| Abstract: | 一. 研究背景
青少女懷孕及生育的問題近幾年來在台灣逐漸受到重視，且已成為重大的公共衛生、醫療及社會問題。台灣15-19歲之青少女生育率自1986年起迄今皆維持在千分之十六至十八，每年由15-19歲青少女所產下的嬰兒數約有15000至16000名，此外有偶青少女生育率於1994年高達千分之七百二十六。懷孕將帶給青少女多種壓力，因此容易產生許多身心問題及引發不良後果。然而早期育兒對青少女精神狀態的影響卻所知有限，且多數研究皆侷限在產後數月或一年內，長期的身心影響則缺乏研究。因此本研究目的是以台中市都會區的青少女母親為研究對象，來調查其在產後的精神症狀並分析其相關因素。
二.材料與方法
本研究為橫斷式研究(Cross-sectional Study)，生育青少女組為台中市86年1月至12月的新生兒出生證明中所有母親年齡小於20歲且為單胞胎之初產婦。另選擇對照組共兩組，一組為未生育之青少女，另一組則為生育之成年婦女。本研究採問卷調查其內容包括基本資料調查表、家庭關懷量表及簡式症狀量表(BSRS)。本研究由台中市各區衛生所護士進行訪視以完成問卷調查。統計用T-score來和常模比較並以multiple longistic regression 分析資料。
三. 研究結果
生育青少女、未生育青少女及生育成年婦女各162人完成問卷，訪視率為81.8﹪，未完成訪視者以多次訪視未遇為主要原因，其次為拒訪。精神症狀之分析：簡式症狀量表中生育青少女GSI平均值之T分數為56.4，比未生育青少女（55.2）及成年婦女（50.1）高，但與常模比較皆屬於正常範圍。PSDI平均值之T分數為48.3，比未生育青少女（47.2）及成年婦女（45.4）高，但與常模比較皆屬於正常範圍。生育青少女十個向度之T分數與常模比較則除了"敵意"略高之外，其餘皆屬正常範圍；至於未生育青少女之T分數，除了恐懼較常模略高，其餘皆屬正常範圍；成年婦女之T分數則全部屬正常範圍。
四.討 論
本研究顯示台灣都會區青少女生育率低於非都市地區，可能與避孕藥之普遍及墮胎的盛行有關。其次生育青少女流動性高及研究中蒐集資料之困難，可為未來研究之參考。本研究以BSRS來測量整體精神症狀的嚴重度，但並未作精神疾病診斷性會談，因此無法了解其盛行率。生育青少女精神症狀之嚴重度未如假設所預期般的嚴重，可能與下列因素有關：1.本研究於產後10個月至1年10個月訪視，精神症狀可能比懷孕或產後數月時輕微。此外本研究屬Cross-sectional study，在同一時間調查不同生產後時間的樣本，因此可能因症狀出現之時間不同而影響精神症狀之嚴重度。2.懷孕時很多身體不適的症狀常被誤認為是憂鬱的症狀，本研究中生育青少女已生下嬰兒，因此憂鬱明顯減少。3.選擇懷孕並產下嬰兒可能是生育青少女及家人所期待的，因此沒有較嚴重的精神症狀。4.青少女懷孕不全然是負面的結果且並非所有生育青少女皆遭遇困難。5.本研究的生育青少女86.4﹪皆已婚，與美國生育青少女僅33﹪結婚的情況大不相同，因此結婚可能使生育青少女獲得較多的社會支持。與未生育青少女比較，生育青少女之整體精神症狀並未較嚴重，可見生育對青少女之精神狀態不完全是負面的影響，或者所承受之壓力及生育所面臨之困難已獲適度支持而改善，但在本研究中並未評估壓力及支持的程度以致無法了解精神症狀與此二者之關係。至於生育青少女為何在敵意的向度中較明顯，青少女懷孕是否是對父母威權影像之憤怒表達、自覺疏離而無歸屬感、顯示其人格特質之傾向或是對外界的一種防衛態度，則需進一步研究來探討。至於未生育青少女出現較高的畏懼及人際間的敏感，可能與本研究樣本68.5﹪皆仍就學中而承受升學壓力或其自我評價較低而與他人相較時顯得比較不自在以及自卑。在BSRS各向度的相關因素的分析中：1.〝與男伴感情〞此一因素與PSDI、GSI及各向度的精神症狀皆呈負相關，顯示生育青少女的精神症狀與男伴感情有密切關聯。2.〝與父親的感情〞也與GSI及各向度精神症狀呈負相關。在台灣父系社會中與父親感情較好時，可能較易得到整個家庭支持。3.〝以往主要居住地〞亦與身體化症狀、強迫性症狀、焦慮、畏懼等呈負相關。城市可能有較多的醫療資源且對性觀念及性行為皆較開放而可能使精神症狀較不嚴重。4.〝喝酒〞與強迫性症狀、敵意、畏懼、疑心呈正相關，但本研究未發現與憂鬱有明顯相關。5.〝藥癮〞與身體化症狀、焦慮及陽性症狀指數呈正相關，但本研究只有4名承認有藥物濫用，因此不能類推。6.〝與母親感情〞只與陽性症狀指數呈負相關，卻與10向度精神症狀皆沒有明顯相關，則需更進一步評估才能了解7.〝年齡〞與陽性症狀指數呈正相關，odds ratio為7.30，即青少女母
A. The background of study:
Adolescent pregnancy and child-bearing have become a source of increasing concern over the past decade in Taiwan and it also have become a problem in public health, medical & social fields. The birth rate among 15-19 years olds had been up to 16-18 births per 1000 adolescent females since 1986. Annually, 15000 to 16000 births were born to adolescents In Taiwan. Besides, the birth rate among the married adolescent female was 726 births per 1000 in 1994. Stress often appeared when adolescents become pregnant or being mothers and it would induce many psychosomatic problem and poor outcomes. However, little was known about the long-term consequence of mental health of childbearing adolescents because most previous studies focus on several months to one-year post-partum. The purpose of this study was to survey the psychiatric symptoms after 10 months to one year and 10 months post-partum for the adolescent mothers living in Taichung City, the psychiatric symptoms of non-childbearing adolescents and adult mother would be compared at the same time.
