [ ] 產後婦女的家庭型態與產後照顧及憂鬱症的相關性白宗平邵馨慧蘇軒陳智長黃麗卿,2 背景與目的 : 產後憂鬱症影響產婦健康以及嬰兒的照顧, 嚴重的產後憂鬱會增加產婦自殺的風險以家庭為基礎的社會支持是重要的保護因子, 然而家庭型態的差異對產後照顧與憂鬱症的影響, 在國內少有研究本研究的目的為探討台灣家庭型態與產後照顧及憂鬱症的相關性方法 : 本研究蒐集北部某醫學中心產後婦女填寫的問卷資料, 問卷資料包括年齡學歷憂鬱量表產後一個月的主要居住地點家庭型態家人支持度嬰兒哺育方式及主要照顧者主要在家烹調者並以家庭型態差異分為大家庭與小家庭兩組進行各項相關資料分析結果 : 總共納入 666 位產婦, 平均年齡為 33.3±3.9 歲, 有 47.7% 產後入住坐月子中心, 家庭型態有 58% 為小家庭小家庭型態的產婦比起大家庭者有較高的年齡 (33.7±3.8 vs. 32.8±4.0), 產後住在月子中心的比例較高 (52.7% vs. 40.7%), 在家烹調者媽媽或是婆婆為的比例較低 (4.6% vs. 63.8%), 長輩給予的家庭支持度也較低 (7.0±4. vs. 7.8±3.2) 以愛丁堡產後憂鬱量表評量, 發現有三成產後婦女為憂鬱傾向或診斷為憂鬱症, 但是不同家庭型態的憂鬱量表的差異沒有統計上意義 ; 小家庭型態的產婦在產後憂鬱量表我感到悲傷以及哀傷項目顯示較低的分數在控制年齡坐月子地點以及主要照顧者相關因素後, 憂鬱量表平均分數與其他各子題的平均分數, 在兩種不同家庭型態上均無統計上的顯著差異結論 : 本研究發現家庭型態影響產後照顧方式, 小家庭產婦在產後較少受到長輩的幫助, 住坐月子中心的比例較高, 且長輩的家庭支持度分數較低, 但是憂鬱症狀與大家庭產婦無差異, 值得進一步探討分析其他社會支持因素 207; 27: DOI: / 家庭型態產後照顧產後憂鬱症馬偕紀念醫院家庭醫學科 2 馬偕醫學院醫學系受理日期 :06 年月 4 日修改日期 :06 年 2 月 7 日同意刊登 :06 年 2 月 27 日通訊作者 : 黃麗卿通訊地址 : 台北市中山區中山北路二段 92 號馬偕醫院家庭醫學科

2 台灣家醫誌民國 06 年 27 卷 3 期白宗平邵馨慧蘇軒等 55 20% [] 9-6% [2,3] [4,5] 40.3% [6] 2% [7] [8] [9] [0,] [2] [0] 研究對象研究方法 0 0

3 Taiwan J Fam Med 56 家庭型態與產後照顧及憂鬱症 207 Vol.27 No.3 (Edinburgh Postnatal Depression Scale, EPDS) Cox Holden Sagovsky [3] [4-6] (specificity) 80-90% 0 82% 86% [7] 統計方法 SPSS 20.0 t-test p < % 8% 47.7% 95% 40.4% 386 (58.0%) 280 (42%) (2.9%) 3 7 (7.6%) 2.9% 7.6% (52.7%) 2 74 (4.%) (58.9%) (7.9 vs. 8.4, p<0.00) (0-2 ) (6.8% vs..7%) 0.78 vs. 0.9, p<0.05 3

4 台灣家醫誌民國 06 年 27 卷 3 期白宗平邵馨慧蘇軒等 57 (n=666) (n=50) 280 (54.9) (n=664) 538 (8.0) 386 (58.0) 280 (42.0) (n=663) 347 (52.3) 36 (47.7) 268 (40.4) 363 (54.7) 33 (5.0) (n=348) 275 (79.0) 52 (4.9) 4 (.2) 4 (4.0) 3 (0.9) (n=344) 4 (.2) 7 (20.6) 07 (3.) 53 (5.4) 89 (25.9) 20 (5.8) <0 457 (68.6) (3.9) >2 7 (7.6)

