online ML Comm ORIGINAL ARTICLE ISSN 1225-8709 / eissn 2005-7571 Korean J Biol Psychiatry 2011;18:134-140 충북대학교의과대학정신과학교실 임성진 신철진 The Effects of Music on the Frontal EEG Asymmetry of the Mothers with Postpartum Blues Sung-Jin Im, MD, Chul-Jin Shin, MD Department of Psychiatry, College of Medicine, Chungbuk National University, Cheongju, Korea ObjectivesZZPostpartum blues is known to be a major risk factor for postpartum depression and can be associated with the problems of language skills, behaviors or learning skills of their children. Therefore, it is very important for clinicians to evaluate precisely and control postpartum blues. Recent studies have found that music has an effect on depressive mood and the frontal EEG asymmetry of the patients with depression. The purpose of this study was to find out the effects of music on the frontal EEG asymmetry of the mothers with postpartum blues. MethodZZAmong one hundred and seventy mothers assessed with Korean version of the Edinburg Postnatal Depression Scale (EPDS), nine mothers with postpartum blues (EPDS 10) as postpartum blues group and nine non-depressive mothers (EPDS < 10) as non-depressive mother group were included. Ten non-labored, non-depressive women were also included as a normal control group. The subjects were evaluated with the State Trait Anxiety Inventory (STAI)-X1, the Visual Analogue Scale (VAS) and the Depression Adjective Checklist-Korean version (K-DACL) and EEG twice before and after the music sesssion with the length of twenty minutes and thirty two seconds. The statistical analyses were done for A1 score (log R - log L) which were computed from the alpha powers at F3 and F4. ResultsZZNo significant difference was noted in demographic data among all three groups. The postpartum blues group had higher scores in the STAI-X1, the VAS and the K-DACL compared to the other groups at baseline, and their A1 scores were lower than those of only normal controls. There was a statistically significant increase of A1 score only in the postpartum blues group after the music session. ConclusionZZThis study suggests that the mothers with postpartum blues may have a frontal EEG asymmetry which is possibly associated with their depressive mood, and the music session can affect the frontal asymmetry positively. Key WordsZZPostpartum blues ㆍ EEG ㆍ Depression ㆍ Music therapy. Received: May 6, 2011 / Revised: June 20, 2011 / Accepted: July 12, 2011 Address for correspondence: Chul-Jin Shin, MD Department of Psychiatry, College of Medicine, Chungbuk National University, 410 Seongbong-ro, Heungdeok-gu, Cheongju 361-711, Korea Tel: +82-43-269-6187, Fax: +82-43-267-7951, E-mail: cjshin@gmail.com 산후우울감 (postpartum blues) 은분만후수일이내에나타날수있는일시적인심리상태로경도의우울증상, 슬픔, 불안정한정동, 불안, 혼란의증상이동반된다고알려져있으 며, 1) 산후우울증을야기하는특정한위험인자 (risk factor) 로여겨지고있다. 