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題名 嬰幼兒照顧者主觀覺知嬰幼兒睡眠問題之相關因素探討
The Factors Associated with Caregivers` Perception of Infant Sleep Problems作者 張哲虹
Chang, Jhe Hong貢獻者 楊建銘
Yang, Chien Ming
張哲虹
Chang, Jhe Hong關鍵詞 嬰幼兒睡眠
照顧者困擾
教養態度一致性
嬰幼兒睡眠知識量
睡眠品質
憂鬱情緒
Infant sleep
parents’ distress
consistency of care attitude
knowledge of infant sleep
sleep quality
depression日期 2013 上傳時間 3-Mar-2014 15:31:01 (UTC+8) 摘要 研究目的：嬰幼兒的睡眠狀態常讓照顧者感到困擾，嬰幼兒睡眠問題越嚴重，照顧者困擾程度越高。然而，跨文化研究與前驅研究的結果發現，台灣嬰幼兒睡眠狀態與照顧者主觀感受之間的關係較不一致，有些孩子的睡眠狀態並沒有太大問題，照顧者仍報告自己感到嚴重的困擾。因此，本研究以網路問卷的方式，分別探討外在環境因素（如：睡眠環境安排、居住型態、與配偶及祖輩教養態度的一致性）及照顧者個人因素（如：照顧者睡眠品質、憂鬱狀態、對嬰幼兒睡眠的知識及失功能信念）是否存在中介及調節的效果，影響照顧者的主觀感受。研究方法：本研究以網路進行問卷調查，透過網路招募共計607位0-3歲嬰幼兒之父母填寫問卷。其問卷內容包括自編睡眠問卷用以了解嬰幼兒睡眠狀態及人口學變項；匹茲堡睡眠品質量表、睡眠知識量表、睡眠認知量表及流行病學研究中心憂鬱量表用以了解父母的睡眠品質、認知及情緒狀態。統計方式則以階層迴歸分析分別探討外在環境因素及個人內在因素的中介及調節效果。研究結果：在照顧者知覺的睡眠問題與嬰幼兒睡眠狀態的關聯性部分，本研究發現當詢問照顧者孩子「是否」有睡眠問題，其結果與嬰幼兒的睡眠狀態無相關或僅有非常低的相關，但若詢問照顧者受嬰幼兒睡眠困擾的「程度」，其結果與嬰幼兒的睡眠狀態則有中度以上的相關。在其他外在因素的部分，睡眠環境安排、與配偶及祖輩教養態度一致性部分對嬰兒睡眠狀態與照顧者主觀困擾程度的預測力扮演調節的角色，除此之外也有部分則是能直接預測照顧者的困擾程度；居住型態則未存在任何調節或直接預測的效果。在照顧者個人內在因素的部分，照顧者睡眠品質存在部分中介的效果，照顧者憂鬱狀態、嬰幼兒睡眠知識量及失功能信念對嬰幼兒睡眠狀態對照顧者主觀困擾程度的預測力亦有部分扮演調節的角色，部分則是直接能預測照顧者主觀困擾。研究結論：本研究結果顯示，過去研究發現照顧者主觀感受與嬰幼兒睡眠狀態間不一致的現象部分可能是因為詢問方法所造成的，照顧者受嬰幼兒睡眠困擾的程度仍然會受到其孩子睡眠狀態的影響。然而，照顧者的困擾程度仍無法完全以嬰幼兒的睡眠狀態來解釋，還會受到外在環境與個人內在因素的影響。在可能影響照顧者困擾程度的因素當中，照顧者嬰幼兒睡眠知識量的影響是最一致的，照顧者的嬰幼兒睡眠知識量少者，孩子睡眠狀態對其主觀困擾程度的預測力較低，也就是說，父母較無法依照孩子實際的睡眠狀態反應其困擾程度；此外，與配偶及祖輩教養態度越不一致、照顧者的睡眠品質越差、憂鬱程度及憤怒相關的失功能信念越高，皆可預測照顧者主觀受嬰幼兒睡眠困擾的程度越高。整體來說，此結果顯示照顧者的認知及情緒因素在嬰幼兒睡眠狀態所帶來的困擾上扮演重要的角色。應用於臨床上，建議未來協助父母處理嬰幼兒睡眠問題時，除了評估嬰幼兒的睡眠狀況外，需進一步了解照顧者所處環境及個人內在狀態的影響，依照顧者的個別狀態給予協助，例如：提供睡眠衛教以增加嬰幼兒睡眠相關知識、協助增加與配偶及祖輩教養態度的一致性、討論與修正其失功能信念、提升睡眠品質及憂鬱情緒的介入等，以降低照顧者受嬰幼兒睡眠困擾的程度。
OBJECTIVE:Sleep problem in infants and children is a common complaint of their caregivers. It is generally assumed that caregeivers’ perceived distress should be associated with the condition of their children’s sleep. However, the results of a previous study and our pilot study showed an inconsistent relationship between infants’ sleep and their parents’ level of distress about their children’s sleep in Taiwan. Some of the parents perceived severe distress even though their children had normal sleep. Thus, the aim of this study is to explore whether some environmental factors (sleep arrangement, family composition, and the consistency of caregiving attitude between couples and grandparents) and internal factors of the caregivers (sleep quality, depression level, knowledge of infant sleep and dysfunctional beliefs of the caregivers) play a mediating or moderating role in the relationship between infant sleep and parents’ level of distress.METHOD:Six hundred and seven parents of infants aged from birth to 3 years were recruited via internet and completed a web-based online questionnaire about their children. The contents of the questionnaire include a self-constructed sleep questionnaire about children`s sleep status and demographic data, the