주요우울장애 환자의 자살시도와 임상평가 척도 결과의 차이

이창훈(Chang Hun Lee),박재홍(Jae Hong Park),최병무(Byeong Moo Choe),유재호(Jae Ho Yoo),김성환(Seong Hwan Kim) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.1

Objectives:The aim of this study was to examine a usefulness of the Beck Scale for Suicidal Ideation(BSI) and the Beck Hopelessness Scale(BHS) to assess the risk of current suicide attempt in patients with major depressive disorder. Methods:Eighty-seven patients with major depressive disorder were participated in this study. All patients were recruited from the psychiatric outpatient clinic or inpatient ward of Dong-A university hospital. We categorized the participants into three groups according to their history of suicide attempts : current suicide attempters, past suicide attempters, non-attempters. The suicide idea and hopelessness of the participants were assessed by the BSI and the BHS, respectively. Also, severity of depression in all subjects was assessed by the Hamilton Rating Scale for Depression(HAM-D). Results:The sum scores of the BSI and the BHS were significantly higher in current suicide attempters and past suicide attempters than non-attempters. However, those were not significantly different between current suicide attempters and past suicide attempters. And the sum score of the HAM-D was significantly higher in current suicide attempters than other two groups. But, it was not significantly different between past suicide attempters and non-attempters. Conclusion:The results of present study suggest that the BSI and the BHS may have limited ability to identify current suicide risk in patients with major depressive disorder. In clinical practice, it is necessary to assess the clinician rating scale such as the HAM-D for evaluating the risk of current suicide attempt.

Prevalence and Risk Factors Associated with Suicide Ideation and Attempts in Korean College Students

Hong-Seok Lee,Sukil Kim,Inyoung Choi,Kyuong-Uk Lee 대한신경정신의학회 2008 PSYCHIATRY INVESTIGATION Vol.5 No.2

Objective: Suicide is a leading cause of death in college age students. Identification of the associated risk factors has important implications for how to prevent and respond to this population; however, few studies have been performed on this topic in this age group. The purpose of this study was to evaluate the prevalence and risk factors associated with suicide ideation and attempts in college students. Methods: Three hundred sixty-eight college students participated in this cross-sectional observational study. The recent (over two weeks) suicide ideation and lifetime suicide attempts were defined according to Moscicki’s suicide behavior index. Sociodemographic variables were assessed and psychopathology measured using the Beck Depression Inventory, the Bipolar Spectrum Diagnostic Scale and the Alcohol Use Disorders Identification Test. A hierarchical multiple logistic regression analysis was used to identify the significant risk factors related to suicide ideation and attempts. Results: The two-week prevalence of suicidal ideation was 9.8%, and the lifetime prevalence of suicide attempts was 3.3%. The univariate analysis showed that students who had more severe depression (p<0.001), a higher probability for bipolar disorder (p<0.001) and decrement of academic achievement (p<0.005) were more likely to have suicide ideation. Those with factors such as severe depression (p<0.05), a higher probability of bipolar disorder (p<0.001), a low socioeconomic status (p<0.001), who lived alone (p<0.01), and were female (p<0.05) had a higher risk for suicide attempts. The most important predictors of suicide ideation, by the logistic regression analysis, were depression, probability for bipolar disorder and academic achievement, and the risks identified for suicide attempts were socioeconomic status and probability of bipolar disorder. Conclusion: Suicide ideation and attempts were common in college students. The results of this study suggest that early identification and management of mood disorders and other sociodemographic risk factors may have implications for intervention and prevention. Objective: Suicide is a leading cause of death in college age students. Identification of the associated risk factors has important implications for how to prevent and respond to this population; however, few studies have been performed on this topic in this age group. The purpose of this study was to evaluate the prevalence and risk factors associated with suicide ideation and attempts in college students. Methods: Three hundred sixty-eight college students participated in this cross-sectional observational study. The recent (over two weeks) suicide ideation and lifetime suicide attempts were defined according to Moscicki’s suicide behavior index. Sociodemographic variables were assessed and psychopathology measured using the Beck Depression Inventory, the Bipolar Spectrum Diagnostic Scale and the Alcohol Use Disorders Identification Test. A hierarchical multiple logistic regression analysis was used to identify the significant risk factors related to suicide ideation and attempts. Results: The two-week prevalence of suicidal ideation was 9.8%, and the lifetime prevalence of suicide attempts was 3.3%. The univariate analysis showed that students who had more severe depression (p<0.001), a higher probability for bipolar disorder (p<0.001) and decrement of academic achievement (p<0.005) were more likely to have suicide ideation. Those with factors such as severe depression (p<0.05), a higher probability of bipolar disorder (p<0.001), a low socioeconomic status (p<0.001), who lived alone (p<0.01), and were female (p<0.05) had a higher risk for suicide attempts. The most important predictors of suicide ideation, by the logistic regression analysis, were depression, probability for bipolar disorder and academic achievement, and the risks identified for suicide attempts were socioeconomic status and probability of bipolar disorder. Conclusion: Suicide ideation and attempts were common in college students. The results of this study suggest that early identification and management of mood disorders and other sociodemographic risk factors may have implications for intervention and prevention.

