yiri'(> r
VAI TRO CUA TLJ DANH GlA BAN THAN DOI VOI ROI LOAN STRESS
SAU SANG CHAN 6 PHU NQ SAU SINH
TS. Bili Thi H6ng Thai
Trudng Dgi hgc Khoa hgc ^ hpi vd Nhdn vdn, Dgi hgc Qud'c gia Hd Npi.
TOM TAT
Cdc sd lieu trong bdi bdo ndy dugc Idy tir ket qud nghien cim ciia de tdi ''Phu na sau sinh - Nhiing rdi nhieu tdm ly vd cdc bien phdp hd trg", ma sd QGTD 1314 do Bgi hgc Quoc gia Hd Npi tdi trg. Tie ket qud dieu tra tren 1.134 sdn phu mdi sinh con trong vdng 12 thdng tra lgi a 3 thanh phd Hd Npi, Dd Ndng vd Hd Chi Minh bdng bp cdng cu tu ddnh gid bdn thdn cua Rosenberg vd thang do stress sau sang chdn, bdi bdo chi ra rang, tu ddnh gid bdn thdn cao lam gidm rdi logn stress sau sang chdn d sdn phu. Ben cgnh do, tu ddnh gid bdn thdn co the dieu tiet mdi quan he giiia nhieng yeu td khdng thugn lgi vdi rdi logn stress. Theo do, nhirng sdn phu trong hodn cdnh kinh ti sa silt, diiu kien hdn nhdn khdng tot vd khdng co su tra giiip sau sinh se cdng tdng diim rdi logn stress khi kit hgp vdi tu ddnh pa bdn thdn d miec dp thap. Trong khi do, cdc yiu td ndy khdng trd thanh nguy ca doi vdi rdi loan stress sau sang chdn khi sdn phu tu ddnh gid bdn thdn a miec chuan vd miec cao.
Tir khoa: Tu ddnh gid bdn thdn. Stress sau sang chdn, Phu nd sau sinh Ngdy nhdn bdi: 7/9/2015; Ngdy duyet ddng bai; 25/9/2015.
1. Dat van de
Ty danh gia ban than dugc hiiu la quan diem ma mdi ca nhan cd va gin giir v l chinh ban than minh, nd thi hien su hai long hoac khdng hai long, chap nhSn hoac khong chip nhan ciia ca nhan vl ban than. Khai niem tu danh gia ban than cd su thay ddi theo thdi gian va theo quan diim ciia timg tac gia. Neu Rosenberg (1965) nhin manh din vai trd cua nhirng nang lyc xa hdi, nhiing thanh tyu ca nhan va ngoai hinh cua mdi ngudi thi Coopersmith (1984) danh gia cao cam nhan cita ca nhan vl nang lyc ban than trong mgi linh vyc cua ddi sdng. Trong khi do. Beck (2001) dl cao hieu qua ciia nhirng nhan djnh ciia ca nhan ddi vdi nhirng su kien trong cugc sdng. Dii cd sy khac biet trong each nhin nhan, nhtmg cac tac gia diu thiia nhan tim quan trgng cda viec ca nhan tu
TAP CHi TAM Vi HOC, S6' 10 (199), 10-2015 47 f j
danh gia ban than mdt each tich cue. Khi miic dp tu danh gia b4n than eang cao, nd cang trd nen bin vUng va ca nhan it bi tac ddng bdi nhiing hoan canh khac nhau cda cudc sdng. Ngugc lai, neu ca nhan cd ty danh gia bin thSn cang thip thi nd cang ttd nen mong manh va ca nhan dl nhay cam trude nhiing thay ddi cua hoan canh sdng (dan theo 3].
Theo bao cao ciia Trung tam Sue khde tam than tre em va thanh thilu nien ciia Phap (2011), tu danh gia ban than vira dugc xem la yeu td bao ve, lai ciing dugc nhin nhan la yeu td nguy eg trong vide phat trien nhOng vin de lien quan den siic khde tam than. Tu danh gia ban than tich cue gan vdi cam nhan hanh phuc, kha nang thich ung tdt va cd thi bao ve ca nhan khdi nhiing tri$u chirng tram cam bang each giam dan va loai bd suy nghT tieu eye [din theo 2].
