DOI QR코드

DOI QR Code

다면적 인성검사 II 재구성판으로 살펴본 주요우울장애 자살 시도자의 심리적 특성

Psychological Characteristics of Suicide Attempters with Major Depressive Disorder using the Minnesota Multiphasic Personality Inventory-2 Restructured Form

  • 최지현 (한림대학교 성심병원 정신건강의학과) ;
  • 박은희 (한림대학교 성심병원 정신건강의학과)
  • Choi, Ji-Hyun (Department of Psychiatry, Hallym University Sacred Heart Hospital) ;
  • Park, Eun-Hee (Department of Psychiatry, Hallym University Sacred Heart Hospital)
  • 투고 : 2020.11.21
  • 심사 : 2021.03.26
  • 발행 : 2021.06.30

초록

연구목적 본 연구는 MMPI-2-RF를 통해 주요우울장애 환자군 중 자살 시도자들의 심리적 특성을 확인하고자 하였다. 방 법 본 연구는 한림대학교 성심병원 정신건강의학과를 방문한 입원 및 외래 환자 중 한국판 K-MINI-Plus 5.0을 통해 DSM-IV의 주요우울장애 진단적 준거를 충족시키는 자 107명을 대상으로 하였다. 이들을 C-SSRS를 사용하여 자살 시도군(n=43)과 비시도군(n=64)으로 분류하였고 ANOVA를 통해 두 집단 간 MMPI-2-RF 척도 점수에서의 차이를 조사하였다. 더불어 우울 증상의 심각도와 공존질환의 이환 여부가 자살 시도 여부에 영향을 주었을 가능성을 고려해 이를 공변인으로 하여 추가적으로 ANCOVA 분석을 수행하였다. 결 과 본 연구에서 자살 시도군이 비시도군에 비해 효능감 결여(NFC), 대인관계 수동성(IPP), 자살/죽음 사고(SUI) 척도에서 유의하게 높은 점수를 나타냈다(p<0.05). 다만 자살/죽음 사고(SUI) 척도의 경우 우울 증상과 공존질환의 이환 여부를 통제한 이후에는 두 집단 간 차이에서 통계적으로 유의한 경향성을 보여주었다(p<0.10). 결 론 본 연구의 결과를 통해 MMPI-2-RF가 중등도 이상의 증상 심각도를 지닌 주요우울장애 집단에서 실제 자살 시도로 이행될 위험이 있는 환자를 심리적 특성을 확인하는데 유용한 도구임을 확인하였다. 이러한 결과를 토대로 본 연구의 한계와 향후 연구 방향에 대해 논의하였다.

Objectives : This study was conducted to investigate differences in psychological characteristics between major depressive disorder (MDD) patients with and without suicide attempt using MMPI-2-RF. Methods : Subjects were 107 MDD patients who had visited the department of psychiatry of hallym university hospital and met the DSM-IV diagnostic criteria of MDD by the korean version of MINI-Plus 5.0.0. The patients were divided into suicidal attempters (n=43) and non-suicidal attempters (n=64) using C-SSRS. The one-way ANOVA was used to compare MMPI-2-RF scale scores between two groups. Additionally, ANCOVA was conducted considering the severity of depressive symptom and comorbidity as covariate. Results : Our results showed that Suicide/Death Ideation (SUI), Inefficacy (NFC) and Interpersonal Passivity (IPP) scales were significantly higher in the MDD patients with suicidal attempt compared to MDD patients without suicidal attempt (p<0.05). However, after controlling for the severity of depressive symptom and comorbidity, SUI scale showed a significant tendency (p<0.10). Conclusions : The result suggests that MMPI-2-RF scales could be a useful tool for identifying patients transitioning to actual suicidal attempts in the moderate or severe major depressive disorder group. Limitations of this study and directions for further research are also discussed.

키워드

과제정보

이 논문은 (주)마음사랑의 연구지원을 받아 수행된 연구임.

