ISSN : 1229-0653
본 연구의 목적은 재난 후 정신질환 발병에 어떠한 이차 스트레스 요인들이 보다 큰 위험요소로 작용하는지 검토하는 것이다. 이를 위해 국립재난안전연구원의 재난피해자 삶의 변화 추적조사 데이터를 활용하여 2012년부터 2017년까지 재난피해자 중에서 재난 전 3개월 간 어떠한 정신질환도 없었던 이들의 데이터를 분석하였다(n=1390). 재난 후 정신질환 발병 집단(n=156)과 아닌 집단(n=1234)으로 구분하고 로지스틱 회귀분석을 실시하여 인구통계학적 요인, 재난 특성, 일차 스트레스 요인, 이차 스트레스 요인들이 재난 후 정신질환 발병을 예측하는지 확인하였다. 그 결과, 여성, 높은 연령, 사회재난 경험, 가구의 현재 월수입이 낮은 경우, 재난으로 상해나 질병 피해를 입었을 경우에 재난 후 정신질환 발병 확률이 높았다. 이차 스트레스 요인 중에서는 재난으로 인해 이웃, 지자체, 정부와 갈등이 있었던 경우, 구호 서비스나 복구과정에서 제공받은 정보가 신뢰롭지 않았을 경우, 국가의 의료지원이 충분치 않았던 경우, 재난 후 총 자산이 감소한 경우에 재난 후 정신질환 발병 확률이 높았다. 이를 통해 당장의 가시적인 피해에만 주목할 것이 아니라 재난 피해자들을 둘러싼 사회·문화적 환경에 내재되어 있던 취약성, 새롭게 발생한 스트레스 요인들을 최소화하는 제도적 방안이 필요함을 제안하였다.
This study aimed to examine which secondary stress factors served as greater risk factors for the onset of mental disorders following a disaster. For this purpose, disaster victim follow-up data from the National Disaster Management Research Institute, obtained between 2012 and 2017, were used to analyze data of victims who showed no symptoms of mental illness for a period of three months prior to the disaster (n=1390). The participants were divided into two groups: those that developed a mental disorder after a disaster (n=156) and those that did not (n=1234). Logistic regression analysis was then performed to determine whether demographic factors, disaster-related factors, psychological factors, primary stress factors, and secondary stress factors predicted the onset of mental disorder following a disaster. The results showed that the risk of developing a mental disorder following a disaster was higher among women, older age, lower monthly income, victims of a social disaster, victims who suffered an injury or disease due to the disaster, and victims who were experiencing high levels of depression and post traumatic stress symptoms at the time of the study. Among secondary stress factors, the risk of developing a mental disorder following a disaster was higher among victims who experienced conflict with neighbors, local and national governments, when the disaster relief service or information provided during the recovery process was unreliable, when the government delivered inadequate medical support, and a decrease in asset. These results suggested that secondary stress management should be included as important factors for consideration in the mental health coping strategies of victims of disasters.
국립정신건강센터 (2018). 재난정신건강 서비스에대한 대국민 인식도 조사 결과 보고서. 서울:국립정신건강센터. 미발간.
김익한, 이은경, 이응택, 김하나, 최준규 (2016). 세월호 참사 피해자 가족의 생활실태 및 심리상태에 따른 공동체 욕구조사. 정책연구, 1-131.
박승진, 최혜라, 최지혜, 김건우, 홍진표 (2010). 한글판 우울증 선별도구(Patient Health Questionnaire-9, PHQ-9)의 신뢰도와 타당도. 대한불안의학회지, 6, 119-122.
배정이, 김희현, 박현주, 신화령, 홍희정, & 손혜숙. (2015). 재난심리지원 전략 개발을 위한홍수 피해자의 경험분석. 한국위기관리논집, 11(9), 23-45.
은헌정, 권태완, 이선미, 김태형, 최말례 조수진. (2005). 한국판 사건충격척도 수정판의 신뢰도 및 타당도 연구. 신경정신의학, 44, 303-310.
