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系統識別號 U0026-2608201322250600
論文名稱(中文) 育兒壓力中介第二色胺酸氫氧基化酶基因多型性對台灣婦女產後憂鬱症狀之影響
論文名稱(英文) Childcare Stress Mediates the Effects of Tryptophan Hydroxylase 2 Gene (TPH2) Polymorphism (C2755A) on Postpartum Depressive Symptoms of Women in Taiwan
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 101
學期 2
出版年 102
研究生(中文) 賴秋嬋
研究生(英文) Chiu-Chan Lai
學號 s86994013
學位類別 碩士
語文別 中文
論文頁數 71頁
口試委員 指導教授-柯慧貞
口試委員-張峰銘
召集委員-藍先元
口試委員-陳彰惠
中文關鍵字 第二色胺酸氫氧基化酶基因  產後憂鬱症狀  育兒壓力煩惱程度 
英文關鍵字 TPH2  Postpartum depressive symptoms  Childcare stress distress level 
學科別分類
中文摘要 研究背景與目的:
本研究旨在釐清第二色胺酸氫氧基化酶基因(Tryptophan Hydroxylase 2 Gene, TPH2)、育兒壓力煩惱程度及產後憂鬱症狀之關係。由於TPH 2與人類大腦血清素的合成有關,並且,過去研究已證實TPH 2與憂鬱有關,本研究小組更進一步發現TPH2-C2755A與婦女情緒障礙有關。由於先前研究也證實育兒壓力事件與婦女產後憂鬱症狀的相關性;亦有研究認為TPH 2可能與壓力反應歷程有關。是故,本研究假設TPH2-C2755A透過育兒壓力煩惱程度之中介,影響產後憂鬱症狀嚴重度。
研究方法:
本研究資料係取自國科會計畫『產後憂鬱症之前因與後果』所蒐集之資料;其中200位婦女參與抽血檢驗,最終有147位婦女完成產後八週之追蹤調查。該研究於懷孕期36週時邀請孕婦進入研究,填寫研究參與同意書後進行抽血,用以檢驗單一核苷酸基因多型性標誌。另外,於婦女產後8週時,以育兒壓力量表評估育兒壓力事件數與其育兒壓力煩惱程度;另以貝氏憂鬱量表評估婦女的產後憂鬱症狀。
結果:
多元階層迴歸分析結果顯示,TPH2- C2755A會透過婦女主觀育兒壓力煩惱程度之中介而影響產後憂鬱症狀;資料顯示,婦女TPH2- C2755A 為AC基因型者,感受到較高程度的育兒壓力,進而出現較高的憂鬱症狀。
結論與建議:
本研究發現婦女在TPH2-C2755A 為AC基因型者,育兒壓力煩惱程度較高,而產後憂鬱症狀也較高。在基因檢測的倫理考量下,不主張對周產期婦女進行基因檢測,但可於婦女產後返診時,評估育兒壓力煩惱程度和產後憂鬱症狀,以儘早了解婦女之育兒壓力與產後憂鬱風險,並適度協助其因應育兒相關壓力與調節情緒。
研究限制:
本研究的限制包含,未測量血清素濃度或腎上腺皮質醇等生理指標作為輔助參考;僅以TPH2單一基因多型性標誌做為研究變項,研究結果的推論上需要更加謹慎。此外,本研究參與人數較少,未來需要更大的樣本數來驗證此研究結果。
英文摘要 The tryptophan hydroxylase 2 Gene, TPH2, is related to serotonin synthesis of the human brain. Previous studies have verified the relation between gene polymorphism in serotonin system and postpartum depressive symptoms. In addition, the relationship between childcare stress events and postpartum depressive symptoms has also been proven in preceding researches. However, a comprehensive model of gene and distress levels about childcare in the formation process of postpartum depressive symptoms has not yet to be clarified. This research aimed to examine the influence of gene polymorphism (TPH2- C2755A) on the postpartum depressive symptoms among women through childcare distress level. Data were collected from the National Science Council’s grant on “Causes and Effects of Postpartum Depression, 1996” . A hundred and forty-seven women completed the whole research process. All of the women provided written informed consent. Women were invited during their 36 weeks of gestation and