용서 프로그램이 정신장애인의 불안, 분노, 우울 및 용서에 미치는 효과

이재숙 우석대학교 교육대학원 2023 국내석사

본 연구는 용서 프로그램이 정신장애인의 용서, 불안, 분노, 우울에 어떠한 영향을 미치는지 살펴보고자 하는 것이 주요 목적이었다. 이러한 연구목적을 달성하기 위해 구체적인 연구 문제를 다음과 같이 설정하였다. 첫째, 용서프로그램이 정신질환자의 용서 정도에 미치는 효과는 유의한가? 둘째, 용서프로그램이 정신질환자의 분노에 미치는 효과는 유의한가? 셋째, 용서프로그램이 정신질환자의 불안에 미치는 효과는 유의한가? 넷째, 용서프로그램이 정신질환자의 우울에 미치는 효과는 유의한가? 이다. 본 연구는 G광역시에 위치한 정신건강복지센터에 등록된 정신장애인 중 용서프로그램에 참가하기를 희망하는 대상자, 총 18명을 대상으로 하였다. 집단 배치는 무선으로 8명이 실험집단, 10명이 통제집단으로 배치되었다. 2022년 06월 13일부터 2022년 07월 4일까지 주 2회씩, 총 7회기에 걸쳐 프로그램에 참여하였고, 1회기당 시간은 총 120분이며 중간에 쉬는 시간을 5분을 두었다. 실험집단에서 프로그램이 진행되는 동안, 통제집단은 아무런 처치도 받지 않았다. 프로그램의 효과 검증을 위해 오영희(2008)가 개발한 한국인 용서척도(KFS), 상태 분노검사, 상태-특성 불안검사, 전겸구와 이민규(1992)가 번안한 Radoloff(1977)의 우울검사를 도구로 사용하였다. 수집된 자료는 SPSS Statistics 25.0 통계 프로그램을 사용하여 빈도분석, 독립표본 t검증, 대응표본 t검증을 실시하였다. 분석된 연구 결과를 요약하면 다음과 같다. 첫째, 용서프로그램은 정신장애인의 용서 정도를 유의미하게 향상시키는데 효과가 있는 것으로 나타났다. 둘째, 용서프로그램은 정신장애인의 불안 감소에 영향을 미치지 못하는 것으로 나타났다. 셋째, 용서프로그램은 정신장애인의 분노 감소에 효과적인 것으로 나타났다. 넷째, 용서프로그램은 정신장애인의 우울 감소에 효과적인 것으로 나타났다. 본 연구는 용서 프로그램이 스트레스와 대인관계에 취약한 정신장애인의 용서 정도가 증진되고, 분노와 우울이 감소하는데 효과가 있는 것으로 확인되었다. 따라서 정신장애인이 용서과정을 통해 상처, 갈등을 건설적으로 다룰 수 있게 도와주고 바람직한 방향으로 상처를 수용하고 극복함으로써, 심리적 재활에 효과가 있다고 볼 수 있다. The main purpose of this study was to examine how the forgiveness program affects forgiveness, anxiety, anger, and depression of the mentally disabled. In order to achieve this research purpose, specific research problems were set as follows. First, is the effect of the forgiveness program on the degree of forgiveness of mentally ill patients significant? Second, is the effect of the forgiveness program on the anger of mentally ill people significant? Third, is the effect of the forgiveness program on the anxiety of mentally ill people significant? Fourth, is the effect of the forgiveness program on the depression of mentally ill patients significant? This study targeted a total of 18 subjects who wished to participate in the forgiveness program among the mentally disabled registered at the Mental Health Welfare Center located in G Metropolitan City. In the group deployment, 8 people were deployed wirelessly as experimental groups and 10 as control groups. From June 13, 2022, to July 4, 2022, he participated in the program twice a week for seven sessions, with a total of 120 minutes per session and five minutes of rest in the middle. During the program in the experimental group, the control group received no treatment. To verify the effectiveness of the program, the Korean forgiveness scale (KFS) developed by Oh Young-hee (2008), the status anger test, the status-characteristic anxiety test, and the depression test of Radoloff (1977), adapted by Jeon Gyeom-gu and Lee Min-kyu (1992), were used as tools. For the collected data, frequency analysis, independent sample t-verification, and corresponding sample t-verification were performed using the SPSS Statistics 25.0 statistical program. The summary of the analyzed research results is as follows. First, the forgiveness program effectively improved the degree of forgiveness of the mentally disabled. Second, it was found that the forgiveness program did not reduce anxiety in the mentally disabled. Third, the forgiveness program effectively reduced the anger of the mentally disabled. Fourth, the forgiveness program effectively reduced depression in the mentally disabled. This study confirmed that the forgiveness program is effective in improving the degree of forgiveness of mentally disabled people who are vulnerable to stress and interpersonal relationships and reducing anger and depression. Therefore, it can be seen that it is effective in psychological rehabilitation by helping the mentally disabled deal with wounds and conflicts constructively through the forgiveness process and accepting and overcoming wounds in a desirable direction.

Mental disability and welfare law in South Korea : Historicizing eligibility, income support, and (De) institutionalization

Adriaenssens, Thomas Cornelis Sungkyunkwan University 2024 국내박사

Welfare law facilitates aims to enable people with mental disabilities to participate in society but can have inadvertent, reverse effects. South Korean disability welfare law has historically treated mental (psychosocial) disability differently from other disabilities, which inadvertently caused segregation, stigmatization, and neglect. This study calls this problem disenablement. Disenablement is problematic because it frustrates the very goals welfare law tries to achieve and risks non-compliance with international obligations like the UN Disability Rights Convention. However, both the disenabling potential of welfare law in particular and South Korean welfare law in general have received limited attention in international legal research. Therefore, this research asks how South Korean mental disability welfare law has historically (1940s-present) approached key issues like eligibility criteria, income support, and (de)institutionalization, and how its chosen approach disenabled. For methodology, this work relies on a document study of legal texts in conjunction with other historical sources like newspapers, complemented with semi-structured interviews with mental disability rights activists. Furthermore, it analyzes comparable Dutch law as a case study to formulate legal and policy recommendations. This work started with a brief, general narrative of the history of Korean welfare law to which each subsequent chapter added the particular narrative of the issue it discussed (eligibility, income support, and institutionalization). It found that, firstly, disability in Korean law is primarily conceived as physical and that this limited access to welfare through mental disability-unfriendly assessment methods and exclusionary provisions. Secondly, disability income support law reinforced a hierarchy of disabilities that disproportionately directed people with mental disabilities to conditional schemes with low benefits and a weak rights-basis. Thirdly, welfare law facilitated the institutionalization of people with mental disabilities but the lack of coordination with other laws frustrated deinstitutionalization. It concludes with a comparative chapter and recommends reforming assessment and income support law to improve the inclusion of mental disability and strengthening procedural rights to facilitate involvement and rights-claiming. 사회복지법은 장애인이 보다 독립적으로 생활하고 삶의 질을 향상시키는 것을 목표로 하지만 의도하지 않은 역효과를 일으킬 수도 있다. 한국의 역사에서 장애인 관련 복지법들은 정신장애를 다른 장애 유형과 다르게 취급해왔는데 이로 인해 의도치 않게 분리와 낙인, 그리고 방치를 초래했다. 본 연구에서는 이러한 역효과 현상을 '무력화(disenablement)'라고 부른다. 무력화는 사회복지법이 달성하고자 하는 목표를 좌절시키고 「유엔 장애인권리협약」과 같은 인권조약의 위반 우려가 있기 때문에 문제가 된다. 아직까지 국제 법학계에서 한국 사회법 그리고 특히 사회복지법이 무력화를 초래할 가능성에 대한 연구가 크게 이루어 지지 않았다. 본 연구는 역사적으로(1940년대~현재) 한국 정신장애인에 대한 사회복지법이 수급자격기준, 소득 보장, 그리고 (탈)원화의 세 가지 핵심 이슈를 어떻게 접근해왔으며, 이와 관련해 어떤 무력화 효과가 발생했는지 검토한다. 방법론은 법적 자료와 신문 등 기타 역사적 자료를 활용했으며 정신장애인권 운동가와 반구조적 인터뷰를 추가적으로 진행하였다. 이어 제안점 제시를 위해 네덜란드 법에 대한 비교법적 사례를 추가하였다. 본 연구는 한국 복지법의 역사를 간략히 소개하되 각 장에서 수급자격기준, 소득보장, 그리고 (탈)원화의 이슈를 논의하였다. 첫째, 한국 법에서 장애는 주로 신체적 장애로 인식되고 있으며, 이로 인해 정신적 장애에 맞지 않는 장애심사방법과 배제적 조항으로 복지에 대한 접근이 제한되고 있다는 점을 확인했다. 둘째, 장애인 소득보장법은 정신장애인들이 급여가 낮고 권리성이 약한 공공부조제도에 불균형하게 의존하게 하고 이는 ‘장애계층구조’를 강화시키는 것으로 보인다. 셋째, 사회복지법이 의도하지 않게 정신장애인의 시설화를 촉진한 반면, 의료법과의 조율 부족으로 탈시설화를 좌절시킨 것으로 나타났다. 마지막으로 네덜란드 법과 비교하며, 정신장애가 포함될 수 있게 심사방법과 소득보장법을 개혁하고, 참여와 사법구제를 촉진하기 위해 절차적 권리의 강화를 권고하는 것으로 끝맺었다.

