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研究生：	蒙習葳 Magongo Celiwe Tracy
論文名稱：	史瓦帝尼早產兒母親產後憂鬱症的患病率盛行率和相關危險因素之探討 Prevalence and Factors Related to Postpartum Depression in Women with Preterm infants in Eswatini
指導教授：	洪筱瑩 Hung, Hsiao-Ying
學位類別：	碩士 Master
系所名稱：	醫學院 - 護理學系 Department of Nursing
論文出版年：	2023
畢業學年度：	111
語文別：	英文
論文頁數：	96
中文關鍵詞：	早產兒、產後、產後婦女、產後抑鬱症
外文關鍵詞：	preterm infant, postpartum, postpartum women, postpartum depression.
相關次數：	點閱：73 下載：1
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背景：早產兒住院的婦女會經歷壓倒性的負面情緒，這可能導致心理困擾，使她們容易患上產後抑鬱症 (PPD)。在埃斯瓦蒂尼，PPD 可能仍未得到充分診斷，因為那裡沒有定期評估孕產婦的心理健康狀況。本研究旨在調查和描述埃斯瓦蒂尼早產兒住院婦女產後抑鬱症的患病率和相關因素。方法：採用方便抽樣的橫斷面相關研究設計，從史瓦帝尼的兩家公立醫院招募了 110 名參與者。使用愛丁堡產後抑鬱量表、人際社會支持評估量表 12、一般自我效能感量表和父母壓力量表。進行 Pearson 卡方檢驗和 Mann-Whitney U 檢驗以分別檢查感興趣的分類變量和連續變量與女性 PPD 狀態之間的關係。進行多元邏輯回歸分析以建立與 PPD 相關的因素的最終模型。結果：這些女性的平均年齡為 27.30±6.09 歲，大多數 PPD 篩查呈陽性，佔 63.6%。計劃外懷孕的人患抑鬱症的可能性是計劃懷孕的人的 4.23 倍 (AOR=4.23, p= 0.04)，有產後並發症的人患抑鬱症的可能性是沒有的人的 14.16 倍(AOR=14.16, p = 0.002），父母壓力得分每增加 1 分，抑鬱的機率增加 4%（AOR= 1.04，p= 0.002），自我效能得分每增加 1 分，抑鬱的機率降低 17% (AOR=0.83, p= 0.001)。結論：本研究發現 PPD 的患病率驚人。這些發現對於開發成功的預防和早期心理教育干預措施以及為所有有 PPD 風險的女性制定篩查程序具有重要意義。關鍵詞：早產兒，產後，產後婦女，產後抑鬱症。

Background: Women with hospitalized preterm infants experience overwhelming negative emotions which may lead to psychological distress predisposing them to postpartum depression (PPD). PPD may remain underdiagnosed in Eswatini where maternal mental health is not routinely assessed. This study aimed to investigate and describe the prevalence and examine the related factors of postpartum depression in women with hospitalized preterm infants in Eswatini. Methods: A cross-sectional, correlational study design with convenience sampling was utilized to recruit 110 participants from two public hospitals in Eswatini. Edinburgh Postnatal Depression Scale, Interpersonal Social Support Evaluation Scale-12, General Self-Efficacy Scale, and Parental Stress scale were used. Pearson’s chi-square tests and Mann-Whitney U test were performed to examine the relationship between interested categorized variables and continuous variables with women’s PPD status respectively. Multiple logistic regression analysis was performed to build final model for factors related to PPD. Results: The average age of these women was 27.30  6.09 years old, a majority screened positive for PPD, 63.6%. Those with unplanned pregnancy were 4.23 times more likely to be depressed compared to those with planned pregnancies (AOR=4.23, p= 0.04), those with postpartum complications were 14.16 times more likely to be depressed compared to those without(AOR=14.16, p= 0.002), with every 1-point increase in parental stress scores the odds being depressed increased by 4% (AOR= 1.04, p= 0.002) and with every 1-point increase in self-efficacy scores the odds of being depressed decreased by 17% (AOR=0.83, p= 0.001). Conclusion: This study found an alarming prevalence of PPD. The findings have a considerable implication for developing successful prevention and early psychoeducational interventions and formulating screening routine for all women at risk of PPD. Keywords: preterm infant, postpartum, postpartum women, postpartum depression.