Ngugc lai, ty danh gia ban than thap cd mdi lien he mat thiet vdi tinh trang tram cam bat ke d ngudi trudng thanh hay thanh thieu nien, vdi rdi loan lo au, vdi sy hai Idng ve cupc sdng d miic dp thiip, vdi nhiing trang thai cam xiic am tinh nhu sy hudn ehan, xu hudng kich ddng va thd a, vdi mac cam tdi Idi va ndi am sp bi that bai [dan theo 10].
Viec mang thai va sinh con tit lau da dugc nhin nhan nhu mdt su kien sang chan ddi vdi phu nit. Nhirng nghien ciru thyc nghiem ciia Engelhard va cdng su (2006), cua Pierrehumbert (2004) da khang dinh nguy ca cao mac stress sau sang chan d nhirng san phy cd eae bien chiing thai san nhu de non, say thai hay thai chit luu. Tuy nhien, theo Vythilingum (2010), ngay ca khi san phu khdng cd biln chiing thai san thi ban than viec mang thai cung cd thi la ngudn goc khien hg trai nghiem nhiJng bilu hien sang chan. Dieu nay da timg duge khing dinh trong nghien cim eua Arizmendi va Affonso (1987), cung nhu nghien ciru cila Moleman -ya cdng sy (1992), cac tac gia da md ta nhiing triSu chiing stress sau sang chan xuit Men d nhttng san phu mang thai binh thudng va khong cd can thiep san khoa [din theo 7].
Rat nhidu nghien ciru da chi ra tam quan trpng cua mirc dp ty danh gia ban than trong giai doan thai ki cda ngudi phu nit. Theo Hall va cdng su (1996), hrong qua trinh mang thai va sinh nd, neu ngudi me cd ty danh gia ban than thap thi dieu nay se anh hudng tieu cue din sire khde, tham chi cd thi gay nen rdi loan lo au va tram cam d hp. Ciing nhu vay, viec cd mirc do tu danh gia ban than thap sau sinh se la mdt ylu td nguy eg cho sy phat triin ciia rdi loan trim cam sau sinh. Trong khi dd, ty danh gia ban than cao se giiip san phu han chi nhiing cam xuc tieu eye trong qua trinh sinh nd va trong 3 thang diu sau sinh [din theo 5].
•Trong bai bao nay, chiing tdi nghien ciiu anh hudng eiia ty danh gia ban than ddi vdi rdi loan stress sau sang chin d san phu. Theo dd, tu danh gia ban
48 TAP CHI TAM Vi HOC, Sd 10 (199), 10-2015
than vita dugc nhin nhan nhu mdt bien ddc lap cd kha nang tac ddng va dy bao miic do bi stress cua san phu, ddng thdi ciing dupe nhin nhan nhu mdt biln trung gian, cd vai trd dilu tilt mdi quan he gitia nhiing ylu td nguy co (dilu kien kinh te, sy trg giiip sau sinh, mdi quan he hdn nhan ciia san phy) ddi vdi miic do bi stress cua san phu.
2. Phirong phap va gia thuyet nghiSn ciru
Nghien ciiu dugc tien hanh bang phuang phap dilu tra bing bang hdi (tit thang 3 din thang 7/2014) tren 1.134 san phu tai thanh phd Ha Ndi, Da Ning va Hd Chi Minh. Tudi trung binh eua khach thi nghien ciiu la 28,39 tudi, vdi frinh dp hpc vin khac nhau, gdm: trung hpc pho thdng (ehilm 29,8% toan mlu nghien ciiu), trung cip nghi (ehilm 12,5%) va cao ding, dai hpc, sau dai hpc (chiem 57,7%). Tinh theo thai gian sinh con thi 7,1% sd san phu da sinh con dugc dudi 1 thang; 20,7% sd san phu da sinh con tir I din dudi 3 thang; 24,7%
sd san phy da sinh con tit 6 thang din dudi 9 thang va 27,5% so san phu da sinh con tit 9 thang din dudi 1 nam.
Chiing tdi sii dyng thang do 10 item ciia Rosenberg (1965) dl do mite dp ty danh gia ban than eiia san phy, thang do cd he sd Cronbach's Alpha vdi a = 0,687. Ve rdi loan stress sau sinh, chiing tdi xay dyng mdt thang do danh gia vdi 20 item, dya vao cac tieu chuan chin doan ciia DSM-IV vl rdi loan stress sau sang chan va cac nghien cim lam sang ve cac dau hieu ciia rdi loan stress sau sinh d phu nii. Thang do cd he sd Cronbach's Alpha vdi a = 0,875.
