唇顎裂嬰兒之母親的社會網絡互動系統對憂鬱情緒與接納態度的調節效果及主要效果

Abstract

生出唇顎裂兒的母親需面對新生兒顏面、生理雙方面的長期照養問題，因此母親本身之心理適應是值得深入探討的議題。本研究由「社會網絡互動系統觀」的角度切入，探討（1）正負向的社會網絡互動（社會支持與社會困擾）、（2）不同社會網絡互動類型（情緒、訊息與工具性）、（3）不同社會網絡來源（丈夫、父、母、公、婆）等三個面向對於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）效果與主要效果。共有50位進行過第一次唇修補手術的唇顎裂兒（平均年齡135天）及49位一般新生兒（平均年齡49天）之母親參與研究。本研究先比較這兩組母親於社會網絡互動系統中之各面向、憂鬱情緒以及對孩子的接納態度之差異。再以階層迴歸分析檢驗在排除了唇顎裂組母親於第一次修補手術之前的「初始衝擊」程度後，唇顎裂兒手術後母親所「覺知到的社會網絡互動系統」對其憂鬱情緒與接納態度的預測力。結果發現，兩組受試母親的憂鬱程度與接納程度沒有顯著差異，但相較於一般新生兒母親，唇顎裂兒母親覺知到較多支持。而且，唇顎裂兒母親的社會支持對於接納態度有顯著預測力；而社會困擾則同時對接納態度與憂鬱情緒都有顯著預測力，其與初始衝擊的交互作用也對接納態度有負向預測力，這些結果顯示了社會支持的主要效果及社會困擾的主要效果及惡化效果。本研究另發現情緒及訊息支持與接納態度有顯著相關，而訊息困擾與憂鬱情緒有顯著相關，丈夫的支持對於母親的接納態度有顯著預測力，而公婆與丈夫帶來的困擾都與母親的憂鬱情緒有顯著相關。本研究的結果符合社會困擾會影響正向心理適應指標的跨越效果假設，也顯示社會困擾對於唇顎裂兒母親的心理適應有獨立於社會支持之外的預測力。本研究另指出了特定類型的社會支持、困擾對唇顎裂兒母親的影響，以及華人家庭中所提供之社會網絡互動對唇顎裂兒母親心理適應的效果，並據以提出了在臨床介入時的具體建議。

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 thus is worth in-depth investigations. The present study adopted a system approach of social network interaction investigating (1) the positive/negative feature (i.e., social support and social undermining), (2) the types (i.e., emotional, informational, and instrumental support/undermining), and (3) the resource (i.e., husband, parents, and parents-in-law) of social network interaction. The goal was to examine the moderating effect (i.e., buffering or exacerbating) and main effect of the social network interaction system on maternal depression and attitude toward accepting the CLP child. Fifty mothers of CLP infants, who have already finished the first lip repair surgery (mean age = 135 days), and 49 mothers of healthy infants (mean age = 49 days) participated in this study. Between-group comparisons with respect to the perceived social network interaction system, the degree of depression, and acceptance toward the CLP infants were conducted. Mothers of CLP infants perceived more social support but were not more depressed or less accepting compared with those in the healthy group. Hierarchical regression analysis on the predictability of social network interaction system to degrees of depression and acceptance indicated that perceived social support significantly predicted the degree of acceptance; while perceived social undermining predicted both acceptance and depression, and its interaction with maternal sense of personal impact over giving birth to CLP infants predicted acceptance negatively. These findings supported the main effect of social support and the main and exacerbating effect of social undermining. This study also found that emotional and informational support were correlated with acceptance, informational undermining with depression, support from husband with acceptance, and social undermining from husband, mother-in-law, and father-in-law with depression. On the whole, this study supported the cross-over effect hypothesis of social undermining and suggested social undermining has a unique contribution, both in terms of main effect and moderating effect, toward maternal psychological adjustment of CLP infants. Moreover, this study also demonstrated that maternal adjustments were most vulnerable to several particular types of social support and social undermining, which may be related to the social network and interaction pattern embedded in Chinese family structure. Clinical suggestions derived from findings of this study were also provided.