Contents
Chapter 1	1
Introduction	1
1.1 Background	1
1.2 Significance of the study	4
1.3 Research purpose	5
1.4 Research questions	6
Chapter 2	7
Literature review	7
2.1 Preterm birth	7
2.2 Postpartum depression	9
2.2.1 Prevalence of PPD	9
2.2.2 Postpartum period	10
2.2.3 The theoretical perspective of PPD	12
2.2.4 Factors associated with postpartum depression	14
2.3 Study framework	24
2.4 Definition of terms	26
Chapter 3	28
Methods	28
3.1 Research design	28
3.2 Study setting	28
3.3 Research Sample	29
3.3.1 Sampling strategy	29
3.3.2 Inclusion criteria	29
3.3.3 Exclusion criteria	30
3.3.4 Sample Size	30
3.4 Data collection	30
3.4.1 Research Instruments	30
3.4.2 Data collection	34
3.4.3 Data analysis	34
3.5 Human subject protection plan and Ethical consideration	36
Chapter 4	37
Results	37
4.1 Characteristics of the sample	37
4.2 Prevalence of Postpartum depression status	41
4.3 Status of the women’s parental stress	41
4.4 Women’s self-efficacy	41
4.5 Women’s social support	41
4.6 Factors related to postpartum depression status by depression status.	43
4.7 Relationship between Parental stress, General Self-efficacy, and Interpersonal Social Support with postpartum depression.	47
4.8 Determining factors related to postpartum depression status of women in logistic regression.	48
Chapter 5	50
Discussion	50
5.1 Summary of the main findings	50
5.2 This study findings comparison with previous studies	50
5.3 Characteristics of women and their preterm infants in relation to PPD	51
5.4 The relationship between maternal parental stress and PPD	52
5.5 The relationship between maternal self-efficacy and PPD	53
5.6 The relationship between maternal social support and PPD	53
5.7 Main factors related to PPD in women with hospitalized preterm infants in Eswatini	53
5.8 Clinical application and recommendations	57
5.9 Strengths and limitations	57
5.10 Conclusion	58
References	59
Appendix I: Information sheet and Consent form	73
Appendix II:  Data collection checklist (researcher’s use)	78
Appendix 111. Participant’s Questionnaires.	79
Appendix IV: Research protocol clearance	89
Appendix V: Raleigh Fitkin Memorial Hospital Permission letter	90
Appendix VI: Mbabane Government Hospital Permission letter	91
Appendix VII: Edinburgh Postnatal Depression Scale scores for the women (N =110)	92
Appendix VIII: Parental Stressor Scale scores for the women (N = 110)	93
Appendix IX:  General Self-Efficacy Scale scores for the women (N =110)	95
Appendix X:  Interpersonal Social Support Evaluation Lisst-12 scores for the women (N= 110)	96
List of tables
Table 1. Summary of the instruments used in the study	33
Table 2 Characteristics of women and their infants (N=110)	39
Table 3 Edinburg Postnatal Depressions scale, Interpersonal Social Support Evaluation list-12, General Self-efficacy scale and Parental stress scale descriptive statistics.	42
Table 4 Distribution of participant’s characteristics and factors by postpartum depression status (N = 110)	44
Table 5 Correlation coefficient showing relationship amongst Edinburg Postnatal Depressions scale, Interpersonal Social Support Evaluation list-12, General Self-efficacy scale and Parental stress scale	47
Table 6 Binary logistic regression model for factors related to postpartum depression (N = 110).	49
List of figures 
Figure 1 The study framework for factors related to postpartum depression of the women with preterm infants during hospitalization	25
List of Abbreviations
EHHRRB          Eswatini Health and Human Research Review Board
EPDS                 Edinburgh Postnatal Depression Scale
GSE.                  General Self-efficacy Scale
ISSEL               Interpersonal Social Support Evaluation List-12
MCH                 Mother and Child Health
MGH                Mbabane Government Hospital 
NICU                Neonatal Intensive Care Unit
PPD                  Postpartum Depression 
PSS                   Parental Stress Scale 
SPSS                 Statistical Package for Social Science
                                    

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