著者

長田 恭子 北岡 和代

出版者

ウェルネス・ヘルスケア学会

雑誌

Journal of wellness and health care (ISSN:24333190)

巻号頁・発行日

vol.41, no.1, pp.113-123, 2017

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This study was performed to examine changes after talking to alleviate suicidal ideation in people with depression or bipolar disorder that have attempted suicide, and to clarify the role of the researcher in this process. Data were collected through unstructured interviews with participants suffering from depression or bipolar disorder that were hospitalized because of attempted suicide. The interview began when they emerged from the crisis situation, and continued after discharge from hospital. From the contents of the interview, we analyzed the parts where emotions and thoughts before and after suicide were expressed and the remarks of the researcher. The participants were five women, and the interview number ranged from three to eight times. We extracted six categories based on analysis of participantsʼ narratives. There were four categories regarding strong obsession with death and great anxiety and loneliness: "Obsession with death," "Loneliness the same as before suicide attempt," "Anxiety about an uncertain future," and "Losing self-confidence by confronting reality." In addition, there were two categories regarding alleviation of suicidal ideation and newfound affirmation of life: "Feeling inclined to live" and "Developing motivation for life." Throughout the interview process, the researcher strove to "wait patiently for participants to express their feelings and thoughts," never hurrying them or interrupting their remarks. In the second half of the interview, to address participantsʼ everyday problems "the researcherʼs ideas were shared so that participants could change their behavior." When attendees made an effort and experienced behavioral changes, the researcher focused on the positive by "urging participants to be aware that they are changing and to notice what they are doing." The results of this study clearly showed that after a suicide attempt patients with depression were moving forward but still vacillating between life and death. Even those that were hopeless and desperate enough to choose their own death had taken definite steps toward the future. Nurses need to recognize this, come close to their wavering emotions, and provide support to help them think positively and find hope for the long term.本研究は、自殺企図を行ったうつ病あるいは双極性障害をもつ者の希死念慮を緩和していく過程における語りの変化と研究者の関わりを明らかにすることを目的とした。自殺未遂が原因で入院となったうつ病あるいは双極性障害をもつ者を対象に、ナラティヴ・アプローチの原則に基づいた非構造化面接を行った。面接内容より、自殺に至るまでや自殺企図後の感情や思考が表現されている部分とその前後の研究者の発言を分析対象とした。 参加者は女性 5 名、面接回数は 3 ~ 8 回であった。参加者の語りを分析した結果、1)死への執着があり不安や孤独感が強い時期には【死への執着】【自殺前と変わらない孤独感】【先がみえない不安】【現実に直面することによる自信喪失】の 4 つのカテゴリー、2)自殺念慮が緩和し生きることを肯定し始めた時期には【生きることに気持ちが向く】【生への意欲の芽生え】の 2 つのカテゴリーが抽出された。研究者は、参加者が考えや気持ちを表現できるようにゆっくり待つ姿勢を示した。面接の2回目以降は、参加者が多面的な見方ができるよう、また変化を自覚できるよう問いかけた。参加者は生と死の間を揺れ動きながらも前に進んでいること、一度は自ら死を選ぶほどの絶望の淵に立たされた人であっても、わずかながらの希望をもち将来に向かって歩き始めていることが明らかになった。看護師は、自殺企図に至ったうつ病者の揺れ動く気持ちに寄り添い、肯定的に思考を変化させて希望を見出せるよう長期的にサポートしていくことが重要だと考えられる。