자살 시도에 영향을 미치는 정신사회적 요인
The Psychosocial Factors Affecting Suicide Attempt
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초록
자살은 의학적이며 사회적인 문제로 최근 자살 및 자살 시도의 위험요인에 대한 규명에 관심의 초점이 모아지고 있다. 그러나, 자살 시도자에 대한 연구는 인구통계학적 특징에 대한 분석에 국한되어 자살 당시의 위험요인과 정신의학적 요인에 대한 탐색은 미미한 실정이다. 이 연구의 목적은 자살 시도자의 인구통계학적이며 사회경제적인 변인 및 자살 시도의 치명도, 마지막으로 정신의학적 요인을 규명하는 것이다. 본 연구에서 응급실에 방문한 자살 시도자의 경우 여자가 남자에 비해 우세하였으며 30대, 20대 등의 자살율이 높았다. 60대 이상에서는 남자의 자살율이 더 높았다. 학력 분포에서 고졸이 제일 많은 부분을 차지하였고 미혼자보다는 기혼자가 자살 시도 위험에 더 많이 노출되었다. 무직과 주부가 대부분이었으며 사회경제적 상태는 중, 중하가 가장 많았다. 자살 시도의 위험성은 경도 및 최경도, 구조 가능성은 높음과 매우 높음 등이 대부분이었으며 전체 RRR은 17~29의 범위에 집중되어 있었다. 자살 시도자들의 정신과적 질환으로는 주요 우울 장애가 가장 많았다. 본 연구는 자살 시도의 위험 요인과 보호 요인을 파악하기 위한 연구의 전단계로 사료된다. 추후 이러한 자살 시도자들에 대한 심층적 역학연구 및 면담을 통해 자살 시도 예방 프로그램에 대한 전향적 후속 연구가 요구될 것으로 생각된다.
Abstract
Objectives：A lots of studies have investigated the psychosocial characteristics of suicidal attempters in order to find efficient coping strategy and treatment intervention. The purpose of this study was to examine the psychosocial factors affecting the suicide attempt in psychiatric patients. Methods：Two hundred eighty patients who attempted suicide and admitted in the emergency room in 3 university hospitals from December 2003 to May 2006 were recruited in this study. The patients were interviewed using Structured Clinical Interview for DSM-IV Axis I disorder (SCID-RV), Lethality of Suicide Attempt Ratings Scale (LSARS) and Risk-Rescue Rating system (RRR). Results：The suicide attempters have psychosocial characteristics of female preponderance, age 20-39, high school in educational level, married in marriage condition, inoccupation, house makers in occupation. Most of attempters used the nonsevere methods such as drug ingestion or wrist cutting, and selected home as the place of attempt. The delay until discovery was less than 4 hours for most suicide attempters, and the rate of asking for help directly or dropping clues were high. Major depressive disorder was the most common psychiatric illness among attempters. Conclusions：The present study would be the early stage to explore the risk factor and protect factor of suicidal attempt. This study suggests that the closed observation to potential-suicidal attempter in daily life is critical to protect against the fatal results due to suicidal attempts. (J Korean Neuropsychiatr Assoc 2007;46(2):129-135)
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