응급실에 반복적으로 내원하는 자살시도자의 특성분석

이정연 경희대학교 대학원 2023 국내석사

Backgrounds Since a significant number of suicide attempters presenting to the emergency room are exposed to suicide reattempts without special treatment after discharge from the emergency room, there is a need for appropriate classification and assessment that can predict risk factors for suicide reattempts. This study aimed to analyze the lethality of suicide and violence risk according to the characteristics of suicide attempters with repeated visits to the emergency room. The purpose of this study is to verify the risk factors for repeated suicide attempts including lethality of suicide and violence risk, and to provide fundamental data for the development of future suicide reattempt prediction protocols. Design and Methods A retrospective study design was conducted using electronic medical records. The subjects were selected among 4,322 psychiatric emergency patients who visited the Emergency center of the general hospital in S city from January 1, 2019 to December 31, 2021. A total of 1322 suicide attempters who met the selection criteria were evaluated using the Risk-Rescue Rating Scale and V- RISK-10. A comparative analysis was conducted among adults who presented to the emergency room for suicide attempts during the above period. We compared repeated attempters (n=361) who presented two or more times within a year, and single attempters (n=961) who presented once during the period. The collected data was analyzed by independent t-test, ANOVA, Spearman correlation coefficient and logistic regression analysis using the SPSS 26.0 program. Results Lethality of suicide was higher for males than females (t=-3.85, p<.001), especially for those in their 60s and older (F=11.38, p<.001), and significantly higher for those with no previous psychiatric history (t=3.39, p<.001). The highest suicide lethality was observed for physical illness among suicide motives (F=4.35, p<. 001). Violence risk was higher for males than females (t=-2.48, p=. 014), higher for those on Medicaid than those with NHIS (t= 5.63, p<.001), higher if a family guardian was not secured (t=-5.44, p<.001), and higher if there was a history of past psychiatric treatment (t=-5.73, p<.001). Correlation analysis showed a statistically significant relationship between the lethality of suicide and repeated suicide attempts (r=.070, p=.038). A significant negative relationship was observed between rescue scores and repeated suicide attempts (r=-.057, p=.038). The risk score did not show a significant correlation with repeated attempts. Violence risk showed a statistically significant amount of relationship with repeated suicide attempts (r=.400, p<.001), and did not show a statistically significant correlation with the risk score, the rescue score or the lethality of suicide. The following factors were found to be statistically significant in influencing repeated suicide attempts: lethality of suicide, violence risk, age, insurance status, guardians, past psychiatric history, COVID -19 pandemic, WBC, and Plt. Lethality of suicide was found to significantly increase the possibility of repeated suicide attempts (OR=1.02, 95% CI: 1.01-1.03), and violence risk was found to increase the likelihood of repeated suicide attempts (OR=1.34, 95% CI: 1.28-1.41). Medicaid recipients (OR=1.53, 95%CI: 1.02-2.30) were found to be significant to retry suicide than those with NHIS. Suicide attempters who had no family guardian (OR=1.54, 95%CI: 1.10-2.15) were also significantly more likely to repeat suicide attempts. In case of having history of previous psychiatric treatment (OR=2.62, 95%CI: 1.71-4.02) and before COVID-19(OR=1.47, 95%CI: 1.05-2.06) showed statistically high possibility of repeated attempts. Conclusion The study found that lethality of suicide, violence risk, age, insurance status, guardians, past psychiatric practice history, COVID-19 pandemic, WBC, and Plt were influential factors in repeated suicide attempts. Lethality of suicide and violence risk was found to be associated with a higher risk of repeated suicide attempts, and the risk of repeated suicide attempts was higher if the patient had no family or relative guardian or had a past psychiatric treatment history. A national psychiatric emergency system for follow-up observation and intervention is required to prevent and break the cycle of chronically repeated suicide attempts. It should focus on high-risk groups with risk factors and sustained management.

(The) effect of alcohol use on the characteristics of suicidal behaviors and risk of repetition of suicide attempt

이진희 Graduate School, Yonsei University 2019 국내박사

Suicide is one of the most serious public health problems, according to the World Health Organization report, about one million people die from suicide each year. Suicide is known to occur because of the combined effects of various factors, but numerous studies have reported particular relation with alcohol drinking. Alcohol is used widely worldwide and is known to cause not only various physical diseases but also problems related to impulse control such as violence, self-harm, and suicide. Therefore, this study aimed to outline the transient and prolonged effects of alcohol use patterns on suicide attempters. The participants in this study were suicide attempters who visited Gangwon Western Region Emergency Medical Center during the 6-year period from March 1, 2010, to December 31, 2015. This study obtained the sociodemographic and clinical information of these participants. Through the interview by psychiatrist, the Participants were categorized into following three groups according to alcohol use pattern at the time of the suicide attempt: 1) suicide attempters with neither alcohol use disorder nor acute alcohol consumption (NAU), 2) suicide attempters who had used alcohol during the suicide attempt but did not have alcohol use disorder (AAU), and 3) suicide attempters with alcohol use disorder (AUD). Group comparisons and multivariate Cox proportional models for suicidal behavior were used for statistical analysis. The results showed that patients with AUD attempted suicide with more help seeking behaviors and had higher proportion of low medical lethality compared to not only NAU but also AAU group and AUD was related to higher risk of suicide reattempt compare to other groups and the increased risk was prolonged longer period. The findings of study suggest the impulsive suicide attempts are more strongly associated with AUD than with AAU and AUD was found to increase the risk of repeated suicide attempts. The results highlight the importance of evaluation of alcohol use for suicide attempters regardless of whether they had consumed alcohol at the time of the recent suicide attempt, and need of specific and individualized aftercare programs with suicide attempters with alcohol use disorder for the sufficient duration. 세계보건기구(WHO) 보고서에 따르면 자살은 가장 심각한 공중 보건문제 중 하나이며 매년 약 100 만 명이 자살로 사망하는 것으로 알려졌다. 자살은 여러 가지 요인의 복합 효과로 인해 발생하는 것으로 알려져 있지만, 많은 연구에서 특히 알코올 사용과 밀접한 관계가 있음이 보고되었다. 알코올은 전 세계적으로 널리 사용되고 있으며 다양한 신체적 질병 뿐만 아니라 폭력, 자해, 자살과 같은 충동 조절과 과 관련된 문제를 일으키는 것으로 알려져 있다. 본 연구에서는 자살 시도자의 알코올 사용 패턴의 일시적인 효과와 지속적인 효과에 대하여 개괄적으로 설명하고자 목표하였다. 본 연구는 2010 년 3 월 1 일부터 2015 년 12 월 31 일까지 강원 영서 권역응급센터를 방문한 자살시도자를 대상으로 하였다. 연구자들은 대상자의 사회인구학적 및 임상적 정보를 수집하였고, 정신과 의사의 인터뷰를 통하여 대상자의 자살시도 당시 알코올 사용 유형에 따라서 1)비알코올사용 자살시도자(NAU), 2) 급성알코올사용 자살시도자(AAU), 3)알코올사용장애가 있는 자살시도자 (AUD) 군으로 나누어서 자살행동의 특성 및 자살 재시도 위험을 비교하였다. 분석 결과, 알코올사용장애가 있는 자살시도자는 비알코올사용 자살시도자 및 급성알코올사용 자살시도자와 비교하였을 때, 자살행동의 결과로 낮은 의학적 치명도 비율이 높았고 (각각, NAU 84.2%, AAU 89.5%, AUD 92.0%, p=0.017), 높은 구조 가능도 점수(각각, NAU 11.64±2.17; AAU 11.90±2.23; AUD 12.46±2.05, p<0.001)를 보였다. 그럼에도 불구하고 알코올사용장애가 있는 자살시도자의 향후 자살 재시도의 위험은 비알코올사용 자살시도자군과 비교하였을 때, 60 개월까지 지속적으로 유의하게 증가되어 있는 것으로 관찰되었다(HR 2.96, 95% CI 1.23-7.10). 본 연구 결과, 자살 시도 당시 알코올 사용 여부와 상관없이 알코올사용장애가 있는 자살시도자는 보다 충동적이고 반복적인 자살 시도를 반복한다는 것을 고려할 때, 응급실에 내원한 자살시도자의 알코올사용장애에 대한 면밀한 평가와 충분한 기간의 주의 깊은 관찰 및 관리의 필요성이 강조된다.