Hai thang do duge thiet ke dang 4 bac vdi quy dmh diem di tCt 1 - hoan toan sai den 4 - hoan toan diing. Rieng vdi thang do ty danh gia ban than, cac item ngugc chieu dugc ddi diem trong qua trinh nh$p sd lieu.
Sd lieu didu tra dugc xu ly bang phan mem SPSS 16.0 vdi cac phep tinh ty le %, diem trung binh, do lech chuan trong mieu ta chung ve miic dp tu danh gia ban than va miic dp mac rdi loan stress sau sinh g san phu. Diem trung binh chung ciia toan thang do (X) va dd lech ehuan (SD) dupe su dung de xep hang cac mirc do ty danh gia ban than/rdi loan stress sau sinh, vdi cac gia tri nhu sau:
Thang do ty danh gia ban than ed diem trung binh chung cua toan thang do (X) la 30,12 va do lech chuin (SD) la 4,29. Cac mire do tu danh gia ban than gdm: 1/ DTB < X - ISD (dudi 26 diem); Ty danh gia ban than mue thap;
2/ X - ISD < DTB < X -I- ISD (26 diim din 34 diim): Ty danh gia ban than miic chuin; 3/ DTB > X-i- ISD (tren 34 diem den 40 diem): Ty danh gia ban than miic cao.
Thang do stress cd diim ming binh toan thang do (X) la 33,71 va dp lech chuin (SD) la 10,97. Cac miic do sfress dugc xae dinh nhu sau: 1/ DTB < X - 1 SD (dudi 23 diim): Khdng cd sfress; 2/ X - I SD < DTB < X + I SD (ttr 23 din
TAPCH|-TAMLyHOC,S610(199), 10-2015 49
44 diim): Stress miic chuin/ehip nhin dugc; 3/ X -I- ISD < DTB < X -I- 2SD (tren 44 din 55 diim): Stress miic nhe; 4/ X + 2SD < DTB < X -I- 3SD (tten 55 din 66 diim): Stress miic vita va 5/ X -^ 3SD < DTB (tren 67 din 80 diim):
Stress miic nang.
Phep phan tich tuang quan nhi bien vdi he sd tuong quan r Person dugc sii dung nhim kiem tra mdi lien hi gitia bien ty danh gia bin than va biln sh-ess sau sang chan. Phep hdi quy don biln dugc su dung nhim tim hieu kha nang du bao cua biln tu danh gia ban than ddi vdi sy thay ddi cua bien rdi loan stress sau sang chan. Cudi ciing, phep phan tich Anova 2 nhan td dupe ap dung dl tim hiiu vai trd dieu tilt cua bien ty danh gia ban than ddi vdi mdi quan he giiia cac bien ve dieu kien nhan khiu, xa hdi ciia sdn phy vdi rdi loan stress sau sang chan.
Gia thuyet nghien ciiu la: 1/ Cang ty danh gia ban than cao, mite dp stress sau sang chan cua san phu cang giam va 2/ Miic dd ty danh gia ban than cd the dieu tiet mdi quan he giiia nhiing yeu td gay cang thang (dieu ki$n kinh te, moi quan he hdn nhan, su trp giiip sau sinh) va rdi loan stress sau sinh ciia san phu.
3. Kit qua nghien cirn
3.1. Anh hiedng cua tu ddnh gid ban thdn den rdi logn stress sau sang chdn d sdn phu
• a. Mu-clhap
• b. Mirc chuan
f^C MLTtCOO
_b. 68.50%
Bieu 3d 1: Ty le cdc mue dp tu ddnh gid bdn thdn ciia phu nii sau sinh
Xetn xet miic dp ty danh gia ban than cua phu nii sau sinh, ket qua dilu tra cho thiy khach thi trong nghien cdu cd DTB tu danh gia ban than thip nhit la II va eao nhit la 40, vdi DTB ehung la 30,12. DTB ehung tu danh gia ban than cua nhdm khach thi trong nghien eiiu nay cOng gan tuong ddng vgi kit qua nghien ciiu eiia Hatcher ya cdng sy (2008) tren khach thi la nhiing ba me don than ngudi My gde Phi. Ap dyng thang do 10 item cila Rosenberg, cac tac gia cdng bd DTB chung ty danh gia ban than cua nhdm san phu nay dat 28,6 diim va do l$ch chuin la 8,2 [din theo 6].
