한국학교보건학회지제 30 권제 2 호, 2017 년 8 월 J Korean Soc Sch Health Vol. 30. 2, 174-180, August 2017 p-issn 1225-9608 e-issn 2288-9957 https://doi.org/10.15434/kssh.2017.30.2.174 국립군산대학교간호학과 Relations of Depression, Ego-resilience and Health Behaviors in High School Students Eun Gyeong Kim Department of Nursing, Kunsan National University ABSTRACT Purpose: This study examined depression, ego-resilience and health behaviors of high school student in order to understand the relationship among these variables. Methods: The study used raw data from the Korean Children and Youth Panel Survey conducted in 2015. Data was analyzed using SPSS 21.0 for descriptive statistics, t-test, x 2 test, Pearson's correlation coefficients, and multiple regression analysis. Results: Gender, school performance, economic status, subjective health status, drinking behavior and ego-resilience had significant effects on depression. Moreover, school performance, subjective health status, smoking behavior, duration of exercise during physical education classes, and depression had significant effects on ego-resilience. Conclusion: Based on these findings, we need to develop the interventions for depression and ego-resilience for adolescents, considering the related factors to health status and behaviors. Key Words: High school student, Depression, Ego-resilience, Health behavior 서론 1. 연구의필요성 청소년기는급격한신체적발달과부모로부터독립하여정체성을형성하는심리적발달이이루어지는중요한시기이다. 이시기에나타나는신체적, 정서적변화및다양한사회적요구들로인하여많은갈등과혼란을겪게되며, 불안이나좌절, 우울등의심리적부적응을경험하게된다. 우울은슬픈감정이나외로움으로나타나는증상으로어느연령대에서도발병할가능성이있지만청소년기의발달특성으로그가능성이매 우높기때문에더욱많은관심을기울여야한다 [1]. 우리나라의경우 2016년제12차청소년건강행태온라인조사결과우울경험률은 25.7% 로 4명중 1명은우울을경험하고있다 [2]. 전체적으로학년이올라갈수록우울경험률이높아지고, 남자청소년에비해여자청소년의우울경험률이높은데, 초기청소년기부터여성의유병률이남성보다 1.5~3배정도높게나타난다 [1]. 청소년의우울감경험에대한여러실태조사에따르면과거부터현재까지성인에비해우울감경험률이더높고, 우울증유병률이증가하는경향을보인다 [3]. 청소년의우울은가정생활, 학교생활의부적응, 자살등정신건강문제를유발하는등부정적영향을미친다. 특히청소 Corresponding author: Eun Gyeong Kim Department of Nursing, Kunsan National University, 558, Daehak-ro, Gunsan 54150, Korea. Tel: +82-63-469-1994, Fax: +82-63-469-7429, E-mail: egkim@kunsan.ac.kr Received: Jul 3, 2017 / Revised: Aug 9, 2017 / Accepted: Aug 11, 2017 This is an open access article distributed under the terms of the Creative Commons Attribution n-commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 174 Journal of the Korean Society of School Health
