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아동·청소년 자살고위험군 자살예방평가 및 프로그램

Development of Suicide Prevention Programs for Mental Health Professionals Working with Children and Adolescens at High Risk of Suicide

  • 양정순 (익산시정신건강복지센터) ;
  • 우희순 (원광대학교 의과대학 작업치료학과)
  • Yang, Jeong-Soon (Iksan Mental Health Welfare Center) ;
  • Woo, Hee-Soon (Dept. of Occupational Therapy, Wonkwang University)
  • 투고 : 2024.04.24
  • 심사 : 2024.07.24
  • 발행 : 2024.08.31

초록

우리나라 자살률은 Organization for Economic Cooperation and Development 국가 중 압도적 1위이며, 특히 아동·청소년들은 삶의 만족도가 낮고, 자살률 또한 매년 증가하고 있다. 아동·청소년 시기는 어느 발달단계보다 격동적이고 충동적인 시기로 자살 그 자체가 치명적이고, 전염성이 높다. 또한 의미 있는 작업을 잃어버렸을 경우에도 자살률이 높은데, 이는 자살고위험군 아동·청소년도 마찬가지이다. 정신건강복지법이 개정되고, 정신건강전문요원에 작업치료사가 포함되기 시작하면서 정신건강서비스에 있어 작업치료를 포함한 다학제적 접근이 강조되고 있다. 아동·청소년 자살을 막기 위한 선별도구로 자살사고척도(Suicidal Ideation Questionnaire), Beck의 자살사고척도(Beck Scale for Suicide Ideation), 콜롬비아 대학 자살 심각성 평가 척도(Columbia-Suicide Severity Rating Scale), 청소년용 삶의 이유척도(The Reasons for Living Inventory for Adolescents), 학생 정서·행동 특성검사(Student Emotional and Behavioral Screening Test)가 사용되었고, 작업치료평가도구인 Canadian Occupational Performance Measure도 사용되었다. 또한 다양한 학문과 기관에서 다양한 자살예방프로그램이 제시되고 있다. 하지만 자살고위험군 현실적 특성상 신속하고 적기에 서비스를 제공해야 하기 때문에 다른 자살예방프로그램보다 상대적으로 그 수가 적으며 이 또한 대부분 인지행동적 측면에 초점이 맞춰져 있다. 따라서 본 연구는 아동·청소년 자살고위험군을 대상으로 정신건강서비스를 제공하는 전문가들에게 다양한 자살예방프로그램을 소개하고, 각기 처해 있는 실정에 맞게 현장에서 활용할 수 있도록 하는 데 목적이 있다.

Korea has the highest suicide rate among Organization for Economic Cooperation and Development countries, with increasing rates observed among children and adolescents with low levels of life satisfaction. Patients in these age groups exhibit particularly turbulent and impulsive behaviors, which make suicide highly contagious and fatal. The loss of meaningful work or activities increases the risk of suicide, especially in young people. Following revisions to the Mental Health Welfare Act (2016), which has included occupational therapists among mental health professionals, a multidisciplinary approach including occupational therapy has been emphasized upon in mental health services. Screening tools for preventing suicide in children and adolescents include the Suicidal Ideation Scale, Beck's Suicidal Ideation Scale, Columbia-Suicide Severity Rating Scale, Reasons for Living Scale for Adolescents, and the Student Emotional and Behavioral Characteristics Test. The Canadian Occupational Performance Measure, which is an occupational therapy evaluation tool, is also used. Various suicide prevention programs have been proposed across academic disciplines; however, due to the urgent nature of high-risk groups, there is a need for timely services. Currently, most existing programs focus primarily on the cognitive-behavioral aspects. In this study, we aimed to introduce diverse suicide prevention programs for mental health professionals working with high-risk children and adolescents in order to equip them with the relevant information and help apply their learnings effectively in different situations.