50 TAP CHi TAM Vi HOC, S6' 10 (199), 10 - 2015
Mdt each cy thi hon, bieu dd 1 ehi ra ty le san phy trong nghien ciiu ciia chiing tdi danh gia ban than theo cac mile khac nhau.
Bieu dd I cho thay, ty le san phu danh gia ban thiin d miic chuan la cao nhat, chiem 68,5%. Ty le san phy ty danh gia ban than d miic cao la 14,8% va ty le san phu ty danh gia ban than d mite thap la 16,7%. Ddi vdi nhiing phu nil mdi sinh con, viec ty danh gia ban than khdng chi quan trgng trong ddi sdng tam ly ciia ca nhcin hg, ma nd cdn cd the anh hudng mdt each tich cue hoac tieu cue den viee nhin nhan ve ehuyen sinh de, ehuyen cd con va cham sdc con, cung nhu mdi quan he giQa san phy vdi nhiing ngudi than khac trong gia dinh.
Do do, dti ty le phu nil danh gia thap vl ban than d nghien citu nay thip hon nhieu so vai nhiing ngudi danh gia ban than theo hudng tich eye, chiing tdi cho rang ket qua nay rat dang quan tam trong cdng tac theo doi va cham sdc cho cae san phy.
Lien quan den rdi loan stress sau sinh, ket qua dieu tra chi ra rang trong sd 1.134 san phu dugc nghien ciru, cd 86,10% san phu cd bieu hien stress vdi cac miic do nhu d bieu do 2.
B a. Stress mue chap nhan diroc
• b Stress mirc nhe
sc.Stress niircvlJa
• d. Stress niirc nSng
Biiu dd 2: Cdc miec dp hi rdi logn stress a phu nie sau sinh
Xet trong nhdm phy nil cd roi loan stress sau sinh (929 khach the), ket qua d bilu dd 2 cho thiy cd 82,6% phu nit bi rdi loan stress nim d miic chip nhan dugc (dd la mue chuin himg binh cua nhdm miu nghien eiiu). Dilu nay cd nghia la, mac du nhdm phu nil nay cd nhiing bieu hien cua roi loan stress sau sinh, nhung mdc dp rdi loan ciia hp nim trong ranh gidi chip nhan dugc, hp d nguang eang thing eho phep. Nhu vay, that su chi cd 17,4% phu nO trong nghien ciiu nay bi rdi loan stress sau sinh theo cac miie do khac nhau. Trong do, cd 11,5% phu nii bi rdi loan stress d miic nhe; 4,6% d miic vita va 1,3% hi rdi loan stress d miic nang.
TAP CHiTAM Vi HOC, Sd 10 (199), 10 - 2015 51
Tim bilu mdi tuong quan giiia ty danh gia ban than va miie dg rdi loan stress sau sinh d nhiing san phu cd bilu hien stress (929 san phu), phan tich tuong quan nhi biln cho thiy cd jnoi tuong quan nghich vdi miic do kha manh giiia hai biln nay vdi r = -0,458; p = 0,000. NghTa la, eang ty danh gia ban than thip, san phu cang cd xu hudng cd diim sd rdi loan stress sau sang chan cao ya ngugc lai, cing ty danh gia ban than cao thi diim sd stress d san phu cang_thap.
Kit qua nay cho thiy tim quan trgng cua viec chip nhan ban than ddi vdi nhOng bilu hien cua rdi loan stress d nhdm khach thi trong hoan caiih mang thai va sinh con. Khi ca nhan nhin nhan minh tich cue va cd gia tri, ddng thdi hg chip nhan ban than nhu minh vdn cd vdi nhiing uu diim va nhugc diem cua rieng minh thi miie do bilu hien stress d hp cang thip. Rpsenberg (1983) nhan dinh, ty danh gia ban thSn cao la diu hieu eua sy chip nhan, sy nhan ai va sy hai long cua ca nhan vl ban than minh ma khdng diy ca nhan din viec ddi hdi su hoan hao [din theo 10]. Va nhu vay, ty danh gia ban than tieh eye giiip phu nH sau sinh dat dupe su can bang trong ddi sdng tam ly.