년기우울증은자살의주요위험요인으로청소년의질병과장애의주요원인으로나타나고있다 [4]. 또한청소년기의우울은비행, 약물남용, 문제음주등과도상관관계가있어 [5,6], 장기적으로성인기의사회적기능수행에부정적인결과를초래하는것으로나타났다 [7]. 그리고우울을경험한청소년의경우현재흡연하고있을가능성이높으며흡연을시작할위험이증가한다 [8]. 이와같이청소년기주요정서문제인우울은개인의신체적정서적손상외에가족, 학교및사회전체에영향을미칠수있어심각한사회적문제로인식되고있다 [9]. 이에따라청소년의우울에관심을가지고이를예방할수있는관련요인들에대해연구가수행되어왔다 [4,10]. 우울은청소년기에흔하게나타나며정신적측면과건강위험행동에부정적인영향을미치므로중재방안마련을위해다차원에서관련요인에대한반복연구가필요하다. 지금까지선행연구를통해청소년의우울과관련있는요인으로보고되고있는것중하나가자아탄력성이다 [11]. 자아탄력성은내적 외적인스트레스에대하여융통성있고풍부한적응능력으로 개인의자아통제를변동시키는역동적능력 이라고할수있다 [12]. 즉, 위험한환경이나부정적인생활사건등스트레스가증가하는상황하에서도스트레스의영향을덜받으며, 변화나역경에유능하게대처함으로써충격, 역경으로부터빨리회복되는힘, 혹은상황에따라서알맞게대처하는능력을의미한다고할수있다 [11]. 청소년우울과자아탄력성에대한선행연구에서자아탄력성이높은청소년은그렇지않은청소년에비해우울수준이낮았다 [11]. 또한자아탄력성은청소년의건강증진행위에간접적으로긍정적인영향을미치는것으로보고되었다 [13]. 우울과자아탄력성의관계에대한선행연구를살펴보면우울의심리적특성으로자아존중감, 사회적지지, 정서조절, 자아정체감, 분노통제등이보고되고있고 [14] 자아탄력성은청소년들의정신건강에영향을미쳐부정적인정서를감소시킨다는연구결과를나타내었다 [15]. 지금까지우울과자아탄력성의영향요인에대한연구는주로개별적으로이루어져왔고건강행위와의관련성에대한연구는미흡한실정이며고등학생을대상으로우울및자아탄력성과건강행위와의관계에대한연구는거의이루어지지않았다. 최근청소년자살과우울이심각한사회문제로대두되고있는상황에서관련요인에대한선행연구결과를뒷받침하고, 우울및자아탄력성과건강행위와의관계를명확하게하기위하여연구대상과도구, 방법등을다양화한연구가필요하다. 이에본연구는고등학생들의건강행위에따른우울및자아탄력성의정도를파악하고, 영향요인들을확인하여청소년의정신건강증진을위한학교보건프로그램개발의근거자료를마련하고자수행되었다. 본연구의목적은고등학생을대상으로하여우울, 자아탄력성과건강행위의정도와상관관계를파악하고우울과자아탄력성에영향을미치는요인을분석하는것을목적으로하였다. 구체적인목적은다음과같다. 고등학생들의일반적특성, 건강행위, 우울및자아탄력성의정도를파악한다. 고등학생들의일반적특성과건강행위에따른우울, 자아탄력성의차이를비교하고상관관계를확인한다. 고등학생들의우울과자아탄력성에영향을미치는요인들을분석한다. 연구방법 1. 연구설계 본연구는고등학생의우울, 자아탄력성과건강행위의정도를파악하고, 이들변수의상관관계와관련요인을분석하기위한이차자료분석연구이다. 2. 연구대상및자료수집본연구의분석데이터는한국청소년정책연구원의한국아동 청소년패널조사 (Korean Children and Youth Panel Survey, KCYPS) 의 6차년도 (2015) 조사자료를사용하였다. 2010 년에시작된한국아동 청소년패널조사 (KCYPS) 는아동 청소년성장 발달의다양한양상을종합적으로파악하여학제간연구 (interdisciplinary study) 와관련정책개발에기초자료로제공하는것을목적으로하고있다. 2010년층화다단집락추출법으로표집된초등학교 1학년과 4학년, 중학교 1학년을대상으로매년조사를실시하고있다. 본연구의대상은중학교 1학년패널의 6차년도인 2015년당시고등학교 3학년학생 2,056 명이다. 3. 연구도구 1) 일반적특성일반적특성변수는성별, 학업성적, 경제상태. 주관적건강상태등이다. 주관적건강상태는자신의건강상태에대한자가평가로 매우건강한편이다 는 5점, 건강한편이다 는 4점, Vol. 30. 2, 2017 175
보통이다 는 3점, 건강하지못한편이다 는 2점, 매우건강하지못한편이다 는 1점으로점수화하였다. 본연구에서의건강행위는흡연, 음주, 체육시간중운동시간으로흡연과음주는지난 1년동안경험유무이다. 2) 우울 Kim 등 [16] 이개발한간이정신진단검사중우울척도의 13 문항중 3문항을제외하고수정한 10문항으로구성되었으며각문항들은 4점 Likert 척도 (1점: 매우그렇다 ~4점 : 전혀그렇지않다 ) 로되어있다. 본연구에서는 10문항의총점으로점수가높을수록우울의정도가높은것으로하였다. 척도에는 죽고싶은생각이든다, 사람들앞에나서기를싫어한다, 기운이별로없다, 불행하다고생각하거나슬퍼하고우울해한다, 걱정이많다, 울기를잘한다, 어떤일이잘못되었을때나때문이라는생각을자주한다, 외롭다, 모든일에관심과흥미가없다, 장래가희망적이지않은것같다, 모든일이힘들다 등의문항이포함되어있으며개발당시도구의신뢰도 Cronbach s 는.80이었으며본연구에서의신뢰도Cron- bach s 는.88이었다. 3) 자아탄력성 Block과 Kreman이개발한척도를번안한 Yoo 와 Shim [17] 의척도로총 14문항으로구성되어있으며 나는갑자기놀라는일을당해도금방괜찮아지고그것을잘이겨낸다, 나는매우에너지 ( 힘 ) 가넘치는사람이다, 나는내가의지가강한사람이라고자신있게말할수있다 등의문항이포함되어있다. 1에서 4까지 (1점: 전혀그렇지않다 ~4점 : 매우그렇다 ) 의 4 점 Likert 척도로, 점수가높을수록자아탄력성이높은것을의미한다. 개발당시도구의신뢰도 Cronbach s 는.67이었으며본연구에서는.85였다. 4. 