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

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 obstetricsrelated 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%. Woman with spontaneous delivery had a higher rate of early maternalinfant 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 maternalinfant 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 maternalinfant 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.