정신건강사회복지사의 직무요인이 정신장애인에 대한 태도에 미치는 영향 : 사회적 지지의 조절효과를 중심으로

김혜진 전북대학교 일반대학원 2017 국내석사

This study purpose of examine the relationship between job factors of mental health social worker and the attitudes toward people with psychiatric disabilities, to explore the social support is possible as protecting factor in those relationship. This study surveyed mental health social workers who work in mental health settings(mental health hospitals, mental health centers, social rehabilitation facilities et al.) attending conservative education, using total 197 case for final analysis. The result of the research is as follows. First, mental health social worker’s attitudes toward people with psychiatric disabilities, job stress, social support were above average. The client violence experience was lower than the average, but the sexual violence was higher than the average. Second, between dependent variables and major variables showed that client violence, job stress, and social support correlated with attitudes toward people with psychiatric disabilities. The less the client violence experience, the lower the job stress, and the higher the social support, the more positive the attitudes toward people with psychiatric disabilities. Third, job factors had a statistically significant negative impact on the attitudes toward people with psychiatric disabilities. Social support has a statistically significant positive impact on attitudes toward people with psychiatric disabilities. Fourth, social support has a moderating effect on client violence and attitudes toward people with psychiatric disabilities. The higher the level of client violence, the little difference the level of attitudes toward people with psychiatric disabilities in the group with higher social support, while the level of attitudes toward people with psychiatric disabilities in the group with lower social support was rapidly lowered. But social support showed no moderating effect between job stress and the attitude toward people with psychiatric disabilities. The implications and suggestions of the study are as follows. First, In order to maintain the positive attitude toward people with psychiatric disabilities of mental health social worker, continuing education and human rights education are needed with active preventive measures and systematic support. Second, Based on the results of the study, it is necessary to provide policy support for mental health social worker 's improvement of working environment. Third, In this study the social support was found to be an important moderating variable in the relationship between client violence experiences and attitudes toward people with psychiatric disabilities. This is significant in that it sought ways to mitigate the negative impacts on client violence and attitudes toward people with psychiatric disabilities. Fourth, In this study the social support shown to have no moderating effect between mental health social worker's job stress and attitudes toward people with psychiatric disabilities. The results of this study need to be interpreted carefully, and the moderating effect of social support is required to be verified through various studies in the future.

The Impact of Community Mental Health Services on Psychiatric Medical Service Utilization of Individuals with Psychiatric Disabilities

