보조생식술을 받는 부부의 부부적응, 부부 의사소통, 정신건강이 임신결과에 미치는 영향

Abstract

본 연구는 보조생식술을 받는 부부의 부부적응, 부부 의사소통, 정신건강이 임신결과에 미치는 영향을 파악하여 보조생식술의 임신결과 향상을 위한 간호 중재 개발의 기초자료를 제공하기 위해 시도된 서술적 조사연구이다. 연구 대상자는 서울소재 산부인과 종합병원에 내원하여 체외수정(In VitroFertilization, IVF)을 받고 있는 난임 부부로 연구 참여에 동의한 220명이다. 자료 수집은 2020년 3월 2일부터 2020년 4월 30일까지 이루어졌다. 연구도구는 부부적응 측정을 위해 Spanier의 부부적응척도(Dyadic Adjustment Scale: DAS)를 Busby 등이 개정한 RDAS의 한국판도구를 사용하였고, 부부 의사소통은 Olson 등(David H, Olson, David G. Fournier, Joahn M. Druckmen)이 1982년에 개발한 ENRICH(Enriching and Nurturing Relationship Issues, Communication and Happiness)를 김윤희가 번역한 것 중 부부 의사소통 10문항을 이용하여 측정하였다. 정신건강 측정은 Derogatis 등이 개발한 자기보고식 정신건강평가 척도인 간이정신진단검사(SCL-90-R)를 이훈구가 요인분석을 하여 47문항으로 만든 정신건강 평가척도 SCL-47(Symptom CheckList-47)을 사용하였다. 수집된 자료 분석을 위해 SPSS 26.0 program을 이용하였고, 기술통계, t-test, ANOVA, Scheffe’s test, Pearson's correlation coefficient, Hierarchical logistic regression으로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 대상자는 여성 110명, 남성 110명으로 구성된 110쌍의 부부로, 여성의 평균연령은 36.82±4.12세, 남성의 평균 연령은 38.54±4.25세이다. 35세 이상 여성은 응답자의 66.4%(73명)이었다. IVF(In Vitro Fertilization) 시술이 처음인 경우는 50.9%(56명)로, 첫 시술과 2회 이상 시술 비율이 유사한 수준이었다. 여성 응답자의 60.9%(67명)은 시술비용에 부담을 느끼는 것으로 나타났다. 대상자의 교육정도는 여성 93.7%(103명), 남성 91.8%(101명)가 대학교 졸업 이상이었다. 난임의 원인에 대해서는 원인불명이라고 응답한 비율이 가장 높았다(여성의 40.0%, 남성 53.6%). 2. 대상자의 부부적응은 여성이 3.81±0.66점, 남성은 3.75±0.62점으로 여성의 부부적응이 높았으나, 남녀 간 차이는 통계적으로 유의하지 않았다. 대상자의 부부 의사소통은 여성이 4.19±0.58점으로 남성 3.99±0.56점보다 높았고 통계적으로 유의한 차이를 보여(t=-2.566, p=.011), 여성이 남성보다 부부 의사소통이 잘 된다고 인식하는 것으로 나타났다. 대상자의 정신건강은 여성이 1.40±0.36점, 남성은 1.35±0.38점이었으며, 남녀 간 차이는 통계적으로 유의하지 않았다. 3. 여성의 부부 의사소통은 35세 미만이 4.34±0.55점, 35세 이상은 4.11±0.59점으로 35세 미만 여성이 부부 의사소통이 잘 되는 것으로 인식하였다 (t=-2.017, p=.046). 결혼기간이 3년 미만인 경우(4.37±0.47점)가 3년 이상인 경우(4.08±0.62점)에 비해 의사소통이 더 잘 된다고 인식하였다(t=-2.606, p=.010). IVF 시술 비용 부담이 높은 경우 부부 의사소통이 잘 되지 않는다고 인식하였다(t=4.434, p=.006). 남성의 정신건강은 난임 기간이 2년 미만인 경우(1.27±0.21)가 2년 이상인 경우(1.41±0.45)보다 좋은 것으로 나타났다(t=2.139, p=.035). IVF 첫 시술인 경우(1.27±0.23)가 2회 이상 시술한 경우(1.44±0.48)보다 정신건강이 좋은 것으로 나타났다(t=-2.282, p=.025). 4. 난임 여성과 남성의 부부적응과 부부 의사소통은 양의 상관관계(여성 r=.754, p<.001, 남성 r=.658 p<.001), 부부적응과 정신건강은 음의 상관관계 (여성 r=-.591, p<.001, 남성 r=-.413, p<.001), 부부 의사소통과 정신건강은 음의 상관관계(여성 r=-.498, p<.001, 남성 r=-.436, p<.001)가 있는 것으로 확인되었다. 부부적응이 높을수록 부부 의사소통이 잘 되고, 부부적응이 높을수록 정신건강이 좋은 것을 의미하며 부부 의사소통이 잘 될수록 정신건강이 좋은 것을 의미한다. 5. 임신결과에 영향을 미치는 요인을 확인하기 위해 Hierarchical logistic regression을 시행한 결과, 여성은 연령(OR=0.834, 95% CI=0.730-0.952, p=.007), 소득수준(300∼499만원, OR=6.243, 95% CI=1.351-28.858, p=.019; 500만원 이상 OR=5.141, 95% CI=1.087-24.308, p=.039), 정신건강 하위 항목 중 편집증(OR=0.115, 95% CI=0.016-0.849, p=.034), 남성은 연령(OR=0.881, 95% CI=0.785-0.989, p=.031), 결혼 기간(OR=0.828, 95% CI=0.707-0.969, p=.019), 정신건강 하위 항목 중 신체화(OR=0.236, 95% CI=0.076-0.731, p=.012)가 임신결과에 유의한 영향을 미치는 것으로 나타났다. 본 연구 결과 남성과 여성의 정신건강이 유의미한 차이가 나타나지 않은 것은 난임의 정신건강 요소에 관한 사정 및 중재는 남성을 포함한 부부를 대상으로 해야 함을 시사한다. 