【目的】ライフ・ライン・メソッドを用いて、COVID-19感染症流行下の妊娠期から子育て期の母親の経験とレジリエンス促進要因を解明して、社会的孤立や育児不安を予防する切れ目のない支援策を検討することを目的とした。レジリエンスとは、困難に遭遇してもうまく適応していける力とされている。
【対象と方法】子育てひろばに登録中の2歳または3歳の子どもを養育中の母親51名を対象に、質問紙票調査と半構造化面接調査を実施した。ライフ・ライン・メソッドとは、心理的健康状態の変化とその理由を視覚的に尋ねる方法である。本研究は慶應義塾大学看護医療学部研究倫理委員会の承認を得て実施した。
【結果と考察】妊娠前から現在までの心理的健康状態の変化は、「悪化→浮沈み→回復」、「悪化→浮沈み→悪化」「良い状態→浮沈み→回復」「良い状態→浮沈み→悪化」の4つのパターンが認められた。心理的健康状態に影響を及ぼす要因は、「妊娠」「出産」「母親の体調」「子どもへの思い」「育児」「対人関係」「サポート」「社会資源」「家族の体調」「仕事」「引っ越し」「積極的対処」「コロナ渦」といった多岐の領域にわたる内容が抽出された。高いレジリエンスと関連した要因は、子どもが2歳を過ぎて、母親自身の心身健康が回復したり、周囲の人の支えや協力があることなどであった。低いレジリエンスと関連した要因は、出産時から子どもが2歳になる時までの、育児の葛藤や不安、夫や実家との関係不良、サポート不足、コロナ感染流行への不安や恐怖、コロナ渦特有の環境が齎す子どもの成長発達への影響の懸念、コロナ渦での社会や世間の理解や対応の乏しさなどであった。先行研究でも指摘されてきたような従来の育児不安や負担に加えて、コロナ渦特有の未知のウィルス感染への恐怖や、子どもを育む環境の厳しい制約、協力体制不足などの困難が加わることで、母親や育児を行う家庭への負担がより一層大きく、かつ複雑化していたことが伺えた。今回のCOVID-19感染爆発のような未曽有の事態が起こっても、社会的孤立や育児不安を予防・軽減できる妊娠期からの切れ目のない支援体制の基盤を整備することが急務である。そのために、本研究で明らかになった、レジリエンスとの関連性が認められた要因を中心に、母親の心理的健康状態を悪化させる要因を排除・軽減するとともに、心理的健康状態を改善させる要因を付与・促進する両方向からの支援の検討が極めて重要であることが考えられた。
Objective: One aim of the current study was to use the life-line interview method to elucidate mothers’ experiences from pregnancy to child-rearing and factors promoting resilience during the COVID-19 pandemic. Another aim was to examine seamless forms of assistance to prevent social isolation and anxiety over child-rearing. Resilience is defined as the ability to adapt to difficulties encountered.
Subjects and Methods: A questionnaire was administered to and semi-structured interviews were conducted with 51 mothers who were rearing a 2- or 3-year-old child and who were registered with a parenting association. The life-line interview method is a method of visually inquiring about changes in psychological health and the reasons for those changes. This study was conducted with the approval of the Ethical Review Committee of the Faculty of Nursing and Medical Care, Keio University.
Results and Discussion: Four patterns of changes in psychological health from prior to pregnancy to the present were noted: “Worsening mental health → Ups and downs → Recovery,” “Worsening mental health → Ups and downs → Worsening mental health,” “Good mental health → Ups and downs → Recovery,” and “Good mental health → Ups and downs → Worsening mental health.” A wide range of factors affecting psychological health were identified, including “pregnancy,” “childbirth,” “the mother’s physical condition,” “feelings toward the child,” “rearing a child,” “interpersonal relationships,” “support,” “social resources,” “the physical condition of family members,” “work,” “moving,” “positive coping,” and “the COVID-19 pandemic.” Factors associated with a high level resilience were the recovery of the mother’s mental and physical health after the child’s turned two and assistance and cooperation from others. Factors associated with a low level resilience were conflicts and anxieties over child-rearing from the child’s birth until the child turned 2, poor relationships with one’s husband and parents, a lack of support, anxieties and fears of the COVID-19 pandemic, concerns about the effects of conditions specific to the COVID-19 pandemic on a child’s growth and development, and a lack of understanding and assistance from society and the public during the COVID-19 pandemic. In addition to long-standing anxiety over child-rearing and the burden of child-rearing as were noted in previous studies, mothers described added difficulties, such as the fear of an unknown viral epidemic particular to the COVID-19 pandemic, the severe restrictions on conditions in which to rear children, and the lack of a system of cooperation. This increased and complicated the burden placed on mothers and families rearing children. Even in an unprecedented situation such as the outbreak of COVID-19, a foundation needs to be promptly laid for a system of seamless assistance starting in pregnancy to prevent and reduce social isolation and anxiety over child-rearing. To that end, two approaches to assistance are vital. Assistance needs to eliminate or reduce the factors that worsen the psychological health of mothers, with a focus on factors that were found to be associated with resilience according to this study, and it also needs to impart and promote factors that improve the psychological health of mothers.
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