바로가기메뉴

본문 바로가기 주메뉴 바로가기

logo

잠재프로파일분석(LPA)을 활용한 PTSD 증상과 외상 후 성장 수준의 양상: 폭식, 비자살적 자해, 문제성 음주행동에서의 차이

Latent Profile Analysis of PTSD symptoms and PTG among Adults in South Korea: the Differences in Binge Eating, Non-Suicidal Self-Injury, and Problem Drinking Behaviors

한국심리학회지 : 문화 및 사회문제 / Korean Psychological Journal of Culture and Social Issues, (P)1229-0661; (E)1229-0661
2019, v.25 no.4, pp.325-351
https://doi.org/10.20406/kjcs.2019.11.25.4.325
이덕희 (성균관대학교 외상심리건강연구소)
이동훈 (성균관대학교 외상심리건강연구소)
정하영 (성균관대학교 외상심리건강연구소)
  • 다운로드 수
  • 조회수

초록

본 연구는 외상 사건을 경험한 국내 성인의 외상 후 스트레스(Post Traumatic Stress Disorder) 증상과 외상 후 성장(Post Traumatic Growth) 양상을 토대로 잠재계층(latent class)을 도출하고, 각 집단 구분에 영향을 미치는 특성을 탐색하며, 집단에 따른 자기파괴적 행동의 차이를 탐색함으로써, 외상 사건을 경험한 개인에 대해 보다 심층적으로 이해하고자 한다. 이를 위해 본 연구에서는 DSM-5 진단기준에 해당하는 외상 사건을 경험한 국내성인 860명을 대상으로 잠재프로파일분석(Latent Profile Analysis)과 R-3STEP 방식을 이용하였다. 집단 예측 변인으로 개인의 인구사회학적 변인(성별, 연령, 최종 학력, 종교유무, 종교활동 정도, 월 평균 소득)과 사회적 고립, 외상 경험 빈도가 포함되었으며, 종속변인으로 자기파괴적 행동(폭식 정도, 비자살적 자해 유무, 음주의 양, 음주 형태, 음주로 인한 정신 사회적 문제)을 포함하였다. 연구결과 집단은 '저 PTSD/중 PTG집단', '저 PTSD/고 PTG집단', '고 PTSD/고 PTG집단'으로 분류되었다. 또한 성별, 최종학력, 사회적 고립, 외상 노출 빈도가 집단 예측 변인으로 영향을 미치는 것으로 나타났으며, 폭식 정도, 비자살적 자해 유무, 음주 형태, 음주로 인한 정신사회적인 문제에서 집단 간 차이가 있는 것으로 나타났다. 마지막으로 본 연구의 결과를 바탕으로 논의와 시사점을 제시하였다.

keywords
PTSD 증상, 외상 후 성장, 사회적 고립, 외상 경험 빈도, 폭식, 비자살적 자해, 문제성 음주, 잠재프로파일분석

Abstract

The present study examined patterns of co-occurrence between DSM-5 posttraumatic stress disorder(PTSD) symptoms and posttraumatic growth(PTG) among Korean populations(n= 860). Latent profile analysis was used to identify subclasses and suggested that the 3-class model fit best: (1) Low PTSD/Mild PTG group (2) Low PTSD/High PTG group; (3) High PTSD/High PTG group. Class membership was predicted by demographic variables, social isolation, and frequency of traumatic experiences. Classes also differed with respect to self-destructive behaviors(binge eating, non-suicidal self-injury, and problem drinking). These findings contribute to future research about the coexisting patterns of PTSD and PTG, and to identify high-risk individuals who suffer from trauma-related problems in clinical practice.

keywords
PTSD symptoms, PTG, social isolation, frequency of traumatic experiences, binge eating, problem drinking, non-suicidal self-injury, Latent profile analysis
투고일Submission Date
2019-08-27
수정일Revised Date
게재확정일Accepted Date
2019-11-29

참고문헌

1.

권재기 (2012). 범주형 혼합모형의 잠재계층 수 결정을 위한 적합도 지수의 평가: 몬테카를로 시뮬레이션 연구. 고려대학교 대학원 박사학위 청구논문.

2.

김교헌, 김지환 (1989). 한국판 UCLA 고독척도. 충남대학교 학생생활연구소, 16, 13-30.

3.

