당뇨병 환자의 자살위험: 1형 및 2형 당뇨병에 따른 자살 위험의 차이를 중심으로 = Suicide Risk in Diabetes Patients: The Differences in Suicidal Risks According to Type 1 and Type 2 Diabetes

국문 초록 (Abstract)

본 연구는 1,021,208명으로 구성된 ‘건강보험 표본코호트 데이터베이스’를 이용하였으며, 2006년부터 2015년까지 10년간의 사망원인 자료를 토대로 분석하였다. 당뇨병 환자의 자살위험을 확인하기 위하여 2006년에 당뇨병으로 진단받은 환자 및 암환자를 제외한 931,732 명을 최종분석대상으로 하였다. 분석방법은 당뇨병 진단이후 자살위험비를 확인하기 위하여 Cox 비례위험 모형(Cox proportional hazard model)을 통하여 분석하였다. 당뇨병 환자의 Hazard ratio(HR: 위험비)는 일반인보다 1.45배 (1.23 to 1.71)높았으며, 당뇨병 형태에 따라서는 1형 당뇨병 환자는 2.43배 (1.34 to 4.39) 2형 당뇨병 환자는 1.43배 (1.21 to 1.70) 높은 것으로 나타났다. 1형 당뇨병 환자의 특성으로는 고소득군 에서만 자살 위험비가 3.83배 (1.23 to 11.96)높게 나타났으며, 2형 당뇨병 환자의 특성으로는 20-39세 연령의 자살 위험비가 2.97배 (1.88 to 4.71)로 가장 높게 나타났다. 연구 결과 당뇨병 환자의 자살위험은 일반인 대비 높은 것을 알 수 있었으며, 당뇨병 형태에 따른 자살 위험비의 경향이 다르게 나타나는 것도 확인할 수 있었다. 이에 당뇨병 환자의 자살 예방을 위해서는 본 연구에서 나타난 자살위험 요인들을 고려하여 적절한 치료와 함께 정신건강 관리 등과 같은 적극적인 지원이 필요할 것이다.

다국어 초록 (Multilingual Abstract)

The study used the Health Insurance Sample Cohort DB, which consists of 1,021,208 people, and analyzed the cause of death for 10 years from 2006 to 2015 based on the data. The analysis method was analyzed through Cox proportional risk model to confirm the risk of suicide after diagnosis of diabetes. Hazard ratio(HR: risk ratio) of diabetic patients was 1.45 times (1.23 to 1.71) higher than that of normal people. Type 1 diabetes patients were 2.43 times(1.34 to 4.39) and Type 2 diabetes patients were 1.43 times(1.21 to 1.70) higher than that of normal people. Type 1 diabetes patients were 3.83 times higher in the high income group(1.23 to 11.96), and Type 2 diabetes patients were the highest in the suicide HR 2.97 times (1.88 to 4.71) of the age of 20-39. The results of this study showed that the risk of suicide in diabetic patients was higher than that of the general public, and the tendency of suicide HR was different according to the type of diabetes. Therefore, in order to prevent suicide in diabetic patients, it is necessary to take proper treatment and actively support such as mental health management considering the suicide risk factors shown in this study.

참고문헌 (Reference)

1 전홍진, "우울증과 자살" 대한의사협회 54 (54): 370-375, 2011

2 최령, "만성질환이 노인들의 스트레스인지, 우울증상 경험 및 자살생각에 미치는 영향" 보건의료산업학회 4 (4): 73-84, 2010

3 김춘숙, "도시노인의 폐경후의 삶" 경영연구원 4 (4): 9-22, 2010

4 Harriss, L., "Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury" 186 (186): 60-66, 2005

5 Mann, J. J., "Toward a clinical model of suicidal behavior in psychiatric patients" 156 (156): 181-189, 1999

6 Seo, M. S., "The relationship between pulmonary function and suicidal ideation in Korean adults: a nationwide survey" 23 (23): 1037-1045, 2018

7 Barnard, K. D., "The prevalence of co‐morbid depression in adults with Type 1diabetes : systematic literature review" 23 (23): 445-448, 2006

8 Anderson, R. J., "The prevalence of comorbid depression in adults with diabetes : a meta-analysis" 24 (24): 1069-1078, 2001

9 노정현, "The Diabetes Epidemic in Korea" 대한내분비학회 31 (31): 349-353, 2016

10 Sadock, V. A., "Synopsis of psychiatry behavioral Sciences/clinical psychiatry" Arjmand 135-182, 2007

11 Ahn, E., "Suicide rates and risk factors among Korean cancer patients, 1993-2005" 19 (19): 2097-2105, 2010

12 Lee, S. U., "Suicide rates across income levels : retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea" 27 (27): 258-264, 2017

13 Roy, A., "Suicide attempts and ideation in African-American type 1 diabetic patients" 179 (179): 53-56, 2010

14 World Health Organization, "Suicide Prevention (SUPRE)"

15 Harriss, L., "Suicidal intent in deliberate self-harm and the risk of suicide: the predictive power of the Suicide Intent Scale" 86 (86): 225-233, 2005

16 American Diabetes Association, "Standards of medical care for patients with diabetes mellitus" 20 (20): 2013

17 Wu, S. F. V., "Relationships among depression, anxiety, self-care behaviour and diabetes education difficulties in patients with type-2 diabetes : a cross-sectional questionnaire survey" 48 (48): 1376-1383, 2011

18 Hawton, K., "Psychiatric service development and suicide" 2009

19 Erlangsen, A., "Physical diseases as predictors of suicide in older adults : a nationwide, register-based cohort study" 50 (50): 1427-1439, 2015

20 Organization for Economic Co-operation and Development, "OECD Health Data 2017"

21 Voaklander, D. C., "Medical illness, medication use and suicide in seniors : a population-based case–control study" 62 (62): 138-146, 2008

22 Brådvik, L., "Long‐term suicide risk of depression in the Lundby cohort 1947–1997–severity and gender" 117 (117): 185-191, 2008

23 Fuller-Thomson, E., "Lifetime prevalence of suicidal ideation in a representative sample of Canadians with type 1 diabetes" 83 (83): e9-e11, 2009

24 Egede, L. E., "Independent factors associated with major depressive disorder in a national sample of individuals with diabetes" 26 (26): 104-111, 2003

25 Ceretta, L. B., "Increased prevalence of mood disorders and suicidal ideation in type 2 diabetic patients" 49 (49): 227-234, 2012

26 Wibell, L., "Increased mortality in diabetes during the first 10 years of the disease. A population‐based study(DISS)in Swedish adults 15–34 years old at diagnosis" 249 (249): 263-270, 2001

27 Lee, S. U., "Impact of disability status on suicide risks in South Korea : analysis of National Health Insurance cohort data from 2003 to 2013" 10 (10): 123-130, 2017

28 International diabetes Federation, "IDF diabetes Atlas Eighth Edition 2017"

29 Kjølseth, I., "Elderly people who committed suicide–their contact with the health service. What did they expect, and what did they get?" 14 (14): 938-946, 2010

30 정종현, "Depression and Mortality in People with Type 2 Diabetes Mellitus, 2003 to 2013: A Nationwide Population-Based Cohort Study" 대한당뇨병학회 41 (41): 296-302, 2017

31 Lee, J., "Cohort profile: the national health insurance service–national sample cohort (NHIS-NSC), South Korea" 46 (46): e15-e15, 2016

32 Chung, S. D., "Chronic prostatitis and depressive disorder: a three year population-based study" 134 (134): 404-409, 2011

33 Statistis Korea, "2016 Cause-of-Death Statistics Results"