Birincil Baş Ağrısı Olan Çocuk ve Ergenlerde Psikopatoloji ve Annelerinde Artmış Depresyon Düzeyleri: Kontrollü Bir Çalışma

Amaç: Bu çalışmanın birincil amacı birincil baş ağrısı olan çocuk ve ergenlerde depresyon, anksiyete ve aleksitimi düzeylerini kontrol grubu ile karşılaştırmak, aleksitimi düzeyleri ile depresyon ve anksiyete düzeylerinin ilişkisini incelemektir. Çalışmanın ikincil amacı ise hasta ve kontrol grupları arasında annelerin depresyon ve anksiyete düzeylerinin karşılaştırılmasıdır. Gereç ve Yöntem: Ankara Üniversitesi Tıp Fakültesi Çocuk Nöroloji Polikliniği’ne başvuran, birincil baş ağrısı tanısı alan 30 çocuk ve ergen hasta grubunu oluşturmuştur. Yaş ve cinsiyet açısından eşleştirilen 30 çocuk ve ergen ise kontrol grubu olarak alınmıştır. Tüm çocuk ve ergenlere araştırmacı tarafından,DSM-IV için yarı yapılandırılmış klinik görüşme uygulanmıştır. Çalışmaya katılan tüm çocuklara Çocuklar için Depresyon ölçeği ve Süreklik Durumluk Kaygı ölçeği, Toronto Aleksitimi ölçeği; annelerine ise Beck Depresyon ölçeği ve Beck Anksiyete ölçeği uygulanmıştır. Bulgular: Hasta ve kontrol grubu arasında depresyon, anksiyete ve aleksitimi düzeyleri açısından anlamlı bir farklılık saptanmamıştır (p>0,05). Birincil baş ağrılı çocuk ve ergenlerin annelerinin depresyon düzeyi sağlıklı kontrollerin annelerine göre anlamlı düzeyde daha yüksek saptanırken (p=0,01), anksiyete düzeyleri açısından anlamlı bir farklılık bulunmamıştır (p=0,124). Sonuç: Birincil baş ağrısı olan çocukların annelerinde yüksek depresyon seviyeleri bulunması, çocuk ve ergenlerin komorbid psikiyatrik durumlarının değerlendirilmesinin yanında annelerin de psikiyatrik değerlendirmesinin önemini göstermektedir. Annenin psikolojik olarak desteklenmesinin baş ağrısı olan çocukların ruh sağlığının korunmasında ve tedavisinde önemli olabileceği akılda tutulmalıdır.

Psychopathology in Children and Adolescents with Primary Headache and Higher Depression Levels in Mothers: A Controlled Study

Objectives: The primary aim of this study was to compare depression, anxiety and alexithymia levels in children and adolescents with primary headache to the control group and to investigate the relationship between alexithymia and depression, anxiety levels. The second aim of the study was to compare maternal depression and anxiety levels between the case and the control groups. Materials and Methods: The study group was composed of 30 children and adolescents as a case group who were admitted to the Pediatric Neurology clinic of the Ankara University, with a diagnosis of primary headache. Thirty healthy children and adolescents matched in terms of age and sex were included in this study as a control group. All children and adolescents were applied Kiddie Schedule for Affective Disorders and Schizophrenia DSM-IV by the researcher. All children and adolescents participating in the study were assessed for The Children’s Depression Inventory and State-Trait Anxiety Inventory, Toronto Alexithymia scale and mothers completed Beck Depression Inventory and Beck Anxiety scale. Results: There was no significant difference among depression, anxiety and alexithymia levels in the case and control groups (p>0.05). The depression levels of mothers in the case group were significantly higher than in the healthy controls (p=0.01), whereas there was no difference in terms of anxiety levels (p=0.124). Conclusion: The higher levels of depression in mothers of children with primary headache show the importance of mothers’ psychiatric evaluation as well as the comorbid psychiatric disorders in children and adolescents. It should be kept in mind that the psychological support of the mother may be important for the prevention and treatment of children with primary headache.

Kaynakça

1. Wöber-Bingöl C. Epidemiology of migraine and headache in children and adolescents, Curr Pain Headache Rep. 2013;17:341.

2. Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: A systematic review of population-based studies, Developmental Medicine & Child Neurology. 2010;52:1088-1097.

3. Bellini B, Arruda M, Cescut A, Saulle C, Persico A, Carotenuto M, Gatta M, Nacinovich R, Piazza FP, Termine C, Tozzi E, Lucchese F, Guidetti V. Headache and comorbidity in children and adolescents, J Headache Pain. 2013;14:79.

4. Margari F, Lucarelli E, Craig F, Petruzzelli MG, Lecce PA, Margari L. Psychopathology in children and adolescents with primary headaches: categorical and dimensional approaches. Cephalalgia, 2013;33:1311-1318.

5. Powers SW, Gilman DK, and Hershey AD. Headache and psychological functioning in children and adolescents, Headache. 2006;46:1404-1415.