Cudi ciing, nhihig kit qua tit phep hdi quy tuyin tinh cho thay ty danh gia ban than cd kha nang du bao eho sy thay ddi diim sd rdi loan stress sau sinh d san phu (bang I).
Bdng 1: Tdm tdt md hinh hoi quy giiea tu ddnh gid bdn thdn vd rdi logn stress sau sinh
Mo hinh
1 R
0,458 R binh phirong 0,210
R binh phuang hieu chinh
0,209
Durbin-Watson
9,287 a. Bien du bdo: Tu ddnh gid ban thdn.
b. Bien phu thuoc: Diem rdi logn stress sau sang chdn.
Tham sd R binh phuang hieu chinh la 0,209 cho thay 20,9% sy bien ddi ve diem sd stress sau sinh cd the dugc giai thich bang sy bien ddi ciia diem sd ty danh gia ban than d cac phu nit sau sinh. Ndi each khac, mite dp ty danh gia ban than cd thi du bao dupe sy thay ddi 20,9% diem sd stress sau sang chin d nhdm san phu trong nghien ciiu nay.
Cu thi ban, nhiing thdng sd d bang 2 cho thiy he sd v l dp ddc trong phuong trinh hdi quy giOa ty danh gia ban than va diim trung binh stress la 1,126. Dieu nay cd nghia la cit mdi khi diim ty danh gia ban than tSng len 1 diem thi diSm trung binh stress sau sang chan se giam di 1,126 diim.
52 TAPCHITAM LV HOC, S6' 10 (199), 10 - 2015
B S i ^ ^ a i ™ -
Bdng 2: Cdc he so hoi quy giiia tu ddnh gid bdn thdn vd roi logn stress sau sinh
Md hinh
1 (Constant) TIT danh gia ban than
Do doe H e s o B
69,540 -1,126
fio lech 2,193
,073
Gia tri t
31,705 -15,491
Miic y nghia p
0,000 0,000 a. Bien phu thudc: Diem rdi logn stress sau sang chdn.
Cac ket qua trinh bay d tren cho phep chiing tdi khang dinh gia thuyet 1 trong nghien ciiu. Tu danh gia ban than eua san phu cd the anh hudng den rdi loan stress sau sinh ciia hp theo hudng khi san phu cang ty danh gia ban than cao thi diim v l stress sau sang chin d hg cang giam va ngugc lai.
Tren thyc tl, khdng chi miic dd ty danh gia ban than ma cd rit nhieu yeu td nguy CO khac cd the gay xuat hien stress sau sang chan d san phu hoac lam tang diim sd stress d hg. Dd ed thi la dilu kien kinh te khd khan, tinh trang thit nghiep, khdng cd bao hilm xa hgi va thilu ving sy hd trg, giup do sau sinh (Seguin va Cosette, I99I) [din theo 8]. Dd cung cd thi la mdi quan he vg chdng khdng thuan lgi (Bourgeois va Sutter, 1996) [din theo 1]. Nhiing khd khan din tii tinh Uang site khde cua em be hay nhimg van dl lien quan den sue khde ciia san phu (Ratcliff va cdng sy, 2014) [din theo 9J cung nhu dac diem tinh each eua hp (Graignic-Philippe va cgng sy, 2004) [din theo 4] diu cd thi trd thanh nhiing ylu td tilm nang cho rdi loan sttess sau sang chan d phu nil sau sinh.
Tren co sd nhiing kit qua vl anh hudng cua ty danh gia ban than den rdi loan stress sau sang chin, chiing tdi tilp tuc lam sang td vai trd dilu tiet ciia hiin tu danh gia ban than ddi vdi mdi quan he giiia nhiing yen td nguy co va rdi loan stress sau sang chin. Nghia la, chiitig tdi nhin nhan tu danh gia ban than nhu mdt biln trung gian, cd kha nang dilu tilt mdi quan h? giiia bien ddc lap (chiing tdi tap trung vao 3 ylu td la dilu kieii kinh te, mdi quan he hdn nhan va sy trg giup sau sinh) va biln phu thudc (diim sd rdi loan sUess cua san phu).