2-4) 우리나라의경우산후우울감은분만후 3~5일사이에가장흔하고산모의 22~70% 에서나타난다고보고되었다. 5) 산후우울증 (postpartum depression) 은산모의약 13% 에서나타나는심각한질환으로분만후 12주이전 134 Copyright 2011 Korean Society Biological Psychiatry
EEG Alpha Asymmetry, Postpartum Blues and Music Im SJ, et al 에나타나고, 2주이상지속되는증상을주소로한다. 6) 산후우울증은산모의정신사회적인측면에도영향을미칠뿐만아니라모자사이의관계및태아에게도나쁜영향을미치는것으로알려져있다. 7-9) 즉, 산후우울감은산모자신뿐아니라영아에게도영향을미치는산후우울증을야기할수있는주요위험인자이며산후우울증보다초기에나타나기때문에이에대한평가와증상의조절은향후산모와태아의건강과상태에있어매우중요하다고할수있다. Goldstein 10) 이좌측뇌손상과우울증상의관련성을보고한이후로뇌의좌, 우반구활성비대칭현상과기분장애와의연관성에대한연구들이지속적으로이루어졌다. 이전의여러연구들에서우울증환자들이정상인에비해좌반구전두엽의상대적인활성이부족하다는보고를하였고 11-13) 또다른연구에서는우반구활동성이좌반구보다크면부정적정서와관련이있고, 좌반구활동성이우반구보다크면긍정적정서와관련이있음을보였다. 14) 기존의연구에서는좌, 우반구비대칭여부를주로뇌파의측정을통해알아보았는데, 이는증가된알파파가해당반구의활동감소를의미하였다는보고 15-17) 와우울증환자들의알파파워가우반구보다좌반구에서더욱크다는것은좌반구가우반구에비해덜활성화되었다는것을의미한다는선행연구를기반으로하였다. 18) 또한 Henriques 와 Davidson 11) 은뇌파의좌우반구비대칭을알아보는방식으로 A 1(= log R - log L) 값을제안하였는데여기서 log R은우반구 F4 영역에서측정한알파파의파워값을자연로그치환한것을의미하며, log L은좌반구 F3 영역에서측정한알파파의파워값을자연로그치환한것을의미한다. 또한이들은비대칭지수 (A 1) 의증가가우반구알파파의파워가상대적으로좌반구에비해커진다는것을뜻하고, 이것은상대적으로우반구에비해좌반구의활성이더커졌음을의미한다고보고하였다. 19) 산후우울증에관련해서도뇌의활성과함께태아에게미치는영향에대한몇몇연구가시행되었는데뇌활성의비대칭을보이는산모에게서태어난아이의뇌활성또한비대칭의양상을보이며이러한아이는환경자극에대한반응이떨어짐을보인다는연구 20) 와우울증인엄마를가진아이들이상대적으로더큰전두엽의비대칭활성을보이며이러한아이들에게서더약한감정적인반응을보였다는연구들이보고되었다. 21) 산후우울증은모아애착 (maternal-infant attachment) 과관련된중요한질병임에도불구하고아직우리나라에서는출산후나타나는일과적현상으로여겨져간과되기쉬울뿐아니라아이를곁에서떼어놓기힘든산모의특성상예방과치료적인측면에서의인식또한매우소홀하다. 따라서우울증의증상이심화되어치료를요하는상황이되기이 전에산모스스로조절이가능하고짧은시간에손쉽게적용할수있는중재적방법이필요할것으로여겨지고있다. 기존에알려져있는몇가지중재적인방법들중음악이우울감을호전시키는데도움이된다는다양한연구들이있었다. 우울증을가진여자청소년을대상으로음악을들려준 14명의환자군에서심리적이완만하게한동수의대조군에비해비대칭이던전두엽의알파파가대칭적으로변함을보고하였으며 22) 우울증을가진여성들에서 20분간의음악세션 (music session) 이후음악을듣기전보다더대칭적인형태의뇌파가나타나고상태특성불안척도 (State-Trait Anxiety Index, 이하 STAI) 역시감소되었다는결과가보고되었다. 23) 본연구는산후우울감을보이는산모들의기분증상에대하여음악이중재적인영향을미칠수있는지를뇌파의변화를통해확인해보고자하였다. 연구대상 청주시내개인산후조리원에서산후조리중인산모 170 명을대상으로자기보고식검사인에딘버러산후우울증척도 (Edinburgh Postnatal Depression Scale Korean version, 이하 K-EPDS) 를사용하여산후우울감여부를판단하였다. 이중만 18세미만, 현재 Axis I 장애로진단받았거나인격장애가있는경우, 알코올혹은약물남용및의존의과거력이있거나치매, 망상, 환각의증거나심각한자살위험이상존하는경우, 기질적뇌질환이나임상적으로의미있는신체질환의과거력이있는경우, 최근 2주간항우울제투약경험이있거나현재투약중인경우, 30일이내에플루옥세틴 (fluoxetine) 을투약한적이있는경우와연구참여에동의하지않은경우를제외한총 18명의산모가연구에참여하였다. 이들은 10점의절단점을기준으로산후우울감을보이는산모군 9명과우울감을보이지않는산모군 9명으로분류되었다. 정상대조군은청주의 C 대학내모집공고를보고참여의사를밝힌만 18세이상의건강한여성으로정신과전공의에의해실시한면담에서뇌손상의과거력이나정신과적병력이없는것으로확인된사람중추후시행한 Beck 우울진단표 (Beck Depression Inventory, 이하 BDI) 점수가 9점이하인 10명을대상으로하였다. 모든대상군은오른손잡이였으며연구내용을이해하고동의한사람만을대상으로하였다. 본연구는충북대학교병원생명윤리위원회의승인을얻었으며참여자는연구의목적과방법에대한충분한설명을들은후동의서를작성하였다. journal.biolpsychiatry.or.kr 135
