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아동학대 피해자를 위한 심리사회적 개입의 효과: 체계적 문헌고찰 및 메타분석

Effects of psychosocial interventions for victims of child maltreatment: A systematic review and meta-analysis

심은정|하혜주
한국청소년정책연구원 (National Youth Policy Institute)|2021.11|한국청소년연구 (Studies on Korean Youth)|제32권 제4호|pp. 65-95|DOI 10.14816/sky.2021.32.4.65

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참고문헌

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메타분석아동학대체계적 문헌고찰meta-analysissystematic reviewchild maltreatment심리사회적 개입psychosocial intervention
주제분류기타사회과학

초록

본 연구는 아동학대 피해자 대상 심리사회적 개입 연구의 현황 및 특성을 확인하기 위해 국내외 학술지에 게재된 32편의 연구를 대상으로 체계적 문헌고찰을 진행하였다. 그리고 고찰에 포함된 연구 중 24편을 대상으로 개입 효과에 대한 메타분석을 수행하였다. 또한 개입 대상 연령을 기준으로 성인, 아동 및 청소년 개입으로 구분한 후, 개입 유형(e.g., 외상-초점 인지행동치료, 마음챙김 기반 치료, 교육, 문제해결훈련) 및 결과 지표(i.e., 정신장애 증상, 대인관계/사회적 문제, 자아 개념, 기능 및 적응, 기타 심리적 문제)에 따른 개입 효과의 차이를 검증하기 위해 하위집단 분석을 실시하였다. 아동학대 피해자 대상 개입은 주로 외상-초점 인지행동치료나 마음챙김 기반 치료, 교육 등이었으며, 개입의 1차 목표는 주로 외상 후 스트레스나 우울의 감소, 혹은 자아존중감 향상이었다. 메타분석 결과, 아동학대 피해자 대상 심리사회적 개입은 0.63(95% CI, 0.51-0.76)의 중간 정도의 효과가 나타났고, 효과는 추후 측정에서도 유지되었다(g=0.67). 더불어, 개입 유형에 따른 효과의 차이가 관찰되었고, 성인에게는 인지행동치료와 지속노출치료를 결합한 치료, 아동에게는 치료놀이, 외상-초점 인지행동치료가 타 치료에 비해 더 효과적인 것으로 나타났다. 결과 지표에 따른 차이는 유의하지 않았으나, 아동의 대인관계/사회적 문제, 기타 심리적 문제에 대해서는 심리사회적 개입의 효과가 없는 것으로 나타났다. 본 연구 결과는 아동학대 피해자가 경험하는 다양한 심리사회적 문제에 대한 다중요소 심리사회적 개입이 보다 효과적일 수 있음을 시사한다.

Abstract

This study performed a systematic review and meta-analysis of psychosocial interventions for victims of child maltreatment. Thirty-two articles published in domestic and international journals, and 24 studies were included for the purposes of meta-analysis. Subgroup analysis was performed to determine whether the intervention effect sizes (ESs) depend on the types of intervention or outcome variables. Psychosocial interventions for victims of child maltreatment were mainly trauma-focused cognitive behavioral therapy (TF-CBT), mindfulness-based therapy, or education, and were provided with a focus on post-trauma stress, depression, or self-esteem. The result of the meta-analysis was an observed medium level ESs (g=0.63; 95% CI, 0.51-0.76), and these effects were maintained at follow-up assessment (g=0.67). Additionally, ESs varied depending on the intervention type. Specifically, for adults with a history of child maltreatment, CBT combined with prolonged exposure therapy was more effective than other types, and for maltreated children, play therapy and trauma-focused CBT were more effective. Differences in the type of outcome variable were not significant, but there was no effect of interventions on interpersonal/social and other psychological problems of maltreated children. This finding suggests that psychosocial interventions made up of multiple components are more effective in improving the psychosocial problems for victims of child maltreatment.

