成人同種造血細胞移植後3年未満の体験者の心理的適応─心理的適応に関する質問紙開発および心理的適応と身体状況との関係の探索

Psychological Adjustment of Survivors up to Three Years After Adult Allogeneic Hematopoietic Cell Transplantation : Development of a Questionnaire Related to Psychological Adjustment and Search for the Relationship between Psychological Adjustment and Physical Condition

要旨

　本研究は成人同種造血細胞移植体験者の心理的適応状況の評価指標となる質問紙を作成し，これを通して心理的適応状況を把握することと，加えて心理的適応にかかわる身体状況，気分状態との関係を明らかにすることを目的とした．文献検討と同種造血細胞移植体験者のインタビューから「自尊感情」「肯定感」「安定感」「満足」の4つの下位概念27項目の質問紙原案を作成し，同種造血細胞移植後3年未満の体験者69名を対象に調査を実施した．項目の分析と因子分析の結果，心理的適応質問紙は「自尊感情」「肯定感」「安定感」「満足」の4つの下位概念16質問項目となり，内的一貫性による信頼性（Cronbach's α係数＝0.72〜0.88）が確認された．SF-36v2との間に相関が認められ（r＝0.63，p＜0.01）併存的妥当性が確認された．精錬後の心理的適応質問紙を合計した得点と身体状況の関係においては，慢性GVHD（移植片対宿主病）あり群で有意に心理的適応得点が低く（p＝0.026），倦怠感などの身体症状の得点が高いと心理的適応得点が低いという有意な負の相関が認められた（r＝−0.58，p＜0.01）．質問紙の検証から移植治療によって変化した身体や生活でも状況を肯定的に評価する心理的適応が存在し，心理的適応とQOLの間に相関関係があることが示された．

Abstract

　This study has three purposes:(1)To create a questionnaire that will become an index for evaluating psychological adjustment of adult allogeneic hematopoietic cell transplantation survivors;(2) To assess the state of psychological adjustment of subjects using the questionnaire;(3)To clarify how psychological adjustment relates to physical condition and emotional condition. A draft questionnaire was created based on a review of literature and interviews with allogeneic hematopoietic cell transplantation survivors. The draft comprised a total of 27 questions from the 4 subordinate concepts of self.esteem, self.affirmative feeling, stability and satisfaction. The draft questionnaire was then used to conduct a study on 69 survivors up to three years after adult allogeneic hematopoietic cell transplantation. As the first step, psychological adjustment questionnaire draft item analysis and factor analysis were conducted. Based on the results of these analyses, the questionnaire was then refined to 16 questions comprising the 4 subordinate concepts of self.esteem, self.affirmative feeling, stability and satisfaction. Cronbach's α coefficient of the refined questionnaire was between 0.72 and 0.88, confirming reliability by internal consistency. A significant correlation was seen between the psychological adjustment questionnaire and SF-36v2(r=0.63, p＜0.01), confirming concurrent validity. Regarding the relationship between physical condition and the adjustment score obtained by summing the scores of the refined questionnaire, subjects with chronic graft versus host disease (GVHD)had significantly lower psychological adjustment scores(p=0.026). In addition, there was a negative correlation between high scores for physical symptoms such as fatigue and low scores for psychological adjustment(r=-0.58, p＜0.01). In conclusion, evaluations of the questionnaire developed in this study suggested that, for allogeneic hematopoietic cell transplantation survivors, even in the situation of physical condition or lifestyle change after transplantation, assessing the situation with a sense of self.affirmation can put them in a psychologically stable state of adjustment. The results have shown that there is correlation between psychological adjustment and QOL.