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1 한국학교보건학회지제 27 권제 3 호, 2014 년 12 월 J Korean Soc Sch Health Vol.27.3, , December 2014 ISSN (Print) ISSN (Online) 여대생의신체상만족도와우울과의관계에서자아존중감의매개효과 노주희 김영은 정다솜 정지윤 김한솔 도성희 조수진 주수민 김혜윤 박소율 신지영 울산대학교의과대학간호학과 Mediating Effects of Self-esteem in the Relationship between Body Image and Depression of Female University Students Ju-Hee Nho Young-Eun Kim Da-Som Jeong Ji-Yun Jeong Han-Sol Kim Seong-Hee Do Su-Jin Cho Su-Min Joo Hye-Yoon Kim So-Yul Park Ji-Young Shin Department of Nursing, University of Ulsan ABSTRACT Purpose: The purpose of this study was to identify the mediation of self-esteem between body image and depression among female university students. Methods: This was a cross-sectional survey design. We collected 193 female university students. They was completed a self reported questionnaire including demographic characteristics, body image, self-esteem and depression. Data were collected using self-report questionnaires and analyzed with the SPSS 20.0 Program. Results: The mean age was 21.3 years old. Over 58% of subjects hoped for plastic surgery, and 78.8% had experienced weight loss control. There were a positive correlation between body image and self-esteem (r=.60, p<.001), and negative correlations between body image and depression (r=-.47, p<.001), self-esteem and depression (r=-.50, p<.001). Self-esteem had a partial mediating effect in the relationship between body image and depression of female university students. Conclusion: Based on the findings of this study, depression management program focusing on body image management and self-esteem improvement are recommended to control depression in female university students. Key Words: Body image, Self-esteem, Depression, Female university students 서론 1. 연구의필요성현대사회가날씬하고마른체형을이상화하고있으며이러한성향은매스컴을통해더욱강화되고있다 (Pak, & Son, 2002). 여성은남성에비해자신의신체에대한만족도가낮 으며 40~50% 의여성이자신의신체에대해불만족한다고보고되었다 (Edlund, Hallqvist, & Sjoden, 1994). 대학또래집단에서신체적매력이인기를결정하는중요한요소로평가되어여대생들은맹목적인미의추구를위해의식적으로지나친체중조절을하는경향이있다 (Choi & Lee, 1997). 