또한 난임 부부의 정신건강 증진을 위해 부부적응 및 부부의 의사소통 요소에 주목해야 할 필요가 있다. IVF 임신결과는 난임부부의 연령과 결혼 기간, 여성의 소득수준, 정신건강 중 편집증, 남성의 정신건강 중 신체화가 영향을 미치는 것으로 확인되었다. IVF 임신성공을 위해 부부의 연령과 소득수준, 결혼 기간, 여성과 남성의 정신건강 수준을 고려해야 하며 난임 여성의 편집증, 남성의 신체화를 포함한 정신건강 증진을 위한 간호 중재 프로그램의 개발 및 적용이 요구된다.;This study is a descriptive survey that aims to understand the effects of marital adjustment, marital communication, and mental health on couples receiving assisted reproductive technology (ART) on their pregnancy outcomes in order to provide basic information for developing nursing interventions to improve pregnancy outcomes using ART. Study participants were 220 infertile couples who visited the Obstetrics and Gynecology General Hospital located in Seoul and received in vitro fertilization(IVF). The research protocol included obtaining informed consent from participants, and data collection took place from March 2 to April 30, 2020. Data collection instruments included the following. The Korean version of the Revised Dyadic Adjustment Scale(RDAS,) in which Spanier’s (1976) original scale was revised by Busby et al. (1995), was used to measure marital adjustment. Marital communication was measured by ten items related to a couple`s communication taken from the Enriching and Nurturing Relationship Issues Communication and Happiness (ENRICH) Marital Satisfaction Questionnaire developed by Olson et al. (1982) and translated into Korean by Yun-hee Kim. Mental health was measured using the Symptom Check List-47 (SCL-47), an adaptation prepared by Hun-goo Lee(1986) of the Symptom Checklist-90-R (SCL-90-R), a self-report psychometric instrument developed by Derogatis et al.(1973). SPSS 26.0 software was utilized to analyze the data, including descriptive statistics, t-test, ANOVA, Scheffe's test, Pearson correlation coefficient, and Hierarchical logistic regression. The results of this study are as follows. 1. General and fertility characteristics of subjects The subjects were 110 couples including 110 women and 110 men. The average age of women was 36.82±4.12 years and the average age of men was 38.54±4.25 years. Women over 35 years of age accounted for 66.4%(73) of respondents. About half the couples 50.9%(56) had undergone IVF for the first time, with the remaining couples 49.1%(54) having had the procedure twice or more. A little over half 60.9%(67) of female respondents were found to be financially burdened with the cost of the procedure. Regarding the educational level of participants, 93.7%(103) of women and 91.8%(101) of men had graduated from college or a higher-level institution. The most commonly reported cause of infertility was “unknown” (40.0% of women and 53.6% of men). 2. Marital adjustment, marital communication, and mental health in infertile women and men The mean marital adjustment score for women (3.81±0.66 points) was higher than that of men (3.75±0.62 points), but the difference was statistically insignificant. For marital communication, the women’s average score (4.19 ± 0.58 points) was also higher than the men’s (3.99±0.56 points), and this difference was statistically significant (t=-2.566, p=.011). This finding indicates that marital communication is rated as better by women than men. No significant difference was found between women and men on the mental health measure; the mean score for women was 1.40±0.36 points and that for men was 1.35±0.38 points. 3. Marital adjustment, marital communication, and mental health according to demographic characteristics of participants Women under the age of 35 years scored on average 4.34±0.55 points on marital communication, while those over age 35 scored on average 4.11±0.59 points, indicating that younger women rated marital communication as better than older women (t=–2.017, p=.046). Women who had been married less than three years tended to perceive marital communication as better (4.37±0.47 points) than women with