키워드

참고문헌

  1. Ahn, S. J., Park, E. H., Hong, H. J., Song, J. E., Yook, K. H., & Kim, S. E. (2013). The role of resilience as a protective factor for suicide in adolescent patients with depression. Korean Journal of Clinical Psychology, 32(2), 351-366. https://doi.org/10.15842/kjcp.2013.32.2.005 
  2. Averill, J. (1982). Anger and aggression: An essay on emotion. Springer-Verlag. https://doi.org/10.1007/978-1-4612-5743-1 
  3. Beck, A. T. (1979). Cognitive therapy and the emotional disorders. International Universities Press. https://books.google.co.kr/books?id=nSFvAAAAQBAJ&dq=+Beck,+A.+T.+(1976).+Cognitive+therapy+and+the+emotional+disorders.+New+York,+NY:+International+Universities+Press.+&lr=&hl=ko&source=gbs_navlinks_s 
  4. Byeon, W. J., & Kim, C. K. (2006). Effects of sociodemographic variables, self-differentiation and internal systems on ego-identity of middle-aged women. Journal of the Korean Home Economics Association, 44(12), 155-165. 
  5. Cho, H. H., Kang, J. M., & Kim, W. S. (2018). Trends in research on adolescent suicide interventions. Child Health Nursing Research. 24(4), 393-406. http://doi.org/10.4094/chnr.2018.24.4.393 
  6. Choi, H. M., & Lee, S. H. (2014). The development and application of a narrative therapy program to promote adolescents mental health. Journal of Arts Psychothreapy, 10(2), 311-335. 
  7. Choi, J. W., Moon, H. Y., Jeon, J. A., & Park, Y. C. (2021). Survey on the mental health of teenagers. Sejong, Korea: National Youth Policy Institute. https://www.nypi.re.kr/repository/handle/2022.oak/2927 
  8. Choi, S. H., & Kim, H. S. (2021). A meta-analysis of the effects of suicide preventive interventions for adolescents: Analyses depending on primary, secondary and tertiary preventive approaches. Korean Journal of Child Psychotherapy, 16(2), 1-23. http://doi.org/10.23931/kacp.2021.16.2.1 
  9. Choi, Y. A. (2003). Horticultural therapy. Hakjisa. https://www.hakjisa.co.kr/mobile/subpage.html?page=book_book_info&bidx=537 
  10. Du, J. Y. (2004). The effects of group counselling program for mental health on the juvenile's suicide factors (Master's thesis). Youngnam Theological University.
  11. Eom, S. H., & Roe, H. G. (2021). Developing and verifying the effectiveness of an internal family system (IFS) application group-counseling program to reducing shame among youth. Journal of Humanities and Social Science 21, 12(4), 1449-1464. http://doi.org/10.22143/HSS21.12.4.103 
  12. Garbarino, J. (1985). Adolescent development: An ecological perspective. Merrill Publishing Company. https://books.google.co.kr/books/about/Adolescent_Development.html?id=6JQEAQAAIAAJ&redir_esc=y 
  13. Giegling, I., Olgiati, P., Hartmann, A. M., Calati, H. J., Moller, H., Rujescu, D., & Serretti, A. (2009). Personality and attempted suicide. Analysisofanger, aggression and impulsivity. Joumal of Psychiatric Research, 43(16), 1262-1271. http://doi.org/10.1016/j.jpsychires.2009.04.013 
  14. Glasser, W. (1998). Choice theory: A new psychology of personal freedom. Harper Collins. https://www.sciepub.com/reference/181636 
  15. Ha, M. S. (2014). The effects of group art therapy on the emotional and behavioral characteristics of adolescents in the suicide risk group (Master's thesis). Yeungnam University. 
  16. Jang, H. K. (2009). The reality of reading therapy for young people. Jungmun Publishing. 
  17. Jang, H. P. (2000). Theoretical approach to group counseling. JoongAng Jeokseong Publishing Company. 
  18. Jeong, S. Y., & Choi. H, C. (2013). The effect of unconditional self-acceptance as a mediator between attachment to mother and life satisfaction in children. Korea Journal of Youth Counseling, 21(2), 1-24. http://doi.org/10.35151/kyci.2013.21.2.001 
  19. Jung, S. A., Ahn, D. H., Chung, S. Y., Jeong, Y. G., & Kim, Y. Y. (2008). Development of screening test for adolescent mental health and problem behavior. Journal of the Korean Neuropsychiatric Association, 47(2), 168-176. 
  20. Kang, D. S. (2008). Effects of mental health promotion program based on reality therapy on the depression and suicide ideation of adolescents (Unpublished master's thesis). Kyungnam University.
  21. Kang, S. Y. (2015). Analysis on effectiveness of the spiritual education program for preventing youth suicide (Doctoral dissertation). Hoseo University.