김주은, 송용수, 고은정, 신성만 (2019). 포항 지진을 경험한 대학생의 외상 후 스트레스 장애 및 외상 후 성장에 영향을 미치는 요인에 관한 연구: 사회적지지, 핵심신념 붕괴, 반추 스타일을 중심으로. 상담학연구, 20(2), 107-123.

4.

김정란, 장유정, 조 항 (2019). 상담 및 심리치료에서의 트라우마(trauma) 연구동향 (2001-2017). 상담학연구, 20(1), 67-91.

5.

김지윤, 이동훈, 김시형 (2018). PTSD 증상의 조건비율에 근거한한국 성인의 트라우마 경험에 관한 연구. 한국심리학회지: 문화및사회문제, 24(3), 365-383.

6.

박윤미, 윤혜미 (2011). 외상생존자와 일하는 사회복지사의 소진에 대한 역할갈등, 업무부담과 이차적 외상 스트레스 및 자기효능감의 영향. 한국아동복지학, 36, 289-322.

7.

박주언, 김원형, 노대영, 원성두, 김하경, 강석훈, 홍나래, 박성용, 김대호, 채정호 (2016). 재난정신건강평가 워크북. 대안불안의학회.

8.

박현정, 하여진, 박민호, 오현철, 이준호, 이진실, 박수억 (2011). 서울교육종단연구 2010 사용자매뉴얼. 서울: 서울특별시교육연구정보원.

9.

서윤아 (2014). 비자살적 자해에 영향을 미치는 복합외상 및 복합외상증후군의 탐색. 충북대학교 석사학위 논문.

10.

송승훈, 이홍석, 박준호, 김교헌 (2009). 한국판 외상후 성장 척도의 타당도 및 신뢰도 연구. 한국심리학회지: 건강, 14(1), 193-214.

11.

염유성 (2017). 한국판 PC-PTSD-5의 타당화 연구. 충북대학교 일반대학원 석사학위논문.

12.

오현승, 이동훈 (2018). 키워드 네트워크 분석을 활용한 PTSD(Post Traumatic Stress Disorder) 연구동향 탐색. 재활심리연구, 25(4), 823-838.

13.

윤명숙 (2013). 사회복지사의 외상경험과 외상 후 스트레스장애의 관계에 미치는 사회적 지지의 조절효과. 정신보건과 사회사업, 41(4), 174-200.

14.

이동훈, 이수연, 윤기원, 최수정, 김시형 (2017). 성격 5 요인, 외상 후 인지, 사건관련 반추, PTSD 증상, 외상 후 성장의 관계: 외상 후 성장모델을 중심으로. 한국심리학회지: 일반, 36(2), 241-270.

15.

이동훈, 이춘화, 신지영, 강민수, 서은경 (2017). 세월호 재난으로 자녀를 잃은 부모들의 사회적 지지, 갈등, 고립경험에 관한 연구. 상담학연구, 18(5), 331-355.

16.

이병욱, 이충헌, 이필구, 최문종, 남궁기 (2000). 한국어판 알코올 사용장애 진단 검사 (AUDIT: Alcohol Use Disorders Identification Test) 의 개발: 신뢰도 및 타당도 검사. 중독정신의학, 4, 83-92.

17.

이수진 (2012). 외로움과 대인관계문제의 관계에서 초기부적응도식의 조절효과. 숙명여자대학교 교육대학원 석사학위 논문.

18.

이임순. (1997). 정상인의 섭식유형 및 다이어트 양상. Korean Journal of Clinical Psychology, 16(1), 87-100.

19.

최승미, 김영재, 권정혜 (2013). 인지적, 문제해결적 행동 대처 및 사회적 지지가 외상 후 성장에 미치는 영향. 인지행동치료, 13, 307-328.

20.

홍세희 (2019). 잠재계층, 잠재전이, 성장혼합모형. 박영사.

21.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.

22.

Arpawong, T. E., Sussman, S., Milam, J. E., Unger, J. B., Land, H., Sun, P., & Rohrbach, L. A. (2015). Post-traumatic growth, stressful life events, and relationships with substance use behaviors among alternative high school students: A prospective study. Psychology & Health, 30(4), 475-494.

23.

Asparouhov, T., & Muthén, B. (2014). Auxiliary variables in mixture modeling: Three-step approaches using M plus. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 329-341.

24.

Ayache, R., Benticha, S., Goutaudier, N., & Chabrol, H. (2016). Psychiatric outcomes after childbirth: can posttraumatic growth protect me from disordered eating symptoms?. Archives of Gynecology and Obstetrics, 293(6), 1271-1278.

