臺灣博碩士論文加值系統

中文摘要
背景
台灣約15％育齡夫婦有不孕困擾，且不孕症婦女治療期間約有7～20％有憂鬱症狀，在成為母親後其心理壓力可能仍高。產後情緒障礙將會降低母親關懷自身及其嬰兒的能力，影響母嬰健康。目前國內外針對不孕婦女的研究多偏重治療過程中所遭受的心理社會問題，少有針對是否因先前不孕治療經驗不同而導致產後憂鬱相關之探討，因此引發研究動機。
目的
描述產後6個月內不孕症婦女的憂鬱之盛行率和檢驗社會人口學、憂鬱症病史、孕產史、健康史、母乳哺餵、壓力變化、社會支持、不孕症史，及不孕症療程與產後憂鬱的影響，找出能預測不孕症治療產婦其產後憂鬱的相關因子。
方法
本研究為橫斷式調查於2014年11月至2015年5月，資料收集採結構式問卷（產後憂鬱以愛丁堡產後憂鬱量表測量），以電訪及病歷回顧方式於北部某醫學中心進行收案，共收180位產後6個月內不孕症婦女。研究變項包含社會人口學、個人／家族憂鬱症病史、孕產史、產婦／嬰兒健康史、母乳哺餵、壓力變化、社會支持、不孕症史、不孕症治療變項，依變項為產後六個月內憂鬱。
結果
不孕症婦女產後六個月內憂鬱症盛行率為34.4％。二元邏輯斯迴歸分析發現：「有母乳哺餵者」(OR=0.347,95% CI=0.123~0.980)、「社會支持較高者」(OR=0.901, 95% CI=0.853~0.952)、「治療期盼嬰兒性別符合期望者」(OR=0.177, 95% CI=0.060~0.523)，產後憂鬱的危險性較低；「自覺產後壓力比接受治療前大者」(OR=4.403, 95% CI=1.512~12.822)、「不孕症診斷年數> 3年者」(OR=5.158, 95% CI=1.825~14.577)、「此次受孕年齡為高齡（≧35歲)者」(OR=8.313, 95% CI=2.642~26.155)、「此次受孕方式是經由IVF受孕者」(OR=5.738, 95% CI=1.420~23.189)、「曾歷經三種不同療程者」(OR=8.671, 95% CI=2.382~31.567)，產後憂鬱的危險性較高。以上八個變項共可解釋不孕症婦女產後憂鬱的50.6%變異量。
結論
台灣不孕症產婦其產後憂鬱的盛行率高，且與不孕症診斷年數長、高齡受孕、侵入性治療受孕、及接受多項療程有關。顯示政策上應針對不孕症婦女增設周產期相關心理健康諮詢與產後憂鬱之防治，健康照護人員應加強不孕症受孕婦女孕產衛教，並提升產後支持與協助。
關鍵詞：不孕症、產後憂鬱、橫斷式調查

Abstract
Background
Around 15% of all couples of childbearing age in Taiwan have infertility. About 7~20% of women have depressive symptoms during infertility treatment, and the psychological pressure might remain high when they become mothers. Postpartum mood disorder of mothers will lower the ability of taking care of themselves and the baby, thus affect the health of the mother and the baby. Most of previous researches on infertile women focused on psychosocial problems during infertility treatment, few focused on examining the effect of different infertility treatments on postpartum depression.
Objective
The study aimed to describe the prevalence of postpartum depression within 6 months of childbirth in women conceived with infertility treatment, and examine the effect of socio-demographic, history of depression, pregnancy history, healthy history, breastfeeding, perceived pressure, social support, history of infertility, and infertility treatments on postpartum depression.
Method
This study was a cross-sectional survey performed from November 2014 through May 2015. The study participants were 180 women who conceived with infertility treatment and were within 6 months postpartum at a medical center in Taipei, Taiwan. Data were collected by telephone interviews and chart review using a structured questionnaire. The study variables included socio-demographic, personal and family history of depression pregnancy history, women and infant healthy history, breastfeeding, pressure change, social support, history of infertility, and infertility treatment. The dependent variable is postpartum depression within 6 months after delivery as measured by the Edinburgh Postnatal Depression Scale.
Result
The prevalence of postpartum depression within 6 months after delivery is estimated at 34.4% among the study women. The binary logistic regression revealed that breastfeeding (OR=0.347,95% CI=0.123~0.980), social support (OR=0.901, 95% CI=0.853~0.952), and baby gender in line with expectations (OR=0.177, 95% CI=0.060~0.523) were negatively associated with postpartum depression. Perceived postpartum pressure higher than before infertility treatment (OR=4.403, 95% CI=1.512~12.822), duration since infertility diagnosis longer than 3 years (OR=5.158, 95% CI=1.825~14.577), maternal age older than 35 years old (OR=8.313, 95% CI=2.642~26.155), pregnancy via IVF (OR=5.738, 95% CI=1.420~23.189), and experiencing three different courses of infertility treatment (OR=8.671, 95% CI=2.382~31.567) were associated with a higher risk for postpartum depression. These eight variables explained 50.6% of variances for postpartum depression.
Conclusion
Women who conceived with infertility treatment in Taiwan had a high prevalence of postpartum depression. Longer duration since infertility diagnosis, older maternal age, conception via invasive treatment, and multiple courses of infertility treatment were associated with an increased risk for postpartum depression. Policies regarding infertility treatment should incorporate mental health counselling and prevention of postpartum depression. Health care professionals should enhance pregnancy- and labor-related health education for women who conceived through infertility treatment and offer them more support and help after delivery.
Keywords: infertility, postpartum depression, cross-sectional survey

