婚姻適應、伴侶溝通、社會支持與父親產後憂鬱傾向之關係

Relationships Amorg Marital Adjustment, Communication Patterns, Social Support, and Paternal Postpartum Depression

在男性轉變為父親的過程中，承受的心理壓力與面對社會角色轉換的適應問題並不亞於母親，孩子出生後也可能出現產後憂鬱的風險，但父親在配偶生產前後此段期間的心理健康在臺灣較少成為研究的關注焦點。本研究的目的在探討婚姻適應、伴侶溝通模式、產後社會支持與臺灣父親產後憂鬱傾向的關聯，並檢視憂鬱傾向組及非憂鬱傾向組的父親在上述各方面之差異。258位配偶為初產的父親在產後1至6個月參與本研究，填寫婚姻適應、伴侶溝通模式、產後社會支持及憂鬱情緒等量表。以愛丁堡產後憂鬱症量表（Edinburgh Postnatal Depression Scale, EPDS）≧10分為切截點，20.16％的臺灣父親在孩子出生後有憂鬱傾向；有憂鬱傾向的父親在婚姻適應上較差，與配偶的溝通模式中「相互建設」的互動方式較少，「要求／退縮」、「互相逃避」等負向溝通模式較多；但是有憂鬱傾向的父親也知覺到較多的產後社會支持。另外，父親在產後知覺到的溝通模式在父親產後婚姻適應與產後憂鬱關聯中具有部分中介效果。臺灣父親產後憂鬱的現象需要更多的關注，婚姻關係不良及負向溝通模式為危險因子，然而社會支持對臺灣父親產後憂鬱的影響，則需更多相關研究來進一步釐清其關係。