여중고생의 85% 가자기체중에만족하지못한다고한결과와 (Hong, Park, Shin, & Park., 1997) 우리나라여대생의 90% 정도가 Corresponding author: Ju-Hee Nho Department of Nursing, University of Ulsan, 93 Daehakro, Nam-gu, Ulsan , Korea. Tel: , Fax: , jhnho@ulsan.ac.kr 투고일 : 2014년 12월 3일 / 심사완료일 : 2014년 12월 17일 / 게재확정일 : 2014년 12월 18일 This is an open access article distributed under the terms of the Creative Commons Attribution n-commercial License ( by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. c 2014 The Korean Society of School Health
2 여대생의신체상만족도와우울과의관계에서자아존중감의매개효과 자신의체형이실제보다크다고생각하는신체상불일치가나타난결과 (Lee, Kim, & Yom, 2005) 는여성이자신의외모에대한열등감이크고여성의자아개념에부정적인영향을미쳐자신의가치를낮게만들수있다는것 (Choi & Lee, 1997) 을보여준다. 신체상이란자신의신체적모습에대해개인이갖고있는정신적인심상으로, 자신의신념, 가치, 목표, 성격및자신에대한다른사람들의견해등이통합되어이루어진다 (Luckmann & Sorensen, 1980). 신체상은의식적, 무의식적으로청년후기의발달과제인자아존중감형성에영향을주므로대학생시기에자신에대한긍정적인자기개념을형성하는것은매우중요하다. 신체적특성에대한문제를크게느낄수록신체적부분과자아에대한부정적느낌들은더욱커지게되며기본적인신체상에위협을받게되면, 정체감이파괴되어정상적인생활, 모든사회관계및대인관계의붕괴로자아존중감의상실을초래한다 (Wassner, 1982). 신체상에대한불만족은낮은자긍심, 사회적불안과대인관계문제, 우울증등과도연관성이있으며 (Wardle, Haase, & Steptoe, 2006) 신체상이부정적일수록우울성향이높다고하였다 (Pak & Son, 2002). Kwak (1999) 은아동을대상으로연구하여신체상만족도가높을수록우울수준이더낮았고, 신체상만족도가낮을수록우울수준이더높아진다고보고하였다. 그러나신체상만족도가비슷한경우에어떤대상자는우울해지고, 어떤대상자는우울해지지않는다. 이에관해연구자들은신체상만족도와우울간의여러중재요인들중인지관련요인으로자아존중감과우울관계에대한연구를많이시행하고있다. 자아존중감은우울에영향을미친다고하였고 (Pak & Son, 2002; Wardle, Haase, & Steptoe, 2006) 아동과청소년을대상으로한구조방정식모형의표준화된경로계수를확인한연구에서는신체만족이자아존중감에.35, 자아존중감은우울에 -.72로나타나자아존중감이신체만족으로인한우울에매개효과가있다고하였다 (Kim, 2003). 최근시행된대학생의신체상과심리적변수와의관련연구에서는매스미디어가신체지각에영향을미치며, 신체만족도가높을수록자아존중감이향상되고 (Jeon & Kim, 2013), 신체만족집단은자아존중감이높고우울이낮은것으로나타났다 (Lee, 2009). 이러한결과는신체상만족도, 자아존중감과우울사이에관련은있으나자아존중감이여대생의신체상만족도와우울과의관계에있어매개효과가있는지에대한연구는미흡한실정이다. 자아존중감이신체상만족도와우울간의매개변수로작용한다는결과는아동과청소년을대상으로한연구에국한되어있어 (Kim, 2003), 성인초 기여대생의자아존중감이신체상만족도와우울간에매개효과가있는지에대한연구가필요한실정이다. 우리나라여대생들을대상으로한신체상관련연구는섭식행동, 신체상불일치, 우울, 체질량지수, 매스미디어의영향 (Hwang, 2009; Lee, Kim, & Yom, 2005; Oh, 2003; Shin & Paik, 2003; Jeon & Kim, 2013; Lee, 2009) 등관련변수들이신체상과심리적변수에미치는영향에대한연구가대부분으로여대생의신체상만족도, 자아존중감과우울간의관계를심층적으로이해하기에는부족하다. 특히, 여대생은성인초기발달단계로추후임신과출산을경험하여야하며이들의건강은태아의건강과도관련이되는중요한시기이다. 이에우리나라여대생의신체만족도와우울과의관계에서자아존중감의매개효과를규명함으로써, 향후여대생의긍정적인신체상만족도와정서를갖도록하기위한효과적인중개개발에기초자료를마련하고자본연구를시도하였다. 2. 연구목적본연구의목적은여대생의신체상만족도와우울간의상호관계에서자아존중감의매개효과를확인하기위함이며구체적인목적은다음과같다. 대상자의신체상만족도, 자아존중감과우울정도를파악한다. 신체상만족도, 자아존중감과우울의관련성을파악한다. 대상자의신체상만족도와우울과의관계에서자아존중감의매개효과를확인한다. 연구방법 1. 연구설계본연구는여대생의신체상만족도와우울간의상호관계에서자아존중감의매개효과를확인하기위한서술적상관관계연구이다. 2. 연구대상및자료수집본연구는 U광역시일대학교재학생을대상으로구조화된설문지를이용하여면대면자기보고식설문조사로실시되었다. 설문조사는 2014년 9월 1일부터 2014년 9월 17일까지시행되었으며대상자에게본연구의목적, 내용, 연구자료분석 Vol ,