  22. Kim, H. W., Kim, Y. K., Park. J. Y., Hong, C. B., Lee, K. Y., Park, T. J., & Kim, J. S. (2017). The relationship between smoking and suicidal behavior in Korean adolescents: 12th Korea youth risk behavior web-based survey. Korean Journal of Health Promotion, 17(4), 219-233. http://doi.org/doi:10.15384/kjhp.2017.17.4.219 
  23. Kim, J. H. (2014). Influence of acquired capability for suicide on adolescents'suicide attempt: Focusing on experiences of domestic violence (Master's thesis). Yeungnam University.
  24. Kim, J. R., & Kim, H. J. (2021). Development of art therapy programs for youth at risk of suicide. Journal of Korea Academia-Industrial Cooperation Society, 22(1), 543-552. http://doi.org/10.5762/KAIS.2021.22.1.543 
  25. Kim, M. A. (2013). A study on the effects of the group counselling programs of emotion coaching for adolescents in suicidal crisis (Master's thesis). Keimyung University.
  26. Kim, R., Kwon, H. I., Lee, Y. h., Yook, K. H., Song, J. E., Song, M. A., & Hong. H. J. (2015). Risky behavior sub types and suicide attempts in adolescents with depression. Korean Journal of Child & Adolescent Psychiatry, 26(3), 149-158. http://doi.org/10.5765/jkacap.2015.26.3.149 
  27. Kim, S. D., & Lee, W. K. (2004). Theory and application of psychodrama. Hakjisa. 
  28. Korea Disease Control and Prevention Agency. (2023, Sept ember 11). Youth health behavior survey statistics in 2022. https://www.imhc.or.kr/user/board/view.php?sq=9960&board_code=data_out&search=YToxOntzOjEwOiJib2FyZF9jb2RlIjtzOjg6ImRhdGFfb3V0Ijt9 
  29. Korean Association of Mental Health Social Workers. (2016). Understanding and application of mental health and social welfare. Yale Plannin. https://product.kyobobook.co.kr/detail/S000001958354 
  30. Lee, D. Y., Seo, H. Y., Sim, I. O., & Lee, H. M. (2015). The effect of laughter therapy on depression, suicidal ideation and resilience for adolescent. Korean society for Wellness, 10(2), 137-146. 
  31. Lee, G. S., Jang, E. H., & Kim, E. Y. (2016a). Development of a suicide prevention program for adolescents. Korea Journal of Youth Counseling, 24(2), 99-124. http://doi.org/10.35151/kyci.2016.24.2.006 
  32. Lee, H. J., Shin, M. S., Ko, H. J., & Kwak, Y. S. (2014). A study of the reliability and validity of the Korean version of the reasons for living inventory for adolescents. Journal of the Korean Academy of Child and Adolescent Psychiatry, 25(3), 163-170. http://doi.org/10.5765/jkacap.2014.25.3.163 
  33. Lee, J. I., & Oh, S. G. (2013). The effects of 'suicide prevention program' on suicidal risk and suicidal attitudes of adolescent. Forum For Youth Culture, 37, 81-101. https://doi.org/10.17854/ffyc.2014.01.37.81 
  34. Lee, J. S., Kang, D. H., & Park, S. Y. (2016b). Effects of a small group occupational therapy program on adolescents at risk of suicide: A preliminary study. Korean Journal of Occupational Therapy, 24(1), 39-52. https://doi.org/10.14519/jksot.2016.24.1.04 
  35. Lee, S. Y. (2013). The effect of anger adjustment program on anger, idea about suicide, and school life of middle school students who have attempted to commit a suicide (Master's thesis). Kyungsung University.
  36. Lee, S. Y., Chae, S. M., Jeong, J. W., Yoon, S. M., & Cha, M. R. (2017). Reinforcing the care programs for the suicide attempters in Korea (Publications, No. 2017-28), Korea Institute for Health and Social Affairs. https://repository.kihasa.re.kr/handle/201002/29086 
  37. Lee, Y. S. (2010). Laughter therapy. Hanam Press. https://www.yes24.com/Product/Goods/80460936 
  38. Lewis, G., & Sloggett, A. (1998). Suicide, deprivation, and unemployment: Record linkage study. BMJ, 317(7168), 1283-1286. http://doi.org/10.1136/bmj.317.7168.1283 
  39. Lim, S. W. & Oh, K. S. (2012). Suicide prevention by education. Journal of Korean Medical Association, 55(4), 349-355. http://doi.org/10.5124/jkma.2012.55.4.349 
  40. Maltsberger, J. T. (1991). Psychotherapy with older suicidal patients. Journal of Geriatric Psychiatry, 24(2), 217-234. https://psycnet.apa.org/record/1992-13681-001 
  41. Ministry of Education. (2023). 2023 student emotional and behavioral characteristics test and management manual. Student Mental Health Support Center. https://www.smhrc.kr/dataCenter/dataView?pageNo=1&dataId=304&searchKeyword=null 
  42. Moreno. (1972). Psychodrama: First volume. Beacon House. https://www.amazon.com/Psychodrama-First-FourthNew-Introduction/dp/B000I9LQHE 
