우리나라 알코올 문제의 현황과 관리정책의 방향

서동우 이화여자대학교 가정과학대학 식품영양학과 아시아 식품영양연구소 1999 食品營養情報 Vol.- No.9

우리나라 정신보건전달체계 모형

서동우 漢陽大學校 精神健康硏究 1999 精神健康硏究 Vol.18 No.-

사회인구학의 임상적 특성과 입원시설 종류에 따른 정신보건시설 입원환자의 재원기간 분포

서동우 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.6

연구목적 : 장기입원 및 입소로 인한 정신보건체계의 비효율성과 정신질환자의 인권침해 등이 우려되고 있는 시점에서 다양한 정신보건시설에 입원 및 입소하고 있는 정신질환자의 재원기간의 분포를 정신질환자의 사회인구학적, 임상적 특성 및 정신보건시설의 종류별로 살펴보고자 본 연구를 수행하였다. 방 법 : 시도 분포, 도농 분포 등을 고려하여 임의로 추출한 국립정신병원, 공립정신병원, 사립정신병원, 대학병원, 종합병원, 정신과 의원의 정신의료기관 12개소, 정신요양시설과 부랑인시설 각 4개소, 무허가 기도원 2개소 등 총 22개소의 정신보건시설의 1,028명의 입원 및 입소 정신질환자를 대상으로 면접조사를 실시하였다. 면접조사는 1999년 4월부터 8월에 걸쳐 정신과 전문의와 정신과 임상경력이 있는 사회복지사가 한 팀이 되어 시설을 직접 방문하여 무작위 추출한 입원환자를 대상으로 실시하였다. 결 과 : 우리 나라 전체 정신보건시설 입원 및 입소환자의 평균 재원기간은 1,368일이었고, 성, 연령, 교육 및 종교 등의 사회인구학적 특성과 경제적 상태, 의료보장 형태, 가족지지정도, 입원전 거주형태 등의 사회경제적 특성, 정신질환 종류, 발병 연령, 입원횟수 등의 임상적 특성, 과거 직업력, 일상 및 사회 생활기능 수준, GAF 점수 등의 기능장애 수준 등에 따라 재원기간에 유의한 차이를 보였으나 결혼상태와 정신과 증상의 심각도와 재원기간은 유의한 관련성을 보이지 않았다. 정신보건시설별로는 정신요양시설이 가장 긴 재원기간을 보였고, 그 다음이 부랑인시설, 무허가기도원, 사립정신병원 환자의 재원기간이 다른 시설보다 유의하게 긴 편이었다. 토 론 : 정신보건시설 재원기간의 적정성을 위해서는 적절한 입원(입소) 후 지역사회로 퇴원시킬 수 있도록 정신보건시설 공급자를 유인하는 정책과 장기입원(입소)를 선호하는 정신질환자 가족에게 퇴원과 지역사회 거주를 선택할 수 있도록 하는 의료 및 사회경제적 유인체계인 지역사회정신보건 체계의 구축이 필요하다고 하겠다. Objectives : Recently the issue on the violation of human rights has been raised in mental health system in Korea. In these cirmstances this study was conducted to investigate the length of stay of psychiatric inpatients by sociodemographic, clinical characteristics, and type of mental health facilities. Methods : The total 1,028 subjects were randomly selected from 22 mental health facilities, including mental hospitals, general hospitals, psychiatric clinics, mental health welfare facilities, welfare facilities for homelessness, and illegal asylums. The subjects were interviewed by psychiatrists and social workers with clinical experiences. Results : The average length of stay of psychiatric inpatients of mental health facilities in Korea was 1,368 days, and it was statistically different according to sociodemographic and clinical characteristics such as sex, age, education, religion, economic status, type of medical security, degree of family support, living condition before admission, diagnosis, age of onset, and number of admissions. In addition, the length of stay was associated with the type of mental health facilities. Conclusion : For more appropriated length of stay of psychiatric inpatients, not only various incentives for service suppliers are needed but also medical and socioeconomic incentives for patients and familiy members should be considered in order to facilitate their community-living.

