stress pissn 1225-665X, eissn 2234-1668 stress 2018;26(2):88-94 https://doi.org/10.17547/kjsr.2018.26.2.88 ORIGINAL ARTICLE 소방공무원대상캠프프로그램의스트레스완화효과추적및관련요인탐색 신정하 1 ㆍ심민영 2 ㆍ이정현 2 ㆍ이다영 3 ㆍ전경선 1 ㆍ오승아 1 ㆍ김지애 1 ㆍ김옥주 1 ㆍ양정일 1 ㆍ이희봉 2 국립정신건강센터 1 정신건강사업과, 2 불안스트레스과, 3 한림대학교의과대학자살과학생정신건강연구소 Stress Relief and Related Factors in Camp Program for Firefighters Jungha Shin 1, Minyoung Sim 2, Junghyun H. Lee 2, Da Young Lee 3, Kyungsun Jeon 1, Seunga Oh 1, Jiae Kim 1, Okjoo Kim 1, Jungil Yang 1, Heebong Lee 2 1 Division of Mental Health Services, 2 Department of Stress and Anxiety Disorder, National Center for Mental Health, Seoul, 3 Suicide and School Mental Health Institute, Hallym University College of Medicine, Anyang, Korea This study was supported by the National Center for Mental Health Internal Research Project (No. 2015-6). Received February 20, 2018 Revised April 5, 2018 Accepted April 25, 2018 Corresponding author Minyoung Sim Department of Stress and Anxiety Disorder, National Center for Mental Health, 127 Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea Tel: +82-2-2204-0115 Fax: +82-2-2204-0395 E-mail: mdsim@hanmail.net ORCID: Jungha Shin (http://orcid.org/0000-0001-7392-5395) Minyoung Sim (http://orcid.org/0000-0001-9289-1979) Junghyun H. Lee (http://orcid.org/0000-0001-9116-4593) Da Young Lee (http://orcid.org/0000-0002-4399-4231) Kyungsun Jeon (http://orcid.org/0000-0002-9907-9040) Seunga Oh (http://orcid.org/0000-0001-5734-7812) Jiae Kim (http://orcid.org/0000-0002-2487-0196) Okjoo Kim (http://orcid.org/0000-0003-2866-1727) Jungil Yang (http://orcid.org/0000-0001-9578-1935) Heebong Lee (http://orcid.org/0000-0001-9707-1662) Copyright 2018 by stress. All rights reserved. Key messages 본연구의목적은캠프프로그램에참가한소방공무원의스트레스, 우울, 외상후스트레스의변화를전향적으로조사하여캠프프로그램의효과를검증하고, 스트레스완화와관련된요인을분석하는것이다. 이를위해총 5회에걸쳐지각된스트레스 (PSS-K), 영역별스트레스 (GARS), 외상후스트레스증상 (IES-R) 및우울감 (BDI-II) 의변화를시간경과에따라분석하고, 캠프후 6개월시점의스트레스에영향을미치는요인을조사하였다. 연구결과스트레스수준은캠프참여전보다낮아져캠프후 6개월까지지속되었으나, 우울감은캠프직후에만감소를보였다. 캠프참여전직장스트레스가높고질병스트레스가낮을수록캠프프로그램을통한스트레스완화효과가큰것으로나타났다. 