자료분석자료분석은 IBM SPSS/WIN Statistics 21.0 프로그램을이용하여연구대상자의일반적특성, 건강행위, 우울과자아탄력성에대해빈도, 백분율, 평균과표준편차를구하였다. 일반적특성과건강행위에따른우울과자아탄력성의차이는 t-test와 x 2 test를하였으며, 변수간의상관성은 Pearson correlation coefficient로분석하였고, 우울과자아탄력성에영향을미치는설명요인은 multiple regression analysis 로분석하였다. 연구결과 1. 연구대상의일반적특성, 건강행위, 우울및자아탄력성 연구대상자총 2,056명중남학생이 50.6%, 여학생이 49.4% 였다. 학업성적평균점수는 7점만점에 4.1점, 경제상태는 7점만점에 4.0점, 그리고주관적건강상태는 5점만점에 3.2점으로나타났다. 건강행위는체육교과시간중운동시간은평균 0.7시간으로나타났고흡연은 11.2%, 음주는 27.3% 가각각 예 라고응답하였다. 우울점수는 40점만점에평균 18.8점, 자아탄력성점수는 56점만점에평균 40.5점으로나타났다 (Table 1). Table 1. General Characteristics, Health Behaviors, Depression and Ego-resilience of Subjects (N=2,056) Variables Gender Categories Male Female n(%) or M±SD 1,041 (50.6) 1,015 (49.4) School performance 4.1±1.3 Economic status 4.0±0.9 Subjective health status 3.2±0.6 Exercise time during PEC 0.7±1.2 Smoking Drinking 231 (11.2) 1,825 (88.8) 562 (27.3) 1,494 (72.7) Depression score 18.8±5.5 Ego-resilience score 40.5±5.7 PEC=Physical education classes. 2. 일반적특성과건강행위에따른우울, 자아탄력성의차이및상관관계 대상자의특성에따른우울, 자아탄력성의차이를분석한결과는다음과같다 (Table 2). 성별에따른자아탄력성과우울의차이는유의한결과를보였다. 자아탄력성은남학생들의점수가여학생보다더높았고 (t=6.43, p<.001), 여학생들의우울점수는남학생들보다유의하게더높았다 (t=-8.12, p<.001). 대상자의건강행위에따른차이도유의한결과를보였다. 흡연을하는대상자들이비흡연자들보다자아탄력성점수가유의하게더높았고 (t=2.98, p<.01) 우울점수는유의하지않았다. 음주를하는대상자들이비음주자들보다자아탄력성점수가유의하게 176 Journal of the Korean Society of School Health
더높았고 (t=2.45, p<.05) 우울점수도유의하게더높았다 (t= 2.21, p<.05). 자아탄력성, 우울, 학업성적, 경제상태, 주관적건강상태, 체육교과시간중운동시간등의상관관계를분석한결과 (Table 3), 우울은자아탄력성과부적상관관계를보였고 (r=-.37, p<.01) 학업성적 (r=-.17, p<.01), 경제상태 (r=-.17, p<.01), 주관적건강상태 (r=-.28, p<.01), 체육교과시간중운동시간 (r=-.15, p<.01) 과는부적상관관계를보였다. 자아탄력성은학업성적 (r=.13, p<.01), 경제상태 (r=.11, p<.01), 주관적건강상태 (r=.23, p<.01), 체육교과시간중운동시간 (r=.19, p<.01) 과정적상관관계를보였다. 학업성적은경제상태 (r=.17, p<.01), 주관적건강상태 (r=.11, p<.01) 와정적상관관계를보였다. 경제상태는주관적건강상태 (r=.11, p<.01), 체육교과시간중운동시간 (r=.07, p<.01) 과정적상관관계를보였다. 주관적건강상태는체육교과시간중운동시간과정적상관관계를보였다 (r=.17, p<.01). 3. 우울과자아탄력성관련요인우울과자아탄력성에영향을미치는설명요인을확인하기 위하여다중회귀분석을실시하였다. 우울점수와자아탄력성점수를각각종속변수로유의한상관성을보인변수를독립변수로하였으며, 불연속변수는 Dummy 변수로전환한후실시하였고, 다중회귀분석의동시입력방식 (enter) 으로분석을실시한결과는 Table 4, 5와같았다. 독립변수에대한회귀분석의가정을검정하기위하여공선성통계량을사전검증하였다. 다중공선성의문제진단은공차한계 (tolerance) 와분산팽창인자 (Variance Inflation Factor, VIF) 로하였는데, 공차한계는.82~.95로기준인 0.10 보다훨씬크게나타났고, VIF는 1.05~1.22으로기준인 10 보다매우작아다중공선성 (multicollinearity) 의문제는없었다. 또한잔차의독립성에대한검증으로 Durbinwatson 값을확인한결과각각 2.05와 1.97로 2근처에있어자기상관이없는것으로확인되었다. 