Identifying Risk Patterns for Suicide Attempts in Individuals with Diabetes: A Data-Driven Approach Using Lasso Regression and Association Rule Mining

Narindrarangkura, Ploypun University of Missouri - Columbia ProQuest Dissert 2023 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Diabetes is a major health concern in the United States, with 34.2 million Americans affected in 2020. Unfortunately, the risk of suicide is also elevated in individuals with diabetes, with around 90,000 people with diabetes committing suicide each year. People with type 1 diabetes are three to four times more likely to attempt suicide, and those with newly diagnosed type 2 diabetes are twice as likely to attempt suicide compared to the general population. However, poor mental health comorbidity is still neglected, and more recommendations are needed to support for people with diabetes. It is widely acknowledged that the comorbidity of depression with diabetes is considered a higher risk factor for suicide attempts. Previous studies have used logistic regression to identify risk factors for suicide attempts in individuals with diabetes. However, this technique can be prone to overfitting when the number of variables is high. To address this issue, we used the LASSO (Least Absolute Shrinkage and Selection Operator), a regularization technique, to reduce overfitting in a logistic regression model. It works by adding a penalty term (λ) to the log-likelihood function, which shrinks the estimates of the coefficients. This process allows LASSO to act as a feature selection method, effectively setting coefficients that contribute most to the error to zero. Because few studies have focused on understanding the relationship between suicide attempts and diabetes, we used association rule mining (ARM), an explainable rule-based machine learning technique, for knowledge discovery to reveal previously unknown relationships between suicide attempts and diabetes. This approach has already proved useful in the medical field, where it has been applied to electronic health record (EHR) data to discover associations such as disease co-occurrences, drug-disease associations, and symptomatic patterns of disease. However, no previous studies have used ARM to determine risk factors and predict suicide attempts in people with diabetes. The aim of this dissertation is to identify patterns of risk factors for suicide attempts in individuals with diabetes, with the long-term goal of developing a clinical decision support system that can be integrated into EHRs. This system would allow healthcare providers to identify patients with diabetes at high risk of suicide attempts and provide appropriate preventive measures during outpatient clinic visits. To achieve this goal, we have three specific aims: (1) to identify potential risk factors for suicide attempts in individuals with diabetes through a literature review; (2) to investigate risk factors for suicide attempts in individuals with diabetes using LASSO regression; (3) to identify risk patterns for suicide attempts in individuals with diabetes using association rule mining. In this dissertation, we have reviewed the literature and compiled a list of data elements for suicide attempts in people with diabetes. We then retrieved data on patients with diabetes from Cerner Real-World Data™. LASSO regression was used for feature selection, and ARM was used for investigating the risk patterns. We discovered risk patterns that are understandable and practical for healthcare providers. The findings of this research can inform suicide prevention efforts for people with diabetes and contribute to improved mental health outcomes.

Cost-effectiveness of multi-disciplinary emergency consultation system in suicide attempts by drug overdose in adolescent and adult populations

김솔이 중앙대학교 대학원 2021 국내석사

Introduction: The purpose of this study was to compare the characteristics of suicide attempts by drug overdose between adolescents and adults, and evaluate the cost-effectiveness of multi-disciplinary emergency consultation system (MECS) for suicide attempters with drug overdose. Materials and Methods: The effect of the MECS on suicide attempters with drug overdose was verified by comparing and analyzing the 1-year period from June 1, 2017 to May 31, 2018 (before the MECS was implemented; pre-MECS), and the 1-year period from June 1, 2018 to May 31, 2019 (after MECS was implemented; post-MECS). The data were retrospectively reviewed for a total of 251 patients with suicide attempts by drug overdose who visited the emergency room of a university hospital in Seoul during the period. Results: The adolescent group showed more use of painkillers and less of psychoactive drugs as drugs for suicide attempt (p < 0.01), more impulsive attempts than planned ones (p < 0.01), lower levels of sincerity for suicide (p = 0.04), lower levels of suicide fatality (p = 0.02), and less serious suicide attempts (p = 0.02), compared to the adult group. Adolescents in the post-MECS group showed decreased ICU costs (p = 0.01) and decreased 6-month costs (p = 0.02), compared to those in the pre-MECS group. Adolescents, both with serious attempts (p < 0.01) and non-serious attempts (p < 0.01) in the post-MECS group showed decreased ICU costs, compared to those in the pre-MECS group. Adults with non-serious attempts in the post-MECS group showed decreased ICU costs (p < 0.01), compared to those in the pre-MECS group. Conclusion: Difficulty in impulse control and immature decision-making processes in adolescents could make them vulnerable to internal confusion and external influences, often leading to accidental suicides. Quick cooperation of the multidisciplinary department has reduced unnecessary ICU treatments, especially in adolescents and non-serious suicide attempters. 서론: 약제 과다복용으로 자살시도하는 청소년과 성인의 특성에 차이가 있을 것이라 가정하고 다학제간 응급 협진체계(MECS)가 약제 과다복용 자살시도자에서 비용효과적일 것이라 가정했다. 연구 방법: MECS의 약제 과다복용 자살시도자에서의 비용효과를 밝히기 위해 2017년 6월 1일부터 2018년 5월 31일까지의 1년 (pre-MECS)과, 2018년 6월 1일부터 2019년 5월 31일까지 1년(post-MECS)을 비교 분석하였다. 이 기간 동안 서울 소재의 대학병원 응급실을 방문한 약제 과다복용 자살시도자 251명을 대상으로 데이터를 후향적으로 분석하였다. 결과: 청소년군에서 자살 시도 시 성인군에 비해서 더 많은 진통제를 선택했고 정신과적 약제는 덜 선택하는 경향을 보였고(p<0.01), 계획된 자살 시도보다는 충동적 자살 시도가 많았고 (p<0.01), 자살 시도의 진정성이 더 낮았으며(p=0.04), 자살 시도로 인한 의학적 치명도는 낮은 편이었고(p=0.02), 자살 심각도가 더 낮았다(p=0.02)(Table2). post-MECS 청소년은 pre-MECS 청소년에 비해서 ICU 비용은 더 줄어들었고(p=0.01), 6개월 의료 비용 또한 줄어들었다(p=0.02). post-MECS 청소년에서 pre-MECS 청소년에 비해서 심각한 자살시도군(p<0.01), 심각하지 않은 자살시도군(p<0.01) 모두에서 ICU 비용은 줄어들었다. 심각하지 않은 성인 자살시도군의 경우, pre-MECS보다 post-MECS 에서 ICU 비용(p<0.01)은 줄어들었다. 결론: 청소년의 충동 조절 어려움과 결정 과정의 미숙함이 내적 혼란과 외적 영향에 취약하게 만들어 우발적인 자살 시도로 이어졌다. 또한, 다학제간 응급 협진 체계는 불필요한 ICU 치료를 줄였고, 특히 청소년과 심각하지 않은 자살시도자에서 비용 면에서 효과적이었다.