目錄
致謝------------------------------------------------------------------------------------------------ i 中文摘要---------------------------------------------------------------------------------------- iii
英文摘要-----------------------------------------------------------------------------------------v 目錄--------------------------------------------------------------------------------------------- viii圖目錄-------------------------------------------------------------------------------------------- x
表目錄-------------------------------------------------------------------------------------------- x
第一章 緒論------------------------------------------------------------------------------------- 1
第一節 研究動機與重要性------------------------------------------------------------- 1
第二節 研究目的------------------------------------------------------------------------- 5
第三節 研究問題與假設---------------------------------------------------------------- 6
第二章 文獻查證------------------------------------------------------------------------------- 7
第一節 不孕婦女概述------------------------------------------------------------------- 7
第二節 周產期婦女的產後憂鬱----------------------------------------------------- 17
第三節 不孕症與產後憂鬱之相關研究-------------------------------------------- 27
第三章 研究方法----------------------------------------------------------------------------- 42
第一節 研究設計----------------------------------------------------------------------- 42
第二節 研究架構----------------------------------------------------------------------- 43
第三節 研究對象、取樣方法-------------------------------------------------------- 45
第四節 研究程序----------------------------------------------------------------------- 47
第五節 研究倫理----------------------------------------------------------------------- 49
第六節 研究工具----------------------------------------------------------------------- 50
第七節 資料處理與統計分析-------------------------------------------------------- 61
第四章 研究結果----------------------------------------------------------------------------- 64
第一節 產後六個月內不孕症婦女憂鬱的描述----------------------------------- 64
第二節 不孕症產婦相關變項的描述----------------------------------------------- 67
第三節 不孕症產婦相關變項與其產後憂鬱之間的相關性-------------------- 78
第四節 不孕症婦女產後六個月內憂鬱之顯著預測變項----------------------- 88
第五章 研究討論----------------------------------------------------------------------------- 92
第六章 結論---------------------------------------------------------------------------------- 100
第一節 研究優勢與限制------------------------------------------------------------- 100
第二節 結論---------------------------------------------------------------------------- 101
參考文獻-------------------------------------------------------------------------------------- 103
英文文獻-------------------------------------------------------------------------------- 103
中文文獻-------------------------------------------------------------------------------- 128
附錄-------------------------------------------------------------------------------------------- 134
附件一----------------------------------------------------------------------------------- 134
附件二----------------------------------------------------------------------------------- 136

圖目錄
圖3-1 研究架構------------------------------------------------------------------------------- 44
表目錄
表2-1 產後情感疾患比較------------------------------------------------------------------- 18
表3-1 教育程度分級------------------------------------------------------------------------- 55
表3-2 職業分級------------------------------------------------------------------------------- 55
表3-3 社經地位指數表---------------------------------------------------------------------- 56
表3-4 依變項描述性統計分析------------------------------------------------------------- 61
表3-5 自變項描述性統計分析------------------------------------------------------------- 61
表3-6 推論性統計分析---------------------------------------------------------------------- 63
表4-1 研究對象產後六個月的產後憂鬱率(N=180)----------------------------------- 65
表4-2 研究對象產後六個月內愛丁堡產後憂鬱量表總得分情形(N=180)-------- 65
表4-3 研究對象產後六個月內愛丁堡產後憂鬱量表各題項得分情形(N=180)-- 66
表4-4 研究對象社會人口學資料分佈(N=180)----------------------------------------- 71
表4-5 研究對象憂鬱症病史【個人／家族】資料分佈(N=180)-------------------- 72
表4-6 研究對象孕產史資料分佈(N=180)----------------------------------------------- 73
表4-7 研究對象健康史【產婦／嬰兒】資料分佈(N=180)-------------------------- 74
表4-8 研究對象母乳哺餵及壓力變化資料分佈(N=180)----------------------------- 75
表4-9 研究對象壓力總得分情形(N=180)----------------------------------------------- 75
表4-10 研究對象社會支持及各面向總得分情形(N=180)--------------------------- 75
表4-11 研究對象不孕症史資料分佈(N=180)------------------------------------------ 76
表4-12 研究對象不孕症治療資料分佈(N=180)--------------------------------------- 77
表4-13 研究對象社會人口學資料與產後六個月內憂鬱的相關(N=180)--------- 79
表4-14-1 研究對象孕產史資料與產後六個月內憂鬱的相關(N=180)------------- 81
表4-14-2 研究對象孕產史資料與產後六個月內憂鬱的相關(N=180)------------- 82
表4-15 研究對象健康史【產婦／嬰兒】資料與產後六個月內憂鬱的相關(N
=180) ------------------------------------------------------------------------------- 83
表4-16 研究對象母乳哺餵資料與產後六個月內憂鬱的相關(N=180)------------ 84
表4-17 研究對象產後壓力變化資料與產後六個月內憂鬱的相關(N=180)------ 84
表4-18 研究對象社會支持資料與產後六個月內憂鬱的相關(N=180)------------ 85
表4-19 研究對象不孕症史資料與產後六個月內憂鬱的相關(N=180)------------ 86
表4-20 研究對象不孕症治療資料與產後六個月內憂鬱的相關(N=180)--------- 87
表4-21 預測研究對象產後六個月內憂鬱傾向之二元邏輯斯迴歸分析(N=180
)-------------------------------------------------------------------------------------- 91

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