Korean J Biol Psychiatry 2011;18:134-140 연구방법청주시내에있는산후조리원 3곳에재원중인출산후 24~ 72시간이내인산모를대상으로 K-EPDS 에대한설명과작성요령을교육한뒤희망자에한하여이를시행하였다. 연구에참여하기로한산모 18명과건강한성인 10명은 K-EPDS 시행후 24시간이내에정신과의사의안내에따라자가보고식설문검사인 BDI, 한국형우울형용사체크리스트 (Depression Adjective Checklist-Korean version, 이하 K-DACL), 우울감에대한시각적상사척도 (visual analogue scale, 이하 VAS), 상태불안척도 (State-Trait Anxiety Inventory-X1, 이하 STAI-X1) 를시행하였고결과는정신과의사에의해검토, 확인되었다. 모든참여자들은척도를시행한이후충북대학교병원뇌파실에서 5분간의안정을취한뒤안정기의뇌파를측정하였다. 5분간의뇌파측정이후 20분 32초의음악세션동안이어폰으로선택된음악을청취하였으며, 다시 5분간의안정을취한뒤 5분간뇌파를재측정하였다. 뇌파의측정이모두끝난뒤 K-DACL, VAS, STAI-X1 을시행하였고작성된설문지의내용은다시정신과의사에의해검토되었다. 평가도구에딘버러산후우울증척도 ( 이하 EPDS) 10문항으로구성되어간편하게사용할수있으며기존의다른우울평가척도와는달리산후우울증의특성을고려하여신체적변화나수면장애에대한항목들은제외되어있다. 24) 현재국내에서도번안이되어널리사용되고있는데본연구에서는기존연구에서제안되었던 10점의절단점을기준으로하였다. 25) 벡우울진단표 Beck 등이우울의정서적, 이지적, 동기적, 생리적영역을포괄한우울증상을측정하기위해개발한총 21문항의자기보고형검사이다. 본연구에서는 Lee와 Song 26) 에의해번안된한국판 BDI를사용했다. 한국형우울형용사체크리스트개인의감정상태를나타내는형용사를사용하여현재의우울정서와일시적인우울상태를민감하게측정하는도구로널리사용되고있다. 특히짧은시간간격을두고우울정서의변화를측정하는실험연구나치료성과연구에많이사용되고있다. 우울한기분을나타내는형용사 21개, 긍정적기분을나타내는형용사 11개로총 32문항으로구성되어있으며우리나라에서는우울증변별을위한절단점으로남자 21점, 여자 19점이제안되고있다. 27) 시각적상사척도직접적으로측정할수없는주관적인특성및태도를측정하기위한것으로 2개의끝점을가진선위에자신의위치를표시함으로서현재자신의상태를나타내는방법이다. 민감도및타당도는 Likert scale이나 Borg scale과같은다른선상척도들과매우유사한것으로알려져있다. 28) 상태불안척도상태불안과특성불안을측정하기위한 STAI-X 중상태불안을측정하는것으로총 20문항으로구성되어있다. 원래정상인의불안증상을측정하는도구로개발되었으나, 임상집단의불안측정에도유용한것으로밝혀져있다. 우리나라에서는대학생집단기준으로 52점의절단점이제안되고있다. 29) 음악의선택음악은인간의생리적, 심리적, 사회적반응을유발시키며, 이러한반응에대한연구는이전부터활발히이루어져왔다. 일반적으로레가토적인멜로디중심의음악, 조성의변화가거의없거나급격한멜로디의변화가없으며진행을예측할수있는경우신체적안정을가져오고, 보다느린빠르기, 약한박자, 음악적구조가안정적으로변화하는경우심리적안정을가져온다고알려져있다. 30) 이러한반응을기반으로하여음악치료의 4가지원리인동질의원리, 카타르시스의원리, 이완의원리, 행위과학적원리에입각한곡을선별한뒤, 전문음악치료사의도움을얻어그중 2곡을선곡하였다. 선택된곡은로시니의윌리엄텔서곡과모차르트교향곡 40번제1악장이었으며모든참여자들은곡사이 2초의간격을포함하여 2 곡을이어서듣도록하였고음악세션전, 후로 5분의안정시간이주어졌다. 뇌파의측정및분석모든참여자들은충북대학교병원뇌파검사실에서안정기의뇌파를측정하였다. 조용한환경을유지하기위하여유동인구및소음이적은오후 8~9시경에측정하였으며피험자는몸을움직이지않고가만히누워있는상태에서수행되었다. 눈움직임에의한잡음혼입을막기위해측정시피험자가눈을감도록하였으며조명은가능한어두운상태를유지하였다. 또한뇌파측정시피험자의성실한자세를유도하기위해피험자에게충분한사전설명을실시하였다. 전자파의간섭을최소화하기위해보유하고있던금속성물질은측정시간동안따로보관토록하였다. 또한기록된뇌파의아날로그 (analogue) 파형의정보를바탕으로알파파와세타파의상대적인비율을고려하여 stage I sleep의출현여부를판단하였으며이 136