25.

Berg, S., Mellström, D., Persson, G., & Svanborg, A. (1981). Loneliness in the Swedish aged. Journal of Gerontology, 36(3), 342-349.

26.

Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM‐5 (PCL‐5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489-498.

27.

Bokszczanin, A. (2007). PTSD symptoms in children and adolescents 28 months after a flood: Age and gender differences. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 20(3), 347-351

28.

Bonanno, G. A., & Mancini, A. D. (2012). Beyond resilience and PTSD: Mapping the heterogeneity of responses to potential trauma. Psychological trauma: Theory, Research, Practice, and Policy, 4(1), 74.

29.

Burnam, M. A., Stein, I A., Golding, J. M., Siegel, J. M., Sorenson, S. B., Forsythe, A. B., & Telles, C. A. (1988). Sexual assault and mental disorders in a community population. Journal of Consulting and Clinical Psychology, 56(6), 843-850

30.

Breslau, N., Reboussin, B. A., Anthony, J. C., & Storr, C. L. (2005). The structure of posttraumatic stress disorder: latent class analysis in 2 community samples. Archives of General Psychiatry, 62(12), 1343-1351.

31.

Brooks, M., Graham-Kevan, N., Robinson, S., & Lowe, M. (2018). Trauma characteristics and posttraumatic growth: The mediating role of avoidance coping, intrusive thoughts, and social support. Psychological Trauma: Theory, Research, Practice, and Policy.

32.

Calhoun, L. G., & Tedeschi, R. G. (1999). Facilitating posttraumatic growth: A clinician’s guide. Routledge.

33.

Cao, C., Wang, L., Wu, J., Li, G., Fang, R., Cao, X., ... & Elhai, J. D. (2018). Patterns of posttraumatic stress disorder symptoms and posttraumatic growth in an epidemiological sample of Chinese earthquake survivors: A latent profile analysis. Frontiers in Psychology, 9.

34.

Chopko, B. A., Palmieri, P. A., & Adams, R. E. (2019). Posttraumatic growth in relation to the frequency and severity of traumatic experiences among police officers in small to midsize departments. Journal of Interpersonal Violence, 34(6), 1247-1260.

35.

Collins, L. M., & Lanza, S. T. (2009). Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences. New York: Wiley.

36.

Contractor, A. A., & Weiss, N. H. (2019). Typologies of PTSD clusters and reckless/self- destructive behaviors: a latent profile analysis. Psychiatry Research, 272, 682-691.

37.

Costello, E. J., Erkanli, A., Fairbank, J. A., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 15(2), 99-112.

38.

Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological methods, 1(1), 16.

39.

de Vries, G. J., & Olff, M. (2009). The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 22(4), 259-267.

40.

Eidhof, M. B., Djelantik, A. M. J., Klaassens, E. R., Kantor, V., Rittmansberger, D., Sleijpen, M., ... & ter Heide, F. J. J. (2019). Complex Posttraumatic Stress Disorder in Patients Exposed to Emotional Neglect and Traumatic Events: Latent Class Analysis. Journal of Traumatic Stress, 32(1), 23-31.

41.

Field, A. (2013). Discovering statistics using IBM SPSS statistics. LA: SAGE Publications.

42.

Frazier, P., Ander, S., Perera, S., Tomich, P., Tennen, H., Park, C., & Tashiro, T. (2009). Traumatic events among undergraduate students: Prevalence and associated symptoms. Journal of Counseling Psychology, 56(3), 450-460.

43.

Gabriel, S., Read, J. P., Young, A. F., Bachrach, R. L., & Troisi, J. D. (2017). Social surrogate use in those exposed to trauma: I get by with a little help from my (fictional) friends. Journal of Social and Clinical Psychology, 36(1), 41-63.

44.

Galatzer-Levy, I. R., & Bryant, R. A. (2013). 636,120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science, 8(6), 651-662.

45.

Garner, D. M., & Olmsted, M. P. (1984). Manual for Eating Disorder Inventory (EDI); Plus Manual Supplement. Psychological Assessment Resources.

46.

Garner, R. (1990). When children and adults do not use learning strategies: Toward a theory of settings. Review of Educational Research, 60(4), 517-529.

47.