지역사회 환경에 대한 주관적 인식과 자살생각 및 자살시도의 연관성 : 지역지표를 활용한 다수준분석

조계영 연세대학교 보건대학원 2021 국내석사

연구목적 이 연구의 목적은 2017년 지역사회 건강조사 응답자를 2015년 인구주택 총조사를 통해 추출한 지역박탈지수를 연계하여 지역사회 환경의 주관적 인식 및 지역수준에 따른 자살생각 및 자살시도의 연관성을 파악하여 개인의 주관적 환경 만족도 및 지역 사회환경 수준이 자살생각 및 자살시도에서 가지는 의미와 효과적인 자살 예방정책에 기여할 수 있는 기초자료를 제공하고자 한다. 연구대상 및 방법 2017년 지역사회건강조사 모집단 사전분석 결과 228,381건이 조사되었고 각 변수들의 조사항목에서 무응답 및 결측 응답자 46,694명을 제외하였다. 최종적으로 총 181,687명(남성:74,315명, 여성:107,372명) 중 자살생각 분석 대상자로 14,379명, 자살시도 분석 대상자로 546명이 선정되었으며 보건소번호를 매개체로 2015년 통계청 인구주택총조사 자료를 통해 추출한 지역박탈지수를 결합한 자료를 분석에 활용하였다. 자료 분석방법은 지역사회에 대한 주관적 만족도를 사회적 환경, 물리적 환경, 보건의료서비스 환경으로 구분하고, 지역박탈지수(사회적 박탈, 경제적 박탈을 결합, 4분위수)과 함께 자살생각∙자살시도와의 관련성을 파악하고자 하였다. 이때 개인요인과 지역요인을 함께 고려하여 종속변수와 연관성을 파악할 수 있는 다수준 로지스틱 분석(Multilevel analysis)을 통해 분석하였다. 이와 동시에 인구사회학적 요인, 사회경제적 요인 및 건강행태 요인, 지역지표 등 다른 독립변수들은 보정 처리하였다. 연구결과 자살생각 측면에서 사회적 환경 만족도, 물리적 환경 만족도, 보건의료서비스 환경 만족도 및 지역수준의 연관성을 분석하였다. 사회적 환경 만족 대비 불만족 오즈비가 1.272(95% CI:1.210-1.336), 물리적 환경 만족도의 오즈비는 1.196(95% CI:1.074-1.331)로 사회적 환경과 물리적 환경에 불만족할수록 자살생각이 높아지는 경향을 보였으며 통계적으로 유의했다. 독립변수는 남성보다 여성에서, 20대 대비 50대까지 연령이 증가할수록, 가구 월간소득이 작을수록, 교육수준이 낮을수록, 미혼보다 결혼-비동거 또는 이혼에서, 주관적 건강수준이 나쁠수록, 우울증상이 높을수록, 대도시 대비 농촌에서 자살생각이 높았으며 통계적으로 유의했다(P<0.05). 지역수준의 분산이 총 분산에서 차지하는 비율인 ICC는 약 14.9%의 타당성을 가졌다. 자살시도 측면에서는 지역수준에 해당하는 지역박탈지수, 거주지역, 지역 사회복지예산, 지역 보건예산 등의 모든 변수들은 자살시도에서 영향이 통계적으로 유의하지 않았고 개인요인인 사회적 환경 만족도 오즈비는 1.287(1.048-1.579)으로 사회적 환경에 불만족할수록 자살시도가 높아지는 경향을 보였으며 통계적으로 유의했다. 독립변수는 교육수준이 낮을수록, 주관적 건강상태가 나쁠수록, 우울증상이 높을수록 자살시도가 높았고, 수면시간이 증가할수록 자살시도가 낮았으며 통계적으로 유의했다(P<0.05). ICC는 약 22.3%의 타당성을 가졌다. 보건의료서비스 환경과 지역지표에 해당하는 지역박탈지수는 자살생각과 자살시도 모두 연관성이 없다는 것을 알 수 있었다. 이때 개인요인과 지역요인을 함께 고려하여 종속변수와 연관성을 파악할 수 있는 다수준 로지스틱 분석(Multilevel analysis)을 통해 분석하였다. 이와 동시에 인구사회학적 요인, 사회경제적 요인 및 건강행태 요인, 지역지표 등 다른 독립변수들은 보정 처리하였다. 연구결과 자살생각 측면에서 사회적 환경 만족도, 물리적 환경 만족도, 보건의료서비스 환경 만족도 및 지역수준의 연관성을 분석하였다. 사회적 환경 만족 대비 불만족 오즈비가 1.272(95% CI:1.210-1.336), 물리적 환경 만족도의 오즈비는 1.196(95% CI:1.074-1.331)로 사회적 환경과 물리적 환경에 불만족할수록 자살생각이 높아지는 경향을 보였으며 통계적으로 유의했다. 독립변수는 남성보다 여성에서, 20대 대비 50대까지 연령이 증가할수록, 가구 월간소득이 작을수록, 교육수준이 낮을수록, 미혼보다 결혼-비동거 또는 이혼에서, 주관적 건강수준이 나쁠수록, 우울증상이 높을수록, 대도시 대비 농촌에서 자살생각이 높았으며 통계적으로 유의했다(P<0.05). 지역수준의 분산이 총 분산에서 차지하는 비율인 ICC는 약 14.9%의 타당성을 가졌다. 자살시도 측면에서는 지역수준에 해당하는 지역박탈지수, 거주지역, 지역 사회복지예산, 지역 보건예산 등의 모든 변수들은 자살시도에서 영향이 통계적으로 유의하지 않았고 개인요인인 사회적 환경 만족도 오즈비는 1.287(1.048-1.579)으로 사회적 환경에 불만족할수록 자살시도가 높아지는 경향을 보였으며 통계적으로 유의했다. 독립변수는 교육수준이 낮을수록, 주관적 건강상태가 나쁠수록, 우울증상이 높을수록 자살시도가 높았고, 수면시간이 증가할수록 자살시도가 낮았으며 통계적으로 유의했다(P<0.05). ICC는 약 22.3%의 타당성을 가졌다. 보건의료서비스 환경과 지역지표에 해당하는 지역박탈지수는 자살생각과 자살시도 모두 연관성이 없다는 것을 알 수 있었다. 결론 자살은 보건의료적 문제인식을 가지고 정책 분석 및 관리해 나가야할 중요한 사회적 질병이며 다른 질병과 다르게 자살에 이르면 치료가 불가능하기 때문에 자살위험 연구를 통해 예방에 선제적으로 대응해야 한다. 자살생각에서는 지역사회 환경의 주관적 인식에 해당하는 사회적 환경 만족도, 물리적 환경 만족도가 영향을 미쳤으며, 자살시도에서는 사회적 환경 만족도만 연관성이 있는 것으로 나타났다. 사회적 환경 만족도는 자살생각 및 자살시도 모두에 영향을 미치는 요인으로 분석됨에 따라 주목해야할 필요성이 있으며 이를 위해 개인수준의 관계형성을 위한 사회신뢰 지원과 지역 공동체 단위의 사회참여 정책 등 종합적 접근을 통해 사회적 관계망을 강화해 나가야할 것이다. 자살생각에 영향을 끼치는 물리적 환경 만족도와 지역변수인 거주지역에서 대도시 대비 농촌의 자살생각이 높았고 통계적으로 유의하여 이는 개인의 주관적 물리적 환경 인식과 객관적 지역지표에서 동일한 경향이 나타남에 따라 지역사회의 물리적 환경분야는 자살예방정책에서 관심을 갖고 개선을 위해 노력해야 할 요소임이 분명하다. 반면, 보건의료서비스 환경 만족도와 지역수준을 가늠하는 지역박탈지수는 자살생각 및 자살시도와의 연관성이 없는 것을 확인할 수 있었다. 따라서 개인이 주관적으로 인식하는 사회적, 물리적 환경 개선을 중심으로, 향후 지역사회 환경과 관련된 객관적 지표와 특성을 반영한 심층적인 연구분석을 통하여 효율적이고 차별화된 자살예방 보건정책을 수립해 나가야할 것이다. Objective The purpose of this study is to provide basic data on the subjective perception of community environment and the link between suicidal ideation and suicide attempts by linking the 2017 Community Health Survey respondents to the 2015 Population and Housing Survey. Methods The preliminary analysis of the community health survey population in 2017 found 228,381 cases, excluding 46,694 non-response and missing respondents from each of the variables. Finally, 14,379 people were selected for suicidal ideation analysis out of a total of 181,687 people (74,315 men, 107,372 women), and 546 people were analyzed for suicide attempts, and the health center number was used for analysis. The data analysis method categorized the subjective satisfaction with the community into social, physical, and medical service environments, and identified the relationship between suicidal ideation and suicide attempts along with the area deprivation index (social deprivation, economic deprivation, quartile). At this time, we analyzed it through multilevel analysis, which allows us to identify the relationship with dependent variables by considering individual and regional factors together. At the same time, other independent variables, such as demographic factors, socioeconomic factors and health behavior factors, and regional indicators, were corrected. Results In terms of suicidal ideation, we analyzed the relationship between social environmental satisfaction, physical environmental satisfaction, medical service environmental satisfaction, and local level. The unsatisfactory odds ratio compared to social environmental satisfaction was 1.272 (95% CI:1.210-1.336), and the odds ratio of physical environmental satisfaction was 1.196 (95% CI:1.074-1.331), showing a higher tendency to commit suicide. The independent variable was more likely to commit suicide in rural areas compared to large cities (P<0.05), with Methods The preliminary analysis of the community health survey population in 2017 found 228,381 cases, excluding 46,694 non-response and missing respondents from each of the variables. Finally, 14,379 people were selected for suicidal ideation analysis out of a total of 181,687 people (74,315 men, 107,372 women), and 546 people were analyzed for suicide attempts, and the health center number was used for analysis. The