화병척도와 연구용 화병진단기준 개발 (Development of Hwa-Byung Scale and Research Criteria of Hwa-Byung)

서지정보

· 발행기관 : 대한신경정신의학회
· 수록지 정보 : 신경정신의학 / 48권 / 2호 / 77 ~ 85페이지
· 저자명 : 민성길, 조윤경, 허지은, 송기준, 서신영

초록

한국판 SCID를 통해 진단된 우울증, 불안장애, 신체화장애 및 적응장애 환자들과 화병을 호소하는 환자를 대상으로, 기존의 화병의 증상을 연구한 결과들에서 추출한 가장 빈도가 많은 22개 증상항목들로 구성된‘예비적 화병척도’로 평가한 결과, 이 화병척도의 평가자간 신뢰도는 매우 유의하였고, 또한 화병과 우울증 간에 유의한 차이를 보여 그 타당도도 인정되었다. 또한 로지스틱 회기분석에서 그 화병진단 예측력 또한 높았다. 이러한 연구결과를 근거로 연구용 화병진단기준을 제안하였는데, 이는 주관적 분노, 억울하고 분함, 분노표현, 열감, 미움, 한 등 6 개 특유
의 핵심 화병증상과, 치밀어 오름, 목가슴 덩어리, 답답함, 가슴 두근댐, 구갈, 한숨, 잡념, 잘 놀람, 하소연 등 8개 화병관련 신체 및 행동증상과, 원인적 개념 등을 포함하고 있다.

영어초록

Objectives: The aim of this study was to identify the characteristic symptoms for diagnosis of Hwabyung (HB), a culture-related anger syndrome in Korea; to construct a rating scale for HB and test its validity and reliability; and propose diagnostic criteria for HB.
Methods: Subjects were male and female Korean patients, who were diagnosed following Structured Clinical Interview (SCID) as having depressive disorders, anxiety disorders and somatoform disorders and who reported as having self-labeled HB. A HB Scale was constructed with 22 of the most common symptoms of HB as identified by previous studies. The HB scale’s inter-rated reliability was tested with 60 subjects. Its validity was tested by comparison between a HB only group(n=47) and depressive disorder only group (n=44). Logistic regression analysis was conducted to make a predictive model of HB. Based on these results diagnostic criteria for HB was proposed.
Results: Inter-rated reliability in each of all the items and the total score of the HB Scale were statistically significant. The HB scale differentiated HB from depressive disorder with statistical significance. In logistic regression analysis, the ability of the HB model to predict symptoms of heat sensation,
ukwool/boon (feeling of unfairness), and subjective anger was high with sensitivity of 80.0%, specificity of 88.4%, accuracy of 84.1% and area under ROC of 0.92. Based on these results and information from previous research, diagnostic criteria of HB were formulated.
Conclusion: The HB Scale was found to be reliable and valid. Consequently, diagnostic criteria of HB were proposed, to include subject anger, “kwool/boon” (Feeling of unfairness), expressed anger, heat sensation, hostility, “haan”, pushing-up in the chest, epigastric mass, respiratory stuffiness, palpitation, dry mouth, sighing, racing thoughts, and lamentation.

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