Wang Shuu-Jiun, Juang Kai-Dih, Fuh Jong-Ling, Lu Shiang-Ru
Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Neurology. 2007 May 1;68(18):1468-73. doi: 10.1212/01.wnl.0000260607.90634.d6.
To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with chronic daily headache (CDH).
We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview-Kid (MINI-Kid). Clinical correlates and impacts were investigated.
A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had > or =1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score > or = 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score > or = 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave.
This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with chronic daily headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations.
调查以社区为基础的慢性每日头痛（CDH）青少年中合并精神障碍的患病率及其相关因素和自杀风险。
我们从一个非转诊学生样本（n = 7900）中识别并招募了122名患有CDH的青少年。CDH亚型根据《国际头痛疾病分类》第2版（ICHD-2）的最新标准进行分类。对每名患有CDH的受试者进行面对面的精神科访谈，以根据儿童版迷你国际神经精神访谈（MINI-Kid）评估抑郁和焦虑障碍以及自杀风险。调查临床相关因素和影响。
共有121名受试者（31名男性/90名女性，平均年龄13.8岁）完成了精神科访谈。57名受试者（47%）有一种或多种评估出的精神科合并症，其中重度抑郁症（21%）和惊恐障碍（19%）是最常见的两种诊断。20%的受试者当前自杀风险被评估为高（得分≥10）。女性和年龄较大与抑郁障碍有关。偏头痛的存在与精神科合并症相关（比值比[OR]=3.5，p = 0.002）。伴有先兆的偏头痛与精神障碍的关联比不伴有先兆的偏头痛更强。伴有先兆的偏头痛也独立预测高自杀风险（得分≥10）（调整后的OR = 6.0，p = 0.028）。相比之下，CDH亚型、头痛频率或药物滥用并无相关性。合并的精神障碍与医生会诊或更多病假天数无关。
这项以社区为基础的研究表明，慢性每日头痛青少年中精神障碍和自杀风险的合并症发生率很高。偏头痛发作的存在，尤其是伴有先兆的偏头痛，是这些关联的主要预测因素。
