지역 정신보건센터에 등록된 조현병 환자의 삶의 질 및 관련 정신사회적 요인
Objectives This study aimed to identify the relationship between quality of life (QoL) and psychosocial factors of schizophrenia patients registered in a community mental health center. Methods The ninety patients with schizophrenia, diagnosed by Diagnostic and Statistical Manual of Mental Disorders...
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| Published in | Journal of the Korean Society of Biological Psychiatry Vol. 21; no. 1; pp. 28 - 35 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Korean |
| Published |
대한생물정신의학회
01.02.2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1225-8709 2005-7571 |
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| Abstract | Objectives This study aimed to identify the relationship between quality of life (QoL) and psychosocial factors of schizophrenia patients registered in a community mental health center. Methods The ninety patients with schizophrenia, diagnosed by Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision, registered in a community mental health center were studied cross-sectionally. Four trained personnels interviewed each subject individually for the assessment of QoL, psychopathology, severity of depressed mood, insight of illness, attitude toward drugs, social function, degree of social supports and conflicts. Results QoL was significantly related to the psychopathology, depressed mood, social conflict, social support; and other aspects of QoL were slightly differently related to depressed mood, social conflict, social support and attitude toward drug by scales. In multiple regression analysis, depressed mood (20.0%) and social conflict (10.3%) were contributed to QoL assessed by Korean version of 4th revision of Schizophrenia Quality of Life. Social support (21.4%), social conflict (20.9%) and depressed mood (3.1%) were contributed to QoL assessed by Korean modification of the Scale to measure Subjective Well-being under Neuroleptic treatment. Conclusions These findings demonstrated that QoL of schizophrenia patients in a community is affected by depressed mood, social support and conflict rather than psychotic symptoms, insight and attitude toward drugs. And this result suggests the necessity of approaching not only to the psychotic symptoms but also to the psychosocial characteristics in caring schizophrenia patients in the community. |
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| AbstractList | 조현병은 만성 경과를 취하면서 한 개인의 삶에 큰 장애를 주는 정신질환으로 인구의 약 1%에서 발병한다고 알려져 있다.1) 과거에는 조현병에 대한 치료의 목표가 단순히 정신증상의 경감에 초점이 맞춰져 있었으나, 현재는 환자의 삶의 질(quality of life) 증진이 점차 중요한 치료 목표이자, 조현병 환자의 새로운 약물 효과를 측정하는 연구 및 임상적 여러 영역에 있어서도 중요한 평가도구가 되고 있다.2) 삶의 질에 대해서 세계보건기구에서는 “한 개인이 살고 있는 문화권과 가치체계의 맥락 안에서 자신의 목표, 기대, 규범, 관심과 관련하여 인생에서 자신이 차지하는 상태에 대한 개인적인 지각”으로 정의하고 있다. 이런 정의는 삶의 질을 문화적, 사회적, 환경적인 배경에 중점을 둔 주관적인 평가로 보는 관점을 반영한다.3)삶의 질의 주관적 평가가 가지는 의미가 재평가되고, 그에 대한 관심이 높아짐에도 불구하고, 신체적 질병군의 환자들과는달리, 조현병 환자들의 주관적 삶의 질의 평가는 용이하지 않고, 동시에 신뢰하기 어려운 것으로 인식되어 왔다.4) 그러나 점차 조현병 환자의 경우에도 주관적 삶의 질에 대한 자기 평가가 가능하다는 합의가 도출되고 있다.5)특히 최근에는 삶의 질과 정신사회적 특성과의 관련성에 관한 연구들이 속속 보고되고 있고, 정신사회적 기능의 중요성이 시사되고 있다. 조현병 환자에서 사회적 기능 수준이 높을수록, 사회적 적응을 잘 할수록 삶의 질이 높으며, 사회적 관계, 가족 등이 삶의 질에 중요한 역할을 한다는 등의 연구결과들이 보고되면서 조현병 환자의 삶의 질과 정신사회적 특성들의 의미 있는 상관관계가 주목을 받기 시작했다.
