| 作者：Marlene Busko | | 出處：WebMD醫學新聞 |
September 25, 2008 — 不管孩子的行為如何，有憂鬱和身體暴力關係的母親，相較於那些沒有憂鬱或虐待的母親，打小孩的機會達兩倍。
這些發現來自全國取樣的幼稚園小孩和他們的母親，線上登載於9月11日的Archives of Disease in Childhood期刊。
主要研究者、麻州波士頓大學醫學院的Michael Silverstein醫師寫道，我們的資料顯示，母親的憂鬱、暴力環境與對各種行為的小孩採取打罵式管教有關。
研究者也發現，這些是常見且可修飾的風險因素，且與影響打小孩的頻率相比，影響這些母親是否用打來教訓她的小孩更容易。
【放棄原則、寵壞小孩？】
研究者寫道，過去10年，父母親使用非濫權的打罵來教訓行為錯誤的小孩已經變成有爭議的議題；如果小孩的健康照護提供者鼓勵父母親採取有效溝通，他們需要更瞭解打小孩的影響。
之前的研究顯示，如果母親憂鬱、父母親有暴力關係、小孩本身說謊、偷竊或者無禮，比較可能會被打。
研究者試圖探究母親憂鬱、家中成人間的暴力與小孩挨打之間的關聯，以確認怎樣的小孩行為會影響其挨打。
分析資料來自Early Childhood Longitudinal Study研究的幼稚園世代，這是1998至1999年間對美國幼稚園學童進行取樣的研究，該研究採取面對面雙親訪談與教師調查。
研究者根據美國流行病學研究中心之憂鬱量表問卷中的12項問題的反應，確認這些小孩的母親是否有臨床明顯的憂鬱症狀。
對於「當你和你的伴侶有嚴重意見分歧的時候，你有多常以毆打對方或者摔東西？」這問題的回答為「從未如此」以外的答案者，被視為處於有家庭暴力環境。
以老師對於社會排序量表的反應來評估小孩的自我控制、正向、負向與外化行為；以「有些小孩很乖，有些則沒有。如果有，在過去一週你打過小孩幾次？」這個問題確認母親打小孩的頻率。
總共有12,764對母親和小孩完成這份資料，根據母親的風險因素分成以下四種互斥的類別：
* 沒有臨床憂鬱症狀也沒有暴力環境(n = 10,299)。
* 憂鬱症狀 (n = 1742)。
* 暴力環境(n = 487)。
* 憂鬱症狀和暴力環境(n = 236)。
在幼稚園和6.2歲時評估這些親子之間的關係，男孩有50%強，母親平均年紀為33歲，有2至3個小孩。
【四分之一以上的母親打過小孩】
沒有臨床憂鬱症狀也沒有暴力環境的母親，約有四分之一打過小孩，有其中一種風險因素的母親約有三分之一打過小孩，有兩種因素的母親約有半數打過小孩。
每週平均打小孩的次數有類似的模式。
【打小孩的母親類別與頻率】 母親風險類別
| 打過小孩的母親比率 (%)
| 每週打小孩的次數
| 沒有臨床憂鬱症狀也沒有暴力環境
| 24 | 1.49 | 憂鬱症狀
| 35 | 1.68 | 家庭暴力環境
| 33 | 1.68 | 憂鬱症狀和家庭暴力環境
| 46 | 1.92 |
相較於沒有憂鬱症狀者，有憂鬱的母親打過小孩的比率將近60%；有憂鬱且和其配偶暴力爭吵的母親打小孩的機率更高達2.5倍。
【憂鬱和/或家庭暴力環境之母親打小孩的校正風險比】 風險因素
| 校正風險比 (95% CI)*
| 沒有憂鬱或者沒有家庭暴力
| 1.00
| 憂鬱症狀
| 1.59 (1.40 – 1.80)
| 家庭暴力環境
| 1.48 (1.18 – 1.85)
| 憂鬱症狀和家庭暴力環境
| 2.51 (1.87 – 3.37)
|
*根據母親的年紀、小孩的年紀和性別、兄弟姊妹數、家庭社會經濟地位校正風險比；未校正小孩的行為。
若校正小孩的正向或負向行為之後，前述打小孩的風險依舊成立。
許多研究認為，小孩越早挨打，未來越可能出現行為問題。他們寫道，應考慮進行母親的憂鬱對小孩惡化暴力行為影響之後續研究。
Silverstein醫師接受國家心智健康研究中心與Physician Faculty Scholars Program之 Robert Wood Johnson基金會的支持。研究作者報告沒有利益衝突。 | |
Depressed, Abused Mothers More Likely to Spank Their Children
By Marlene Busko
Medscape Medical News
September 25, 2008 — Women who are both depressed and in physically abusive relationships are more than twice as likely as women who are not depressed or abused to spank their children, regardless of the child's behavior.