참고문헌 (79)

  1. 김수영, "NECA 체계적 문헌고찰 매뉴얼. NECA 연구방법 시리즈", 1~287 (2011)
  2. 김수정, "아동 빈곤의 사회경제적 비용 추계", 한국사회복지학, 69(3), pp.9~33 (2017), 한국사회복지학회[DOI]
  3. 김은주, "국내 학대피해 아동을 위한 중재를 위한 연구의 메타분석", 놀이치료연구, 16(3), pp.1~13 (2012), 한국아동심리재활학회
  4. 김혜영, "방임 아동의 자존감(self-esteem)향상을 위한 현실치료 프로그램 개발및 효과성 연구", 아동과 권리, 5(2), pp.61~80 (2001)
  5. 노푸른, "수용전념치료(ACT)가 아동기 외상을 경험한 청소년의 자아존중감, 자아탄력성 및 대인관계 문제에 미치는 효과", 한국심리학회지: 건강, 19(4), pp.885~907 (2014), 한국건강심리학회[DOI]
  6. 박은민, "가정학대 피해 가출 청소년을 위한 정서조절 집단상담 프로그램 개발", 한국심리학회지: 상담 및 심리치료, 21(1), pp.93~111 (2009), 한국상담심리학회
  7. 보건복지부, "2020 아동학대 주요통계", 보건복지부 아동학대대응과, ~ (2021)
  8. 서민정, "수용-전념 치료가 아동기 정서적 학대 경험이 있는 대학생의 정서인식과 표현 및 부정적 신념에 미치는 효과", 한국심리학회지: 건강, 17(3), pp.557~572 (2012), 한국건강심리학회[DOI]
  9. 성영혜, "집단 치료놀이(Group Theraplay)를 통한 그룹홈 학대 아동의 '자아상(Self-Image)' 형성", 아동과 권리, 8(3), pp.439~462 (2004), 한국아동권리학회
  10. 신지현, "부모의 학대와 방임이 자녀의 사회적 위축에 미치는 영향: 자아존중감의 매개효과를 중심으로", 학교사회복지, (44), pp.1~22 (2018), 한국학교사회복지학회[DOI]
  11. 안현의, "복합외상(complex trauma)의 개념과 경험적 근거", 한국심리학회지:일반, 26(1), pp.105~119 (2007), 한국심리학회
  12. 양재원, "얼굴표정 정서 인식 능력과 고등학생의 심리사회적 적응 및 또래관계", Korean Journal of Clinical Psychology, 30(2), pp.475~495 (2011), 한국임상심리학회[DOI]
  13. 오혜경, "학대 아동 대상 중재에 대한 통합적 문헌고찰: 국내·외 학대 아동 중재 관련 연구(2009–2019)를 중심으로", 한국모자보건학회지, 24(2), pp.111~121 (2020), 한국모자보건학회[DOI]
  14. 유새봄, "수용전념치료(ACT)가 아동기 정서적 피학대 경험이 있는 대학생의 복합 PTSD 증상, 수용 및 외상 후 성장에 미치는 효과", 디지털융복합연구, 16(3), pp.561~572 (2018), 한국디지털정책학회[DOI]
  15. 이주연, "집단 치료놀이가 학대아동의 학교적응력에 미치는 효과", 아동복지연구, 2(2), pp.115~135 (2004)
  16. 이주연, "학대받은 아동의 애착증진을 위한 집단 치료놀이 프로그램 효과", 아동복지연구, 6(4), pp.97~114 (2008)
  17. 정익중, "아동학대 경험이 또래집단으로부터의 소외로 이어지는 발달경로", 아동학회지, 29(4), pp.79~95 (2008), 한국아동학회
  18. 최지영, "외상 경험 아동에 대한 근거기반치료", Korean Journal of Clinical Psychology, 37(4), pp.605~620 (2018), 한국임상심리학회[DOI]
  19. 하지혜, "아동학대 피해 아동의 정신질환 유병률 조사", 신경정신의학, 54(4), pp.542~548 (2015), 대한신경정신의학회[DOI]
  20. 하혜주, "학대 피해경험이 심리사회적 발달에 미치는 영향: 성향점수매칭분석", 한국청소년연구, 31(4), pp.223~249 (2020), 한국청소년정책연구원[DOI]
  21. Ahn, J., "Estimating the prevalence rate of child physical and psychological maltreatment in South Korea", Child Indicators Research, 10(1), pp.187~203 (2017)[DOI]
  22. Arslan, G., "Psychological maltreatment, emotional and behavioral problems in adolescents : The mediating role of resilience and self-esteem", Child Abuse & Neglect, 52, pp.200~209 (2016)[DOI]
  23. Bernstein, D. P., "Development and validation of a brief screening version of the Childhood Trauma Questionnaire", Child abuse & neglect, 27(2), pp.169~190 (2003)[DOI]
  24. Bohus, M., "Dialectical Behaviour Therapy for Post-traumatic Stress Disorder after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder : A Randomised Controlled Trial", Psychotherapy &Psychosomatics, 82(4), pp.221~233 (2013)[DOI]
  25. Bohus, M., "Dialectical Behavior Therapy for Posttraumatic Stress Disorder(DBT-PTSD)Compared With Cognitive Processing Therapy(CPT)in Complex Presentations of PTSD in Women Survivors of Childhood Abuse : A Randomized Clinical Trial", JAMA Psychiatry, 77(12), pp.1235~1245 (2020)[DOI]
  26. Borenstein, M., "Introduction to meta-analysis" (2011), John Wiley & Sons
