소방공무원의 직무유형에 따른 불면과 신체화증상과의 관계 = The Relationship between Insomnia and Somatization According to Types of Work of Firefighters

다국어 초록 (Multilingual Abstract)

Objectives：Firefighters are always under stress due to their job environment, and they are likely to become psychologically vulnerable due to continuous exposure to traumatic events, which is a stressful situation that requires emergency standby at all times. The aims of this study were to examine mental health factors for each division of firefighters and to see the relationship between sleep and somatization symptoms among them.
Methods：General characteristics and related inspections were conducted through self-reporting questionnaires for 1,264 firefighters working at Chungbuk fire stations. Several mental health factors were investigated by the Insomnia Severity Index, Severity of somatic symptoms, Impact of Event Scale, Perceived Stress Scale, Resilience Scale, Alcohol Dependent Screening Scale, and the Center for Epidemiologic Studies Depression Scale Depression Scale and Mini-International Neuropsychiatric Interview.
Results：Among the mental health variables, the relationship between insomnia and somatization varies significantly depending on types of work. It was reported that the first aid team was significantly higher than the fire suppression and rescue team. Post-traumatic stress, depression and drinking also differ significantly depending on types of work. The first aid team reported more posttraumatic stress than the fire suppression team and more depressed mood than the rescue team. The administration part had more alcohol consumption than the fire suppression or first aid team. Resilience was significantly higher in the rescue team than the first aid team. No significant differences between the types of work about stress and suicide risks. Insomnia, stress, and post-traumatic stress were significant predictors of somatization among firefighters. Above all, insomnia was significant mental health variable affecting somatization.
Conclusions：Various mental health factors were different according to the types of work in firefighters. The First aid team was more vulnerable to mental health variables such as insomnia and somatization than other divisions.
Insomnia is the most important cause of somatization in firefighters, so it is recommended that they be treated for insomnia and to prepare institutional policies.

국문 초록 (Abstract)

연구목적소방공무원은 직무 환경 상 항상 비상대기를 해야 하는 스트레스 상황에 처해있으며, 지속적인 외상적 사건에의 노출로 인해 불면, 우울을 포함한 다양한 정신질환에 취약 해지기 쉽다. 이에 소방공무원들의 직무 유형별 정신건강요인의 차이 유무를 살펴보고, 특히 그 중에서도 업무의 지장 및 불편을 줄 수 있는 불면과 신체화증상과의 관련성을 보고자 한다.
방 법충청북도 소재 지역 소방서에 근무하는 소방공무원 1264명을 대상으로 자기보고식 설문지를 통하여 일반적특성 및 관련 검사를 수행하였다. 불면증 심각성 척도(ISI), 신체화 증상 척도(PHQ-15), 사건 충격 척도(IESR- K), 스트레스 척도(PSS-10), 회복탄력성 척도(K-CD-RISC-2), 알코올 의존 선별검사 척도(AUDIT-K), 역학연구센터 우울 척도(CES-D) 및 국제 신경정신평가(MINI-plus)의 자살 척도를 활용하여 정신건강상태현황 조사 및 요인 간의 관련성을 평가하였다.
결 과정신건강요인들 중 불면증과 신체화증상의 관련성은 직무 유형에 따라 유의한 차이가 있으며 구급 직군이화재진압 직군과 구조 직군보다 유의하게 높은 것으로 보고되었다. 사건 충격, 우울, 음주도 직무 유형에 따라유의한 차이가 있으며, 사건 충격은 구급 직군이 화재진압 직군보다 높고 우울은 구급 직군이 구조 직군보다높으며 음주는 행정 직군이 화재진압 직군, 구급 직군보다 높은 것으로 보고되었다. 회복탄력성은 구조 직군이구급 직군보다 유의하게 높았다. 스트레스, 자살위험성은 직무 유형에 따라 유의한 차이가 없는 것으로 보고되었다. 또한 소방공무원 신체화증상의 유의한 예측 인자로 불면증, 스트레스, 사건 충격이 있었으며, 특히 불면의 영향이 큼을 보여주었다.
결 론본 연구를 통해 지역 소방공무원들의 직무 유형에 따라 다양한 정신건강 변인에서 유의한 차이가 있음을 확인할 수 있었으며, 특히 구급 직군의 경우가 타 직군에 비해 불면, 신체화 증상, 큰 사건 충격, 취약한 회복탄력성 등 여러 정신건강변인에서 취약한 상황으로 보고되었다. 그 중 불면의 경우 모든 직무유형에서 신체화 증상에의 의미 있는 예측인자임을 확인할 수 있었다.

참고문헌 (Reference)

1 이방락, "한국판 신체증상목록의 표준화 예비연구" 대한신경정신의학회 41 (41): 2002

2 정지원, "주요우울증에서 자살경향성 : 공존질환의 영향" 대한신경정신의학회 51 (51): 85-92, 2012

3 김건형, "일부 소방공무원의 직무스트레스로 인한 사회심리적 건강, 피로도 및 수면영향 연구" 대한직업환경의학회 18 (18): 232-245, 2006

4 권순찬, "일개 소방서 소방관들의 외상후 스트레스 증상 및 관련요인" 대한직업환경의학회 20 (20): 193-204, 2008

5 배점모, "소방공무원의 출동충격, 사회적 지지, 대처행태와 PTSD 증상 및 심리적 복지감 간의 관계" 한국행정학회 44 (44): 141-163, 2010

6 안승현, "소방공무원의 직업적 자긍심이 직무만족에 미치는 효과: 직무유형의 조절효과를 중심으로" 한국인사행정학회 18 (18): 93-113, 2019

