Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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The Correlation Between Defense Mechanism and Posttraumatic Stress Disorder in Burn Patients

화상 환자의 방어기제와 외상후 스트레스 장애와의 관련성

  • Lee, Dowon (Department of Adult Psychiatry, National Center for Mental Health) ;
  • Choi, Yanghwan (Hwasa Burn Clinic) ;
  • Kim, Jong Dae (Department of Surgery, Daejeon Hwa Hospital) ;
  • Son, Kyung-Lak (Department of Psychiatry, Dongguk University Ilsan Hospital) ;
  • Im, Woo Young (Department of Psychiatry, College of Medicne, Konyang University) ;
  • Jun, Jin Yong (Department of Mental Health Service, National Center for Mental Health)
  • 이도원 (국립정신건강센터 성인정신과) ;
  • 최양환 (화사의원) ;
  • 김종대 (대전화병원 외과) ;
  • 손경락 (동국대학교 일산병원 정신건강의학과) ;
  • 임우영 (건양대학교병원 정신건강의학과) ;
  • 전진용 (국립정신건강센터 정신건강사업)
  • Received : 2021.11.12
  • Accepted : 2021.12.24
  • Published : 2021.12.31
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Abstract

Objectives : This study was designed to investigate the correlation between defense mechanism and posttraumatic stress disorder in burn patients. Methods : We recruit 40 burn patients and we evaluate sociodemographic characteristics, characteristics related to burn, korean version of Impact of Event Scale-Revised (IES-R), Korean Version of Center for epidemiologic studies depression scale (CES-D) and Ewha Defense Mechanisms Test (EDMT). Multiple regression analysis was performed to evaluate the correlation between EDMT score and IES-R score. Results : Factor 2 of EDMT which consists of Ego-expansion subjects was significantly correlate with IER-S score. In factor 2, Controlling (β=-0.299, p<0.05), Sublimation (β=-0.276, p<0.05) is significantly correlate with IER-S score. Conclusions : Some subjects of defense mechanism was significantly correlate with IES-R score. it might be helpful to understand defense mechanism for the posttraumatic stress disorder in burn patients.

연구목적 화상 환자의 방어 기제에 따른 외상 후 스트레스 증상의 정도를 알아보고자 이 연구를 수행하였다. 방 법 화상을 진단받은 환자 40명을 대상으로 사회 인구학적 특성, 화상 관련 특성, 한국판 사건충격척도 개정판(Impact of Event Scale-Revised, IES-R), 한국판 역학조사 우울증 척도(Center for epidemiologic studies depression scale, CES-D), 이화방어기제(Ewha Defense Mechanisms Test, EDMT)를 측정한 후 다중회귀분석을 실시하였다. 결 과 자아 확대적 방식으로 구성된 EDMT의 요인 2의 점수가 IES-R 점수와 통계학적으로 유의한 상관관계가 있었으며(β=-0.318, p=0.018), EDMT의 요인 2중에서는 통제(β=-0.299, p<0.05), 이타주의(β=-0.276, p<0.05)가 IES-R점수와 통계학적으로 유의한 상관관계가 있었다. 결 론 이 연구에서 화상 환자의 외상 후 스트레스장애는 통제, 이타주의 방어 기제와 상관성이 있었으며 화상 환자의 치료에 있어 방어 기제를 평가하는 것은 추후 외상 후 스트레스 장애의 심각도 판단에 도움을 줄 것으로 생각된다.

Keywords

Acknowledgement

이 연구는 2017년도 국립정신건강센터 임상연구사업(연구과제: 2017-21)의 지원을 받아 수행된 연구임.

