妊娠・産褥期の自殺及び自殺企図事例から学ぶ支援スタッフのかかわり

Interaction of Supportive Staff with Patients Based on Lessons Learned from Cases of Suicide and Planned Suicide During Pregnancy and the Postnatal Period

目的

　妊娠・産褥期に精神科関連の諸問題を呈した女性への保健師の支援を振り返り、支援スタッフに求められる実効的な関与のあり方を検討する。

対象と方法

　保健師活動に精通した経験15年以上の保健師が、妊娠・産褥期の深刻な自殺企図事例に関与した保健師が所属する機関に出向いてインタビューを実施し（2007.9月〜2008.1月）、結果を多面的に分析した。

結果

　自殺既遂者7名、自殺企図後昏睡状態者1名の情報を得た。8例中7例はうつ病の既往や妊娠中の抑うつ症状を認め、6例が精神科受診をしていた。全例に自殺企図前に危機のサインが確認された。望まない妊娠が5例あり、不妊治療成功による出産が2例あった。妊娠・産褥期の家族等の支持体制が不十分な例が多く、そのほとんどに親族との強い葛藤関係があった。産後の実家への里帰りは4例が忌避したが、結果的には7例が不規則な里帰りになり、予定通りの産後にはならなかった。こうした家族背景が児に対する不適切な養育・虐待要因となっているものが5例であった。

結論

　1）妊娠・産褥期に現れる母の精神障害の特徴を理解し、特に精神疾患の既往を持つ場合や望まない妊娠・長期間里帰りの情報を得た場合は行政区を越えた関与を意識する。2）地域での家族支援を担う保健師は、産科、小児科、精神科との情報共有、治療環境の評価を行い子どもの安全な環境を保てるよう整備する。

Purpose

To review the assistance of public health nurses provided to patients suffering from psychiatric conditions during pregnancy and the postnatal period and to clarify the role to be played and the assistance to be provided by supportive staff.

Method

A public health nurse with much experience conducted interviews of public health nurses who have dealt with cases of planned suicide during pregnancy and the postnatal period (September 2007 to January 2008).

Results

Reports were received of 7 patients who committed suicide and 1 patient that attempted suicide and remains in a coma. Seven of the 8 patients were recognized to have had previous incidents of depression or depressive symptoms during pregnancy and 6 of those patients had a history of psychiatric treatments. In all cases they exhibited signs of planning suicide. Five of the patients had unwanted pregnancies. Many of the patients lacked a sufficient support system from family members during pregnancy and the postnatal period and had interpersonal conflicts with relatives. Four did not want to go home but were forced to return to their parent's home around the time of the birth. Five were involved in unsuitable childcare or child abuse which was attributed to their family environment.

Conclusion

1) Understand the signs of psychiatric disorders in mothers during pregnancy and the postnatal period and, in particular, be aware of involvement that crosses government administrative borders when information is received that a patient has a history of psychiatric disorders or is having an unwanted pregnancy and must return to her parent's home for a long period of time. 2) Public health nurses will share information with obstetrics department, pediatric department, and psychiatry department to create an environment that will allow evaluation of the treatment environment.