본 연구의 목적은 노인자살예방을 위해 개발된 통합적 위기개입모델을 경기도를 중심으로 적용한 후 위기개입서비스의 실제 개입효과를 검증하는 것이다. 통합적 위기개입모델은 지역사회 통합시스템 접근과 스트레스 취약성 이론을 포함하는 위기개입 이론에 기초하여 개발되었다. 효과성 검증을 위해 노인우울(GDS-K) 및 자살생각(SSI)척도를 활용하였고, 1차 사전검사 258명, 통합적 위기개입 서비스 6개월 제공 후 2차 사후검사 184명, 2-3년 후 역추적을 통해 3차 추수검사 124명의 자료를 수집하여 분석하였다. 분석은 R Statistics computing을 이용하였고, 서로 다른 시점의 다른 검사를 비교하기 위해 검사 동등화 및 측정 시점 간 수직 척도화를 수행한 후 기술통계와 일변량 분산분석을 실시하였고, 마지막으로 베이지언 추정을 이용해 다층모형 분석을 실시하였다. 연구결과 노인자살예방을 위해 개발된 통합적 위기개입모델 적용 후 사전점수에 비해 사후측정에서 통계적으로 유의하게 노인우울과 자살생각을 감소시키는 것으로 나타났는데, 노인우울 감소에 .56의 효과크기를, 자살생각의 감소에 .39의 효과크기를 나타내 모델의 전체적인 효과성이 입증되었다. 그러나 위기개입 후 2-3년 후 추수검사에서 노인우울 및 자살생각이 다시 높아져 원래 상태를 회복하는 것으로 나타나 개입의 장기적인 유지효과는 확인되지 않았다. 노인우울 및 자살생각 변화량에 영향을 주는 요인을 찾기 위해 다층분석을 통해 위기개입 서비스의 각 유형(위기개입 전문상담, 약물치료, 동료상담)과 내담자특성(성별, 연령), 상담자 특성(전문가 연령, 경력, 전공)들 및 위기개입 서비스 유형(위기개입 전문상담)과 상담자 특성(전문가 연령, 경력, 전공)의 상호작용 효과를 살펴본 결과, 유일하게 약물치료가 단독으로 자살생각을 의미있게 낮추는 것으로 나타났으며, 전문가의 전공이 상담전공일 때 전문상담과 상호작용하여 자살생각을 의미있게 감소시키는 것으로 나타났다. 본 연구는 노인자살예방을 위해 개발된 통합적 위기개입모델의 전체효과와 각 개입서비스 유형의 효과를 검증하여 현장 적용의 근거를 확보했다는 데에 의의가 있다.

This study is designed to verify the actual effect on the prevention of the elderly suicide of the integrated crisis intervention service which has been widely provided across all local communities in Gyeonggi-province focusing on the integrated crisis intervention model developed for the prevention of elderly suicide. The integrated crisis intervention model for the local communities and its manual were developed for the prevention of elderly suicide by integrating the crisis intervention theory which contains local community's integrated system approach and the stress vulnerability theory. For the analysis of the effect, the geriatric depression and suicidal ideation scale was adopted and the data was collected as follows; The data was collected from 258 people in the first preliminary test. Then, it was collected from the secondary test of 184 people after the integrated crisis intervention service was performed for 6 months. The third collection of data was made from 124 people after 2 or 3 years later using the backward tracing method. As for the analysis, the researcher used the R Statistics computing to conduct the test equating, and the vertical scaling between measuring points. Then, the researcher conducted descriptive statistics analysis and univariate analysis of variance, and performed multi-level modeling analysis using Bayesian estimation. As a result of the study, it was found out that the integrated crisis intervention model which has been developed for the elderly suicide prevention has a statistically significant effect on the reduction of elderly suicide in terms of elderly depression and suicide ideation in the follow-up measurement after the implementation of crisis intervention rather than in the first preliminary scores. The integrated crisis intervention model for the prevention of elderly suicide was found to be effective to the extent of 0.56 for the reduction of depression and 0.39 for the reduction of suicidal ideation. However, it was found out in the backward tracing test conducted 2-3 years after the first crisis intervention that the improved values returned to its original state, thus showing that the effect of the intervention is not maintained for long. Multilevel analysis was conducted to find out the factors such as the service type(professional counseling, medication, peer counseling), characteristics of the client (sex, age), the characteristics of the counselor(age, career, major) and the interaction between the characteristics of the counselor and intervention which affect depression and suicidal ideation. It was found that only medication can significantly reduce suicidal ideation and that if the counselor's major is counseling, it significantly further reduces suicidal ideation by interacting with professional counseling. Furthermore, as the characteristics of the suicide prevention experts are found to regulate the intervention effect on elderly suicide prevention in applying integrated crisis intervention model, the primary consideration should be given to the counseling ability of these experts.

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elderly suicide, geriatric depression, crisis intervention, counselor's factors, multilevel moderating effect