김유진 서울대학교 대학원 2025 국내박사

정신장애인의 진정한 회복을 위해서는 의료이용 뿐만 아니라, 개인의 필요에 맞춘 지역사회 기반 재활 서비스에 대한 접근이 필수적이다. 그러나 한국의 정신건강서비스 전달체계는 치료 중심의 의료 모델로 운영되고 있으며, 정신장애인이 지역사회에서 독립적으로 생활할 수 있도록 지원하는 서비스는 부족한 실정이다. 포괄적인 지역사회 정신건강서비스는 정신장애인의 회복을 촉진할 뿐만 아니라, 고용, 주거, 문화 참여 등 다양한 삶의 영역에서 자립할 수 있도록 돕는 중요한 역할을 한다. 그럼에도 불구하고, 한국의 정신장애인은 국제적으로도 정신건강 의료 이용에 대한 의존도가 높으며, 이는 정신건강서비스 전달체계의 문제를 시사한다. 본 연구는 한국의 정신장애인의 의료이용 수준이 지역사회 정신건강서비스의 한계와 밀접한 관련이 있을 것이라는 가설을 검증하고자 하였다. 의료이용 수준은 정신건강의학과 입원 일수, 외래 방문 빈도, 외래 서비스 이용 여부를 주요 지표로 설정하여 분석하였다. 본 연구는 국민건강보험공단(NHIS)의 개인 수준 자료와 통계청(KOSIS)의 지역 수준 변수를 통합하여, 지역사회 정신건강서비스가 정신장애인의 정신건강 의료이용에 미치는 영향을 분석하였다. 계층적 자료 구조를 반영하기 위해 계층적 선형 모형(HLM)을 적용하였으며, 개인 수준에서는 인구학적 특성과 건강 상태 변수를, 지역 수준에서는 지역사회 정신건강서비스 변수를 포함하여 분석하였다. 또한, 본 연구는 Andersen의 의료 이용 모델을 확장하여 지역사회 정신건강서비스가 정신건강 의료이용에서 대안적 또는 보완적 역할을 수행하는지를 탐색하였다. 개인 수준에서 소인 요인으로 성별과 연령, 가능 요인으로 소득과 의료급여 수급 여부, 필요 요인으로 동반질환 개수를 포함하였다. 지역 수준에서는 각 지역 인구의 평균 연령을 소인 요인으로, 재정 자립도, 정신건강의학과 병원 및 의원 수, 정신요양시설 수, 사례 관리사 수, 1인당 정신건강 예산을 가능 요인으로 포함하였다. 필요 요인으로는 등록된 정신장애인 수를 반영하였다. 나아가 정신재활시설과 정신건강복지센터와 같은 지역사회 정신건강서비스가 정신건강 의료이용에서 대안적 혹은 보완적 역할을 수행하는지를 검증하고자 하였다. 본 연구는 다음의 세 가지 주제를 중심으로 구성되었다. 첫째, 지역사회 정신건강서비스 수준이 입원 일수에 미치는 영향을 분석한 결과, 지역 수준에서는 정신건강의학과 병원과 정신요양시설 수가 많을수록 입원 기간이 길어지는 경향을 보였다. 반면, 정신재활시설이 많은 지역에서는 입원 기간이 짧아지는 것으로 나타났다. 개인 수준에서는 성별, 연령, 의료급여 수급 여부, 동반질환 개수가 입원 일수에 유의미한 영향을 미쳤으며, 남성과 고령자의 입원 기간이 길어지는 경향을 보였고, 동반질환이 많은 개인 역시 입원 기간이 더 길었다. 둘째, 지역사회 정신건강서비스가 외래 방문 빈도에 미치는 영향을 분석한 결과, 지역 수준에서는 평균 연령이 낮고 정신요양시설과 사례 관리사 수가 적으며, 1인당 정신건강 예산이 높은 지역에서 외래 방문 빈도가 증가하였다. 또한, 정신재활시설과 정신건강복지센터가 적은 지역에서 외래 방문 빈도가 증가하여, 이러한 서비스가 정신건강의학과 외래 서비스 이용을 대체할 가능성을 보여주었다. 개인 수준에서는 성별, 연령, 의료급여 수급 여부, 동반질환 개수가 외래 방문 빈도에 유의미한 영향을 미쳤으며, 여성이 남성보다, 의료급여 수급자가 비수급자보다 더 자주 방문하였다. 또한, 연령이 낮을수록, 동반질환 개수가 많을수록 외래 방문 빈도가 높았다. 셋째, 지역사회 정신건강서비스 수준이 외래 서비스 이용 여부에 미치는 영향을 분석한 결과, 지역 수준에서는 평균 연령이 낮고 정신요양시설이 적으며, 등록된 정신장애인 수가 많은 지역에서 외래 서비스 이용 가능성이 증가하였다. 또한, 정신재활시설과 정신건강복지센터가 많은 지역에서 외래 서비스 이용 가능성이 유의미하게 증가하여, 해당 서비스가 정신건강의학과 외래 치료를 보완하는 역할을 하고 있음을 보여주었다. 개인 수준에서는 여성이 남성보다 외래 서비스를 더 많이 이용하였으며, 연령이 높을수록 외래 서비스 이용 가능성이 낮았다. 의료급여 수급자는 외래 서비스 이용 가능성이 높았고, 동반질환 개수가 적은 개인이 외래 서비스를 더 자주 이용하였다. 본 연구 결과, 정신재활시설을 중심으로 한 지역사회 정신건강서비스의 확충은 정신건강의학과 입원 일수를 감소시켜 입원 치료의 대안으로 기능할 수 있음을 시사한다. 또한, 정신재활시설과 정신건강복지센터는 정신건강의학과 외래 진료 빈도를 줄이는 데 기여하여, 기존 정신건강 의료서비스의 대안적 역할을 수행할 수 있음을 보여준다. 마지막으로, 정신재활시설과 정신건강복지센터는 정신건강의학과 외래 이용 가능성을 증가시켜, 의료서비스의 보완적 역할을 수행하는 데 중요한 역할을 할 수 있음을 시사한다. 즉, 정신재활시설과 정신건강복지센터는 외래 이용 빈도를 낮추면서도 서비스 접근성을 향상시켜 정신건강서비스의 효율성을 높이는 데 기여하며, 기존 의료서비스의 대안적 역할과 보완적 역할을 동시에 수행할 수 있음을 나타낸다. 따라서, 지역사회 정신건강서비스의 강화는 정신건강 관리의 접근성과 효율성을 향상시키고, 기존의 정신건강의학과 입원 및 외래 치료에 대한 의존도를 줄이는 데 기여할 수 있다. 정신재활시설과 정신건강복지센터는 정신건강의학과 서비스 과잉 이용을 완화하는 대안적 역할과 지속적인 돌봄을 촉진하는 보완적 역할을 동시에 수행한다. 본 연구는 다양한 정신건강 욕구를 충족시키는 동시에, 정신건강서비스 전달체계 전반의 균형 잡힌 운영을 위해 지역사회 정신건강서비스의 적정 수준 확보가 중요하다는 점을 시사한다. For true recovery of individuals with psychiatric disabilities, access to community-based rehabilitation services tailored to their needs is essential, along with psychiatric healthcare utilization. However, South Korea’s mental health service delivery system remains treatment-centered, providing insufficient support for rehabilitation and community reintegration services that would help individuals with psychiatric disabilities live independently. Comprehensive community mental health services not only foster recovery of individuals with psychiatric disabilities but also play a crucial role in supporting their independence in various aspects of life, such as employment, housing, and cultural participation. Despite the importance of community mental health services, individuals with psychiatric disabilities in South Korea exhibit exceptionally high reliance on mental health medical services, raising concerns about potential issues within the mental health care delivery system. This study hypothesizes that the high utilization of psychiatric healthcare in South Korea is closely linked to the limitations of community mental health services. To investigate this, healthcare utilization was measured using indicators such as the number of psychiatric inpatient days, outpatient visits, and whether individuals accessed outpatient care. This study integrates individual-level data from the National Health Insurance Service (NHIS) with regional-level variables from the Korean Statistical Information Service (KOSIS) to analyze the impact of community mental health services on psychiatric service utilization. A hierarchical linear model (HLM) was employed to examine demographic and health status variables at the individual level, alongside community mental health services at the regional level within a hierarchical data structure. Additionally, this study incorporates Andersen’s healthcare utilization model to explore how multilevel factors, including alternative and complementary community mental health services, influence psychiatric service use. Specifically, at the individual level, predisposing factors include gender and age, while enabling factors encompass income and the current status of receiving medical aid. Need factors are represented by the number of comorbidities. At the contextual level, which considers provincial characteristics, predisposing factors include the average age of the population within each province. Enabling factors cover the financial autonomy rate, the number of psychiatric hospitals, clinics, and mental health sanatoriums, as well as the availability of case managers and the mental health budget per capita. Need factors are reflected by the number of registered individuals with psychiatric disabilities. Lastly, this study expands on Andersen’s healthcare utilization model by exploring the role of potential alternative or complementary community mental health services, such as mental health rehabilitation facilities and primary mental health welfare centers. Including raw numbers of facilities and personnel in the analysis may directly reflect regional scale differences, so all relevant regional-level variables were standardized to address these disparities. The study is organized around three main topics. First, the study examines how inpatient days vary depending on the level of community mental health services. At the regional level, areas with a higher number of psychiatric hospitals and mental health sanatoriums had longer inpatient stays. Regions with a higher number of mental health rehabilitation facilities experienced shorter inpatient days. At the individual level, factors such as gender, age, medical aid status, and the number of comorbidities significantly influenced inpatient days, with men and older adults showing a tendency for longer hospital stays. Individuals with more comorbidities also experienced longer inpatient stays. Second, the study investigates the impact of community mental health services on the number of outpatient visits. At the regional level, the number of outpatient visits increased in regions with a lower average age, fewer mental health sanatoriums, fewer case managers, and higher mental health budgets per capita. In the context of community mental health services, regions with fewer mental health rehabilitation facilities and primary mental health welfare centers showed higher numbers of outpatient visits, highlighting the potential alternative role of community services in psychiatric outpatient utilization. At the individual level, gender, age, medical aid status, and the number of comorbidities had significant effects. Women and medical aid recipients had a higher number of outpatient visits. Younger individuals visited more frequently, and those with more comorbidities also had an increased number of outpatient visits. Third, the study explores factors influencing the utilization of outpatient services based on community mental health service levels. At the regional level, a lower average age and fewer mental health sanatoriums increased the likelihood of outpatient service experience, as did a higher number of registered individuals with psychiatric disabilities. Areas with a greater number of mental health rehabilitation facilities and primary mental health welfare centers demonstrated a significantly higher likelihood of outpatient service utilization, indicating that community mental health services function as a complement to psychiatric outpatient care. At the individual level, women were more likely than men to utilize outpatient services, while older adults were less likely to utilize outpatient services. Medical aid recipients had a significantly higher likelihood of utilizing outpatient services, and individuals with fewer comorbidities were more likely to use outpatient services. These findings indicate that the expansion of community mental health services, particularly mental health rehabilitation facilities, plays a crucial role in reducing psychiatric inpatient days, suggesting that these facilities can function as an alternative to inpatient psychiatric care. Additionally, both mental health rehabilitation facilities and mental health welfare centers contribute to lowering the frequency of psychiatric outpatient visits, underscoring their potential as alternatives to traditional psychiatric medical services. Furthermore, the increased availability of these facilities is associated with improved access to outpatient psychiatric care, emphasizing their complementary role in the mental health service system. In other words, while these facilities reduce the frequency of outpatient visits, they simultaneously enhance service accessibility, improving the overall efficiency of mental health services. This suggests that psychiatric rehabilitation facilities and mental health welfare centers serve both an alternative and complementary function within the existing mental health service system. Strengthening community mental health services can enhance the overall accessibility and efficiency of mental health care, reducing reliance on traditional psychiatric inpatient and outpatient services. Mental health rehabilitation facilities and welfare centers play a dual role, acting both as alternatives to reduce excessive psychiatric service use and as complements to improve the continuity of care. These findings underscore the importance of balancing the availability of community services to address diverse mental health needs while supporting the broader mental health care system.

