Psychological Characteristics of Infant Outpatients and their Parents in Korean Traditional Clinic

서 론 , ,

. Psychological Characteristics of Infant Outpatients and their Parents in

Korean Traditional Clinic

Soo-Jin Lee

, Soon-Im Byun

, Kyung-Seon Kim

, Hye-Jin Kim

, You-Jin Yang

, Ki-Rim Gang

, Myoung-Geun Kim

, Hyeon Choi

, Han Chae

1

Dept. of Psychology, Yonsei University,

Bundang HAMSOA Oriental Clinic

3

School of Korean Medicine, Pusan National University

4

Korea Institute of Oriental Medicine,

HAMSOA Oriental Clinic Network

Objectives: Since Korean traditional medicine has an integrative perspective by its nature, the patients’ psychological and physical problems in a Korean traditional clinic may be resolved through a more integrative approach. The purpose of this study was to describe the latent characteristics of psychological health of child outpatients and their parents visiting Korean traditional clinic with physical complaints and was to propose an alternative curriculum to meet their needs based on their psychological and physical aspects.

Methods: Subjects studied consisted of 100 outpatients (59 boys, 41 girls, mean age 55 months, age range 18 to 83 months) and their parents. Behavior characteristics for children were measured by Korean version of Child Behavior Checklist for Ages 1.5-5 (CBCL1.5-5) while parenting stress, depression, and anxiety for parent were measured by Korean-Parenting Stress Index-Short Form (K-PSI-SF), Center for Epidemiologic Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI), respectively. The data of subjects were compared to those of standardized groups and then were compared according to child’s gender within sample.

Results: Child participants were reported to have significantly higher scores of all CBCL 1.5-5 subscales than the standardized group. When compared, no differences of K-PSI-SF, CES-D, and STAI was found between parents of participants and the standardized groups. However, parents of child participants with at-risk psychological problems showed significantly higher scores of all parenting stress subscales than those of all child participants. In addition, the mothers of boy participants demonstrated significantly higher anxiety, depression and parenting stress than those of girl participants irrespective of psychological severity.

Conclusions: We discussed the implication of these results in clinical situation and make recommendations for curriculum of psychiatry and pediatrics with the aim of improving proper diagnosis, consulting and treatment.

Key Words : Infant outpatient, parents, psychological characteristics, curriculum improvement 이수진

, 변순임

, 김경선

, 김혜진

, 양유진

, 강기림

, 김명근

, 최현

, 채한

1

연세대학교 심리학과,

분당함소아한의원,

부산대학교 한의학전문대학원,

한국한의학연구원,

함소아한의원네크워크 Original Article

Received：5 June 2009 Revised：9 July 2009 Accepted：13 July 2009

Correspondence to：채한(Han Chae)

(626-870) 경남 양산시 물금읍 범어리 부산대학교 한의학전문대학원 양생기능의학부

Tel：+82-51-510-8470, Fax：+82-51-510-8470, E-mail：[email protected]

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연구방법 1. 피험자

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5 100

(Fig. 1).

DRC(departmental

review committee) ,

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2. 심리검사

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1) - (Child

Behavior Checklist for Ages 1.5-5: CBCL 1.5-5)

1.5 5

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Participants (n=100)

Exclusion criteria

a. Younger than 18 month; 1 b. Older than 84 months; 7 c. Missing data; 3

d. Possible school admission; 5

Psychological characteristics of infant outpatients and their parents Hospital Outpatients

(n=270)

Sampled pool (n=116)

Characteristics of Infant outpatients

a. Compare with standardized group b. Gender difference

Characteristics of Parents a. Compare with

standardized group b. Gender difference

Characteristics of Clinical status (CBCL) group a. Compare with total

participants (n=100) b. PSI, CES-D, STAI

Fig. 1.

,

.