EEG Alpha Asymmetry, Postpartum Blues and Music Im SJ, et al 를통해해당데이터를제거하고자하였다. 뇌파의측정은현재충북대병원뇌파검사실에서보유하고있는 Grasstelefactor사의 Twin Comet EEG/PSG(EEG/ LTM) 를이용하였다. Ag-AgCl 전극을국제 10~20 전극배치기준에의하여 18개의전극을부착하였고기준전극은독일뇌파협회의영상학위원회에서추천하는 Cz를이용하였으며접지전극 (ground electrode) 은이마에각기부착하였다. 측정된뇌전위는 Grasstelefactor사의 AS40 앰프로보내지며 0.5 Hz에서 100 Hz 대역의신호가통과하도록설정되었다. 증폭된신호는개인용컴퓨터로전송되어수학적연산을처리하였으며 TWin R EEG & LTM Clinical Software를이용하여 artifact의제거와퓨리에변환 (fast fourier transform) 을통한 uv2/hz 형태의알파파워값으로변환되었다. 얻어진자료들중 F3과 F4 부위에부착한전극을통해얻어진결과를 ASCII 파일로변환후뇌파의정량적분석을실시하였다. 각파형중알파밴드의주파수대역은 8~13 Hz로정의하였으며 F3, F4 영역에서의알파파의절대파워 (absolute power) 값을구한뒤 A 1 = log R - log L의공식에의거하여 A 1 값을계산하였다. 자료의처리및분석모든통계적처리는 SPSS 12.0 version(spss Inc., Chicago, IL, USA) 을사용하였다. 각그룹사이의 A 1 값과척도의차이를비교하기위해 Kruskal-Wallis test와 Mann-Whitney U test를사용하였고, 음악세션이후 A 1 값과척도의변화를보기위해 Wilcoxon signed rank test를시행하였다. 통계적유의수준은 p < 0.05로정의하였다. 그룹간인구통계학적특징의비교 세그룹의평균연령은산후우울감을보이는산모군 (31.67 ± 5.29세 ) 과우울감을보이지않는산모군 (31.34 ± 4.89세 ), 정상대조군 (30.0 ± 2.62세 ) 사이에유의한차이를보이지않았으며교육수준에서도그룹간차이는유의하지않았다. 또한두산모그룹의평균재태기간은산후우울감을보이는산모군 (38.44 ± 1.33 주 ) 과우울감을보이지않는산모군 (37.56 ± 2.74 주 ) 사이에유의한차이를보이지않았으며출산방법, 출산횟수, 수유방법에서도그룹간의차이는유의하지않았다 (Table 1). 그룹간 A 1 과우울, 불안척도들의기선값비교세그룹간 K-DACL(p = 0.005), VAS(p = 0.000), STAI-X1 (p = 0.001) 점수는통계적으로유의한차이를보였고, A 1 값은통계적으로유의하지는않았으나집단간차이에대한경향성을보였다 (p = 0.054)(Table 2). 그룹간비교에서산후우울감을보이는산모군의 A 1 값은정상대조군의 A 1 값에비해유의하게낮은결과를보였다 (p = 0.015)(Fig. 1). Table 1. Comparison of demographic characteristics among postpartum blues group, non-depressive mother group and normal control group Characteristics Postpartum blues group (n = 9) Non-depressive mother group (n = 9) Normal control group (n = 10) Mean SD Mean SD Mean SD Age 31.67 5.29 31.34 4.89 30.0 2.62 Gestational period 38.44 1.33 37.56 2.74 Education n % n % n % High school 6 67 5 56 4 44 College 3 33 4 44 5 56 Parity Primipara 6 67 7 78 Multipara 3 33 2 33 Infantile sex Male 7 78 6 67 Female 2 22 3 33 Feeding Breast 4 44 3 33 Formula 3 33 1 11 Mixed 2 23 5 56 p-value The statistical analyses were done by Kruskal-Wallis test, Mann-Whitney U test or chi-square test. N : number, SD : standard deviation, : not significant journal.biolpsychiatry.or.kr 137
Korean J Biol Psychiatry 2011;18:134-140 Table 2. Comparison of K-EPDS, BDI, STAI-X1, VAS, K-DACL and A1 score among postpartum blues group, non-depressive mother group and normal control group Postpartum blues group (n = 9) Non-depressive mother group (n = 9) Normal control group (n = 10) Mean SD Mean SD Mean SD p-value K-EPDS -15.44 04.13-06.56 1.67 0.000 BDI -24.78 13.80 0-7.44 3.50 0-3.50 2.68 0.000 A1 0-0.62 00.59 01 0.54 0-0.04 0.71 0.054 STAI-X1-59.89 14.62-34.89 7.44-34.20 5.59 0.001 VAS 0-7.47 01.78 0-3.32 1.44 0-1.83 1.12 0.000 K-DACL -21.22 10.29 0-6.11 5.69 0-9.00 4.30 0.005 The statistical analyses were done by Kruskal-Wallis