Ashley J. Britton, J. Nicole Weaver, Tiffany Grimes, Jason Blizzard, and Dr. Bernadette ... activities) and account for an estimated 10 million primary care provider ...
Examination of the Psychosocial Impact of Headache Disability and Psychiatric Comorbidity in a College Sample Ashley J. Britton, J. Nicole Weaver, Tiffany Grimes, Jason Blizzard, and Dr. Bernadette Heckman The University of Georgia Background •Epidemiological research has determined that headache disorders are the most prevalent of all neurological conditions and have demonstrated that the psychosocial impact of headaches is significant (Shapiro & Goadsby, 2007;Smitherman, McDermott, & Buchanan, 2011). •Additionally, migraine is the most prevalent disabling neurological condition which disproportionately affects approximately 17-18% of women (nearly 3 times more common than in men) during their prime productivity years (Graves, 2006; Shapiro & Goadsby, 2007).
•Chronic headaches, especially those severe in intensity, result in loss of productivity (i.e. missed days of school or work and/or related activities) and account for an estimated 10 million primary care provider office visits per year (Curry & Green, 2007). •Research in community and clinical samples of headache patients shows a bidirectional association between increased headache frequency and the likelihood of being diagnosed with a psychiatric (Lanteri-Minet, Radat, Chautard & Lucas, 2005; Breslau et al., 2000, 2003; Smitherman, McDermott, & Buchanan, 2011). Purpose •Despite the high prevalence of migraine and psychiatric disorders in undergraduate university students understudied (Smitherman, McDermott, & Buchanan, 2011), and the frequent use of this relatively high functioning population in research studies, the impact of migraine on university students is greatly understudied (Smitherman, McDermott, & Buchanan, 2011). Rees and Sabia (2011) reported that despite the fact that migraines are common and debilitating, little is known about their effect on educational attainment. •The current study attempts to address this gap in the literature by determining if depression and anxiety have high co-occurring prevalence rates in a relatively high functioning college-aged population with headaches. The absence of this headachedepression link in this population would not support the common bidirectional pathophysiology hypothesis.
Methodology Participants: •161 college students were recruited from two departmental research pools at a large southeastern university. •75 of the 121 students who satisfied eligibility criteria (more than 2 headache days per month) completed headache diagnostic interviews and seven headache-specific measures.
Design: •Participants completed a brief web-based eligibility survey assessing headache activity and school-related performance. •Those who met eligibility criteria were contacted via email within 24 hours to schedule a face-to face meeting with the student researcher. •Written consent was given before beginning the semi-structured 3045 minute interview with the student PI to measure headache incidence, severity, self-management of headache activity, and potential effect on academic performance. •The interview also assessed for headache disorder diagnosis, disability associated with headache activity and for comorbid psychiatric disorders.
Methodology cont. Materials: •The diagnostic interview administered by the student researcher included an adapted headache diagnostic interview, the Migraine Disability Assessment (MIDAS) and the Prime-MD. •After the interview, participants completed a series of paper and pencil psychosocial measures which included the following: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Headache Management Self-Efficacy Scale (HMSE), Headache Specific Locus of Control (HSLoC), Multidimensional Scale of Perceived Social Support (PSSS), Headache Disability Inventory (HDI), and an Academic Performance Self-Assessment (SAA) adapted from the measure used by the University of Southern Indiana's University Division Advising department program.
Results Sample Characteristics Demographics: The overall sample was predominately white (70.8%), and predominately female (79.5%) with a mean age of 19.71. Academic Performance: Nearly 90% of sample reported GPA above 3.0 •54% of sample reported GPA in 3.51-4.0 range •~33% of sample reported GPA in 3.01-3.5 range Headache Characteristics: •The mean number of disability days over the past 3 months (reported productivity of 50% or less) was 16 days across work and school settings, household chores, and family/social/leisure activities. •The mean number of headache days over past 3 months was 14.2. Psychological Symptoms: •Mean BDI score = 7.2 •Mean BAI score = 9.6
Conclusion & Implications This study sought to answer two primary questions: 1)Is there a relationship between headache activity & anxiety/ depressive symptoms in this healthy non-clinical sample? •Consistent with the literature chronic headaches in this healthy non-clinical sample are associated with significantly more depressive symptoms, which fall in the mild range of depression (mean BDI score = 13.8). •Participants experiencing migraine headaches also had significantly higher rates of depression relative to participants with tension-type headache. However, the depressive symptoms migraine sufferers had as compared to those with tension-type headaches were not clinically significant. •While both frequency and type of headache are related to depressive symptoms, relative to their counterparts, participants who reported more headache days demonstrated levels of depression in the clinical range.
The major implication for these findings is that patients presenting with chronic headaches should also be assessed and treated for depression since the bi-directional pathophysiological hypothesis is present in this population as well. 2)What is the relationship among headache activity, academic functioning /performance, disability associated with school/work, and social functioning in this healthy non-clinical sample? •Consistent with the literature, this healthier sample also experiences the negative impact of headaches as reflected in their loss of productivity across work and school settings, household chores, and family/social/leisure activities. •Participants with migraines reported higher rates of disability than did participants with tension-type headache, as reported by missed work or school days as well as productivity reported to be 50% or less (Migraine = 21.9 days vs. TTH = 13.1 days). •Participants with migraines also experienced greater severity of headaches and higher compared to participants with tension-type headache. •Participants with chronic headache, compared to episodic, experienced greater negative impact on their academic performance and higher functional disability. The implication of these findings is that while many people in the general population may minimize or not report headache-related disability, the negative psychosocial impact is still significant.
Limitations
Study Question #1: Is headache related to depression and anxiety in relatively healthy populations? YES Headache Diagnosis (Migraine vs. Tension-Type Headache) People with Migraine vs. Tension-Type Headache (TTH) tended to have: •Significantly higher BDI scores (M = 9.07 vs. TTH = 6.03) •Significantly more days of disability than did people with TTH (Migraine = 21.9 days vs. TTH = 13.1 days); and •Significantly more severe headaches (head pain) as rated on the Midas grade scale of 1 (little or no disability) to 4 (severe disability). Headache Type (Chronic vs. Episodic) Chronic TTH & Migraine are significantly associated with: •More severe depressive symptoms with a mean BDI score of 13.8; •Greater disruption is academic performance due to personal and social life habits (4.6 Chronic vs. 3.39 Episodic); and •Higher functional Disability (as indicated on the HDI).
•The limitation with the sample is that it was a sample of convenience recruited from the departments of psychology and counseling & human development services. Students within both departments were required to complete 3-6.5 research credits, determined by their department.
– This sample characteristic is also believed to account for the majority of the participants’ GPAs being skewed to the right of the normal distribution curve. •The sample was not diverse with regard to gender (though this is consistent with research on gender differences in headache incidence) or race.
•A final limitation is that there was some confusion about administration of the Prime-MD interview which was not noticed until after data collection ended. Therefore it is believed that the percentage of students meeting criteria for substance abuse and eating disorder diagnoses is lower than what might typically be seen in this population. Future Directions •Additional studies on relatively healthy populations should be conducted to further test the bi-directional pathophysiology hypothesis. •Future studies conducted with healthier, relatively high functioning populations should also aim to be more representative of the nation’s ethnic composition.
