Korean Clinical Psychology Association
[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 38, No. 1, pp.45-59
ISSN: 1229-0335 (Print) 2466-197X (Online)
Print publication date 28 Feb 2019
Received 13 Nov 2018 Revised 10 Jan 2019 Accepted 11 Feb 2019
DOI: https://doi.org/10.15842/kjcp.2019.38.1.004

삶의 중단 여부 결정에 관여하는 판단 요소들

최소영 ; 박기환
가톨릭대학교 심리학과
Judgment Factors Involved in Taking a Decision to End One’s Life
Soyoung Choi ; Kee-Hwan Park
Department of Psychology, The Catholic University of Korea, Bucheon

Correspondence to: Kee-Hwan Park, Department of Psychology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon, Korea; E-mail: psyclinic@catholic.ac.kr

© 2019 Korean Clinical Psychology Association


본 연구는 삶의 중단을 두고 갈등하는 자살의 심리적 과정을 경험의 지속 여부에 관한 의사결정의 한 유형으로 개념화하고, 자살 의사결정에 관여하는 주된 판단 요인들을 확인하고자 하였다. 본 연구의 목적은 현재 및 과거 경험에 대한 평가와 미래 예측이라는 판단 요소들이 서로 어떤 관련성을 가지는지, 각각이 자살 결정에 어떤 영향을 미치는지 확인하는 것이다. 이를 위해, 고통스러운 현재와 비관적인 미래는 동일하되, 과거 삶이 불리하거나 우호적인 것으로 기술된 두 가지 종류의 시나리오에 128명의 대학생과 대학원생들을 무작위로 할당해 평정하도록 하였다. 그 결과 첫째, 과거 삶 만족도와 현재 고통 심각도, 미래개선 가능성 중 죽음을 선택할 의사와 가장 관련성이 높은 변인은 미래개선 가능성으로 나타났다. 둘째, 현재 고통 심각도는 불리한 과거 삶 조건에서만 죽음을 선택할 의사를 예측했다. 마찬가지로 불리한 과거 삶 조건에서만 과거 삶 만족도와 현재 고통 심각도가 미래개선 가능성에 대해 유의한 상관을 보였다. 셋째, 불리한 과거 삶이든 우호적인 과거 삶이든 과거 삶 만족도는 죽음을 선택할 의사를 예측하지 못하였다. 본 연구 결과는 자살 의사결정이 일반적인 의사결정과 마찬가지로 경험에 대한 평가와 미래 예측이라는 두 가지 판단에 기초하며, 과거 삶에 역경이 많았던 사람들은 자살위기에서 직면한 고통을 어떻게 평가하는가가 미래 예측이나 자살 결정에 영향을 줄 수 있음을 보여준다. 또 미래에 대한 긍정적인 기대 정도가 자살 결정을 억제하는 가장 중요한 변인임을 시사한다.


In this study we conceptualized the psychological process of suicide as a type of decision whether to continue an experience and tried to identify the main judgment factors involved in suicide decision making. The purpose of this study was to examine the relationship between the evaluation of present and past experiences and future prediction, and how each one affects suicide decision. For this purpose, 128 undergraduate and graduate students were randomly assigned to two types of scenarios. Each scenario described adverse or favorable past life experiences while present and future conditions are the same. The results of this study were as follows: first, among past life satisfaction, current pain severity, and positive future expectation, the most relevant variable affecting the choice to die was positive future expectation. Second, current pain severity predicted the choice to die only under adverse past life conditions. Similarly, past life satisfaction and current pain severity showed significant correlation with positive future expectation, only under adverse past life conditions. Third, past life satisfaction did not predict the choice to die. The results of this study suggest that suicide decision making is based on two judgments - evaluation of experience and future prediction. The future predictions or suicide decisions of those who had a lot of adversity in their past lives may be influenced by how they assess the pain they face in the suicide crisis. Additionally, the results suggest that positive expectations for the future are the most important variables that inhibit suicide decisions.