Relationship between Stroke, Disability and Mental Distress of Productive Ages Population in East Borneo (Based on Indonesia Basic Health Research 2013)

한나 코이릴 서울대학교 대학원 2020 국내석사

Background: Stroke is the major cause of death in many countries. Stroke prevalence in Indonesia increased from 7% in 2013 to 10.9% in 2018. The highest prevalence of stroke in Indonesia, East Borneo province, increased 2 times from 7% to 14% in 5 years. Depression and anxiety also become the most common emotional disturbances after stroke. Post-stroke depression (PSD) is highly prevalent among stroke survivors and is associated with significant morbidity and mortality. This study was population-based study as there has been a little research about this topic and they mainly used hospital-based study design. Objectives: The general objective of this study was to know the correlation between post-stroke disability and mental distress at productive age (15 – 64 years) in East Borneo. Some specific objectives are to know whether severity level of disability has association with mental distress, whether stroke has association with the severity level of disability, whether stroke with disability synergistically increased the chance of having mental distress and whether other individual characteristics such as gender, employment status, age group, education level, marital status associated with mental distress. Methods: Data was taken from the Basic Health Research Survey in 2013 with a total sample of 15277 people. Variables in this research were independent variables including disability level, stroke status and individual characteristics such as gender, age group, employment status, education level, and marital status. The dependent variable was the mental distress status. The data were analysed using univariate analysis to describe each variable with the frequency and percentage distribution and using spearman correlation and logistic regression to see the relationship between the 2 variables. The software used in this analysis process was SPSS and R software Results: Disability level had enough correlation with mental distress. People with high disability level were more likely to develop mental distress. While education level, gender, employment status, marital status, age group and stroke have weak correlation with mental distress. Based on logistic regression results, being female, older, married, having stroke, having high disability by stroke and having no education background significantly increases the risk of having mental distress (p-value <0.05). On the other hand, being stroke-high disabled and unemployed were not significantly increase the risk of having mental distress (p-value > 0.05). Diagnosed as stroke also correlated with having more severe disability. Being stroke significantly increase the risk of having more severe disability (p-value <0.05). Conclusion: As most of stroke and disabled people living in East Borneo are in their peak of productive ages and have significant tendency of having mental distress, it would be better if government did some intervention such as early screening for mental distress and providing some training to live their life without feeling burdensome to people around them. Keywords: Stroke, Disability, Mental distress, Women 배경 : 뇌졸중은 많은 국가에서 주요 사망 원인이다. 인도네시아의 뇌졸중 유병률은 2013 년 7 %에서 2018 년 10.9 %로 증가했다. 인도네시아 보르네오 주에서 가장 높은 뇌졸중 유병률은 5 년 동안 7 %에서 14 %로 2 배 증가했다. 우울증과 불안은 뇌졸중 후 가장 흔한 정서적 장애가 된다. 뇌졸중 후 우울증 (PSD)은 뇌졸중 생존자들 사이에서 널리 퍼져 있으며 상당한 이환율 및 사망률과 관련이 있다. 이 연구는 주제에 대해 인구 기반 조사를 이용한 연구이다. 목표 :이 연구의 일반적인 목표는 이스트 보르네오의 생산 연령 (15 – 64 세)에서 뇌졸중 후 장애와 정신건강문제 사이의 상관 관계를 파악하는 것이 있다. 주체적인 목표는 중증 장애 수준이 정신건강문제과 관련이 있는지, 뇌졸중이 중증 장애 수준과 관련이 있는지, 장애가 있는 뇌졸중이 정신건강문제를 가질 가능성을 증가시키고 성별, 고용 상태, 연령과 같은 기타 개인 특성과의 연관성이 있는지 착안하고자 한다 방법 : 이 연구는 2013년 인도네시아 기초 건강 조사에 참여한 총 15227 명의 자료를 분석하였다. 이 연구의 변수는 장애 수준, 뇌졸중 상태 및 성별, 연령 그룹, 고용 상태, 교육 수준 및 결혼 상태와 같은 개인 특성을 포함한 변수이다. 종속 변수는 정신 문제 상태였다. 정신건강문제의 측정은 SRQ-20 설문을 이용하여 유무로 정의하였고, 장애의 측정은 WHODAS-12 도구를 이용하여 장애 정도를 4수준으로 범주화하였다. 데이터는 일 변량 분석을 사용하여 빈도 및 백분율 분포를 갖는 각 변수를 설명하고 스피어맨 상관 및 로지스틱 회귀를 사용하여 두 변수 간의 관계를 확인하였다. 이 분석에 사용 된 소프트웨어는 SPSS 및 R 소프트웨어이다. 결과 : 장애 수준은 정신건강문제과 관련이 있었다. 장애 수준이 높은 사람들은 정신건강문제를 겪을 가능성이 더 컸다. 교육 수준, 성별, 결혼 여부, 연령 그룹 및 뇌졸중은 정신건강문제의 상관 관계가 약한 반면, 고용 상태는 거의 상관 관계가 없었다. 로지스틱 회귀 분석 결과에 따르면, 여성, 노인, 결혼, 취업, 뇌졸중, 뇌졸중으로 인한 장애가 많고 교육 배경이 없는 경우 정신건강문제가 발생할 위험이 크게 증가한다 (p- 값 <0.05). 반면에, 뇌졸중에 의해 장애가 있다고 해서 정신건강문제의 위험이 크게 증가하지는 않는다 (p- 값> 0.05). 뇌졸중은 또한 더 심각한 장애를 갖는 것으로 나타났다. 뇌졸중이되면 더 심각한 장애가 발생할 위험이 상당히 높아진다 (p- 값 <0.05). 결론 : 이스트 보르네오에 거주하는 대부분의 뇌졸중 및 장애인은 생산성이 가장 높은시기에 정신건강문제를 겪는 경향이 있으므로 정부가 정신건강문제를 조기에 선별하고 훈련을 제공하는 등의 개입을하는 것이 필요하다. 키워드 : 뇌졸중, 장애, 정신건강문제, 여자들