data analysis method categorized the subjective satisfaction with the community into social, physical, and medical service environments, and identified the relationship between suicidal ideation and suicide attempts along with the area deprivation index (social deprivation, economic deprivation, quartile). At this time, we analyzed it through multilevel analysis, which allows us to identify the relationship with dependent variables by considering individual and regional factors together. At the same time, other independent variables, such as demographic factors, socioeconomic factors and health behavior factors, and regional indicators, were corrected. Results In terms of suicidal ideation, we analyzed the relationship between social environmental satisfaction, physical environmental satisfaction, medical service environmental satisfaction, and local level. The unsatisfactory odds ratio compared to social environmental satisfaction was 1.272 (95% CI:1.210-1.336), and the odds ratio of physical environmental satisfaction was 1.196 (95% CI:1.074-1.331), showing a higher tendency to commit suicide. The independent variable was more likely to commit suicide in rural areas compared to large cities (P<0.05), with lower monthly household income, lower education, lower marital-non-habitat or divorce, lower subjective health, higher depression and higher age than men (P<0.05). ICC, which accounts for the proportion of regional-level variance in total variance, had a validity of about 14.9%. In terms of suicide attempts, all variables, such as area deprivation index, residential area, local social welfare budget, and local health budget, were statistically insignificant in suicide attempts, and social environmental satisfaction odds was 1.287 (1.048-1.579). The lower the level of education, the worse the subjective health condition, the higher the depression, the higher the suicide attempt, the lower the suicide attempt as the sleep time increased, and the statistically significant (P<0.05). ICC has a validity of about 22.3%. The area deprivation index, which corresponds to the medical service environment and regional indicators, showed that both suicidal ideation and suicide attempts were not related. Conclusion Suicide is an important social disease that needs to be analyzed and managed with health and medical awareness, and unlike other diseases, it cannot be treated if it reaches suicide, so it should be preemptively responded to prevention through suicide risk research. In suicidal ideation, social environmental satisfaction and physical environmental satisfaction, which correspond to the subjective perception of the community environment, were influenced, and only social environmental satisfaction was associated in suicide attempts. As social environmental satisfaction is analyzed to affect both suicidal ideation and suicide attempts, it is necessary to pay attention to the social network through a comprehensive approach such as social trust support for lower monthly household income, lower education, lower marital-non-habitat or divorce, lower subjective health, higher depression and higher age than men (P<0.05). ICC, which accounts for the proportion of regional-level variance in total variance, had a validity of about 14.9%. In terms of suicide attempts, all variables, such as area deprivation index, residential area, local social welfare budget, and local health budget, were statistically insignificant in suicide attempts, and social environmental satisfaction odds was 1.287 (1.048-1.579). The lower the level of education, the worse the subjective health condition, the higher the depression, the higher the suicide attempt, the lower the suicide attempt as the sleep time increased, and the statistically significant (P<0.05). ICC has a validity of about 22.3%. The area deprivation index, which corresponds to the medical service environment and regional indicators, showed that both suicidal ideation and suicide attempts were not related. Conclusion Suicide is an important social disease that needs to be analyzed and managed with health and medical awareness, and unlike other diseases, it cannot be treated if it reaches suicide, so it should be preemptively responded to prevention through suicide risk research. In suicidal ideation, social environmental satisfaction and physical environmental satisfaction, which correspond to the subjective perception of the community environment, were influenced, and only social environmental satisfaction was associated in suicide attempts. As social environmental satisfaction is analyzed to affect both suicidal ideation and suicide attempts, it is necessary to pay attention to the social network through a comprehensive approach such as social trust support for individual-level relationships and community-level social participation policies. The physical environment of the community is clearly a factor to pay attention to and improve suicide prevention policies, as rural suicide was higher than large cities and statistically significant trends in individuals' subjective physical environmental awareness and objective regional indicators. On the other hand, area deprivation index, which measures environmental satisfaction in medical services and regional levels, showed no connection between suicidal ideation and suicide attempts. Therefore, efficient and differentiated suicide prevention health policies should be established through in-depth research analysis that reflects objective indicators and characteristics related to the community environment, focusing on improving the social and physical environment subjectively recognized by individuals.

