소아 및 청소년 두통 환자의 심리적 특성
Psychological Characteristics of Children and Adolescents with Headaches
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목 적:본 연구는 반복되는 두통을 주소로 내원한 소아 및 청소년의 행동 및 정서적 문제를 조사하고 일차두통의 유형에 따른 심리학적 특성에 대해 분석하였다. 방 법:2006년 12월부터 2008년 4월까지 고려대학교 안산병원 소아신경클리닉에 내원한 4-17세의 두통 환자 269명과 두통을 비롯한 다른 질병이 없는 31명을 대상으로 연구하였다. 대상군의 심리학적 특성은 아동ㆍ청소년행동평가척도, 한국 아동 인성검사, 아동용 우울 척도를 통해 평가하였고, t-test를 사용해 결과를 비교하였다. 결 과:전체 일차두통군과 대조군을 비교해 본 결과, 신체증상척도, 사고의 문제 척도, 주의집중척도, 내재화 문제행동척도, 불안척도, 우울척도, 신체화척도, 사회관계척도, 정신증척도 등이 두통환자군에서 더 높은 점수를 보였다. 만성매일두통과 삽화성두통 집단을 비교한 결과, CDI와 자아탄력성, 신체화 척도에서 집단 간 차이를 보였다. 편두통과 긴장형두통은 통계적으로 의미 있는 차이가 없었다. 결 론:소아 및 청소년 두통 환자들은 내재화된 문제행동을 수반하고 있으며, 만성매일두통의 경우가 삽화성두통에 비해서 우울, 신체화 등을 더 많이 호소하고 대처능력이 매우 낮아 적응에 부정적인 영향을 줄 수 있다. 효과적으로 두통을 치료하기 위해서는 두통환자의 심리적 특성을 고려한 접근이 필요하다.
Abstract
Purpose:Headaches are associated with psychiatric illness, and can affect all aspects of a functioning child. We examined the behavioral and emotional problems of children and adolescents suffering from headaches. Methods:Children and adolescents(N=269) aged 4 to 17 suffering from headaches and their age-matched controls(N=31) were assessed using the Korean Child Behavior Checklist(K-CBCL), Korean Personality Inventory for Children (KPI-C), and Children's Depression Inventory(CDI). Results:Psychological profiles were analyzed in three stages. First, the primary headaches had a statistically significant tendency to show problems in anxiety, depression, somatization, and psychosis scales of KPI-C, and somatic complaints, thought, and internalizing problems of K-CBCL than in the control group(P<0.05). Second, migraines(N=162) and tension-type headaches (N=57) showed no statistically significant difference(P>0.05). Finally, the chronic daily headaches(CDH)(N= 43) had statistically significantly higher scores in CDI and somatization of KPI-C than in the episodic headaches(P<0.05). In respect to ego-resilience scale of KPI- C, CDH had statistically significantly lower score than in the episodic headaches(P<0.05). Conclusion:Children and adolescents with headaches show greater internalizing problems(anxiety, depression, somatization, and thought problems) than their healthy peers. Patients with CDH will have a negative effect on their adaptations because they have a lower ego-resilience and more symptoms of depression and somatization than children suffering from episodic headaches and controls.
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