Korean Clinical Psychology Association
[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 37, No. 4, pp.465-478
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 30 Nov 2018
Received 21 May 2018 Revised 13 Sep 2018 Accepted 18 Sep 2018
DOI: https://doi.org/10.15842/kjcp.2018.37.4.001

우울증 환자 집단에서 비자살적자해가 자살시도에 미치는 영향

김초롱1 ; 이승환2 ; 장혜인1,
1성균관대학교 심리학과
2일산백병원 정신건강의학과
Influence of Non-Suicidal Self-Injury on Suicide Attempt among Depressed Patients
Cho Long Kim1 ; Seung-Hwan Lee2 ; Hyein Chang1,
1Department of Psychology, Sungkyunkwan University, Seoul
2Department of Psychiatry, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Korea

Correspondence to: Hyein Chang, Department of Psychology, Sungkyunkwan University, 25-2 Sungkyunkwan-ro, Jongno-gu, Seoul, Korea; E-mail: hichang @skku.edu

© 2018 Korean Clinical Psychology Association

초록

자살은 여타 병리와 다르게 완수될 경우 돌이킬 방법이 전혀 없다는 점에서 학술적, 임상적 주의가 요구되는 병리적 행동으로, 자살률이 높은 한국사회에서는 그 예방적 중요성이 더욱 크다고 할 수 있다. 그간 다양한 이론들이 자살을 설명하기 위해 주력해왔으며, 본 연구는 자살에 대한 최신 이론인 대인관계적 심리이론에서 제안된 개념인 습득된 자살잠재력과 자살욕구를 통해 비자살적자해와 자살시도 간의 관계를 설명하고자 하였다. 그러나 비자살적자해와 자살시도 간의 관계에서 습득된 자살잠재력과 자살욕구를 모두 살펴보아야 할 필요성에도 불구하고, 이를 통합적으로 검증한 연구는 거의 없었다. 본 연구에서는 우울증상을 경험하고 있는 정신건강의학과 환자군 91명을 대상으로 비자살적자해, 습득된 자살잠재력, 자살욕구, 자살시도 횟수를 자기보고식 질문지와 압통계, 구조화된 면담을 통해서 측정하였다. 분석 결과, 비자살적자해는 습득된 자살잠재력의 하위요인인 죽음에 대한 두려움의 감소를 유의하게 예측하지 못했던 반면, 또 다른 하위요인인 통증인내력 매개를 거쳐 자살시도를 유의하게 예측하는 것으로 나타났다. 더불어, 통증인내력이 자살시도를 예측하는 데 있어 자살욕구의 수준이 유의한 조절효과를 보였다. 비자살적자해와 통증인내력, 자살욕구 그리고 자살시도를 모두 포함한 통합적 모형에 대한 조절된 매개분석 결과, 비자살적자해가 통증인내력 매개를 거쳐 자살시도를 예측할 때, 자살욕구가 통증인내력이 자살시도로 이어지는 경로를 유의하게 조절하는 것으로 나타났다. 이러한 결과들은 자살시도와 유의한 상관을 나타낸 흡연과 우울 공변인의 효과를 통제한 이후에도 마찬가지로 유의했다. 위와 같은 결과를 통해 본 연구는 비자살적자해가 자살시도의 횟수를 높이는 데 있어 습득된 자살잠재력과 자살욕구가 어떠한 역할을 하는지 살펴보았으며, 이러한 기제는 그간 자살에 대한 위험요인으로 알려진 우울증상의 수준을 통제한 이후에도 유의하다는 것을 확인하였다. 마지막으로 이러한 결과를 바탕으로 본 연구의 한계점과 이론적, 임상적 의의를 논하였다.

Abstract

Suicide is a pathological behavior that requires academic and clinical attention because it cannot be undone once accomplished. Prevention of suicide is especially important in South Korea, as the suicide rate is alarmingly high. This study aimed to investigate the relationship between non-suicidal self-injury and suicide attempt considering the roles of the acquired capability for suicide and suicidal desire, which are the concepts proposed in the interpersonal psychological theory, the latest theory of suicide. A total 91 psychiatric patients with reported depressive symptoms provided data on non-suicidal self-injury, acquired capability for suicide, suicidal desire, and the number of lifetime suicide attempts using self-report inventories. Additionally we used a pressure algometer and structured interview. Results indicated that non-suicidal self-injury significantly predicted suicide attempt, mediated by pain tolerance, which is one of the subcomponents of acquired capability for suicide. Furthermore, suicidal desire moderated the relationship between pain tolerance and suicide attempt. Lastly, pain tolerance mediated the relationship between non-suicidal self-injury and suicide attempt when suicidal desire was high but not when suicidal desire was low. Results were still significant after controlling for the effects of smoking and depressive symptoms. Implications and limitations of the study are discussed.

Keywords:

non-suicidal self-injury, acquired capability for suicide, suicidal desire, suicide attempt

키워드:

비자살적자해, 습득된 자살잠재력, 자살욕구, 자살시도

Acknowledgments

The present article is based on a master's thesis study conducted by the first author under the guidance of the third author.

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