A Study on the Influence of Family Capital on the Mental Health of People With Disabilities : Focusing on the Mediating Effect of Psychological Capital and Interpersonal Skills

양범 우석대학교 일반대학원 2022 국내박사

중국 인구조사 동향 예측에 따르면, 장애인 인구는 계속 늘어날 것으로 전망하고 있다. 취약한 집단인 장애인의 생존은 정치, 경제를 포함하여 사회 안전망에도 영향을 주기 때문에, 장애인의 삶의 질과 심리적건강의 개선은 중국의 시급한 사회문제가 되고 있다. 본 연구는 가족자본이 상대적으로 열악한 장애인을 대상으로 심리적자본과 대인관계기술이 장애인의 심리적 건강에 미치는 영향을 규명하여 장애인의 심리적건강과 심리적자본과 대인관계기술을 개선하기 위한 실천적, 정책적 제언을 목적으로 한다. 이러한 연구목적을 달성하기 위해 본 연구의 연구 문제는 다음과 같다. 첫째, 중국장애인의 가족자본, 심리적자본, 대인관계기술, 심리적건강은 어떠한가? 둘째, 중국장애인의 가족자본이 심리적건강에 미치는 영향은 어떠한가? 셋째, 중국장애인의 가족자본이 심리적자본과 대인관계기술에 미치는 영향은 어떠한가? 넷째, 심리적자본과 대인관계기술이 중국장애인의 심리적건강에 미치는 영향은 어떠하가? 다섯째, 심리적자본과 대인관계기술이 중국장애인의 가족자본과 심리적건강 사이에 미치는 매개효과는 어떠한가? 본 연구는 중국 산둥성 장애인을 대상으로 진행하였다. 본 연구의 목적에 맞는 총 353개의 유효한 설문지를 수집·분석하였다. 본 설문지는 장애인 관련 기관의 방문을 통하여 설문지를 수집하였다. 분석방법은 SPSS 24.0을 사용하여 수집된 자료에 대한 기술통계분석, 신뢰도 분석, 차이 분석, 상관관계분석을 진행하였고, AMOS23.0을 사용하여 연구모형과 가설을 검증하고, bootstrap을 통하여 매개 검증을 수행하였다. 본 연구의 연구결과는 다음과 같다 첫째, 가족자본은 장애인의 심리적건강에 직접적인 영향을 미치는 것으로 나타났다. 가족자본이 장애인의 심리적건강에 미치는 직접적인 영향 중 가족경제자본과 가족문화자본은 장애인의 심리적건강에 긍정적인 영향을 미치며, 가족사회자본은 장애인의 심리적건강에 직접적인 영향을 미치지 않는 것으로 나타났다. 둘째, 심리적자본은 가족자본과 장애인의 심리적건강 사이에서 매개 역할을 하는 것으로 나타났다. 가족자본은 심리적자본에 긍정적인 영향을 미치고, 심리적자본은 장애인의 심리적건강에 긍정적인 영향을 미치는 것으로 나타났다. 심리적자본은 가족경제자본과 가족문화자본 그리고 장애인들의 심리적건강 사이의 매개역할 하는 것으로 나타났지만, 심리적자본은 장애인들의 가족사회자본과 심리적건강 사이의 매개자 역할을 하지 않는 것으로 나타났다. 셋째, 대인관계기술은 가족자본과 심리적건강을 매개 역할을 하는 것으로 나타났다. 가족자본은 대인관계기술 의사소통 능력에 긍정적인 영향을 미치고, 대인관계기술은 장애인의 심리적건강에 긍정적인 영향을 미치며, 대인관계기술은 가족자본과 장애인의 심리적건강에 매개역할을 하는 것으로 나타났다. 이러한 연구결과는 다른 선행연구와도 일치한다. 이러한 연구결과를 바탕으로 장애인의 심리적 건강을 개선하기 위하여 다음과 같이 정책적, 실천적 제언하고자 한다. 정책적인 제언으로 첫째, 중국 정부는 장애인들의 위한 특수교육과 조기교육에 주목할 필요가 있다. 정부는 더 많은 장애인들이 특수학교에서 조기교육과 특수교육을 받을 수 있도록 특수학교와 특수학급에 대한 지원을 늘려야 한다. 둘째, 장애인의 사회통합을 위하여 정부는 장애인을 위한 직업재활에 초점을 맞추어 정책을 구현할 필요가 있다. 직업재활과 직업훈련을 통하여 사회에서 살아가는데 필요한 직업을 구할 수 있도록 정책적인 지원이 있어야 한다. 셋째, 장애인의 소득보장을 위하여 장애연금이나 급여를 도입할 필요가 있다. 정부는 장애인의 가족복지를 개선하고, 장애인의 삶의 질을 향상하기 위하여 최저생활비와 의료비를 포함한 장애급여나 연금을 제공할 필요가 있다. 넷째, 정부, 가족, 전문가 등의 지원과 협조를 통해 가족의 관심을 바탕으로 한 심리적 문제에 대한 예방체계를 구축하고 심리적문제에 대한 정부지원을 확대할 필요가 있다. 실천적 제언으로 첫째, 장애인을 위한 전문가들은 장애인의 정신건강에 적극적으로 관심을 가지고 관련 기관과의 자원조정을 할 필요가 있다. 전문가를 통하여 심리특강, 자조모임, 심리활동으로 장애인의 심리적자본과 대인관계기술을 향상시켜 장애인의 심리적 고통을 경감할 필요가 있다. 둘째, 장애가 있는 가정은 가족 내 사회 자본과 가족 외 사회 자본을 개선하기 위하여 긍정적이고 수용적인 분위기를 조성하도록 전문가와 관련 기관이 지원할 필요가 있다. 셋째, 가족 구성원들은 장애인과 더 많이 소통하고, 사회 활동에 참여하도록 지원하고, 대인관계기술이 향상될 수 있도록 사람들과 교류를 적극적으로 격려해야 한다. 본 연구와 관련하여 학문적인 제언은 첫째, 지역의 특성을 고려하여 연구를 진행할 필요가 있다. 둘째, 양적연구를 보완하기 위하여 장애인을 인터뷰하거나 대표적인 사례를 선정하여 연구를 할 필요가 있다. 셋째, 본 연구를 토대로 연구범위를 확대하여 장애인의 심리적 건강에 미치는 다양한 요인을 고려할 필요가 있다. According to the Chinese census forecast, the disabled population is expected to increase. Since the survival of people with disabilities, a vulnerable group affects the social safety net, including politics and economy, the improvement of the quality of life and psychological health of the people with disabilities has become an urgent social problem in China. This study aims to make practical and policy suggestions to improve the mental health, psychological capital, and interpersonal skills of the people with disabilities by investigating the effect of psychological capital and interpersonal skills on the psychological health of the people with disabilities. In order to achieve this research purpose, the research problems of this study are as follows. First, what is the family capital, psychological capital, interpersonal skills, and mental health of the people with disabilities in China? Second, what is the effect of the family capital of the people with disabilities in China on mental health? Third, what is the effect of the family capital of the people with disabilities in China on psychological capital and interpersonal skills? Fourth, what is the effect of psychological capital and interpersonal skills on the mental health of the people with disabilities in China? Fifth, what is the mediating effect of psychological capital and interpersonal skills on the family capital and mental health of the people with disabilities in China? This study was conducted on the people with disabilities in Shandong Province, China. 353 valid questionnaires suitable for this study were collected and analyzed. This questionnaire was collected through visits to institutions related to the people with disabilities. As for the analysis method, descriptive statistics analysis, reliability analysis, difference analysis, and correlation analysis were conducted on the collected data using SPSS 24.0, and research models and hypotheses were verified using AMOS23.0 and mediated through bootstrap. The research results of this study are as follows. First, it was found that family capital directly affected the mental health of the people with disabilities. Among the direct effects of family capital on the mental health of the people with disabilities, it was found that family economic capital and family cultural capital had a positive effect on the mental health of the people with disabilities, and family social capital did not directly affect the mental health of the people with disabilities. Second, psychological capital was found to play a mediating role between family capital and the mental health of the people with disabilities. It was found that family capital had a positive effect on psychological capital, and psychological capital had a positive effect on the mental health of the people with disabilities. Psychological capital was found to play a mediating role between the family economic capital, family cultural capital, and the mental health of the people with disabilities, but psychological capital did not play a mediating role between family social capital and the mental health of the people with disabilities. Third, it was found that interpersonal skills plays a mediating role between family capital and mental health. It was found that family capital had a positive effect on the communication ability of interpersonal skills, interpersonal skills had a positive effect on the psychological health of the people with disabilities, and interpersonal skills played a mediating role in family capital and the mental health of the people with disabilities. These findings are consistent with other previous studies. Based on these research results, to improve the mental health of the people with disabilities, I would like to make policy and practical suggestions as follows. As policy suggestions: First, the Chinese government needs to pay attention to special education and early education for the disabled. The government should increase support for special schools and special classes so that more people with disabilities can receive early education and special education in special schools. Second, for the social integration of the people with disabilities, the government needs to implement policies focusing on vocational rehabilitation for the disabled. There should be policy support to find a job necessary to live in society through vocational rehabilitation and vocational training. Third, it is necessary to introduce a disability pension or salary to guarantee the income of the disabled. The government needs to provide disability benefits or pensions, including minimum living expenses and medical expenses, to improve the family welfare of the disabled and the quality of life of the people with disabilities. Fourth, it is necessary to establish a prevention system for psychological problems based on family interest and expand government support for psychological problems through support and cooperation from the government, family, and experts. As practical suggestions: First, experts for the people with disabilities need to be actively interested in the mental health of the people with disabilities and coordinate resources with related organizations. It is necessary to alleviate the psychological pain of the people with disabilities by improving the psychological capital and interpersonal skills of the disabled through special lectures, self-help meetings, and psychological activities through experts. Second, families with disabilities need to be supported by experts and related organizations to create a positive and receptive atmosphere to improve social capital within the family and social capital outside the family. Third, family members should actively encourage exchanges with people to communicate more with the people with disabilities, participate in social activities, and improve interpersonal skills. Academic suggestions regarding this study are: First, it is necessary to research in consideration of regional characteristics. Second, to supplement quantitative research, it is necessary to interview the people with disabilities or exceptional representative cases for research. Third, it is necessary to consider various factors affecting the mental health of the people with disabilities by expanding the scope of research based on this study.

