잠재프로파일분석(LPA)을 활용한 PTSD 증상과 외상 후 성장 수준의 양상: 폭식, 비자살적 자해, 문제성 음주의 차이 = Latent Profile Analysis of PTSD symptoms and PTG among Adults in South Korea: the Differences in Binge Eating, Non-Suicidal Self-Injury, and Problem Drinking

국문 초록 (Abstract)

본 연구는 외상 사건을 경험한 국내 성인의 외상 후 스트레스(Post Traumatic Stress Disorder) 증상과 외상 후 성장(Post Traumatic Growth) 양상을 토대로 잠재계층(latent class)을 도출하고, 각 집단 구분에 영향을 미치는 특성을 탐색하며, 집단에 따른 자기파괴적 행동의 차이를 탐색함으로써, 외상 사건을 경험한 개인에 대해 보다 심층적으로 이해하고자 한다. 이를 위해 본 연구에서는 DSM-5 진단기준에 해당하는 외상 사건을 경험한 국내성인 860명을 대상으로 잠재프로파일분석(Latent Profile Analysis)과 R-3STEP 방식을 이용하였다. 집단 예측 변인으로 개인의 인구사회학적 변인(성별, 연령, 최종 학력, 종교유무, 종교활동 정도, 월 평균 소득)과 사회적 고립, 외상 경험 빈도가 포함되었으며, 종속변인으로 자기파괴적 행동(폭식 정도, 비자살적 자해 유무, 음주의 양, 음주 형태, 음주로 인한 정신 사회적 문제)을 포함하였다. 연구결과 집단은 ‘저 PTSD/중 PTG집단’, ‘저 PTSD/고 PTG집단’, ‘고 PTSD/고 PTG집단’으로 분류되었다. 또한 성별, 최종학력, 사회적 고립, 외상 노출 빈도가 집단 예측 변인으로 영향을 미치는 것으로 나타났으며, 폭식 정도, 비자살적 자해 유무, 음주 형태, 음주로 인한 정신사회적인 문제에서 집단 간 차이가 있는 것으로 나타났다. 마지막으로 본 연구의 결과를 바탕으로 논의와 시사점을 제시하였다.

다국어 초록 (Multilingual Abstract)

The present study examined patterns of co-occurrence between DSM-5 posttraumatic stress disorder(PTSD) symptoms and posttraumatic growth(PTG) among Korean populations(n= 860). Latent profile analysis was used to identify subclasses and suggested that the 3-class model fit best: (1) Low PTSD/Mild PTG group (2) Low PTSD/High PTG group; (3) High PTSD/High PTG group. Class membership was predicted by demographic variables, social isolation, frequency of traumatic experiences. Classes also differed with respect to self-destructive behaviors(self-harm, alcohol use disorder, and eating disorder). These findings contribute to future research about the coexisting patterns of PTSD and PTG, and to identify high-risk individuals who suffer from trauma-related problems in clinical practice.

참고문헌 (Reference)

1 송승훈, "한국판 외상후 성장 척도의 타당도 및 신뢰도 연구" 한국건강심리학회 14 (14): 193-214, 2009

2 김교헌, "한국판 UCLA 고독척도" 충남대학교 학생생활연구소 16 : 13-30, 1989

3 염유성, "한국판 PC-PTSD-5의 타당화 연구" 충북대학교 일반대학원 2017

4 이병욱, "한국어판 알코올 사용장애 진단 검사 (AUDIT: Alcohol Use Disorders Identification Test) 의 개발: 신뢰도 및 타당도 검사" 4 : 83-92, 2000

5 김주은, "포항 지진을 경험한 대학생의 외상 후 스트레스 장애 및 외상 후 성장에 영향을 미치는 요인에 관한 연구: 사회적지지, 핵심신념 붕괴, 반추 스타일을 중심으로" 한국상담학회 20 (20): 107-123, 2019

6 오현승, "키워드 네트워크 분석을 활용한 PTSD(Post Traumatic Stress Disorder) 연구 동향 탐색" 한국재활심리학회 25 (25): 823-838, 2018