중심단어 : 소방공무원, 스트레스, 캠프, 힐링프로그램 Abstract Background: This study aims to test the effectiveness of a camp program and to analyze the factors related to stress relief. To this end, the present study conducted prospective research for six months on the change of stress, depression, and the level of post-traumatic stress among the firefighters who participated in the camp program. Methods: The perceived stress (PSS-K), stress by the different portion (GARS), post-traumatic stress symptoms (IES-R) and depression (BDI-II) were evaluated at five sessions over the span of six months, and the change of each measure was analyzed. Those five sessions were before the camp, right after the camp and a month, three months and six months after the camp. Moreover, this study assessed characteristics of sociodemographic, firefighting task and mental health that are related to the level of stress at six months after the camp. Results: Compared with before the camp, the level of depression was significantly lower right after the camp. However, the level did not have significant difference after a month period. At one month after the camp, the level of stress was significantly lower than before the camp, and was maintained after six months. The predictive factors of the degree of stress relief after the camp were high job stress and low disease stress. Conclusions: This study has found that the stress relief from the camp continued until six months after the camp, and the stress-relieving effect through the camp was substantial for those with higher job stress and lower disease stress. Key Words: Firefighters, Stress, Camp, Healing program 서론 소방공무원은화재ㆍ재난ㆍ재해등각종위급한상황에서국민의생명과재산을보호하며 ( 소방기본법제1조 ) 사고 현장에서보여준투철한직업정신과헌신으로지난 3년간우리나라국민이가장신뢰하고존경받는직업 1위를차지하였다 (Kim HY, 2014). 하지만이러한평가뒤에는교대근무, 야간출동, 인력부족, 생활안전및민원처리등의과도한
Stress Relief and Related Factors in Camp Program for Firefighters 89 직무부담등으로인한 (Paley MJ et al., 1994; Park KH, 2002) 신체적부담과주취자폭행, 민원제기, 업무수행시경험하는직간접외상으로소방공무원의스트레스및외상후스트레스등정신건강은일반인에비해열악한것으로알려져있다 (Guidotti, 1992; Stephen et al., 2006; Moon YS, 2011; Lee JH et al., 2017). 적절한스트레스는긴장감을유지시켜업무수행에도움을주지만과도하게누적된스트레스는정서적탈진, 신체적고갈된느낌, 분노, 조급한태도등으로나타날수있으며, 특히직장생활에서경험하는스트레스는직무만족도와조직몰입도를낮춰조직전체에도부정적영향을미친다. 우리나라는직장인중 22% 가스트레스고위험군으로조사되었으나 (Chang SJ et al., 2005) 소방공무원의경우이보다높은수치를기록하고있다. 부산지역소방공무원을대상으로한연구에서 18.1% 가고위험스트레스집단, 67.8% 가잠재적스트레스집단으로조사되어 14.1% 만이건강집단으로분류되었으며 (Moon YS, 2011), 소방공무원의스트레스는경찰, 해경보다높은것으로나타났다 (Lee JY, 2011). 특히소방공무원은업무수행중외상이될만한사건을경험한비율이 80% 를넘으며이중 10.5 36.8% 가외상후스트레스고위험군으로 (National Fire Agency, 2008; Moon YS, 2011) 일반인구의 7.8% 에비해 4배이상높은수치를기록하고있다. 소방공무원의외상후스트레스장애유병률은전세계적으로높은수치를기록하고있는데, 대만소방공무원의외상후스트레스장애유병률은 10.5% 로조사되었으며 (Chen YS et al., 2007) 독일의경우 18.2% 에달한다 (Dieter W et al., 1998). 