3 노주희 김영은 정다솜등 시익명성, 사생활보장및중도포기가능성을설명한후자발적인서면동의서를받은후에시행하였다. 설문조사는약 20 분의시간이소요되었다. 연구대상자는편의추출방법으로선택하였고, 총 200명의대상자가참여하였다. 정보가미흡하거나중도포기한경우를제외하고총 193명의자료가최종분석에포함되었다. 대상자수는 G*Power 3.10 프로그램을이용하였을때적정표본수를산출한결과, 80% 검정력수준에서상관분석 ( =.05, 효과크기.50) 에필요한표분수를산정한결과최소 106명이요구되었다. 대상자탈락률 20% 를고려한표본수는 128명이었다. 따라서본연구표본수 193명은적합한것으로판단된다. 3. 연구도구 1) 신체상만족도신체상만족도측정을위해 Mendelson, Meldelson, Andrews, Balfour와 Bucholz (1997) 에의해개발된청소년과성인을위한신체상만족도척도 (Body Esteem Scale, BES) 를사용하였다. 이도구는전반적인외모에대한신체상만족도를측정하는것으로 Lee (2009) 가번안한것을사용하였다. 4점척도의 23문항으로점수가높을수록자신의신체에대한만족도가높은것을의미한다. Lee (2009) 의연구에서 Cronbach's 는.79, 본연구에서의 Cronbach's 는.89로나타났다. 2) 자아존중감자아존중감은자신을존경하고바람직하게여기며가치있는존재라고생각하는것을말한다 (Rosenberg, 1965). 자아존중감측정을위해 Rosenberg (1965) 가개발한자아존중감척도 (Rosenberg Self-Esteem Scale, RSES) 를 Jon (1974) 이번안한도구를사용하였다. 총 10문항 4점척도로점수가높을수록자아존중감이높은것을의미한다. 측정도구의신뢰도는개발당시 Cronbach's 는.81, 본연구에서의 Cronbach's 는.83으로나타났다. 3) Beck의우울척도 (Beck Depression Inventory, BDI) 우울은우울측정도구 (Beck Depression Inventory, BDI) 를 Lee와 Song (1991) 이한국어로번안한도구로측정하였다. 각항목은정서적, 인지적, 동기적, 신체적및기타증상들에대한 21가지문항으로이루어져있다. 각문항은 0~3점사이의점수로나타나며점수가높을수록우울이심한것을의미한 다. 본연구에서의 Cronbach's 는.88로나타났다. 4. 자료분석본연구의자료분석은 IBM SPSS 20.0 for Windows (SPSS Inc, 2009) 를이용하여이루어졌다. 연구대상자의일반적특성, 신체상만족도, 자아존중감, 우울은서술적통계를사용하였으며, 일반적특성에따른신체상만족도, 자아존중감과우울은 t-test, ANOVA, 사후분석은 Scheffe test를시행하였다. 각변수의정규성검정은 Shapiro-wilk 검정을이용하여 p=.05 이상임을확인하였다. 신체상만족도, 자아존중감과우울과의상관관계를파악하기위해 Pearson s correlation coefficients 를사용하였다. 자아존중감의매개효과검증은단순및다중회귀분석을사용하여검증하였다. 정규분포와등분산성을확인하였고, 다중공성선진단결과문제가없는것으로나타났다. 신체상만족도와우울과의관계에서자아존중감의매개효과를검증하기위하여 Baron과 Kenny (1986) 가제시한방법을사용하였다. 매개효과검증을위해다음의세단계의회귀분석과전제조건이성립해야한다. 첫째, 독립변인과매개변인의회귀분석을통한유의한영향확인, 둘째, 독립변인과종속변인에대한회귀분석에서유의미한관계의확인이있어야한다. 세번째로독립변인과매개변인모두에대한종속변인의회귀분석이필요하며, 매개변인이반드시종속변인에유의한영향을미치고종속변인에대한독립변인의영향이두번째회귀분석보다세번째회귀분석에서반드시감소되어야한다. 이때세번째식에서독립변인과종속변인의관계가유의하지않으면완전매개효과, 유의하면부분매개효과가있는것으로해석한다. 연구결과 1. 연구대상자의일반적특성대상자의일반적특성은 Table 1과같다. 평균나이는 21.3 세이고학년은 2학년이 40.9% 로가장많았다. 성형수술을한사람은 17.6%(34 명 ) 이었으며성형수술을희망하는부위가있는사람은 58.5%(113명 ) 이었다. 체중감량조절을한경험이있는사람은 78.8%(152 명 ) 이며신체상에관심이있는대상자는 95.9%(185 명 ), 이성친구가있는대상자는 40.4%(78 명 ) 이었다. 198 Journal of the Korean Society of School Health