정신보건관련시설 입원(소)자의 주요 정신장애 유병률 : 전국 20개 시설의 입원(소)자를 대상으로

조성진,조맹제,서동우,함봉진,홍진표,배재남,이준영,이동우,박종익,전홍진,김성주,김용익 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.6

Objectives : One of the objectives of this study is to estimate the prevalence rates of psychiatric diagnoses in the combined populations of psychiatric hospitals, psychiatric nursing facilities and homeless asylums using the Korean version of the Composite International Diagnostic Interview (K-CIDI), which is a comprehensive and fully standardized interview schedule to assess psychiatric disorders for diagnosis. The Other objective is to compare with previously studied prevalence rates of Psy-chiatric diagnoses using the results of this study. Methods : The study subjects, aged from 181o 64 years, were randomly selected from 64,582 institutionalized population of psychiatric hospitals, Psychiatric nursing facilities and homeless asylums as of 30, June, 2001. Twelve trained interviewers administered the K-CIDI to the selected respondents. A total of 1,875 respondents (male 1,194, female 681) completed the interview. Results : The lifetime and one year prevalences of any diagnosis excluding nicotine dependence · withdrawal, anxiety disorder, eating disorder, somatoform disorder were 88.2% (male 88.1%, female 88.3%), and 65.8% (male 62.7%, female 73.7%), respectively. The lifetime and one year prevalences of schizophrenia and other psychotic disorders were 78.5% (male 75.3%, female 83.7%), and 56.8% (male 51.9%, female 64.8%), respectively. The lifetime and one year prevalences of alcohol use disorder (dependence/abuse) were 26.7% (male 37.9%, female 8.3%), and 8.7% (male 12.8%, female 2.1%), respectively. The lifetime and one year prevalences of mood disorder were 18.1% (male 13.5%, female 25.8%), and 10.4% (male 7.2%,female 16.9%), respectively. The lifetime and one year prevalences of schizophrenia and other psychotic disorders were comparable with the 2001 community survey by 1.19% to 1.32%, and 0.51% to 0.61%, respectively. The lifetime and one year prevalences of schizophrenia were also comparable by 0.16% to 0.28%, and 0.16% to 0.25%, respectively. There were no significant changes of prevalence rates when correction were applied to other psychiatric diagnosis. Conclusion : The results of this study could be used for evaluating the distribution of psychiatric diagnoses in mental health related facilities and for planning mental health policies.

알코올의존 고의심군의 사회인구학적 특성 및 위험요인 분석 : 전국적 확률표본을 대상으로 Nationwide Probability Sample Survey

