주요우울증 환자의 신체화 정도에 따른 정서적, 인지적 요인 연구 = Differences of Affective and Cognitive Characteristics in Depressive Patients according to the Severity of Somatization

다국어 초록 (Multilingual Abstract)

Objective : The purpose of this study is to investigate the differences of affective and cognitive characteristics in depressive patients according to the severity of somatization, and to find the association of these factors on the severity of somatization. Methods : 86 patients with depressive disorders who had somatic discomfort without clinically significant medical illness were enrolled. The following measures were used : 1) Patient Health Questionnaire-15 (PHQ-15), 2) Beck Depression Inventory (BDI), 3) State-Trait Anxiety Inventory (STAI), 4) Toronto Alexithymia Scale-20-K (TAS-20-K), 5) Symptom Interpretation Questionnaire (SIQ). Patients were divided into two groups: mild to moderate somatization group as a score of ≤10, severe somatization group as a score of ＞11 on PHQ-15. The scales were compared with each group. Results : The mean score of BDI in severe somatization group were significantly high. The score of total, subscale 1 (‛Difficulties identifying feelings’) and 2 (‛Difficulties describing feelings’) in TAS-20-K and the scores of total, psychological, physical and catastrophic interpretation in SIQ were significantly high in severe somatization group. Finally, results of logistic regression showed that subscale 1 (‛Difficulties identifying feelings’) in TAS-20-K and physical interpretation in SIQ had significantly influence on the severe somatization. Conclusion : Among all variances, ‘difficulties identifying feelings’ and ‘physical interpretation’ were the most influential predictors for the severe somatization. These results suggested that therapeutic approach based on these characteristics according to the severity of somatization could be important for the management of somatizer.

참고문헌 (Reference)

1 박문규, "신체화 집단의 감정표현불능 증후군 및 대처 손상: 로샤의 인지, 정서, 행동 및 스트레스 관리 분석" 한국임상심리학회 26 (26): 407-427, 2007

2 나영석, "불안 증상을 동반한 신체화 환자의 인지적 특성" 대한신경정신의학회 43 (43): 726-732, 2004

3 Kirmayer LJ, "Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics" 179 : 647-655, 1991

4 Bagby RM, "The twenty - item Toronto Alexithymia Scale-I. Item ‘election and crossvalidation of the factor structure" 38 : 23-32, 1994

5 Wise TN, "The stability of alexithymia in depressed patients" 28 : 173-176, 1995

6 Shin HK, "The interpretation, inference, and memory biases of bodily sensations in somatization group [dissertation]"

7 Song JY, "The characteristics of illness behavior in patients with somatization" 5 : 176-184, 1997

8 Kroenke K, "The PHQ-15 : Validity of a new measure for evaluating the severity of somatic symptoms" 64 : 258-266, 2002

9 Kroenke K, "Symptoms in the community. Prevalence, classification, and psychiatric comorbidity" 153 : 2474-2480, 1993

10 Fabrega H, "Somatoform disorder in psychiatric setting" 176 : 431-439, 1988

11 Lipowski ZJ, "Somatization and depression" 31 : 113-120, 1990

12 Lipowski ZJ., "Somatization : the concept and its clinical application" 145 : 1385-1368, 1998

13 Sifnoes PE, "Short-term psychotherapy and emotional crisis" Harvard University Press 1972

14 Walker LS, "Psychosocial correlates of recurrent childhood pain: a comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders" 102 : 248-258, 1993

15 Han CS, "Psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) for measuring the somatic symptoms of psychiatric outpatients" 50 : 580-585, 2009

16 Lloyd GG, "Psychiatric syndromes with a somatic presentation" 30 : 113-120, 1986

17 Spielberger CD, "Manual for the State Trait Anxiety Inventory" Consulting Psychologists Press 1970

18 Honkalampi K, "Is alexithymia a permanent feature in depressed patients? Results from 6-months follow-up study" 69 : 303-308, 2000

19 Lamb SE, "Factors that modify the association between knee pain and mobility limitation in older women : the women’s health and aging study" 59 : 331-337, 2000

20 Kroenke K., "Efficacy of treatment for somatoform disorders : a review of randomized controlled trials" 69 : 881-888, 2007

21 Lee YH, "Development and validation of a Korean version of the 20-item Toronto Alexithymia Scale(TAS-20K)" 35 : 888-899, 1996

22 Katon W, "Depression and somatization: a review. Part II" 72 : 241-247, 1982

23 Hiller W, "Causal symptom attributions in somatoform disorder and chronic pain" 68 : 9-19, 2010

24 Robbins JM, "Attribution of common somatic symptoms" 21 : 1029-1045, 1991

25 Simon GE, "An international study of the relation between somatic symptoms and depression" 341 : 1329-1335, 1999

26 Cox BJ, "Alexithymia in panic disorder and social phobia" 36 : 195-198, 1995

27 Honkalampi K, "Alexithymia and depression : a prospective study of patients with major depressive disorder" 42 : 229-234, 2001

28 Won HT, "A study on the cognitive characteristics of somatization (I) : The reliability and validity of the korean version of somatosensory amplification scale and symptom interpretation questionnaire" 17 : 33-39, 1998

29 Lee JJ, "A research using PHQ-15 on the somatic symptoms of the first visiting patients with depressive disorder at a university hospital [dissertation]"

30 Lee YH, "A Study of the Reliability and the Validity of the BDI, SDS, and MMPI-D Scales" 10 : 98-113, 1991

31 Hahn H, "A Standardization Study of Beck Depression Inventory in Korea" 25 : 487-502, 1986