3.2. Vai tro diiu tiit cua tu ddnh gid bdn than ddi vdi mdi quan he giiia nltdngyiu td nguy ca vd rdi logn stress sau sang chdn 6 sdn phu
Vai tro ciia tie ddnh gid bdn thdn ddi vdi mdi quan he giiia dieu kien kinh ti vd rdi logn stress sau sang chdn
TAP C H ( T A M LV HOC, Sd 10 ( 1 9 9 ) , 10 - 2 0 1 5 53
Cac nghien ciiu vl phu nil sau sinh deu chi ra rang dieu kien kinh tl khd khan, sy bit dn vl viec lam khiln san phu di roi vao nhiing rdi loan tam ly.
Trong nghiSn ciiu cua chung tdi, su sa sut ve di6u kien kinh t l lam tang ty 1$
san phu mic stress sau sinh, vdi 98,l%i san phu roi vao hoan canh khd khan vl tai chinh cd bilu hien stress so vdi 85,4% san phu khdng ed sy suy giam kinh tl trong thdi gian mang thai va sinh con. Ben canh dd, dii ket qua dieu tra ghi nhan sy khac biet cd y nghTa thdng kS trong diim sd stress sau sang chin d hai nhdm phu nd cd khd khan kinh te (DTB = 42,12) va khdng cd khd khan kinh tl (DTB = 35,43), nhung cac diem sd nay cho thay ca hai nhdm san phu diu co stress d miic ch&p nhan dugc.
Tuy nhien, cac kdt qua ve DTB stress sau sang chan g tirng nhdm san phu thay ddi khi cd su tham gia cua bien ty danh gia ban than. Phep phSn tich Anova 2 nhan td cho thay, kha nang tac dpng cua bien ty danh gia ban than len mdi quan he giira dieu kien kinh te va rdi loan stress d san phy ttong nghien ciiu nay vdi F(2,897) = 4,234; p = 0,015 (hinh 1).
DTB Slrsnsauslnli
Si^
Hinh 1: Anh hudng cua tie ddnh gid bdn thdn len mdi quan he giiea dieu kien kinh te vd rdi logn stress sau sinh
Sd li$u d hinh 1 cho thiy su phan hda ro net d nhdm san phu roi vao hoan canh sa sut vl kinh t l trong thdi gian mang thai va sinh con. Theo dd, khi san phu tu danh gia ban than d miic cao thi DTB v l stress cua hp la 27,75 (tniie chap nhfa dugc), khi san phu tu danh gia ban than g miic chuin thi DTB vd sh-ess cua hp la 37,43 (miic chip nhan dugc). Nhtmg nhiing san phu cd hoan canh kinh te gia dinh sa siit cgng them ty danh gia ban than d mirc thip thi DTB stress cda hp tang len thanh 51,55. Liie nay, miic dd stress ciia hp da ehuyin tit miic chip nhSn dupe sang miie nhe.
54 TAP CH(TAM Lf HOC, S6' 10 (199), 10 - 2015
Trong khi do, nhiing san phu khdng roi vao tinh trang suy thoai kinh te thi du hg danh gia ban than d miic thip (DTB stress = 41,75), miic chuin (DTB stress = 35,55) hay miic cao (DTB stress = 28,49) thi mile dp rdi loan stress eiia hg vin nam trong mirc chip nhan dugc.
Nhu vay, khi nhin nhan rdi loan stress sau sang chin g phu nii sau sinh til dieu kien kinh te, cac kit qua nghien ciiu diu chi ra ring sy bip benh va khd khan ve kinh t l lam tang ty le va miic dp stress d san phu. Tuy nhien, nhiing ket qua trong hinh 1 luu y chiing ta ve tim quan trgng eua ty danh gia ban than ciia san phu ddi vdi rdi lo^n stress sau sinh. Cd thi dl dang nhan thiy ring nhiing san phu dii d dieu kien kinh t l khd khan, nhung cd ty danh gia ban than d mirc eao va miic chuin thi diem ve rdi loan stress sau sinh eiia hg gin nhu khdng khac biet so vdi nhiing san phu khdng cd khd khan vl kinh tl (hg diu mac stress d mirc chip nhan dugc). Chi rieng nhiing san phu vita ed khd khan ve kinh te, viia ty danh gia ban than thip mic stress d miic nhe.
