探討早產兒父親之父子依附關係及相關心理社會影響因素

Abstract

研究背景與目的：隨著醫療科技的進步，讓許多低體重早產兒的存活率大幅提昇。對於出生後住在加護病房的早產兒，父親是第一個月最常接觸早產兒的重要關係人。本研究旨在了解早產兒父親在面臨此壓力事件時，其父親人格特質、心理狀態與父子依附關係之相關性，並分析影響父子依附關係之相關因素。 研究方法：本研究採取縱貫式研究設計(Longitudinal Design)，以結構式問卷重複測量方式收集資料。分別於早產兒出生後進入新生兒加護病房一週內與出生滿一個月後進行資料收集，研究對象取自台灣北部某兩家醫學中心新生兒加護病房，資料收集自2010年6月至2011年7月期間，採立意取樣(Purposive Sampling)，共收得50位新生兒加護病房之早產兒父親。有效樣本數為37位，回收率達74%。 研究工具：本研究採用結構式問卷與病歷查閱的方式來收集資料，依研究架構中的概念分為三大部分：包括研究對象人口學資料包括:基本資料表、華人健康量表(CHQ-12)以及艾氏人格量表中文版(EPQ) ; 心理狀態部份包括雙親不確定感認知量表(PPUS)、 情境焦慮量表、流行病學研究中心憂鬱量表(CES-D) ;以及測量父子依附關係之父子依附關係量表。經整理編碼後，採SPSS 17.0進行統計。 研究結果：研究參與的早產兒父親介於21~52歲，平均年齡為35.06歲(SD=5.24)，教育程度為大學/學院共21人(42%)佔最多數，人格特質有八成以上皆為外傾性高者。在早產兒部份以女生為多數，大部分都是第一胎，平均週數則為29週又6天，平均出生體重則為1238.3公克，疾病嚴重程度平均為16.44分。 在基本屬性中，父親的宗教信仰和出生滿一個月後的不確定感和焦慮感等心理狀態因素分別達顯著差異(F=3.54, p<0.05; F=4.95, p<0.05)；父親人格特質在出生一週內和早產兒父親之不確定感、焦慮感達顯著差異(t=2.10, p<0.05; t=3.29, p<0.05) ，而在出生滿一個月後和早產兒父親之人格特質和焦慮感及憂鬱情形等心理狀態因素有達顯著差異(t=2.55, p<0.05; t=2.25, p<0.05)；早產兒出生體重和出生一週內的早產兒父親之不確定感、焦慮感分別達顯著差異(F=3.55, p<0.05; F=3.24, p<0.05)；父親教育程度和出生滿一個月後的父子依附關係達顯著差異(F=3.85, p<0.05)；早產兒出生週數和出生一週內及出生滿一個月後的父子依附關係分別達顯著差異(t=2.42, p<0.05;t=2.08, p<0.05)，且早產兒疾病嚴重度和出生一週內及出生滿一個月後的父子依附關係分別達顯著差異(F=3.45, p<0.05; F=2.66, p<0.05) 。 在早產兒父親心理狀態變化中，不確定感、焦慮感皆隨著時間不同而有降低之趨勢，且不確定感的變化情形有顯著差異(t=4.09, p<0.001)；而父子依附關係之變化情形則隨著時間而有顯著增加(t=-8.30, p<0.001)。在心理狀態中，以不確定感和父子依附關係間有負相關(γ= -0.39, p<0.05），且父親的人格特質外傾性程度和不同時期的父子依附關係皆有達顯著正相關(γ=0.28, p<0.05; γ=0.38, p<0.05) ，父親人格特值外傾性傾向愈明顯者會有較好的父子依附關係。出生一週內以及出生滿一個月後的不確定感和焦慮感分別達統計顯著正相關(γ=0.51, p<0.01; γ=0.33, p<0.05)；且焦慮感和憂鬱情形亦分別達統計顯著正相關(γ=0.67, p<0.01; γ=0.70, p<0.01)。 不論出生一週內或是出生滿一個月後的父子依附關係，其重要預測變項為(1)早產兒出生時的疾病嚴重程度愈低，可預測其父子依附關係愈佳；(2)早產兒父親的外傾性人格特質傾向愈大者，可預測其父子依附關係愈佳(F=0.51, p<0.001; F=0.33, p<0.001)。 討論及臨床應用：由研究結果可得知早產兒的狀況好壞以及病況的不確定感對父親的影響程度之大，甚而影響至出生一個月後的父子依附關係的建立。臨床醫護人員更應主動提供資訊並給予支持，將早產兒父親納入以家庭為中心的照護中，以協助獲得較佳的心理壓力調適和父子依附關係的建立。