이나빈, 안현의 (2016). 생태체계이론에 기반한재난피해자들의 외상 후 스트레스 장애관련변인 메타분석. 한국심리학회지: 일반, 35(4), 525-562.
조선미 (2016). 참사피해자 중 단원고 희생자 가족대상 실태조사. 4⋅16 세월호 참사 특별조사위원회.
Anwar, J., Mpofu, E., Mathews, L. R., & Brock, K. E. (2013). Risk factors of postraumatic stress disorder after an earthquake disaster. Journal of Nervous and Mental Disease, 201, 1045-1052.
Bei, B., Bryant, C., Gilson, K. M., Koh, J., Gibson, P., Komit, A., & Jud, F. (2013). A prospective study of the impact of floods on the mental and physical health of older adults. Aging and Mental Health, 17, 92-102.
Crabbs, M. A., & Black, K. U. (1984). Job change following a natural disaster. Vocational Guidance Quarterly.
Chamlee-Wright, E., & Storr, V. H. (2010). Expectations of government’s response to disaster. Public Choice, 144, 253-274. doi:DOI 10.1007/s11127-009-9516-x
Chan, C. S., & Rhodes, J. E. (2014). Measuring Exposure in Huricane Katrina: A Meta-Analysi and an Integrative Data Analysis. Plos One, 9, 1-15.
Davidson, J.R., McFarlane, A.C. (2006) The extent and impact of mental health problems after disaster. Journal of Clinical Psychiatry, 67, 9-14.
Duffy, M., Bolton, D., Gilespie, K., Ehlers, A., &Clark, D. M. (2013). A community study of the psychological efects of the Omagh Car Bomb on Adults. PLoS One, 8, e7618.
Furr, J. M., Comer, J. S., Edmunds, J. M., &Kendall, P. C. (2010). Disasters and youth: A meta-analytic examination of posttraumatic stress. Journal of Consulting and Clinical Psychology, 78(6), 765-780. doi:10.1037/a0021482
Galea, S., Nandi, A., & Vlahov, D. (2005). The epidemiology of post-traumatic stress disorder after disasters. Epidemiologic reviews, 27(1), 78-91.
Giannopoulou, I., Strouthos, M., Smith, P., Dikaiakou, A., Galanopoulou, V., & Yule, W. (2006). Post-traumatic stress reactions of children and adolescents exposed to the Athens 1999earthquake. European Psychiatry, 21(3), 160-166.
Goenjian, A. K., Najarian, L. M., Pynoos, R. S., &Steinberg, A. M. (1994). Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. The American Journal of Psychiatry, 151(6), 895-891.
Halpern, J., & Tramontin, M. (2007). Disaster mental health: Theory and practice. Belmont, CA:Thompson Broks/Cole.
Kroenke, K., Spitzer, R.L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16, 606-613.
Lock, S., Rubin J., Murray, V., Rogers, B., Amlot, R., Williams R. (2012). Secondary stressors and extreme events and disaster: a systematic review of primary research from 2010-2011. PLoS curents, 4.
Lowe, S. R., Chan, C. S., & Rhodes, J. E. (2010). Pre-hurricane perceived social support protects against psychological distress: A longitudinal analysis of low-income mothers. Journal of consulting and clinical psychology, 78(4), 551.
Lowe, S. R., Tracy, M., Cerdá, M., Norris, F. H., &Galea, S. (2013). Immediate and Longer-Term Stressors and the Mental Health of Hurricane Ike Survivors. Journal of Traumatic Stress, 26(6), 753-761.
Lommen, M. J., Sanders, A. J., Buck, N., & Arntz, A. (2009). Psychosocial predictors of chronic Post-Traumatic Stres Disorder in Sri Lankan tsunami survivors. Behaviour Resarch and Therapy, 47, 60-65.
