우울증 환자에서 자살 시도 유무에 따른 방어기제와 심리적 특성 차이
Differences in Defense Mechanisms and Psychological Characteristics According to Suicide Attempt in Patients with Depression
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참고문헌
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초록
Objectives: The objective of the present study was to identify the differences between the defense mechanisms and psychologi『cal characteristics implemented by patients who have attempted suicide, and those implemented by depressed patients who have not. Methods: We recruited 250 depressed patients (67 with a history of one or more suicide attempts, and 183 patients without any history of suicide attempts) identified based on diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disor『ders-IV-text revision. We compared the clinical and psychological characteristics of the two groups using the Symptom Checklist- 90-Revised (SCL-90-R), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Personality Disorder Questionnaire-4+ (PDQ-4+), and the Defense Style Questionnaire (DSQ). Results: The patients who had a history of suicide attempt(s) recorded higher scores in all subscales of the SCL-90-R (except phobic anxiety), as well as the Infrequency (F), Back Infrequency [F(B)], Hypochondriasis (Hs), Depression (D), Psychopathic deviate (Pd), Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), Hypo『mania (Ma) scales of the MMPI than those patients with no history of attempted suicide. The patients with no history of suicide attempt(s) recorded higher scores on the Correction (K), Superlative self-presentation (S) scales of the MMPI than those who had attempted suicide. The incidence of paranoid, schizotypal, avoidant, dependent, depressive and negativistic personality disorders (as assessed by the PDQ criteria) was elevated in those patients with histories of suicide attempt(s). Maladaptive and image-distorting defense style, as assessed by the DSQ, and acting out and affiliation were also greater in those with histories of suicide attempt(s). Conclusion: It appears that depressed patients who attempt suicide experience more clinical symptoms, use primitive defense mechanisms and, apparently, have some predictably characteristic problems. Thus, these findings might be useful to those in clini『cal practice, for the purpose of evaluating depressed patients at high risk for attempted suicide, versus clinically depressed patients who are not. Psychoanalysis 2017;28(4):96-106
Abstract
Objectives: The objective of the present study was to identify the differences between the defense mechanisms and psychologi『cal characteristics implemented by patients who have attempted suicide, and those implemented by depressed patients who have not. Methods: We recruited 250 depressed patients (67 with a history of one or more suicide attempts, and 183 patients without any history of suicide attempts) identified based on diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disor『ders-IV-text revision. We compared the clinical and psychological characteristics of the two groups using the Symptom Checklist- 90-Revised (SCL-90-R), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Personality Disorder Questionnaire-4+ (PDQ-4+), and the Defense Style Questionnaire (DSQ). Results: The patients who had a history of suicide attempt(s) recorded higher scores in all subscales of the SCL-90-R (except phobic anxiety), as well as the Infrequency (F), Back Infrequency [F(B)], Hypochondriasis (Hs), Depression (D), Psychopathic deviate (Pd), Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), Hypo『mania (Ma) scales of the MMPI than those patients with no history of attempted suicide. The patients with no history of suicide attempt(s) recorded higher scores on the Correction (K), Superlative self-presentation (S) scales of the MMPI than those who had attempted suicide. The incidence of paranoid, schizotypal, avoidant, dependent, depressive and negativistic personality disorders (as assessed by the PDQ criteria) was elevated in those patients with histories of suicide attempt(s). Maladaptive and image-distorting defense style, as assessed by the DSQ, and acting out and affiliation were also greater in those with histories of suicide attempt(s). Conclusion: It appears that depressed patients who attempt suicide experience more clinical symptoms, use primitive defense mechanisms and, apparently, have some predictably characteristic problems. Thus, these findings might be useful to those in clini『cal practice, for the purpose of evaluating depressed patients at high risk for attempted suicide, versus clinically depressed patients who are not. Psychoanalysis 2017;28(4):96-106
참고문헌 (42)
- Angst F, "Mortality of patients with mood disorders: follow-up over 34-38 years", J Affect Disord, 68, pp.167~181 (2002)
- Beautrais AL, "Personality traits and cognitive styles as risk factors for serious suicide attempts among young people", Suicide Life Threat Behav, 29, pp.37~47 (1999)