Background and Purposes: The survival of preterm infants increased remarkably with the advancement of medical science and technology. Fathers played the key role for those preterm infants who lived in neonatal intensive care unit during the first month after birth. This study aimed to explore the correlation between father’s personality characteristic, psychosocial factors and father- infant attachment while facing this stressful event, and to analyze the factors that affect father-infant attachment. Methods: A longitudinal design was conducted, and data were collected by a structured- questionnaire repeated measurement in two times when the preterm infant admitted to neonatal intensive care unit after delivery in the first week and first month. A total of 50 eligible subjects, fathers, was selected by the purposive sampling from the neonatal intensive care unit of two medical canters in north Taiwan during June 2010 to July 2011. The total valid sample size was 37 with a response rate of 74%. Measurement: The data were collected by the structured questionnaires and chart review. The questionnaires include (1). the demographic information, Chinese Health Questionnaire (CHQ-12) and Eysenck Personality Questionnaire (EPQ); (2). the psychological status including Parent’s Perception of Uncertainty in Illness (PPUS), State-Trait Anxiety Inventory (STAI) and Center for Epidemiologic Studies Depression Scale (CED-S); and (3). the Father-Infant Attachment Inventory. The data were analysed by the Software SPSS 17.0. Results: The subjects aged from 21 to 52 (M = 35.06, SD = 5.24), the majority educational level in college (42%) and nearly 80% personality characteristic are introversion-extroversion. Most of preterm infants were female and the average gestation age were 29 weeks more 6 days, the average birth weight were 1238.3 gm, the average of Neonatal Therapeutic Intervention Scoring were 16.44. There were significant differences between the religion of father and uncertainty of illness and status of anxiety in the first month (F=3.54, p<0.05; F=4.95, p<0.05). The personality characteristics of father were significantly different to the uncertainty of illness and status of anxiety in the first week (t=2.10, p<0.05; t=3.29, p<0.05), and there were also significant differences between the status of anxiety and depression in the first month (t=2.55, p<0.05; t=2.25, p<0.05). Moreover the birth weight of preterm infant was significantly different to the uncertainty of illness and status of anxiety in the first week (F=3.55, p<0.05; F=3.24, p<0.05). Father’s educational background were significantly different to the father-infant attachment in the first month (F=3.85, p<0.05), and the gestational age and Neonatal Therapeutic Intervention Scoring Scale were the significant factors related to the father-infant attachment in the first week (t=2.42, p<0.05; F=3.45, p<0.05) and in the first month (t=2.08, p<0.05; F=2.66, p<0.05). The score of uncertainty of illness and anxiety of preterm fathers were decreased, the uncertainty of illness were significantly changed (t=4.09, p<0.001) and attachment were significantly increased during the first month (t=-8.30, p<0.001). The uncertainty of illness significantly negative correlated to the father-infant attachment (γ= -0.39, p<0.05). The fathers’ extroversion of personality characteristic were significantly positive correlated to the father-infant attachment in different times during one month (γ=0.28, p<0.05; γ=0.38,p<0.05). Participants who had more extroversion of personality characteristic were provided a better father-infant attachment. There was significantly positive correlation between anxiety and uncertainty of illness in both the first week (γ=0.51, p<0.01) and the first month (γ=0.33, p<0.05); and the score of anxiety also was significantly positive correlated to the depression in the different two times (γ=0.67, p<0.01; γ=0.70, p<0.01). The predictors of father-infant attachment in both the first week and the first month were the extroversion of personality characteristic and the level of Neonatal Therapeutic Intervention Scoring (F=0.51, p<0.001; F=0.33, p<0.001). Conclusions and applications in nursing: The findings indicate that the condition of preterm infant and the uncertainty of illness deeply influence these preterm fathers, even to determine the father-infant attachment in the first month. Clinical health providers should involve the preterm fathers into the “Family centered care” and provide related information to help them have better adaptation and attachment during the first month of their pretem infants staying in the NICU.