긍정심리학 기반 원예치료프로그램이 청년자살시도자의 자살사고와 플로리시에 미치는 효과

한수지 제주대학교 사회교육대학원 2024 국내석사

이 연구는 응급실에 내원 한 청년 자살시도자 대상으로 긍정심리학 기반 원예치료프로그램을 실시했을 때 청년 자살시도자의 자살사고와 플로리시에 미치는 효과를 알아보기 위한 것이다. 00시 소재 권역응급의료센터에 내원하여 신체적, 정신적 응급처치 후 외래치료 및 입원치료를 받는 청년 자살시도자 3명을 대상으로 2023년 9월 1일부터 11월 20일까지 주1∼2회 120분씩 총 5회기에 걸쳐 긍정심리학 기반 원예치료프로그램을 진행하였다. 긍정심리학 기반 원예치료 프로그램은 다음과 같은 연구 문제를 가지고 있다. 첫째. 긍정심리학 기반 원예치료프로그램이 청년 자살시도자의 자살사고 감소에 효과가 있는가? 둘째, 긍정심리학 기반 원예치료프로그램이 청년 자살시도자의 플로리시 향상에 효과가 있는가? 연구방법은 질적연구방법과 양적연구방법을 혼합하여 사용하였다. 질적연구방법은 심층면담, 참여관찰 그리고 자료수집이다. 심층면담은 자살시도자 초기평가지를 기반으로 질문하였고 중요한 자살위험 요인이 발견되거나 관련 정보가 더 필요한 경우 후속 질문을 하는 반구조화된 방식으로 진행하였다. 프로그램을 진행하는 동안 대상자와 1:1로 상호작용하며 참여관찰 하였다. 프로그램 진행 내용을 전부 녹취하여 전사하였고 활동지, 과제물, 발표 자료, 만족도 등을 자료수집하였다. 이를 바탕으로 자살사고와 플로리시 하위요소 기준으로 범주화하여 질적분석을 하였다. 양적연구방법은 실험법으로 설계 후 사전·사후 검사를 하였다. 자살사고의 변화를 알아보기 위해 자살사고 척도와 살아야 하는 이유 척도를 사용하였고 플로리시 변화를 알아보기 위해 긍정심리치료 척도를 사용하였다. 모집단 수가 적어 Shapiro-Wilk를 통하여 정규성을 확인 후, 정규성을 따르는 분포는 대응 표본 t 검증을 하였고 정규성을 따르지 않는 분포는 비모수 검증인 윌콕슨 부호순위 검증을 시행하였다. 이 연구의 결과를 요약하면 다음과 같다. 첫째, 긍정심리학 기반 원예치료프로그램은 청년 자살시도자의 자살사고 감소에 효과가 있었다. 정량적 분석을 시행한 결과 청년 자살시도자의 자살사고 감소에 유의미한 효과가 나타나지 않았으나 자살사고 사전·사후 전체 평균이 감소(45.00->24.67)하는 변화를 보였다. 그리고 살아야 하는 이유의 하위요소인 생존과 대처 신념에서 유의미한 효과(t=-4.345, p<.05)가 나타났다. 생존과 대처 신념은 자살 생각(r=-2.4)과 부적 상관으로 생존과 대처 신념이 많을수록 자살 생각을 적게 한다고 한다(Lee, Hyun, & Lee, 2010). 정성적 분석에서 대상자들은 자살사고가 감소하거나 없음을 표현하였고 삶의 의욕, 애착, 미래에 대한 기대, 관계 부분에서 살아야 할 이유가 증가한 긍정적인 변화가 보였다. 둘째, 긍정심리학 기반 원예치료프로그램은 청년 자살시도자의 플로리시 향상에 유의미한 효과가 있었다. 정량적 분석에서 청년 자살시도자의 플로리시 증가에 유의미한 효과(t=-4.539, p<0.5)가 나타났다. 하위요소인 몰입(t=-15.497, p<0.1), 성취(t=-5.500, p<.05)에서도 유의미한 효과가 나타났다. 긍정 정서, 관계, 의미는 유의미한 효과가 나타나지 않았으나 사전·사후 전체 평균 점수가 모두 증가한 변화를 보였다. 정성적 분석에서 대상자 모두 플로리시가 증가한 모습을 보였다. 즐거움, 재미, 호기심 등의 긍정 정서가 증가하였고 삶의 의미, 성취, 관계에서도 긍정적 변화 보였다. 대상자 모두 자신의 강점에 대해 잘 인지하고 발휘하는 모습 보였다. 이 연구 결과를 기반으로 청년 자살시도자의 자살사고 감소와 플로리시 증가를 위한 후속 연구의 기초자료를 제공하고 청년 자살시도자의 자살 재시도 예방을 위한 프로그램으로 유용하게 제공될 수 있기를 기대한다. This study aims to identify the effect of positive psychology-based horticultural therapy programs on suicidal ideation and flourishing in youth suicide attempters who visit emergency rooms. Three youth suicide attempters, who were either being treated as outpatients or hospitalized after visiting a regional emergency medical center in OO city, where they received physical and psychological emergency treatment, participated in the program between September 1st and November 20th, 2023, for 120 minutes per session once or twice a week for a total of five sessions. The positive psychology-based horticultural therapy program has the following research questions: First, is the program effective in reducing the suicidal ideation of youth suicide attempters? Second, is the program effective in improving the flourishing of youth suicide attempters? A mixture of qualitative and quantitative research methods was used to conduct this study. Qualitative research methods such as in-depth interviews and participant observations were used to collect the participants' data. The in-depth interviews were semi-structured; participants were asked to answer questions based on the initial assessment questionnaire for suicide attempters, and if significant suicide risk factors were found or more information was required, follow-up questions were also asked. The researcher interacted with the participant one-on-one during the interview and participant observation. The entire program was recorded and transcribed. Qualitative analysis was conducted after categorizing sub-elements of suicidal ideation and flourishing based on the participants' activity sheets, assignments, presentation materials, and satisfaction levels. For quantitative research, an experimental research method was used, and pre- and post-tests were conducted. The suicidal ideation scale and reasons for living scale were used to identify changes in suicidal ideation, and the positive psychotherapy scale was used to identify changes in flourishing. The population was too small, so the Shapiro-Wilk test was used to evaluate normality. For normally distributed data, a paired t-test was conducted. The Wilcoxon signed-rank test, a non-parametric test for matching samples, was conducted for non-normally distributed data. The following is a summary of this research. First, the positive psychology-based horticultural therapy program was effective in reducing the suicidal ideation of youth suicide attempters. Qualitative analysis showed that all participants expressed a reduction in or absence of suicidal ideation, and reasons for living increased in areas such as the will to live, attachments, expectations for the future, and relationships. On the other hand, quantitative analysis showed that the program did not have a significant effect in reducing the suicidal ideation of youth suicide attempters. However, the average score of suicidal ideation decreased when comparing pre- and post-tests (from 45.00 to 24.67). In addition, the program had a significant effect on survival and coping beliefs (t=-4.345, p<.05), which are the sub-elements of reasons for living. As survival and coping beliefs have a negative correlation to suicidal ideation (r=-2.4), the higher the survival and coping beliefs, the less suicidal ideation (Lee, Hyun, & Lee, 2010). Second, the program was effective in improving the flourishing of youth suicide attempters. The qualitative analysis showed that flourishing in all participants improved. Positive effects such as pleasure, fun, and curiosity also improved, and the meaning of life, achievements, and relationships also showed positive changes. All participants recognized and demonstrated their strengths well. A significant effect in improving flourishing in youth suicide attempters (t=-4.539, p<0.5) also occurred in quantitative analysis. In addition, the program had a significant effect on immersion (t=-15.497, p<0.1) and achievement (t=-5.500, p<.05), which are sub-elements of flourishing. There were no significant effects on positive effects, relationships, and meaning, but all of the average scores increased when comparing pre- and post-tests. This study is expected to provide primary data for follow-up research to validate the effectiveness of suicidal ideation and flourishing in youth suicide attempters and a post-management program for youth suicide attempters in preventing any re-attempts in suicide.