4 여대생의신체상만족도와우울과의관계에서자아존중감의매개효과 2. 일반적특성에따른신체상만족도, 자아존중감과우울 연구대상자의신체상만족도는평균 56.1점, 자아존중감은 29.2점, 우울은 8.0점으로나타났고일반적특성에따른신체상만족도, 자아존중감과우울은 Table 2와같다. 학년에따라 Table 1. General Characteristics of Participants Characteristics Categories n (%) or M±SD Age (year) 21.3±1.72 (range: 19~32) Grade Plastic surgery Hope for plastic surgery Weight loss control Interested in body image Boyfriend Freshman Sophomore Junior Senior 75(38.9) 79(40.9) 18 (9.3) 21(10.9) 34(17.6) 159 (82.4) 113 (58.5) 80(41.5) 152 (78.8) 41(21.2) 185 (95.9) 8(4.1) 78(40.4) 115 (59.6) 신체상만족도와자아존중감의차이가있었고사후검정결과 2학년이 4학년에비해신체상만족도와자아존중감이낮았다 (F=4.46, p =.005; F=2.97, p =.033). 성형수술을원하는대상자는그렇지않은대상자에비해신체상만족도와자아존중감이낮았으며, 우울점수는더높았다 (t=4.99; p<.001; t= 3.11, p=.002; t=-2.61, p=.010). 체중감량조절경험이있고이성친구가없는대상자의신체상만족도는더낮게나타났다 (t=2.15, p=.033; t=-4.02, p<.001). 3. 신체상만족도, 자아존중감과우울과의관계 연구대상자의신체상만족도는자아존중감과양의상관관계를나타냈고 (r=.60, p<.001), 우울과는음의상관관계를보였다 (r=-.47, p <.001). 또한자아존중감과우울은음의상관관계를나타냈다 (r=-.50, p<.001)<table 3>. Table 3. Correlations of Body Image, Self-esteem, and Depression Variables BES RSES RSES.60 (<.001) BDI -.47 (<.001) -.50 (<.001) BES=Body Esteem Scale; RSES=Rosenberg Self-Esteem Scale; BDI=Beck Depression Inventory. Table 2. Body Image, Self-esteem, and Depression by General Characteristics of Participants Characteristics Age (year) Grade Plastic surgery Hope for plastic surgery Weight loss control Interested in body image Boyfriend Categories 21 >22 Freshman Sophomore Junior Senior BES RSES BDI M±SD torf(p) M±SD torf(p) M±SD torf(p) 56.1± ± ± ± ± ± ±8.84 a 58.4± ±9.52 b 57.6± ± ± ± ± ± ± ± ± ± (.080) 4.46 (.005, a<b -.96 (.340) 4.99 (<.001) 2.15 (.033).24 (.818) (<.001) 29.0± ± ± ±3.86 a 29.2± ±3.89 b 29.4± ± ± ± ± ± ± ± ± ± (.322) 2.97 (.033, a<b (.645) 3.11 (.002).97 (.332).76 (.449) (.062) BES=Body Esteem Scale; RSES=Rosenberg Self-Esteem Scale; BDI=Beck Depression Inventory; Scheffe test. 8.3± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± (.334) 1.29 (.28) 1.87 (.064) (.010).16 (.871) -.86 (.392) 1.10 (.274) Vol ,