test. A1 = logr - logl (R : alpha power at F4/L : alpha power at F4), K-EPDS : edinburgh postnatal Depression Scale Korean version, BDI : Beck Depression Inventory, STAI-X1 : State-Trait Anxiety Inventory-X1, VAS : Visual analogue scale, K-DACL : Depression Adjective Checklist-Korean version, N : number, SD : standard deviation Table 3. Change of A1, STAI-X1, VAS and K-DACL scores in postpartum blues group after the music session 1.8 1.3 N/A * N/A Postpartum blues group (n = 9) Before [Mean (SD)] After [Mean (SD)] p-value A1 0-0.62 (00.59) 05 (00.32) 0.021* 0.8 STAI-X1-59.89 (14.62) -48.78 (15.80) 0.008* VAS -07.47 (01.80) 0-5.87 (02.44) 0.015* 0.3 K-DACL -21.22 (10.29) -15.33 (09.99) 0.011* -1.2 * : Significant difference after the music session by Wilcoxon signed rank test, p < 0.05. Before : befere the music session, After : after the music session, A1 = logr - logl (R : alpha power at F4/ L : alpha power at F4), STAI-X1 : State-Trait Anxiety Inventory-X1, VAS : visual analogue scale, K-DACL : Depression Adjective Checklist-Korean version, N : number, SD : standard deviation -1.7-2.2 PPD NDM NC Fig. 1. Distribution of A1 score in postpartum blues group, non-depressive mother group and normal control group before the music session. * : Postpartum blues group had significantly lower A1 scores compared to normal controls (p = 0.015). A1 = logr - logl (R : alpha power at F4/L : alpha power at F4), N/A : not applicable. Mean A1 score : postpartum blues group (-0.62), non-depressive mother group (1), normal control group (-0.04). PPD : Postpartum blues group (n = 9), NDM : non-depressive mother group (n = 9), NC : normal control group (n = 10). 그룹간음악세션전, 후의 A 1 값과우울, 불안척도들의점수변화비교 산후우울감을보이는산모군에서만음악세션이후 A 1 값 이유의하게증가하였다 (p = 0.021)(Table 3)(Fig. 2). K-DA- CL, VAS, STAI-X1 점수는산후우울감을보이는산모군과 우울감을보이지않는산모군에서모두유의하게감소하였다. 출산은여러가지정신질환의위험성을높이는원인이될 수있으며, 31) 산욕기는기분장애에취약한시기로이러한기 분장애중산후우울감은많은수의산모들이경험하는것으로알려져있다. 32) 본연구는산모자신과그영아에게도영향을미칠수있는산후우울증의주요위험인자이며보다초기에평가될수있는산후우울감을보이는산모를그대상으로하였다. 또한이전의여러연구들에서확인되었던우울증과뇌파비대칭현상의관계를바탕으로산후우울감을보이는산모들의뇌파비대칭을확인하고음악에의한뇌파의좌우반구비대칭의변화를확인해보고자하였다. 본연구에서는 K-EPDS 를사용하여산후우울감을평가하였다. EPDS는산후우울감을평가하기위해널리사용되고있는척도로, 이전의여러연구들에서 EPDS를출산후 1 주이내에시행하였을때 2, 3개월후나타나는산후우울증을효과적으로예견할수있음과 33) EPDS를통해산후우울감을측정하는것이산후우울증의발생을예측하는데유용하고측정한결과를신뢰할수있음을보고하였다. 34) 본연구에서산후우울감을보이는산모군은정상대조군에비해전두엽좌우반구활성의비대칭이더크게나타나는결과를보였다. 이는기존연구들을통해지속적으로보고되어온우울군에서의상대적인좌반구활성의감소현상 35) 을반복검증한것으로우반구의활동성이좌반구보다크면부정적정서와연관되고, 좌반구의활동성이우반구보다크면 138
