Dindo Lilian N, Recober Ana, Haddad Rita, Calarge Chadi A
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
Michael Debakey Veterans Affairs, Health Services Research and Development, Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.
Int J Behav Med. 2017 Aug;24(4):528-534. doi: 10.1007/s12529-016-9620-5.
Depression and anxiety are highly comorbid psychiatric conditions and both are common in adult patients with migraine. This study aims to examine the unique associations between major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a well-characterized group of older adolescents and college-age individuals with migraine.
Participants (N = 227), between 15 and 20 years old, who were unmedicated or within 1 month of beginning antidepressant treatment underwent a comprehensive psychiatric assessment to establish the presence of MDD and GAD, according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision, and to rate their symptom severity using the Longitudinal Interval Follow-up Evaluation for Adolescents (A-LIFE). They then completed the ID-Migraine. The Student's t test and chi-square test were used to compare continuous and categorical variables, respectively, across participants with vs. without migraine. Logistic regression analysis examined the association between the presence of migraine and psychopathology.
A diagnosis of MDD was associated with significantly increased risk of having migraine. Moreover, more severe and persistent ratings of depression were associated with an even higher likelihood of having migraine. A diagnosis of GAD was also significantly associated with the presence of migraine. The prevalence of comorbid MDD and GAD was significantly higher in participants with migraine than those without migraine (55 vs. 22%, p < 0.0001). When examined concurrently, GAD remained significantly associated with migraine, with a statistical trend for MDD to be associated with it.
The comorbidity of migraine, MDD, and GAD has important clinical and research implications. Patients who suffer from any of these problems should be screened for all three in order to receive comprehensive care. Shared psychological and biological vulnerabilities may be involved in the three conditions. Greater understanding of the shared vulnerabilities can lead to unified treatments.
抑郁症和焦虑症是高度共病的精神疾病，在成年偏头痛患者中都很常见。本研究旨在探讨在一组特征明确的患有偏头痛的大龄青少年和大学生中，重度抑郁症（MDD）和广泛性焦虑症（GAD）之间的独特关联。
年龄在15至20岁之间、未服用药物或开始抗抑郁治疗后1个月内的参与者（N = 227），根据《诊断与统计手册》第四版修订版进行了全面的精神评估，以确定是否存在MDD和GAD，并使用青少年纵向间隔随访评估（A-LIFE）对其症状严重程度进行评分。然后他们完成了ID-偏头痛评估。分别使用学生t检验和卡方检验来比较有偏头痛和无偏头痛参与者的连续变量和分类变量。逻辑回归分析研究了偏头痛的存在与精神病理学之间的关联。
MDD的诊断与患偏头痛的风险显著增加相关。此外，更严重和持续的抑郁评分与患偏头痛的可能性更高相关。GAD的诊断也与偏头痛的存在显著相关。偏头痛患者中MDD和GAD共病的患病率显著高于无偏头痛患者（55%对22%，p < 0.0001）。同时检查时，GAD仍然与偏头痛显著相关，MDD与之相关有统计学趋势。
偏头痛、MDD和GAD的共病具有重要的临床和研究意义。患有这些问题中任何一种的患者都应接受这三种疾病的筛查，以便获得全面护理。这三种情况可能涉及共同的心理和生物学易感性。对共同易感性的更深入了解可导致统一的治疗方法。