5 노주희 김영은 정다솜등 4. 신체상만족도와우울과의관계에서자아존중감의매개효과본연구에서신체상만족도와우울과의관계에서자아존중감의매개효과를검정하기위해, Baron과 Kenny (1986) 의 3 단계회귀분석에따른자아존중감의매개효과를검증하였다 <Table 4>. 1단계에서독립변인인신체상만족도가매개변인인자아존중감에미치는영향을검정한회귀분석에서 β값이.60 이었고통계적으로유의하였다 (p <.001). 2단계에서독립변인인신체상만족도가우울에미치는영향을검정한회귀분석에서 β값이 -.47이었고통계적으로유의하였다 (p<.001). 마지막으로매개변인인자아존중감이종속변인인우울에미치는영향을검정하기위해신체상만족도와자아존중감을예측요인으로하고우울을종속변인으로하여회귀분석을실시한결과, 신체상만족도와자아존중감이우울에유의한예측요인으로나타났다 (β=-.27, p=.001; β=-.34, p<.001). 또한우울에대한설명력을살펴보면, 신체상만족도단독으로는 21.6% (p<.001), 자아존중감이투입되었을때는 28.6% (p<.001) 로늘어, 자아존중감이개입됨으로써우울변량에대한설명력이더높아졌다. 신체상만족도와우울과의관계에서자아존중감의매개효과는유의한부분매개변인인것으로확인되었다. 논의본연구는일대학의여대생을대상으로신체상만족도, 자아존중감과우울정도를파악하고신체상만족도와우울간의상호관계에서자아존중감의매개효과를확인하기위해시행되었다. 연구대상자의평균연령은 21.3세로초기성인기에해당되어사회에적응해나가는시기로많은인간관계를형성하며자신의외모에관심을많이갖게되는시기임을알수있다. 이러한대상자들중성형수술을희망하는부위가있는대상자는 58.5%, 체중감량조절을한경험이있다고한대상자는 78.8%, 신체상에관심이있다고하는대상자는 96% 로나타났다. 이는 50% 이상의여대생들이자신의체형에불만족하고, 70% 이상이체중조절에관심이있다고한선행연구 (Hwang, 2009; Joo & Park, 1999; Lee, Kim, & Yom, 2005) 의결과와일치하는결과이다. 날씬하고자하는인식이우리사회의보편적인문화현상이되어마른체형을추구하는왜곡된인식으로중고등학생시절부터체중조절을시도하거나 (Kim & Cha, 2007). 잘못된방법의체중조절로건강문제가발생될수있으며, 여대생은추후임신과출산을경험하게될연령층으로이들의건강상태가태아에게도영향을미칠수있다 (Kim & Kim, 2000). 따라서여대생의적절한신체상인식과적절한체중조절을위한보건교육프로그램이필요할것으로본다. 연구결과, 신체상만족도와우울은음의상관관계를나타냈다. 즉, 신체상만족도가높을수록우울정도는낮았고이러한결과는선행연구결과 (Cho & Kim, 1997; Pak & Son, 2002) 와일치한다. 신체불만족이높은사람은우울경향이높고, 신체불만족은강한열등감과자아개념의악화등으로정신적고통, 불안, 우울증등의정신질환과관련된다. 신체적특성을들어비하하는용어를듣는경우심한모욕감을느끼게되는것은신체불만족이자아개념의또다른요소인자아존중감에미치는영향이크다는것을보여준다 (Lee, 2009). 자아존중감은자신에대한믿음이나신념, 평가와관련있는것으로 (Lee, 2009) 본연구에서신체상만족도가높을수록자아존중감도높다는것을확인하였다. 자신의신체상에대한왜곡정도가클수록자아존중감이낮았으며, 자신의신체를긍정적으로지각하고매력성을높게평가하는사람이자아존중감수준이높게나온다는선행연구결과 (Hong, 2006) 와일치한다. 미의기준을신체적매력과날씬함에두고자신의외모와체중에대한우려로체형과신체에만족하지않는경우자존감이저하하는경우가발생한다. 본연구에서도성형수술을희망하는대상자는신체상만족도와자아존중감이낮고우울수준이높게나온결과는외모적인요소가자아개념과정서에영향을미친다는것을보여주고있다. Table 4. Mediating Effect of Self-esteem in the Relationship between Body Image and Depression Steps β t p Adj. R 2 F p 1. BES RSES < < BES BDI < < BES, RSES BDI BES BDI RSES BDI <.001 BES=Body Esteem Scale; RSES=Rosenberg Self-Esteem Scale; BDI=Beck Depression Inventory < Journal of the Korean Society of School Health