외상후스트레스장애는우울증, 불면, 알코올중독의동반이환율이 80% 에이를뿐아니라 (Ronald CK et al., 1995) 자살률까지증가시킨다 (Pompili M et al., 2013; Boffa JW et al., 2017). 또한우리나라소방공무원의우울증은 19.2 39.7% 에달하며 (National Fire Agency, 2008; Kim TW et al., 2010) 최근 5년간소방공무원의순직및공상자가 54.1% 증가한것으로조사되어 (National Fire Agency, 2017) 각종사고현장의최일선에서일하는소방공무원의안전을위협하는요소가되고있다. 소방공무원의정신건강문제가이슈가되면서근무처우개선과함께정신건강증진을위한다양한프로그램이시도되고있다. 미국은국립 PTSD 센터 (National PTSD center) 를중심으로프로그램을제공하고있으며, 일본은소방공무원의정신건강에대한관리를법적으로명시하고이를따르고있다 (National Fire Agency, 2008). 우리나라는소방서심실안정실운영, 찾아가는심리상담, 가족심리치유교실, 산림치유등의스트레스관리를위한힐링프로그램이주로시행되고있다 (Jo SD, 2014). 각지자체에서는소속소방공무원들을대상으로 2박 3일혹은 4박 5일간캠프프로그램을운영하였는데주로단체디브리핑, 아로마테라피, 숲치료, 명상및요가등의프로그램으로구성되었다 (Park YW et al., 2013). 연구에서캠프프로그램 5 7개월후외상후 스트레스장애, 우울감, 스트레스수준이모두감소하였다고보고한바있으나 (Jo SD, 2014) 아직까지이에대한연구가많지않아효과성에대한근거는부족한실정이다. 따라서본연구는국립정신건강센터에서시행한소방공무원의스트레스관리를위한캠프프로그램을통해소방공무원의스트레스, 우울감및외상후스트레스증상의변화를 6개월동안전향적으로조사하여캠프프로그램의효과성을분석하고캠프프로그램의효과를극대화할수있는요인을분석하고자하였다. 연구방법 1. 연구대상및연구설계본연구는 2014년 3월부터 11월까지국립정신건강센터에서운영한캠프프로그램에참여한 20 60세소방공무원중본연구에대한충분한설명을들은후자발적으로연구에참여하겠다는의사를밝힌참여자 90명을대상으로하였다. 먼저참여자들의나이, 성별, 결혼상태, 교육수준, 근무년수등의기본인구학적정보를파악하고, 캠프프로그램참여에따른정신건강수준의변화를확인하기위해캠프참여전과종료직후, 캠프후 1, 3, 6개월시점에스트레스수준, 우울감, 외상후스트레스증상자가설문척도를우편발송및수거를통해전향적으로조사하였다. 2. 연구도구 1) 한국판지각된스트레스척도참여자들이주관적으로느끼는스트레스정도를확인하기위해한국판지각된스트레스척도 (Korean Perceived Stress Scale, PSS-K) 를사용하였다. PSS-K는총 10문항으로구성되며최근한달간스트레스지각과관련된문항에대해 전혀없다 0점부터 매우자주있다 4점까지 4점척도이다. 점수가높을수록스트레스가심한것으로 14 16점은경미한수준, 17 18점은중간수준, 19점이상인경우심한수준으로분류된다 (Cohen S et al., 1988; Park JO et al., 2010). 2) 영역별스트레스척도생활의어떤영역에서스트레스를크게받고있는지영역별스트레스척도 (Global Assessment of Recent Stress Scale, GARS) 를사용하여확인하였다. GARS는최근일주일간의스트레스정도를평가하며일 / 직장 / 학교생활, 대인관계, 관계의변화, 질병및상해, 경제적문제, 비일상적인사건, 일상생활의변화유무, 전반적스트레스정도의 8가지세부항목에대한스트레스를 0점 9점으로평가하며점수가높을수록스트레스가높은것을의미한다 (Linn MW, 1986; Ko JK et al., 2000). 3) 한국판사건충격척도외상후스트레스증상을조사하기위해한국판사건충격척도 (Impact of Events Scale-Revised, IES-R) 를사용하였
90 Jungha Shin, et al. http://www.stressresearch.or.kr/ 다. IES-R은과각성, 회피, 재경험의하위척도로구분되며, 특정사건과관련하여최근 7일동안의스트레스를 전혀아니다 부터 매우그렇다 중체크하여 17점이하는정상, 18 점 24점은부분외상, 25점이상은완전외상으로분류하였다 (Weiss DS et al., 1997; Eun HJ et al., 2005). 4) 한국판벡우울척도한국판벡우울척도 2판 (Beck Depression Inventory-II, BDI-II) 은우울증상의심각도를측정하기위한 0 3점의 4 점 Likert 척도로총 21문항으로구성되며 0 13점은정상, 14 19점은가벼운우울, 20 28점은중등도의우울, 29 63점은심한우울을나타낸다 (Beck A et al., 1996; Sung HM et al., 2008). 