虚血性心疾患をもつ外来通院女性患者の心理的ストレス反応と影響要因に関する研究

Psychological Stress Reaction and Psychological Stressors in Women with Ischemic Heart Disease under Follow-up Treatment on an Outpatient Basis

要旨

　本研究の目的は，虚血性心疾患で外来通院をする女性患者の心理的ストレス反応に影響を及ぼす要因を明らかにすることである．対象は回復期,維持期の心臓リハビリテーションを実施していない80歳以下（平均年齢64.5歳）の患者75名．調査内容は心理的ストレス反応尺度（PSRS-50R），タイプA行動特性尺度，情緒的支援ネットワーク尺度，自作ストレス源の4尺度と，対象者の属性である．

　対象者の心理的ストレス反応に影響を及ぼした変数は，心筋梗塞・冠動脈再建術・治療期間1年以上・無職・年収300万円以下・タイプA行動特性あり・情緒的支援ネットワークなし・ストレス源であった．ストレス源では「老化による衰え」「運動療法」「病気の先行き」が，うつ・不安・無気力・怒り・絶望などのストレス反応に影響を及ぼし，「家族の健康」「家族への責任」は引きこもりに影響を及ぼしていた．虚血性心疾患女性患者のストレス支援には，生活状況への個別的な対応と家族システムに対する環境調整，ならびに心臓リハビリテーションの必要性が示唆された．

Abstract

　The purpose of this study was to identify the psychological stress reaction and psychological stressors in women with ischemic heart disease who were under follow-up treatment on an outpatient basis. The subjects were 75 women in the convalescence/maintenance phase of ischemic heart disease who were under 80 years of age (mean age,64.5 years of age) and who had not undergone cardiac rehabilitation. To clarify factors that might contribute to psychological stress, we examined the PSRS-50R (Psychological Stress Response Scale-50 Items revised), a type A behavior pattern scale, the emotional support network scale, a stressor scale developed by the author, and the patient attributes.

　These data indicated that the following psychological stress reactions: myocardial infarction, coronary artery bypass graft, long-term treatment, lack of regular occupation, and an annual income under 3 million yen. The analysis also showed that psychological stress reactions were induced by type A behavior pattern, poor emotional support, and stressors. In particular, aging, exercise therapy, and the unknown aspects of illness caused stress reactions such as depression, anxiety, anger, apathy, and despair. The results also showed that health of the family and family responsibilities caused stress reaction hiding. These findings indicated the need for individual intervention in the patient's daily life, environmental management for family support system, and cardiac rehabilitation.