  27. Capron, D. W., "Combined"top-down"and"bottom-up"intervention for anxiety sensitivity : Pilot randomized trial testing the additive effect of interpretation bias modification", Journal of Psychiatric Research, 85, pp.75~82 (2017)[DOI]
  28. Cederbaum, J. A., "Child maltreatment and romantic relationships in adolescence and young adulthood : The mediating role of self-perception", Child Abuse & Neglect, 109, pp.104718~ (2020)[DOI]
  29. Cicchetti, D., "Socioemotional, personality, and biological development : Illustrations from a multilevel developmental psychopathology perspective on child maltreatment", Annual Review of Psychology, 67, pp.187~211 (2016)[DOI]
  30. Cloitre, M., "Skills training in affective and interpersonal regulation followed by exposure : a phase-based treatment for PTSD related to childhood abuse", Journal of Consulting and Clinical Psychology, 70(5), pp.1067~ (2002)[DOI]
  31. Cloitre, M., "Treatment for PTSD Related to Childhood Abuse : A Randomized Controlled Trial", American Journal of Psychiatry, 167(8), pp.915~924 (2010)[DOI]
  32. Cohen, J. A., "A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms", Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), pp.393~402 (2004)[DOI]
  33. Cohen, J. A., "Trauma-focused cognitive behavioural therapy for children and parents", Child and Adolescent Mental Health, 13(4), pp.158~162 (2008)[DOI]
  34. Crugnola, C. R., "Childhood experiences of maltreatment, reflective functioning and attachment in adolescent and young adult mothers : Effects on mother-infant interaction and emotion regulation", Child Abuse & Neglect, 93, pp.277~290 (2019)[DOI]
  35. Cuijpers, P., "Psychotherapy for depression across different age groups : A systematic review and meta-analysis", JAMA Psychiatry, 77(7), pp.694~702 (2020)[DOI]
  36. Daneshmandi, S., "Emotional Schema Therapy Improves Emotion Regulation in Individuals with a History of Child Abuse and Neglect", International Journal of Cognitive Therapy, 12(1), pp.5~15 (2019)[DOI]
  37. da Silva Ferreira, G. C., "Facial emotion processing and recognition among maltreated children : A systematic literature review", Frontiers in Psychology, 5, pp.1~10 (2014)[DOI]
  38. Doretto, V., "Effects of Early neglect experience on recognition and processing of facial expressions : a systematic review", Brain Sciences, 8(1), pp.10~ (2018)[DOI]
  39. Dorrepaal, E., "Stabilizing group treatment for complex posttraumatic stress disorder related to child abuse based on psychoeducation and cognitive behavioural therapy : a multisite randomized controlled trial", Psychotherapy & Psychosomatics, 81(4), pp.217~225 (2012)[DOI]
  40. Dorsey, S., "Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events", Journal of Clinical Child & Adolescent Psychology, 46(3), pp.303~330 (2017)[DOI]
  41. Duberstein, P. R., "Effectiveness of interpersonal psychotherapytrauma for depressed women with childhood abuse histories", Journal of Consulting and Clinical Psychology, 86(10), pp.868~878 (2018)[DOI]
  42. Duval, S., "Trim and fill : a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis", Biometrics, 56(2), pp.455~463 (2000)[DOI]
  43. Edmond, T., "The effectiveness of EMDR with adult female survivors of childhood sexual abuse...eye movement desensitization and reprocessing", Social Work Research, 23(2), pp.103~116 (1999)[DOI]