주요우울장애 환자들의 tryptophan hydroxylase-2 유전자 다형성과 자살시도 및 성격특성의 유전적 연관성

남윤영 연세대학교 대학원 2008 국내박사

Major depressive disorder(MDD) is a common mental illness of high risk of suicide. The suicide risk in patients with MDD may be associated with impulsive-aggression. It has been implicated that decreased serotonergic function might be a common biological mechanism of depression, suicide and impulsive-aggression. The tryptophan hydroxylase-2(TPH2) gene encodes the rate-limiting enzyme, TPH, in the serotonin biosynthesis in brain. We hypothesized the TPH2 genetic variants may predispose to MDD and suicide attempt in MDD. We also investigated whether this predisposition of TPH2 genetic variants to suicide attempts was mediated by impulsive-aggression.One hundred ninety five unrelated patients with MDD(83 suicide attempters and 112 non-attempters) and 206 healthy individuals participated in this study. We analyzed three single nucleotide polymorphisms (SNPs) in the promoter region (rs4570625, rs11178997) and rs7305115 in the exon 7 of the TPH2 gene and haplotypes. Single SNP and haplotype association analyses were conducted. We also examined whether TPH2 gene was related to impulsive-aggression in MDD.We found a higher frequency of G/G homozygotes of SNP rs7305115 and haplotype ATG in patients with MDD compared to controls. SNP rs7305115 predicted the likelihood of MDD(OR=1.97, 95% CI=1.24-3.11, p=0.004) but, after controlling of family history of mood disorder, this significant relahionship was not found. G/G homozygotes of SNP rs7305115 and haplotype TGG was more frequently present in suicide attempters than non-attempters in MDD. SNP rs7305115 predicted the likelihood of suicide attempt in patients with MDD independently from alcohol use disorder and family history of mood disrder(OR=2.37, 95% CI=1.15-4.87, p=0.019). However, we did not found any significant asscociation between SNPs in promoter region and MDD, and suicide attempt respectively. No direct effect of rs7305115 was observed on impulsive-aggression.The TPH2 genetic variants may be involved in the predisposition to MDD and suicide attempt in MDD. However, our results do not support the role of impulsive-aggression as mediators in the process of suicide attempt. These findings may shed light on the biological basis of MDD and suicide attempt and help identify patients at increased risk of suicide. 주요우울장애는 흔한 정신질환으로 자살위험이 높다. 주요우울장애 환자들의 자살시도 위험은 충동-공격성과 관련되는데, 세로토닌 시스템의 기능 저하가 우울증, 자살행동 및 충동-공격성의 공통적인 생물학적 기전으로 제시되고 있다. Tryptophan hydroxylase-2(TPH2) 유전자는 뇌에서 세로토닌 생합성에 관여하는 속도제한 효소인 TPH를 부호화시킨다. 본 연구는 TPH2 유전자 변이가 주요우울장애 및 주요우울장애 환자들에서의 자살시도 취약성에 영향을 미치는지 알아보고자 하였다. 그리고 TPH2 유전자 변이의 자살시도 취약성에 대한 영향이 충동-공격성에 의해 매개되는지의 여부도 함께 규명하였다.본 연구는 주요우울장애 외래환자 195명(자살시도군 83명, 비자살시도군 112명)과 정상 대조군 206명을 대상으로 TPH2 유전자 프로모터의 단일염기다형성 rs4570625와 rs11178997, 7번 exon의 rs7305115 유전자형, 일배체형과 주요우울장애, 자살시도 및 충동-공격성 사이의 연관성을 분석하였다.TPH2 유전자 단일염기다형성 rs7305115의 G/G 동종접합체와 ATG 일배체형 빈도는 주요우울장애 환자군에서 대조군 보다 더 높았다. Rs7305115 유전자형은 주요우울장애 발병을 예측하였지만 (OR=1.97, 95% CI=1.24-3.11, p=0.004), 기분장애 가족력을 통제한 후에는 이 관계는 더 이상 유의하지 않았다. 주요우울장애 환자군에서 자살시도자들의 rs7305115 G/G 동종접합체 및 TGG 일배체형 빈도는 비자살시도자들에 비해 유의하게 더 높았다. 그리고 rs7305115 유전자형은 알코올 사용장애나 기분장애 가족력과는 독립적으로 주요우울장애에서의 자살시도 위험을 예측하였다(OR=2.37, 95% CI=1.15-4.87, p=0.019). 그러나 TPH2 유전자 프로모터의 단일염기다형성들과 주요우울장애, 자살시도 간의 연관성은 각각 유의하지 않았다. 그리고 rs7305115 유전자형에 따른 충동-공격성의 차이도 유의하지 않았다.결론적으로 TPH2 유전자 변이가 주요우울장애 및 주요우울장애 환자들에서의 자살시도 취약성에 영향을 미칠 것으로 생각된다. 그러나 TPH2 유전자 변이에 따른 충동-공격성의 정도에는 차이가 없어 충동-공격성이 TPH2 유전자 변이의 매개체 역할은 하지 않을 것으로 생각된다. 본 연구 결과는 주요우울장애 발병 및 자살시도의 생물학적 원인기전을 규명하고 자살위험이 높은 환자들을 규명하는데 도움을 줄 것으로 기대된다.

