日本人乳がん体験者のソーシャル・サポートと精神的・身体的状況に関する縦断的研究

A Longitudinal Study of Social Support, Psychological and Physical States among Japanese Women with Breast Cancer

要　旨

　本研究の目的は，日本人乳がん体験者のソーシャル・サポートと精神的・身体的状況について経時的に捉えた実態と変容を知ることである．乳がんと診断され手術療法を受ける日本人女性（N＝60）を対象に手術前（Time Ⅰ），手術後2週（Time Ⅱ），手術後1ヵ月（Time Ⅲ），手術後6ヵ月（Time Ⅳ），手術後1年（Time Ⅴ）の5回にわたりデータを収集した．精神的状況を測定するため精神健康調査票を，ソーシャル・サポートのプラス側面であるサポートとマイナス側面であるコンフリクトを測定するためにインターパーソナル・リレーションシップ・インベントリーを使用した．記述統計と反復測定による分散分析により分析を行った．

　各変数の経時的な変容に関する分析結果は，身体的状況のみが有意差（F（4,236）＝66.06，p＜0.0001）を示した．Tukeyによる多重比較を行った結果，この有意差は手術前（M＝0.42，SD＝0.70）と手術後2週（M＝3.08，SD＝1.33）の間，手術前と手術後1ヵ月（M＝3.33，SD＝1.56）の間，手術前と手術後6ヵ月（M＝3.03，SD＝1.59）の間であった．また，精神的状況，サポート，コンフリクトに関する経時的な有意な変容を示さなかったが，各期におけるそれぞれの傾向を示した．

　以上の結果から，看護者はこのような日本人乳がん体験者の手術前後の一連の過程におけるソーシャル・サポート，精神的状況や身体的状況に関する経時的な変容を知り，ケア提供すべきであることを示唆した．

Abstract

　The purpose of this study was to assess changes in social support, psychological, and physical states among Japanese women with breast cancer over time. A convenience sample of 60 Japanese women with breast cancer participated in this longitudinal study. Women were recruited from a hospital in a metropolitan area in Japan. Data were collected five times : before (Time Ⅰ), a few weeks after (Time Ⅱ), one month after (Time Ⅲ), six months after (Time Ⅳ), and one year after breast surgery (Time Ⅴ). Two instruments with established reliability and validity were used : the Japanese versions of the General Health Questionnaire to measure psychological states and the Interpersonal Relationship Inventory to measure support and conflict. Data analyses included descriptive statistics and repeated measures analyses.

　The main results were that repeated measures analyses found no significant differences in subjects' support, conflict, or psychological states across time. However, there were significant differences in physical states (F (4,236) = 66.06, p＜0.0001). Tukey's post hoc analysis identified significant differences in the number of sings and symptoms between Time Ⅰ (M = 0.42, SD = 0.70) and Time Ⅱ (M = 3.08, SD = 1.33), between Time Ⅰ and Time Ⅲ (M = 3.33, SD = 1.56), and between Time Ⅰ and Time Ⅳ (M = 3.03, SD = 1.59).

　This study suggested that nurses need to consider changes in social support, psychological and physical states as important factors to help Japanese women's adjustment to breast cancer as an ongoing process in their lives before and after breast surgery.