6 여대생의신체상만족도와우울과의관계에서자아존중감의매개효과 여대생의자아존중감이높을수록우울수준이감소한결과를고려할때, 여대생의자아존중감수준이우울정도를결정하는데중요한영향을미치는것으로생각된다. 실제, 본연구에서신체만족도와우울과의관계에대한자아존중감의매개효과를검정한결과, 자아존중감이부분매개효과가있음을확인하였다. 우울에대한설명력이신체상만족도단독으로는 21.6% 였고, 자아존중감이투입되었을때는 28.6% 로늘어, 자아존중감이개입됨으로써우울변량에대한설명력이유의하게더높아졌다. 이러한결과는신체상만족도에의해영향을받은자아존중감이우울에영향을미칠뿐아니라자아존중감은여대생의신체상만족도와함께우울에영향을미치는매개역할을하고있음을의미한다. 선행연구에서신체에대한이미지가자아존중감에영향을미친다고하였고 (Davidson, & McCade, 2005) 신체불만족이나자아존중감의저하는우울과깊은관련성이있어, 신체에대해불만족하고낮은자아존중감을가질수록우울한기분이증가한다고보고하였다 (le, Cash, & Winstead, 1985). 자아존중감은우울을설명하는주요한변인이라고하였고 (Kernis, Brockner, & Frankel, 1989) 국내아동과청소년을대상으로한연구에서자아존중감은신체상만족도와우울을매개하는변인이라고하였다 (Kim, 2003). 이러한결과를비추어볼때, 아동과청소년뿐아니라대학생까지신체상만족도와우울과의관계에서자아존중감은매개변인이된다는것을확인하였다는것에본연구의의의가있다고할수있다. 이러한결과는, 여대생의우울감소를목표로하는중재개발시, 신체상만족도향상과더불어자아존중감증진에초점을둔중재가필요하다는것을의미한다. 본연구결과에서나타난바와같이여대생의자아존중감이신체만족도와우울과의관계에서부분매개역할을하므로신체불만족이우울에미치는부정적영향에서도신체상만족도증진에대한자아존중감향상을통해우울을감소시킬수있는긍정적인변화를기대할수있다. 종합해보면, 본연구는여대생의우울에많은영향을미칠수있는다양한변인들중에서여대생들이주요관심을갖는신체상만족도와자아존중감을중심으로하여신체상만족도와우울과의관계에서자아존중감의매개효과를검증하였다. 이들변수관계에서중요한것은신체상만족도와우울과의관계에자아존중감이부분매개효과를가지는것이다. 따라서, 여대생의우울감소를위한중재프로그램을개발하고제공할때, 단순히신체상만족도에대한중재만을다루는것이아니라, 자아존중감을높일수있는중재를함께포함하여제공하는것이효과적일것으로생각된다. 본연구는여대생의신체상만족도와우울의관계에있어서자아존중감의매개효과가있음을검증함으로써향후여대생의우울감소를위한중재를개발하는데기초를마련하였다는점에서의의가있다. 그러나, 본연구는다음과같은제한점을가진다. 첫째, 편의추출방법으로대상자를선정하였고, 80% 정도가 1, 2학년학생으로연구결과를전체여대생집단에게일반화하는데에제한점이있다. 둘째, 일반적특성중체중이나섭식태도같은변인을확인하여제반변수와의관련성을파악하지못한제한점이있다. 셋째, 신체상만족도, 자아존중감과우울과의상관관계를확인하고신체상만족도와우울과의관계에있어서자아존중감의매개효과를확인하였으나, 제반변수들간의인과관계를확인하지못한제한점이있다. 이상의연구를통해, 여대생의신체상만족도와우울과의관계에서자아존중감이부분매개효과가있음을확인하였다. 따라서여대생의우울감소를위한프로그램에신체상만족도에대한적절한사정과긍정적신체상을갖도록하는내용과더불어자아존중감향상을위한내용이포함되면, 여대생의우울정도를감소시킬수있을것으로사료된다. 결론및제언본연구는여대생의신체상만족도, 자아존중감과우울의상관관계를확인하고신체상만족도와우울과의관계에서자아존중감의매개효과를확인하고자시행되었다. 연구의결과에의하면세변수간에모두유의한상관관계가나타난가운데, 신체상만족도와우울과의관계에서자아존중감은부분매개역할을하는것으로나타났다. 이러한결과를바탕으로향후여대생의우울감소를위해신체상증진과자아존중감향상을위한전략을포함하는중재프로그램개발이필요할것으로사료된다. 또한, 여대생이자신의신체상에대해긍정적으로평가하도록하는데적극적인관심이필요하다는것을나타낸다. 이상의결과를바탕으로다음을제언하는바이다. 첫째, 여대생의신체상과자아존중감향상내용이포함된효과적인중재를개발하고이를적용하여우울감소에대한효과를확인하는연구를제언한다. 둘째, 본연구에서는여대생의우울과관련된요인으로신체상만족도와자아존중감만을조사하였으므로, 다른신체적, 사회심리변인을규명하는다양한조사연구를후속연구로제언한다. 셋째, 신체상만족도, 자아존중감과우울의인과관계에대한후속연구를제언한다. Vol ,
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