Classification of Korean suicide attempters and comparison of characteristics between subgroups

김혜영 서울대학교 대학원 2017 국내석사

Introduction: Understanding the structure in populations of suicide attempters is essential to establish the effective suicide prevention strategies. The aim of this study was to explore subgroups among Korean suicide attempters in terms of details of the suicide attempt. Methods: We analyzed a sample of 900 suicide attempters who were treated in the emergency room due to the suicide attempt. Rating variables concerned demographic characteristics, clinical information, and details of the suicide attempt including suicidal intent and lethality assessed by Suicide Intent Scale (SIS) and Columbia-Suicide Severity Rating Scale (C-SSRS). A cluster analysis was performed using the Ward method. Results: Two subgroups were identified. A majority of our sample fell into a subgroup characterized by less planning, methods of low lethality and ambivalence towards death (“unplanned”). The other subgroup made more severe and well-planned attempt, using high lethal methods and taking more precautions to avoid being interrupted (“planned”). We also examined differences in demographic and clinical variables between two subgroups: the unplanned subgroup was predominantly females and more likely to be under psychiatric treatment while the planned subgroup was associated with more males, older age, and physical illness. Conclusions: Cluster analysis extracted two distinct subgroups of Korean suicide attempters. The understanding that a significant portion of suicide attempts in South Korea occur impulsively calls for the development of new prevention strategies tailored to different profiles of subgroups.

