產後疲倦與身心情境因素關係

Psychophysiologic and Situational Correlates of Postpartum Fatigue

本研究的主要目的是根據不愉快症狀理論，探討重要的個人因素、身心情境因素與不同時間序列產後疲倦的關係。立意取樣台北市三所教學醫院，無母嬰合併症產婦189位，於產後第3週時填寫以下六個量表：產後疲倦量表、母乳哺餵經驗量表、憂鬱傾向量表、社會支持量表、睡眠量表及嬰兒氣質量表，並於產後第6、9週繼續追蹤產後疲倦資料。主要結果如下：一、產後疲倦有90〜96％高發生率，程度屬於輕至中度，以身心混合形式最多；對生活造成輕度或中度的影響，並會隨著產後時間遞減。二、個人因素（高齡、第一胎、分娩方式、家庭社經等級）與產後疲倦無顯著相關。三、身心情境因素中，憂鬱傾向、母乳哺餵問題、睡眠品質、社會支持低，與產後疲倦呈顯著相關。四、自變項中憂鬱、嬰兒氣質分別與不同時間產後疲倦有交互作用存在，即「憂鬱傾向」、「磨娘精嬰兒氣質」與產後不同時間序列的疲倦有交互作用，而影響母親產後疲倦感。五、本研究架構所選用的個人因素、身心情境因素等因素，能解釋產後三週疲倦全部變異量之31.4％，其中影響最大的四個因素是「憂鬱」、「年齡」、「哺餵問題」、「分娩方式」；在產後六週時，九項因素能解釋疲倦全部變異量之22.9％，有意義的影響因素是「睡眠品質」；在產後九週九項因素能解釋全部變異量之15.3％，有顯著意義的影響因素是「餵奶問題」和「嬰兒氣質」。本研究之結果可做為評估產後疲倦之重要依據，進而提升產後婦女之生活品質。根據研究結果提出下列幾點建議：在教育方面將不愉快症狀理論推廣至醫院工作人員、一般民眾及父母；未來研究方面，可針對不同影響因素進行大樣本、縱貫性、質量並重的施測，並針對特定的影響因素在產後初期設計介入措施，探討降低產後疲倦之效果。

The purpose of this study is to explore the relationship between postpartum fatigue and associated psychophysiologic and situational factors using the theory of unpleasant symptoms (TOUS). This study applied a longitudinal design. A purposive sample of 189 low-risk pureperium women was recruited at 3 Teaching hospitals in Taipei City. Questionnaires were mailed to the subjects at 3, 6, and 9 weeks postpartum. The questionnaires included six instruments: the Breastfeeding Experience Scale, the Center for Epidemiologic Studies Depression Scale, the Personal Resources Questionnaire, the Visual Analog Sleep Scale, the Neonatal Perception Inventories, and the Postpartum Fatigue Inventory. The results show that: 1 .Postpartum fatigue occurred in 90%~96% of the subjects. Their Fatigue level ranged from mild to moderate, combined both physical and psychological signs, affected daily life mildly or moderately, and the fatigue decreased with time. 2. Personal variables (age, primiparous, delivery mode, socio-economic status) have no effect on postpartum fatigue. 3. Depression, breastfeeding problems, quality of sleep, and social support has significant effect on postpartum fatigue. 4. Depression and infant behavior affects postpartum fatigue differently at different postpartum time points. Total variance explained was 31.4% for fatigue at three weeks postpartum. Significant predictors included depression, age, breastfeeding problems, and mode of delivery. At six weeks postpartum, 22.9% of variances can be explained by nine factors with quality of sleep being a meaningful predictor. At nine weeks postpartum, 15.3% of variances can be explained by the nine factors with breastfeeding problems and infant behavior being meaningful predictors. These results can be used to design interventions for postpartum fatigue thus improving quality of life among postpartum women. The results suggested that medical professionals and general populations should be educated about postpartum fatigue using the TOUS. Longitudinal design with larger sample size is needed to further study the issue. Intervention can be designed to decrease postpartum fatigue.