Pittsburgh Sleep Quality Index (PSQI) to measure parents’ sleep quality, the Parents Sleep Knowledge Inventory (PSKI) to measure parents’ knowledge of infant sleep, the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) to measure dysfunctional beliefs of infant sleep, and the Center for Epidemiologic Studies Depression Scale (CES-D) to measure parents’ depression level. The data was analyzed with hierarchical regression to explore whether environmental and internal factors serve as a mediator or moderator for the association between infant’s sleep condition and parents’ level of distress.RESULTS:The results show no or very low association between parents’ rating on question asking whether their childrens have sleep problems and their children’s sleep condition. However, when asking to rate the level of distress, there was a moderate correlation between the rating and their children’s sleep condition. Among the environmental factors, sleep arrangement and the consistency of care attitude between couples or grandparents is a moderator between infant sleep and parents` level of distress. These factor also plays a role in predicting of parents’ level of distress directly. On the other hand, living composition showed no significant predicting or moderating effects on caregivers’ level of distress. Among the internal factors, parents’ sleep quality was found to be a mediator. Parents’ depression level, parents’ knowledge and dysfunctional beliefs of infant sleep was found to be a moderator between infant sleep and parents` level of distress. These factors were also shown to be a predictor of parents’ level of distress.CONCLUSIONS:In conclusion, the inconsistent relationship between infant sleep and parents’ level of distress in the previous studies maybe due to the wording of questioning. Parents` level of distress was shown to be influenced by infants` sleep. However, parents` level of distress is not explained only by infants` sleep but also by some environmental and internal factors. Parents` knowledge of infant sleep is the most consistent factor that influences parents` level of distress. The less correct the parents’ sleep knowledge, the lower the predictability of infants` sleep on parents` level of distress. In addition, lower consistency of care attitude between couples and grandparents, poorer sleep quality and higher depression level, and higher dysfunctional belief about anger are associated with higher level of distress. Overall, parents` cognitive and emotional factors play an important role in the perceived distress about their childrens’ sleep. The results imply that in clinical intervention for infants’ sleep problem, the environmental and internal factors of parents need to be considered. 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國立政治大學
心理學研究所
98752007