2) (Korean-

Parenting Stress Index-Short Form, K-PSI-SF) (K-PSI) Abidin ¹⁰⁾ Parenting Stress Index ¹¹⁾

, 1~12

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(S/F, short form) , 3

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( : ), 2)

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3) Center for Epidemiologic Studies Depression Scale (CES-D)

Radloff ^12,13) Center for Epidemiologic Studies Depression

Scale(CES-D) . CES-D

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14) CES-D

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3. 결과 분석 방법

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결 과

1. 사회인구학적 특성

100 59 , 41

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55.08 , 54.85

(  (1, 99)=.006, =.936). 59

30 (50.85%) , 41 19

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28 (47.46%) , 20 (48.78%)

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36.61 , 37

(  (1, 96)=.399, =.529).

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34.02 , 35.46

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(  (1, 97)=2.871, =.093).

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(55%), * (18%), * (13%), (2%)

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(Table 1).

35 30 25 20 15 10 5 0

boy girl total

Fig. 2.

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2. 환아의 정신건강 특성

1)

CBCL 7 , ,

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=5.359, <.001), ( (2531)=3.641, <.001), ( (2531)=7.448, <.001), ( (2531)

=3.140, =.002), ( (2531)=4.306, <.001), ( (2531)=6.626, <.001), ( (2531)=4.403,

<.001), ( (2531)=6.664, <.001)

. ,

boy (n=59) girl (n=41) total (n=100)

infant

Age (months) 55.08±14.05 54.85±14.22 54.99±14.05

Sibling

None 30 19 49

Yes 28 20 48

n.a.

1 2 3

father

Age (years) 36.61±2.53 37.00±3.49 36.77±2.95

Education

Graduate school 10 10 20

College 44 24 68

High school 3 7 10

n.a.

2 0 2

mother

Age (years) 34.02±2.62 35.46±5.66 34.62±4.21

Education

Graduate school 4 5 9

College 49 34 83

High school 4 2 6

n.a.

2 0 2

Socio-Economic Status

High in middle 6 7 13

Middle in middle 29 26 55

Low in middle 12 6 18

Low 2 0 2

n.a.

10 2 12

* n.a. means not available

Table 1.

. 2)

CBCL 7

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

(Table 2). , , / ,

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(  (1, 99)=3.565, =.062). ,

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3. 보호자의 정신건강 특성

1)

(PSI) 3

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(Table

3). , PSI ( (426)=.228,

=.819), ( (426)=.901, =.368) ( (426)=1.316, =.189)

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=.001)

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(CES-D) (STAI)

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( (638)=1.755, =.819) ( (138)

=1.068, =.288)

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PSI 3

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4. 고위험군 환아 및 보호자의 정신건강 특성

(CBCL) ,

(PSI), (CES-D), (STAI)

A. Infant outpatients categorized as CBCL subclinical status group 30

25 20 15 10 5 0

boy girl total

B. Mother categorized as PSI subclinical status group. PD: parental distress, DI: dysfunctional interaction, DC: difficult child, total: total stress

14 12 10 8 6 4

0

boy girl total

2

PD DI DC total

C. Parents categorized as CES-D and STAI subclinical status group 12

10 8 6 4

0

boy girl total

2

depression of mother

depression of

father anxiety of mother anxiety of father

Fig. 3.

(n=100) (Table 4).

PSI, CES-D, STAI , CBCL

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24%, 13%, 22% 8%

1.5 3

.

(CES-D) (STAI)

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CBCL , ,

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CBCL , ,

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고찰 및 결론

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CBCL 7 (

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(Table 2).

(Fig. 2)

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(Table

1) .

boy (n=59) girl (n=41) total F (1, 99)

reactivity 3.97±3.01 3.95±2.65 3.96±2.86 0.00

depression anxiety 4.22±2.71 4.15±2.49 4.19±2.61 0.02

somatization 2.93±2.33 2.34±2.01 2.69±2.21 1.74

withdrawal 2.54±2.28 2.10±1.70 2.36±2.07 1.12

sleep problem 3.71±2.45 4.68±2.64 4.11±2.56 3.57

attentional problem 2.29±1.83 1.73±1.43 2.06±1.70 2.66

aggression 10.07±6.48 8.71±5.54 9.51±6.12 1.20

internalizing problems 13.66±7.79 12.54±7.23 13.20±7.55 0.54

externalizing problems 12.36±7.44 10.44±6.52 11.57±7.11 1.77

total problems 41.41±22.10 37.66±19.20 39.87±20.33 0.82

*

p<.05,

p<.01,

p<.001

Table 2.