EEG Alpha Asymmetry, Postpartum Blues and Music Im SJ, et al -0.62 (0.59) 5 (0.32) 1 (0.54) -0.07 (0.73) -0.04 (0.71) -0.15 (0.74) * A B C Before the music session (A1) After the music session (A1) Fig. 2. Change of A1 score in postpartum blues group, non-depressive mother group and normal control group after the music session. * : There was a statistically significant change of A1 to symmetry after the music session in postpartum blues group only by Wilcoxon sign ranked (p = 0.021). A : Change of A1 score in postpartum blues group after the music session. B : Change of A1 score in non-depressive group after the music session. C : Change of A1 score in normal control group after the music session. 긍정적정서와연관된다는이전연구결과의보고와일치하는것이다. 14) 본연구에서는모든참여자들에게 20분 32초의음악세션을시행하였다. 음악을듣는것은일반적으로스트레스를받거나휴식을취하고싶을때가장손쉽게할수있는방법중의하나이다. Altshuler 36) 는우울증환자들이밝은음악보다슬픈음악에더빨리자극받게된다는사실을발견하였고이를통해음악을듣는사람의그때기분과정신템포에맞는곡을선택하면환자는그음악을받아들여유효한변화를가져올수있다는 동질의원리 를제시하였다. 이외에도아리스토텔레스의 시학 에서기인한카타르시스의원리, 다양한내적, 외적자극에의해유발된심리적인불균형을음악을통해완화할수있다는균형의원리등이음악치료의주된원리로사용되고있다. 37)38) 본연구에서는이러한음악치료의원리의적용과함께멜로디중심으로진행을예측할수있으며음악적구조가안정적으로변화하여신체적, 심리적안정을가져올수있는음악 39)40) 중 2곡을선곡하였다. 음악세션을시행하고난이후산후우울감을보이는산모군의주관적우울감이감소하는결과를보였는데, 이는우울증환자들을대상으로기존에이루어졌던대부분의연구에서제시한결과와도일치하는것이다. 41) 또한산후우울감을보이는산모군에서만좌반구전두엽의상대적인활성이증가된결과는우울감을호소하는군에서그렇지않은군에비해음악세션을시행하였을때좌반구전두엽의상대적인활성이우울감을호소하는군에서만유의하게증가했던이전의연구결과와일치하는것이다. 22) 따라서, 본연구에서나타난좌반구전두엽의상대적인활성이증가한결과는음악이산후우울감을보이는산모의정서에보다긍정적인영향을미칠수있고우울증의증상이심화되어치료를필요로하기전그증상을중재하는데에도움이될가능성이있음을보인것으로, 이러한정서의변화를뇌파의측정이라는객관적인지표를통해확인하였다 는점에서본연구의의의를찾을수있겠다. 본연구는참여자가호소하는우울감에대한객관적인평 가를시행하지않았다. 또한각참여군의사례비율은맞추었 으나참여군의수가부족하였다. 그러나산모의우울감과관 련된기존의뇌파연구는대부분산모와태아의관계에대한 연구이므로, 산후우울감의중재에대한본연구는예비연구 의가치가있을것으로판단되며추후동질한대집단을이용 한연구가필요할것으로생각된다. 본연구는산후우울감에 대한단기적인영향만을본것으로산후우울증으로진행되 는과정에대해서는확인하지못하였다. 이를확인하기위해 서는추후지속적인관찰과뇌파의측정을통한장기적인연 구가필요할것으로생각된다. 중심단어 : 산후우울감 뇌파 우울 음악요법. Conflicts of interest The authors have no financial conflicts of interest. REFERENCES 1) Kendell RE. Emotional and physical factors in the genesis of puerperal mental disorders. J Psychosom Res 1985;29:3-11. 2) Fossey L, Papiernik E, Bydlowski M. Postpartum blues: a clinical syndrome and predictor of postnatal depression? J Psychosom Obstet Gynaecol 1997;18:17-21. 3) Paykel ES, Emms EM, Fletcher J, Rassaby ES. Life events and social support in puerperal depression. Br J Psychiatry 1980;136:339-346. 4) Crotty F, Sheehan J. Prevalence and detection of postnatal depression in an Irish community sample. Ir J Psychol Med 2004;21:117-121. 5) Kwon JH. A Test of A Vulnerability-Stress Model of Postpartum Depression. Korean J Clin Psychol 1997;16:55-67. 6) O Hara MW, Swain AM. Rates and risks of postpartum depression: a meta-analysis. Int Rev Psychiatry 1996;8:37-54. 