Korean Clinical Psychology Association
[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 40, No. 3, pp.192-207
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 30 Aug 2021
Received 26 May 2021 Revised 02 Aug 2021 Accepted 03 Aug 2021
DOI: https://doi.org/10.15842/kjcp.2021.40.3.002

삶의 지속여부 결정에 관여하는 판단요인

최소영 ; 박기환
가톨릭대학교 심리학과
Judgment Factors Involved in Deciding Whether to Continue Living
Soyoung Choi ; Kee-Hwan Park
Department of Psychology, The Catholic University of Korea, Bucheon, Korea

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

© 2021 Korean Clinical Psychology Association


본 연구는 자살을 삶의 지속여부에 대한 결정의 결과로 보고 의사결정에 관여하는 주된 판단 요인들을 확인하고자 하였다. 이를 위해 안락사 시나리오를 통해 삶과 죽음의 선택 문제를 제시하고 과거 삶 만족도, 현재 고통 심각도, 미래개선 가능성이라는 세 가지 의사결정 변인들이 어떤 관련을 보이는지, 죽음을 선택할 의사에 각각 어떤 영향을 미치는지 확인하였다. 일반 성인남녀 515명을 대상으로 4가지 유형의 안락사 시나리오, 우울 증상, 자살 행동, 낙관성 및 비관성, 정적정서 및 부적정서에 관한 자료를 수집하였다. 모든 시나리오 유형에서 미래개선 가능성 예측은 죽음을 선택할 의사와 가장 강한 상관을 보였으며, 위계적 회귀모형 분석에서도 죽음을 선택할 의사에 관한 설명력이 가장 큰 변인으로 나타났다. 네 가지 시나리오 집단별로 위계적 회귀분석을 실시한 결과, 현재 고통 심각도는 미래개선 가능성 다음으로 죽음을 선택할 의사에 관한 설명력이 높았다. 모든 유형의 시나리오에서 과거 삶 만족도는 죽음을 선택할 의사에 관한 설명력이 유의하지 않았다. 본 연구 결과는 경험의 지속여부에 대한 의사결정과 마찬가지로 삶의 지속여부에 대한 의사결정에서도 미래에 대한 예측이 가지는 중요성을 확인해 준다. 동시에 자살 의사결정의 경우 생애 경험의 종점인 현재에 대한 평가가 과거 삶 전반에 대한 평가보다 더 중요한 판단 요인임을 시사한다.


This study attempted to identify the main judgment factors involved in decision-making by seeing suicide as a result of deciding whether or not to continue life. For this purpose, this study presents the life and death choice situation through the euthanasia scenario and identifies the relationships among three decision-making variables: past life satisfaction, current pain severity, and prediction of future improvement. In addition, the effects of the three variables on euthanasia choice were examined. Data were collected from 515 adults, who rated Suicidal Behavior Questionnaire-Revised (SBQ-R), Center for Epidemiologic Studies Scale-Depression (CES-D), Life Orientation Test-Revised (LOT-R), and Positive Affect and Negative Affect Schedule (PANAS), and one of four types of euthanasia scenarios. In all scenario types, the prediction of future improvement was strongly correlated with euthanasia choice, and the result of hierarchical regression analysis revealed that future prediction was the most important variable explaining euthanasia choice. The current pain severity was the second most important variable explaining the choice of euthanasia. In all scenarios, past life satisfaction was not a significant predictor of euthanasia choices. The results confirm the importance of predicting the future in deciding whether to continue living, as in the deciding whether to continue the experience. In addition, evaluation of the present is a more important factor than evaluation of past life as a whole in suicide decisions.


suicide, decision making, euthanasia, experience evaluation, future prediction


자살, 의사결정, 안락사, 경험 평가, 미래 예측

Author contributions statement

SYC, a graduate student at the Catholic University of Korea who is now a certified mental health professional, designed study, collected and analyzed data, and led manuscript preparation. KHP, a professor at the Catholic University of Korea, supervised the research process, provided critical feedback, participated in revision of the manuscript, and approved the final submission.


