한국형 불안 선별도구 개발: 현행 불안평가 도구 개관 및 예비문항 개발
Development of the Korean Screening Tool for Anxiety Disorders: Review of Current Anxiety Scales and Development of Preliminary Item Pools
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정신질환 예방과 조기개입을 강조하는 현대의 정신건강 정책에 있어 신뢰롭고 타당하며, 민감도와 특이도가 높은 선별도구를 개발하는것은 필수 전제 과제이다. 현재까지 불안을 조기에 민감하게 선별하며, 비임상적인 불안과 임상적 주의가 요구되는 불안을 신뢰롭게 구분을 할 수 있는 도구가 부재하다. 이에 연구 프로젝트 뿐 아니라 병원 및 다양한 임상현장에서 사용할 수 있는 한국형 불안 선별도구를 개발하는 것이 시급하다. 새로운 한국형 불안 선별도구(Korean screening tool for anxiety disorders, K-ANX)는 기존의 척도들이 지니는 한계점을 극복하되, DSM-5 및 RDoC 진단기준을 반영하고, 범불안장애 선별도구에서 반드시 고려되어야 하는 측정 영역을 포괄할 수 있어야한다. 동시에 선별도구의 특성에 맞게 최소한의 문항으로 민감도와 특이도를 높일 수 있도록 구성되어야 한다. 본 연구에서 K-ANX project 의 제1단계로서, 임상심리, 정신의학, 심리측정 전문가 그룹을 구성하여 기존 척도들을 체계적으로 분석하였고, 측정 영역을 비롯해 민감도와 특이도를 포함한 심리측정적 특성을 분석하여 제시하였다. 또한 다학제의 전문가로 구성된 외부 전문가 패널과 문항 영역 및 문항의내용 분석을 실시하여 한국형 불안 선별도구의 방향에서 합의를 도출하였으며, 불안 환자들과의 포커스그룹을 실시하고 이를 문항개발과정에 반영하였다. 이를 기반으로 273문항의 범불안장애 예비문항을 개발하였고, 일반인 150명을 대상으로 예비연구를 실시하였다. 그결과, 각 영역별 분포가 정적 편포로 나타났으며, 전체 문항 내용이 일반인의 일상적인 불안 증상과 다른 임상적 수준의 범불안 징후를 다루고 있음이 확인되었다. 또한 현재 여러 임상 장면에서 가장 널리 사용되는 BAI와의 상관 분석 결과, K-ANX의 예비문항이 적절한 공존타당도를 지니고 있으면서도 BAI에서 다루지 않은 다양한 영역까지 포괄하고 있어 추후 범불안장애 선별도구로서 활용될 수 있는 적절한 문항 풀(pool)을 형성하고 있음이 시사되었다. 추후 환자군을 대상으로 한 예비검사를 추가로 실시하여 임상군과 비임상군을 잘 변별할 수있는 문항을 선정하고, 이를 토대로 범불안장애 선별도구를 개발하는 과정이 필요할 것으로 여겨진다.
Abstract
The Ministry for Health & Welfare Affairs has marked a major milestone in a new mental health paradigm emphasizing the importance of preventative and early interventions. In this context, the development of a reliable and valid screening tool for mental disorders has become a high priority. A consensus has recently emerged among experts that there is a paucity of screening tools available for anxiety disorders and none of them is sufficient in its sensitivity and specificity. The development of new screening approaches for anxiety disorders was therefore recommended. In the current study, the multi-disciplinary research team comprised of clinical psychologists, psychiatrists and psychometricians, conducted a systematic review of existing screening tools for anxiety disorders to analyze strengths and limitations of the tools and to summarize the background and rationale for development of the new Korean screening tool for anxiety disorders (K-ANX). The K-ANX aims to cover recent diagnostic criteria from the DSM-5 and RDoC in a concise manner with sufficient diagnostic sensitivity and specificity. We also summarize the sub-domains of anxiety disorders and develop 273 preliminary item pools of the K-ANX. A preliminary study using the K-ANX was then conducted with 150 individuals whice showed that it demonstrates high concurrent validity with the BAI. Finally, the directions for the validation of the final K-ANX project were discussed.
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