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系統識別號 U0026-0812200913563014
論文名稱(中文) 華人憂鬱代間傳遞之縱貫性研究:家庭獨立性調節母親產後憂鬱對其學齡前兒童憂鬱症狀之影響
論文名稱(英文) A Longitudinal Study of Intergenerational Depression in Taiwan: Family Independence Moderates the Effect of Maternal Depression on Depressive Symptoms of preschool aged offspring
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 95
學期 2
出版年 96
研究生(中文) 陳琬萱
研究生(英文) Wan-Hsang Chen
電子信箱 s8693104@mail.ncku.edu.tw
學號 S8693104
學位類別 碩士
語文別 中文
論文頁數 73頁
口試委員 指導教授-柯慧貞
召集委員-謝碧玲
口試委員-葉光輝
中文關鍵字 兒童憂鬱症狀  母親產後憂鬱  家庭獨立性 
英文關鍵字 family independence  children’s depressive symptoms  maternal postpartum depression 
學科別分類
中文摘要 【研究背景】
研究發現兒童時期憂鬱會造成兒童往後發展出許多不良後果,憂鬱的兒童會有較多人際衝突和自殺意念,並且有較高的風險可能在往後成人時期也發展出憂鬱但是,有些研究指出母親憂鬱和兒童發展出憂鬱有關,但也有研究發現兩者沒有相關,研究結果並不一致;此不一致可能是因母親憂鬱與兒童憂鬱之關係會受到調節變項影響,而家庭獨立性可能是調節母親憂鬱和兒童憂鬱症狀間關係的因素。家庭獨立性在東西方文化上有不同的意涵,大致來說,東方屬於集體主義的社會(台灣、日本、韓國),西方屬於個體主義的社會,個體主義較重視的獨立自主,而集體主義較重視互依的關係,較不鼓勵獨立自主,也有較多的控制。過去研究指出,相較於西方個體主義社會下的兒童/青少年,東方集體主義社會(日本、韓國)的兒童/青少年知覺家中父母的控制較多和給予較少獨立自主,而且在高控制低獨立的家庭功能之下,也可以感受到父母的溫暖和被接受,相反的,如果父母給予較多獨立和較少的控制,兒童會覺得不被父母接受,也知覺到父母較少的溫暖;因此,在東方集體主義社會下,當母親憂鬱的時候,若家庭可以較不鼓勵獨立自主,給予較多控制,讓孩子感受到家庭的溫暖和接受,補償母親因為憂鬱而給予他們的孩子較少溫暖和愛,可能降低兒童發展出較多的憂鬱症狀。

【研究目的】
本研究目的:在控制兒童六歲時的母親憂鬱症狀之後,檢驗家庭獨立性是否能調節母親的產後憂鬱(產後八週)和其兒童六歲時的憂鬱症狀之關係。本研究假設:當母親產後八週有憂鬱症,家庭的低獨立性可以防止兒童六歲時發展出較多憂鬱症狀。

【研究方法】
參與者:本研究的參與者是國科會計畫『產後憂鬱症之前因與後果』長期追蹤的婦女及其子代(1994-1995),收集自成大醫院婦產科門診;總共有135對親子(68位男生; 67位女生)納入本縱貫性研究分析。研究工具:由專業研究員使用半結構式診斷晤談量表(CMSADS-L)評估母親產後憂鬱診斷,利用兒童行為情緒量表(CBECL)評估兒童的憂鬱症狀,家庭功能量表(FFS)評估家庭獨立性,貝氏憂鬱量表(BDI)評估母親憂鬱症狀。研究程序:在三個時間點(產後八週、兒童五歲、兒童六歲),每次研究員都先以打電話的方式詢問參與者是否願意參加本次研究,並以電話訪談的方式晤談當時母親的憂鬱狀況(current CMSADS),之後再郵寄量表給母親填寫。而後母親與其孩子分別帶入不同的實驗室開始進行衡鑑。

【研究結果】
利用多元階層迴歸分析家庭獨立性是否調節母親產後憂鬱和兒童憂鬱症狀間之關係,在控制兒童六歲時的母親憂鬱症狀後,母親產後憂鬱和家庭獨立性的交互作用可以顯著預測兒童的憂鬱症狀,且只有在家庭獨立性高分組中,母親的產後憂鬱才可以預測兒童有較多的憂鬱症狀。

【結論與建議】
在我們的文化之下,當母親產後八週憂鬱時,低家庭獨立性或許可以防止其子代在未來(六歲)發展出較多的憂鬱症狀,這個結果提供我們臨床上預防和介入的方針。本研究有一些限制,兒童的憂鬱症狀只有母親的報告資料,缺少其他人的評估資料,例如父親、老師的評估;經過長期追蹤,本研究「追蹤且有效」的參與者只剩33%,但是比較參與和非參與者,兩組在基本人口學上沒有顯著差異;另外,本研究是中型樣本,未來需更大的樣本來驗證此研究結果。


關鍵詞:兒童憂鬱症狀、母親產後憂鬱、家庭獨立性
英文摘要 【Background and Purpose】
Childhood depression has been found to be associated with a variety of adverse behavioral outcomes, interpersonal conflicts, suicidal ideation and attempts, and depression in adulthood. Therefore, children’s depression was worth investigating. Some studies have confirmed that maternal postpartum depression was correlated to depressive symptoms in the offspring, other studies have pointed to opposite findings. The findings were inconsistent. Family independence could be a moderating role between maternal postpartum depression and children’s depressive symptoms. Cultural differences on such issues have been gradually emphasized. Individualist cultures highlighted independence while collectivist cultures highlighted interdependence. Compared with individualist cultures, more family control (low family independence) were reported in collectivist cultures, and children also viewed family interdependence (more control) with a normative view. Some studies have noted that children of low independent families (more control and less autonomy) in collectivist cultures (Taiwan, Japan, and Korea) received warmth and acceptance. If other family members provided more control and less autonomy (low family independence), children with depressed mothers were compensated for the perception of their mother’s rejection and reduced warmth. Therefore, this longitudinal study examined whether family independence moderated the relationship of maternal postpartum depression at 8 weeks assessed by diagnostic interviews to children’s depressive symptoms at age 6. 