suicide, decision making, experience evaluation, future prediction


자살, 의사결정, 경험 평가, 미래 예측


  • Apkarian, A. V., Sosa, Y., Krauss, B. R., Thomas, P. S., Fredrickson, B. E., Levy, R. E., . . . & Chialvo, D. R. (2004). Chronic pain patients are impaired on an emotional decision-making task. Pain, 108, 129-136. [https://doi.org/10.1016/j.pain.2003.12.015]
  • Atzmüller, C., & Steiner, P. M. (2010). Experimental vignette studies in survey research. Methodology, 6, 128-138. [https://doi.org/10.1027/1614-2241/a000014]
  • Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97, 90-113. [https://doi.org/10.1037/0033-295X.97.1.90]
  • Baumeister, R. F., Bratslavsky, E., Finkenauer, C., & Vohs, K. D. (2001). Bad is stronger than good. Review of General Psychology, 5, 323-370. [https://doi.org/10.1037/1089-2680.5.4.323]
  • Beck, A. T., Kovacs, M., & Weissman, A. (1975). Hopelessness and suicidal behavior: An overview. Journal of the American Medical Association, 234, 1146-1149. [https://doi.org/10.1001/jama.1975.03260240050026]
  • Buehler, R., & Griffin, D. (2003). Planning, personality, and prediction: The role of future focus in optimistic time predictions. Organizational Behavior and Human Decision Processes, 92, 80-90. [https://doi.org/10.1016/S0749-5978(03)00089-X]
  • Chon, K. K., Choi, S. C., & Yang, B. C. (2001). Integrated adaptation of CES - D in Korea. The Korean Journal of Health Psychology, 6, 59-76.
  • Dahlsgaard, K. K., Beck, A. T., & Brown, G. K. (1998). Inadequate response to therapy as a predictor of suicide. Suicide and Life‐Threatening Behavior, 28, 197-204.
  • Diener, E., Wirtz, D., & Oishi, S. (2001). End effects of rated life quality: The James Dean effect. Psychological Science, 12, 124-128. [https://doi.org/10.1111/1467-9280.00321]
  • Dombrovski, A. Y., & Hallquist, M. N. (2017). The decision neuroscience perspective on suicidal behavior: Evidence and hypotheses. Current Opinion in Psychiatry, 30, 7-14. [https://doi.org/10.1097/YCO.0000000000000297]
  • Emanuel, E. J., Daniels, E. R., Fairclough, D. L., & Clarridge, B. R. (1996). Euthanasia and physician-assisted suicide: Attitudes and experiences of oncology patients, oncologists, and the public. The Lancet, 347, 1805-1810. [https://doi.org/10.1016/S0140-6736(96)91621-9]
  • Ellis, T. E. (2006). The study of cognition and suicide: Beginnings and developmental milestones. In T.E. Ellis (Ed.). Cognition and suicide: Theory, research, and therapy (pp. 13-28). Washington, DC: American Psychological Association. [https://doi.org/10.1037/11377-000]
  • Fortune, S., Stewart, A., Yadav, V., & Hawton, K. (2007). Suicide in adolescents: Using life charts to understand the suicidal process. Journal of Affective Disorders, 100, 199-210. [https://doi.org/10.1016/j.jad.2006.10.022]
  • Gibbs, L. M., Dombrovski, A. Y., Morse, J., Siegle, G. J., Houck, P. R., & Szanto, K. (2009). When the solution is part of the problem: Problem solving in elderly suicide attempters. International Journal of Geriatric Psychiatry, 24, 1396-1404. [https://doi.org/10.1002/gps.2276]
  • Guillaume, S., Perroud, N., Jollant, F., Jaussent, I., Olie, E., Malafosse, A., & Courtet, P. (2013). HPA axis genes may modulate the effect of childhood adversities on decision-making in suicide attempters. Journal of Psychiatric Research, 47, 259-265. [https://doi.org/10.1016/j.jpsychires.2012.10.014]
  • Halpern-Felsher, B. L., & Cauffman, E. (2001). Costs and benefits of a decision: Decision-making competence in adolescents and adults. Journal of Applied Developmental Psychology, 22, 257-273. [https://doi.org/10.1016/S0193-3973(01)00083-1]
  • Harris, K. M., McLean, J. P., Sheffield, J., & Jobes, D. (2010). The internal suicide debate hypothesis: Exploring the life versus death struggle. Suicide and Life-Threatening Behavior, 40, 181-192. [https://doi.org/10.1521/suli.2010.40.2.181]
  • Hughes, R. (1998). Considering the vignette technique and its application to a study of drug injecting and HIV risk and safer behaviour. Sociology of Health & Illness, 20, 381-400. [https://doi.org/10.1111/1467-9566.00107]
  • Hughes, R., & Huby, M. (2012). The construction and interpretation of vignettes in social research. Social Work and Social Sciences Review, 11, 36-51. [https://doi.org/10.1921/17466105.11.1.36]