우울영향요인분석결과설명력은 21% 로 (F=78.395, p<.001) 우울에영향력이있는변수는성별여자 (β=.14, p<.001), 학업성적 (β=-.10, p<.001), 경제상태 (β=-.09, p<.001), 주관적건강상태 (β=-.17, p<.001), 음주 (β=.09, p<.001), 자아탄력성점수 (β=-.29, p<.001) 로나타났으며, 체육교과시간중운동시간은통계적으로유의한영향력을주지않는것으로나타났다 (Table 4). Table 2. Differences of Depression and Ego-resilience by General Characteristics (N=2,056) Variables Gender Categories Male Female Depression Ego-resilience M±SD t p M±SD t p 17.79±5.39 19.73±5.37-8.19 <.001 41.27±5.87 39.68±5.36 6.43 <.001 Smoking 19.32±6.01 18.67±5.39 1.56.120 41.53±6.34 40.35±5.58 2.98 <.01 Drinking 19.16±5.40 18.59±5.49 2.22 <.05 40.99±5.85 40.29±5.61 2.45 <.05 Table 3. Correlation among Ego-resilience, Depression, and General Characteristics Depression score Ego-resilience score School performance Economic status Subjective health status Duration of exercise during PEC Variables r r r r r r Depression score 1 Ego-resilience score -.37* 1 School performance -.17* 13* 1 Economic status -.17*.11*.17* 1 Subjective health status -.28*.26*.11*.11* 1 Duration of exercise during PEC -.15*.19*.04.07*.17* 1 *p<.01; PEC=Physical education classes. Vol. 30. 2, 2017 177
Table 4. Influencing Factors on Depression Variables (Baseline) B SE β t p Constant 36.20 1.08 33.52 <.001 Gender (Female) 1.55 0.23.14 6.69 <.001 School performance -0.44 0.09 -.10-5.11 <.001 Economic status -0.54 0.13 -.09-4.32 <.001 Subjective health status -1.52 0.19 -.17-7.96 <.001 Duration of exercise during PEC -0.11 0.10 -.02-1.07.283 Drinking () 1.14 0.25.09 4.49 <.001 Ego-resilience score -0.28 0.02 -.29-13.59 <.001 Tolerance=0.86~0.95, VIF=1.05~1.15, Durbin-watson=2.05, Adj. R 2 =.21, F=78.395, p<.001 PEC=Physical education classes. Table 5. Influencing Factors on Ego-resilience Variables (Baseline) B SE β t p Constant 39.84 1.12 35.65 <.001 Gender (Female) -0.31 0.25 -.03-1.19.232 School performance 0.31 0.09.07 3.34.001 Economic status 0.15 0.13.02 1.13.260 Subjective health status 1.36 0.09.14 6.69 <.001 Duration of exercise during PEC 0.54 0.11.01 5.14 <.001 Smoking () 1.07 0.42.06 2.53.012 Drinking () 0.52 0.29.04 1.81.070 Depression score -0.31 0.02 -.29-13.68 <.001 Tolerance=0.79~0.94, VIF=1.06~1.26, Durbin-watson=1.97, Adj. R 2 =.19, F=58.119, p<.001 PEC=Physical education classes. 자아탄력성영향요인분석결과설명력은 19% 로 (F=58.119, p<.001) 자아탄력성에영향력이있는변수는학업성적 (β=.07, p=.001), 주관적건강상태 (β=.14, p<.001), 체육교과시간중운동시간 (β=.01, p<.001), 흡연 (β=.06, p=.012), 우울점수 (β=-.29, p<.001) 로나타났으며, 성별, 경제상태, 음주는통계적으로유의한영향력을주지않는것으로나타났다 (Table 5). 논의 청소년기의발달과정상혼란스러운특성으로우울이유발되기쉽고, 이러한우울증은방치할경우학습장애, 자살, 약물남용, 비행, 현실장애등의다른문제를초래할수있다 [4-6]. 이에본연구는청소년을대상으로인구사회학적특성과건강행 위에따른우울과자아탄력성의차이를비교하고우울과자아탄력성에영향을미치는변수를파악하여청소년건강증진프로그램의기초자료를마련하고자시도되었다. 