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취약계층과 안전계층 노인에서 우울증상과 인지기능 저하가 자살의도에 미치는 영향
서경훈(Kyung Hoon Suh),최경화(Kyung-Hwa Choi),황재연(Jae Yeon Hwang),임경미(Kyung Mi Yim),전영주(Yeong Ju Jeon),김형준(Hyung Joon Kim),한창환(Chang Hwan Han),류성곤(Sung Gon Ryu) 대한사회정신의학회 2015 사회정신의학 Vol.20 No.2
연구목적 : 본 연구의 목적은 노인 인구 집단에서 취약성에 따라 우울 증상과 인지 장애가 자살 사고에 미치는 영향을 알아보고자 함이다. 방 법 : 총 347명의 65세 이상 지역사회 거주 노인들을 대상으로 모집하여 그들의 사회인구학적 정보, 가족관계, 건강 상태, CAGE 점수, 스트레스 정도, 단축형 노인우울척도 점수를 수집하였다. 인지 장애와 자살 사고는 각각 한국판 간이 정신상태 판별검사, 자살생각 척도를 이용하여 평가되었다. 결 과 : 취약 계층에서 자살사고의 유병률은 18.5%, 안전 계층에서는 8.2%였다. 취약계층에서의 우울 증상은 자살사고와 관련이 있었다(Odds ratio : 6.1, 95% confidence interval : 1.93 to 19.33). 결 론 : 본 연구에서, 낮은 사회경제적 상태에 있는 취약 계층의 노인이 안전 계층의 노인에 비해 자살 사고의 위험이 높았다. 이 결과는 미래의 정신 보건 정책이 낮은 사회경제적 상태에 있는 지역사회 거주 노인들의 중요성을 고려하여야 한다는 점을 시사한다. Objectives : The purpose of this study was to examine the influence of depressive symptoms and cognitive impairment on suicidal ideation in an elderly population, according to vulnerability. Methods : A total of the 347 community-dwelling elderly individuals aged 65 years or older were recruited and information on their sociodemographics, family relationships, health status, CAGE (Cut down, Annoyed, Guilty, Eye-opener) scores, stress levels, and scores on the Korean version of the Short Geriatric Depression Scale was collected using questionnaires. Cognitive impairment and suicidal ideation were evaluated by using the Mini Mental Status Exam-Korean version (MMSE-K) and the Scale for Suicide Ideation (SSI), respectively. Results : The prevalence of suicidal ideation in the vulnerable group was 18.5% and in the secure group was 8.2%. The presence of depressive symptoms in the vulnerable group was associated with suicidal ideation (Odds ratio : 6.1, 95% confidence interval : 1.93 to 19.33). Conclusion : In this study, the risk of suicidal ideation in the vulnerable group consisting of low-socioeconomic status elderly individuals was higher than that in the safety group. These results suggest that future mental healthcare policies should consider the importance of community-dwelling elderly individuals with low-socioeconomic status.
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자살시도자들에서 충동성과 자살시도의 의학적 치명도와의 관계
박지원,서경훈,손경훈,한재현,전영주,정유진,이원준,성수정,한창환,조규종,황재연,Park, Ji Won,Suh, Kyung Hoon,Son, Kyung Hoon,Han, Jae Hyun,Jeon, Yeong Ju,Jung, Yu Jin,Lee, Won Joon,Seong, Su Jeong,Han, Chang Hwan,Cho, Gyu Chong,Hwang, J 대한생물정신의학회 2018 생물정신의학 Vol.25 No.4
Objectives Although impulsivity has long been thought as an important factor influencing suicidal behaviors, it is unknown whether impulsivity increases the risk of dying from suicidal behaviors and what specific component among constructs of impulsivity contributes to the risk of dying among suicide attempters. Methods To elucidate the association between impulsivity and medical lethality of suicide attempt among suicide attempters, we consecutively recruited 46 suicide attempters who visited an emergency room of a general hospital located in a metropolitan area, Seoul, Republic of Korea, due to suicide attempts and consented to participate in this study. Then we assessed medical lethality with the Beck Lethality Scale (LS) and impulsivity with the Korean version of the Barratt Impulsiveness Scale-11-Revised (BIS). Demographic variables were obtained from medical records and structured social work reports for suicide attempters. Results Although total scores of the BIS did not correlate with LS scores, only the scores of self-control, that is one of the Barrett's six theoretical constructs of impulsivity in which the higher score indicates less self-control and more impulsivity, had a significant positive correlation with scores of LS (p = 0.003). The association remained significant after adjusting for variables known to affect suicide lethality such as job status, recent alcohol consumption, diagnosis of depressive disorders, and having a plan for suicide (${\beta}=0.429$, p = 0.009). Conclusions Not impulsivity in general, but poor self-control, in particular, predicts lethal suicidal behaviors among suicide attempters. The degree of self-control should be evaluated when assessing patients with elevated suicide risk, and proper measures should be installed to prevent possible future lethal suicide attempts.
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