【Method】
In 1994-1995, participants were recruited to participant in the project, “The causes and consequences of postpartum depression” at the OBS/GYN Department of a national university hospital. One hundred and thirty-eight mother-child dyads (69 boys, 69 girls) were recruited in the final sample of this longitudinal study. Mothers completed the measures of maternal depression (CMSADS-L), Beck Depression Inventory (BDI), family independence (FFS), and children’s depressive symptoms (CBECL/4-16). T-test, x2, and Pearson correlation were used to examine demographic data and the relationships among all variables. A hierarchical regression analysis was used to explore whether the role of family independence moderated the association between maternal postpartum depression and depressive symptoms in their offspring.

【Results】
The present study found that the interaction between family independence and maternal postpartum depression at 8 weeks significantly predicted depressive symptoms in offspring at age 6. Further analyses showed that maternal depression predicted children’s depressive symptoms in families with high-family independence, but did not in families with low-family independence. 

【Discussion】
Our findings showed that low family independence in the Chinese culture, protected children with depressed mothers from developing depressive symptoms at age 6. The identification of protective factors for the development of children’s depressive symptoms informed the direction of preventive intervention. There are several limitations in this study. First, child depressive symptoms (CBECL) were only based on maternal reports. Second, the participants’ drop-out rate of this study was only 33.5%. Third, the present study possessed of a moderate-size sample.


Keywords: children’s depressive symptoms, maternal postpartum depression, family independence
論文目次 中文摘要------------------------------------------------I
Abstract----------------------------------------------III
致謝----------------------------------------------------V
目錄--------------------------------------------------VII
附錄目錄-----------------------------------------------IX
表目錄-------------------------------------------------IX
圖附錄-------------------------------------------------IX

第一章 緒論-------------------------------------------1
第一節 兒童憂鬱之重要性-------------------------------2
壹、兒童憂鬱之定義與臨床表現----------------------------2
貳、兒童憂鬱之盛行率------------------------------------4
參、小結------------------------------------------------6
第二節 母親產後憂鬱和兒童憂鬱之關係-------------------7
    壹、母親產後憂鬱之定義與盛行率------------------7
    貳、母親產後憂鬱對兒童憂鬱症狀之影響------------8
    參、小結---------------------------------------10
第三節 母親產後憂鬱、家庭獨立性與兒童憂鬱之關係------11
壹、家庭功能之相關理論---------------------------------11
貳、家庭功能之定義與測量-------------------------------13
參、家庭獨立性之定義-----------------------------------18
肆、家庭獨立性在中西方文化之差異-----------------------18
伍、家庭獨立性在憂鬱代間傳遞中的角色-------------------21
陸、小結-----------------------------------------------22
第四節 研究目的與假設--------------------------------23
壹、研究目的-------------------------------------------23
貳、研究假設-------------------------------------------23
第二章 研究方法--------------------------------------24
第一節 研究參與者------------------------------------24
第二節 研究工具--------------------------------------26
第三節 研究程序--------------------------------------29
第四節 統計分析--------------------------------------30
第三章 結果------------------------------------------31
第一節 人口學變項之分析------------------------------31
第二節 多元迴歸分析----------------------------------33
第三節 變項間之相關----------------------------------34
第四章 討論------------------------------------------35
第一節 研究結果之總結--------------------------------35
第二節 解釋與討論------------------------------------35
壹、家庭功能調節母親與其子代憂鬱代間傳遞之探討---------35
貳、相關重要因子之討論---------------------------------37
參、家庭功能測量之討論---------------------------------39
第三節    研究限制與未來方向-----------------------41
第四節    研究應用與建議---------------------------42
第五章 參考文獻--------------------------------------43
附錄目錄
附錄一、兒童情緒行為量表-------------------------------63
附錄二、家庭功能量表-----------------------------------70

表目錄
表一  家庭功能量表(FFS)初步向度整理一覽表----------53
表二  自主趨勢與融合趨勢在不同社會中的可能組合-------54
表三  本研究樣本中「追蹤且有效組」和「未追蹤或排除組」的基本人口學變項與重要變項之平均數和標準差---------------55
表四  兒童五歲時追蹤到且有效樣本的基本人口學變項,以及參與者和未參與者在基本資料上的比較-----------------------56
表五  兒童六歲時追蹤到且有效樣本的基本人口學變項,以及參與者和未參與者在基本資料上的比較-----------------------57
表六  階層迴歸分析:家庭功能是否調節母親產後憂鬱和兒童憂鬱症狀間的關係-----------------------------------------58
表七  階層迴歸分析:在家庭獨立性「高分組」,預測母親產後憂鬱是否會影響兒童憂鬱症狀-----------------------------59
表八  本研究重要變項之相關---------------------------60

圖附錄
圖一  環繞模式---------------------------------------61
圖二  家庭功能調節模式-------------------------------23
圖三  收案流程圖-------------------------------------62
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