研究の限界と今後の課題

社会的支援のレベル，経済状況，個人的資源（例えば，自動車を有する）など，地域生 活は個人の制御外の要因の影響を受ける可能性があり，これら環境要因を統制できていな いことは本研究の限界である．また，年齢，発症年齢，罹患期間から示唆されるように本 研究の対象者は主に慢性期の方であったことも研究の限界である．特に，研究2ではLASMI 下位項目ごとに分析を実施したことは多仮説検定にあたる．そのため，本研究の結果の一 般化には慎重を要する．今後は異なる病期での検討および，LASMI下位項目ごとにランダ ムサンプリングを実施した上での分析が求められる．

しかし，本研究の結果は新興の文献を裏付けており，動機付けられた行動の減少や非言 語的コミュニケーションの欠損など，社会機能に陰性症状が与える重要な役割を強調して いる．近年，統合失調症を発症する前の段階での予防的介入が重要視されている．特に，

意欲の低下や，失快楽症，非社会性，感情鈍麻は，社会機能に重大な影響を与えるようで あり，これらサブドメインへの早期対処および介入が特に重要であることを示唆する．本 研究の結果は対象者の支援および心理社会的治療の発展に寄与するものであると考えるが，

さらなる研究の発展に向け，研究デザインを横断研究ではなく縦断的に組むことも重要で ある．また，本研究の結果をSSTやCBTと組み合わせモジュール化した介入方法をRCT やCCTなどを用いて検討することが求められていると考える．

55 謝辞

研究にご協力いただきました高野謙二先生，西嶋康一先生，益子看護部長様，そして，

各対象者様を担当する医師，メディカルスタッフの皆様には大変お世話になりました．こ こに改めて深謝を捧げます．

特に常にご多忙を極めながらも，研究開始当初から終了までいつも温かな励ましと丁寧 で的確なご指導を下さった谷口敬道先生，平野大輔先生に心よりお礼を申し上げます．

さらに，研究の実施および博士論文の執筆にあたり作業活動分析学領域の学友の皆様，

有用な議論をさせて頂きありがとうございました．

最後に，本研究で実施された調査に参加して下さいました対象者さんに心よりお礼を申 し上げます．本当にありがとうございました．

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