團體人際心理治療對嬰幼兒母親適應狀況之影響研究

An Outcome Study of Interpersonal Psychotherapy Group on Adjustment of Mothers with Infants and Toddlers

本研究旨在探討團體人際心理治療對臺灣嬰幼兒母親適應問題之影響。立意招募育有3歲內嬰幼兒之母親接受團體介入（共35人）。以貝克憂鬱量表第二版來看，憂鬱分數達界斷值之憂鬱傾向者有48.57%；以孩子年齡來看，未滿1歲之嬰兒母親為45.71%。每梯次團體為8次，每次90分鐘，本研究共進行6梯次。參加者中有4位流失，31位持續參與，持續參加者之出席率為89.1%。研究對象於基準期、團體後、團體結束3個月後，填寫貝克憂鬱量表第二版、配對適應量表、社會支持問卷、愛丁堡產後憂鬱量表、母嬰連結量表及基本資料表。為了解對嬰兒母親之介入效果，另選取他項研究中僅接受縱貫評估之嬰兒母親為對照樣本。以意向分析對遺漏之資料進行插補，以描述統計、相依樣本單因子／二因子混合設計變異數分析進行資料整理，發現團體人際心理治療可降低嬰幼兒母親之憂鬱，對基準期具憂鬱傾向者尤為明顯，且憂鬱傾向者對先生支持的知覺在團體結束3個月後有提升。另外，以嬰兒母親來看，介入組之母嬰連結感有上升，對照樣本則無變化。由結果推測團體人際心理治療對促進嬰幼兒母親之適應有正向效果，但這些效果會隨著樣本特徵（基準期憂鬱狀態、孩子年齡）而異。研究者對研究結果之意涵及未來的研究與實務方向進行討論。