Neria, Y., Nandi, A., & Galea, S. (2008). Posttraumatic stress disorder following disasters: a systematic review. Psychological Medicine, 38, 467-480. doi:doi:10.1017/S0033291707001353
Norris, F. H., & Elrod, C. L. (2006). Psychological consequences of disaster: a review of past literature. Methods for Disaster Mental Health Research, 20-42.
Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002). 60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981–2001. Psychiatry: Interpersonal and Biological Processes, 65(3), 207-239.
Norris, F. H., Friedman, M. J., & Watson, P. J. (2002). 60,000 Disaster Victims Speak: Part II. Summary and Implications of the Disaster Mental Health Research. Psychiatry: Interpersonal and Biological Processes, 65(3), 240-260.
Norris, F. H., Perilla, J. L., Riad, J. K., Kaniasty, K., & Lavizzo, E. A. (1999). Stability and change in stress, resources, and psychological distress following natural disaster: Findings from Hurricane Andrew. Anxiety, Stress & Coping, 12(4), 363-396.
Norris, F. H., & Uhl, G. A. (1993). Chronic Stress as a Mediator of Acute Stress: The Case of Hurricane Hugo 1. Journal of Applied Social Psychology, 23(16), 1263-1284.
Paranjothy, S., Gallacher, J., Amlot, R., Rubin, G. J., Page, L., Baxter, T., Wight, J., Kirrage, D., McNaught, R., & Palmer, S. R. (2011). Psychosocial impact of the summer 2007 floods in England. BMC public health, 11(1), 145.
Raja, M., Onofri, A., Azoni, A., Borzelino, B., &Melchiore, N. (2008). Post-traumatic stress disorder among people exposed to the Ventotene street disaster in Rome. Clinical Practice and Epidemiolgy in Mental Health, 4, 5.
Rajkumar, A. P., Mohan, T. S., & Tharyan, P. (2013). Lessons from the 204 Asian tsunami:epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communites. International Journal of Social Psychiatry, 59, 123-129
Rivière, S., Schwoebel, V., Lapierre-Duval, K., Guinard, A., Gardette, V., & Lang, T. (2008). Predictors of symptoms of post-traumatic stress disorder after the AZF chemical factory explosion on 21 September 2001, in Toulouse, France. Journal of Epidemiology and Community Health, 62, 455-460.
Shaw, J. A., Espinel, Z., & Shultz, J. M. (2012). Care of children exposed to the traumatic effects of disaster. American Psychiatric Pub.
Stephenson, J., Vaganay, M., & Cameron, R. (2015). Impact of secondary stressors on urban and rural communities affected by repeated flooding and the potential resulting health implications:A pilot study. International Research Journal of Public and Environmental Health, 2(9), 127.
Tachibana, A., Kitamura, H., Shindo, M., Honma, H., & Someya, T. (2014). Psychological distress in an earthquake-devastated area with pre-existing high rate of suicide. Psychiatry research, 219(2), 336-340.
Van Griensven, F., Chakraband, M. L. S., Thienkrua, W., Pengjuntr, W., Lopes Cardozo, B., Tantipiwatanaskul, P., Mock, P. A., Ekasawin, S., Varangrat, A., Gotway, C., Sabin, M., &Tapero, J. W. (2006). Mental health problems among adults in tsunami-afected areas in southern Thailand. Journal of the American Medical Asociation, 296, 537-548.
Van Ommeren, M., Saxena, S., & Saraceno, B. (2005). Mental and social health during and after acute emergencies: emerging consensus? Bulletin of the World Health Organization, 83, 71-75.
Wickrama, K. A. S., & Wickrama, K. T. (2008). Family context of mental health risk in tsunami affected mothers: findings from a pilot study in Sri Lanka. Social Science and Medicne, 6, 94-107.
Williams, R., Bisson, J., & Kemp, V. (2014). Principles for responding to people’s psychosocial and mental health needs after disasters. Occasional Paper, 94.
Weiss, D. S., & Marmar, C. R. (1997). Assessing psychological trauma and PTSD. New York:Guilford Press.