응급실에 내원한 자살 시도자의 특성과 반복 자살 시도에 영향을 미치는 요인

최진희,서완석,구본훈,김혜금,이영지,천은진 대한생물치료정신의학회 2020 생물치료정신의학 Vol.26 No.1

Objectives:Suicide attempt history is one of the major suicide risk factors and the suicide mortality rate increases with the number of suicide attempts. This study aimed to compare demographic and clinical factors between first and multiple suicide attempters and investigate risk factors for multiple suicide attempts. Methods:Participants were 537 patients who were admitted to an emergency room after attempting suicide and divided into two groups (393 first attempters and 144 multiple attempters). Demographic factors, clinical characteristics, and suicide-related characteristics were compared between the two groups. Variables with a p-value lower than 0.1 were included in a multivariate logistic regression analysis. Logistic regression models were considered to identify independent risk factors for multiple suicide attempts. The significance level was set to 0.05. Results:Among demographic factors, the two groups differed in age, sex, education, occupation, and marital and cohabitation status. Multiple attempters were more likely to have a mental disorder, current use of psychiatric medication, interpersonal and psychiatric motivation for suicide, current suicidal thoughts, help seeking behavior, awareness of suicide, and agreement with psychiatric follow up. In the regression analysis, unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use emerged as significant risk factors of multiple suicide attempts. Conclusion:The study’s findings suggested that there are differences in the demographic and clinical characteristics of first and multiple suicide attempters. Specific strategies that consider unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use may be valuable for future suicide prevention.

Differences between Impulsive and Non-Impulsive Suicide Attempts among Individuals Treated in Emergency Rooms of South Korea

Meerae Lim,이수정,Jong Ik Park 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.4

ObjectiveaaA considerable proportion of suicide attempts are the result of sudden desires. Understanding such impulsive suicide attempts is necessary for effective interventions. We evaluated the impulsivity of suicide attempters treated in emergency rooms. The aim of the study was to identify the characteristics of impulsive suicide attempts by comparing these individuals to those who attempted to commit suicide in a non-impulsive manner. MethodsaaThis study analyzed suicide attempters who visited the emergency departments of seven selected university hospitals. A total of 269 medical records in which impulsivity of suicide attempt were confirmed were subject to be analyzed. The impulsivity of the suicide attempt was examined using a summative score of items 6 and 15 on the Suicide Intent Scale. ResultsaaA total of 48.0% of the participants were impelled by sudden inclinations to attempt suicide. Impulsive attempters were younger, unmarried and less physical illness than non-impulsive attempters, whereas no significant differences were found on psychiatric history and previous suicide history. Impulsive suicide attempters had suicide ideations that were not as severe (χ2=55.33, p<0.001) or intense (t=-8.38, p<0.001) as their counterparts’. Furthermore, medical results of impulsive suicide attempts were better than non-impulsive suicide attempts (t=-3.77, p<0.001). ConclusionaaThe results suggested that a considerable proportion of suicide attempts were the result of sudden inclinations. Impulsive attempts were made in relatively earlier stages of suicide ideation; consequently, they have less intent than non-impulsive attempts.