7 이임순, "정상인의 섭식유형 및 다이어트 양상" 16 (16): 87-100, 1997

8 박주언, "재난정신건강평가 워크북" 대안불안의학회 2016

9 홍세희, "잠재계층, 잠재전이, 성장혼합모형" 박영사 2019

10 최승미, "인지적, 문제해결적 행동 대처 및 사회적 지지가 외상 후 성장에 미치는 영향: PTSD 증상 수준에 따라" 한국인지행동치료학회 13 (13): 307-328, 2013

11 박윤미, "외상생존자와 일하는 사회복지사의 소진에 대한 역할갈등, 업무부담과 이차적 외상 스트레스 및 자기효능감의 영향" 한국아동복지학회 (36) : 289-322, 2011

12 이수진, "외로움과 대인관계문제의 관계에서 초기부적응도식의 조절효과" 숙명여자대학교 교육대학원 2012

13 이동훈, "세월호 재난으로 자녀를 잃은 부모들의 사회적 지지, 갈등, 고립경험에 관한 연구" 한국상담학회 18 (18): 331-355, 2017

14 이동훈, "성격 5요인, 외상 후 인지, 사건관련 반추, PTSD 증상, 외상 후 성장의 관계: 외상 후 성장모델을 중심으로" 한국심리학회 36 (36): 241-270, 2017

15 박현정, "서울교육종단연구 2010 사용자매뉴얼"

16 김정란, "상담 및 심리치료에서의 트라우마(trauma) 연구동향(2001-2017)" 한국상담학회 20 (20): 67-91, 2019

17 윤명숙, "사회복지사의 외상경험과 외상 후 스트레스장애의관계에 미치는 사회적 지지의 조절효과" 한국정신건강사회복지학회 41 (41): 174-200, 2013

18 서윤아, "비자살적 자해에 영향을 미치는 복합외상 및 복합외상증후군의 탐색" 충북대학교 대학원 2014

19 권재기, "범주형 혼합모형의 잠재계층 수 결정을 위한 적합도 지수의 평가 : 몬테카를로 시뮬레이션 연구" 고려대학교 대학원 2012

20 Garner, R., "When children and adults do not use learning strategies : Toward a theory of settings" 60 (60): 517-529, 1990

21 Contractor, A. A., "Typologies of PTSD clusters and reckless/self-destructive behaviors : a latent profile analysis" 272 : 682-691, 2019

22 Frazier, P., "Traumatic events among undergraduate students : Prevalence and associated symptoms" 56 (56): 450-460, 2009

23 Mota, N. P., "Trauma exposure, DSM-5 post-traumatic stress disorder, and sexual risk outcomes" 56 (56): 215-223, 2019

24 Brooks, M., "Trauma characteristics and posttraumatic growth: The mediating role of avoidance coping, intrusive thoughts, and social support" 2018

25 Goar, S. G., "Trauma Exposure, Posttraumatic Stress Disorder and Alcohol Use Disorder among Females in Jos, North Central Nigeria" 21 (21): 2-, 2018

26 Goodman, R., "The use of mindfulness in trauma counseling" 34 (34): 254-268, 2012

27 Sippel, L. M., "The unique roles of emotional numbing and arousal symptoms in relation to social connectedness among military veterans in residential treatment for PTSD" 81 (81): 271-282, 2018

28 Breslau, N., "The structure of posttraumatic stress disorder : latent class analysis in 2 community samples" 62 (62): 1343-1351, 2005

29 Smith, N. B., "The role of trauma symptoms in nonsuicidal self-injury" 15 (15): 41-56, 2014

30 Curran, P. J., "The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis" 1 (1): 16-, 1996

31 Russell, D., "The revised UCLA Loneliness Scale : concurrent and discriminant validity evidence" 39 (39): 472-, 1980

32 Prins, A, "The primary care PTSD screen (PC-PTSD): development and operating characteristics" 9 (9): 9-14, 2003

33 Prins, A., "The primary care PTSD Screen for DSM-5(PC-PTSD-5) : development and evaluation within a veteran primary care sample" 31 (31): 1206-1211, 2016