본연구결과우울에영향력이있는변수는성별, 학업성적, 경제상태, 주관적건강상태, 음주, 자아탄력성점수로나타났고자아탄력성에영향력이있는변수는학업성적, 주관적건강상태, 체육교과시간중운동시간, 흡연, 우울점수로나타났다. 성별은우울에영향을미치는요인으로나타났으며이는선행연구 [18] 의결과와일치한다. 본연구에서남학생들의자아탄력성이여학생보다높게나타났는데선행연구에서성별에따른자아탄력성에대한연구결과는일관되지않게보고되고있다. Lee와 Park [19] 의연구에서남학생이여학생에비해자아탄력성이더높은것으로나타났으나 Kim [20] 의연구에서 178 Journal of the Korean Society of School Health
는전반적으로여자가남자보다높게나타났다. 한편 Kim 과 Lee [21] 의연구에서성별과자아탄력성사이에의미있는관계가존재하지않는다는연구결과도제시되어본연구결과와일치하였다. 따라서청소년우울예방및감소를위한방안마련시성별이고려되어야하며자아탄력성에대한성별의영향은추후반복연구를통해재확인이필요할것으로생각된다. 학업성적은우울과자아탄력성에모두영향을미치는것으로나타났는데다수의선행연구결과학업스트레스는청소년우울의가장강력한예측변수로나타나 [22] 본연구결과와유사하다고볼수있다. 우리나라교육환경에서는학교생활중입시가가장강조되어항상학업스트레스에노출되는데자아탄력성이낮은청소년들은학업스트레스를더높게인지하게된다 [23]. 자아탄력성은어려움이나스트레스상황에서문제해결력이높으며부적응적인문제를예방하는중요한보호요인으로보고되고있다 [12]. 본연구결과에서학업성적은우울과부적상관관계를, 자아탄력성과정적상관관계를나타내었고우울은자아탄력성과부적상관관계를나타내었으므로특별히학업성적이낮은청소년의우울중재를위한자아탄력성증진프로그램개발이필요하다고생각된다. 주관적건강상태의경우우울과자아탄력성에모두영향을미치는것으로나타났는데청소년의건강인식은건강에관한자아개념으로성인기건강에관한정체성으로이어져매우중요하다 [24]. 일반적으로건강이좋지않으면심리사회적적응에도어려움을겪게될개연성이크며건강상태가좋을수록우울정도가적고, 자신의신체건강수준이높다고인식할수록우울정도가낮은것으로보고되고있다 [25]. 본연구결과우울은주관적건강상태와부적상관관계를, 자아탄력성과정적상관관계를보였으므로자신의건강에대한평가가낮은청소년의경우특히우울에대한선별검사와자아탄력성증진을위한중재가실시되어야할것이다. 경제상태는우울의영향요인으로나타났는데선행연구에서도자신이경제적으로하층에속한다고생각할수록우울이높은것으로나타나본연구결과와일치하고있다 [26]. 음주도우울의영향요인으로나타났고국내청소년을대상으로한선행연구에서청소년들은우울을해소하기위해음주를하고있는것으로보고되어본연구결과와유사하였다 [27]. Wong 등 [28] 은알코올과담배포함한물질사용은우울의강도와지속시간을더악화시키면서자살의위험요인이될수있다고설명하였으나음주및흡연과우울은인과적인선후관계가명확하지않으므로추후연구를통해확인이필요하다. 한편, 흡연을경험한경우자아탄력성점수가높았고흡연 은자아탄력성의영향요인으로나타났는데 Nam과 Yoon [29] 의연구에서는자아탄력성이높을수록흡연과음주위험이낮은것으로보고되어추후연구대상이나도구를고려한반복연구를통해확인이필요하다고생각된다. 체육교과시간중운동시간은자아탄력성에영향을미치는요인으로나타났고자아탄력성과정적상관관계를보였다. 선행연구에서자아탄력성은건강증진행위와긍정적인상관관계를나타내었고 [13] Seo [30] 의연구에서신체활동수준이높을수록긍정적자기개념과자기효능감이증가한다고보고되었으므로청소년정신건강증진을위한자아탄력성중재시학교에서의운동시간이고려되어야할것이다. 결론 본연구는고등학생의우울, 자아탄력성과건강행위간의관계를파악하기위한서술적조사연구로청소년건강증진을위한학교보건사업프로그램의기초자료를마련하고자시도되었다. 연구결과학업성적과주관적건강상태는고등학생의우울과자아탄력성에공통으로영향을미치며우울과자아탄력성은서로유의하게영향을미치는관계로확인되었다. 특히주관적건강상태는우울과자아탄력성에모두영향을미치고건강행위는개별적으로각각우울과자아탄력성에영향을미치므로우울예방과자아탄력성및건강증진행위를연계한통합적접근방법이모색되어야할것으로생각된다. 본연구는고등학생을대상으로하여건강행위, 우울, 자아탄력성을파악하고이들의관계와영향을미치는요인을확인하였고이는학교보건사업에서청소년의우울중재와자아탄력성증진프로그램개발의근거자료로그의의가있다. 하지만본연구는단면적연구로전후관계나원인적인과성은알수없다는제한점이있으므로향후후속연구를통하여청소년우울, 자아탄력성과건강행위간의인과관계를검증할필요가있다. 이해관계 The author declared no conflict of interest. REFERENCES 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Publishing; 2013. p. 1-991. 2. Korea Centers for Disease Control and Prevention. Reports on the 12th Korea youth risk behavior web-based survey. Seoul, Vol. 30. 2, 2017 179