  • Atzmu̎ller, C., & Steiner, P. M. (2010). Experimental vignette studies in survey research. Methodology, 6, 128-138. [https://doi.org/10.1027/1614-2241/a000014]
  • Baek, K., Kwon, J., Chae, J. H., Chung, Y. A., Kralik, J. D., Min, J. A., . . . Kim, S. (2017). Heightened aversion to risk and loss in depressed patients with a suicide attempt history. Scientific Reports, 7, 11228. Retrieved from https://doi.org/10.1038/s41598-017-10541-5 [https://doi.org/10.1038/s41598-017-10541-5]
  • Bauer, B. W., & Capron, D. W. (2020). How behavioral economics and nudges could help diminish irrationality in suicide-related decisions. Perspectives on Psychological Science, 15, 44-61. [https://doi.org/10.1177/1745691619866463]
  • Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97, 90-113. [https://doi.org/10.1037/0033-295X.97.1.90]
  • Becker, E. S., Strohbach, D., & Rinck, M. (1999). A specific attentional bias in suicide attempters. The Journal of Nervous and Mental Disease, 187, 730-735. [https://doi.org/10.1097/00005053-199912000-00004]
  • 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]
  • Choi, S., & Park, K. H. (2019). Judgment factors involved in taking a decision to end one’s life. Korean Journal of Clinical Psychology, 38, 45-59. [https://doi.org/10.15842/kjcp.2019.38.1.004]
  • 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.
  • 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]
  • Evans, G., & Farberow, N. L. (1988). Encyclopedia of Suicide. New York, NY: Glen Evans.
  • Evans, J., Williams, J. M. G., O’loughlin, S., & Howells, K. (1992). Autobiographical memory and problem-solving strategies of parasuicide patients. Psychological Medicine, 22, 399-405. [https://doi.org/10.1017/S0033291700030348]
  • 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]
  • Gilbert, P., & Allan, S. (1998). The role of defeat and entrapment (arrested flight) in depression: An exploration of an evolutionary view. Psychological Medicine, 28, 585-598. [https://doi.org/10.1017/S0033291798006710]
  • 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]
  • Jeon, H. J. (2011). Depression and suicide. Journal of the Korean Medical Association, 54, 370-375. [https://doi.org/10.5124/jkma.2011.54.4.370]
  • 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., 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]
  • Kahneman, D., & Riis, J. (2005). Living, and thinking about it: Two perspectives on life. In F. A. Huppert, N. Baylis, & B. Keverne (Eds.). The science of well-being (pp. 285-304). Oxford, Oxfordshire: Oxford University Press. [https://doi.org/10.1093/acprof:oso/9780198567523.003.0011]
  • Lee, J. H. (2011). Assisted suicide and criminal law - focused on assisted suicide as a certain type of euthanasia. Journal of Law and Policy Research, 11, 963-994.
  • Lee, G. W., Hyun, M. H., & Lee, S. J., (2010). A study on the validation of the reasons for living inventory. The 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). 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, Il., 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.
  • Lee, S. J., Jang, M. S., Kwak, H. W. (2013). Study of emotion processing with suicide ideation tendency group. The Korean Journal of Counseling and Psychotherapy, 25, 603-620.
  • 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. (1981). [The Suicidal Behaviors Questionnaire (SBQ)]. Unpublished instrument. Seattle, Washington: University of Washington.
  • Loewenstein, G., & Schkade, D. (1999). Wouldn’t it be nice? Predicting future feelings. In D. Kahneman, E. Diener, & N. Schwarz (Eds.). 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]
  • 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]
  • 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]
  • 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]
  • Park, S. J., & Lee, H. J. (2019). The relationship between positive future thinking and suicidal ideation in depressed college students. Korean Journal of Clinical Psychology, 38, 145-156. [https://doi.org/10.15842/kjcp.2019.38.2.002]
  • 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]
  • Sanson, A., Dickens, E., Melita, B., Nixon, M., Rowe, J., Tudor, A., & Tyrrell, M. (1998). Psychological perspectives on euthanasia the terminally ill: An Australian Psychological Society discussion paper. Australian Psychologist, 33, 1-11. [https://doi.org/10.1080/00050069808257255]
  • 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]
  • Schwarz, N. (2000). Emotion, cognition, and decision making. Cognition & Emotion, 14, 433-440. [https://doi.org/10.1080/026999300402745]
  • 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.
  • Silverman, M. M., Berman, A. L., Sanddal, N. D., O’carroll, P. W., & Joiner, T. E. (2007a). Rebuilding the tower of babel: A revised nomenclature for the study of suicide and suicidal behaviors part 1: Background, rationale, and methodology. Suicide and Life-Threatening Behavior, 37, 248-263. [https://doi.org/10.1521/suli.2007.37.3.248]
  • Silverman, M. M., Berman, A. L., Sanddal, N. D., O'Carroll, P. W., & Joiner, T. E. (2007b). Rebuilding the tower of babel: A revised nomenclature for the study of suicide and suicidal behaviors part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life-Threatening Behavior, 37, 264-277. [https://doi.org/10.1521/suli.2007.37.3.264]
  • The Statistics Korea. (2020). Causes of death statistics in 2019. Press releases. Retrieved from http://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board?bmode=read&bSeq=&aSeq=385219&pageNo=1&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt=
  • 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. [https://doi.org/10.2458/jmm.v7i2.20321]
  • 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 der Geest, S., & Satalkar, P. (2019). Autonomy and dying: Notes about decision-making and “completed life” euthanasia in the Netherlands, Death Studies, DOI: 10.1080/07481187.2019.1671543 [https://doi.org/10.1080/07481187.2019.1671543]
  • Van der Heide, A., Deliens, L., Faisst, K., Nilstun, T., Norup, M., Paci, E., . . . Van der Maas, P. J. (2003). End-of-life decision-making in six European countries: Descriptive study. The Lancet, 362, 345-350. [https://doi.org/10.1016/S0140-6736(03)14019-6]
  • 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 Van Heeringen, K (Ed.), Understanding suicidal behaviour: The suicidal process approach to research, treatment, and prevention (pp. 76-93). Chichester, West Sussex: John Wiley and Sons.
  • 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]