대구지하철 참사를 경험한 소방대원의 외상 후 스트레스 유형

다국어 초록 (Multilingual Abstract)

The purpose of the present study was to identify the subjective types and
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* A thesis submitted to the Committee of Graduate School, Chungnam National University in partial fulfillment of the requirements for the degree of Doctor of Public Health conferred in February, 2006.

structures of the posttraumatic stress in firefighters who experienced the Daegu subway fire disaster, to develop assessment tool for types and to provide a basis for an effective program development supporting the firefighters to cope with and to decrease posttraumatic stress substantially in following disasters.
This study used Q-methodology that is self-psychology and abductive logics including concepts of reasoning to the hypothesis and operant definition.
The process of research through Q-methodology has been conducted as follows;
1. Selecting Q-populations was conducted through the in-depth interviews by the 13 firefighters experienced the Daegu subway fire disaster and through literature review on the previous studies and books from December, 2004 to April, 2005.
2. 130 Q-statements were selected for posttraumatic stress as a Q-populations. Among them, the statements considered to have common significance or values were categorized by theme. 44 statements for posttraumatic stress were selected as a Q sample.
3. For P-sample, 25 firefighters experienced the Daegu subway fire disaster and who agreed to participate this survey was selected.
4. The selected 44 statements were printed on 9cm x 5 cm cards and P-sample were done Q-sorting by classifying in 11 scales.
5. Collected data were analyzed with a factor analysis using the QUANL PC program.
The results are as follows;
There are 3 types of posttraumatic stress : Emotional arousal trauma, Physiological symptom experience, trauma experience persistence.
The first type of firefighters have a more mild symptom because they'd endeavored to decrease their stress by an active approach. But increased arousal reactions have been experienced continuously.
The second type of firefighters have a physiological symptom brought by anxiety and strain from not managing the stress.
The third type of firefighters have a trauma experience persistence state that they keep reexperiencing, avoidance and hyperarousal symptom, So this type of of firefighters have experienced a most severe posttraumatic stress symptom.
Q-block is developed as a assessment tool for big size sample. Q-block contains Q1, Q2, Q3 questionnaire. The Q1-block contains『My feeling with regard to the disaster is insensitivity.』,『It seems that my feeling with regard to the disaster is insensitivity as time goes on.』,『The stress has disappeared a little bit when I talked about the disaster.』. The Q2-block contains『I have suffered from the muscular pain or migraine and always been tired after the disaster.』,『It seems that the power of memory and concentration impaired gradually after the disaster.』,『I have frequently suffered from bronchial symptoms and a cold sweat.』. The Q3-block contains『I have tried to avoiding the situation and event that remind me of the disaster.』,『I have been painful when the memory related to the disaster came across my mind suddenly without intent.』,『I have avoided to tell about the disaster because family and friends should be worried about my job, a firefighter.』.
Base on the result of this research, it is identified that firefighters' posttraumatic stress is categorized into three types which have unique and distinct characteristics, these three types overrapping.
The types are showed that firefighters had experienced not only reexperience of the accident, avoidance and increased hyperarousal symptoms by the diagnosis criteria of American Psychological Association (APA, 1994) but also partial posttraumatic stress symptoms of various levels. The need for institutional system is proposed to decrease posttraumatic stress and to cope with it appropriately through pattern analysis Also this study can be supplying crucial data for the development of intervention program for posttraumatic stress of firefighters by understanding subjectivity of posttraumatic stress.
The Q-block as an assessment tool is developed to generalize this result by Q methodology for large sample. So this Q-block design will be helpful for assessing posttraumatic stress of firefighters in quantitative research and for determining psychiatric health level of firefighters.

국문 초록 (Abstract)

대구 지하철 참사를 경험한 소방대원들이 경험한 외상 후 스트레스의 주관적 유형을 파악하고 유형을 측정할 수 있는 사정도구를 개발하하고자 Q 방법론을 적용하여 2004년 12월에서 2005년 4월까지 대구 지하철 참사 현장에 참여한 소방대원을 대상으로 44개의 진술문을 11점 척도상에 분류하도록 한 뒤 Q요인분석을 실시하였다. 연구결과 대구 지하철 참사를 경험한 소방대원들의 외상 후 스트레스 유형은 정서적 과민형, 생리적 증상 경험형, 외상경험지속형의 세 가지 유형으로 분류되었다.발견된 세 유형을 큰 표본의 대구 지하철 참사를 경험한 소방대원들을 대상으로 가설연역적 방법의 양적 연구를 실시할 수 있도록 측정하는 도구인 Q1, Q2, Q3의 Q-block을 개발하여 외상 후 스트레스 경험을 주관성으로 접근하여 중재 프로그램 개발을 위한 좋은 자료를 제공하고 있으며 큰 표본 조사를 위한 Q-block design의 개발으로 향후 대량 재해 발생 시 소방대원들이 경험하는 외상 후 스트레스를 확인하고 측정할 수 있는 도구로서 외상 후 스트레스라는 주관적 경험을 양적연구에서 검증할 수 있는 토대를 마련하였다.

목차 (Table of Contents)

• Ⅰ. 서 론 = 1
• Ⅱ. 방법론적 배경 = 5
• Ⅲ. 연구 방법 = 8
• 1. 연구설계 = 8
• 2. 연구절차 및 방법 = 8
• 1)Q모집단 구성 = 10
• 2)Q표본의 선정 = 11
• 3)P표본의 구성 = 16
• 4)Q분류과정 및 방법 = 16
• 5)자료처리 및 분석방법 = 18
• 6)측정도구개발 = 19
• Ⅳ. 연구 결과 = 20
• 1. 소방대원의 외상 후 스트레스 Q유형의 형성 = 20
• 2. 소방대원의 외상 후 스트레스 유형별 결과 = 23
• 1)유형 1 = 23
• 2)유형 2 = 35
• 3)유형 3 = 43
• 3. 세 유형 측정을 위한 도구 Q-block 개발 = 51
• Ⅴ. 고찰 = 54
• 1.유형의 형성에 대한 고찰 = 54
• 2.유형별 특성에 대한 고찰 = 59
• 3.평가도구(Q-block) = 65
• 4.재해발생 시 대처 전략 = 66
• Ⅵ. 결 론 및 제언 = 68
• 참고문헌 = 71
• ABSTRACT = 77