產後親子早期接觸、產後憂鬱與自傷意念之相關性探討

The Correlation between Early Maternal-Infant Contact after Childbirth and Postpartum Depression and Self-Harm Ideation

10.30074/FJMH.202003_33(1).0003

周寶鈺(Pao-Yu Chou)；施妙芳(Miao-Fang Shih)

親子早期接觸 ； 產後憂鬱 ； 自傷意念 ； early maternal-infant contact ； postpartum depression ； self-harm ideation

中華心理衛生學刊

33卷1期（2020 / 03 / 01）

63 - 93

繁體中文

研究目的：探討產後親子早期接觸、產後憂鬱與自傷意念之相關性。研究方法：本研究採橫斷性研究設計，於北部某醫學中心產後病房納入226位符合收案條件之產婦為研究對象，以問卷進行資料收集。問卷相關資料以SPSS 20.0進行分析。研究結果：1.產後親子早期接觸執行率94.5%。產後憂鬱（EPDS ≥ 13分）比率為19.7%，產後有自傷意念者為13.3%。2.自然生產親子早期接觸的比率高於剖腹產，有親子早期接觸之產婦罹患產後憂鬱的比率顯著較低。3.生產方式（p = .046, 95% CI [0.14, 0.98]）、新生兒性別（p = .004,95% CI [0.08, 0.62]）、產後疲憊（p = .002, 95% CI [1.13, 1.72]）、產後自傷意念（p = .000,95% CI [0.01, 0.10]）與產後憂鬱呈現顯著相關；剖腹產、生下男嬰、疲憊指數較高、有自傷意念者易產生產後憂鬱。4.憂鬱總分（p = .000, 95% CI [0.68, 6.86]）與產後自傷意念呈現顯著相關。研究結論：1.早期親子接觸之產婦出現產後憂鬱的比率顯著較低，應提供並鼓勵產婦早期與新生兒接觸。2.生產方式（剖腹產）與產後憂鬱顯著相關，臨床應著力於降低不必要的剖腹生產。3.應給予產下男嬰者更多的關注，預防或及早發現產後憂鬱的發生。4.產後憂鬱與自傷意念顯著相關，對於有憂鬱情緒者應提供關懷的護理措施，預防其產生自傷的意念或行為。

Purpose: This study explores the correlation between early maternal-infant contact after childbirth and postpartum depression and self-harm ideation. Methods: We used a cross-sectional design. A total of 226 women in the postpartum ward of a medical center in northern Taiwan completed questionnaires consisting of demographic items and obstetrics-related items, and the visual analogue scale for fatigue (VASF), and the Edinburgh postpartum depression Scale (EPDS). The statistical methods included descriptive statistics and Chi-square tests, independent t-tests, a one-way ANOVA, as well as ordinal logistic regression analysis. Results: The postpartum early maternal-infant contact rate was 94.5%. The incidence of postpartum depression (EPDS ≥ 13) was 19.7%, and of postnatal self- harm ideation was 13.3%. Women with spontaneous delivery had a higher rate of early maternal-infant contact than those who received a cesarean section (p = .016). The mean EPDS score for early maternal-infant contact was 7.88 ± 4.80, and the mean score for no early maternal-infant contact was 11.17 ± 4.28 (p = 0.022). The rate of postpartum depression in women with early maternal-infant contact was significantly lower (p = .007). Fatigue (95% CI [1.13, 1.72]; p = .002), mode of delivery (spontaneous delivery vs. cesarean section) (95% CI [0.14, 0.98]; p = .046), neonatal gender (female vs. male) (95% CI [0.08, 0.62]; p = .004), and self-harm ideation (95% CI [0.01, 0.10]; p = .000) were significantly associated with postpartum depression. The EPDS score is significantly associated with postnatal self-harm ideation (95% CI [0.68, 6.86]; p = .000). Conclusions: Postpartum depression and self-harm ideation are significantly related. The rate of postpartum depression with early maternal-infant contact is significantly lower than without it. Early maternal contact with newborns should be encouraged. Experiencing a cesarean section is significantly related to postpartum depression and to postpartum self-harm ideation. Clinical efforts should be made to reduce unnecessary caesarean sections. It is especially important to watch mothers who birth a male baby to prevent or detect postpartum depression early. Postpartum depression is significantly related to self-harm ideation. For those who have depression, care should be provided to prevent self-harm ideation or behavior.

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