  44. Egger, M., "Bias in meta-analysis detected by a simple, graphical test", BMJ, 315(7109), pp.629~634 (1997)[DOI]
  45. Farina, V., "Trauma-focused cognitive behavioral therapy a clinical trial to increase self-efficacy in abused the primary school children", Journal of Education and Health Promotion, 7, pp.33~ (2018)[DOI]
  46. Farnia, V., "Comparison of trauma-focused cognitive behavioral therapy and theory of mind : Improvement of posttraumatic growth and emotion regulation strategies", Journal of Education and Health Promotion, 7, pp.58~ (2018)[DOI]
  47. Farnia, V., "Effect of trauma-focused cognitive behavioral therapy on reduction social and emotional maladjustment of physically abused children : A clinical trial", International Journal of Pediatrics, 5(8), pp.5473~5481 (2017)[DOI]
  48. Feather, J. S, (2012), 학지사
  49. Foa, E. B., "Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls : a randomized clinical trial", JAMA : Journal of the American Medical Association, 310(24), pp.2650~2657 (2013)[DOI]
  50. Gardner, M. J., "The association between five forms of child maltreatment and depressive and anxiety disorders : A systematic review and meta-analysis", Child Abuse & Neglect, 96, pp.104082~ (2019)[DOI]
  51. Gorey, K. M., "Guilt, isolation and hopelessness among female survivors of childhood sexual abuse : effectiveness of group work intervention", Child Abuse & Neglect, 25(3), pp.347~355 (2001)[DOI]
  52. Hedges, L. V., "Statistical methods for meta-analysis" (1985), Academic Press
  53. Higgins, J. P., "Measuring inconsistency in meta-analyses", BMJ, 327(7414), pp.557~560 (2003)[DOI]
  54. Ju, S., "Developmental trajectories and longitudinal mediation effects of self-esteem, peer attachment, child maltreatment and depression on early adolescents", Child Abuse & Neglect, 76, pp.353~363 (2018)[DOI]
  55. Jung, K., "A randomized controlled trial on cognitive restructuring and imagery modification to reduce the feeling of being contaminated in adult survivors of childhood sexual abuse suffering from posttraumatic stress disorder", Psychotherapy and Psychosomatics, 82(4), pp.213~220 (2013)[DOI]
  56. Lau, M., "Outcome of systemic and analytic group psychotherapy for adult women with history of intrafamilial childhood sexual abuse : a randomized controlled study", Acta Psychiatrica Scandinavica, 116(2), pp.96~104 (2007)[DOI]
  57. Leenarts, L. E., "Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment : A systematic review", European Child & Adolescent Psychiatry, 22(5), pp.269~283 (2013)[DOI]
  58. Lim, Y., "Relationships between parental maltreatment and adolescents’ school adjustment : Mediating roles of self-esteem and peer attachment", Journal of Child and Family Studies, 26(2), pp.393~404 (2017)[DOI]
  59. McLaughlin, K. A., "Mechanisms linking childhood trauma exposure and psychopathology : A transdiagnostic model of risk and resilience", BMC Medicine, 18(1), pp.1~11 (2020)[DOI]
  60. Mohammadkhani, P., "Develropment, validation and reliability of child abuse self report scale(CASRS)in IRANIAN students", Medical Journal of The Islamic Republic of Iran(MJIRI), 17(1), pp.51~58 (2003)