102資料來源 http://thesis.lib.nccu.edu.tw/record/#G0098752007 資料類型 thesis dc.contributor.advisor 楊建銘 zh_TW dc.contributor.advisor Yang, Chien Ming en_US dc.contributor.author (Authors) 張哲虹 zh_TW dc.contributor.author (Authors) Chang, Jhe Hong en_US dc.creator (作者) 張哲虹 zh_TW dc.creator (作者) Chang, Jhe Hong en_US dc.date (日期) 2013 en_US dc.date.accessioned 3-Mar-2014 15:31:01 (UTC+8) - dc.date.available 3-Mar-2014 15:31:01 (UTC+8) - dc.date.issued (上傳時間) 3-Mar-2014 15:31:01 (UTC+8) - dc.identifier (Other Identifiers) G0098752007 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/64324 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學研究所 zh_TW dc.description (描述) 98752007 zh_TW dc.description (描述) 102 zh_TW dc.description.abstract (摘要) 研究目的：嬰幼兒的睡眠狀態常讓照顧者感到困擾，嬰幼兒睡眠問題越嚴重，照顧者困擾程度越高。然而，跨文化研究與前驅研究的結果發現，台灣嬰幼兒睡眠狀態與照顧者主觀感受之間的關係較不一致，有些孩子的睡眠狀態並沒有太大問題，照顧者仍報告自己感到嚴重的困擾。因此，本研究以網路問卷的方式，分別探討外在環境因素（如：睡眠環境安排、居住型態、與配偶及祖輩教養態度的一致性）及照顧者個人因素（如：照顧者睡眠品質、憂鬱狀態、對嬰幼兒睡眠的知識及失功能信念）是否存在中介及調節的效果，影響照顧者的主觀感受。研究方法：本研究以網路進行問卷調查，透過網路招募共計607位0-3歲嬰幼兒之父母填寫問卷。其問卷內容包括自編睡眠問卷用以了解嬰幼兒睡眠狀態及人口學變項；匹茲堡睡眠品質量表、睡眠知識量表、睡眠認知量表及流行病學研究中心憂鬱量表用以了解父母的睡眠品質、認知及情緒狀態。統計方式則以階層迴歸分析分別探討外在環境因素及個人內在因素的中介及調節效果。研究結果：在照顧者知覺的睡眠問題與嬰幼兒睡眠狀態的關聯性部分，本研究發現當詢問照顧者孩子「是否」有睡眠問題，其結果與嬰幼兒的睡眠狀態無相關或僅有非常低的相關，但若詢問照顧者受嬰幼兒睡眠困擾的「程度」，其結果與嬰幼兒的睡眠狀態則有中度以上的相關。在其他外在因素的部分，睡眠環境安排、與配偶及祖輩教養態度一致性部分對嬰兒睡眠狀態與照顧者主觀困擾程度的預測力扮演調節的角色，除此之外也有部分則是能直接預測照顧者的困擾程度；居住型態則未存在任何調節或直接預測的效果。在照顧者個人內在因素的部分，照顧者睡眠品質存在部分中介的效果，照顧者憂鬱狀態、嬰幼兒睡眠知識量及失功能信念對嬰幼兒睡眠狀態對照顧者主觀困擾程度的預測力亦有部分扮演調節的角色，部分則是直接能預測照顧者主觀困擾。研究結論：本研究結果顯示，過去研究發現照顧者主觀感受與嬰幼兒睡眠狀態間不一致的現象部分可能是因為詢問方法所造成的，照顧者受嬰幼兒睡眠困擾的程度仍然會受到其孩子睡眠狀態的影響。然而，照顧者的困擾程度仍無法完全以嬰幼兒的睡眠狀態來解釋，還會受到外在環境與個人內在因素的影響。在可能影響照顧者困擾程度的因素當中，照顧者嬰幼兒睡眠知識量的影響是最一致的，照顧者的嬰幼兒睡眠知識量少者，孩子睡眠狀態對其主觀困擾程度的預測力較低，也就是說，父母較無法依照孩子實際的睡眠狀態反應其困擾程度；此外，與配偶及祖輩教養態度越不一致、照顧者的睡眠品質越差、憂鬱程度及憤怒相關的失功能信念越高，皆可預測照顧者主觀受嬰幼兒睡眠困擾的程度越高。整體來說，此結果顯示照顧者的認知及情緒因素在嬰幼兒睡眠狀態所帶來的困擾上扮演重要的角色。應用於臨床上，建議未來協助父母處理嬰幼兒睡眠問題時，除了評估嬰幼兒的睡眠狀況外，需進一步了解照顧者所處環境及個人內在狀態的影響，依照顧者的個別狀態給予協助，例如：提供睡眠衛教以增加嬰幼兒睡眠相關知識、協助增加與配偶及祖輩教養態度的一致性、討論與修正其失功能信念、提升睡眠品質及憂鬱情緒的介入等，以降低照顧者受嬰幼兒睡眠困擾的程度。 zh_TW dc.description.abstract (摘要) OBJECTIVE:Sleep problem in infants and children is a common complaint of their caregivers. It is generally assumed that caregeivers’ perceived distress should be associated with the condition of their children’s sleep. However, the results of a previous study and our pilot study showed an inconsistent relationship between infants’ sleep and their parents’ level of distress about their children’s sleep in Taiwan. Some of the parents perceived severe distress even though their children had normal sleep. Thus, the aim of this study is to explore whether some environmental factors (sleep arrangement, family composition, and the consistency of caregiving attitude between couples and grandparents) and internal factors of the caregivers (sleep quality, depression level, knowledge of infant sleep and dysfunctional beliefs of the caregivers) play a mediating or moderating role in the relationship between infant sleep and parents’ level of distress.METHOD:Six hundred and seven parents of infants aged