지역사회 거주 정신질환자의 자기낙인이 회복에 미치는 영향 : 자기결정과 실천관계의 매개효과 = Effects of Self-Stigma on Recovery among Community-Dwelling People with Mental Illness: The Mediating Effects of Self-Determination and Practice Relationship

다국어 초록 (Multilingual Abstract)

Purpose: This study aimed to investigate the mediating effects of self-determination and practice Relationship on the relationship between self-stigma and recovery among community-dwelling individuals with mental illness.

Methods: A cross-sectional survey was conducted with 168 service users of community mental health welfare centers and psychiatric rehabilitation facilities. Data were collected using structured questionnaires assessing self-stigma, recovery, self-determination, and practice Relationship. Descriptive statistics, Pearson’s correlation, and multiple regression analysis were performed using SPSS 25.0, and mediation analysis was conducted using the PROCESS macro (Model 4) with bootstrapping (5,000 resamples).

Results: The mean level of self-stigma was 2.65 on a 5-point scale, which is lower than the midpoint, whereas recovery (3.40), self-determination (3.24), and practice Relationship (3.66) were all above the midpoint. Correlation analysis showed that self-stigma was significantly and negatively correlated with recovery (r=−.17), self-determination (r=−.19), and practice Relationship (r=−.27). Both self-determination (r=.73) and practice Relationship (r=.64) showed significant positive correlations with recovery. In the mediation model, the direct effect of self-stigma on recovery was not statistically significant (B=0.02, p=.770). However, the indirect effects through self-determination (B=−0.11, 95% BootCI [−0.22, −0.01]) and practice Relationship (B=−0.08, 95% BootCI [−0.17, −0.02]) were both significant, indicating full mediation.

Conclusion: These findings suggest that self-stigma does not undermine recovery directly, but rather indirectly by diminishing the internal resource of self-determination and the external relational resource of the practice Relationship. Therefore, recovery-oriented interventions for people with mental illness should focus on simultaneously empowering self-determination and fostering strong, collaborative therapeutic alliances with practitioners.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 연구의 필요성 1
• 2. 연구의 목적 3
• 3. 용어 정의 4
• Ⅱ. 문헌고찰 7
• 1. 정신질환자의 자기낙인, 회복, 자기결정, 실천관계의 개념 7
• 2. 정신질환자의 자기낙인, 회복, 자기결정 및 실천관계와 회복 간의 관계 13
• Ⅲ. 연구방법 19
• 1. 연구 설계 19
• 2. 연구 대상 19
• 3. 연구 도구 20
• 4. 자료 수집 방법 및 절차 24
• 5. 윤리적 고려 25
• 6. 자료 분석 방법 25
• Ⅳ. 연구결과 27
• 1. 연구대상자의 일반적 특성 및 정신질환 특성 27
• 2. 연구대상자의 자기낙인, 회복, 자기결정, 실천관계 정도 27
• 3. 연구 대상자의 일반적 특성에 따른 자기낙인, 회복, 자기결정, 실천관계의 차이 29
• 4. 대상자의 자기낙인, 회복, 자기결정, 실천관계 간의 관계 32
• 5. 대상자의 자기낙인이 회복에 미치는 영향에서 자기결정과 실천관계의 매개효과 32
• Ⅴ. 논의 37
• Ⅵ. 결론 및 제언 43
• 1. 결론 43
• 2. 제언 44
• 참 고 문 헌 46
• 부 록 55