References

  1. Health Insurance review and assessment service. [Homepage on the internet]. Available from: https://opendata.hira.or.kr/.
  2. Van Loey NE, Van Son MJ. Psychopathology and psychological problems in patients with burn scars. Am J Clin Dermatol 2003;4:245-272. https://doi.org/10.2165/00128071-200304040-00004
  3. Hurren JS. Rehabilitation of the burned patient: james laing memorial essay for 1993. Burns 1995;21:116-126. https://doi.org/10.1016/0305-4179(95)92136-Z
  4. Ulmer JF. An exploratory study of pain, coping, and depressed mood following burn injury. J Pain Symptom Manage 1997;13:148-157. https://doi.org/10.1016/S0885-3924(96)00301-6
  5. Breslau N. The epidemiology of posttraumatic stress disorder: what is the extent of the problem? J Clin Psychiatry 2001;62 Suppl 17:16-22.
  6. Arif M, Ramprasad K. Prevalence of anxiety and depression in burns patients in a tertiary care hospital. IOSR JDMS 2013;10:6-9. https://doi.org/10.9790/0853-1040609
  7. Johnson J, Maxwell A, Calea S. The epidemiology of posttraumatic stress disorder. Psychiatr Ann 2009;39:326-334. https://doi.org/10.3928/00485713-20090514-01
  8. Baur KM, Hardy PE, Van Dorsten B. Posttraumatic stress disorder in burn populations: a critical review of the literature. J Burn Care Rehabil 1998;19:230-240. https://doi.org/10.1097/00004630-199805000-00009
  9. Hobbs K. Which factors influence the development of posttraumatic stress disorder in patients with burn injuries? A systematic review of the literature. Burns 2015;41:421-430. https://doi.org/10.1016/j.burns.2014.10.018
  10. Bryant RA. Predictors of PTSD following burn injury. Burns 1996;22:88-92. https://doi.org/10.1016/0305-4179(95)00099-2
  11. Beresford TP. Psychological Adaptive Mechanisms: Ego Defense Recognition in Practice and Research. New York, NY: Oxford University Press;2012.
  12. Vaillant GE. Ego Mechanisms Of Defense: A Guide For Clinicans And Researchers. Washington, DC: American Psychiatric Pub;1992.
  13. Perry JC, Cooper SH. An empirical study of defense mechanisms. Arch Gen Psychiatry 1989;46:444-452. https://doi.org/10.1001/archpsyc.1989.01810050058010
  14. Bond M, Perry JC, Gautier M, Goldenberg M, Oppenheimer J, Simand J. Validating the self-report of defense styles. J Person Disord 1989;3:101-112. https://doi.org/10.1521/pedi.1989.3.2.101
  15. Nickel R, Egle UT. Psychological defense styles, childhood adversities and psychopathology in adulthood. Child Abuse Negl 2006;30:157-170. https://doi.org/10.1016/j.chiabu.2005.08.016
  16. Silverstein, R. Combat-related trauma as measured by ego developmental indices of defenses and identity achievement. J Genet Psychol 1996;157:169-179. https://doi.org/10.1080/00221325.1996.9914855
  17. Eun HJ, Kwon TW, Lee SM, Kim TH, Choi MR, Cho SJ. A study on reliability and validity of the korean version of impact of event scale-revised. J Korean Neuropsychiatr Assoc 2005;44:303-310.
  18. Cho MJ, Kim KH. Diagnostic validity of the CES-D (Korean version) in the Assessment of DSM-III-R major depression. J Korean Neuropsychiatry Assoc 1993;32:381-399.
  19. Kim JE, Lee KH, Kim JK, Park YS. Ewha diagnostic test of defense mechanism. Seoul: Hana Medical Publishing Company;1991. p.7-61.
  20. Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979;41:209-218. https://doi.org/10.1097/00006842-197905000-00004
  21. Weiss D.S. The impact of event scale: revised. In Crpss-cultural assessment of psychological trauma and PTSD 2007;229-238
  22. Lim HK, Woo JM, Kim TS, Kim TH, Choi KS, Chung SK, Chee IS, Lee KU, Paik KC, Seo HJ, Kim W, Jin B, Chae JH; Disaster Psychiatry Committee in Korean Academy of Anxiety Disorders. Reliability and validity of the Korean version of the Impact of Event Scale-revised. Compr Psychiatry 2009; 50:385-390. https://doi.org/10.1016/j.comppsych.2008.09.011
  23. Rhee KH, Kim JU, Kim JK, Park YS. A standardization study of EWHA defense mechanism test. J Korean Neuropsychiatr Assoc 1991;30:582-592.
  24. O'Leary VE, Alday CS, Ickovics JR. Models of life change and posttraumatic growth. In R.G. Tedeschi, C.L. Park, & L.G. Calhoun (Eds.), Posttraumatic growth: Positive changes in the aftermath of crisis. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers;1998. p.1-22.
  25. Ehde DM, Patterson DR, Wiechman SA, Wilson LG. Posttraumatic stress symptoms and distress following acute burn injury. Burns 1999;25:587-592. https://doi.org/10.1016/S0305-4179(99)00050-9
  26. Ehde DM, Patterson DR, Wiechman SA, Wilson LG. Posttraumatic stress symptoms and distress 1 year after burn injury. J Burn Care Rehabil 2000;21:105-111. https://doi.org/10.1097/00004630-200021020-00005
  27. Sadeghi-Bazargani H, Maghsoudi H, Soudmand-Niri M, Ranjbar F, Mashadi-Abdollahi H. Stress disorder and PTSD after burn injuries: a prospective study of predictors of PTSD at Sina Burn Center, Iran. Neuropsychiatr Dis Treat 2011;7:425-429. https://doi.org/10.2147/NDT.S23041
  28. Vaillant GE, McCullough L. The role of ego mechanisms of defense in the diagnosis of personality disorders;1998.
  29. Kim TH, Kim Y, Lee SM, Eun HJ, Kim DI, Kang YS. Posttraumatic stress disorder in physically injuried patients after motor vehicle accidents. J Korean Neuropsychiatr Assoc 1998;37:650-659.
  30. Breslau N, Davis GC, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 1990;48:216-222. https://doi.org/10.1001/archpsyc.1991.01810270028003
  31. North CS, Smith EM, Spitznagel EL. Posttraumatic stress disorder in survivors of a mass shooting. Am J Psychiatry 1994;151:82-83. https://doi.org/10.1176/ajp.151.1.82
  32. Kaplan HL, Sadock BJ. Comprehensive textbook of psychiatry IV. Baltimore: Williams & Willkins;1989.
  33. Vaillant GE, Vaillant CO. Natural history of male psychological health: XII. A forty-five year study of successful aging at age 65. American Journal of Psychiatry 1990;147:31-37. https://doi.org/10.1176/ajp.147.1.31
  34. Vaillant GE, Bond M, Vaillant CO. An empirically validated hierarchy of defense mechanisms. Archives of General Psychiatry 1986;43:786-794. https://doi.org/10.1001/archpsyc.1986.01800080072010