자살 예방을 위한 집중관리 대상으로서의 중독

곽문환,강현영,이시진,한갑수,김수진,이의중,이성우 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.2

Purpose: The Korean government has tried to decrease the suicide death rate over the last decade. Suicide attempts, particularly non-fatal attempts, are the most powerful known risk factor for a completed suicide. An analysis of suicide attempt methods will help establish the effective preventive action of suicide. Fit prevention according to the method of suicide attempt may decrease the incidence of suicide death. Self-poisoning is suggested as a major method of both suicide attempts and suicide death. The aim of this study was to determine if a self-poisoning patient is a suitable target for the prevention of the suicide. Methods: This was retrospective analysis of a prospective cohort, which included patients who presented to the emergency department (ED) after a self-harm or suicide attempt from Jan 2013 to Dec 2017. The proportion of methods in suicide attempts, psychological consultation, and fatality according to the suicide attempt method were analyzed. The types of poison were also analyzed. Results: Poisoning was the most common method of suicide attempts (52.1%). The rate of psychological consultations were 18.8% for all patients and 29.1% for poison patients (p<0.001). The rate of mortality in poisoning was 0.6%. Psychological consultation was performed more frequently in admission cases than discharged cases. The most common materials of poisons was psychological medicines and sedatives that had been prescribed at clinics or hospital. Conclusion: Self-poisoning is a major method of suicide attempt with a high rate of psychiatric consultation, low mortality rate, versus others methods. The prevention of suicide death for suicide attempts may focus on self-poisoning, which is the major method of suicide attempts. A suitable aftercare program for self-poisoning may be an effective method for preventing suicide if an early diagnosis and management of psychiatric disorders through psychiatric consultation can be made, and early connection to social prevention program for non-fatal patients are possible.

자살시도자와 자살 사망자의 자살 방법, 스트레스 요인 및 정신과적 진단

오시현,안지혜,서지효,구혜린,김민정,장혜연,김석주 대한수면의학회 2022 수면·정신생리 Vol.29 No.1

Objectives: Suicide is the major public mental health concerns all over the world. The comparison of suicide attempters and suicide completers could be the fundamental evidence for the suicide prevention. The aim of this study is to explore the differences between suicide attempters and suicide completers in terms of the stressors, suicide methods, and psychiatric diagnosis. Methods: Two types of secondary data were collected for the analyses. Data of the suicide attempters (n = 680) were gathered by intensive reviewing the medical records of Samsung Medical Center, Seoul, Republic of Korea. Data of suicide completers (n = 11,722) were collected by the psychological autopsy data which were gathered by Korean Foundation for Suicide Prevention. Suicidal methods, psychiatric disorders and stressors before suicidal attempt were compared between suicide attempter and completers. Results: Suicide completers were older and male predominant compared to suicidal attempt. Hanging or gas intoxication were more commonly used in the suicide completion, while wrist cutting or drug intoxication were more common in suicide attempters. All types of stressors were found to be high in suicide completers than suicide attempters. However, the proportion of economic and physical stress were greater in suicide completers, while the proportion of family stress were greater in suicide attempters. According to the recorded diagnoses, the rates of depressive disorders, sleep-wake disorders, substance-related disorders were higher in suicide completers, while the rates of anxiety disorders and trauma- and stressor-related disorders, bipolar and related disorders and somatic symptom disorders were higher in suicide attempters. However, after controlling the gender and age, there were no significant differences in diagnosis between suicide attempters and suicide completers. Conclusion: These findings implicate that suicide attempters and completers differed in suicide methods and type of stress. The results suggests that economic stressors, physical illness might raise the risk of suicide completion.

