外来化学療法を受ける患者の精神的問題とその関連要因の検討

Factors Related to PsychoLogical Problems among Cancer Outpatients receiving Chemotherapy

要旨

　本研究は，外来化学療法を受けているがん患者を対象に，不安，抑うつの関連要因について基本属性，疾患特性，および社会参加との関連から明らかにすること，また精神的サポートの獲得の現状，およびその不安，抑うつとの関連を明らかにすることを目的とした．外来化学療法を受ける20歳以上のがん患者90人を対象に配票調査を行い，回答の得られた77部（回収率85.6％）を分析対象とした．

　Hospital Anxiety and Depression Scaleを用いて検討を行った結果，配偶者のいる人で抑うつ得点が低く，副作用の程度が高い人，休職している人，社会活動をしていない人で不安，抑うつ得点が高いという結果であった．約7〜9割の対象者が精神的サポートを獲得していると回答し，そのなかでも情報の獲得をしている人は不安，抑うつ得点が低く，気持ちの表出をしている人は抑うつ得点が低く，医療者へ相談している人は不安得点が高い結果であった．また交互作用の検討の結果，症状の程度と不安の程度の関連性に対する「気持ちの表出」の緩衝効果がみられた．

　外来化学療法を受ける患者が良好な精神健康を維持しながら治療を継続できるよう支援するためには，これらの要因を理解して関わることの重要性が示された．

Abstract

　The purpose of this study was to examine the association of anxiety and depression with demographic characteristics, disease-related characteristics, and social participation in cancer outpatients. Furthermore, the extent that cancer outpatients received psychological support and its relationship with anxiety and depression for those receiving chemotherapy was identified.

　Self-reported questionnaires were distributed to 90 cancer outpatients and responses obtained from 77 of these patients were analyzed. The Hospital Anxiety and Depression Scale revealed that patients with partners had lower depression scores. Those with more severe side effect symptoms, those taking sick leave, and those who did not engage in social activities had higher anxiety and depression scores. Approximately 70~90 percent of patients received psychological support. Obtaining enough information was associated with lower anxiety and depression scores, expressing emotions was associated with lower depression scores, and receiving advice from medical staff was associated with higher anxiety scores. There was an interaction effect between the extent of side effect symptoms and psychological support on anxiety levels.[KT1]

　Our findings suggest that a thorough understanding of these factors will assist nurses in maintaining the psychological well-being of cancer outpatients who receive chemotherapy.