Korea: Korea Centers for Disease Control and Prevention; 2016. p. 1-391. 3. Dumas JE, Nilsen WJ. Abnormal Child and Adolescent Psychology. Boston: Allyn and Bacon; 2003. p. 1-548. 4. Kim HJ. A study for Influential factors on depression of adolescents [master's thesis]. Seoul: Kookmin University; 2015. p. 1-91. 5. Park SY, Læ HJ. Determinants of problem-drinking behavior among Korean adolescents: Focusing on socio-demographic, health and delinquent behavior factors. The Journal of Korean Society for Wellness. 2013;8(1):33-44. 6. Lee JS, Lee HS. Relationships of individual and family variables with adolescents' depression. Journal of Korean Home Economics Education Association. 2012;24(4):77-89. 7. Lee S, Hoe M. The analysis of longitudinal causal relationship between depression and delinquency in adolescents. Journal of Youth Welfare. 2015;17(2):241-264. 8. Ahn JH. The relationship between the propensity of depression and smoking of high-school girls in Korea [master's thesis]. Seoul: Ewha University; 2000. p. 1-67. 9. Kim BY, Lee CS. A meta-analysis of variables related to suicidal ideation in adolescents. Journal of Korean Academy Nursing. 2009;39(5):651-661. https://doi.org/10.4040/jkan.2009.39.5.651 10. Lim ST, Kim JH, Jeong US. The moderating effects of perfectionism on the relations between stressors and depression of youths. Journal of Youth Welfare. 2011;13(3):243-260. 11. Kim SH. Relationship between middle school students' egoresilience and their stress and depression [master's thesis]. Cheongju: Chungbuk National University; 2010. p. 1-77. 12. Block J, Kremen AM. IQ and ego-resiliency:conceptual and empirical connections and separateness. Journal of Personality and Social Psychology. 1996;70(2):349-361. 13. Robert LS. An investigation of a theoretical model of health- Related outcomes of resilience in middle adolescents [dissertation]. New Jersey: The State University of New Jersey; 2013. p. 1-134. 14. Yoon SY. Mediating effects of self-encouragement on the relationship between academic stress and mental health among adolescents [master's thesis]. Seoul: Sungshin Women's University; 2011. p. 1-41. 15. Jeong MG. The effect of multicultural adolescent's selfresilience on mental health. Korean Journal of Youth Studies. 2015;22(11): 137-162. 16. Kim JW, Kim GI, Won HT. Korean manual of symptom checklist-90-revision (SCL-90-R). Seoul: ChungAng Apitude Publishing; 1984. p. 7-39. 17. Yoo SK, Shim HW. Psychological protective factors in resilient adolescents in Korea. The Korean Society Educational Psychology. 