청소년 자살시도 경험에 관한 질적 연구 - 자살시도 이전 단계, 자살시도 단계, 자살실패 이후 단계 경험을 중심으로

정주연,박재연 한국청소년학회 2015 청소년학연구 Vol.22 No.7

This research was performed through interviews of adolescent survivors with Suicidal Attempt Experiences based on their Pre-suicide attempt, in thoes day of suicide attempt, after suicide attempt Experiences. Only Seven study participants were chosen among the Adolescent Clients who reported their Suicidal Attempt Experiences in counseling center. The participants had a semi-structured one-on-one interviewing and the data was analyzed by the method of Consensual Qualitative Research (CQR). The analyses included 18 domains; the result summarized as follows. Pre-suicide attempt stage experience was classified into ‘cause of suicide attempt’, ‘inner and extrinsic experience before suicide attempt’, and ‘the time required from the first suicidal ideation to real attempt’. Of these, ‘interpersonal relation’ has great effect on cause of suicide attempt. Suicide attempt stage experience was classified into ‘the first suicide attempt time’, ‘inner experience after suicidal decision’, ‘place of suicide attempt’, ‘instrument’, and ‘method’. ‘There is no will to live.’ is most typical among inner experience of suicide attempt. After failure of suicide stage experience was classified into ‘psychological state after failure’, ‘the most difficult part’, ‘the effort to overcome difficulty’, ‘what kind of support they need’. The result showed that after failure of suicide attempt, the most difficult thing is ‘consciousness of others’ and the most needful help is ‘attention’. Stages of adolescent suicide attempt experience and the meaning of the experiences turned out through this research can contribute to practical strategy arrangements and have very important suggestions in the perspective of adolescent suicide prevention. 본 연구는 자살시도 경험이 있는 생존 청소년의 자살시도 이전, 자살시도 당시, 이후 경험을 바탕으로 수행 되었다. 이를 위해 상담센터에 내원한 청소년 내담자 중 자살시도 경험을 보고 하였던 7명을 선정하여 인터뷰하였다. 반 구조화된 질문을 활용하여 1:1 면담방식으로 진행하였으며, 추출된 자료는 합의적 질적 연구방법(Consensual Qualitative Research: CQR)에 의하여 분석하였다. 분석과정을 통하여 최종 18개의 영역을 도출하였는데, 자살시도 이전 단계경험은 ‘자살시도 원인’, ‘자살시도 직전 내·외적 경험’, ‘처음 자살 생각부터 실제 시도까지 소요시간’ 둥으로 영역이 나누어졌다. 이 중 자살시도의 원인으로는 ‘대인관계’가 가장 많은 영향을 미치고 있었다. 자살시도 단계의 경험은 ‘첫 자살시도 시기’, ‘자살 결심 후 내적 경험’, ‘자살시도 장소’, ‘도구’, ‘방법’, 등의 영역으로 나누어졌는데, 자살시도 단계의 내적 경험 중에는 ‘살아갈 의욕 없음’이 가장 전형적 이었다. 자살 실패 이후 경험으로는 ‘실패 후 심리적 상태’, ‘가장 힘든 점’, ‘힘든 상황을 극복하기 위한 노력’, ‘어떤 도움이 필요한가’, 등의 영역으로 나누어졌는데, 그 결과 실패 이후 가장 힘든 점으로는 ‘타인에 대한 의식’이며, 가장 필요한 도움은 ‘관심’인 것으로 나타났다. 이 연구를 통해 밝혀진 청소년의 자살시도에 대한 단계별 경험과 그 경험이 주는 의미는 청소년 자살 예방적 관점에서 매우 큰 시사점과 실천적 전략을 마련하는데 기여할 수 있을 것이다.

Comparison of Clinical Characteristics between Single and Repeated Suicide Attempters Admitted to Emergency Room

Taehoon Koo,Kwanghun Lee,Wan Seok Seo,Jong Hun Lee,Hee-Cheol Kim,Sang Won Lee,Seunghee Won 대한신경정신의학회 2016 신경정신의학 Vol.55 No.3

Objectives This study compares single and repeat suicide attempts, and evaluates the risk factors associated with suicide re-attempts. Methods Two hundred and seventy-nine patients admitted to emergency rooms in four university hospitals in Daegu after suicide attempt were included in this study (n=179 single suicide attempters, n=100 repeated attempters). A structured interview focused on demographic, clinical, suicidal and psychological characteristics was administered to these patients after recovery from physical and psychological impairments. Results Individuals with repeated suicide attempts were younger, more highly educated, had more history of psychiatric treatments, took more psychiatric medications, and had more sustained suicidal ideations, bipolar disorders and personality disorders than individuals with single suicide attempt. Individuals with repeated suicide attempts marked significantly higher scores in the Childhood Trauma Questionnaire, Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale. Multivariate logistic regression showed that below the sixties, history of psychiatric treatments, personality disorders, substance use disorders and sustained suicidal ideations were significantly associated with predictive factors for subsequent suicide attempt. Conclusion Our findings suggest that repeat suicide attempters have different clinical characteristics from single suicide attempters, and some risk factors raise the risk of further suicide attempts. It is necessary for suicidal prevention program planners to be aware of these risk factors, especially for first-time suicide attempters

