Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy.
Neuropsychiatr Dis Treat. 2013;9:1061-6. doi: 10.2147/NDT.S49364. Epub 2013 Aug 5.
Self-esteem is related to the broadly understood concept of self-schemas and is a crucial mechanism for a correct psychological development in children and adolescents. The impact of the many psychological difficulties linked to the migraine without aura (MoA) and recurrent headache attacks, such as anger and separation anxiety, on self-esteem has not yet been well investigated. The aims of the present study were to assess self-esteem levels in an objective way and to verify their possible relationship and correlation with the frequency and intensity of migraine attacks, in a population of children and adolescents affected by MoA.
The study population was comprised of 185 children (88 males [M],97 females [F]) aged between 6 and 12 years (mean 9.04 ± 2.41 years) referred consecutively for MoA to the Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples and of 203 healthy controls (95 M, 108 F) with mean age 9.16 ± 2.37 years, recruited from schools in Campania. The monthly headache frequency and the mean headache duration were assessed from daily headache diaries kept by all the children, and MoA intensity was assessed on a VAS (visual analog scale). To further evaluate their level of self-concept, all subjects filled out the Multidimensional Self-Concept Scale (MSCS).
The two study groups were comparable for age (P = 0.621), sex (P = 0.960), and z-score BMI (P = 0.102). The MoA group showed a significant reduction in the MSCS total score (P < 0.001) and in the Social (P < 0.001), Affect (P < 0.001), Family (P < 0.001), and Physical (P < 0.001) domains of the MSCS compared with the control group. The Pearson's correlation analysis showed a significantly negative relationship between MoA clinical characteristics and MSCS scores, and similarly the frequency of attacks was significantly negatively related with the Social (r = -0.3176; P < 0.001), Competence (r = -0.2349; P = 0.001), Physical (r = -0.2378; P = 0.001), and total (r = -0.2825; P < 0.001) scores of the MSCS. On the other hand, the MoA duration was significantly negatively related with the Social (r = -0.1878; P = 0.01), Competence (r = -0.2270; P = 0.002), Physical (r = -0.1976; P = 0.007), and total (r = -0.1903; P = 0.009) scores of the MSCS.
Our study first identified differences in self-esteem levels, with an objective tool, in children affected by MoA compared with controls, suggesting the need for evaluation of self-esteem for better psychological pediatric management of children with migraine.
自尊与广泛意义上的自我图式概念有关，是儿童和青少年正确心理发展的关键机制。与无先兆偏头痛（MoA）和复发性头痛发作相关的许多心理困难，如愤怒和分离焦虑，对自尊的影响尚未得到很好的研究。本研究的目的是客观评估自尊水平，并验证其与偏头痛发作频率和强度的可能关系和相关性，研究对象为受 MoA 影响的儿童和青少年人群。
研究人群包括连续就诊于那不勒斯第二大学儿童头痛中心临床儿童和青少年神经精神病学诊所的 185 名儿童（88 名男性[M]，97 名女性[F]），年龄在 6 至 12 岁之间（平均 9.04 ± 2.41 岁），以及从坎帕尼亚地区的学校招募的 203 名健康对照组（95 名男性[M]，108 名女性[F]），平均年龄为 9.16 ± 2.37 岁。所有儿童均使用每日头痛日记记录每月头痛发作频率和平均头痛持续时间，MoA 强度则通过视觉模拟量表（VAS）评估。为了进一步评估他们的自我概念水平，所有受试者都填写了多维自我概念量表（MSCS）。
两组在年龄（P = 0.621）、性别（P = 0.960）和 z 评分 BMI（P = 0.102）方面无显著差异。与对照组相比，MoA 组的 MSCS 总分（P < 0.001）以及社会（P < 0.001）、情感（P < 0.001）、家庭（P < 0.001）和身体（P < 0.001）领域的得分显著降低。Pearson 相关分析显示，MoA 临床特征与 MSCS 评分之间存在显著负相关，同样，发作频率与社会（r = -0.3176；P < 0.001）、能力（r = -0.2349；P = 0.001）、身体（r = -0.2378；P = 0.001）和总分（r = -0.2825；P < 0.001）得分呈显著负相关。另一方面，MoA 持续时间与社会（r = -0.1878；P = 0.01）、能力（r = -0.2270；P = 0.002）、身体（r = -0.1976；P = 0.007）和总分（r = -0.1903；P = 0.009）呈显著负相关。
本研究首次使用客观工具，确定了受 MoA 影响的儿童与对照组之间自尊水平的差异，这表明需要评估自尊，以更好地对偏头痛儿童进行心理儿科管理。