(PSI)

(CES-D), (STAI)

(Table 3),

(Table 2).

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20,21)

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CBCL , ,

, 92%

ile, , 8%

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24%, 13%, 22% .

1.5~3 /

boy (n=59) girl (n=41) Total F (1, 99)

Mother

PSI

parental distress 32.34±7.30 30.56±6.53 31.61±7.02 1.56 dysfunctional

interaction 22.07±5.77 19.17±5.56 20.88±5.84 6.28

difficult child 26.81±7.61 25.73±7.49 26.37±7.54 0.48 total stress 81.22±16.52 75.46±15.82 78.86±16.40 3.04

depression 14.10±12.22 9.73±6.98 12.31±9.91 4.89

anxiety 41.44±11.44 37.15±8.73 39.68±10.58 4.11

Father depression 7.90±6.28 7.93±7.08 7.91±6.58 0

anxiety 33.93±7.43 35.00±10.95 34.37±9.00 0.34

*

p<.05,

p<.01,

p<.001 Table 3.

internalizing problems (n=24)

externalizing problems (n=13)

total problems (n=22)

mean±SD t (122) mean±SD t (111) mean±SD t (120)

Mother

PSI

parental

distress 35.71±6.90 2.5777

33.85±7.34 1.0769 35.59±7.01 2.4082

dysfunctional

interaction 25.00±6.29 3.0579

27.46±6.35 3.7845

26.32±5.65 3.978

difficult child 33.42±7.73 4.0939

35.85±7.40 4.273

34.91±6.91 4.8785

total stress 94.13±15.77 4.1257

97.15±16.65 3.7764

96.82±14.16 4.7576

Depression 15.83±11.77 1.5055 12.62±12.40 0.103 16.18±13.03 1.5617 Anxiety 43.71±11.23 1.6561 40.54±10.23 0.2767 44.27±11.54 1.8125

Father Depression 7.25±6.07 0.4476 8.31±6.58 0.2062 8.45±7.44 0.3403

Anxiety 32.54±10.70 0.8616 31.77±12.60 0.9327 34.45±11.46 0.4123

*

p<.05,

p<.01,

p<.001

Table 4.

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(somatization) ( :

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. CBCL

(CES-D) (STAI)

(PSI)

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감사의 글

(2 )

참고문헌

1. Flisher AJ, Kramer RA, Grosser RC, Alegria M, Bird HR, Bourdon KH et al. Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine. 1996;27:11 45-54.

2. Oh EY, Kim SK, Park JH, Park MK. A study on the degree of agreement to detect high-risk children between parents and teachers using the K-Child Behavior Checklist(CBCL). Ajou Medical Journal. 1998;3(2):122-30.

3. Eun B-L. A suggestion of health insurance for

children. Korean Journal of Pediatrics. 2008;51

(4):339-42.

4. Pavuluri MN, Luk SL, McGee R. Help-seeking for behavior problems by parents of preschool children: A community study. Journal of American Academy of Child & Adolescent Psychiatry.

1996;35(2):215-22.

5. Choi HY. Future of traditional medical clinics.

pp. 103-123. 2009 Material for orientation and education for university entrants. Pusan National University School of Oriental Medicine. 2009.2.

13~2.19.

6. Jeong MJ, Lee SY. Investigating the present situation for oriental-medical examination and treatment of ADHD children. J Korean Oriental Pediatrics. 2006;20(3):105-16.

7. Sim M, Lee JH, Kim TH, Ryoo YS, Kang HW.

A study on Oriental-medical Understanding of Tic Disorders (Within Dong yui bo gam Book).