7) Goodman SH, Gotlib IH. Children of Depressed Parents: Alternative Pathways to Risk for Psychopathology. Washington DC: American Psychological Association Press;2002. 8) Radke-Yarrow M, Klimes-Dougan B. Parental depression and offspring disorders: A developmental perspective. In S. H. Goodman & I. H. Gotlib (Eds.). Children of Depressed Parents: Mechanisms journal.biolpsychiatry.or.kr 139
Korean J Biol Psychiatry 2011;18:134-140 of Risk and implications for Treatment. Washington DC: American Psychological Association;2002. 9) Nagata M, Nagai Y, Sobajima H, Ando T, Nishide Y, Honjo S. Maternity blues and attachment to children in mothers of full-term normal infants. Acta Psychiatr Scand 2000;101:209-217. 10) Goldstein K. The Organism: A holistic approach to biology. NY: The American Book Co;1939. 11) Henriques JB, Davidson RJ. Regional brain electrical asymmetries discriminate between previously depressed and healthy control subjects. J Abnorm Psychol 1990;99:22-31. 12) Davidson RJ. Cerebral asymmetry, emotion and affective style. In Brain Asymmetry (Davidson & Hugdahl, Eds.). Cambridge MA: The MIT press;1995. 13) Gotlib IH, Ranganath C, Rosenfeld P. EEG alpha asymmetry, depression, and cognitive functioning. Cognition and Emotion 1998; 12:449-478. 14) Davidson RJ, Irwin W. The functional neuroanatomy of emotion and affective style. Trends Cogn Sci 1999;3:11-21. 15) Shagass C. Electrophysiological studies of psychiatric problems. Rev Can Biol 1972;31:77-95. 16) Ray WJ. The electrocortical system. In J.T. Cacioppo & L.G. Tassinary (Eds.). Principles of psychophysiology. Cambridge: Cambridge University Press;1990 p.385-412. 17) Smit DJ, Posthuma D, Boomsma DI, De Geus EJ. The relation between frontal EEG asymmetry and the risk for anxiety and depression. Biol Psychol 2007;74:26-33. 18) Schmidt LA, Trainor LJ. Frontal brain electrical activity (EEG) distinguishes valence and intensity of musical emotions. Cognition and Emotion 2001;15:487-500. 19) Choi SW, Jekal EJ, Ahn CI. Depression and Baseline Prefrontal EEG Alpha Wave Asymmetry. Korean J Clin Psychol 2008;27:1053-1069. 20) Field T, Diego M, Hernandez-Reif M, Schanberg S, Kuhn C. Right frontal EEG and pregnancy/neonatal outcomes. Psychiatry 2002; 65:35-47. 21) Jones NA, Field T. Massage and music therapies attenuate frontal EEG asymmetry in depressed adolescents. Adolescence 1999;34: 529-534. 22) Field T, Martinez A, Nawrocki T, Pickens J, Fox NA, Schanberg S. Music shifts frontal EEG in depressed adolescents. Adolescence 1998;33:109-116. 