5) 캠프프로그램캠프프로그램은자연휴양림및연수원에서 3박 4일일정으로총세차례에걸쳐진행되었으며, 소방공무원의정신건강에대한이해를높이기위한정신건강교육과심박변이도 (Heart Rate Variability, HRV) 를활용한스트레스측정및정신건강평가를통해본인의정신건강상태와스트레스수준을객관적으로확인하도록하였다. 이를바탕으로스트레스를해소하고정신건강증진에도움되는안정화요법 (relaxation therapy), 숲치료 (Forest therapy), 미술치료 (Art therapy), 야외신체활동, 성격유형검사 (Myers-Briggs Type Indicator, MBTI) 와집단상담및정신건강의학과전문의와의일대일심층상담으로구성하였다 (Table 1). 본연구는국립정신건강센터임상시험심사위원회의심사및승인 ( 승인번호2015-01) 을받아수행되었다. 3. 자료분석캠프프로그램참여전과캠프종료직후, 캠프후 1, 3, 6개월의스트레스수준 (PSS-K, GARS), 외상후스트레스증상 (IES-R), 우울감 (BDI-II) 점수를선형혼합모형 (linear mixed model) 을사용하여시간의경과에따른변화를평가하였다. 또한 Paired t-test를이용하여캠프참여전과각시점에서의점수를비교하였으며, bonferroni correction을통해다중비교효과를교정하였다. 캠프후스트레스완화에대한예측인자를알아보기위해캠프참여전과캠프후 6개월의 PSS-K 점수변화를종속변수로근무년수, 외상경험횟수, 캠프참여전영역별스트레스점수, 우울감점수, 외상후스트레스증상점수를독립변수로한선형회귀분석을시행하였다. 통계분석은 STATISTICA 7.0 version을사용하였다. 결과 1. 인구학적배경연구대상자의인구학적특징은 Table 2와같다. 캠프참여전설문조사에참여한소방공무원은총 90명으로남자가 82명 (91.1%), 여자가 8명 (8.9%) 이였다. 평균연령은 41.1±9.1 세, 평균근무년수는 14.1±9.0년이었으며전체대상자중 65명 (72.2%) 이기혼이었다. 교육수준은대학교졸업이상이 34명 (37.8%) 로가장많았고전문대학교졸업 31명 (34.4%), 고등학교졸업 20명 (22.2%), 기타 5명 (5.6%) 으로분포하였다. 직급은소방장이 28명 (31.1%) 으로가장많았고담당업무는화재진압 35명 (38.9%), 구급 26명 (28.9%), 행정및기타 19명 (21.1%), 구조 10명 (11.1%) 순이었다. 업무만족도는 보통이다 로응답한비율이가장높았다. 캠프후 1, 3, 6개월시점에서설문에응답한소방공무원은각각 20 Table 1. Camp program contents Title Contents Day 1 Orientation Introduction and pre-mental health assessment Group Stress assessment Using HRV (Heart Rate Variability) Individual Mental health education Understanding of stress and the present state of stress of firefighters, how to cope with stress Group Group therapy Experience empathy and support by sharing experiences with colleagues Group Relaxation therapy Ⅰ Practice relaxation therapy to control anxiety and tension - Abdominal breathing, Muscle Group relaxation therapy Day 2 Forest therapy Stress relief through walking in the forest and meditation Group Individual counseling (Group 1) Explanation of mental health assessment results and 1:1 consultation with Mental health Individual medicine doctor on individual issues Art therapy Ⅰ Understanding stress situation and expressing feelings freely through art-using craft Group Relaxation therapy Ⅱ Practice relaxation therapy to control anxiety and tension-autogen training Group Day 3 Art therapy Ⅱ Understanding stress situation and expressing feelings freely through art-using drawing Group Individual counseling (Group 2) Explanation of mental health