母親憂鬱與幼兒睡眠之關聯研究

背景與目的：比起嬰兒時期，孩子的睡眠在進入幼兒期後已較為穩定、能代表之後長期的睡眠狀況，加上母親憂鬱影響幼兒睡眠之探討尚少，及文獻顯示睡眠安排（睡前儀式一致性與睡眠形式）與幼兒睡眠有關，故本研究探討母親憂鬱與幼兒睡眠之關聯，及睡眠安排於二者間之調節角色。研究方法：以立意取樣邀請一至三歲幼兒父母填寫問卷，含貝克憂鬱量表（Beck Depression Inventory, Second Edition, Beck, 1961/2000）、簡易嬰幼兒睡眠問卷（Brief Infant Sleep Questionnaire, Sadeh, 2004）與背景資料表。睡眠問題的指標為睡眠問題嚴重度、夜醒次數、潛伏期及夜間睡眠時間等四項；睡眠形式為同床、同房不同床、不同房等三種。樣本數共126位母親及85位父親，包含85對父母。在母親組及父母組，母親平均年齡分別為33.01歲（SD = 4.33）、33.56歲（SD = 4.26）；幼兒平均年齡分別為1.79歲（SD = 0.58）、1.75歲（SD = 0.59）；男童佔51.6%、45.9%。使用SPSS 29版進行描述統計、t檢定、卡方分析、相關分析與線性迴歸分析。研究結果：在母親組，具憂鬱傾向者之幼兒的睡眠問題嚴重程度（M = 2.52, SD = 1.22）顯著高於非憂鬱傾向者（M = 1.98, SD = 0.82）（t = 2.63*）；具憂鬱傾向者之幼兒的睡眠潛伏期（M = 61.79, SD = 33.82）顯著長於非憂鬱傾向者（M = 44.68, SD = 25.39）（t = 3.18**）。母親憂鬱與幼兒睡眠問題嚴重度、夜醒次數及睡眠潛伏期分鐘數有顯著正相關（r = .24~.30**）。在父母組，母親憂鬱傾向高者，幼兒睡眠潛伏期（M = 59.46, SD = 36.37）顯著高於非憂鬱傾向者（M = 40.67, SD = 24.72）（t = 2.47*），父親填答之幼兒睡眠問題嚴重度（M = 2.36, SD = 1.10）顯著高於非憂鬱傾向者（M = 1.79, SD = 0.77）（t = 2.76*）。母親憂鬱與父母填答之幼兒睡眠問題嚴重度、睡眠潛伏期和母親填答之幼兒夜醒次數達顯著正相關（r = .24~.33**）。以母親月收入、母親教育程度與幼兒健康狀態為控制變項進行迴歸分析，發現在母親組母親憂鬱程度越高，可預測幼兒睡眠問題嚴重程度越高、睡眠潛伏期越長。在父母組，則母親憂鬱對幼兒睡眠無預測力。在調節作用方面，母親組中發現不同睡眠形式可以調節母親憂鬱與幼兒睡眠問題嚴重度之預測關係。即同床時，母親憂鬱程度越高可預測幼兒睡眠問題嚴重度越高（β = 0.41***），但在同房不同床、不同房狀況則無預測關係。另外，睡前儀式一致性不具調節母親憂鬱與幼兒睡眠間關係的作用。研究結論：母親憂鬱與幼兒睡眠問題、夜醒次數、睡眠潛伏期有關。睡眠安排中的睡眠形式為母親憂鬱預測幼兒睡眠問題嚴重度的調節因子。本研究由母親及父親之雙重觀點描述本地幼兒睡眠狀況，並發現幼兒睡眠地點是調節母親憂鬱預測幼兒睡眠問題嚴重度的因素。即唯有在親子同床的狀況下，母親憂鬱方能預測幼兒睡眠問題嚴重度，同房不同床、不同房則是母親憂鬱影響幼兒睡眠問題之保護因子。研究結果能做為實務界對父母進行衛教指引之依據。未來研究可擴大樣本數目與代表性，並以客觀方式評估幼兒之睡眠。

Background and Purpose: The sleep patterns of toddlers are generally more stable than those of infants, suggesting the establishment of a long-term sleep rhythm. However, research examining the impact of maternal depression on toddler sleep remains limited. Some studies have indicated that sleep arrangements, including the consistency of bedtime rituals and sleep placements, are associated with toddler sleep patterns. Consequently, this study aims to investigate the relationship between maternal depression and toddler sleep, with particular focus on the moderating role of sleep arrangements in this relationship.Methods: A purposive sampling method was employed to recruit parents of toddlers aged one to three years. Participants completed several questionnaires, including the Beck Depression Inventory (Second Edition, Beck, 1961/2000), the Brief Infant Sleep Questionnaire (Sadeh, 2004), and a background information form. Indicators of sleep problems included perceived severity of the sleep problem, number of night awakenings, sleep latency, and total nighttime sleep duration. Sleep placements were categorized into co-sleeping, same-room with a separate bed, and separate rooms. The sample comprised 126 mothers and 85 fathers, including 85 dyads. The average age of mothers was 33.01 years (SD = 4.33) in the mother group and 33.56 years (SD = 4.26) in the dyad group. The average age of toddlers was 1.79 years (SD = 0.58) in the mother group and 1.75 years (SD = 0.59) in the dyad group. Boys comprised 51.6% and 45.9% of the sample, respectively. Descriptive statistics, t-tests, chi-square