5 Taiwan J Fam Med 58 家庭型態與產後照顧及憂鬱症 207 Vol.27 No.3 2 p <0 272 (70.5) 85 (66.) (.7) 47 (6.8) >2 69 (7.9) 48 (7.) (82.8) 220 (78.6) (52.) 28 (58.7) (4.7) 08 (38.6) (53.) 59 (56.8) 20 (5.2) 3 (4.6) 203 (52.7) 3 (40.7) (53.8) 34 (46.6) (46.2) 39 (53.4) 74 (4.6) 06 (63.8) < (58.4) 60 (36.) 74 (9.2) 5 (8.2) p* p *t

6 台灣家醫誌民國 06 年 27 卷 3 期白宗平邵馨慧蘇軒等 % 58% % 33.3% 36.0% 3.6% [8] % 25.7% [9] 36 (47.7%) 50 [20] [2] [9] [0,] [8] [9] [0]

7 Taiwan J Fam Med 60 家庭型態與產後照顧及憂鬱症 207 Vol.27 No [2] 0 4% 3 7% [22] % [7] 03.4% 3 7.6% 86 [9].. Lindahl V, Pearson JL, Colpe L: Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 2005; 8: Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS: Psychiatric disorders

8 台灣家醫誌民國 06 年 27 卷 3 期白宗平邵馨慧蘇軒等 6 in pregnant and postpartum women in the United States. Arch Gen Psychiatry 2008; 65: Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C: Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Res 204; 25: O Hara MW, McCabe JE: Postpartum depression: current status and future directions. Annu Rev Clin Psychol 203; 9: Gjerdingen DK, Yawn BP: Postpartum depression screening: importance, methods, barriers, and recommendations for practice. J Am Board Fam Med 2007; 20: Chen CH, Tseng YF, Wang SY, Lee JN: The prevalence and predictors of postpartum depression. Nurs Res 994; 2: Heh SS: Validation of the Chinese version of the Edinburgh Postnatal Depression Scale: detecting postnatal depression in Taiwanese women. Nurs Res 200; 5: Bobo WV, Yawn BP: Concise review for physicians and other clinicians: postpartum depression. Mayo Clin Proc 204; 89: Heh SS, Coombes L, Bartlett H: The association between depressive symptoms and social support in Taiwanese women doing the month. Int J Nurs Stud 2004; 4: Hung CH: Women s postpartum stress, social support, and health status. West J Nurs Res 2005; 27: Hung CH, Lin CJ, Stocker J, Yu CY: Predictors of postpartum stress. J Clin Nurs 20; 20: Robertson E, Grace S, Wallington T, Stewart DE: Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 2004; 26: Cox JL, Holden JM, Sagovsky R: Detection of postnatal depression: development of the 0- item Edinburgh Postnatal Depression Scale. Br J Psychiatry 987; 50: Myers ER, Aubuchon-Endsley N, Bastian LA, et al: Efficacy and safety of postnatal depression for postpartum depression. Comparative Effectiveness Review No. 06. Rockville: Agency for Healthcare Research and Quality (AHRQ) Cox J, Holden J: Perinatal Mental Health: A Guide to the Edinburgh Postnatal Depression Scale. Glasgow, Scotland: Bell & Bain Ltd, Matthey S, Henshaw C, Elliott S, Barnett B: Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: implications for clinical and research practice. Arch Womens Ment Health 2006; 9: Lee DT, Yip SK, Chiu HF, et al: Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale. Br J Psychiatry 998; 72: Hung CH, Stocker J, Hsu HT: Comparing Taiwanese women's biopsychosocial features by location of postpartum recovery. Appl Nurs Res 204; 27: Chien LY, Tai CJ, Ko YL, Huang CH, Sheu SJ: Adherence to Doing-the-Month practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan. Res Nurs Health 2006; 29: Chen ML, Huang ZX: A pilot study of the