장애인 대상 한의 방문진료사업의 정신건강 개선 효과에 대한 연구 : 뇌병변장애 및 지체장애를 중심으로

고원준 상지대학교 일반대학원 2022 국내박사

최근 코로나19의 장기화로 인한 문제는 보건의료 뿐만 아니라 사회 전반적으로 많은 영향을 끼치고 있다. 그로인해 국민들중에는 우울, 걱정, 불안, 무기력감, 울분등 부정적인 감정을 느끼는 비율이 늘어나고 이는 장애인을 비롯한 취약계층에서 뚜렷하게 나타나는 특성이 있다. 장애인에 대한 의료접근성 및 건강형평성 제고 방안으로 시행된 한의약 방문진료는 한의학적 치료 술기를 통해 대상자의 정신건강, 소화기계, 근골격계 등 다양한 영역의 개선을 목표로 시행되고 있다. 지체장애인 및 뇌병변장애자가 호소하는 정신관련 증상개선의 목적으로 3개월간의 침, 전침, 전자뜸, 한약제제로 구성된 한의약 방문 진료를 시행하였다. 침치료의 경우 풍지(GB20), 족삼리(ST36), 사신총(EX-HN1), 합곡(LI4), 곡지(LI11), 절골(GB39), 태계(KI3)를 전침치료의 경우 신문(HT7)과 내관(PC6)을 전자뜸의 경우 삼음교(SP6)와 견정(GB21)을 선정하여 시술하였다.  3개월간의 한의약 방문 진료를 마친후 주요평가지표인 PHQ-9, K-CES-D, BDI가 유의하게 감소되었으며 이차평가지표인 EQ-VAS와 VAS 모두 유의하게 개선되었다. 대상자의 만족도와 의견에서 프로그램의 구성, 대상자의 건강인식 및 관리능력, 증상 예방, 건강향상, 추후 참여 여부, 주변인 추천 여부등 여러 항목 에서 높은 만족도를 보였다.  이에따라 장애인 대상자들에게 이루어진 한의약 방문진료의 정신건강의 증진 성과를 보고하고자 한다. Recently, the problems caused by the prolonged COVID-19 have a lot of impact not only on health care, but also on politics, society, and economy. As a result, the proportion of people experiencing various negative emotions such as anxiety, worry, depression, resentment, stress, and helplessness is increasing among the people, and this is a characteristic that is evident in the vulnerable groups including the disabled. Accordingly, Korean Medicine visit treatment, which was implemented as a measure to improve medical accessibility and health equity for the disabled, is being implemented with the goal of improving the target's musculoskeletal system, digestive system, and mental health in various areas through korean medical treatment techniques. For the purpose of improving mental symptoms such as stress, anxiety, and depression complained of by people with physical disabilities and brain lesions, a three-month visit to Korean Medicine consisting of acupuncture, electroacupuncture, electronic moxibustion, and herbal medicines was performed. For acupuncture, Pungji(GB20), Joksamri(ST36), Sashinchong (EX-HN1), Hapgok(LI4), Gokji(LI11), Hyeonjong(GB39), Taegye(KI3) are used. For electroacupuncture, Shinmun(HT7) and In the case of electronic moxibustion, the inner tube (PC6) was operated by selecting Sameumgyo(SP6) and Gyeonjeong(GB21). After 3 months of korean medicine visit treatment, the main evaluation indicators PHQ-9, K-CES-D, and BDI were significantly reduced, and both EQ-VAS and VAS, the secondary evaluation indicators, were significantly improved. In the subject's satisfaction and opinion, high satisfaction was shown in various items such as program composition, subject's health awareness and management ability, symptom prevention, health improvement, future participation, and recommendation from people around him. The purpose of this report is to report on the improvement of mental health of korean medicine visit treatment for persons with disabilities.