  • Hunter, E. C., & O'Connor, R. C. (2003). Hopelessness and future thinking in parasuicide: The role of perfectionism. British Journal of Clinical Psychology, 42, 355-365. [https://doi.org/10.1348/014466503322528900]
  • Hsee, C. K., & Hastie, R. (2006). Decision and experience: Why don't we choose what makes us happy? Trends in Cognitive Sciences, 10, 31-37. [https://doi.org/10.1016/j.tics.2005.11.007]
  • Hsee, C. K., & Zhang, J. (2004). Distinction bias: Misprediction and mischoice due to joint evaluation. Journal of Personality and Social Psychology, 86, 680-695. [https://doi.org/10.1037/0022-3514.86.5.680]
  • Jobes, D. A., & Mann, R. E. (1999). Reasons for living versus reasons for dying: Examining the internal debate of suicide. Suicide and Life-Threatening Behavior, 29, 97-104.
  • Joiner Jr, T. E., Brown, J. S., & Wingate, L. R. (2005). The psychology and neurobiology of suicidal behavior. Annual Review of Psychology, 56, 287-314. [https://doi.org/10.1146/annurev.psych.56.091103.070320]
  • Jones, C., & Aronson, E. (1973). Attribution of fault to a rape victim as a function of respectability of the victim. Journal of Personality and Social Psychology, 26, 415-419. [https://doi.org/10.1037/h0034463]
  • Jollant, F., Bellivier, F., Leboyer, M., Astruc, B., Torres, S., Verdier, R., . . . & Courtet, P. (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry, 162, 304-310. [https://doi.org/10.1176/appi.ajp.162.2.304]
  • Jollant, F., Buresi, C., Guillaume, S., Jaussent, I., Bellivier, F., Leboyer, M., . . . & Courtet, P. (2007). The influence of four serotonin-related genes on decision-making in suicide attempters. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 144, 615-624. [https://doi.org/10.1002/ajmg.b.30467]
  • Jollant, F., Lawrence, N. S., Olie, E., O’daly, O., Malafosse, A., Courtet, P., & Phillips, M. L. (2010). Decreased activation of lateral orbitofrontal cortex during risky choices under uncertainty is associated with disadvantageous decision-making and suicidal behavior. Neuroimage, 51, 1275-1281. [https://doi.org/10.1016/j.neuroimage.2010.03.027]
  • Kahneman, D., & Riis, J. (2005). Living, and thinking about it: Two perspectives on life. In F. A. Huppert, N. Baylis, & B. Keverne (Ed.). The science of well-being (pp. 285-304). Oxford, UK: Oxford University Press. [https://doi.org/10.1093/acprof:oso/9780198567523.003.0011]
  • Kahneman, D., Fredrickson, B. L., Schreiber, C. A., & Redelmeier, D. A. (1993). When more pain is preferred to less: Adding a better end. Psychological Science, 4, 401-405. [https://doi.org/10.1111/j.1467-9280.1993.tb00589.x]
  • Kemp, S., Burt, C. D. B., & Furneaux, L. (2008). A test of the peak-end rule with extended autobiographical events. Memory & Cognition, 36, 132-138. [https://doi.org/10.3758/MC.36.1.132]
  • Kim, S. Y. H., De Vries, R. G., & Peteet, J. R. (2016). Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry, 73, 362-368. [https://doi.org/10.1001/jamapsychiatry.2015.2887]
  • Lee, G. W., Hyun, M. H., & Lee, S. J. (2010). A study on the validation of the Reasons for Living Inventory. Korean Journal of Health Psychology, 15, 227-242. [https://doi.org/10.17315/kjhp.2010.15.2.004]
  • Lee, H. H., Kim, E. J., & Lee, M. G. (2003). Brief report: A validation study of Korea Positive and Negative Affect Schedule: The PANAS Scales. Korean Journal of Clinical Psychology, 22, 935-946.
  • Lee, H. S., Kim, S. Y., Park, I., Kang., Y. J., Lee, J. Y., & Kwon, J. H. (2012). The reasons of suicide-related ideation and behavior and the reasons for not choosing suicide among College Students. The Korean Journal of Counseling and Psychotherapy, 24, 703-728.
  • Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory. Journal of Consulting and Clinical Psychology, 51, 276-286. [https://doi.org/10.1037/0022-006X.51.2.276]
  • Linehan, M. M., & Nielsen, S. L. (1981). Assessment of suicide ideation and parasuicide: Hopelessness and social desirability. Journal of Consulting and Clinical Psychology, 49, 773-775. [https://doi.org/10.1037/0022-006X.49.5.773]
  • Loewenstein, G., O'Donoghue, T., & Rabin, M. (2003). Projection bias in predicting future utility. The Quarterly Journal of Economics, 118, 1209-1248. [https://doi.org/10.1162/003355303322552784]
