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慢性每日头痛的生物心理社会框架:一项混合方法研究。

A Bio-Psychosocial Framework for Chronic Daily Headaches: A Mixed Methods Study.

作者信息

Balasubramanian Bhuvaneshwari, Nair Vasundharaa S, George Nimmy, Reddy AshokV, Thomas Priya Treesa, Kulkarni Girish B

机构信息

Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India.

Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India.

出版信息

J Patient Exp. 2021 Nov 5;8:23743735211049672. doi: 10.1177/23743735211049672. eCollection 2021.

Abstract

Chronic daily headaches (CDH) are primarily understood from a psychophysiological formulation. A broad biopsychosocial understanding, where there is equal importance given to biological, psychological and socio-cultural factors, is underexplored in headache. Socio-cultural factors, such as gender, socio-economic factors can perpetuate and worsen the condition. For an effective and sustainable intervention, these factors need to be considered. The current study aims to explore and develop a biopsychosocial framework for headache disorders. A convergent parallel mixed methods design was used and participants were recruited from a tertiary referral care hospital, Bengaluru, India. Headache Assessment Sheet, GAD 7, HDRS, PSS and B COPE were used in the quantitative phase. The data was analysed using r software. Qualitative phase of the study, in depth interview guide was used and data analysed thematically. Quantitative phase, 38 participants were recruited. The average age, was 38.02 (±10.17), majority of the participants being females 31 (81.58%). The mean duration of illness was 8.63 (±4.73) years. The anxiety scores positively correlated with pain intensity (r = 0.50 at  ≤ .001) and the median anxiety scores varied with photophobia ( ≤ .03). The anxiety scores correlated with PSS (r = 0.428 at  ≤ .007) and HDRS (r = 0.428 at  ≤ .007) scores. Gender variations in coping were seen, avoidant coping having higher median scores in women. (≤ .08). In qualitative phase of the study, six participants were recruited. Three main themes emerged from the qualitative phase of the study: Chronic daily headaches are influenced by biological, psychological, environmental and socio-cultural factors. A bio-psychosocial framework will help to understand and develop targeted interventions.

摘要

慢性每日头痛(CDH)主要从心理生理学角度来理解。在头痛领域,对生物、心理和社会文化因素同等重视的广泛生物心理社会理解尚未得到充分探索。社会文化因素,如性别、社会经济因素,会使病情持续并恶化。为了进行有效且可持续的干预,需要考虑这些因素。本研究旨在探索并建立一个针对头痛障碍的生物心理社会框架。采用了收敛平行混合方法设计,参与者从印度班加罗尔的一家三级转诊医院招募。在定量阶段使用了头痛评估表、广泛性焦虑量表(GAD 7)、汉密尔顿抑郁量表(HDRS)、压力知觉量表(PSS)和应对方式问卷(B COPE)。数据使用R软件进行分析。在研究的定性阶段,使用了深度访谈指南并进行了主题数据分析。定量阶段招募了38名参与者。平均年龄为38.02(±10.17)岁,大多数参与者为女性,共31名(81.58%)。平均病程为8.63(±4.73)年。焦虑评分与疼痛强度呈正相关(r = 0.50,p≤0.001),且焦虑中位数评分随畏光情况而变化(p≤0.03)。焦虑评分与PSS(r = 0.428,p≤0.007)和HDRS(r = 0.428,p≤0.007)评分相关。在应对方式上存在性别差异,回避应对在女性中的中位数评分更高(p≤0.08)。在研究的定性阶段招募了6名参与者。研究的定性阶段出现了三个主要主题:慢性每日头痛受生物、心理、环境和社会文化因素影响。生物心理社会框架将有助于理解并制定有针对性的干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d42e/8573514/c25fec935035/10.1177_23743735211049672-fig1.jpg

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