Exploring Differential Exposure to Adverse Social Determinants of Health for Children with Developmental Disabilities and Their Related Health Outcomes and Resiliency

Lauer, Emily University of Massachusetts Boston ProQuest Disser 2022 해외박사(DDOD)

Children with developmental disabilities have greater exposure to social factors that can adversely affect health, deemed “social determinants of health”, and have poorer health outcomes than children without these disabilities. While health outcomes can be related to the etiology of a child’s disability, recent studies suggest 20-50% of their poorer mental and physical health outcomes are due to adverse social determinants. Due to the nature of developmental disabilities, these children are hypothesized to be more susceptible to adverse social determinants and to have lower innate resilience-related skills and resources. This dissertation examined children with developmental disabilities and their families regarding how they are exposed to social determinants of health across three levels– structural, intermediary, and proximal. It then examined how health-related outcomes were associated with these exposures, how frequently children with developmental disabilities and their families have potential mitigating resources and skills, and whether the presence of these factors changes the association between social determinants and health-related outcomes. I analyzed two years (2018-2019) of data from the U.S. National Survey of Children’s Health. Children with developmental disabilities had greater odds of exposure to adverse social determinants of health across multiple domains, and substantially worse mental and behavioral health outcomes and greater unmet medical needs than children without developmental disabilities. These outcomes were strongly associated with exposures to adverse social determinants of health. While social determinants across all three levels were significantly associated with these adverse outcomes, factors that affect the child’s family stability and function and their relationship with their parents were among those most strongly associated with poor mental and behavioral health outcomes and unmet medical needs in multivariable models. Children with developmental disabilities had significantly lower levels of resilience resources, and these resources were less effective in mitigating the association between adverse social determinants of health and poor mental and behavioral health outcomes and unmet medical needs than for children without developmental disabilities. This study contributes valuable evidence at the national level that may better enable public policy, public health programs and social and health-related service systems in mitigating adverse health outcomes for children with of developmental disabilities.

A Multi-Method Exploration of the Ethical "Grey Areas" in Bullying and Bystander Intervention: Centering the Perspectives of Youth With Specific Learning Disabilities

Manchanda, Sarah University of California, Berkeley ProQuest Disser 2024 해외박사(DDOD)

Youth with disabilities are overrepresented in the bullying dynamic and experience poor mental health and school engagement outcomes associated with this involvement. However, limited existing research has looked at differences in bullying involvement based on disability category, and how youth with disabilities make decisions about bullying involvement and bystander intervention. This multi- method study examined how students with Specific Learning Disabilities (SLD) have engaged in bullying, been impacted by this engagement, and think about bullying involvement. Drawing on quantitative analyses of surveys (N=221) and mixed methods analyses of clinical interviews (N=78), this dissertation research garnered an understanding of how youth with SLD have been involved in bullying and impacted by this involvement. In addition, this dissertation examined how these youth reason and make decisions about cyberbullying involvement and bystander intervention.A person-centered analysis was conducted in order to: 1) elucidate distinct profiles of bullying involvement amongst youth with SLD ; 2) examine if and how demographic characteristics are associated with profile membership; and 3) examine if and how school engagement and mental health outcomes are associated with profile membership. This study revealed four distinct profiles of bullying involvement: Low Involvement profile (low levels of victimization and perpetration), Mildly Involved profile (mild levels of both victimization and perpetration), Moderately/ highly Victimized profile (low levels of perpetration and moderate to high levels of victimization), and Moderately Frequent Bully-Victim profile (moderate to high levels of both victimization and perpetration). The highest percentage of youth (37%) were in Profile 1, or the low involvement group. Participants in this group experienced the lowest levels of victimization and perpetration in comparison to participants in other groups. Profile 2, or the mildly involved group, was the smallest profile in this study with 14% of participants classified in this group. Participants in this group experienced mild levels of both victimization and perpetration in comparison to participants in other profiles. Profile 3, or the moderately/highly victimized group, included 18% of participants in this study. Members of this group reported higher mean scores for victimization than participants in other groups (particularly for verbal and physical victimization). Finally, Profile 4 or the moderately frequent bully-victim profile, was the second largest of the four profiles with 31% of participants classified in this group. Participants in this group experienced higher levels of combined victimization and perpetration than those in other groups.Significant results emerged when analyzing associations between bullying involvement profile and demographic variables as predictors, as well as associations between bullying involvement profiles and school engagement and mental health outcomes. Demographic variable analyses revealed that select demographic variables were associated with some the four bullying involvement profiles. Older participants (grades 6-12) when compared to younger participants (grades 1-5) were more likely to be in the moderate/highly victimized group or profile 3 than in the low involvement bullying group or profile 1. In addition, when compared to White youth, racial minority (non-White) youth were more likely to be in lower bullying involvement groups. Furthermore, youth who identified as LGBTQIA+ were more likely to be in the lower bullying involvement groups than youth who identified as straight. Membership in Profile 2 (mild bullying involvement) and Profile 4 (moderate bully-victim) was significantly and negatively associated with school engagement when compared to Profile 1 (low bullying involvement). In addition, Profile 3 (moderately/highly victimized) showed a negative trend that approached statistical significance. Results showed more positive associations between membership in Profiles2, 3, and 4 than Profile 1 for internalizing symptoms. Additionally, results found more positive associations between membership in Profiles2 and 4 than Profile 1 for externalizing symptoms.). Taken together, these results highlight the negative effects on school engagement and increased rates of internalizing and externalizing symptoms associated with bullying involvement (particularly the combination of perpetration and victimization noted in profiles 2 and 4).A mixed methods analysis was employed drawing on Social Domain Theory in order to understand how youth with SLD evaluated and justified their evaluations of cyberbullying and bystander intervention in hypothetical situations. As anticipated, the majority of participants evaluated cyberbullying as unacceptable across all four situations. Participants had more negative evaluations of cyber harm when directed at a victim with a disability as compared to a victim without a disability. In addition, participants had more positive evaluations, or felt cyber harm was more understandable or acceptable, when the harm took place as an act of retaliation or within the context of a friendship than in unprovoked situations and between a transgressor and victim who are not friends. Although there were no significant age or gender differences in general evaluations of each situation, there were significant age and gender differences in response to the retaliation and friendship counter probes. Younger participants (7-10-year-old) had more negative evaluations of cyberbullying in response to counter probes about whether the act of cyberbullying was an act of retaliation than did older adolescent participants (15-18-year-old). These age differences were also observed in how younger participants (7-10-year-old) evaluated cyberbullying between friends in the science classroom significantly more negatively than did older adolescents (15-18-year-old). With regard to gender differences, in the zoom conversation situation, female participants had significantly more negative evaluations of cyberbullying between friends than did males. Although age and gender differences were observed, these differences were more significant in response to contextual features. Specifically, these results highlight the ways in which participants considered the disability of a victim, interpersonal ties between a transgressor and victim, and the intention of these acts of harm in evaluating the acceptability of these actions.With regard to how youth with SLD evaluated and justified these evaluations of bystander intervention in cyberbullying situations, there were some differences between youth with low and moderate to high levels of bullying involvement. When compared to the low involvement bullying group, a higher percentage of participants in the mild to high involvement group endorsed supporting the victim and a passive response, and a lower percentage endorsed telling an authority figure in most situations. Participants who drew on moral justifications were more likely to endorse a bystander intervention that involved supporting the victim whereas those who drew on non-moral justifications (i.e., personal or social conventional) were more likely to endorse intervening by telling an authority figure. These findings highlight the associations between how participants conceptualize the bystander intervention (i.e., as a moral or non-moral action) and the specific actions participants endorsed in response to witnessing acts of cyberbullying. In addition, these findings suggest that there is a connection between prior experiences of bullying and bystander intervention decision making.This study's findings have several implications. One, youth with SLD were involved in varying frequencies and forms of bullying as defined by the four bullying involvement groups, and the frequency of bullying involvement was significantly associated with both school engagement and mental health outcomes. Specifically, students who were involved in perpetrating bullying and also victimized were at highest risk of negative school engagement and mental health outcomes. This finding highlights the need to tailor interventions to students based on the specific forms and frequency of bullying involvement. Two, youth with SLD reasoned with more complexity (i.e., had mixed evaluations or found cyberbullying acceptable) in situations that involved retaliatory action or cyberbullying that took place between friends than in general contexts of cyberbullying. This finding underscores the need for developing intervention practices that explore these considerations and involve youth in the process of studying other factors that are relevant in evaluating situations of cyberbullying. Finally, the majority of youth in this study endorsed responding to cyberbullying situations by taking actions to support the victim. Some developmental differences were noted in these evaluations in addition to differences based on profile of bullying involvement. In addition, participants were most likely to draw on moral considerations in endorsing a response of supporting the victim. These findings suggest that future interventions should center youths' perspectives, involve authority figures such as teachers and parents, and involve a component of building skills and competence in the particularities of bystander intervention online.