  43. Nam, S. H. (2008). A study on psychosocial mechanism of copycat suicide ideation among adolescents. Studies in Humanities and Social Sciences, 1(19), 49-84. 
  44. National Center for Mental Health. (2022). Evidence-based mental health assessment tool. https://www.ncmh.go.kr/ncmh/board/boardView.do?fno=37&menu_cd=01_01&no=9059&bn=newsView 
  45. OECD. (2023). Suicide rates (indicator). http://doi.org/doi:10.1787/a82f3459-en 
  46. Oh, M. H., Ko, Y. J., Ko, H. E., Kim, J. J., Kim, J. H., Yang, G. O., & Cho, N. J. (2015). Understanding occupational therapy. Beommun Education. 
  47. Osman, A., Downs, W. R., Kopper, B. A., Barrios, F. X., Baker, M. T., Osman, J. R., Besett, T. M., & Linehan, M. M. (1998). The reasons for living inventory for adolescents (RFLA): Development and psychometric properties. Journal of Clinical Psychology, 54, 1063-1078. http://doi.org/10.1002/(SICI)1097-4679(199812)54:8<1063::AID-JCLP6>3.0.CO;2-Z 
  48. Park, B. G. (2006). An exploratory study of eco-system factors on adolescents suicidal ideation (Doctoral dissertation). Chungbuk National University.
  49. Park, K. H., & Kim, E. S. (2015). The effect of horticultural group program on depression and suicidal thought of female middle school students, Korean Journal of Arts Therapy, 15(1), 61-78. https://doi.org/10.35594/kata.2015.15.1.004 
  50. Park, K. R., & Kim, H. S. (2022). The effects of a suicide prevention program applied on psychodrama in female high school students. Korea Journal of Psychiatric Nursing, 31(3), 269-278. https://doi.org/10.12934/jkpmhn.2022.31.3.269 
  51. Park. S. W. (2019). A study on the effectiveness of suicide prevention gatekeeper education program for adolescents (Master's thesis). Soongsil University.
  52. Relf, D. (1981). Dynamics of horticultural therapy. Rehabilitation Literature, 42(5-6), 147-150. https://pubmed.ncbi.nlm.nih.gov/7268166/ 
  53. Reynolds, W. M., & Mazza, J. J. (1999). Assessment of suicidal ideation in inner-city children and young adolescents: Reliability and validity of the suicidal ideation questionnaire-JR. School Psychology Review, 28, 17-30. 
  54. Seo, M., Kim, E. h., Lee, T. Y., & Kim, J. H. (2018). Senior youth mental health counseling intervention manual: Suicide and self-harm. Korea Youth Counseling and Welfare Development Institute. https://www.kyci.or.kr/userSite/lib/public_read.asp?idx=R319&Page=1&Gubun=T&orderMdate=%EC%A0%95%EB%A0%AC&SearchGubun=bname&SearchText=%EA%B3%A0%EC%9C%84%EA%B8%B0 
  55. Shin, M. S. (1992). An empirical study of the mechanism of suicide: Validation of the scale for escape from the self (Doctoral dissertation). Yonsei University. 
  56. Shin, M. S., Park, K. B., Oh, K. J., & Kim, Z. S. (1990). A study of suicidal ideation among high school students: The structural relation among depression, hopelessness and suicidal ideation. Korean Journal of Clinical Psychology, 9(1), 1-19. 
  57. Shin, S. J., Jeong, E. S., Heo, M. K., & Yoon, E. J. (2020). The effect of great program customized to high risk adolescents with suicide attempt and self harm. Korea Journal of Youth Counseling, 28(1), 73-97. https://www.kyci.or.kr/fileup/lib_pdf/2020-33-4.pdf 
  58. Shin, C. H., & Yoo, E. Y. (2022). History of mental health service in Korea and entailment of mental health occupational therapists according to amendment to mental health act. Journal of the Korean Occupational Therapy Association, 30(4), 19-33. https://www.earticle.net/Article/A421479 
  59. Statistics Korea. (2023, September 21). Causes of death statistics in 2022 (Press Releases). https://kostat.go.kr/board.es?mid=a20108100000&bid=11773&act=view&list_no=427470 
  60. Statistics Research Institute. (2023). Children and youth wellbeing in Korea 2022 (Press Releases). https://kostat.go.kr/board.es?mid=b10105000000&bid=0060&act=view&list_no=426078 
  61. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. Norton & company. https://wwnorton.com/books/Narrative-Means-to-Therapeutic-Ends/ 
  62. Yang, Y. A. (2020). Occupational therapy evaluation. Edufactory. 
  63. Yoo, J. S., Son, J. W., & Nam, M. S. (2010). The effects of a depression intervention and suicide prevention program in adolescents with high risk of suicide. Journal of Korean Academy of Community Health Nursing, 21(1), 71-81. https://koreascience.or.kr/article/JAKO201033062369502.page  1033062369502.page