Goar, S. G., Tungchama, F. P., Taru, M. Y., Nwoga, C. N., & Bankat, M. (2018). Trauma Exposure, Posttraumatic Stress Disorder and Alcohol Use Disorder among Females in Jos, North Central Nigeria. J Psychiatry, 21(453), 2.

48.

Goodman, R., & Calderon, A. (2012). The use of mindfulness in trauma counseling. Journal of Mental Health Counseling, 34(3), 254-268.

49.

Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253-263.

50.

Hays, R. D., & DiMatteo, M. R. (1987). A short-form measure of loneliness. Journal of Personality Assessment, 51(1), 69-81.

51.

Hill, K. G., White, H. R., Chung, I. J., Hawkins, J. D., & Catalano, R. F. (2000). Early adult outcomes of adolescent binge drinking: person and variable‐centered analyses of binge drinking trajectories. Alcoholism: Clinical and Experimental Research, 24(6), 892-901.

52.

Hruska, B., Irish, L. A., Pacella, M. L., Sledjeski, E. M., & Delahanty, D. L. (2014). PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims: A latent class analysis. Journal of Anxiety Disorders, 28(7), 644-649.

53.

Johnson, H., & Thompson, A. (2008). The development and maintenance of post- traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28(1), 36-47.

54.

Joseph, S., & Linley, P. A. (2006). Growth following adversity: Theoretical perspectives and implications for clinical practice. Clinical Psychology Review, 26(8), 1041-1053.

55.

Kim, M. M., Ford, J. D., Howard, D. L., & Bradford, D. W. (2010). Assessing trauma, substance abuse, and mental health in a sample of homeless men. Health & Social Work, 35(1), 39-48.

56.

Kline, A., Weiner, M. D., Ciccone, D. S., Interian, A., Hill, L. S., &Losonczy, M. (2014). Increased risk of alcohol dependency in a cohort of National Guard troops with PTSD: a longitudinal study. Journal of Psychiatric Research, 50, 18-25.

57.

Kokaliari, E. D. (2014). An exploratory study of the nature and extent of nonsuicidal self-injury among college women. International Journal of Population Research, 2014.

58.

Lowenthal, M. F., & Robinson, B. (1976). Social networks and isolation. Handbook of Aging and the Social Sciences, 5, 432-56.

59.

McDiarmid, L., Taku, K., & Phillips, M. (2017). Posttraumatic growth associated with perceived changes in health values and reduced alcohol use among bereaved college students. Traumatology, 23(4), 309.

60.

Milligan-Saville, J., Choi, I., Deady, M., Scott, P., Tan, L., Calvo, R. A., ... & Harvey, S. B. (2018). The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service. Psychiatry Research, 270, 1110-1115.

61.

Minihan, S., Liddell, B. J., Byrow, Y., Bryant, R. A., & Nickerson, A. (2018). Patterns and predictors of posttraumatic stress disorder in refugees: A latent class analysis. Journal of Affective Disorders, 232, 252-259.

62.

Mota, N. P., Turner, S., Taillieu, T., Garcés, I., Magid, K., Sethi, J., ... & Afifi, T. O. (2019). Trauma exposure, DSM-5 post- traumatic stress disorder, and sexual risk outcomes. American Journal of Preventive Medicine, 56(2), 215-223.

63.

Muthén, B., & Muthén, L. K. (2000). Integrating person‐centered and variable‐centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism: Clinical and experimental research, 24(6), 882-891.

64.

Nietlisbach, G., & Maercker, A. (2009). Social cognition and interpersonal impairments in trauma survivors with PTSD. Journal of Aggression, Maltreatment & Trauma, 18(4), 382-402.

65.

Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70(3), 300-310.

66.

Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural equation modeling: A multidisciplinary Journal, 14(4), 535-569.

67.

Pastor, D. A., Barron, K. E., Miller, B. J., & Davis, S. L. (2007). A latent profile analysis of college students’ achievement goal orientation. Contemporary Educational Psychology, 32(1), 8-47.

68.

Prins, A., Bovin, M. J., Smolenski, D. J., Marx, B. P., Kimerling, R., Jenkins-Guarnieri, M. A., ... & Tiet, Q. Q. (2016). The primary care PTSD Screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. Journal of general internal medicine, 31(10), 1206-1211.

69.

Prins, A, Ouimette, P, Kimerling, R, Cameron, R. P, Hugelshofer, D. S, Shaw-Hegwer, J, & Sheikh, J. I. (2003). The primary care PTSD screen (PC-PTSD): development and operating characteristics. Primary care psychiatry, 9(1), 9-14.