their blood was collected for testing a single nucleotide gene polymorphism. Postpartum depressive symptoms were measured using the Beck Depression Inventory-Chinese version and then distress levels of childcare stress were assessed by the Childcare Stress Inventory 8 weeks after delivery. Hierarchical regression analyses showed that the TPH2 gene polymorphism C2755A predicted postpartum depressive symptoms, and was mediated through childcare stress distress levels. Women who had the gene polymorphism (TPH2- C2755A) with AC heterozygote experienced a higher degree of childcare stress and tended to have more serious symptoms of depression. Gene polymorphism (TPH2- C2755A) among women with different genotypes might have direct influences on the postpartum depressive symptoms through the distress levels of childcare. The present research indicated that the stressful events about childcare not only the women who had the gene polymorphism (TPH2- C2755A) with AC heterozygote but also the postpartum depressive women have the highest distress towards regarding childcare preparation and self-adjustment. It is highly suggested that clinical practitioners can provide postpartum depressive women health knowledge and care skills of newborn physical development, principles of timetable regulate, feeding strategies, and sleep health education.
論文目次 中文摘要I
英文摘要III
誌謝V
目錄VII
表目錄IX

第一章 研究背景1
第一節 產後憂鬱研究之重要性1
一、產後憂鬱的症狀表現及盛行率1
二、產後憂鬱對婦女及伴侶的負面影響2
三、產後憂鬱對子代的負面影響3
第二節 產後憂鬱之遺傳與壓力因素探討5
一、產後憂鬱的遺傳研究6
(一)產後憂鬱的不同遺傳研究6
(二)第二色胺酸氫氧基化酶(TPH2)基因與憂鬱症狀之相關研究10
二、產後憂鬱症狀與育兒壓力之探討13
(一)育兒壓力的內涵13
(二)產後憂鬱症狀與育兒壓力之相關研究15
三、基因與壓力之間的關係17
(一)壓力的定義17
(二)TPH2與壓力反應之相關研究 17
四、小結19
第三節 研究目的與研究假設22
第二章 研究方法23
第一節 研究參與者23
第二節 研究工具23
第三節 研究程序26
第四節 統計分析27
第三章 研究結果28
第一節 基本資料表之人口學變項和臨床變項分析28
第二節 CC和AC基因型婦女人口學變項和臨床變項之分29
第三節 研究變項之相關分析30
第四節 多元階層迴歸分析31
第五節 育兒壓力量表之因素分析 32
第六節 育兒壓力煩惱程度的分析 34
第四章 討論35
第一節 研究結果之總結35
第二節 研究結果之解釋和討論36
一、產後八週憂鬱症狀之結果探討36
二、TPH2- C2755A、婦女教育年數、育兒壓力煩惱程度以及產後八週憂鬱症狀相關之探討36
三、育兒壓力煩惱完全中介TPH2-C2755A預測婦女產後八週憂鬱症狀之探討 38
四、婦女知覺到的育兒壓力因素之探討39
第三節 研究限制與未來研究方向 42
第四節 研究的臨床應用和建議43
第五章 參考文獻45
附錄
附錄一 育兒壓力量表 68
附錄二 貝氏憂鬱量表 70

表目錄
表一 追蹤和流失追蹤組婦女的人口學變項及臨床變項58
表二 CC與AC基因型婦女的人口學變項及臨床變項60
表三 TPH2-C2755A、婦女的教育年數、育兒壓力煩惱程度與產後八週憂鬱症狀之相關分析62
表四 產後八週憂鬱症狀的階層迴歸分析:以TPH2-C2755A、育兒壓力煩惱程度為預測變項62
表五 育兒壓力量表探索性因素分析摘要表63
表六 育兒壓力量表之適配度考驗指數66
表七 CC和AC基因型婦女在育兒壓力量表的因素分數67
表八 正常組和產後憂鬱組婦女在育兒壓力量表的因素分數67
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