참고문헌

  1. OECD.Sat [homepage on the Internet]. Paris: Organisation for Economic Co-operation and Development; [updated 2019 Aug; cited 2019 Aug]. Available from: http://stats.oecd.org/.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder. 5th ed. Arlington, American Psychiatric Press;2013. p.160-162.
  3. Chioqueta AP, Stiles TC. Suicide risk in outpatients with specific mood and anxiety disorders. Crisis 2003;24:105-112. https://doi.org/10.1027//0227-5910.24.3.105
  4. Fairweather-Schmidt AK, Anstey KJ, Mackinnon AJ. Is suicidality distinguishable from depression? Evidence from a community-based sample. Aust N Z J Psychiatry 2009;43:208-215. https://doi.org/10.1080/00048670802653331
  5. Brent DA, Perper JA, Moritz G, Allman C, Friend AMY, Roth C, Schweers J, Balach L, Baugher M. Psychiatric risk factors for adolescent suicide: a case-control study. J Am Acad Child Adolesc Psychiatry 1993;32:521-529. https://doi.org/10.1097/00004583-199305000-00006
  6. Dobscha SK, Denneson LM, Kovas AE, Teo A, Forsberg CW, Kaplan MS, Bossarte R, McFarland BH. Correlates of suicide among veterans treated in primary care: case-control study of a nationally representative sample. J Gen Intern Med 2014;29:853-860. https://doi.org/10.1007/s11606-014-3028-1
  7. Kandel DB, Raveis VH, Davies M. Suicidal ideation in adolescence: Depression, substance use, and other risk factors. J Youth Adolesc 1991;20:289-309. https://doi.org/10.1007/BF01537613
  8. Jeon HJ. Depression and suicide. J Korean Med Assoc 2011;54:370-375. https://doi.org/10.5124/jkma.2011.54.4.370
  9. Ryu S, You S. Psychological characteristics differentiating suicide attempters from Ideators: an examination of acquired capability for suicide and temperament. Korean J Clin Psychol 2017;36;589-603 https://doi.org/10.15842/kjcp.2017.36.4.010
  10. Lee SA, Kim GH, Seo SY. Comparison of emotional and psychological characteristics between suicide attempters and nonattempters in depressed patients: using MMPI-2 profiles. Korean J Psychosom Med 2012;20:40-49.
  11. Joung M, Seo S. Predictors of attempts at suicide: a focus on the attune adolescent facing a suicidal crisis. Korean J Youth Stud 2014;25:145-171.
  12. Choi JH, Kim HG, Cheon EJ, Lee YJ, Park HJ, Kim JY, Koo BH. Differences in defense mechanisms and psychological characteristics according to Suicide attempt in patients with depression. Psychoanal 2017;28:96-106. https://doi.org/10.18529/psychoanal.2017.28.4.96
  13. Glassmire DM, Stolberg RA, Greene RL, Bongar B. The utility of MMPI-2 suicide items for assessing suicidal potential: development of a suicidal potential scale. Assessment 2001;8:281-290. https://doi.org/10.1177/107319110100800304
  14. Glassmire DM, Tarescavage AM, Burchett D, Martinez J, Gomez A. Clinical utility of the MMPI-2-RF SUI items and scale in a forensic inpatient setting: association with interview self-report and future suicidal behaviors. Psychol Assess 2016;28:1502-1059. https://doi.org/10.1037/pas0000220
  15. Kopper BA, Osman A, Osman JR, Hoffman J. Clinical utility of the MMPI-A content scales and Harris-Lingoes subscales in the assessment of suicidal risk factors in psychiatric adolescents. J Clin Psychol 1998;54:191-200. https://doi.org/10.1002/(SICI)1097-4679(199802)54:2<191::AID-JCLP8>3.0.CO;2-V
  16. Spirito A, Faust D, Myers B, Bechtel D. Clinical utility of the MMPI in the evaluation of adolescent suicide attempters. J Pers Assess 1988;52:204-211. https://doi.org/10.1207/s15327752jpa5202_2
  17. Butcher JN. Minnesota multiphasic personality inventory-2: manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press;2001.
  18. Tellegen A, Ben-Porath YS, McNulty JL, Arbisi PA, Graham JR, Kaemmer B. MMPI-2 Restructured Clinical (RC) scales: development, validation, and interpretation. Minneapolis: University of Minnesota Pres;2003.
  19. Ben-Porath YS, Tellegen A. MMPI-2-RF: manual for administration, scoring and interpretation. Minneapolis: University of Minnesota Press;2008.
  20. Beck AT, Steer RA, Beck JS, Newman CF. Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide Life Threat Behav 1993;23:139-145. https://doi.org/10.1111/j.1943-278X.1993.tb00378.x
  21. Venables NC, Yancey JR, Kramer MD, Hicks BM, Krueger RF, Iacono WG, Joiner TE, Patrick CJ. Psychoneurometric assessment of dispositional liabilities for suicidal behavior: phenotypic and etiological associations. Psychol Med 2018;48:463-472. https://doi.org/10.1017/S0033291717001830
  22. Anestis JC, Gottfried ED, Joiner TE. The utility of MMPI2-RF substantive scales in prediction of negative treatment outcomes in a community mental health center. Assessment 2015;22:23-35. https://doi.org/10.1177/1073191114536771
  23. Stanley B, Michel CA, Galfalvy HC, Keilp JG, Rizk MM, Richardson-Vejlgaard R, Oquendo MA, JohnMann JJ. Suicidal subtypes, stress responsivity and impulsive aggression. Psychiatry Res 2019;280:1249-1254.