Vai trd cua tu ddnh gid bdn thdn ddi vdi mdi quan he giiia tinh trgng hon nhdn vd roi logn stress sau sang chdn
Tinh tr?ng hSn n h ;
Hinh 2: Anh hudng cua tu ddnh gid bdn thdn len moi quan he giiea tinh trgng hdn nhdn vd roi logn stress sau sinh
Tinh trang hdn nhan hay mdi quan he vdi ngudi chdng ludn dugc xem xet trong cac nghien citu ve phu nit sau sinh. Mdt mdi quan he vg chdng khdng dn djnh, sy thieu gan bd vl trach nhiem va tinh cam giiia san phu va chdng ludn la nguy ca lam xuat hien cac rdi loan tam ly d san phu. Nd cung de dpa din kha nang cham sdc con eua ngudi me. Mae dii vSy, tinh trang hdn nhan
TAP CHITAM LV HOC, Sd 10 (199), 10 - 2015 55
khdng phai ludn anh hudng mdt each dijng nhSt den mgi san phu. Nhin nhan tac ddng cua tu danh gia ban than din mdi quan he giOa tinh trang hdn nhan va rdi loan sB-ess sau sinh, kit qua dilu tra cho thiy vai trd ciia ttr danh gia ban than ddi vdi mdi quan he nay la cd y nghTa thdng ke vdi F(2,g9o) = 16,334;
p = 0,000 (hinh 2).
Cac kit qua d hinh 2 ghi nhan sy khac bidt giiia cac nhdm san phu trong eung mdt hoan eanh hdn nhan. Cu thi la, d nhdm san phy lam me don than hay li than, li hdn, gda thi khi hp ty danh gia ban than d mdc cao, DTB ve stress cua hg dat 29,17 diim (trong ngudng chip nhan dugc). Tugng ty nhu vay, khi hp ty danh gia ban than d mdc chuin thi DTB vl stress cua hp la 34 (thupc nguong chip nhan dupe). Tuy nhien, nlu san phy rai vao tinh trang vua lam me don than/li hdn/li than/gda vua cd mdc dp tu danh gia ban than thip thi DTB stress eua hp tang len thanh 57,14. Luc nay, rdi loan shress sau sang chan d hp da chuyen sang mdc vua.
d nhdm san phu sdng cimg chdng tai thdi diem nghien cdu, du ed sy khac biet vl DTB sdess theo eac mdc dp tu danh gia ban than cao (DTB stress = 28,26), ty danh gia ban than mdc chuin (DTB sdess = 35,7) va ty danh gia ban than mdc thip (DTB stress = 41,54) nhung hp vin duy tri stress d ngudng chap nhan dupe.
Vai trd cua tu ddnh gid bdn thdn ddi vdi mdi quan he giiea sie tra giup sau sinh vd rdi logn stress sau sang chdn
Dupe giup da trong thdi gian mang thai, dac biet la trong nhiing thang diu sau sinh la dilu rat quan trgng ddi vdi san phu. Vi liic nay, san phu khdng chi ban ehe ve mat sdc khde ma cdn cd the cd nhdng bdi rdi trong viec cham sdc con. Do do, sy quan tam, giup dd danh cho san phy la dieu vd cung quan trpng giup nguoi me cd cam giac an tpan. Trong nghien cdu nay, cd 85,5%
nhiing san phu dugc trg giup sau sinh cd bieu hien stress. Trong khi do, ty le nay q nhtmg san phu khdng dugc giup do sau sinh la 96,3%. Tuy nhien, DTB vl stress g hai nhdm san phu cd ngudi giup dd (DTB = 35,39) va khdng cd ngudi giup dd (DTB = 42,56) vin thudc ngudng chap nhan duge.
Ket qua nghien cdu tiep tuc ghi nhan vai trd ciia tu danh gia ban than ddi vdi mdi quan he giiia viee dugc giup do sau sinh va rdi loan stress sau sinh d san phu vdi Fjj.ggg, = 6,999; p = 0,001 (hinh 3).
Hinh 3 ghi nhan su phan hda giua nhiing san phu trong cung mdt nhdm.
Cu the, d nhiing san phu khdng cd ai cham sdc sau sinh, neu hg ty danh gia ban than d mde cao thi DTB stress cua hg dat 27,78 (nguang chip nh&i dugc). Khi hp tu danh gia ban than d mdc chuin thi DTB stress ciia hp dat 39,32 (nguong
56 TAP CH( TAM Vi HOC, S6 10 (199), 10-2015
chap nh$n dugc). Nhung khi hp ty ddnh gia ban than d mdc thip thi DTB stress tang ISn thanh 54,44, day hp rgi vao stress mdc nhe.