from birth to 3 years were recruited via internet and completed a web-based online questionnaire about their children. The contents of the questionnaire include a self-constructed sleep questionnaire about children`s sleep status and demographic data, the Pittsburgh Sleep Quality Index (PSQI) to measure parents’ sleep quality, the Parents Sleep Knowledge Inventory (PSKI) to measure parents’ knowledge of infant sleep, the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) to measure dysfunctional beliefs of infant sleep, and the Center for Epidemiologic Studies Depression Scale (CES-D) to measure parents’ depression level. The data was analyzed with hierarchical regression to explore whether environmental and internal factors serve as a mediator or moderator for the association between infant’s sleep condition and parents’ level of distress.RESULTS:The results show no or very low association between parents’ rating on question asking whether their childrens have sleep problems and their children’s sleep condition. However, when asking to rate the level of distress, there was a moderate correlation between the rating and their children’s sleep condition. Among the environmental factors, sleep arrangement and the consistency of care attitude between couples or grandparents is a moderator between infant sleep and parents` level of distress. These factor also plays a role in predicting of parents’ level of distress directly. On the other hand, living composition showed no significant predicting or moderating effects on caregivers’ level of distress. Among the internal factors, parents’ sleep quality was found to be a mediator. Parents’ depression level, parents’ knowledge and dysfunctional beliefs of infant sleep was found to be a moderator between infant sleep and parents` level of distress. These factors were also shown to be a predictor of parents’ level of distress.CONCLUSIONS:In conclusion, the inconsistent relationship between infant sleep and parents’ level of distress in the previous studies maybe due to the wording of questioning. Parents` level of distress was shown to be influenced by infants` sleep. However, parents` level of distress is not explained only by infants` sleep but also by some environmental and internal factors. Parents` knowledge of infant sleep is the most consistent factor that influences parents` level of distress. The less correct the parents’ sleep knowledge, the lower the predictability of infants` sleep on parents` level of distress. In addition, lower consistency of care attitude between couples and grandparents, poorer sleep quality and higher depression level, and higher dysfunctional belief about anger are associated with higher level of distress. Overall, parents` cognitive and emotional factors play an important role in the perceived distress about their childrens’ sleep. The results imply that in clinical intervention for infants’ sleep problem, the