23) Tornek A, Field T, Hernandez-Reif M, Diego M, Jones N. Music effects on EEG in intrusive and withdrawn mothers with depressive symptoms. Psychiatry 2003;66:234-243. 24) Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782-786. 25) Kim YG, Won SD, Choi SH, Lee SM, Lim HJ, Kim KH. Validation Study of the Korean Version of Edinburgh Postnatal Depression Scale (K-EPDS). J Korean Soc Dep Bip Disorders 2005;3:42-49. 26) Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean J Clin Psychol 1991;10:98-113. 27) Lee YH. A Study of the Reliability and Validity of the Depression Adjective Check List-Korean Version. Korean J Clin Psychol 1999; 18:151-165. 28) Grant S, Aitchison T, Henderson E, Christie J, Zare S, McMurray J, et al. A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise. Chest 1999;116:1208-1217. 29) Kim JT, Shin DK. A study based on the standardization of the ST- AI for Korea. New Med J 1978;21:69-75. 30) Pelletier CL. The effect of music on decreasing arousal due to stress: a meta-analysis. J Music Ther 2004;41:192-214. 31) McGrath MM, Meyer EC. Maternal self-esteem: from theory to clinical practice in a special care nursery. Child Health Care 1992; 21:199-205. 32) Cummings EM, Davies PT. Maternal depression and child development. J Child Psychol Psychiatry 1994;35:73-112. 33) Yamashita H, Yoshida K, Nakano H, Tashiro N. Postnatal depression in Japanese women. Detecting the early onset of postnatal depression by closely monitoring the postpartum mood. J Affect Disord 2000;58:145-154. 34) Urry HL, Nitschke JB, Dolski I, Jackson DC, Dalton KM, Mueller CJ, et al. Making a life worth living: neural correlates of well-being. Psychol Sci 2004;15:367-372. 35) Kline JP, Allen JJ, Schwartz GE. Is left frontal brain activation in defensiveness gender specific? J Abnorm Psychol 1998;107:149-153. 36) Altshuler IM. The organism as a whole and music therapy. Sociometry 1945;8:227-232. 37) Jeong YJ. Music therapy. In R.O. Benenzon (Eds.) Music therapy manual. Shin Won Agency Co. Seoul: Hana Medical Publishing;2002 p.49-58. 38) Choi BC. The development of music therapy theory and music therapists awareness of theoretical approaches. Korean J Music Ther 2006;8:1-12. 39) Oakes S. The influence of the musicscape within service environments. J Serv Market 2000;14:539-556. 40) Chang MY, Chen CH, Huang KF. Effects of music therapy on psychological health of women during pregnancy. J Clin Nurs 2008; 17:2580-2587. 41) Coan JA, Allen JJ. Frontal EEG asymmetry as a moderator and mediator of emotion. Biol Psychol 2004;67:7-49. 140