가족구성원의 흡연여부에 따른 청소년의 자살생각 및 시도와의 관련성

서의진 연세대학교 보건대학원 2019 국내석사

Background and purpose The mental health of adolescents is related to the quality of life throughout their entire lives, and there is a lot to do with the prevention of social problems. However, adolescence is not fully mature physically or mentally and lacks the ability to cope with various changes, making it an easy step to develop mental health problems due to the burden of adjustment. There are various factors affecting mental health problems of adolescents, and in this study, to identify mental health behaviors of young people at the family member level, we analyze the relevance of the adolescent's suicide thoughts and experiences in suicide attempts based on whether or not family members smoke in order to provide basic data to develop policies to promote youth mental health. Subjects and methods This study defined dependent variables as teenagers' thoughts of suicide and experience in suicide by analyzing teenagers who participated in the Korea Youth Risk Behavior Web-Based Survey conducted by the Korea Centers for Disease Control and Prevention (2014; 72,060; 68,043; 2016; 65,528; 2018; 60,039). As an interesting variable, family members were divided into father, mother, brother, sister, grandfather and grandmother, and were classified as parents (father, mother) and other members (brother, mother, grandfather and grandmother) to analyze whether or not each member was smoking. The purpose of the study was to analyze the relevance of teenage suicide thoughts and suicide experiences to whether family members smoked or not, and chi-square test was conducted. And to determine whether Entire family members and Their parents’smoked, affects teenagers' thoughts and attempts to commit suicide, a multi-logistic regression was conducted. Results Of the total 265,670 teenagers who participated in the Youth Health Behavior Online Survey, 145,802 answered that there were smokers among the family members, 54.9 percent of the total. Among them, 7,539 male students had thought of committing suicide when there were smokers in their families, which takes up 10.4 percent, and female students 16.6 percent with 12,131. While 2.2 percent of male students with 1,629 had attempted suicide, 3.8 percent female students with 2,792 did. When there are smokers in the family, both male(OR: 1.04, 95% CI: 1.00-1.09) and female(OR: 1.10, 95% CI: 1.06-1.15) students have significant relevance in thinking about suicide, while the experience of suicidal thoughts has been statistically significant only in the case of girls(OR: 1.13, 95% CI: 1.05-1.21). especially when a mother smoke, both male(suicide thoughts OR: 1.27, 95% CI: 1.09-1.58, suicide attempt OR: 1.22, 95% CI: 0.88-1.70) and female(suicide thoughts OR: 1.22, 95% CI: 1.04-1.42, suicide attempt OR: 1.23, 95% CI: 0.95-1.58) students have significant relevance in suicidal thoughts. Considering the demographic and social factors of family members and adolescents and the factors of physical health, it was found that the lower the household income level, the lower the final educational background of the father and mother, the higher the stress level, the higher the cross-ratio of thinking about suicide and the experience of suicide. Conclusion Even when the various demographic, sociological and physical health factors of family members and adolescents were controlled, the presence of smokers among family members has been shown to have statistically significant associations with adolescents' thinking of suicide and attempted suicide. It has been found that mental health problems of adolescents are most closely related their parents' health behaviors, and the mother's health behaviors among parents were more closely related to the adolescent's suicide thought and suicide attempt experience. And, The mental health problems of adolescents were found to be higher in the lower grade adolescents. Especially, in the case of male students, the experience of suicide thought and suicide attempt was high in the middle school students compared to high school students. In order to improve the mental health of young people in the future, a family member unit, including parents, needs to approach them based on early prevention and health promotion rather than treatment-oriented ones. 배경 및 목적 : 청소년의 정신건강은 전 생애를 통한 삶의 질과 연관되어 있으며, 사회적인 문제 발생의 예방과도 많은 관련성이 있다. 다만, 청소년기는 신체적, 육체적으로 완전히 성숙하지 못하고 다양한 변화에 대한 대처 능력이 부족하여 이에 대한 적응 부담감으로 인해 정신건강 문제가 발생하기 쉬운 단계이다. 이 연구에서는 청소년의 정신건강행태를 파악하기 위해 가족구성원의 흡연 여부에 따른 청소년의 자살 생각 및 자살시도 경험과의 관련성을 분석하고, 이를 통해 청소년 정신건강 증진을 위한 정책 마련의 기초 자료를 제공하고자 한다. 연구방법 : 이 연구는 청소년건강행태온라인조사에 참여한 청소년(2014년도; 72,060명, 2015년도; 68,043명, 2016년도; 65,528명, 2018년도; 60,039명)을 분석대상으로 하여 종속변수는 청소년의 자살 생각과 자살시도 경험으로 정의하였다. 흥미 변수로써 가족구성원은 아버지, 어머니, 형제·자매, 할아버지·할머니로 구분하였고, 부모님(아버지, 어머니)과 그 외 기타 가족구성원(형제·자매, 할아버지·할머니)으로 분류하여 각 구성원 별 흡연 여부를 분석하였다. 연구목적에 따라 가족구성원의 흡연 여부에 따른 청소년의 자살생각 및 자살시도 경험과의 관련성을 분석하기 위하여 카이제곱검정(χ2 tests)을 실시하였고, 전체 가족구성원 뿐만 아니라 부모의 흡연 여부가 청소년의 자살생각 및 자살시도에 미치는 영향을 파악하기 위하여 다중 로지스틱 회귀분석을 실시하였다. 연구결과 : 청소년건강행태온라인조사에 참여한 청소년 총 265,670명 중에서 가족구성원 중 흡연자가 있다고 응답한 대상자는 145,802명으로 전체 54.9%였다. 이 중에서 가족구성원 중 흡연자가 있을 시 자살 생각을 한 경험이 있는 남학생은 7,539명으로 10.4%, 여학생은 12,131명으로 16.6%이며, 자살시도를 한 경험이 있는 남학생은 1,629명으로 2.2%, 여학생은 2,792명으로 3.8%로 확인되었다. 가족구성원의 흡연 여부에 따라 남학생(OR: 1.04, 95% CI: 1.00-1.09) 및 여학생(OR: 1.10, 95% CI: 1.06-1.15) 모두 자살생각 경험과 유의한 관련성이 있으며, 자살시도 경험은 여학생(OR: 1.13, 95% CI: 1.05-1.21)의 경우에만 통계적으로 유의하였다. 특히, 가족구성원 중 어머니가 흡연할 시 남학생(자살생각 OR: 1.27, 95% CI: 1.09-1.58, 자살시도 OR: 1.22, 95% CI: 0.88-1.70)과 여학생(자살생각 OR: 1.22, 95% CI: 1.04-1.42, 자살시도 OR: 1.23, 95% CI: 0.95-1.58) 모두 자살생각 경험의 교차비가 통계적으로 유의하게 높았다. 가족구성원과 청소년의 인구·사회학적 요인, 신체건강 요인을 고려했을 시 중학생일수록, 가구 소득수준이 낮을수록, 아버지와 어머니의 최종학력이 낮을수록, 스트레스 수준이 높을수록 자살생각 및 자살시도 경험의 교차비가 높았다. 결론 : 가족구성원 중 흡연자가 있을 시, 가족구성원 및 청소년의 인구·사회학적, 신체 건강적 요인들을 통제하더라도 청소년의 자살생각 및 자살시도 경험은 통계적으로 유의한 연관성이 있다. 청소년의 정신건강 문제는 부모의 건강행태와 가장 밀접한 연관성이 있고, 부모 중에서도 어머니의 건강행태가 청소년의 자살생각 및 자살시도 경험과의 관련성이 높았다. 청소년의 정신건강 문제도 청소년 학년이 낮을수록 문제가 더 높게 발생하는 것으로 확인되었으며 특히나 남학생의 경우에는 고등학생 대비 중학생에서 자살생각과 자살시도 경험이 모두 높게 발생하였다. 향후 청소년의 정신건강 증진을 위해서는 부모를 포함한 가족구성원 단위에서 치료중심보다는 조기 예방과 건강증진 측면에서의 접근이 필요할 것으로 보인다.

자살사망자 및 자살시도자의 사회경제적 비용

임재희 경희대학교 대학원 2016 국내박사

Introduction Suicide is the most serious health problem worldwide and an important social problem emerging in South Korea today. South Korea’s suicide rate was approximately 2.5 times higher than the Organisation for Economic Co-operation and Development (OECD) average in 2012 and about eight times higher than that of Greece, which had the lowest suicide rate amongst all OECD countries. Suicide accounts for the single highest economic burden compared to other diseases; however, in South Korea, few studies exist on the economic cost of suicides and suicide attempts. Therefore, the study aim was to calculate these economic costs using current data. Methods Cause-of-death data from the National Statistical Office for 2010 were used to ascertain the socioeconomic costs resulting from suicides and suicide attempts in South Korea. Suicides were estimated and loss of future income due to early death was calculated; additionally, the number of rescued suicide attempters was estimated by inverting the number of suicide attempts and suicides, and the indirect and direct costs from a suicide attempt were calculated. As the code for estimating the suicides and suicide attempts could have been overlooked or entered incorrectly if only the data from the Health Insurance Review and Assessment Service were used, potentially leading to an underestimation of the data, the garbage code, which can redistribute cause of death according to age and gender, was applied and the costs were compared. The costs were also calculated based on the application of labor force participation rates. Results The direct medical cost for suicide attempts after applying the labor force participation rate was 152,443 million won; without applying the labor force participation rate, it was 272,937 million won. The direct non-medical cost after applying the labor force participation rate was 7,534 million won; without applying the labor force participation rate, it was 12,902 million won. For the indirect costs from loss of productivity following medical assistance, the outpatient medical cost was 3,456 million won and the hospitalization cost was 239,003 million won after applying the labor force participation rate; without applying the labor force participation rate, the costs were 5,001 million won and 362,079 million won, respectively. The cause-of-death statistics indicated that the cost arising from early death was 7,370,155 million won. After applying the labor force participation rate and the garbage code, it was 7,917,322 million won; without applying the labor force participation rate, it was 9,869,710 million won; and, after applying the garbage code, it was 10,610,850 million won. Thus, the socioeconomic costs resulting from the total number of suicides was 6,665,951 million won for men and 1,653,837 million won for women after applying the labor force participation rate; without applying the labor force participation rate, the costs were 8,262,917 million won and 3,000,852 million won, respectively. Conclusion In South Korea, suicides, suicide attempts, and their associated economic costs are increasing annually; for suicides and suicide attempts, the economic costs were very high, and the resulting national losses were high. Thus, appropriate measures for prevention should be conducted for people suffering from mental disorders, such as depression, as well as for potential suicide attempters with a family history of suicide. Various short- and long-term measures should be implemented for suicide rate reduction and efforts made accordingly to elicit a real impact.