조성진,서국희,남정자,서동우,조맹제 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.6

연구목적 : 본 연구는 일반 성인인구중 '술을 즐겨 마신다'고 응답한 20세 이상의 대상자들에게 CAGE를 적용하고, CAGE 총점이 2점 이상일 때 알코올의존 고의심군으로 규정하였다. 이들 알코올의존 고의심군들의 유병률을 산출하고. 사회인구학적 특성 및 음주양태를 알코올 비의존군과 비교분석하고 알코올의존 고 의심군의 위험요인들을 알아보고자 하였다. 연구방법 : 전국을 6대도시, 기타도시. 군 지역으로 층화하여 얻은 110개 기본 표본조사구에서 15∼69세에 해당되는 5,805명중 20세 이상인 5,331명을 선정하였다. 시골지역에서 대상자가 과잉 선정된 것이 결과에 미치는 영향을 제거하기 위하여. 실재 면접대상자인 5.331명에 대하여 지역에 따른 보정을 시행하였다 이들을 비의존군(CAGE<1)으로 구분하여. 이들의 사회인구학적 특성과 음주양태를 비교하였다. 조사자료 통계는 빈도, 백분율, chi-square test 및 multiple logistic regression analysis를 사용하였다. 연구결과 : 본 조사연구의 분석결과를 통계적으로 유의한 차이를 보인 항목으로 살펴보면 다음과 같다. 1) 전체 음주비율은 33.7%였고, 남녀별 음주비율은 각각 26.3%와 7.40%였다. 전체 알코올의존 고의심군 비율은 10.9%였으며. 남녀별 알코올의존 고의심군 비율은 각각 9.94%와 0.94%였다. 2) 음주자들의 사회인구학적 특성을 비교한 결과. 남자에서 알코올의존 고의심군이 알코올 비의존군들에 비해서 나이가 더 많고, 학력이 낮으며, 서비스직에 종사하며, 기혼자나 배우자와 사별한 사람이 많았고, 우울증상을 동반한 경우가 많은 것으로 나타났다. 여자의 경우, 알코올의존 고의심군이 알코을 비의존군보다 학력이 낮고,월평균수입이 작으며 우울증상을 동반한 경우가 많으며, 흡연경험이 많은 것으로 조사되었다. 3) 음주자들의 음주양태를 비교한 결과를 보면, 남자에서 알코올의존 고의심군들은 알코을 비의존군 보다도 음주횟수가 많고, 음주량도 많으며 , 절주를 시도한 경우도 많았고, 또 소주를 선호하였다. 여자의경우, 알코올의존 고의심군들이 알코올 비의존군과 비교하여 음주 횟수가 많았고, 음주량도 유의미하게 많았으며. 지난 1년간 과음 횟수도 많았고, 절주나 금주를 더 많이 시도하였다. 4)사회인구학적 변인들의 다중로짓분석 결과, 남자는 교육년수가 6년 이하이고.우울증상을 동반할 경우, 알코올의존 고의심군이 될 위험성이 높은 것으로 조사되었다. 여성에서 통계적으로 유의한 위험요인은 없었으나, 역시 저학력과 우울증상이 높은 위험도를 시사하였다. 결론: 본 연구에서 알코올의존 고의심군의 유병률은 10.9%이었고, 남녀비율은 10.6대 1로 감소하는 경향을 보였다. 알코올의존 고의심군의 위험요인며 우울증상과 초등학교 이하의 학력인 것을 고려할 때 우울증상의 조기발견과 치료, 저학력자에 대한 집중적인 교육이 필요할 것으로 생각된다. 0bjectives : The aims of this study were 1) to estimate prevalence rates of drinkers, two subtypes of drinkers-drinkers without dependence and drinkers with probable alcohol dependence(AD) using CAGE, and 2) to fed out the correlates of sociodemographic variables and drinking patterns of the drinkers with probable AD by comparing those of the drinkers without dependence,3) to analyse risk factors for the drinkers with probable AD. Methods : Using data from face-to-face interviews conducted during 1995, we investigated the prevalence and characteristics of two subtypes of drinkers in a national probability sample of 1,695 drinkers 20 years of age and older, We defined drinkers with CAGE scores 2 and over as drinkers with probable AD, and scores less than 1 as drinkers without dependence. The comparisons of sociodemogaphic characteristics and drinking patterns between two subtypes of drinkers were examined through chi-square test using weighted data. Statisical analysis including multiple logistic recession analysis were done for each sex, respectively. Because of the large number of coefficients estimated, Bonferroni's method was used to compute p values. Results : The results were as fo11ows 1) Prevalence of the drinkers was 33.7% in the total sample. Prevalence rate of male and female drinker were 26.3% and 7.40%, respectively. Prevalence of the drinkers with probable AD was 10.9%. for males the prevalence of the drinkers with probable AD was 9.99% and for females 0.94%. 2) According to sociodemographic variables between drinkers without dependence and drinkers with probable AD, males drinkers with probable AD were older, less educated, more depressive, married marital status and were more likely to have occupations of service section than male drinkers without dependence. female drinkers with probable AD were less educated, more depressive and had less monthly income than drinkers without dependence. 3) As for the drinking patterns, male drinkers with probable AD drank more frequently, had more drinks, had more trying to quit drinking and preferred Soju. Female drinkers with probable AD drank more frequently, had more drinks, were more trying to quit drinking, too. 4) Multiple logistic recession analysis showed that the risk factors for male drinkers with probable AD were lower education(≤6 years) and depressive symptoms. For females, depressive symptoms and lower education(≤6 years) were strongly indicative of risk factors though not reaching the statistical significance. Conclusions : Preva1ence of the drinkers with probable AD was 10.9%, and male to female ratio was 10.6 1, which was lower than previous results. Depressive symptoms and lower education proved to be strong predictors for alcohol dependence. This suggest that early detection and treatment of depression and public education for the lower education group should be important.

Epidemiology of Suicide in Korea

JinPyo Hong,MyengJi Bae,Tongwoo Suh 대한신경정신의학회 2006 PSYCHIATRY INVESTIGATION Vol.3 No.2

In 2002, an estimated 877,000 lives were lost worldwide through suicide. In Korea, suicidal deaths have increased very rapidly since the economic crisis in 1997, and suicide is regarded as one of the most serious public health and social issues in Korea. This study examines the current situation and trends of the recently increasing rates of suicidal deaths, ideas, and attempts in Korea. This study reanalyzed the 20-year statistics of suicidal deaths recently published by the National Statistical Office and the data of the National Health Interview Survey conducted in 1995 and 1998. The suicidal mortality rate in Korea is quite high compared to those in other OECD countries and the rate of increase is the highest. The rate of suicidal idea is high among males, those in their late teens and those in their seventies. The suicidal attempt rate is higher among females and those in their late teens. Suicide, one of the important causes of death in the younger age group, has a greater socioeconomic impact than other common causes of death in the older age group. Therefore, we are in urgent need of a public mental health network to prevent suicide and to detect and treat early mental health problems leading to suicide.

