주요 우울 장애 환자에서 낮은 자아 존중감과 자살 시도의 관련성: 예비 연구

The Relationship between Low Self-Esteem and Suicide Attempt in Patients with Major Depressive Disorder: A Pilot Study

본 연구는 우울증 환자에서 자아 존중감의 정도 및 이와 관련된 심리사회적 요인들이 자살 시도와 어떠한 관련성이 있는지 알아보기 위해 시도되었으며, 이를 위해 전체 연구 참여자를 자살 시도군과 자살 비시도군으로 나누어 비교하였다. 그 결과 자살 시도군은 자살 비시도군에 비해 낮은 자아 존중감과 높은 자살 사고를 보였다. 우울 증상의 경우 전체 BDI 점수에서는 유의한 차이가 없었으나, BDI 하부 요인 중 부정적 태도가 자살 시도군에서 높은 수치로 나타났다. 단계적 다변량 로지스틱 회귀 분석을 사용하여 우울감 및 자살 사고 정도를 보정한 이후에도 낮은 자아 존중감은 자살 시도와 유의한 관련성을 보였다. 낮은 자아 존중감은 주요 우울 장애 환자의 자살 시도에 중요한 역할을 하는 것으로 여겨지며, 자살 시도 예방과 관리에 있어서 우울 증상 및 자살 사고의 심각도 뿐만 아니라 낮은 자아 존중감 또한 중요하게 고려해야 함을 시사한다.

Objective Depression is a major risk factor for suicide, and several psychological factors such as low self-esteem are involved in suicide. The aim of this study was to investigate the difference in self-esteem between non suicide attempters and suicide attempters with major depressive disorder. Methods The study subjects consisted of 52 patients who received inpatient or outpatient treatments at the Hallym University Sacred Heart Hospital. All participants were diagnosed as major depressive disorder by Korean version of the Mini-International Neuropsychiatric Interview. Columbia Suicide Severity Rating Scale (C-SSRS) was used to evaluate patient’s suicide attempt. They completed a questionnaire that included Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI) and Beck Scale for Suicide Ideation (BSI). Results A total of 52 subjects were evaluated by C-SSRS, and among them, 32 were non suicide attempters and 20 were suicide attempters. Compared to non suicide attempters, suicide attempters showed significantly lower levels of self-esteem (t=3.492, p=0.001) and higher levels of BSI (t=-4.890, p<0.001). Although there was no significant difference between two groups for severity of overall depressive symptoms, negative attitude subscale of BDI was higher in suicide attempters than non suicide attempters (t=-2.596, p=0.014). A stepwise multivariate logistic regression analysis showed that low self-esteem was significant association with suicide attempt after adjusted by negative attitude subscale of BDI and BSI (odds ratio=0.779, p=0.042). Conclusion The present study indicated that low self-esteem plays a significant role in suicide attempters with major depressive disorder. Assessment of suicide risk should include not only suicide ideation and severity of overall depressive symptoms but also low self-esteem.