  • Loewenstein, G., & Schkade, D. (1999). Wouldn’t it be nice? Predicting future feelings. In D. Kahneman, E. Diener, & N. Schwarz (Ed.). Well-being: Foundations of hedonic psychology. (pp. 85-105). New York, NY: Russell Sage Foundation.
  • MacLeod, A. K., Pankhania, B., Lee, M., & Mitchell, D. (1997). Parasuicide, depression and the anticipation of positive and negative future experiences. Psychological Medicine, 27, 973-977. [https://doi.org/10.1017/S003329179600459X]
  • MacLeod, A. K., Rose, G. S., & Williams, J. M. G. (1993). Components of hopelessness about the future in parasuicide. Cognitive Therapy and Research, 17, 441-455. [https://doi.org/10.1007/BF01173056]
  • MacLeod, A. K., Tata, P., Evans, K., Tyrer, P., Schmidt, U., Davidson, K., . . . & Catalan, J. (1998). Recovery of positive future thinking within a high‐risk parasuicide group: Results from a pilot randomized controlled trial. British Journal of Clinical Psychology, 37, 371-379. [https://doi.org/10.1111/j.2044-8260.1998.tb01394.x]
  • MacLeod, A. K., Tata, P., Tyrer, P., Schmidt, U., Davidson, K., & Thompson, S. (2005). Hopelessness and positive and negative future thinking in parasuicide. British Journal of Clinical Psychology, 44, 495-504. [https://doi.org/10.1348/014466505x35704]
  • Mann, R. E. (2002). Reasons for living versus reasons for dying: The development of suicidal typologies for predicting treatment outcomes (Unpublished Doctoral dissertation). Catholic University, Washington DC, America.
  • Naudts, K., Ducatelle, C., Kovacs, J., Laurens, K., Van Den Eynde, F., & Van Heeringen, C. (2006). Euthanasia: The role of the psychiatrist. The British Journal of Psychiatry, 188, 405-409. [https://doi.org/10.1192/bjp.bp.105.010256]
  • Neeleman, J., de Graaf, R., & Vollebergh, W. (2004). The suicidal process; prospective comparison between early and later stages. Journal of Affective Disorders, 82, 43-52. [https://doi.org/10.1016/j.jad.2003.09.005]
  • Olie, E., Ding, Y., Le Bars, E., de Champfleur, N. M., Mura, T., Bonafe, A., . . . & Jollant, F. (2015). Processing of decision-making and social threat in patients with history of suicidal attempt: A neuroimaging replication study. Psychiatry Research: Neuroimaging, 234, 369-377. [https://doi.org/10.1016/j.pscychresns.2015.09.020]
  • Oravecz, R., & Moore, M. M. (2006). Recognition of suicide Risk according to the characteristics of the suicide process. Death Studies, 30, 269-279. [https://doi.org/10.1080/07481180500493492]
  • Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443-454. [https://doi.org/10.1177/107319110100800409]
  • Pollock, L. R., & Williams, J. M. G. (1998). Problem solving and suicidal behavior. Suicide and Life-Threatening Behavior, 28, 375-387.
  • Pollock, L. R., & Williams, J. M. G. (2001). Effective problem solving in suicide attempters depends on specific autobiographical recall. Suicide and Life-Threatening Behavior, 31, 386-396. [https://doi.org/10.1521/suli.31.4.386.22041]
  • Pollock, L. R., & Williams, J. M. G. (2004). Problem-solving in suicide attempters. Psychological Medicine, 34, 163-167. [https://doi.org/10.1017/S0033291703008092]
  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. [https://doi.org/10.1177/014662167700100306]
  • Richard-Devantoy, S., Berlim, M. T., & Jollant, F. (2014). A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychological Medicine, 44, 1663-1673. [https://doi.org/10.1017/S0033291713002304]
  • Richard-Devantoy, S., Olie, E., Guillaume, S., Bechara, A., Courtet, P., & Jollant, F. (2013). Distinct alterations in value-based decision-making and cognitive control in suicide attempters: Toward a dual neurocognitive model. Journal of Affective Disorders, 151, 1120-1124. [https://doi.org/10.1016/j.jad.2013.06.052]
  • Richard-Devantoy, S., Olie, E., Guillaume, S., & Courtet, P. (2016). Decision-making in unipolar or bipolar suicide attempters. Journal of Affective Disorders, 190, 128-136. [https://doi.org/10.1016/j.jad.2015.10.001]
  • Rogers, J. R. (2003). The anatomy of suicidology: A psychological science perspective on the status of suicide research. Suicide and Life-Threatening Behavior, 33, 9-20. [https://doi.org/10.1521/suli.]
