台灣近年產後憂鬱盛行率為10-20%，與亞洲其他國家相比有偏高之情形，因此衛生福利部國民健康署於2014年將原本10次的產檢，額外再增加兩次由菸品健康福利捐補助的產前衛教指導，並將孕期心理適應衛教指導納入第三孕期（29-35週），但目前台灣尚未針對孕產婦衛教指導服務補助方案之孕期心理適應衛教部分進行評值，因此本研究目的為探討孕產婦衛教指導服務補助方案對產後憂鬱之成效，並檢驗與產後憂鬱相關的因子。
本研究於2016年11月至2017年3月間以立意取樣的方式，於台北、台中、高雄、宜蘭（北、中、南、東部）共六間參與「孕產婦衛教指導補助方案」之區域、地區醫院及婦幼診所為主要收案場所，共285位孕婦採結構式問卷於第三孕期（29-35週）完成第一次資料收集，113名婦女完成產前（36週）追蹤問卷，114名婦女完成產後一個月追蹤問卷。研究變項包含基本資料、孕產資料、社會支持、衛教情形、接受孕產婦衛教指導輔助方案後的滿意度、產後情緒障礙的知識、產後情緒障礙處理的自我效能、孕期憂鬱以及產後憂鬱。
結果顯示，70-80%的懷孕婦女對於衛教指導的介入感到滿意；第三孕期及產前「產後情緒障礙的知識」(p=.884)、「產後情緒障礙處理的自我效能」(p=.669)以及「孕期憂鬱」(p=.121)，並未隨著衛教後時間的推移而有顯著差異；在醫護人員使用手冊來做衛教的部分，結果也發現無論有、無特別使用口頭衛教，在第三孕期及產前36週的知識、自我效能及孕期憂鬱總分平均值皆未達顯著。另外本研究使用愛丁堡產後憂鬱量表（Edinburgh Postpartum Depression Scale, EPDS）為測量工具，以≧10分為切點進行憂鬱評估，第三孕期憂鬱盛行率為37.5%、產前36週憂鬱盛行率為41.6%，以及產後憂鬱盛行率為30.7%。多元邏輯斯迴歸分析（Multiple logistic regression）的研究結果發現，胎次為第二胎的婦女罹患產後憂鬱的風險較第一胎低（OR:0.324, 95%CI: 0.116-0.902）；衛教時間越長罹患產後憂鬱的風險越高（OR:1.120, 95%CI: 1.013-1.238）。第三孕期婦女對於衛教的時間越滿意，罹患產後憂鬱的風險就越低（OR: 0.213, 95%CI: 0.074-0.612）。產後情緒障礙的知識越高罹患產後憂鬱的風險越高（OR: 1.533, 95%CI: 1.006-2.335）。產後情緒障礙處理的自我效能越高，產後憂鬱的風險就越低（OR:0.919, 95%CI: 0.848-0.997）。孕期憂鬱罹患產後憂鬱的危險是沒有孕期憂鬱的1.24倍（OR:1.243, 95%CI: 1.108-1.394）。
本研究結果顯示，使用孕婦健康手冊以及口頭衛教來做心理適應衛教的介入並無法在孕婦知識、自我效能及產後憂鬱上顯示成效。可能與衛教時間不足、且醫護人員在個別使用手冊及口頭衛教來做衛教時，並未特別選擇高危險群給予衛教或轉介，因此如何提升醫護人員對產後憂鬱高風險婦女之敏感度，並針對高危險群給予衛教介入或轉介，應是未來加強的重點。產後情緒障礙處理的自我效能以及孕期憂鬱與產後憂鬱間具有顯著相關，因此可以將此做為參考，加強孕婦自我效能，並篩檢孕期憂鬱者予以介入，以藉此提升衛教成效，降低產後憂鬱的發生。