assessment results and 1:1 consultation with a Mental health Individual medicine doctor on individual issues Physical activity Awareness of physical reactions due to stress and learn how to relieve stress Group Personality type test Identifying interpersonal relationship patterns according to personality traits and finding ways to Group relieve stress using MBTI (Myers-Briggs Type Indicator) Day 3 Wrap up Feedback on the program, post-metal health assessment and satisfaction survey Group
Stress Relief and Related Factors in Camp Program for Firefighters 91 Table 2. Demographic and clinical characteristics in study participants Pre a) (n=90) 6 Months b) (n=39) Mean±sd/n (%) Mean±sd/n (%) p Sex Male 82 (91.1) 34 (87.2) 0.53 female 8 (8.9) 5 (12.8) Age (yr) 41.1±9.1 41.4±9.7 0.87 Marital Status Unmarried 21 (23.3) 8 (20.5) 0.75 Married 65 (72.2) 28 (71.8) Seperated/Divorced 4 (4.5) 3 (7.7) Educational Level High School 20 (22.2) 8 (20.5) 0.75 College 31 (34.4) 12 (30.8) University and over 34 (37.8) 18 (46.1) Ect 5 (5.6) 1 (2.6) Tenure (yr) Average 14.1±9.0 14.7±9. 0.73 10< 34 (37.8) 15 (38.5) 10 20 27 (30.0) 10 (25.6) 20> 29 (32.2) 14 (35.9) Position Firefighter 19 (21.1) 7 (17.9) 0.86 Senior fire sergeant 20 (22.3) 9 (23.1) Fire sergeant 28 (31.1) 11 (28.2) Fire lieutenant 20 (22.2) 10 (25.6) Above fire captain 3 (3.3) 2 (5.2) Work type Firefighters 35 (38.9) 17 (43.6) 0.72 Rescuers 10 (11.1) 4 (10.3) Emergency medical team 26 (28.9) 8 (20.5) Administrators/ect. 19 (21.1) 10 (25.6) Job satisfaction Very satisfied 3 (3.3) 3 (7.7) 0.97 Satisfied 34 (37.8) 14 (35.9) Average 37 (41.1) 16 (41.0) Not satisfied 15 (16.7) 5 (12.8) Not at all satisfied 1 (1.1) 1 (2.6) PSS-K c) 18.4±5.2 17.9±5.1 0.65 Normal ( 13) 13 (14.4) 6 (15.4) 1.0 Mild to moderate (14 18) 29 (32.2) 13 (33.3) Severe ( 19) 48 (53.4) 20 (51.3) GARS d) 41.6±19.4 37.6±18.2 0.28 Job/Work/School Life 5.0±2.2 4.6±2.2 0.34 Relationship 4.3±2.4 3.8±2.4 0.28 Change in relationship 3.6±2.7 3.4±2.7 0.70 Illness or injury 4.0±2.4 3.8±2.3 0.66 Economic problem 3.6±2.6 3.2±2.3 0.41 Unusual event 3.0±2.4 2.8±2.3 0.66 Change in daily life 2.3±2.1 1.8±1.7 0.19 Overall stress 4.1±2.3 3.7±2.1 0.35 IES-R e) 30.3±22.4 29.0±22.2 0.76 Hyperarousal 8.3±6.9 7.7±6.8 0.65 Avoidance 10.9±8.2 10.9±8.4 1.00 Re-experience 11.1±8.6 10.5±8.7 0.72 Normal ( 17) 31 (34.4) 13 (33.3) 0.93 Partial