유방암 환자의 우울장애 예측변인
Biopsychosocial Predictors of Depressive Disorder in Breast Cancer Patients
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초록
본 연구에서는 생물심리사회적 모델에 기초하여 유방암 환자의 우울장애 분포를 확인하고 암관련 요인, 개인적 특성, 유방암 관련 신체증상, 심리사회적 특성 등 4개의 영역으로 구분하여 우울장애의 예측변인을 규명하였다. 128명의 유방암 환자가 연구에 참여하여 CES-D와 DSM-IV에 근거한 평가척도를 실시하였고 암관련 요인, 개인적 특성, 유방암관련 신체증상 그리고 낙관성, 자기존중감, 배우자 지지 등의 심리사회적 변인을 설문평가 하였다. 그 결과 유방암환자의 31%가 우울집단으로 나타났고, 14%는 우울장애 집단으로 확인되었다. 우울장애 집단과 일반 집단에 대한 차이 검증결과 우울장애 집단에서 가슴 증상, 팔 증상이 더 심하였으며, 낙관주의, 자기 존중감이 더 낮았다. 위계적 이항 회귀분석 결과 우울장애 예측에 있어 암관련 요인, 개인적 특성, 유방암 관련 신체증상 등의 객관적 요인의 설명력은 유의하지 않았고 심리사회적 변인이 투입되었을 때 그 설명력이 유의하여 94.9%가 정확히 분류되었다. 특히 낙관주의가 부족할수록 우울장애 집단에 속할 가능성이 높았다. 이에 따라 유방암 환자의 우울 장애 빈도가 높다는 것과 우울장애 발병에서 낙관성과 같은 심리사회적 변인의 중요성을 확인하였다.
Abstract
The purpose of this study was to examine the prevalence and analyze the various predictors of depressive disorder in women with breast cancer on the basis of biopsychosocial model. A total of 128 breast cancer patients were recruited, and they were assessed on the basis of cancer-related variables, sociodemopraphic variables, symptoms of depression, cancer-related somatic symptoms, and psychosocial variables (optimism, self esteem, husband support). The results showed that 31% of the patients exhibited a high level of depressive symptoms, and 14% of the patients were classified as having depressive disorder. The 4-step hierarchical binary logistic regression analysis was significant, and the rate of correct prediction was 94.9%. Before entering the psychosocial variables, none of the cancer-related variables, sociodemographic variables or cancer-related somatic symptoms was significant. The high risk of depressive disorder in breast cancer patients was associated with a personality trait. The results supported that depressive symptomatology in breast cancer patients is not associated with objective variables, but rather that it is very strongly linked with psychological variables. Finally, the implications for the identification of and psychosocial intervention for depressive disorder in breast cancer patients were discussed.
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