environmental and internal factors of parents need to be considered. The intervention may need to include procedures targeting these factors, such as increasing consistency of care attitude between couples and grandparents, giving sleep hygience education to increase knowledge of infant sleep, discussing and modifying the dysfunctional beliefs, improving parents’ sleep quality and treating depression. en_US dc.description.tableofcontents 中文摘要 i英文摘要 iii第一章 緒論 1第一節 研究動機與目的 1第二章 文獻探討 5第一節 嬰幼兒睡眠的發展與睡眠問題的定義 5第二節 嬰幼兒睡眠問題的流行病學研究 8一、 盛行率及病因探討 8二、 亞洲國家嬰幼兒睡眠問題的比較 10第三節 可能影響照顧者主觀感受之因素 12一、 社會文化與環境因素 13二、 照顧者的睡眠品質 17三、 照顧者的憂鬱情緒 17四、 照顧者認知因素扮演的角色 19第四節 研究目的與假設 21第三章 研究方法 30第一節 研究對象 30第二節 研究程序 30第三節 研究工具 31一、 睡眠問卷 31二、 匹茲堡睡眠品質量表 33三、 照顧者睡眠知識量表 33四、 照顧者對嬰幼兒睡眠認知量表 34五、 流行病學研究中心憂鬱量表 35第四節 資料分析 36第四章 研究結果 38第一節 研究對象之人口學統計資料 38第二節 嬰幼兒睡眠狀態與照顧者主觀困擾之描述統計 43一、 安撫入睡問題 43二、 夜醒問題 48第三節 各變項間之相關 53一、 嬰幼兒安撫入睡耗時、照顧者受安撫入睡困擾程度與各變項間的相關係數 53二、 嬰幼兒夜醒次數及夜醒再入睡耗時、照顧者受夜醒困擾程度與各間的相關係數 55第四節 中介效果的檢驗 571. 睡眠品質在嬰幼兒安撫入睡耗時對照顧者安撫困擾程度解釋力的中介效果 572. 睡眠品質在嬰幼兒夜醒次數對照顧者夜醒困擾程度解釋力的中介效果 593. 睡眠品質在嬰幼兒夜醒再入睡耗時對照顧者夜醒困擾程度解釋力的中介效果 60第五節 調節效果的檢驗 61一、 影響嬰幼兒安撫入睡耗時對照顧者安撫困擾程度解釋力之調節效果檢驗 61二、 影響嬰幼兒夜醒次數對照顧者夜醒困擾程度解釋力之調節效果檢驗 77三、 影響嬰幼兒夜醒後入睡耗時對照顧者夜醒困擾程度解釋力之調節效果檢驗 95第五章 討論 114第一節 嬰幼兒睡眠與照顧者困擾程度的一致性探討 114第二節 外在環境的影響之探討 116第三節 個人內在因素的影響之討論 118第四節 研究限制與未來展望 122參考文獻 124附錄一 睡眠量表 132附錄二 中文版匹茲堡睡眠品質量表 136附錄三 照顧者嬰幼兒睡眠知識量表 138附錄四 照顧者嬰幼兒睡眠認知量表 140附錄五 流行病學研究中心之憂鬱量表 141 zh_TW dc.format.extent 1074723 bytes - dc.format.mimetype application/pdf - dc.language.iso en_US - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0098752007 en_US dc.subject (關鍵詞) 嬰幼兒睡眠 zh_TW dc.subject (關鍵詞) 照顧者困擾 zh_TW dc.subject (關鍵詞) 教養態度一致性 zh_TW dc.subject (關鍵詞) 嬰幼兒睡眠知識量 zh_TW dc.subject (關鍵詞) 睡眠品質 zh_TW dc.subject (關鍵詞) 憂鬱情緒 zh_TW dc.subject (關鍵詞) Infant sleep en_US dc.subject (關鍵詞) parents’ distress en_US dc.subject (關鍵詞) consistency of care attitude en_US dc.subject (關鍵詞) knowledge of infant sleep en_US dc.subject (關鍵詞) sleep quality en_US dc.subject (關鍵詞) depression en_US dc.title (題名) 嬰幼兒照顧者主觀覺知嬰幼兒睡眠問題之相關因素探討 zh_TW dc.title (題名) The Factors Associated with Caregivers` Perception of Infant Sleep Problems en_US dc.type (資料類型) thesis en dc.relation.reference (參考文獻) 中文部分：王春美（民90）。父母知覺與祖輩親職教養行為一致性之研究（碩士論文）。取自http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi?o=dnclcdr&s=id=%22089NCYU0658004%22.&searchmode=basic 內政部統計處（民101）。內政部戶政司統計年報。取自 http://sowf.moi.gov.tw/stat/year/y02-02.xls內政部統計處（民100）。內政部99年單親家庭狀況調查統計結果摘要分析。取自 http://sowf.moi.gov.tw/stat/gender/100analysis2-7.doc張哲虹、穆淑琪、周舒翎、楊建銘（民99年11月）。父母受嬰幼兒睡眠問題影響之嚴重程度與其可能因素。第四十九屆台灣心理學會張貼之論文，中正大學國際會議廳。章英華、杜素豪、廖培珊（民101）。台灣社會變遷基本調查計畫：第六期第二次調查計畫執行報告。台北：中央研究院社會學研究所。楊浩然（民91）。青少年憂鬱疾患及憂鬱症狀之追蹤研究（博士論文）。取自http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi/ccd=lV6RKQ/search?s=id=%22090NTU01544002%22.&openfull=1&setcurrent=0盧孟良、車先蕙、張尚文、沈武典（民91）。中文版貝克憂鬱量表第二版之信度和效度。臺灣精神醫學，16(4)，301-310。英文部分：Abramson, L. 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