6. Knook LM, Konijnenberg AY, van der Hoeven J, Kimpen JL, Buitelaar JK, van Engeland H, de Graeff-Meeder ER. Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy? Eur Child Adolesc Psychiatry. 2011;20:39-48.

7. Guidetti V, Galli F, Fabrizi P, Giannantoni AS, Napoli L, Bruni O, Trillo S. Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study, Cephalalgia. 1998;18:455-462.

8. Wei CB, Jia JP, Wang F, Zhou AH, Zuo XM, Chu CB. Overlap between Headache, Depression, and Anxiety in General Neurological Clinics: A Cross-sectional Study, Chin Med J (Engl). 2016;129:1394-1399.

9. Balottin U, Fusar Poli P, Termine C, Molteni S, Galli F. Psychopathological symptoms in child and adolescent migraine and tension-type headache: a meta-analysis, Cephalalgia. 2013;33:112-122.

10. Cerutti R, Valastro C, Tarantino S, Valeriani M, Faedda N, Spensieri V, Guidetti V. Alexithymia and psychopathological symptoms in adolescent outpatients and mothers suffering from migraines: a case control study, J Headache Pain. 2016;17:39.

11. M. Gatta, C. Spitaleri, U. Balottin, A. Spoto, L. Balottin, S. Mangano, P.A. Battistella. Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache, The journal of headache and pain. 2015;16:98.

12. Galli F, Canzano L, Scalisi TG, Guidetti V. Psychiatric disorders and headache familial recurrence: a study on 200 children and their parents, J Headache Pain. 2009;10:187-197.

13. Walker LS, Garber J, Greene JW. Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization, Journal of Abnormal Child Psychology. 1991;19:379-394.

14. Garber J, Zeman J, Walker LS. Recurrent abdominal pain in children: psychiatric diagnoses and parental psychopathology, Journal of the American Academy of Child & Adolescent Psychiatry. 1990;29:648- 656.

15. Engel ML, Winiarski DA, Reidy BL, Brennan PA. Early-Life Somatic Complaints: Longitudinal Associations with Maternal and Child Psychopathology, Journal of Developmental & Behavioral Pediatrics. 2018;39:573-579.

16. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADSPL): initial reliability and validity data, J Am Acad Child Adolesc Psychiatry. 1997;36:980-988.

17. Gökler B, Ünal F, Pehlivantürk B, Çengel-Kültür E, Akdemir D, Taner Y. Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam Boyu Şekli-Türkçe Uyarlamasının Geçerlik ve Güvenirliği, Çocuk ve Gençlik Ruh Sağlığı Dergisi. 2004;11:109-116.

18. Ünal F, Öktem F, Çetin Çuhadaroğlu F, Çengel Kültür SE, Akdemir D, Foto Özdemir D, Çak HT, Ünal D, Tıraş K, Aslan C, Kalaycı BM, Aydos BS, Kütük F, Taşyürek E, Karaokur R, Karabucak B, Karakök B, Karaer Y, Artık A. [Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)], Turk Psikiyatri Derg. 2019;30:42-50.

19. Kovacs M. Rating scales to assess depression in school-aged children, Acta Paedopsychiatr. 1981;46:305-315.

20. Öy B. Çocuklar için depresyon ölçeği: Geçerlik ve güvenirlik çalışması, Türk Psikiyatri Dergisi. 1991;2:132-136.

21. Spielberger CD, Edwards CD. STAIC premilary manual for the StateTrait Anxiety Inventory for Children (“How I Feel Questionnaire”). Palo Alto; Calif: Consulting Psycholgists Press; 1973.

22. Ozusta HS. Çocuklar için Durumluk-Surekli Kaygı Envanteri uyarlama, geçerlik ve güvenirlik çalışmasi, Türk Psikoloji Dergisi. 1995;10:32-44.

23. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia scale--I. Item selection and cross-validation of the factor structure, Journal of Psychosomatic Research. 1994;38:23-32.

24. Güleç H, Kose S, Yazici M, Çıtak S, Evren C, Borckardt J, Sayar K. The Turkish Version of the 20-Item Toronto Alexithymia Scale (TAS20): Reliability, Validity, and Factorial Structure, Bulletin of Clinical Psychopharmacology. 2009;19:214-220.

25. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain, Pain. 1983;17:45-56.

26. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties, J Consult Clin Psychol. 1988;56:893-897.

27. Ulusoy M, Şahin NH, Erkmen H. Turkish Version of the Beck Anxiety Inventory: Psychometric Properties, Journal of Cognitive Psychotherapy. 1998;12.

28. Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. Beck depression inventory (BDI), Archives of General Psychiatry. 1961;4:561-571.

29. Hisli N. Beck Depresyon Envanteri’nin üniversite ögrencileri icin gecerliligi, güvenilirligi, J. Psychol. 1989;7:3-13.

30. Bruijn J, Locher H, Passchier J, Dijkstra N, Arts WF. Psychopathology in children and adolescents with migraine in clinical studies: a systematic review, Pediatrics. 2010;126:323-332.