- Bond M., "Empirical studies of defense style: relationships with psychopathology and change", Harv Rev Psychiatry, 12, pp.263~278 (2004)
- Bond MP, "An empirical study of the relationship between diagnosis and defense style", Arch Gen Psychiatry, 43, pp.285~288 (1986)
- Brent DA, "Psychiatric risk factors for adolescent suicide: a case-control study", J Am Acad Child Adolesc Psychiatry, 32, pp.521~529 (1993)
- Busch FN, "Psychodynamic Treatment of Depression" (2007), American Psychiatric Publishing
- 조맹제, "한국 주요정신장애의 유병률 및 관련요인：2006 전국정신질환역학조사", 신경정신의학, 48(3), pp.143~152 (2009), 대한신경정신의학회
- Chung MW, "A preliminary study for the development of a defense style questionnaire adapted for Koreans", J Korean Neuropsychiatr Assoc, 32, pp.707~716 (1993)
- Clopton JR, "Identification of suicide attempters by means of MMPI profiles", J Clin Psychol, 39, pp.868~871 (1983)
- Corruble E, "Defense styles in depressed suicide attempters", Psychiatry Clin Neurosci, 58, pp.285~288 (2004)
- Corruble E, "Impulsivity: a relevant dimension in depression regarding suicide attempts?", J Affect Disord, 53, pp.211~215 (1999)
- Corruble E, "Defense styles, impulsivity and suicide attempts in major depression", Psychopathology, 36, pp.279~284 (2003)
- Daigle M., "MMPI inmate profiles: suicide completers, suicide attempters, and non-suicidal controls", Behav Sci Law, 22, pp.833~842 (2004)
- Derogatis LR, "SCL-90: an outpatient psychiatric rating scale--preliminary report", Psychopharmacol Bull, 9, pp.13~28 (1973)
- Foster T, "Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland", Br J Psychiatry, 175, pp.175~179 (1999)
- Gould MS, "Psychosocial risk factors of child and adolescent completed suicide", Arch Gen Psychiatry, 53, pp.1155~1162 (1996)
- Henriksson MM, "Mental disorders and comorbidity in suicide", Am J Psychiatry, 150, pp.935~940 (1993)
- Hovanesian S, "Defense mechanisms and suicide risk in major depression", Arch Suicide Res, 13, pp.74~86 (2009)
- Isometsä ET., "Psychological autopsy studies--a review", Eur Psychiatry, 16, pp.379~385 (2001)
- 전홍진, "우울증과 자살", 대한의사협회지, 54(4), pp.370~375 (2011), 대한의사협회
- Jeon HJ, "Lifetime prevalence and correlates of suicidal ideation, plan, and single and multiple attempts in a Korean nationwide study", J Nerv Ment Dis, 198, pp.643~646 (2010)
- Study on development of suicide prevention policy: foreign national suicide prevention strategy and analysis of domestic activities, "Jeon WT", Ministry of Health Welfare, 1~221 (2004)
- Johnson JG, "Defense styles as predictors of personality disorder symptomatology", J Personal Disord, 6, pp.408~416 (1992)
- Kim DI, "The preliminary study of reliability and validity on the Korean version of personality disorder questionnaire-4+(PDQ-4+)", J Korean Neuropsychiatr Assoc, 39, pp.525~538 (2000)
- 김혜금, "DSM-Ⅳ B와 C 군집 인격장애에서 방어기제와 심리적 특성의 차이: 경계성 인격구조 이론과의 시사점", 정신분석, 25(1), pp.13~23 (2014), 한국정신분석학회
- Kim KI, "Korean Manual of Symptom Checklist-90-revision" (1984), Jungangjeokseong Publishing
- 김성완, "자살시도 위험요인 및 자살에 대한 태도 연구", 신경정신의학, 49(4), pp.367~373 (2010), 대한신경정신의학회
- Kim SW, "Relationship between a history of a suicide attempt and treatment outcomes in patients with depression", J Clin Psychopharmacol, 31, pp.449~456 (2011)
- 김소영, "한국에서의 메스암페타민 남용 또는 의존 환자의 인격장애에 관한 연구", 생물치료정신의학, 9(2), pp.204~212 (2003), 대한생물치료정신의학회
- The survey of mental disorders in Korea 2016, "Korean Ministry of Health and Welfare", Korean Ministry of Health and Welfare, ~ (2017)
- Lester D., "Why people kill themselves: a 1990s summary of research findings on suicidal behavior" (1992), Charles C Thomas
- Lewinsohn PM, "Psychosocial risk factors for future adolescent suicide attempts", J Consult Clin Psychol, 62, pp.297~305 (1994)
- Nordström P, "Temperamental vulnerability and suicide risk after attempted suicide", Suicide Life Threat Behav, 26, pp.380~394 (1996)
- OECD., "Health at a glance 2015: OECD indicators", pp.56~57 (2015), OECD Publishing
- Roy A, "Cerebrospinal fluid monoamine metabolites and suicidal behavior in depressed patients. A 5-year follow-up study", Arch Gen Psychiatry, 46, pp.609~612 (1989)
- Seoul National University College of Medicine., "The epidemiological survey of mental disorders in Korea 2011", Ministry of Health and Welfare, ~ (2012)
- Serin RC, "An examination of suicide attempts among inmates", Forum Correct Res, 14, pp.40~42 (2002)
- Soloff PH, "Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study", Am J Psychiatry, 157, pp.601~608 (2000)
- Statham DJ, "Suicidal behaviour: an epidemiological and genetic study", Psychol Med, 28, pp.839~855 (1998)
- Statistics Korea., "Death statistics in 2015" (2016), Statistics Korea
- Wang MC, "Purpose in life and reasons for living as mediators of the relationship between stress, coping, and suicidal behavior", J Posit Psychol, 2, pp.195~204 (2007)
- World Health Organization., "Suicide prevention (SUPRE)", World Health Organization, ~ (2009)