These study findings, from a nationally representative sample of kindergarten-aged children and their mothers, are published online September 11 in the Archives of Disease in Childhood.
"Our data suggest that meaningful associations between maternal depression, violence exposure, and spanking persist in the face of varying child behaviors," the researchers, led by Michael Silverstein, MD, at Boston University School of Medicine, in Massachusetts, write.
The investigators also suggest these are "common and potentially modifiable risk factors and are more apt to affect whether or not a mother uses spanking to discipline her children than they are to affect the frequency of spanking."
Spare the Rod, Spoil the Child?
Over the past 10 years, parental use of nonabusive spanking to discipline a misbehaving child has become a controversial topic, the group writes. If child healthcare providers are to engage in effective discussions with parents about this, they need to better understand the dynamics of child spanking.
Previous studies have shown that children are more likely to be spanked if they have a depressed mother, if their parents have a violent relationship, or if they themselves lie, steal, or are disrespectful.
The investigators sought to study the link between maternal depression, violence between the adult partners in the home, and child spanking and determine how child behaviors might affect spanking.
They analyzed data from the Early Childhood Longitudinal Study, Kindergarten Cohort, a nationally representative sample of children in the United States who attended kindergarten in 1998–1999. The study uses face-to-face parent interviews and teacher surveys.
The investigators determined whether the mothers of these children had clinically significant depressive symptoms based on their responses to a 12-item version of the Center for Epidemiologic Studies Depression Scale questionnaire.
They defined exposure to in-home violence as a reply other than "never" in response to the question: "When you have a serious disagreement with your partner, how often do you end up hitting or throwing things at each other?"
Teacher responses to a social rating scale were used to assess a child's tendency to exhibit self-controlled, positive behavior or negative, externalizing behavior.
The mother's frequency of spanking was determined by asking her: "Sometimes kids mind pretty well and sometimes they don't. About how many times, if any, have you spanked (child) in the past week? "
The 12,764 biological mother-child pairs with complete data were assigned to 1 of 4 mutually exclusive categories based on maternal risk factors:
- No clinically significant depressive symptoms and no violence exposure (n = 10,299).
- Depressive symptoms (n = 1742).
- Violence exposure (n = 487).
- Depressive symptoms and violence exposure (n = 236).
The mother-child pairs were assessed during the kindergarten year when the children had a mean age of 6.2 years. Just over 50% of the children were male. On average, the mothers were 33 years old and had 2 to 3 children living at home.
Spanking Reported by More Than 1 in 4 Mothers
Spanking was reported by about 1 in 4 mothers who were neither depressed nor exposed to violence in the home, by about 1 in 3 mothers who had 1 risk factor, and by about 1 in 2 mothers with both risk factors.
The mean number of spankings per week followed a similar pattern.
Prevalence and Frequency of Reported Child Spanking | Mother's Risk Group | Mothers Who Spanked Their Children (%) | Mean Number of Spankings Per Week | | No depressive symptoms or exposure to domestic violence | 24 | 1.49 | | Depressive symptoms | 35 | 1.68 | | Exposure to domestic violence | 33 | 1.68 | | Depressive symptoms and exposure to domestic violence | 46 | 1.92 |
Compared with those with no depressive symptoms, mothers who were depressed were almost 60% more likely to spank their child; mothers who were both depressed and had violent arguments with their partners were 2.5 times more likely to spank their child.
Adjusted Odds Ratios for Child Spanking Among Mothers With Depressive Symptoms and or Exposure to Domestic Violence | Risk Factors | Adjusted Odds Ratio (95% CI)* | | No depressive symptoms or exposure to domestic violence | 1.00 | | Depressive symptoms | 1.59 (1.40 – 1.80) | | Exposure to domestic violence | 1.48 (1.18 – 1.85) | | Depressive symptoms and exposure to domestic violence | 2.51 (1.87 – 3.37) |
*Odds ratio adjusted for mother's age, child's age and sex, number of siblings in the home, and family socioeconomic status; not adjusted for child behaviors.
The risks of spanking remained the same after further adjustment for either positive or negative child behavior.
Several studies suggest that regular spanking early in a child's life may predispose the child to behavior problems in later life. "Subsequent research on the impact of maternal depression on children should consider the potentially exacerbating effects of violence," they write.
Dr .Silverstein is supported by the National Institute of Mental Health and the Robert Wood Johnson Foundation under its Physician Faculty Scholars Program. The study authors report no competing interests.
Arch Dis Child. Published online September 11, 2008. Abstract
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[ 本帖最後由 goodcat1111 於 2008-10-5 12:08 編輯 ] |
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