analyses, correlation analyses, and linear regression analyses were conducted using SPSS version 29.Results: In the mother group, the severity of toddler sleep problem was significantly higher in the depressive sub-group (M = 2.52, SD = 1.22) compared to the non-depressive sub-group (M = 1.98, SD = 0.82) (t = 2.63*). The average minute of sleep latency in the depressive sub-group (M = 61.79, SD = 33.82) was significantly longer than in the non-depressive sub-group (M = 44.68, SD = 25.39) (t = 3.18**). Maternal depression demonstrated significant positive correlations with the severity of toddler sleep problem, number of night awakenings, and sleep latency (r = .24 to .30**). In the dyad group, toddlers of depressive mothers had longer sleep latency (M = 59.46, SD = 36.37) compared to toddlers of non-depressive mothers (M = 40.67, SD =24.72) (t = 2.47*). Fathers in the depressive sub-group perceived toddler sleep problem as more severe (M = 2.36, SD = 1.10) compared to the non-depressive sub-group (M = 1.79, SD = 0.77) (t = 2.76*). Maternal depression showed significant positive correlations with toddler sleep problem severity, number of night awakenings, and sleep latency, as reported by mothers (r = .24 to .33**). After controlling for mothers' monthly income, education level, and toddler health status, regression analysis revealed that higher levels of maternal depression predicted greater severity of toddler sleep problem and longer sleep latency in the mother group. However, no predictive relationship was found in the dyad group. Regarding moderating effects, sleep placements moderated the predictive relationship between maternal depression and toddler sleep problem severity in the mother group. Specifically, higher maternal depression predicted greater severity of toddler sleep problem when co-sleeping (β = 0.41***), but no predictive relationship was found for same-room with a separate bed or separate rooms. Furthermore, the consistency of bedtime rituals did not moderate the relationship between maternal depression and toddler sleep.Conclusion: Maternal depression is associated with toddler sleep problem severity, number of night awakenings, and sleep latency. Sleep placements function as a moderating factor in the relationship between maternal depression and toddler sleep problem severity. This study contributes to our understanding of the sleep status of Taiwanese toddlers from the perspectives of both mothers and fathers. The findings suggest that sleep placements moderate the impact of maternal depression on toddler sleep problem severity. Specifically, maternal depression predicts greater severity of toddler sleep problem severity only when co-sleeping. In contrast, same-room with a separate bed and separate room placements appear to serve as protective factors against the effects of maternal depression on toddler sleep. These findings may inform parenting consultations on sleep practices. Future research with larger, more representative samples, and the use of objective sleep assessments, is warranted.