정신지체아동의 심리분석과 미술치료 : 사례 연구를 중심으로

황인정 성신여자대학교 교육대학원 2003 국내석사

정신지체는 유전적 원인에 의해 또는 질병 및 뇌장애로 인하여 청소년기 전에 야기된 정신발달 저지 또는 지체 상태를 말한다. 정신지체의 원인은 매우 복잡하여 사람마다 다르므로 꼭 꼬집어서 무엇이 원인이라고 말하기는 힘들다. 어떤 학자는 밝혀진 정신지체의 원인만 해도 200여 가지나 된다고 보고하고 있다. 그러나 원인을 크게 나누면 유전적인 요소와 출생 후의 환경적인 요소로 나눌 수 있는데, 경우에 따라서는 이 두 가지가 복합적으로 섞여 있는 경우도 많다. 이러한 정신지체아동은 특히 의사소통과 대인관계에 큰 문제를 가지고 있어서 그들의 정신세계와 의식을 이해하기란 매우 어렵다. 이런 점에서 내면세계가 가장 많이 표출되어지는 그림을 통해 그들의 정신세계를 분석해 보는 것은 그들의 심리 이해와 내면세계를 꿰뚫어 볼 수 있는 좋은 방법이라 할 수 있다. 본 연구는 2002년 5월부터 2003년 5월까지 경기도에 소재한 S선교단체의 도움을 받아 19명의 정신지체아동이 그린 500여점의 그림을 수집하여 3단계로 나누어 주조색과 내용의 두 가지 측면에서 분석하여 심리적 특성을 상징적으로 알아보고, 그림 변화에 따른 사회적 행동 발달을 제시함으로서 묘화 활동에 의한 임상적 효과를 밝히고자 하는 것이다. 연구한 결과 다음과 같은 결론을 얻었다. 첫째, 연구 대상 아동들이 처음 그림을 그렀을 때에 주조색에 있어서 녹색, 파란색, 보라색을 가장 많이 사용하였고, 이에 따른 심리적 의미는 내향적, 자기 억제성, 감정 표현의 결여, 억제된 불안성, 질병, 친구로부터 고립감이었다. 둘째, 연구 대상 아동들이 처음 그림을 그렸을 때에 표현한 내용은 무엇인지 알 수 없는 낙서그림(23.9%), 물고기그림(15%), 짐승그림(13.3%) 등의 순서로 그림의 대부분을 차지했고, 사람그림은 5.5%로 드물었으며, 여러 사람을 그리지 않고 1~2명 정도의 사람만을 표현하였다. 이 특징에서 정신지체아동은 대인관계 형성 결핍으로 인해 사람을 거의 그리지 않는다고 볼 수 있다. 셋째, 연구 대상 아동들의 그림 변화에 있어서 주조색의 고른 분포, 인물 표현은 미술교육이 정신지체아동의 전반적인 정신발달에 도움을 준다고 생각된다. 넷째, 그림은 대인관계, 언어, 환경 변화에 장애를 가지고 있는 정신지체 아동을 관찰하고 이해하는데 중요한 매체라 할 수 있다. 다섯째, 미술이 지니는 활동성과 흥미도는 사회적 접촉이 어려운 정신지체아동들과 연구자간의 신뢰적인 관계를 형성하는데 도움을 주며, 미술 활동은 연구 대상 아동들이 세상 밖으로 한걸음 나오도록 하는 역할을 함으로써 정신지체아동의 가장 주된 결함인 사회성 결함에 가장 큰 발달을 가져와 대인관계 형성과 언어발달에 큰 도움을 준다고 생각된다. 이와 같은 연구 결과를 통해 본 연구는 정신지체아동을 위한 미술교육이 보다 치료로써의 미술 교육적 접근으로 연구가 이루어지기를 바라고, 무엇보다 정신지체아동을 위한 미술교육 프로그램 개발의 필요성이 인식되기를 바라는 바이다. Mental disability refers a condition when one's mental development has stopped or delayed by a hereditary fact, illness or brain injury before an adolescent period. There are various causes of mental disability, and those causes are different from each people therefore it is hard to say there is a specific cause of mental disability. One scholar actually said there are more than two hundreds causes to be listed. However, it is possible to divide causes into two categories genetic and environmental factors - in some cases, those two factors are all involved. Because children with mental disability have problems with communication and personal relation, it is hard to understand their mind and thoughts. As their mind and thoughts are well expressed by drawing, it is a good way to analyze the drawing to see their psychological and internal state. For the research, more than five hundreds of drawings from May, 2002 to May 2003 were collected. The main purpose of this research is to show the clinical effects on art activity throughout studying psychological aspects by dividing materials into three steps and analyzing these materials with two aspects main color used and content, and suggesting social activity development on changes in drawings. The result of the research is following. First of all, when children with mental disability draw pictures, they mainly used green, blue and purple colors the psychological meaning of those colors will be introversion, self suppression, lack of expressing emotion, restrained anxiety, disease and difficulty on environmental adaptability. Secondly, drawings were about scribbling(23.9%), fish(15%), animals (13.3%). Drawings about people were only 5.5% and also there were one or two people in the pictures. Throughout this result, it is necessary to say retarded children don't usually draw people due to lack of developing personal relationship. Thirdly, changes in wide range of use of main colors and character expression of those children's drawings will help their general psychological development. Fourthly, drawing is an important way to observe and understand mentally disable children with difficulties on personal relation and communication. Lastly, activities and interests on art help to build faithful relationship between researcher and retarded children. And as art activity plays a role for retarded children to take part in the society, it will bring a change on sociality which has been known as the main defect of the those children, and also it will generally help to develop personal relationship and language formation.