[[alternative]]Psychological Health and Parenting Stress Among Women who Conceived Assisted Reproductive Technology: A Triangulation Study

[[abstract]]本研究目的乃在探討接受人工協助生殖科技治療後的懷孕婦女在孕育期之心理健康及親職壓力之時序變化與其相關因子，並探索這群婦女在歷經不孕後經由人工協助生殖科技治療成功生育子嗣的生活經驗。 研究設計方法採三角交叉法，量性研究採縱向設計中的時間序列研究，以台北市某醫院之生殖中心為研究場域，透過網路的問卷調查系統調查三個孕期的母胎依附、孕期壓力、焦慮、憂鬱、社會支持與婚姻關係以及產後二個月的焦慮、憂鬱、社會支持、婚姻關係與親職壓力，總計收取有效樣本158人。質性研究由量性研究中的樣本，抽取接受人工協助生殖科技治療後成功受孕生產，以產後逾二個月之婦女為研究對象，經由一對一的深度訪談來收集資料，收案11人。 量性研究結果三個孕期的焦慮以第一孕期42.30±11.11分為最高，過了第一孕期後婦女的焦慮下降，第二孕期與第三孕期呈現較為穩定的狀態，依序為38.03±10.58分以及38.39±10.36分，而在產後時期焦慮則又上升為41.18±11.68分。三個孕期的憂鬱以第一孕期8.43±4.44分最高，第二孕期為7.21±4.23分、第三孕期則為6.99±4.11分，顯示懷孕婦女的憂鬱在三個孕期呈現逐步下降的趨勢，然而在產後時期憂鬱則又上升為8.39±5.25分。以10分為憂鬱的分割點時，第一孕期有憂鬱症狀者66人(36.9%)、第二孕期為45人(25.7%)、第三孕期為46人(27.4%)、產後時期為55人(34.8%)。 以不同長期追蹤模式來評估心理健康的長期發展，結果發現與焦慮有關的因素為時間變化、懷孕壓力、社會支持、母胎依附、合併中醫治療、胎兒數、母親年齡。與憂鬱有關的因素為時間變化、懷孕壓力、社會支持、孕期不適、合併中醫治療、結婚期間。質性研究結果發現婦女歷經不孕後經由人工協助生殖科技治療成功生育子嗣的生活經驗涵蓋了三個主題：自己與一般自然受孕的母親是不同的、努力確保腹中胎兒的安全與喜迎新生命的到來。 歷經不孕接受人工協助生殖科技治療後懷孕的婦女其第一孕期與產後二個月的焦慮、憂鬱程度較高，不同長期追蹤模式結果顯示壓力與社會支持是影響孕期與產後時期心理健康的重要因子，本研究結果可提供人工生殖機構所屬人員照護婦女時之參考。 本研究建議臨床醫護人員應於婦女的第一孕期與產後二個月時，發展合宜的介入措施以降低婦女的孕期壓力與親職壓力，而社會支持在抵禦周產期的焦慮與憂鬱時可以扮演一個保護性的因子，因此適當的社會支持介入將是合宜也是必須的。[[abstract]]The purpose of this study was to investigate changes over time in related factors for the psychological health and parenting stress during the first, second and third trimesters of pregnancy and postpartum among women who conceived assisted reproductive technology, and to explore the lived experience of pre-expectancy, expectancy and parent phase for two months postpartum. This study adopted a mix-method research design, including a quantitative longitudinal and time-series design repeated measure and a qualitative phenomenon approach. The instruments included: Modified Maternal Fetal Attachment Scale, Pregnancy Stress Rating Scale, State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Maternity Social Support Scale, Intimate Bond Measure and Parenting Stress Index. In quantitative research, a convenience sample consisting of 158 pregnant women at a fertility center in Taiwan completed a web-based questionnaire. In qualitative research, a purposive sample consisted of 11 women two months after delivery, and data were collected through one-on-one interviews. The results showed that women who conceived assisted reproductive technology felt more anxious in the first trimester, and that state anxiety score was 42.30±11.11. After the first trimester, state anxiety score decreased and existed in a stable state. The second and third trimesters were 38.03±10.58 and 38.39±10.36, respectively. At two months postpartum, anxiety score increased to 41.18±11.68. The EPDS scores for the first, second, and third trimesters were 8.43±4.44, 7.21±4.23, and 6.99±4.11, respectively. We found that melancholy decreased smoothly through the pregnancy. However, at two months postpartum, EPDS score increased to 8.39±5.25. Using EPDS ≧10 as the cut off score of depression, the prevalence of depression in the first, second, third trimester and postpartum two months were 36.9%, 25.7%, 27.4%, and 34.8%, respectively. Three GEE time-varying longitudinal models were used to evaluate the longitudinal development of women’s psychological health. The result showed the risk factors for anxiety included the time change, pregnancy psychological stress, social support, maternal-fetal attachment, received Chinese herbals, number of fetus, and age. The related factors for depression included the time change, pregnancy psychological stress, social support, received Chinese herbals, and length of marriage. The qualitative data were analyzed by using Colaizzi’s phenomenological approach, and three themes emerged from the interview data: the conception processes of IVF different from the natural conception, ensuring the fetus safety, and the coming new joyful life. In first trimester and two months postpartum, women who conceived assisted reproductive technology felt more anxious and depressed. Three time-varying longitudinal models found the pregnancy psychological stress and social support would be the most important predictors for psychological health. Our findings may help healthcare professionals to understand the psychological health during pregnancy and postpartum periods among women who conceived assisted reproductive technology and as a theoretical base in providing health care. This study suggested that clinical staff should develop proper intervention in the women’s first trimester and two months after delivery to reduce the women’s psychological stress for pregnancy and parenting stress. In addition, social support can act as a protective factor in resisting anxiety and depression in the perinatal period. Therefore, a proper intervention of social support is both decent and necessary