In the transition to fatherhood, fathers experience the same psychological stress as do mothers and require similar adaptation to their new social role. They are also at risk of postpartum depression; however, in Taiwan, new fathers' stress and emotions have received less focus from researchers. The prevalence rate of paternal postpartum depression has varied from 8.4% to 10.4% among studies (Cameron et al., 2016; Paulson & Bazemore, 2010). Compared with the 5% prevalence rate of depression in the general population of male adults, the risk of depression in the first year after a man becomes a father is approximately double or higher (Cameron et al., 2016; Madsen & Juhl, 2007; Paulson & Bazemore, 2010). Paternal postpartum depression not only negatively affects the father but also the infant's cognition, emotional and behavioral development, and future mental health and parenting behaviors (Epifanio et al., 2015; Melrose, 2010; Wilson & Durbin, 2010). Furthermore, paternal postpartum depression can have a negative impact on marital satisfaction as well as increase the risk of the partner suffering postpartum depression (Don & Mickelson, 2012; Paulson & Bazemore, 2010). From a systemic family perspective, the birth of a child is a major change in the family system. The subsystems of the couple, family of origin, family-in-law, and even friends are also impacted and must adjust to the birth of a child. Moreover, the marital relationship inevitably changes to accommodate the newborn family member. A father's marital adaptation is significantly negative correlation with depression (Foli et al., 2013; Rollè et al., 2017) and anxiety (Rollè et al., 2017; Zerach & Magal, 2017). Furthermore, Norhayati et al. (2015) and Yim et al. (2015) found that marital relationships and postpartum depression are highly correlated. Beach et al. (1990) proposed the marital discord model of depression and suggested that disturbances in a marital relationship are the powerful predictor of future depression symptoms. According to this theory, marital adjustment problems are associated with partners' handling of conflict in hostile and unsupportive manners, which fosters eventual increases in depressive symptoms. Heene, Buysse, &Van Oost (2005) found that negative communication patterns such as demand-withdraw and avoidance patterns were partial mediators in the link between depression and marital distress. Recent studies have also supported the notion that marital communication patterns may play a crucial mediating role between marital adjustment and depression; furthermore, such patterns are often targeted in interventions for depression in couple relationships (Harper & Sandberg, 2009; Heene et al., 2007; Jou, 2009). Although some studies have supported a negative association between paternal postpartum depression and social support (Gao et al., 2009; Wang & Chen, 2006), other studies have reported inconsistent results in that the effect of social support might be influenced by cultural factors. In Hong Kong, Leung et al. (2005) found that the more support a mother receives from her family-in-law, the higher her level of postpartum depression. This could be explained by the fact that most new mothers in Hong Kong live with their in-laws, and the more help they receive from family, the higher the frequency of potential conflict is. In Taiwan, families tend to provide substantial social support to couples during the postpartum period. Husbands may often encounter problems and conflicts between their parents and wives when couples have more contact with close family members (Lai et al., 2010). In this case, the social support perceived by the man may have a negative effect on his mental health. This study aimed to investigate (1) the prevalence of paternal postpartum depression in Taiwan; (2) the association between marital adjustment, communication patterns, postpartum social support, and paternal postpartum depression among Taiwanese fathers; (3) the mediating influence of three partner communication patterns (constructive communication, demand-withdraw communication, and mutual avoidance) on the relationship between marital adjustment and paternal postpartum depression; and (4) the differences between depressive fathers and nondepressive fathers in terms of marriage adjustment, partner communication patterns, and social support after their spouse gives birth to their first baby. This study recruited 258 Taiwanese fathers with their first baby in their current marriages. Their average age was 33.2 years (standard deviation [SD] = 4.17) and the average length of their marriage was 20.7 months. In terms of education level, 41.9% and 32.6% of participants had attended college and graduate school, respectively; moreover, 43.8% of participants share child-raising responsibilities with their wives and nannies; and 43.3% of participants and their wives were the main caregivers for their babies. The study was conducted in medical centers, obstetrics and gynecology clinics, and 37 mothering classes in Taiwan, and an online questionnaire was distributed on relevant parenting community platforms. Demographic and research data were collected using self-reported questionnaires. Each questionnaire contained the Dyadic Adjustment Scale (Spanier, 1976), Communication Patterns Questionnaire (Christensen & Sullaway, 1984), Postpartum Social Support Questionnaire (Hopkins & Campbell, 2008), and the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987). The participants completed the questionnaire between 1 and 6 months after their babies were born, with an average of 11.7 weeks (SD = 2.8). When EPDS score ≥10 was used as the cutoff, 20.16% of the first-time fathers experienced paternal postpartum depression. Fathers with superior marriage adaptation had more constructive and less demand-withdraw and mutual avoidance communication with their spouses as well as lower levels of postpartum depression. The results supported the hypotheses that communication patterns partially mediate links between marital adjustment and paternal postpartum depression. Compared with nondepressive fathers, depressive fathers (EPDS ≥ 10) were significantly less satisfied with their marital relationships and had less constructive and more negative communication patterns with their spouses, such as demand-withdraw and mutual avoidance; however, these fathers perceived receiving more social support during the postpartum period, including that from parents, parents-in-law, and friends, but no significant difference existed between the two groups regarding social support from spouses. Although this result is different from most Western research findings, it is similar to those in the Hong Kong study of Leung et al. (2005), who found a significantly positive association between the level of social support provided by mothers' family-in-law and their postpartum depression. Given the family-oriented culture of Taiwan, a newborn, especially the first child of a couple, usually receives much attention from both sides of the family. Social support related to childcare provided by grandparents as well as excessive advice and involvement in child-raising practices from family members, relatives, and friends could increase fathers' stress levels. Therefore, the availability of social support does not necessarily have a protective or buffering effect on paternal postpartum depression (McVey & Tuohy, 2007). In sum, the prevalence of paternal postpartum depression in Taiwan discovered in this study warrants more clinical and research attention. Although negative marital adjustment and communication patterns were found to be risk factors associated with paternal postpartum depression, the impact of postpartum social support on Taiwanese fathers' postpartum depression must be investigated further.