34 Costello, E. J., "The prevalence of potentially traumatic events in childhood and adolescence" 15 (15): 99-112, 2002

35 Blevins, C. A., "The posttraumatic stress disorder checklist for DSM‐5(PCL‐5) : Development and initial psychometric evaluation" 28 (28): 489-498, 2015

36 Tedeschi, R. G., "The posttraumatic growth inventory : A revision integrating existential and spiritual change" 30 (30): 11-18, 2017

37 de Vries, G. J., "The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands" 22 (22): 259-267, 2009

38 Milligan-Saville, J., "The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service" 270 : 1110-1115, 2018

39 Johnson, H., "The development and maintenance of post-traumatic stress disorder(PTSD)in civilian adult survivors of war trauma and torture : A review" 28 (28): 36-47, 2008

40 Schoedl, A. F., "The clinical correlates of reported childhood sexual abuse : an association between age at trauma onset and severity of depression and PTSD in adults" 19 (19): 156-170, 2010

41 Tedeschi, R. G., "The Posttraumatic Growth Inventory : Measuring the positive legacy of trauma" 9 (9): 455-471, 1996

42 Weathers, F. W., "The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility" 462 : 1993

43 Weathers, F. W., "The Life Events Checklist for DSM-5 (LEC-5)"

44 Wang, J., "Structural equation modeling: Applications using Mplus" Higher Education Press 2012

45 Gabriel, S., "Social surrogate use in those exposed to trauma : I get by with a little help from my(fictional)friends" 36 (36): 41-63, 2017

46 Nietlisbach, G., "Social cognition and interpersonal impairments in trauma survivors with PTSD" 18 (18): 382-402, 2009

47 Burnam, M. A., "Sexual assault and mental disorders in a community population" 56 (56): 843-850, 1988

48 Ayache, R., "Psychiatric outcomes after childbirth : can posttraumatic growth protect me from disordered eating symptoms?" 293 (293): 1271-1278, 2016

49 Nock, M. K., "Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents : results from the National Comorbidity Survey Replication Adolescent Supplement" 70 (70): 300-310, 2013

50 Tedeschi, R. G., "Posttraumatic growth: Conceptual foundations and empirical evidence" 15 (15): 1-18, 2004

51 Chopko, B. A., "Posttraumatic growth in relation to the frequency and severity of traumatic experiences among police officers in small to midsize departments" 34 (34): 1247-1260, 2019

52 McDiarmid, L., "Posttraumatic growth associated with perceived changes in health values and reduced alcohol use among bereaved college students" 23 (23): 309-, 2017

53 Arpawong, T. E., "Post-traumatic growth, stressful life events, and relationships with substance use behaviors among alternative high school students : A prospective study" 30 (30): 475-494, 2015

54 Ryu, W., "Post-traumatic Stress Disorder and Social Isolation among North Korean Refugee Women in South Korea: The Moderating Role of Formal and Informal Support" 10 (10): 1246-, 2018

55 Cao, C., "Patterns of posttraumatic stress disorder symptoms and posttraumatic growth in an epidemiological sample of Chinese earthquake survivors: A latent profile analysis" 9 : 2018

56 Minihan, S., "Patterns and predictors of posttraumatic stress disorder in refugees : A latent class analysis" 232 : 252-259, 2018

57 김지윤, "PTSD 증상의 조건비율에 근거한한국 성인의 트라우마 경험에 관한 연구" 한국문화및사회문제심리학회 24 (24): 365-383, 2018

58 Bokszczanin, A., "PTSD symptoms in children and adolescents 28 months after a flood : Age and gender differences" 20 (20): 347-351, 2007

59 Hruska, B., "PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims : A latent class analysis" 28 (28): 644-649, 2014