  • Rozin, P., & Royzman, E. B. (2001). Negativity bias, negativity dominance, and contagion. Personality and Social Psychology Review, 5, 296-320. [https://doi.org/10.1207/S15327957PSPR0504_2]
  • Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063-1078. [https://doi.org/10.1037/0022-3514.67.6.1063]
  • Schoenberg, N. E., & Ravdal, H. (2000). Using vignettes in awareness and attitudinal research. International Journal of Social Research Methodology, 3, 63-74. [https://doi.org/10.1080/136455700294932]
  • Schreiber, C. A., & Kahneman, D. (2000). Determinants of the remembered utility of aversive sounds. Journal of Experimental Psychology: General, 129, 27-42. [https://doi.org/10.1037/0096-3445.129.1.27]
  • Schwarz, N. (2000). Emotion, cognition, and decision making. Cognition & Emotion, 14, 433-440. [https://doi.org/10.1080/026999300402745]
  • Seo, Y. S., Rhie, S. Y., & Choi, Y. H. (2010). Development of an ethical decision-making model for issues in end-of-life decisions. Korean Journal of Counseling and Psychotherapy, 22, 1075-1102.
  • Shneidman, E. (1993). Suicide as psychache. The Journal of Nervous and Mental Disease, 181, 145-147. [https://doi.org/10.1097/00005053-199303000-00001]
  • Shneidman, E. (1998). The suicidal mind. New York, NY: Oxford University Press.
  • Statistics Korea. (2017). Causes of death statistics in 2017. Retrieved from KOSTAT (http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=370710).
  • Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245-251. [https://doi.org/10.1037/0033-2909.87.2.245]
  • Steiner, P. M., Atzmüller, C., & Su, D. (2016). Designing valid and reliable vignette experiments for survey research: A case study on the fair gender income gap. Journal of Methods and Measurement in the Social Sciences, 7, 52-94.
  • Taylor, P. J., Gooding, P., Wood, A. M., & Tarrier, N. (2011). The role of defeat and entrapment in depression, anxiety, and suicide. Psychological Bulletin, 137, 391-420. [https://doi.org/10.1037/a0022935]
  • Thurman, Q. C. (1986). Estimating social-psychological effects in decisions to drink and drive: A factorial survey approach. Journal of Studies on Alcohol, 47, 447-454. [https://doi.org/10.15288/jsa.1986.47.447]
  • Van Heeringen, K. (2001). Understanding suicidal behaviour: The suicidal process approach to research, treatment and prevention. Chichester, UK: Wiley.
  • Walster, E. (1966). Assignment of responsibility for an accident. Journal of Personality and Social Psychology, 3, 73-79. [https://doi.org/10.1037/h0022733]
  • Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070. [https://doi.org/10.1037/0022-3514.54.6.1063]
  • Wenzel, A., Brown, G. K., & Beck, A. T. (2009). Cognitive therapy for suicidal patients: Scientific and clinical applications. Washington, DC: American Psychological Association. [https://doi.org/10.1037/11862-000]
  • Williams, J. M., & Broadbent, K. (1986). Autobiographical memory in suicide attempters. Journal of Abnormal Psychology, 95, 144-149. [https://doi.org/10.1037/0021-843X.95.2.144]
  • Williams, J. M. G., Ellis, N. C., Tyers, C., Healy, H., Rose, G., & Macleod, A. K. (1996). The specificity of autobiographical memory and imageability of the future. Memory & Cognition, 24, 116-125. [https://doi.org/10.3758/BF03197278]
  • Williams, J. M. G., & Pollock, L. R. (2001). Psychological aspects of the suicidal process. In K. van Heeringen (Ed.), Understanding suicidal behaviour: The suicidal process approach to research, treatment, and prevention. Chichester, UK: John Wiley and Sons.
  • Wirtz, D., Kruger, J., Scollon, C. N., & Diener, E. (2003). What to do on spring break? The role of predicted, on-line, and remembered experience in future choice. Psychological Science, 14, 520-524. [https://doi.org/10.1111/1467-9280.03455]
  • Yeom, Y. M. (1998). The effect of learned optimism program for college students (Unpublished master’s thesis). Keimyung University, Daegu, Korea.
  • Young, M. A., Fogg, L. F., Scheftner, W., Fawcett, J., Akiskal, H., & Maser, J. (1996). Stable trait components of hopelessness: Baseline and sensitivity to depression. Journal of Abnormal Psychology, 105, 155-165. [https://doi.org/10.1037/0021-843X.105.2.155]