Kaczynski Karen, Gambhir Rupa, Caruso Alessandra, Lebel Alyssa
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
Headache. 2016 Mar;56(3):491-500. doi: 10.1111/head.12709. Epub 2015 Oct 31.
This retrospective chart review examined a mediation model of parent and family functioning, childhood depression, and functional disability in youth with chronic headaches. Specifically, we evaluated whether depression mediates the relations between protective parenting and functional disability and between family functioning and functional disability.
Children and adolescents with chronic and recurrent headache report elevated symptoms of depression. Children with chronic pain conditions, including chronic headaches, have also been found to originate from families with greater conflict, poorer cohesion, and lower organizational structure, and impaired family functioning is associated with greater disability in youth with chronic pain.
Three hundred and eighty-two patients ages 5-17 years who underwent a multidisciplinary evaluation at a tertiary pediatric headache clinic were included in this study. Participants completed a pain intensity rating, the Children's Depression Inventory, and the Functional Disability Inventory. A parent completed the Family Relationship Index and the Adult Responses to Children's Symptoms questionnaires. Structural equation modeling was used to examine a mediation model and several alternative models.
Mediation was not supported, but an alternative model with both direct and indirect pathways provided excellent fit to the data: χ2(1) = 0.745, P = .39; comparative fit index = 1.00, root mean square error of approximation = 0.00 (CI: 0.00-0.17). Family functioning (β = -0.19, P < .01) and protective parenting (β = 0.17, P < .01) were associated with depression, but not disability. Depression was linked to disability (β = 0.24, P < .01). There was an indirect pathway from family functioning to depression to disability (β = -0.05, P < .05).
Family context is an important variable to consider in youth with chronic headaches and disability. While many studies have identified family functioning and depressive symptoms as separately linked to functional impairment, to our knowledge, we are the first to demonstrate depression as an intermediary variable between family dysfunction and disability within the pediatric headache population.
本回顾性病历审查研究了慢性头痛青少年中父母及家庭功能、儿童期抑郁和功能残疾的中介模型。具体而言，我们评估了抑郁是否在保护性养育与功能残疾之间以及家庭功能与功能残疾之间起中介作用。
患有慢性复发性头痛的儿童和青少年报告有更高的抑郁症状。患有慢性疼痛疾病（包括慢性头痛）的儿童也被发现来自冲突更大、凝聚力更差、组织结构更低的家庭，而家庭功能受损与慢性疼痛青少年的更大残疾有关。
本研究纳入了382名年龄在5至17岁之间、在三级儿科头痛诊所接受多学科评估的患者。参与者完成了疼痛强度评分、儿童抑郁量表和功能残疾量表。一名家长完成了家庭关系指数和成人对儿童症状问卷。采用结构方程模型来检验中介模型和几个替代模型。
中介作用未得到支持，但一个同时包含直接和间接路径的替代模型与数据拟合良好：χ2(1) = 0.745，P = 0.39；比较拟合指数 = 1.00，近似误差均方根 = 0.00（置信区间：0.00 - 0.17）。家庭功能（β = -0.19，P < 0.01）和保护性养育（β = 0.17，P < 0.01）与抑郁相关，但与残疾无关。抑郁与残疾相关（β = 0.24，P < 0.01）。存在一条从家庭功能到抑郁再到残疾的间接路径（β = -0.05，P < 0.05）。
家庭环境是患有慢性头痛和残疾的青少年中需要考虑的一个重要变量。虽然许多研究已确定家庭功能和抑郁症状分别与功能损害有关，但据我们所知，我们是首个在儿科头痛人群中证明抑郁是家庭功能障碍与残疾之间中介变量的研究。