trauma (18 24) 11 (12.2) 6 (15.4) Severe trauma ( 25) 48 (53.4) 20 (51.3) BDI-Ⅱ f) 13.1±10.9 12.0±10.6 0.60 Normal ( 13) 52 (57.8) 24 (61.5) 0.85 Mild (14 19) 14 (15.6) 6 (15.4) Moderate (20 28) 13 (14.4) 4 (10.3) Severe ( 29) 11 (12.2) 5 (12.8) a) Pre: before participating in camp program, b) 6 Months: 6 months after camp program ends, c) PSS-K: Korean Perceived Stress Scale, d) GARS: Global Assessment of Recent Stress Scale, e) IES-R: Impact of Events Scale-Revised, f) BDI-II: Beck Depression Inventory-II. 명, 61명, 39명이었으며, 응답자와비응답자간의인구학적특성, 스트레스, 외상후스트레스증상및우울감수준은유의한차이를보이지않았다. 2. 캠프프로그램참여후정신건강상태변화및관련요인분석 캠프프로그램참여전과비교했을때 PSS-K는캠프직후유의한변화를보이지않았으나캠프 1개월후유의하게
92 Jungha Shin, et al. http://www.stressresearch.or.kr/ 낮아졌으며 (t=3.930, p<0.001) 캠프 6개월후에도유의하게낮은수준을유지하였다 (p=0.005). GARS 또한 PSS-K 와마찬가지로캠프직후에는유의한감소를보이지않았으나캠프 1개월후유의하게낮아져 (t=2.846, p=0.005) 캠프 6개월후까지지속되었다 (p=0.006). BDI-II는캠프직후유의하게감소하였으나 (t=3.208, p=0.001) 캠프후 1개월부터 6개월까지유의미한감소는보이지않았으며, IES-R은프로그램직후부터캠프후 6개월까지유의미한변화를보이지않았다 (Fig. 1). PSS-K 점수변화를예측하는요인은높은직장스트레스, 낮은질병스트레스수준이었다 (Table 3). 고찰 본연구는캠프프로그램이소방공무원의스트레스, 우울감및외상후스트레스증상의완화에미치는효과와스트레스호전과관련된요인을분석하였다. 연구에서캠프프로그램에참여한소방공무원의스트레스수준은캠프직후감소하여그효과가캠프후 6개월까지지속되었는데, 캠프프로그램에포함되어있는정신건강교육, 집단상담, 안정화요법, 미술치료, 숲치료가스트레스완화에기여하였을것으로보인다 (Biddle SJ et al., 1989; Kim IH, 2000; Hwang HK et al., 2006; Kang YS, 2011). 또한집단상담은비슷한외상을경험한동료소방공무원들의공감과지지를통해 (Salzer et al., 2002; Solomon, Fig. 1. Trends mental health conditions after participating in the camp program. Table 3. Prediction factor of PSS-K score change (n=77) β SE of β B SE of B T (63) p value Tenure (yr) 0.05 0.12 0.03 0.07 0.42 0.67 Traumatic experience count -0.14 0.12-0.21 0.18-1.14 0.25 GARS Job/Work/School Life 0.39 0.18 0.89 0.41 2.15 0.03 Relationship -0.24 0.17-0.50 0.34-1.47 0.14 Change in relationship 0.26 0.14 0.48 0.25 1.87 0.07 Illness or injury -0.58 0.16-1.15 0.31-3.69 0.00 Economic problem 0.08 0.12 0.16 0.24 0.68 0.50 Unusual event 0.02 0.17 0.04 0.35 0.12 0.90 Change in daily life -0.17 0.13-0.41 0.31-1.33 0.18 Overall stress 0.03 0.19 0.07 0.41 0.18 0.86 IES-R 0.10 0.17 0.02 0.03 0.58 0.56 BDI-II -0.24 0.18-0.11 0.08-1.35 0.18