청소년 자살기도자의 정신의학적 특성

송동호,이홍식,전여숙,정유숙 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

연구목적 본 연구는 청소년 자살기도자 집단을 대상으로 자살기도의 방법과 동기, 자살의 위험도, 그리고 임상적 특성을 조사하고, 자살기도자 집단, 청소년 우울증 집단 및 정상 대조집단 간에 우울증상, 자살 사고와 자아상을 비교 조사하며, 아울러 청소년에서 자살기도자를 판별할 요인들을 찾아보고자 하였다. 연구방법 : 연구 대상은 1994년 3월부터 1995년 7월까지 자살을 기도하여 내원한 14∼18세 사이의 모든 환자 21명이 자살기도자 집단이었고, 같은 연구기간 동안 주요 우울증으로 통원치료 또는 입원치료를 받은 14∼18세 사이의 환자 22명이 우울증 집단, 그리고 정상 대조집단은 서울시 소재의 중고등학생 42명이었다. 세 집단을 대상으로 Rick Estimators for Suicide, Scale for Suicidal Ideation, Beck Depression Inventory, Offer's Self Image Questionnaire의 측정도구들을 적용하여 다음과 같은 결과를 얻었다. 연구결과 : 자살기도자 집단이 우울증 집단에 비해 QSIQ의 동성조절척도와 도덕성척도의 점수가 유의하게 낮았으니 두 집단 간에 그 외의 자아상척도들은 유의한 차이가 없었으며, 자살사고와 우울증상 척도에서도 차이가 없었다. 청소년 자살기도자들에서 academic failure, helplessness, suicidal idea, irritable mood, lack of impulse control, 그리고 low morality 등이 우을증 청소년과 판별할 수 있는 요인들임을 알 수 있었다. 청소년 자살기도자들은 자살기도가 비교적 덜 치명적이며 자살위험도도 낮은 편이었다. 한편 거의 절반의 자살기도자가 정신과적 접근이나 치료를 거절한 것으로 나타났다. 청소년에서 자살기도의 직접적인 주요 원인들은 부모와의 말다툼, 학업성적의 저하 또는 실패, 친구들과의 불화 등이었다. 결 론 : 청소년에서 자살기도자의 임상적 특성은 자살을 기도하지 않은 우울증 환자의 특성과 유사하며, 단지 자살기도자들이 보다 충동적이고 낮은 도덕성을 보임을 알 수 있었다. 청소년 자살기도자들에서 우울증 환자들과 판별할 수 있는 요인들이 나타나 이들이 자살의 예측인자일 가능성을 시사하였다. Objectives : We airmed at assessing the clinical characteristics and the suicidal ideas of suicidal attempters, and comparing the depressive symtoms, the suicidal ideas and the perceived self images of suicide-attempters with those of depressive patients and normal controls in adolescence. Methods : We included three groups, aged 14-18 years old: Suicide-attempter group, Depressive patient group, and Normal control group. Suicide-attempter group consisted of 21 patients who attempted suicide, and then were admitted into the emergency room from March 1994 to July 1995. Depressive group consisted of 22 patients who were diagnosed with major depression, and were treated during the same period. Forty-two normal controls were 8-12th grade students. Interview were conducted using following instruments : Risk Estimators for Suicide(RES), Scale for Suicidal Ideation(SSI), Beck Depression Inventory(BDI), and Offer's Self Image Questionnaire(OSIQ). Results : Major reasons of suicide attempt were quarrels with parents, academic failure, conflict with friends and so forth. There were no significant differences of BDI and SSI scores between suicide attempters and depressive adolescents but both groups showed significantly higher scores of BDI and SSI than control group. Suicide attempters showed lower scores of Impulse control and Morals subscales in OSIQ than depressive and control groups. Both suicide attempters and depressive adolescents had lower score of Psychopathology subscale than controls. Discriminating predictors between suicide attempters and depressive adolescents were found : academic failure, helplessness, suicidal idea, irritable mood, lack of impulse control, and low morals. Conclusion : The clinical profiles of suicide attempters were similar to those of depressed adolescents : depressive symptoms severity, suicidal ideas, and most of perceived self-images. Attempters suicide could be predicted in depressed adolescents with several discriminants.

Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents

권아혜,송정은,육기환,전덕인,정명훈,홍나래,홍현주 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.4

We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt and non-suicide attempt groups and we examined significant predictors of suicide attempts. Gender differences in suicidal ideation and suicidal behavior were also analyzed. Among 106 depressed participants, 50 (47.2%) adolescents were classified in the suicide attempt group. Generally, the suicide attempt and non-suicide attempt group shared similar clinical characteristics. The suicide attempt group had more females, more major depressive disorder diagnoses, more depressive episodes, and higher suicidal ideation than the non-suicide attempt group. Suicidal ideation was the only significant predictor of suicidal attempt, regardless of gender. Higher suicidal ideation frequency scores and more non-suicidal self-injurious behaviors were shown in the female suicide attempt group than the male suicide attempt group. It is recommended that suicidal ideation be assessed regularly and managed rigorously to decrease suicide risks in depressive adolescents.