  24. Moon K, Lee J, Heo J. Psychological characteristics of college students with suicide risk in MMPI-2-RF. Korean J Clin Psychol 2015;34:809-827. https://doi.org/10.15842/kjcp.2015.34.3.011
  25. Nam J, Kim D, Kim E. Psychological characteristics of psychiatric outpatients with high suicide risk: using MMPI-2-RF. Psychosom Med 2020;28:8-19.
  26. Lewinsohn PM, Clarke GN, Seeley JR, Rohde P. Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry 1994;33:809-818. https://doi.org/10.1097/00004583-199407000-00006
  27. Yoo SW, Kim YS, Noh JS, Oh KS, Kim CH, Namkoong K, Chae JH, Lee GC, Jeon SI, Min KJ, Oh DJ, Joo EJ, Park HJ, Choi YH, Kim SJ. Validity of Korean version of the mini-international neuropsychiatric interview. Anxiety and Mood 2006;2:50-55.
  28. Han K, Moon K, Lee J, Kim J. MMPI-2-RF: technical manual. Seoul: Maumsarang;2011.
  29. Posner K, Melvin GA, Stanley B, Oquendo MA, Gould M. Factors in the assessment of suicidality in youth. CNS Spectr 2007;12:156-162. https://doi.org/10.1017/S1092852900020678
  30. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:22-33.
  31. Hamilton MAX. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278-296. https://doi.org/10.1111/j.2044-8260.1967.tb00530.x
  32. Yi JS, Bea SO, Ahn YM, Park DB, Noh KS, Shin HK, Woo HW, Lee HS, Han SI, Kim YS. Validity and Reliability of the Korean Version of the Hamilton Depression Rating Scale (KHDRS). J Korean Neuropsychiatric Ass 2005;44:456-465.
  33. Miller SN, Bozzay ML, Ben-Porath YS, Arbisi PA. Distinguishing levels of suicide risk in depressed male veterans: the role of internalizing and externalizing psychopathology as measured by the MMPI-2-RF. Assessment 2019;26:85-98. https://doi.org/10.1177/1073191117743787
  34. Gottfried E, Bodell L, Carbonell J, Joiner T. The clinical utility of the MMPI-2-RF Suicidal/Death Ideation Scale. Psychol Assess 2014;26:1205-1211. https://doi.org/10.1037/pas0000017
  35. Rogers ML, Kelliher-Rabon J, Hagan CR, Hirsch JK, Joiner TE. Negative emotions in veterans relate to suicide risk through feelings of perceived burdensomeness and thwarted belongingness. J Affect Disord 2017;208:15-21. https://doi.org/10.1016/j.jad.2016.09.038
  36. Kim S, Lee HK, Lee K. Assessment of suicidal risk using Minnesota multiphasic personality inventory-2 restructured form. BMC Psychiatry 2020;20:1-10. https://doi.org/10.1186/s12888-019-2374-2
  37. Lee SJ, Kim SA , Kim GU, Young PJ, Keum R. Relationships among suicide traumatic experiences, attitudes toward suicide, depression, self-efficacy, and social support in general adults. J Korean Acad Psychiatric Ment Health Nurs 2020;29:1-13. https://doi.org/10.12934/jkpmhn.2020.29.1.1
  38. Rothmann S, Van RP. Psychological strengths, coping and suicide ideation in the South African Police Services in the North West Province. SA J Ind Psychol 2002;28:39-49.
  39. Valois RF, Zullig KJ, Hunter AA. Association between adolescent suicide ideation, suicide attempts and emotional self-efficacy. J Child Fam Stud 2015;24:237-248. https://doi.org/10.1007/s10826-013-9829-8
  40. Kobayashi Y, Fujita K, Kaneko Y, Motohashi Y. Self-efficacy as a suicidal ideation predictor: a population cohort study in rural Japan. Open J Prev Med 2015;5:61-71. https://doi.org/10.4236/ojpm.2015.52007
  41. Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. The self-efficacy scale: construction and validation. Psychol Rep 1982;51:663-671. https://doi.org/10.2466/pr0.1982.51.2.663
  42. Youngren MA, Lewinsohn PM. The functional relation between depression and problematic interpersonal behavior. J Abnorm Psychol 1980;89:333-341. https://doi.org/10.1037/0021-843X.89.3.333
  43. Joiner TE. Why people die by suicide. Cambridge: M.A. Harvard University Press;2005.
  44. Anestis JC, Finn JA, Gottfried ED, Hames JL, Bodell LP, Hagan CR, Arnau RC, Anestis MD, Arbisi PA, Joiner TE. Burdensomeness, belongingness, and capability: assessing the interpersonal-psychological theory of suicide with MMPI-2-RF Scales. Assessment 2018;25:415-431. https://doi.org/10.1177/1073191116652227
  45. Ferster CB. A functional analysis of depression. Am Psychol 1973;28:857-870. https://doi.org/10.1037/h0035605
  46. Park HJ, Park EH, Jon DI, Jang HA, Jung MH, Hong N, Hong HJ. Impact of depression and emotional intelligence on suicidal ideation of patients with major depressive disorder. Korean Korean J Psychopharmacol 2014;25:107-117.
  47. Jung JW, Kim HC, Sakong JK, Sung HM, Jung SW, Lee EJ, Shin JH, Kim JB. Suicidality in major depressive disorder: the impact of psychiatric comorbidity. J Korean Neuropsychiatr Assoc 2012;51:85-92. https://doi.org/10.4306/jknpa.2012.51.2.85
  48. Yaung H, Lee KJ, Ko HY, Lee SM. The relationship among stress, depression, and suicidal intention: a multigroup analysis across comorbid panic symptoms. Korean J Couns Psychother 2020;32:873-896. https://doi.org/10.23844/kjcp.2020.05.32.2.873