7 이상구, "소방공무원의 직무스트레스 유발원인과 결과에 관한 실증적 연구: 직무특성, 역할혼돈, 동료관계와 조직몰입을 중심으로" 한국화재소방학회 21 (21): 74-86, 2007

8 유지현, "소방공무원의 PTSD 증상과 관련된 심리 사회적 변인들: 우울, 불안, 대처방식 및 사회적 지지를 중심으로" 한국임상심리학회 28 (28): 833-852, 2009

9 O’Leary K, "Why might poor sleep quality lead to depression? A role for emotion regulation" 31 : 1698-1706, 2017

10 Bastien CH, "Validation of the Insomnia Severity Index as an outcome measure for insomnia research" 2 : 297-307, 2001

11 Greene-Shortridge TM, "The stigma of mental health problems in the military" 172 : 157-161, 2007

12 Ring A, "The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms" 61 : 1505-1515, 2005

13 Shin H, "The effect of negative affectivity, alexithymia, somato-sensory amplification, and somatic attribution on somatization : Test of a linear mediation model" 19 : 17-32, 2000

14 Kroenke K, "The PHQ-15 : validity of a new measure for evaluating the severity of somatic symptoms" 64 : 258-266, 2002

15 Sheehan DV, "The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10" 1998

16 Kim K, "Symptomatic study of depression, part 2, aspects of korean depression symptoms" 16 : 46-52, 1977

17 Min S, "Study on the concept of hwabyeong" 28 : 604-616, 1989

18 Kim K, "Somatic and psychological complaints and their correlates with insomnia in the Japanese general population" 63 : 441-446, 2001

19 Carey MG, "Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters" 53 : 928-933, 2011

20 Curcio G, "Sleep loss, learning capacity and academic performance" 10 : 323-337, 2006

21 Ohayon MM, "Severe hot flashes are associated with chronic insomnia" 166 : 1262-1268, 2006

22 Nyer M, "Relationship between sleep disturbance a nd depression, anxiety, and functioning in college students" 30 : 873-880, 2013

23 Dudek B, "Relationship between sense of coherence and post-traumatic stress disorder symptoms among firefighters" 13 : 299-305, 2000

24 Lipowski ZJ, "Psychosomatic medicine: current trends and clinical applications, 29" Oxford University Press 398-400, 1978

25 Yu JH, "Psycho-social variables related to PTSD symptoms in fire-fighters: focusing on depression, anxiety, coping style, and social support" 38 : 415-426, 2009

26 Heinrichs M, "Predicting posttraumatic stress symptoms from pretraumatic risk factors : a 2-year prospective follow-up study in firefighters" 162 : 2276-2286, 2005

27 Lee NY, "Post-traumatic stress experienced by firefighters and paramedics" 9 : 83-93, 2012

28 Cohen S, "Perceived stress in a probability sample of the US" 1988

29 Jun J, "Organizational diagnosis for efficient organizational design and Research service for mid- to long-term development plan by the national fire service" Korean Public Administration Association 2018

30 Jo K, "Optimal cutting value of Korean Alcohol Use Disorders Identification Test(AUDIT-K)for screening dangerous drinkers" 13 : 34-40, 2009

31 Ancoli-Israel S, "Insomnia in special populations : effects of aging, menopause, chronic pain, and depression" 116 : 33-47, 2004

32 Zhong X, "Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation" 98 : 2024-2032, 2005

33 Horowitz M, "Impact of Event Scale : a measure of subjective stress" 41 : 209-218, 1979

34 Fire and Disaster Prevention Agency, "Fire administration data and statistics"

35 Corneil W, "Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries" 4 : 131-, 1999

36 Taylor DJ, "Epidemiology of insomnia, depression, and anxiety" 28 : 1457-1464, 2005

37 Lee J, "Effects of self-complexity and self-efficacy on depression and perceived stress" 2005 : 422-423, 2005

38 Jun J, "Effects of major depression and insomnia on somatization symptoms" 19 : 84-88, 2012

39 Connor KM, "Development of a new resilience scale : The Connor-Davidson Resilience Scale(CD-RISC)" 18 : 76-82, 2003

40 Wayne K, "Depression and somatization : a review" 72 : 127-135, 1982

41 Jun T, "Comparison between self-report scale according to physical symptoms complained by patients with major depression, schizophrenia and mania" 33 : 1219-1231, 1994

42 Brosschot JF, "Cognitive-emotional sensitization and somatic health complaints" 43 : 113-121, 2002

43 Romano JM, "Chronic pain and depression: does the evidence support a relationship?" 97 : 18-, 1985

44 Beekman AT, "Brief communication : criterion validity of the Center for Epidemiologic Studies Depression scale(CES-D) : results from a community-based sample of older subjects in the Netherlands" 27 : 231-235, 1997

45 Weiss DS, "Assessing psychological trauma and PTSD" Guilford Press 399-411, 1997

46 Vaishnavi S, "An abbreviated version of the Connor-Davidson Resilience Scale(CD-RISC), the CD-RISC2 : Psychometric properties and applications in psychopharmacological trials" 152 : 293-297, 2007

47 Shin H, "A study on the cognitive characteristics of somatization(1) : A study on the reliability and validity of the Korean version of the amplification scale and symptom analysis questionnaire" 17 : 33-39, 1998

48 Choung Y., "A study on internal customer satisfaction of 119fire officiers: Focusing on the fire and crisis management headquarters of Kyonggi province" Hankyong National University 2002

49 Stanley IM, "A primary care perspective on prevailing assumptions about persistent medically unexplained physical symptoms" 32 : 125-140, 2002

50 Cohen S, "A global measure of perceived stress" 24 : 385-396, 1983