家族が精神障害者をケアする経験の過程―国内外の文献レビューに基づく共通段階

The Process of Family Experiences in Caring for Persons with Serious Mental Illnesses： Common Stages Identified through a Literature Review

要旨

　目的：家族が精神障害者をケアする経験の過程について国内外の文献をレビューし，研究の動向と過程における共通段階を明らかにする．

　方法：データベースを用い，統合失調症，うつ病，躁うつ病の精神障害者をケアする家族の経験を段階的に過程として記述している1980年以降の国内外の研究論文を検索した．

　結果：海外14論文と国内3論文の合計17の質的論文が対象論文となった．家族の経験全般を分析した海外の9論文から，共通する12の段階，「問題への気づき」「効果的に対処できず憔悴」「危機の訪れ」「診断もしくは疾患と認識」「専門家やシステムへの不満」「否定的感情」「喪失・悲嘆」「スティグマによる困難」「不安定な病状」「効果的な対処方法やシステムの活用」「病状の安定・慢性化」「現実的な希望」を抽出した．

　結論：抽出した共通段階はわが国においても適応可能だと考えられるが，わが国における家族の経験全般を含む過程を研究することが望まれる．

Abstract

　Purpose: To review international and domestic literature on the process of family experiences in caring for a person with a serious mental illness and identifiy common stages of the process.

　Methods: Through a database search, I identified international and Japanese research articles published since 1980 that examined the process of family experiences in caring for a family member with schizophrenia, depression, or bipolar disorder.

　Results: Seventeen qualitative research articles, including fourteen international and three Japanese articles, were identified. From nine international articles on general family experiences, the following twelve common stages of the process were identified: awareness of the problem, ineffective effort and being consumed, crisis, diagnosis or recognition of illness, dissatisfaction with professionals and care systems, negative emotions, feeling of loss and grief, difficulties because of stigma, unstable condition of patient, learning to cope and using care systems, stability and chronicity of patient's condition, and realistic hope.

　Conclusion: Although the identified common stages could be applied to Japanese families, further research on the process of general family experiences in Japan is recommended.