腦性麻痺孩童照顧者親職壓力之兩年追蹤研究

Abstract

本研究有兩個目的：(1) 利用橫斷式研究設計確認腦性麻痺兒童照顧者親職壓力之影響因子，以及(2) 追蹤親職壓力與其影響因子兩年的時間。 親職壓力以中文版短版的親職壓力量表來評量，其包含三層面：(1)照顧者相關的壓力，(2)孩童相關的壓力，以及(3)照顧者-孩童互動相關的壓力。本研究建立三個多元線性迴歸模型以確認三層面的親職壓力的影響因子。潛在影響因子亦包含三領域，(1)孩童相關因子，(2)照顧者相關因子，以及(3)環境因子。本研究亦建立三個廣義估計方程式來分析三時間點的三層面親職壓力及其影響因子。 多元線性迴歸模型顯示不同層面的親職壓力有不同的影響因子，但每層面的影響因子皆包括孩童相關因子、照顧者相關因子以及環境因子。其中，認知導向適應性型態為三層面親職壓力共同之影響因子。 廣義估計方程式分析顯示，三層面之親職壓力在兩年期間皆無顯著變化。三層面之親職壓力與其第一年之影響因子在兩年期間持續有顯著相關。此外，從第一年到第二年的時間，照顧者相關的壓力與孩童利社會行為的關聯由正相關轉為負相關。並且，與第一年相較之下，孩童的同儕問題對照顧者-孩童互動相關的壓力的影響於第二年時變大。 本研究結果可協助臨床治療師由橫斷性以及縱貫性的觀點，對腦性麻痺孩童照顧者的親職壓力提供合適的預防與介入方案。

This research had two purposes: (1) to identify determinants of parenting stress in caregivers of children with CP using a cross-sectional design, and (2) to follow-up parenting stress and its determinants for two years. The Chinese version of Parenting Stress Index short form (PSI/SF-C) was used to assess parenting stress, comprising of three domains, caregiver-related stress, child-related stress, and stress in the caregiver-child relationship. Three separate multiple linear regression models were conducted to identify the determinants of three domains of the PSI/SF-C. Potential determinants encompassed three domains: child-related factors, caregiver-related factors, and environmental factors. Three Generalized estimating equations (GEEs) were used to assess the repeated measures of three domains of the PSI/SF-C and their determinants identified at the entry point. Multiple regression model analyses revealed that different domains of the PSI/SF-C had different determinants, but determinants of each domain of the PSI/SF-C encompassed child-related, caregiver-related, and environmental factors. Particularly, cognitive approach coping pattern was the common determinant shared by all three domains of parenting stress. GEEs analyses revealed that all three domains of parenting stress had no significant changes over the two years. Significant associations between three domains of the PSI/SF-C and their determinants identified at the entry point were found. In addition, the association between caregiver-related stress and prosocial behavior changed from positive to negative at Time 2. The association between peer problems and stress in the caregiver-child relationship increased. Findings of the research help clinicians plan appropriate preventions and interventions on parenting stress from both cross-sectional and longitudinal perspectives.