2002;16(4):189-206. 18. Cho HJ. A study on the risk factors and the protective factors affecting of adolescents' depression [master's thesis]. Seoul: Chung-Ang University; 2016. p. 1-81. 19. Lee EM, Park IJ. The relationships between parent-child bonding and children's ego-resiliency. Korean Journal of Family Welfare. 2002;7(1):3-24. 20. Kim MH. Testing meadiating effects of rumination in the relations between attachment to parent and depression in adolescents [master's thesis]. Gwangju: Kwangju Women's University; 2013. p. 1-52. 21. Kim BR, Lee G. The influence of negative life events, ego-resiliency, and peer relationships. The Korean Education Research Association. 2010;48(3):1-24. 22. Kim JY, Lee DE, Chung YK. The impact of academic stress on delinquent behavior -Focusing on the mediating effect of depression. Journal of the Korean Society of Child Welfare. 2013; 41:101-123. 23. Lee SY. The effects of family-environment on school adjustment of adolescents: Mediating effect of ego-resiliency, academic, academic stress, mental health [dissertation]. Seoul: Seoul Women's University; 2010. p. 1-155. 24. Boardman, JD. Self-rated health among U. S. adolescents. Journal of Adolescent Health. 2006;38(4):401-408. https://doi.org/10.1016/j.jadohealth.2005.01.006 25. Kang HS, Kim KJ. The correlation between depression and physical health among the aged. Journal of Korean Public Health Association. 2000;26(4):451-459. 26. Kim JY, Song YLA. Economic hardship, parent-adolescent communication, and depression in adolescence: A longitudinal approach. Korean Journal of Youth Studies. 2013;20(5):131-155. 27. Song AY, Park KN, Cheong SJ. Study on adolescents' status offenses based on general strain theory: The two level method of ping. Studies on Korean Youth. 2009;20(1):309-337. 28. Wong SS, Zhou B, Goebert D, Hishinuma ES. The risk of adolescent suicide across patterns of drug use: A nationally representative study of high school students in the United States form 1999 to 2009. Social Psychiatry and Psychiatric Epidemiology. 2013;48:1611-1620. https://doi.org/10.1007/s00127-013-0721-z. 29.Nam Y, Yoon H. Influence of environmental risk factors and ego-resiliency on adolescents' risk behaviors. The Korean Journal of the Human Development. 2007;14(2):93-111. 30. Seo YR. Relationship of physical activity with learned helplessness and self perception [master's thesis]. Incheon: Inha University; 2009. p. 1-89. 180 Journal of the Korean Society of School Health