The prevalence of postpartum depression in Taiwan raged 10-20% in recent years, higher than that in other Asian countries. Health Promotion Administration, Ministry of Health and Welfare added two times of prenatal health education to the original 10 times of antenatal check-ups for pregnant women in 2014. The fund came from the Surcharge of Tobacco Products. The two times of prenatal health education included mental health education for prenatal women during the 29th to 35th week of pregnancy. However, the effectiveness of the prenatal health education remains unclear. This study was to explore the effectiveness of the prenatal health education program on postpartum depression, and to examine the factors associated with postpartum depression.
This study adopted a purposive sampling and collected data from November, 2016 through March, 2017. The study participants were recruited from six regional hospitals and clinics in Taipei, Taichung, Kaohsiung and Yilan (Northern, central, southern, and eastern Taiwan). A total of 285 pregnant women were asked to answer structured questionnaires during their third trimester of pregnancy (29-35 gestation weeks). Of them, 113 women completed the follow-up questionnaires at 36 weeks of pregnancy and 114 completed the follow-up questionnaires at one month postpartum. The study variables included demographics, pregnancy and labor related characteristics, social support, contents of health education, satisfaction toward the health education, knowledge and self-efficacy regarding postpartum emotional disturbance, and depression during pregnancy and postpartum.
The results showed that 70-80% of pregnant women were satisfied with the prenatal health education program. Between the time the health education was given (29-35 weeks) and before delivery (36 weeks), there were no significant defferences in knowledge (p=.884), self-efficacy (p=.669), and depression symptoms (p=.121). Use of oral health education in addition to the booklet in the prenatal health education was not significantly related to knowledge, self-efficacy and depression during pregnancy. Based on a cut-off score of 10 using Edinburgh Postpartum Depression Scale (EPDS), prevalence of depression was 37.5% during the third trimester, 41.6% at 36 weeks of pregnancy, and 30.7% at one month postpartum. The result of multiple logistic regression showed the risk of postpartum depression for mutipara women was lower than those primiparous women (OR:0.324, 95%CI: 0.116-0.902). Longer duration of health education was associated with a higher risk of depression (OR:1.120, 95%CI: 1.013-1.238). The higher the satisfication toward duration of prenatal health education, the lower the risk of depression was found (OR: 0.213, 95%CI: 0.074-0.612). Knowledge of emotion disturbance was positively associted with postpartum depression. Higher self-efficacy was significantly associated with a lower risk of postpartum depression (OR:0.919, 95%CI: 0.848-0.997). The odds of post-partum depression was 1.24 times higher among those having depression during pregnancy than those without depression during pregnancy ( OR:1.243, 95%CI: 1.108-1.394).
The results of this study indicated that using maternal health booklet and brief oral health eduation was not effective in improving knowledge, self-efficacy, and postpartum depression. The lack of effect could be due to insufficient duration of health educatioh and the fact that health professionals did not target on high-risk mothers or provide referrals to them. It is important to train health professionals to recognize the high-risk groups and provide necessary intervention or referral. Self-efficacy regarding management of postpartum emotional disturbance and depression during pregnancy were significantly associated with postpartum depression. Enhancing self-efficacy as well as screening for those with depression during pregnancy to provide interventions could help improving the effectiveness of prenatal health education and decreasing postpartum depression.

致謝................................i
中文摘要............................ii
Abstract...........................iv
目 錄.............................vii
表目錄..............................ix
附錄 ...............................xi
第一章 緒論..........................1
第一節 研究動機及重要性...............1
第二節 研究目的......................5
第三節 研究架構......................6
第二章 文獻查證......................7
第一節 孕期心理衛教指導內容...........7
第二節 孕期心理衛教指導成效指標.......11
第三節 孕期心理衛教指導成效的影響因子.14
第三章 研究方法.....................20
第一節 研究設計.....................20
第二節 研究對象.....................21
第三節 樣本數估計...................22
第四節 倫理考量.....................23
第五節 研究工具.....................24
第六節 資料處理與統計分析............33
第四章 研究結果.....................36
第一節 樣本性質描述..................36
第二節 產後情緒障礙的知識、自我效能及孕期憂鬱......45
第三節 社會人口特性、社會支持、衛教情形、知識、自我效能以及孕期憂鬱與產後憂鬱之相關性.............50
第四節 產後憂鬱之多元邏輯斯迴歸分析...57
第五章 討論.........................63
第一節 第三孕期婦女接受衛教指導後的滿意度、產後情緒障礙的知識、產後情緒障礙處理的自我效能、孕期憂鬱及產後憂鬱之討論...63
第二節 第三孕期及產前之產後情緒障礙的知識、產後情緒障礙處理的自我效能及孕期憂鬱相關性之討論........66
第三節 第三孕期婦女基本資料、社會支持、衛教滿意度、產後情緒障礙的知識、產後情緒障礙處理的自我效能及孕期憂鬱，與產後一個月產後憂鬱之相關性討論...................68
第六章結論與建議.....................72
第一節 結論.........................72
第二節 研究限制與優勢................74
第三節、建議........................76
參考文獻............................78
中文部分............................78
英文部分............................81

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