국내에서도 점차 조현병 환자의 삶의 질에 대한 관심이 높아지고 있고, 이를 평가하는 척도의 개발과 표준화가 이루어지고 있는 등 삶의 질 분야에 대한 연구가 관심을 받고 있는 상황으로, 삶의 질과 정신병리 및 정신사회적 특성과의 연관성에 관한 연구들이 상당부분 진행되어 왔다.6)국내 선행연구를 살펴보면, Choi 등7)이 첫 입원 치료를 받은 지 2년 혹은 5년이 경과한 조현병과 기타 정신병 환자를 대상으로 Heinrichs Carpenter Quality of Life Scale(이하 HeinrichsCarpenter QLS)을 사용하여 삶의 질을 평가한 결과 환자들의 삶의 질은 전반적으로 저하되어 있었으며, 조현병 환자군의 삶의 질은 기타 정신병 환자 군에 비해 낮았다. 또한첫 입원 치료 기간이 짧을수록 삶의 질이 상대적으로 높은 역상관관계를 보인 결과를 통해 초기 치료에 대한 반응 정도로부분적이나마 향후 삶의 질을 예측할 수 있다고 하였다.
Yoo 등8)은 조현병 입원환자를 병식의 유무에 따라 분류하고 Quality of Life Inventory를 이용하여 병식 유무에 따른삶의 질의 차이를 검증하였다. 연구 결과 병식이 있는 조현병환자에서 주관적으로 낮은 행복감을 보이며, 특히 대인관계에서의 만족도가 낮은 것으로 나타났다.
Kim 등9)의 연구에서는 다중회귀분석 결과 항정신병 약물에대한 부작용과 우울감이 Korean modification of the Scaleto measure Subjective Well-being under Neuroleptic treatment(이하 KmSWN)로 측정한 주관적 삶의 질 점수에 의미있는 영향을 미침을 확인할 수 있었다. Suh 등10)은 정신병리와 삶의 질의 관계를 연구하였는데, 한국어판 Heinrichs CarpenterQLS를 사용하여 ‘측정한’ 객관적인 삶의 질은 조현병의 양성증상과 음성증상, 그리고 일반적 정신병리가 심할수록 저하되었... Objectives:This study aimed to identify the relationship between quality of life (QoL) and psychosocial factors of schizophrenia patients registered in a community mental health center.
Methods:The ninety patients with schizophrenia, diagnosed by Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision, registered in a community mental health center were studied cross-sectionally. Four trained personnels interviewed each subject individually for the assessment of QoL, psychopathology, severity of depressed mood, insight of illness, attitude toward drugs, social function, degree of social supports and conflicts.
Results:QoL was significantly related to the psychopathology, depressed mood, social conflict, social support; and other aspects of QoL were slightly differently related to depressed mood, social conflict, social support and attitude toward drug by scales. In multiple regression analysis, depressed mood (20.0%) and social conflict (10.3%) were contributed to QoL assessed by Korean version of 4th revision of Schizophrenia Quality of Life. Social support (21.4%), social conflict (20.9%) and depressed mood (3.1%) were contributed to QoL assessed by Korean modification of the Scale to measure Subjective Well-being under Neuroleptic treatment.
Conclusions:These findings demonstrated that QoL of schizophrenia patients in a community is affected by depressed mood, social support and conflict rather than psychotic symptoms, insight and attitude toward drugs. And this result suggests the necessity of approaching not only to the psychotic symptoms but also to the psychosocial characteristics in caring schizophrenia patients in the community. KCI Citation Count: 1 Objectives This study aimed to identify the relationship between quality of life (QoL) and psychosocial factors of schizophrenia patients registered in a community mental health center. Methods The ninety patients with schizophrenia, diagnosed by Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision, registered in a community mental health center were studied cross-sectionally. Four trained personnels interviewed each subject individually for the assessment of QoL, psychopathology, severity of depressed mood, insight of illness, attitude toward drugs, social function, degree of social supports and conflicts. Results QoL was significantly related to the psychopathology, depressed mood, social conflict, social support; and other aspects of QoL were slightly differently related to depressed mood, social conflict, social support and attitude toward drug by scales. In multiple regression analysis, depressed mood (20.0%) and social conflict (10.3%) were contributed to QoL assessed by Korean version of 4th revision of Schizophrenia Quality of Life. Social support (21.4%), social conflict (20.9%) and depressed mood (3.1%) were contributed to QoL assessed by Korean modification of the Scale to measure Subjective Well-being under Neuroleptic treatment. Conclusions These findings demonstrated that QoL of schizophrenia patients in a community is affected by depressed mood, social support and conflict rather than psychotic symptoms, insight and attitude toward drugs. And this result suggests the necessity of approaching not only to the psychotic symptoms but also to the psychosocial characteristics in caring schizophrenia patients in the community. |
| Author | Lee, Jeong Im 안동현 Ahn, Dong Hyun 장창현 이정임 Jang, Chang Hyun |
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| Title | 지역 정신보건센터에 등록된 조현병 환자의 삶의 질 및 관련 정신사회적 요인 |
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