初次診斷為發展遲緩兒童家長之親職壓力及生活品質探討

Parenting Stress and Quality of Life in Parents of Children Newly Diagnosed with Developmental Delays

過去許多研究顯示有醫療診斷兒童之家長的親職壓力較高且生活品質較差，但較少研究探討孩童尚未接受醫療資源時，家長的親職壓力及生活品質狀態。本研究目的為瞭解家長在發展遲緩子女未接受醫療介入時之親職壓力及生活品質，檢視兩者之相關性及探究可能的預測因子。本研究為橫斷面研究設計，採立意取樣，採用親職壓力量表及生活品質問卷臺灣簡明版做為評量工具，統計方法包括，利用單一樣本平均數t檢定與台灣常模比較生活品質，利用皮爾森相關、獨立樣本T檢定、變異數分析探討親職壓力、生活品質及其他因素之相關性，最後利用逐步迴歸分析探索親職壓力及生活品質的預測因子。有效樣本為58位發展遲緩兒童之家長，研究結果顯示，與過去研究相比，初次診斷為發展遲緩兒童之家長親職壓力之平均分數與一般家長相近，未達到顯著差異；與台灣一般民眾的生活品質相比，生理健康、心理、社會關係及環境四大範疇均低於一般民眾，尤其在生理健康及社會關係範疇顯著較低。進一步分析親職壓力及生活品質之預測因子，語言發展遲緩及孩童整體問題行為是影響家長親職壓力家長分量表的預測因子，孩童外化問題行為及孩童性別是影響家長親職壓力兒童分量表的預測因子，孩童內化問題行為是影響家長生活品質心理範疇的預測因子，語言發展遲緩及家庭收入是影響家長生活品質環境範疇的預測因子，至於生理健康及社會關係範疇之預測因子則未被發現。本研究所發現之預測因子可應用於臨床工作，提升臨床醫療人員之敏感度，對家長及孩童提供個別化的介入服務，不但可維持主要照顧者之長期身心健康，同時有效地促進孩童的發展。

Previous studies showed that parents of children with diagnosis have higher levels of parenting stress and poorer quality of life (QOL). There were few studies investigating the status of parenting stress and QOL in parents when their children with developmental delay (DD) have not received early intervention. The aims of this study were to explore the status and factors associated with parenting stress and QOL in parents in caring children with DD, and find predictors of parenting stress and QOL. This was a cross-sectional study by using purposive sampling method. Parenting Stress Index and World Health Organization Quality of Life-BREF were used as major measurement. Participants were 58 parents of children newly diagnosed with DD. One-sample t-test, Pearson correlation analysis, independent-sample t-test, analysis of variance (ANOVA), and stepwise multiple regression analyses were used. The results showed that compared with previous studies, parents of children with DD had similar levels of parenting stress as those of children with typical development. Parents of children with DD reported to have a poorer QOL than general population in Taiwan, statistically poorer in the physical health and social relationships domains. Based on further analysis, speech delay and total problematic behaviors were the predictors of parent subscale of parenting stress, and externalizing problematic behaviors were the predictors of children subscale of parenting stress; internalizing problematic behaviors were the predictors of psychological domain of QOL, speech delay and household income were the predictors of environmental domain of QOL, and the predictors of physical health and social relationship domains were not found in our study. The findings of this study highlighted the importance of clinical implications of these predictors. Healthcare clinicians should provide more individualized parenting skills training services and family-centered intervention for both parents and children with DD, which could further help parents' well-beings and children development.