HIV 감염인의 자살생각과 결정요인

다국어 초록 (Multilingual Abstract)

This study was performed to examine the rate of suicidal ideation in people living with HIV/AIDS and to determine the effects of general characteristics, symptom, functional status, quality of life, depression and perceived stigma on suicidal ideation of those people by building a conceptual model. Four hospitals participating in the government-funded Clinic Counselling Project and 20 public health centers among the whole centers were selected as locations for the survey, considering the number of people with HIV/AIDS, the willingness of HIV/AIDS staff to participate in the survey, and the extent of their understanding for its purpose. The survey was conducted among people with HIV/AIDS visiting one of the selected locations, who agreed to participate in this survey and completed a self-report questionnaire. In total, the number of subjects for the survey was 298. The period of the investigation was from June to December in 2008.
The major findings of the study were as follows :

1. The rate of suicidal ideation of study group was 58.1%, the transition probability was 13.9% from suicidal ideation to suicide attempt. There were no attempts among peoples living with HIV/AIDS who did not think about suicide. The rate of suicidal ideation of people living with HIV/AIDS is much higher than that of general population which is 15%.

2. The suicidal ideation group and non-suicidal ideation group presented differences in terms of general characteristics such as unemployment experience caused by HIV infection, residential status, and social relationship scores. More people in the suicidal ideation group had lost their jobs because of their HIV status, lived alone, and obtained significantly lower scores in social relationship thon those in the non-suicidal ideation group.

3. The mean score of symptom among factors affecting on suicidal ideation was significantly higher in suicidal ideation group than in counterpart and the scores of 4 components of functional status, physical, role, social and cognitive functioning were significantly lower in suicidal ideation group. The suicidal ideation group perceived their health worse, and had a higher mean score for depression, lower quality and satisfaction of life than counterpart. The scores of 4 components of perceived stigma, personalized stigma, disclosure concerns, negative self-image and concern with public attitudes about people with HIV were significantly higher in suicidal ideation group.

4. This study built the conceptual model through literature review and test the significance on the each path in the model using multiple regression and logistic regression analysis. Based on these results of test, the covariance structure model was analyzed and finally modified model satisfying goodness-of-fit was developed. Results from structural equation model indicated that depression and quality of life were determinants that directly affect suicidal ideation, with depression having greater effect than latter. Symptom, functional status, health perception, perceived stigma were indirect determinants of suicidal ideation. High symptom score had indirect effect on increasing suicidal ideation, with functional status, health perception and depression as mediating factors. Good functional status had indirect effect on decreasing suicidal ideation, with health perception and depression as mediating factors. Favorable perception of health had indirect effect on decreasing suicidal ideation, with depression as a mediating factor. Perceived stigma had indirect effect on suicidal ideation, with depression and quality of life as mediating factors. Higher perceived stigma increased the frequency of suicidal ideation. Among general characteristics, determinants indirectly affecting suicidal ideation include: eligibility for welfare benefits; level of education; monthly income level; unemployment experience following HIV infection; and level of social relationship. It was found that the social relationship level had the greatest effect on suicidal ideation.

In conclusion, the rate of suicidal ideation of people living with HIV/AIDS was much higher than that of general population. The suicidal ideation of people with HIV/AIDS was determined by the level of symptom, functional status, health perception, perceived stigma, quality of life and depression. In particular, the level of depression was direct determinant and its effect size was bigger than others. Its coefficient of determination was 0.443.

목차 (Table of Contents)

• Ⅰ. 서 론 1
• 1. 연구의 배경 및 필요성 1
• 2. 연구 목적 5
• Ⅱ. 문헌고찰 및 연구모형 6
• 1. 문헌고찰 6
• 2. 연구모형 18
• Ⅲ. 연구 방법 24
• 1. 연구대상 및 조사방법 24
• 2. 변수 정의 및 측정도구 25
• 3. 자료처리 및 분석방법 28
• Ⅳ. 연구결과 30
• 1. 연구대상자의 자살생각과 자살시도 30
• 2. 연구대상자의 일반적 특성 31
• 3. 연구대상자의 증상, 기능상태, 건강인지, 우울, 삶의 질, 자기낙인점수 비교 33
• 4. 연구모형에 대한 탐색적 분석 35
• 5. 공분산 구조분석 55
• Ⅳ. 고 찰 60
• Ⅴ. 요약 및 결론 67
• 참고문헌 69
• ABSTRACT 80
• 부록 83
• 1. HIV 감염인의 증상 측정도구(SSC-HIV) 83
• 2. HIV 감염인의 자기낙인 측정도구(HIV-Stigma) 84