three or more years of marriage (4.08± 0.61 points; t=–2.606, p=.010). Women who were financially burdened by the high cost of IVF tended to perceive marital communication as less satisfactory than couples not financially burdened (t =4.434, p =.006). The mental health scores of men with less than two years of infertility (1.27±0.21) were found to be higher on average than the scores of those with two or more years of schooling (1.41±0.45; t=2.139, p=.035). The mental health scores of men who had experienced IVF for the first time were found to be higher (1.27±0.23) than the scores of those who had experienced IVF twice or more times (1.44±0.48; t=-2.282, p=.025). 4. Correlation between marital adjustment, marital communication, and mental health of participants Marital adjustment was positively correlated with marital communication among infertile women and men (women: r=.754, p <.001; men: r=.658 p<.001), but marital adjustment was negatively correlated with mental health for women and men (women: r=–.591, p<.001; men: r=–.413, p<.001). Likewise, marital communication was negatively correlated with mental health for both genders (women: r=–.498, p<.001; men: r=–.436, p<.001,). These results suggest that better marital adjustment is associated with both good marital communication and better mental health, and that good marital communication is associated with better mental health. 5. Factors affecting pregnancy outcomes A hierarchical logistic regression was performed to identify factors affecting pregnancy outcomes. The following factors were determined to have significant effects. For women, age (OR=0.834, 95% CI=0.730-0.952, p=.007), income level (3.00–4.99 million won, OR=6.243, 95% CI=1.351-28.858, p=.019; 5.00 or more million won, OR=5.141, 95% CI=1.087-24.308, p=.039), and among sub-items of mental health measure, paranoia (OR=0.115, 95% CI=0.016-0.849, p=.034); and for men, age (OR=0.881, 95% CI=0.785-0.989, p=.031), marriage duration (OR=0.828 95% CI=0.707-0.969, p=.019), and somatization (OR=0.236, 95% CI=0.076-0.731, p=.012). According to the study results, no statistically significant differences were found between women and men undergoing IVF treatment for marital adjustment or mental health, while women scored significantly higher than men on marital communication, indicating that women tended to perceive marital communication as proceeding better than their male counterparts. The results confirmed that age (for women and men), marriage duration (for men), income level (for women), paranoia among sub-items of mental health (for women), and somatization among sub-items of mental health (for men) had significant effects on pregnancy outcomes of IVF. The absence of significant differences between women and men on mental health measures suggests that assessment and intervention on the mental health factor of infertility should target couples, including men. These findings suggest that all infertile couples including men and women should be provided appropriate nursing care, and that age, income level, and marriage duration of a couple, as well as the mental health of both women and men, should be considered in efforts to improve the IVF pregnancy rate. Furthermore, the development and application of nursing intervention programs for promoting mental health are needed, including paranoia in infertile women and somatization in men.