대한민국 법령에 나타난 정신질환에 대한 차별 조항 및 그 개선에 관한 연구

박종익,이성동,정은기,서동우,홍진표 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.2

정신질환으로 인한 총체적 질병부담에 대한 정신건강전문가들의 인식도 조사

김진영,정성훈,서동우,방수영,이해국,정인원 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.1

Objectives : The aim of this study was to investigate how mental health professionals in Korea evaluate the burden of disease caused by psychiatric disorders and to propose future directions of the public mental health policies. Methods : A questionnaire was mailed to 240 mental health professionals, who were composed of psychiatrists from mental hospitals and staffs who are nurses, clinical psychologists and social workers working in the community mental health centers in June, 2004. Two hundred twenty four out of two hundred forty subjects (93.3%), which were composed of 104 psychiatrists and 120 staffs, completed the questionnaire. The questionnaire included 6-item questions about the burden of disease in Korea. Results : Mental health professionals reported that the five diseases with the biggest burden were malignant neoplasms, traffic accidents, schizophrenia, alcohol use disorders and cerebrovascular diseases, consecutively. The burden of alcohol use disorders, cerebrovascular diseases, traffic accidents, unipolar depressive disorder and malignant neoplasms are expected to increase over the next several years. The proportions of psychiatric disorders among all the diseases in terms of burden of disease and medical costs were estimated as 18.4% (±12.8) and 12.0% (±11.7) respectively. Conclusion : This study showed that many of Korean mental health professionals have under-estimated burden of psychiatric disorders, especially, unipolar depressive disorder. It would be necessary to emphasize the importance of unipolar depressive disorder in applying educational and public programs for the mental health professionals, as well as for the general population.

Effect of Antipsychotics on the Quality of Life of Schizophrenic Patients in Community Mental Health Centers : Conventional versus Atypical Antipsychotics

In-Won Chung,Heon Kim,Tongwoo Suh,손정우 대한정신약물학회 2004 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.2 No.1

The purpose of this study was to examine an association between the type of antipsychotic drugs administered and the quality of life of schizophrenic patients attending rehabilitation programs in the community setting. The sociodemographic and clinical information for individual patients attending rehabilitation programs in 16 mental health centers was gathered from questionnaires self-reported by patients and filled by mental health center workers who interviewed the patients. The schizophrenic patients included in this study were categorized into two groups, depending on whether a drug prescribed was a conventional or atypical antipsychotic drug. The patients were selected by 1: 1 matching for sex and age from two groups in order to explore the association of antipsychotics and quality of life (QoL) assessing with Quality of Life Scale (QLS). Confounding effects by some other sociodemographic factors, which might directly influence the selection of antipsychotics and QoL, were excluded by 1: 1 matching for variables. Out of 301 schizophrenic patients, 226 individuals in 113 pairs comprising one person in each group were analyzed to identify the differences between two groups. The QoL of the patients treated with atypical antipsychotics was found to be higher than that of those treated with conventional antipsychotics, even after the results were adjusted for sex, age, and sociodemographic variables such as medical insurance, education, family income per capita and psychiatric institution. These results provide meaningful evidence that atypical antipsychotics improve QoL as compared to conventional antipsychotics among schizophrenic patients who are attending rehabilitation programs in mental health centers.

정신보건법의 주요 쟁점 조항에 대한 선진국과의 사례 비교

홍진표,황순찬,박수빈,서동우,정은기,김진학,박종익,안주연,김수정,장홍석 大韓神經精神醫學會 2009 신경정신의학 Vol.48 No.2

Objectives The Mental Health Act is an initiative aimed at changing and shaping mental health services and protecting human rights of persons with mental disorders. Since the Mental Health Act was legislated in 1995, four amendments have been made according to the issues that arose from public concerns. However, there are still many debates about the human rights protection of the mentally iII. This study aimed to provide information regarding major aspects of the Mental Health Act by comparing them among several developed countries. Methods Current Mental Health Acts of the state of Michigan in the United States, Scotland in England, the state of Victoria in Australia, and Japan were reviewed. Issues regarding the Korean Mental Health Act were collected from seminar materials, news media contents, and mental health professionals Results The definition of subjects in Korean Mental Health Act was more inclusive than other countries and was derived from a medical classification of mental illness. Family members or guardians were granted important responsibilities for deciding the involuntary admission of mentally ill patients in Korea and Japan. In Western countries, Mental Health Review Tribunals or courts have the primary responsibility for important decisions about mentally ill patients. The regulation of immediate dis- charge after request by voluntarily admitted patients was not enacted in all countries except Korea. The mandatory procedure for involuntary admission in Western countries includes an individual case review with personal interview by a Mental Health Review Tribunal or court. Conclusion The Korean Mental Health Act appears to meet the basic standards of Guidelines from international organizations. Our traditional culture and inherent health systems seem to influence the legal regulation of mental health service and might be related to the problems of human rights protection of mentally ill patients in Korea.