B. The method:
This study was a cross-sectional study, the subjects were composed of childbearing adolescent female (n=162) who were drawn form all certificates of live birth of Taichung City between January and December 1997. Non-child bearing adolescent female (n=162) and childbearing adult female (n=162) were two groups for comparison. The questionnaire included basic data, family APGAR and BSRS, which were completed by sanitarian nurses at health station through visiting the subjects from July to October in 1998. We calculated the T-score to compare with the norm of BSRS and made an analysis via multiple longistic regression to investigate the correlates of psychiatric symptoms.
C. The result:
The rate of completing the questionnaire was 81.8%, whereas not meeting the subject after visiting them several times or refusing to receive investigation were the major cause of failure. The T-score of the mean of GSI of childbearing adolescents was 56.4, which was higher than that of non-childbearing adolescents (55.2) & adult mothers (50.1), but all were within the normal limit. The T-score of the mean of PSDI among adolescent mother''s (48.3) was higher than the other two groups (47.2 & 45.4), but they are all within normal limit. The T-score of the means of 10 dimensions except hostility among adolescent mothers were also normal when compared with the norm. All T-score were normal except phobia among non-childbearing adolescents and all data were within normal range for the adult mothers.
D. Discussion:
The birth rate of adolescent in Taichung seems to be lower than that in Taiwan, it may be due to the availability of drugs or abortion. It was difficult for us to contact with those adolescent mothers who decided to receive abortion or moved to another city. The use of BSRS can evaluate the severity of psychiatric symptoms in the viewpoint of subjects, but diagnostic interviews were not performed so the prevalence of any psychiatric disorders can''t be predicted. Some reasons may be considered to decrease the severity of the psychiatric symptoms. 1. The study was performed ten months to one year and ten months post-partum; the psychiatric symptoms were less severe than those during the stage of pregnancy or several months post-partum were. Besides, adolescent mothers of various duration post-partum were surveyed would make the result less severe. 2. Less somatic complaint was noted at post-partum stage would decrease the false-positive rate of the report of depression as the previous studies. 3. Make a decision by adolescent mothers or families to give birth rather than being forced to do it may make psychiatric symptoms less severe. 4. The consequences of adolescent pregnancy & child bearing were not so poor as expected as before. Some adolescent mothers did have a success in taking care of babies and in serving as the role of being a mother 5. An apparent difference was up to 86.4% of our adolescent sample got married and it was quite different from that in USA (33%), marriage may supply much social support. However, We can''t make clear the relationship between stress or social support and the psychiatric symptoms among adolescent mothers was a deficit in our study. "Hostility" was apparent among adolescent mothers and it may represent an objection against their parent''s authority, distant feeling & weak cohesion, one kind of personality trait or a defensive attitude toward child-bearing. Whereas, phobia was apparent among non-childbearing adolescent may be due to stress from school performance.
The correlates with 10 dimensions of BSRS were as the followings: 1. "The relationship with male partner" was negatively correlated with PSDI, GSI & 10 dimensions: it means that the mental health of adolescent mother was closely related to her male partner. 2. "The relationship with father" was negatively correlated with GSI & various psychiatric symptoms: father often dominated in Taiwan society and he may supply main social support. 3. "Living in the city" was negatively with somatization, obsession, anxiety & phobia: it may be due to more available medical resource or more acceptable attitude toward sex in the city. 4. "Alcohol drinking" was positively related with obsession, hostility, phobia & paranoid, but not related with depression in our study. 5. "Substance addiction" was positively related with somatization, anxiety & PSDI. But generalization was difficult due to too small samples with drug addition in our study. 6. "The relationship with mother" was just negatively related with PSDI rather than related with any psychiatric symptoms: it deserves further evaluation to make a final explanation. 7. "Age" was positively related with the PSDI: the younger the adolescent mother was, the more severe PSDI was. |