31. Machnes-Maayan D, Elazar M, Apter A, Zeharia A, Krispin O, EidlitzMarkus T. Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain, Pediatr Neurol. 2014;50:49-56.

32. Sarioglu B, Erhan E, Serdaroglu G, Doering BG, Erermis S, TutuncuoGlu S. Tension-type headache in children: a clinical evaluation, Pediatr Int. 2003;45:186-189.

33. Masi G, Favilla L, Millepiedi S, Mucci M. Somatic symptoms in children and adolescents referred for emotional and behavioral disorders, Psychiatry. 2000;63:140-149.

34. Öztop DB, Taşdelen Bİ, PoyrazoğLu HG, Ozsoy S, Yilmaz R, Şahın N, Per H, Bozkurt S. Assessment of Psychopathology and Quality of Life in Children and Adolescents With Migraine, Journal of child neurology. 2016;31:837-842.

35. Rousseau-Salvador C, Amouroux R, Annequin D, Salvador A, Tourniaire B, Rusinek S. Anxiety, depression and school absenteeism in youth with chronic or episodic headache, Pain Research and Management. 2014;19:235-240.

36. Härmä AM, Kaltiala-Heino R, Rimpelä M, Rantanen P. Are adolescents with frequent pain symptoms more depressed? Scand J Prim Health Care. 2002;20:92-96.

37. Guidetti V, Galli F. Psychiatric comorbidity in chronic daily headache: pathophysiology, etiology, and diagnosis, Curr Pain Headache Rep. 2002;6:492-497.

38. Mazzone L, Vitiello B, Incorpora G, Mazzone D. Behavioural and temperamental characteristics of children and adolescents suffering from primary headache, Cephalalgia. 2006;26:194-201.

39. Blaauw BA, Dyb G, Hagen K, Holmen TL, Linde M, Wentzel-Larsen T, Zwart JA. Anxiety, depression and behavioral problems among adolescents with recurrent headache: the Young-HUNT study, J Headache Pain. 2014;15:38.

40. Bag B, Hacihasanoglu R, Tufekci FG. Examination of anxiety, hostility and psychiatric disorders in patients with migraine and tension-type headache, Int J Clin Pract. 2005;59:515-21.

41. Shim EJ, Park A, Park SP. The relationship between alexithymia and headache impact: the role of somatization and pain catastrophizing, Qual Life Res. 2018;27:2283-2294.

42. Vieira RV, Vieira DC, Gomes WB, Gauer G. Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura, J Headache Pain. 2013;14:18.

43. Natalucci G, Faedda N, Calderoni D, Cerutti R, Verdecchia P, Guidetti V. Headache and Alexithymia in Children and Adolescents: What Is the Connection? Front Psychol. 2018;9:48-48.

44. Burba B, Oswald R, Grigaliunien V, Neverauskiene S, Jankuviene O, Chue P. A controlled study of alexithymia in adolescent patients with persistent somatoform pain disorder, Can J Psychiatry. 2006;51:468-471.

45. Wise TN, Mann LS, Jani N, Jani S. Illness beliefs and alexithymia in headache patients, Headache. 1994;34:362-365.

46. Gatta M, Canetta E, Zordan M, Spoto A, Ferruzza E, Manco I, Addis A, Dal Zotto L, Toldo I, Sartori S, Battistella PA. Alexithymia in juvenile primary headache sufferers: a pilot study, J Headache Pain. 2011;12:71-80.

47. Lane, R. D., & Schwartz, G. E. Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology, The American Journal of Psychiatry. 1987;144:133-143.

48. Palermo TM, Putnam J, Armstrong G, Daily S. Adolescent autonomy and family functioning are associated with headache-related disability, The Clinical Journal of Pain. 2007;23:458-465.

49. Lewandowski AS, Palermo TM. Parent-teen interactions as predictors of depressive symptoms in adolescents with headache, J Clin Psychol Med Settings. 2009;16:331-338.

50. Merikangas KR, Merikangas JR, Angst J. Headache syndromes and psychiatric disorders: association and familial transmission, J Psychiatr Res. 1993;27:197-210.

51. Galli F, Canzano L, Scalisi TG, Guidetti V. Psychiatric disorders and headache familial recurrence: a study on 200 children and their parents, J Headache Pain. 2009;10:187-197.

52. Marmorstein NR, Iacono WG, Markey CN. Parental psychopathology and migraine headaches among adolescent girls, Cephalalgia. 2009;29:38-47.

53. Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective, Am Psychol. 2014;69:142-152.

54. Williamson GM, Walters AS, Shaffer DR. Caregiver models of self and others, coping, and depression: predictors of depression in children with chronic pain, Health Psychol. 2002;21:405-410.

55. Robins PM, Smith SM, Glutting JJ, Bishop CT. A randomized controlled trial of a cognitive-behavioral family intervention for pediatric recurrent abdominal pain, J Pediatr Psychol. 2005;30:397-408.

Kaynak Göster