接受生殖科技治療不孕夫妻情緒反應及因應行為與其相關因素之探討

本研究目的旨在探討接受生殖科技治療的不孕夫妻二者之情緒反應、婚姻關係感受、及因應行為是否有差異，以及不孕夫妻其情緒反應及婚姻關係感受之相關性，情緒反應及因應行為之相關性。本研究採立意取樣，樣本取自於中部某不孕症研究中心接受人工受精或試管嬰兒/胚胎植入的不孕症夫妻為對象，於民國88年10月至89年1月間，共計收取120對夫妻。採結構式問卷調查法，研究工具內容包括基本 資料、情緒量表、因應行為量表、夫妻親密感量表四部分。資料分析以頻率、百分比、t檢定、單因子變異數分析及皮爾森積差分析進行。 研究結果顯示:不孕夫妻之情緒反應夫妻均以「緊張/焦慮」次量表所感受到之情緒困擾最多。不孕夫與妻二者間之情緒反應以「緊張/焦慮」、「憂鬱/沮喪」、「生氣 /敵意」及「疲倦/懶惰」等四個次量表與總量表達統計上之顯著差異。故本研究結果顯示妻子比先生有較多的情緒困擾。不孕夫妻二者間之婚姻關係感受，顯示先生自覺從妻子處感受到較多的控制。不孕夫妻其因應行為皆以「有計劃的解決問題」最常被採用，最少採用的類型均為「逃避/躲避」。不孕夫妻二者間所採用之因應行為以「自我控制」、「尋求社會支持」及「逃避/躲避」等三個次量表與總量表達統計上之顯著差異，本研究結果顯示妻子面對不孕及治療的過程所採用之上述因應行為多於先生。不孕夫妻其情緒反應會因基本屬性與不孕治療及因素不同而有差異，不孕先生情緒反應與教育程度、治療時間、治療次數、現有子女數等變項上達統計上之顯著差異; 不孕妻子情緒反應與治療時間、治療次數、現有子女數等變項上達統計上之顯著差異。不孕夫妻其情緒反應與婚姻關係感受有相關，不孕先生所感受「緊張/焦慮」、「憂鬱/沮喪」、「生氣 /敵意」及「疲倦/懶惰」等情緒時，自覺從妻子處感受到較多的「控制」; 妻子感受「憂鬱/沮喪」、「生氣 /敵意」等情緒時，自覺從其先生處感受到較少的「關懷」。不孕夫與妻其情緒反應與所採用之因應行為有顯著相關，不孕先生情緒總量表與「對抗」、「承擔責任」及「逃避/躲避」之因應行為次量表為中度正相關; 不孕妻子情緒總量表與「對抗」、「自我控制」、「承擔責任」及「逃避/躲避」之因應行為次量表為低度至中度正相關; 與「正面的再評估」次量表呈負相關。且不孕夫與妻在情緒總量表與因應行為總量表呈正相關。臨床醫護人員應認知及重視不孕夫與妻的情緒反應與因應行為的差異，及其相關影響因素，並適時提供專業協助。 關鍵字: 不孕症、生殖科技治療、情緒反應、因應行為、婚姻關係。

The purpose of this study was to explore the following objectives for infertile couples receiving assisted reproductive technologies: their emotional reactions, feelings toward marital relationships, and differences in coping behaviors between wives and husbands. The following objectives were also simultaneously investigated: the correlation between emotional reactions and feelings toward the marital relationship, and the correlation between emotional reactions and coping behavior. A purposive sampling method was adopted to select 120 infertile couples attending an Intrauterine Insemination or In Vitro Fertilization-Embryo Transfer program at an infertility research center in central Taiwan from October 1999 to January 2000. Four research instruments were used to collect data: Demographic Data Form, Profile of Mood States, Ways of Coping Questionnaire, and Intimate Bond Measure. The data were then analyzed by frequency, percentage, t-test, one-way ANOVA, and Pearson’s correlation. The research results showed that, for infertile couples, the emotional reactions of both wives and husbands were most disturbed on the Tension- Anxiety subscale. The emotional reactions of both husbands and wives on the four subscales of Tension-Anxiety, Depression- Dejection, Anger- Hostility, and Fatigue-Inertia demonstrated significant statistical differences with the total scale. This research also showed that wives experienced greater emotional disturbance than husbands did. As for the feelings toward the marital relationship among infertile couples, husbands perceived greater Control over their spouses. Planful Problem Solving was the most-often adopted coping strategy for infertile couples, while Escape- Avoidance was the least-often adopted. The three subscales of coping behavior, Self-Controlling, Seeking Social Support, and Escape-Avoidance, demonstrated significant statistical differences with the total scale. In addition, during the process of infertility and treatment, the above coping strategies were adopted more by wives than husbands. The emotional reactions of infertile couples could vary due to differences in fundamental properties as well as treatments and factors of infertility. Educational levels, treatment duration, number of treatments, and number of existing children were among the variables demonstrating significant statistical differences in the emotional reactions of infertile husbands. Treatment duration, number of treatments, and number of existing children were among the variables demonstrating significant statistical differences in the emotional reactions of infertile wives. The emotional reactions of infertile couples were correlated with feelings toward the marital relationship. When infertile husbands experienced greater Tension-Anxiety, Depression-Dejection, Anger- Hostility, and Fatigue-Inertia, they perceived greater Control over their wives. When wives experienced more Depression-Dejection and Anger- Hostility, they perceived less Care from their husbands. The emotional reactions of infertile couples were significantly correlated to the adopted coping behaviors. The Profile of Mood States from infertile husbands was properly correlated with the Confrontive, the Accepting Responsibility, and the Escape-Avoidance coping subscales. The Profile of Mood States from infertile wives was slightly positively correlated with the Confrontive, the Self-Controlling, the Accepting Responsibility, and the Escape-Avoidance coping subscales, and was negatively correlated with the Positive Reappraisal subscale. The Profiles of Mood States from both husbands and wives were positively correlated with Ways of Coping questionnaires. Clinical medical staff should acknowledge and emphasize differences in emotional reactions and coping behaviors between husbands and wives, as well as the relative influencing factors, to properly provide professional assistance. Key words: Infertility, Assisted reproductive technology, Emotional reaction, Coping behavior, Marital relationship.