9 Taiwan J Fam Med 62 家庭型態與產後照顧及憂鬱症 207 Vol.27 No.3 depressed mood on women in postpartum nursing center. Formosa J Med 204; 8: Murray L, Carothers AD: The validation of the Edinburgh Postnatal Depression Scale on a community sample. Br J Psychiatry 990; 57: Wisner KL, Sit DK, McShea MC, et al: Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 203; 70:

10 [Original Article] 63 The Relationships between Family Structure, Postpartum Care and Depression in Postpartum Tsung-Ping Pai, Hsin-Hui Shao, Hsuan Su, Chih-Chang Chen, and Lee-Ching Hwang,2 Background and Purpose: Postpartum depression affects the health of postpartum women and infant care, and severe postpartum depression increases the risk of suicide. Family-based social support is an important protective factor for postpartum depression. However, few studies in Taiwan focus on the influence of different family structures on postpartum care and depression. The study accordingly aimed to investigate the relationship between family structure, postpartum care and depression in Taiwan. Methods: Questionnaires were collected from postpartum women at a medical center in northern Taiwan during the period from March 204 to August 206. The questionnaire incorporates items related to age, education, depression intensity, place of residence in the first month postpartum, family structure, family support, infant feeding method, the main infant caregiver, and the main person responsible for meal preparation at home. Survey participants were divided into those from nuclear family and those from extended family for data analysis. Results: A total of 666 postpartum women with an average age of 33.3±3.9 years enrolled in the study; 47.7% of the participants stayed in a postpartum nursing center and 58% of them were from nuclear family. Compared to their counterparts, women from nuclear family were older (33.7±3.8 vs. 32.8±4.0), more likely stayed in postpartum nursing center (52.7% vs. 40.7%), fewer mother or mother-in-law were their main home meal preparer (4.6% vs. 63.8%), and perceived lower family support (7.0±4. vs. 7.8±3.2). Overall, 30% of the postpartum women were screened positive depression or depression mood with the Edinburg Postnatal Depression Scale (EPDS). No statistically significant difference was found between women from different family structure. At multivariate analysis, controlling factors as age, place of residence in the first month after delivery and main home meal preparer, the mean score of total scale or individual components of EPDS were no significant difference between the two groups. Conclusion: Family structure influences postpartum care. Women living with nuclear family receive less care from parents or parents-in-law and report a higher percentage of staying in a postpartum nursing center and lower family support score from parents or parents-in-law. Family structure, on the other hand, appears to have no significant impact on depression intensity. Further investigations on other social support factors are needed. (Taiwan J Fam Med 207; 27: 54-63) DOI: / Key words: family structure, postpartum care, postpartum depression Department of Family Medicine, MacKay Memorial Hospital, Taipei; 2 Department of Medicine, Mackay Medical College, New Taipei city, Taiwan. Received: January 4, 207; Revised: February 7, 207; Accepted: February 27, 207.

( s y s t e m ) ( s t r e s s ) (stress model) ( s y s t e m ) [ ] [ 5 ] C o x [ 3 ] 1 [ 1, 2 ] [ 6-8 ] [ 9 ] Tw Fam Med Res 2003 Vol.1 No.1 23

( s y s t e m ) ( s t r e s s ) (stress model) ( s y s t e m ) [ ] [ 5 ] C o x [ 3 ] 1 [ 1, 2 ] [ 6-8 ] [ 9 ] Tw Fam Med Res 2003 Vol.1 No.1 23 1, 4 1, 2 3 1 4 1, 2 1977 E n g e l 1999 5 1 ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 ) 2003 1 2 2-32 stress model, stress analysis [ 1 ] ( p s y c h o g e n e s i s ) (holism) (biomedical model) ( r e d u c t i o

台灣家醫誌 民國 06 年 27 卷 3 期 白宗平邵馨慧蘇軒等 55 20% [] 9-6% [2,3] [4,5] 40.3% [6] 2% [7] [8] [9] [0,] [2] [0] 研究對象 研究方法 0 0

台灣家醫誌民國 06 年 27 卷 3 期白宗平邵馨慧蘇軒等 55 20% [] 9-6% [2,3] [4,5] 40.3% [6] 2% [7] [8] [9] [0,] [2] [0] 研究對象研究方法 0 0