  61. Moher, D., "Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement", PLoS medicine, 6(7), pp.e1000097~ (2009)[DOI]
  62. Naami, A., "Comparison of trauma-focused cognitive-behavioral therapy and theory of mind on increasing social competence among abused children", Journal of Education and Health Promotion, 9, pp.81~ (2020)[DOI]
  63. Richter, N. L., "Group work intervention with female survivors of childhood sexual abuse", Research on Social Work Practice, 7(1), pp.53~69 (1997)[DOI]
  64. Rosenthal, R., "The file drawer problem and tolerance for null results", Psychological Bulletin, 86(3), pp.638~ (1979)[DOI]
  65. Rosner, R., "Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse : A Randomized Clinical Trial", JAMA Psychiatry, 76(5), pp.484~491 (2019)[DOI]
  66. Schwarzer, G., "Meta : General Package for Meta-Analysis", R package version 4.18-2, ~ (2021)
  67. Scott, K. M., "Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults", Archives of General Psychiatry, 67(7), pp.712~719 (2010)[DOI]
  68. Shackman, J. E., "Impact of physical maltreatment on the regulation of negative affect and aggression", Development and Psychopathology, 26(4pt1), pp.1021~1033 (2014)[DOI]
  69. Southam-Gerow, M. A., "Evidence base updates : The evolution of the evaluation of psychological treatments for children and adolescents", Journal of Clinical Child & Adolescent Psychology, 43(1), pp.1~6 (2014)[DOI]
  70. Talbot, N. L., "A randomized effectiveness trial of interpersonal psychotherapy for depressed women with sexual abuse histories", Psychiatric Services, 62(4), pp.374~380 (2011)[DOI]
  71. Taussig, H. N., "Impact of a mentoring and skills group program on mental health outcomes for maltreated children in foster care", Archives of Pediatrics & Adolescent Medicine, 164(8), pp.739~746 (2010)[DOI]
  72. Taussig, H. N., "A Positive Youth Development Approach to Improving Mental Health Outcomes for Maltreated Children in Foster Care: Replication and Extension of an RCT of the Fostering Healthy Futures Program", American Journal of Community Psychology, 64(3, pp.4) (2019), 405~417
  73. Teicher, M. H., "Childhood maltreatment and psychopathology : A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes", American Journal of Psychiatry, 170(10), pp.1114~1133 (2013)[DOI]
  74. Trickett, P. K., "Child maltreatment and adolescent development", Journal of Research on Adolescence, 21(1), pp.3~20 (2011)[DOI]
  75. van der Put, C. E., "Identifying effective components of child maltreatment interventions : A meta-analysis", Clinical Child and Family Psychology Review, 21(2), pp.171~202 (2018)[DOI]
  76. Viechtbauer, W., "Metafor: Meta-Analysis Package for R", R package version 3.0-2, ~ (2021)
  77. Wallis, D. A., "Reduction of trauma symptoms following group therapy", Australian & New Zealand Journal of Psychiatry, 36(1), pp.67~74 (2002)[DOI]
  78. Weber, S., "Quality of life in maltreated children and adult survivors of child maltreatment : A systematic review", Quality of Life Research, 25(2), pp.237~255 (2016)[DOI]
  79. Westbury, E., "The efficacy of group treatment for survivors of childhood abuse", Child Abuse & Neglect, 23(1), pp.31~44 (1999)[DOI]

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