60 Townsend, Peter, "Old People in Three Industrial Societies" Routledge and K. Paul 1968

61 Gratz, K. L., "Measurement of deliberate self-harm : Preliminary data on the Deliberate Self-Harm Inventory" 23 (23): 253-263, 2001

62 Garner, D. M., "Manual for Eating Disorder Inventory(EDI); Plus Manual Supplement" Psychological Assessment Resources 1984

63 Berg, S., "Loneliness in the Swedish aged" 36 (36): 342-349, 1981

64 Zeligman, M., "Loneliness as moderator between trauma and posttraumatic growth" 95 (95): 435-444, 2017

65 Steenkamp, M. M., "Latent classes of PTSD symptoms in Vietnam veterans" 36 (36): 857-874, 2012

66 Vermunt, J. K., "Latent class modeling with covariates : Two improved three-step approaches" 18 (18): 450-469, 2010

67 Collins, L. M., "Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences" Wiley 2009

68 Muthén, B., "Integrating person‐centered and variable‐centered analyses : Growth mixture modeling with latent trajectory classes" 24 (24): 882-891, 2000

69 Kline, A., "Increased risk of alcohol dependency in a cohort of National Guard troops with PTSD : a longitudinal study" 50 : 18-25, 2014

70 Williams, D., "Hurting to Cope : Self-Injurious Behavior as an Escape from Self-Focus" 6 (6): 120-129, 2010

71 Lowenthal, M. F., "Handbook of Aging and the Social Sciences, 5" 432-456, 1976

72 Joseph, S., "Growth following adversity : Theoretical perspectives and implications for clinical practice" 26 (26): 1041-1053, 2006

73 Solomon, Z., "Family functioning, perceived societal support, and combat-related psychopathology : The moderating role of loneliness" 9 (9): 456-472, 1990

74 Calhoun, L. G., "Facilitating posttraumatic growth: A clinician’s guide" Routledge 1999

75 Hill, K. G., "Early adult outcomes of adolescent binge drinking : person and variable‐centered analyses of binge drinking trajectories" 24 (24): 892-901, 2000

76 Field, A., "Discovering statistics using IBM SPSS statistics" SAGE Publications 2013

77 American Psychiatric Association, "Diagnostic and statistical manual of mental disorders (DSM-5)" American Psychiatric Pub 2013

78 Saunders, J. B., "Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption‐II" 88 (88): 791-804, 1993

79 Russell, D., "Developing a measure of loneliness" 42 (42): 290-294, 1978

80 Nylund, K. L., "Deciding on the number of classes in latent class analysis and growth mixture modeling : A Monte Carlo simulation study" 14 (14): 535-569, 2007

81 Tull, M. T., "Comprehensive guide to post-traumatic stress disorders" Springer International Publishing 803-816, 2016

82 Eidhof, M. B., "Complex Posttraumatic Stress Disorder in Patients Exposed to Emotional Neglect and Traumatic Events : Latent Class Analysis" 32 (32): 23-31, 2019

83 Bonanno, G. A., "Beyond resilience and PTSD: Mapping the heterogeneity of responses to potential trauma" 4 (4): 74-, 2012

84 Asparouhov, T., "Auxiliary variables in mixture modeling : Three-step approaches using M plus" 21 (21): 329-341, 2014

85 Kim, M. M., "Assessing trauma, substance abuse, and mental health in a sample of homeless men" 35 (35): 39-48, 2010

86 Kokaliari, E. D., "An exploratory study of the nature and extent of nonsuicidal self-injury among college women" 2014

87 Hays, R. D., "A short-form measure of loneliness" 51 (51): 69-81, 1987

88 Pastor, D. A., "A latent profile analysis of college students’ achievement goal orientation" 32 (32): 8-47, 2007

89 Rahman, A. F., "A latent class analysis of PTSD symptoms among inner city primary care patients" 98 : 1-8, 2018

90 Galatzer-Levy, I. R., "636,120 ways to have posttraumatic stress disorder" 8 (8): 651-662, 2013