唇顎裂嬰兒之母親的社會網絡對憂鬱與接納的調節及主要效果

The Contribution of Social Network Interaction System on Maternal Depression and Acceptance of Cleft Lip and/ or Palate Infants: Moderating and Main Effect

本研究以「社會網絡互動系統觀」的角度探討（1）正負向社會互動（社會支持／困擾）、（2）社會網絡互動類型（情緒、訊息與工具性）、（3）社會網絡來源（丈夫、娘家、夫家）對唇顎裂兒母親的憂鬱情緒與對嬰兒的接納態度的調節（緩衝或惡化）與主要效果。受試者為50位已完成第一次唇修補手術的唇顎裂兒（平均年齡4.5個月）之母親。階層迴歸分析顯示，在排除嬰兒性別、母親教育程度、母親產後的初始衝擊程度後，社會支持仍可預測接納。再排除社會支持及其與衝擊的交互作用後，社會困擾仍可預測接納及憂鬱，而其與衝擊的交互作用也仍可預測接納。亦即社會支持對母親適應具有主要效果。社會困擾對母親適應則具有獨立於社會支持以外的主要及惡化效果；且社會困擾具預測正向心理適應的跨越效果。本研究另發現丈夫支持可增進母親對唇顎裂兒的接納、夫家困擾提升母親的憂鬱、夫家支持則可緩衝初始衝擊對母親之接納態度的負向效果，顯示在華人家庭中唇顎裂兒母親的心理適應與夫家的連動關係。

Mothers of cleft lip and/ or palate (CLP) infants have to face chronic facial, physical, and psychological problems of their children. The psychological adjustment of those mothers may be both affected and moderated by their social network. The present study adopted a system approach to investigate the moderating (i.e., buffering or exacerbating) and main effect of (1) the positive/ negative feature (i.e., social support/ undermining), (2) the types (i.e., emotional, informational, and instrumental support/ undermining), and (3) the resources (i.e., husband, parents, and parent- in- laws) of social network interaction on maternal depression and acceptance toward CLP infants. Fifty mothers of CLP infants filled up the questionnaire for assessing perceived impact over giving birth to CLP infant while their children were in average two months of age. They then filled up the Beck Depression Inventory (Chinese Version), the Rearing Attitude Questionnaire (Liu & Lay, 2005), and the Social Network Interaction System Questionnaire (Lay & Liu, 1996) following the completion of the first lip- repair surgery (mean age = 4.5 months). After controlling for infant gender, maternal educational level, and perceived initial impact, hierarchical regression analyses indicated that maternal perceived social support significantly predict acceptance toward CLP babies (β = .27, p < .01). Next, even when the variance of social support and its interaction with perceived impact had been controlled, maternal perceived social undermining could still independently predict acceptance and depression (βs = -.21 & .30, ps < .05) and the interaction between social undermining and perceived impact could still predict acceptance (β = -.23, p < .05). These findings not only yielded the main effect of social support but also revealed the main and exacerbating effect of social undermining (Cranford, 2004) on maternal psychological adjustment over and beyond the influence of social support. In addition, the predictability of undermining toward acceptance confirmed the cross- over effect of negative social interaction on positive adjustment index (Newsom, Nishishiba, Morgan, & Rook, 2003). This study also found that emotional and informational support correlates with acceptance (rs = .39 & .30, ps < .01 & .05), emotional support with depression (r = -.35, p < .05), emotional and informational undermining with depression (rs = .28 & .35, ps < .06 & .05), support and undermining from husband with acceptance (rs = .33 & -.33, ps < .05), and undermining from husband and in- laws with depression (rs = .35, .33, & .41, ps < .05). Hierarchical regression analyses further indicated that, for those mothers who perceived larger initial impact of giving birth to CLP babies, more instrumental support does not predict increased acceptance. The differential effect of various features, types, and resources of social network on maternal adjustment points to the domain specificity (Finch, 1998) of the social network interaction system. Explicitly, emotional support and undermining as well as instrumental support and undermining play significant roles for maternal adjustment. Meantime, it is suspected that too much instrumental support may deprive maternal sense of control thus hamper adjustment of mothers with high perceived impact. Moreover, that maternal adjustment is more in tune with the support and undermining provided from husband and in- laws may be related to the interaction pattern embedded in Chinese family structure.