자살에 대한 정신의학적 이해 및 예방대책
Psychiatric Understanding of Suicide and Its Prevention
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전 세계적으로는 해마다 백만 명 정도가 자살로 사망하며 아시아에서 보다 더 높은 자살률을 보이고, 이중 한국은 자살의 고위험 국가로 분류된다. 전북 지역의 경우 최근 3년간 전국에서 4-5위의 자살률 순위를 보이는 등 자살은 심각한 사회문제로 대두되고 있다. 자살은 다양한 심리적 원인이 복합적으로 관여하는 어려운 문제인 만큼 자살에 대한 효과적인 정책 마련 및 시행을 위해서는 자살에 대한 정확한 현황 파악 및 이해가 필요하다. 본고에서는 자살에 대한 국내외 현황, 정신의학적 이해, 그리고 자살예방 대응책에 대해 기술하였다. 자살 현황은 일반적 자료 및 최근 전북지역에서 얻어진 지역사회 조사 결과를 정신의학적 이해에서는 자살과 관련된 위험요인 및 보호요인 그리고 자살에 대한 심리내적인 이해를 기술하였다. 자살예방 대응책은 일반인구, 자살에 대한 잠재적위험인구 및 고위험인구를 대상으로 이루어지는 보편적 중재, 선별적 중재 그리고 지시적 중재의 개념과 그 활동 등에 대해 소개하였다. 자살 예방 대책이 성공적인 결과를 가져오기 위해서는 단기간의 성과에 급급하지 않고 장기적인 관점의 지속성 있는 정책추진이 중요하다. 또한 궁극적으로 물질만연주의, 지나친 사회적 경쟁에서 오는 인간성의 피폐를 막고 남을 배려하고 존중하는 정신적 여유와 가치를 소중히 여기는 사회가 되는 것이 중요할 것이다. 본고를 통하여 자살과 관련된 정신보건 분야에 직간접적으로 관여하는 사람들이 자살에 대한 이해를 높이고 나아가 각자의 위치에서 담당할 수 있는 역할을 찾는데 도움이 되었으면 한다.
Abstract
One million people die worldwide from suicide annually and more higher suicide rate was observed in Asian countries compared to western countries. Korea is classified as one of the high risk nations for suicide. Chonbuk area showed 4th-5th suicide rate in Korea for the last three years and suicide has become a serious social problem. Suicide being related with various psychiatric causes is a difficult problem to solve. To make an efficient government policies for the prevention of suicide it has to be accompanied with accurate understanding of suicidal status and causes. In this article, we described domestic and international data for suicide, psychiatric understanding and preventive strategy of suicide. Suicidal data are from general reference and findings on the regional survey study in Chonbuk province. Risk factors, protective factors and intrapsychic understanding of suicide was described in the psychiatric understanding of suicide. The concept and types of activities for universal interventions, selective interventions and indicated interventions are described. The targets of universial, selective and indicated intervention are general population, potential high risk individuals for suicide and previous suicide attempters respectively. To achieve successful outcome, it is critical to maintain consistent policies in a long-term perspective. More fundamentally, preventing materialism and dehumanization stemming from excessive competition in society and creating a social culture highly respecting mind-health value should be followed. We hope that this article would be a valuable resource for the people who are engaged in mental health problem directly or indirectly to improve understanding of suicide and find a proper role which they could.
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