The process of becoming a mother has an effect on the physical and psychological well-being of a woman. Mothers of infants and toddlers often encounter challenges in meeting their needs and their families' needs. Interpersonal relationships play a crucial role in a woman's transition to motherhood. According to Klerman et al. (1974), interpersonal relationships are a core element of interpersonal psychotherapy, which is an appropriate intervention for women having difficulty transitioning to motherhood. Psychotherapy in a group format has several unique therapeutic advantages compared with individualized psychotherapy. For example, participants of group psychotherapy can imitate others and practice their interpersonal behavior in a group setting. Klier et al. (2001) explored the effectiveness of an interpersonal psychotherapy group (IPTG) for postpartum depression . However, their participants were all infant mothers with major depressive disorder. Whether IPTG is effective in preventing adjustment problems among mothers with infants and toddlers is unknown. Furthermore, no study has evaluated the effects of IPTG among Taiwanese women. Therefore, this study evaluated the effects of IPTG on the adjustment problems of Taiwanese mothers with infants and toddlers. We addressed three research questions. First, what is the effectiveness of IPTG on the adjustment of infant/toddler mothers? Second, what are the effects of IPTG on mothers with and without postpartum depression tendencies? Third, what are the differences in postpartum changes between mothers receiving and not receiving IPTG?
We conducted this study after the approval of the Institutional Review Board of Chung Shan Medical University Hospital (CS14052 and CS2-15048). We recruited mothers of children younger than three years old by using the motto: "Wish to enjoy life, learn to fulfill the needs of yourself and your family, and exchange life tips with other mothers of young children." In total, 35 women participated in the IPTG. We conducted six courses of IPTG. Each course consisted of eight sessions of 90 minutes. An IPTG intervention was formulated based on the treatment manual developed by Reay et al. (2012) and the relevant literature. Group discussions also incorporated issues raised by group participants. Outcome indicators were depression severity and relationship status (i.e., marital relationship, social support, and mother-infant bonding). The instruments were the background questionnaire, the Beck Depression Inventory-Second Edition, the Dyadic Adjustment Scale, the Social Support Questionnaire, the Edinburgh Postpartum Depression Scale, and the Mother-Infant Bonding Inventory. Participants completed the assessment before (baseline), immediately after, and three months after the final IPTG session. Between-group comparisons were conducted by two kinds of grouping. One was participants with depressive tendencies (N = 17, 48.57%) or not. The other was infant mothers who received the intervention (N = 16, 45.71%) or not (recruited from other studies, N = 16) (Shieh, 2017a, 2018). Intent-to-treat analysis was applied. After imputation for missing data, we conducted analysis strategies of descriptive statistics, and one-way/two-way ANOVA. If the temporal effects and post hoc comparisons provided significant results, we continued further analyses to identify item-level differences.
The study's main findings are: (1) IPTG has a preventive effect on postpartum depression. Depression severity was lower after the intervention than at baseline. Among participants with depressive tendencies, depression severity immediately after and three months after the intervention was lower than that at baseline. The findings of Klier et al. (2001), Reay et al. (2006), and Mulcahy et al. (2010) indicated immediate and continuing effects on mothers of infants with a diagnosis of major depressive disorder. Our results indicated that IPTG ameliorates depressive symptoms among mothers with symptoms of depression but does not receive a major depressive disorder diagnosis; (2) IPTG has a partial effect on preventing relationship problems for participants. In women with symptoms of depression, perceived husband support was higher three months after the intervention. This finding suggests that the effects of IPTG manifest after a longer interval. We used a two-way ANOVA mixed design to examine the interaction effects of the three evaluation times and the two age groups (i.e., infant group and, toddler group). No significant temporal changes were noted in infant mothers, while significant temporal changes were found in toddler mothers. The results indicated that perceived husband support was higher for toddler mothers than for infant mothers. Our findings are consistent with those of Reay et al. The add-on finding of the present study is that IPTG enhances perceived husband support for toddler mothers. According to the item-level analysis, the improvement in perceived husband support is specifically due to husbands' involvement in housework; and (3) IPTG has a partial effect on preventing bonding problems for infant mothers. Our results indicated several specific changes in mother-infant bonding factors (parental adjustment, confidence, and commitment) and items (more calm, confident, and emotionally engaged in caring for the child). Mulcahy et al. suggested that communication in IPTG improves mother-infant bonding. In group settings, mothers have the opportunity to share their parenting experiences. The perceived universality of their experiences might lessen mothers' feelings of incompetence. Thereby the relationship conflict with infants can be moderated.
This study is the first to explore IPTG's effectiveness in helping Taiwanese mothers adjust to postpartum changes. Limited evidence for the preventive effects of IPTG on adjustment problems is available in the literature. Our study provides preliminary evidence of its effectiveness for mothers with young children. Our results indicate that IPTG can decrease depression severity for women with postpartum adjustment problems. For women with depressive tendencies, IPTG effectively enhances their perceived husband support. Also, for infant mothers, IPTG facilitates their bonding with their children. Accordingly, IPTG is a suitable intervention for promoting the well-being of mothers with young children. However, because the results are correlated to the content of the intervention, the assessment tools adopted, and the characteristics of participants (i.e., baseline depressive symptom, children's age), the results should be generalized with caution. One issue that warrants further investigation is using tailored assessments to obtain women's experiences before and after the intervention. Second, the mechanism of change should be explored. The source of the positive changes is a crucial factor to consider when formulating a better intervention. Whether the interpersonal psychotherapy elements (the topics introduced in the intervention according to interpersonal psychotherapy problem domains, such as role transition, interpersonal conflict, and interpersonal sensitivity) and/or group elements (number of group sessions, the length of each session) play essential roles in the outcome is unknown. A follow-up evaluation over three months is warranted to gain a more comprehensive understanding of the long-term effects of IPTG. The interventions should be modified according to the experience of Taiwanese participants. Finally, the proportion of toddler mothers (54.29%) is higher than that of infant mothers. It might highlight the toddler mothers' needs for mental health services. Toddler mothers should be routinely included in our mental services scheme. Furthermore, infant mothers' obstacles to receiving relevant services should be assessed.