Stress Relief and Related Factors in Camp Program for Firefighters 93 2004) 심리적안정과스트레스완화에도움이된것으로판단된다. 본연구의결과는소방공무원을대상으로한캠프프로그램이스트레스완화에효과가있다는 Jo SD(2014) 의연구결과와일치하는데, Jo는연구에서캠프프로그램테마중숲치료, 단체디브리핑, 아로마테라피, 명상프로그램순으로스트레스완화효과가큰것으로보고하였다. Park YW et al.(2013) 의연구에서는소방방재청이운영한캠프프로그램에참여한소방공무원을대상으로직무스트레스의특성을분석하고이를토대로해결방안을제시하였으나캠프프로그램이스트레스완화에효과가있는지는조사하지않아본연구결과와비교는어려웠다. 하지만소방방재청이소방공무원의스트레스해소방안으로캠프프로그램을운영한것은프로그램을통해스트레스해소및심신안정효과를기대한것으로보인다. 캠프프로그램에참여한소방공무원의스트레스완화에기여하는요인을분석했을때캠프참여전직무스트레스가높을수록스트레스호전이많이되었고, 질병관련스트레스가높을수록스트레스완화효과는낮은것으로나타났다. 소방공무원을대상으로인지행동요법을적용한스트레스관리프로그램은스트레스해소에유의미한효과가없는것으로조사되었는데, 이에대한근거로프로그램을근무시간에시행하여소방공무원의직무스트레스특성과관련된구조적인직무환경을통제하지못한것을제시하였다 (Nam CY et al., 2013). 이는캠프프로그램이스트레스의원인이되는근무환경을벗어나시행한것이스트레스해소에도움이되었음을뒷받침하며특히숲치료는피톤치드, 음이온, 자연광선에노출됨으로써스트레스완화뿐만아니라감수성조절, 면역력증진등에효과가있는것으로나타나 (Woo JM et al., 2012) 본연구가자연휴양림및연수원을캠프프로그램장소로선정한것은적절한것으로보인다. 소방공무원의스트레스는직무요구도가높고역할모호및역할갈등이심하거나물리환경이열악할때높고, 직무만족도가높을때낮다고알려져있다 (Lee SK et al., 2007; Saijo Y et al., 2007; Choi KB et al., 2009; Moon YK, 2011; Choi MS et al., 2012). 따라서소방공무원의스트레스를호전시키기위해캠프와같은정신건강프로그램뿐아니라열악한근무환경개선및직무만족도를향상시키기위한노력도함께뒷받침되어야할것이다. 본연구에참여한소방공무원들은캠프프로그램을통해우울감및외상후스트레스증상은유의한감소를보이지않았는데이는캠프프로그램이우울감및외상후스트레스증상완화에효과가있다는 Jo SD(2014) 의연구결과와일치하지않는다. 이는 JO의연구가사전조사를통해 3가지정신건강척도중한가지이상고위험군으로분류된소방공무원을캠프프로그램참여자로선정한반면, 본연구는국민안전처를통해프로그램에자원한소방공무원이참여한차이로보인다. 사전조사를통해자신의정신건강상태를알고캠프프로그램에참여한소방공무원은정신건강의중요성을 인식하고어려움을해소하기위해프로그램에적극적으로참여하고이는프로그램효과에긍정적영향을미쳤을가능성이크다. 그외프로그램일정이나구성, 진행자들의차이로인해연구결과가다르게나타났을수있어이에대한검증이필요할것으로보인다. 또한캠프프로그램참여자들의우울감및외상후스트레스증상에호전을보이지않는이유는소방공무원의업무특성과관련이있는것으로볼수있다. 소방공무원은외상후스트레스증상의원인이되는외상사건에지속적으로노출되고강도가높은스트레스상황에서근무하여이로인해발생한정신질환및신체질환과관련된질병스트레스는단기간의캠프프로그램으로완화효과를보기에어려울것이다. 우울증은스스로인지하기어렵고전문적인치료를받기힘들며 (Cho HJ et al., 2008) 외상후스트레스증상은치료를하지않을경우 30% 는저절로회복되고 40% 는경한증상, 20% 는중증도증상을경험하며 10% 는악화된다 (Kim CY, 2005) 고알려져있다. 또한우울감과외상후스트레스증상은상호연관이있어우울증상은외상후스트레스장애수준을높이고 (JO SD, 2013) 외상후스트레스증상은우울을더크게증가시킨다 (Bae JM, 2011). 이러한문제를인식하고소방공무원의우울감및외상후스트레스증상을완화하기위해캠프프로그램외감정치유기법 (Park CS, 2014), 음악치료 (Sim KS et al., 2014) 등의프로그램과예방교육, 개인상담, 집단상담, 사례관리및연계 4단계로구성된외상후스트레스통합관리프로그램 (Mo JM et al., 2017) 등이시도되었다. 그러나좀더적극적으로소방공무원의우울, 외상후스트레스증상의호전을위해이러한단기간의프로그램뿐아니라전문적인치료와함께이를해결하기위한국가적인노력이필요할것이다. 본연구의제한점은먼저희망자원자를대상으로캠프프로그램을진행하고캠프참여및추적관찰에참여한대상자의수가적어전체소방공무원을대표할수없다는점이다. 그러나본연구에참여한응답자와비응답자간의인구학적및정신건강상태의차이는보이지않았다. 또한캠프프로그램에참여하지않은대조군이없었기때문에캠프프로그램의효과를비교할수없었고, 다양한세부프로그램으로구성되어스트레스완화를유발한결정적인요인을알수없었다. 마지막으로정신과적병력등결과에영향을미치는중요한변수를통제하지못하였다는제한점이있었다. 그러나이러한제한점에도불구하고본연구는캠프프로그램이소방공무원의스트레스완화에효과가있음을제시하고이와관련된특성을분석함으로써소방공무원의맞춤별정신건강프로그램개발및정신건강증진을위한정책마련에근거로활용할수있다는점에서의의가있겠다. Conflicts of interest The authors declared no conflict of interest.
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