70.

Rahman, A. F., Manatunga, A., Guo, Y., Peng, L., Warnock, M., Ressler, K. J. & Jovanovic, T. (2018). A latent class analysis of PTSD symptoms among inner city primary care patients. Journal of Psychiatric Research, 98, 1-8.

71.

Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472.

72.

Russell, D., Peplau, L. A., & Ferguson, M. L. (1978). Developing a measure of loneliness. Journal of Personality Assessment, 42(3), 290-294.

73.

Ryu, W., & Park, S. (2018). Post-traumatic Stress Disorder and Social Isolation among North Korean Refugee Women in South Korea: The Moderating Role of Formal and Informal Support. Sustainability, 10(4), 1246.

74.

Saunders, J. B., Aasland, O. G., Babor, T. F., De la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption‐II. Addiction, 88(6), 791-804.

75.

Schoedl, A. F., Costa, M. C. P., Mari, J. J., Mello, M. F., Tyrka, A. R., Carpenter, L. L., & Price, L. H. (2010). The clinical correlates of reported childhood sexual abuse: an association between age at trauma onset and severity of depression and PTSD in adults. Journal of Child Sexual Abuse, 19(2), 156-170.

76.

Sippel, L. M., Watkins, L. E., Pietrzak, R. H., Hoff, R., & Harpaz-Rotem, I. (2018). The unique roles of emotional numbing and arousal symptoms in relation to social connectedness among military veterans in residential treatment for PTSD. Psychiatry, 81(3), 271-282.

77.

Steenkamp, M. M., Nickerson, A., Maguen, S., Dickstein, B. D., Nash, W. P., & Litz, B. T. (2012). Latent classes of PTSD symptoms in Vietnam veterans. Behavior Modification, 36(6), 857-874.

78.

Smith, N. B., Kouros, C. D., & Meuret, A. E. (2014). The role of trauma symptoms in nonsuicidal self-injury. Trauma, Violence, & Abuse, 15(1), 41-56.

79.

Solomon, Z., Waysman, M., & Mikulincer, M. (1990). Family functioning, perceived societal support, and combat-related psychopathology: The moderating role of loneliness. Journal of Social and Clinical Psychology, 9(4), 456-472.

80.

Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455-471.

81.

Tedeschi, R. G., & Calhoun, L. G. (2004). “Posttraumatic growth: Conceptual foundations and empirical evidence”. Psychological Inquiry, 15(1), 1-18.

82.

Tedeschi, R. G., Cann, A., Taku, K., Senol‐Durak, E., & Calhoun, L. G. (2017). The posttraumatic growth inventory: A revision integrating existential and spiritual change. Journal of Traumatic Stress, 30(1), 11-18.

83.

Townsend, Peter. 1968. “Isolation, Desolation and Loneliness.” In Ethel Shanas, Peter Townsend, D. Wedderburn, H. Friis, P. Milhoy, and J. Stenhouwer (Eds.), Old People in Three Industrial Societies. London: Routledge and K. Paul.

84.

Tull, M. T., Weiss, N. H., & McDermott, M. J. (2016). Post-traumatic stress disorder and impulsive and risky behavior: Overview and discussion of potential mechanisms. Comprehensive guide to post-traumatic stress disorders, 803-816. Springer International Publishing

85.

Vermunt, J. K. (2010). Latent class modeling with covariates: Two improved three-step approaches. Political analysis, 18(4), 450-469.

86.

Wang, J., & Wang, X. (2012). Structural equation modeling: Applications using Mplus. West Sussex, UK: Higher Education Press.

87.

Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P.,& Keane, T. M. (2013). The Life Events Checklist for DSM-5 (LEC-5). Retrieved from the National Center for PTSD website: http://www.ptsd.va.gov

88.

Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In annual convention of the international society for traumatic stress studies, San Antonio, TX (Vol. 462).

89.

Williams, D. (2010). Hurting to Cope: Self-Injurious Behavior as an Escape from Self-Focus. Undergraduate Review, 6(1), 120-129.

90.

Zeligman, M., Bialo, J. A., Brack, J. L., & Kearney, M. A. (2017). Loneliness as moderator between trauma and posttraumatic growth. Journal of Counseling & Development, 95(4), 435-444.

한국심리학회지 : 문화 및 사회문제