N g u - ^ i ch^i
Hinh 3: Anh huang ciia tit ddnh gid bdn thdn ten mdi quan he giiea viec cd hay khong ngudi chdm soc vd roi logn stress sau sinh
Rieng nhdm san phu cd ngudi trg gidp sau sinh, thi mdc dp ty danh gia ban thSn tuy cd lam thay ddi DTB stress sau sang chan d hp, nhung rade dp stress d nhdm san phy nay vin thudc mdc chap nhan dupe.
Nhu vay, cac ket qua trong phan nay cho phep chung tdi khang dinh gia thuyet thd 2 la ty danh gia ban than cd the dieu tiet mdi quan he gida cac yeu td nguy CO (kinh te gia dinh sa sut, tinh trang hdn nhan khdng tdt va khdng cd su gidp dd sau sinh) vdi rdi loan stress sau sang ehan d phy nu sau sinh. Theo dd, chinh nhung san phu d dilu kien nguy co kit hgp vdi ty danh gia ban than thip la nhihig ngudi cd rdi loan stress cao hon ca.
4. Ket luan
Vai trd eua ty danh gia ban than ddi vdi cae rdi loan tam ly d phu nd sau sinh da duge khing dinh trong nhilu nghien cdu khac nhau. Theo dd, ty danh gia ban than thap kit hpp voi cac yeu td nhu suy nghi tieu eye lam tang mdc dp trim cam d san phy [din theo 6], tu danh gia ban than thip kit hpp vdi cac ylu td gay stress nhu thilu sy trg gidp cung lam tang mdc dp tram cam d san phy [din theo 5]. Nhu nhan xet cua DeLongis, Folkman va Lazarus (1988), nhung ca nhan cd sy ty danh gia ban than thap va khdng hai Idng ve mdi quan he gia dinh ludn thi hien nhung bit dn ve tam ly nhieu hon so vdi nhdng ca nhan cd mdc do ty danh gia ban than cao ket hgp vdi nhiing mdi quan he gia dinh tdt va cd mang luoi trp gidp dn dinh [dan theo 5].
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Cac kit qua ma chung tdi dinh bay d tren eho thay ty danh gia ban than, mdt mat, ddng vai trd anh hudng (theo chilu nghich) din rdi loan stress sau sang chin d san phy cung nhu dy bao cho sy thay ddi diim stress d san phu;
Mat khac, ty danh gia ban thiin ciing lam thay ddi tinh trang stress sau sang chin d cac nhdm phu nu cd chung dac diem nhan khiu, xa hdi. Cu thi la, ciing d nhdm san phu cd dilu kien kinh tl gia dinh sa sut hoac d trong tinh trang hon nhan la dan than/ddc than/li hdn/li than/gda hoac cung thugc nhdm san phu khdng CO ngudi gidp dd sau sinh, chi nhdng san phy danh gia ban than thip mdi dang bao ddng ve diim rdi loan stress sau sinh. Trong khi do, nhung san phu danh gia ban than d mdc chuan va mdc cao khdng cd nguy eo tang diem hay mdc do stress. Cac ket qua nay lim y chung ta ve viec khdng phan chia mdt each dan gian cac san phu vao thanh nhung nhdm khac biet ve nhan khau, xa hdi trong nhin nhan, danh gia ve nhdng rdi loan tam ly sau sinh d hp. Td gde dp tam ly hpc, chdng tdi mudn nhan manh den vai trd cua cac bien gan vdi yeu td tam ly cua ca nhan, ma d nghien cuu nay, ehdng tdi ehi ra la sy chap nhan ban than, ty danh gia ve gia tri ban than cua san phu. Cd the khang dinh rang, nhihig dieu kien khdng thuan lgi nhu kinh tl sa sut, vg chdng li tan hay khdng cd ngudi giup dd sau sinh ed the khien san phy trd nen cang thang, bdi rdi hgn trong thdi gian mang thai va sau sinh. Mac du vay, hoan canh khd khan dd chi trd thanh yeu td thyc sy dang bao ddng khi nd ket hgp vgi ty danh gia ban than d mde thap cua siin phu. Ndi each khac, viec nhin nhan vl gia di ca nhan mdt each tich eye se nang cao long ty trgng d san phu va giiip hp ddi dien vdi khd khan eua hpan eanh sdng mdt each huu hieu hon.
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