Journal of Oriental Neuropsychiatry. 2007;18 (2):1-12.

8. Achenbach TM, Rescorla LA. Manual for the ASEBA preschool forms and profiles. Burlington, VT: University of Vermont, Research center for the Children, Youth & Families. 2000.

9. Oh KJ, Kim YA. Korean version of CBCL for Ages 1.5-5 (CBCL 1.5-5). Seoul: Huno consulting, Inc. 2008.

10. Abidin RR. Parenting Stress Index (PSI) manual.

3rd rev, ed, Odessa, FL: Psychological Assessment Resources, Inc. 1995.

11. Chung KM, Lee KS, Park JA. K-PSI manual Seoul: Hakjisa. 2008.

12. Radloff LS. The CES-D Scale: a self report depression scale for research in the general population. Applied Psychology Measurement.

1977;1:385-401.

13. Radloff LS, Locke BZ. The community mental health survey and CES-D scale: in community survey of psychiatric disorders. In Weissman MM, Myers JD, Ross CE eds. ew Burniswick

NJ: Rutters University Press. 1986.

14. Cho MJ, Kim KH. Diagnostic Validity of the CES-D(Korean Version) in the Assessment of DSM- -R Major Depression. Journal of the Korean Neuropsychiatry Association. 1993;32 (3):381-99.

15. Spielberger CD, Gorsuch RL. Lushene RD.

Manual for the state-trait anxiety inventory, Palo Alto, CA: Consulting Psychologists Press, Inc.

1970.

16. Kim JT. STAI and Sociability. Seoul: Korea University. 1978.

17. Kim YA, Lee J. Moon SJ, Kim YJ, Oh KJ.

Standardization Study for the Korean Version of the Child Behavior Checklist for Ages 1.5-5. The Korean Journal of Clinical Psychology. 2009;28 (1):117-36.

18. Lee KS, Chung KM, Park JA, Kim HJ.

Reliability and Validity Study for the Korean version of Parenting Stress Index Short Form (K-PSI-SF). The Korean Journal of Woman Psychology: 2008;13(3):363-77.

19. Lee BH, Cho SH, Kwak DI. The Evaluation of Minor Stressor in Psychiatric Patients. Journal of the Korean Neuropsychiatry Association. 1996;

35(5):969-81.

20. Kim KS, Kim MR. Study on the recognition and execution of father role. Journal of Mokpo National University. 1988

21. Han EG, Kim SA. A Study on Fair Parental Role Model of Dual Earner Couples, their Expectation for Parental Nursing Capability and Real Nursing Practices. Journal of Korean Home Management Association. 2007;25(2):37-46.

22. Kee CY. Qualitative Process Analysis about the Outcome of Parent Counseling in Play Therapy Journal of Korean Association for Play therapy.

2006;9(2):38-55.

23. Jung KH. Development of curriculum and entrance

examination for School of Oriental Medicine.

KRF. 2007.

24. Ahn KS. Curriculum for traditional medical education. Seoul: KOMEEI. 2007.

25. Cole S, Saravay S, Levinson R. The biopsycho- social model of illness. In: Stoudemire A, eds.

An introduction to human behavior. 3rd ed.

Philadelphia: JB Lippincott. 1997.

26. Steven A. Cole JB. Medical Interview. Seoul:

Hakjisa. 2002.

27. Chae H, Shin SW, Jang WC, Baik YS. Review on Teaching the Traditional Korean Medical Students with Article Writing Program. The

Journal of Oriental medical Classics. 2008;21(1):

285-94.

28. Lee BH, Chae H, Kwon YK. Development of an Integrated Education Model for Acupuncture and Physiologyin Traditional Korean Medicine with Needling Practice and Pain Sensitivity. J Korean Oriental Med. 2007;28(3):173-82.

29. Lee SJ, Park S, Shin SW, Chae H. Development of Complementary and Alternative Medicine Curriculum for Undergraduate Students at College of Oriental Medicine. J Korean Oriental Med.

2008;29(1):25-38.