Coping Skills.when Reading Gives You a Headache

Springerplus. 2015; 4: 801.

Coping strategies among adolescents with chronic headache and mental health problems: a cross-exclusive population-based study

Silje Hartberg

Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Aas, Norway

Health Services Enquiry Centre, Akershus University Hospital, Lørenskog, Kingdom of norway

Jocelyne Clench-Aas

Sectionalization of Mental Health, Department of Wellness Surveillance and Prevention, Norwegian Institute of Public Health, Oslo, Kingdom of norway

Ruth Kjærsti Raanaas

Section of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Aas, Kingdom of norway

Christofer Lundqvist

Health Services Inquiry Centre, Akershus Academy Hospital, Lørenskog, Norway

Department of Neurology, Akershus University Hospital, Lørenskog, Kingdom of norway

Found of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway

Received 2015 Oct 16; Accustomed 2015 December 8.

Abstruse

To examine prevalence of mental health problems amidst adolescents with chronic headache and compare internal and external coping strategies in young people with chronic headaches with and without mental health problems. This study is based on a cross-sectional survey undertaken in Akershus Canton in Norway. A total of 19,985 adolescents were included in the written report, covering lower secondary and upper secondary students, anile 13–19 years. Chronic headache was measured with a single item question based on headache frequency. Mental health was assessed by using the strengths and difficulties questionnaire (SDQ). Internal and external coping strategies were assessed through 7 options for answering the question: What practise y'all practice/what happens when you are burdened by painful thoughts and feelings? Adolescents with chronic headaches showed more frequent mental health issues overall (23 %) compared to those without chronic headache (6 %). Logistic regression analyses showed that those adolescents having both chronic headaches and comorbid mental health problems more oft used internal coping strategies, such as keeping feelings inside (OR 2.05), using calumniating substances (OR 1.79) and talking oneself out of problems (OR 1.55), compared to those without mental wellness problems. Groups with mental wellness problems, especially with chronic headache, less frequently used the external strategy of talking to others about their problem than controls (OR 0.7–0.8). Factor analyses revealed significant differences in profiles of coping strategies betwixt groups. We suggest that attention should be paid towards the high risk group that has both chronic headaches and mental wellness issues and their tendency to utilise destructive internal coping strategies.

Keywords: Mastery, Tension type headache, Migraine, Young adults/students, Strengths and difficulties questionnaire

Groundwork

Headache disorders are among the top ten causes of disability in Europe (Steiner and Martelletti 2007; Steiner et al. 2015). Chronic headache is a major problem in children and adolescents (Gladstein 2004; Guidetti et al. 2000). It is characterized past a loftier degree of psychiatric comorbidity (Guidetti 2002). Stovner and colleagues (2007) found that the worldwide prevalence of chronic headache in the developed population was three % [two.4 % in Norwegian adults (Stovner et al. 2006)]. In children the prevalence ranges from 0.nine to vii.viii % worldwide (Seshia et al. 2010).

For children and adolescents who experience headache problems, psychological problems are well-recognized, but poorly understood clinical phenomena (Powers et al. 2006). The presence of psychiatric comorbidity is associated with poorer prognosis, decreased quality-of-life (Baskin et al. 2006) and increased psychosocial problems (Powers et al. 2006). Several studies advise a bi-directional human relationship betwixt the comorbidity of headache and psychiatric disorders (Gentili et al. 2005; Wang and Juang 2002). Pompili and colleagues (2010) found that the human relationship betwixt migraine and psychopathology has not been systematically studied and suggested that future inquiry should focus on the interplay of factors backside the relationship between migraine, suicide risk and mental illness. In the general population, on the other hand, because of relative low frequency of chronic migraine (Krogh et al. 2015), it is more interesting to written report the relation between tension type headache and mental illness. However, studies propose that psychopathology may be more linked to frequency of headache than to a specific headache diagnosis (Blaauw et al. 2015).

Coping has been defined every bit "constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised every bit taxing or exceeding the resources of the person" (Lazarus and Folkman 1984). Information technology is described equally "an ongoing dynamic process that changes in response to the changing demands of a stressful encounter or event" and as a "purposeful response […] directed towards resolving the stressful response between the self and the surroundings (problem focused coping) or toward […] negative emotions that arise as a event of stress (emotion-focused coping)" (Lazarus and Folkman 1984). In addition to this clarification, coping strategies take been described along axes such equally "internal–external", "voluntary–involuntary", "appointment–detachment" and "chief–secondary" (Lazarus and Folkman 1984; Compas et al. 2001). Though there is disagreement regarding the well-nigh constructive style to describe unlike ways of coping, some strategies have, nevertheless, been suggested to be more related to expert mental health than others (Holen et al. 2012). This may be of importance regarding both diagnosis and treatment of disorders related to mental health and handling of stress and pain. The present written report utilizes an internal vs. external coping strategy axis system (Lazarus and Folkman 1984; Pratt et al. 1985). This is based on the notion that some external strategies may be more than strongly related to good mental health, equally they are based on the individual seeking solutions outside him/herself eastward.g. through communication seeking external help in identifying and solving the problem. Internal strategies, on the other hand, involve efforts to regulate the emotional distress through internal efforts east.grand. past venting negative emotions, using drugs/booze in attempts to attenuate the experienced distress and denying the association between the stressor and the experience (Jorgensen and Dusek 1990). Some internal strategies may be perceived as similar to avoidance strategies or withdrawal, which have been suggested to represent poor accommodation. This has been observed mainly in children and adolescents with depressive or feet symptoms (Holen et al. 2012; Chan 1995; Seiffge-Krenke 2000). An additional reason for choosing this categorization is that, in a treatment perspective the apply of external strategies may be more accessible for therapy while internal coping may be more than hard to assess and influence.

In the field of headache, it is well established that chronic and frequent headache is associated with depressive symptoms and symptoms of anxiety besides as with more than stressful life events (Wittrock and Myers 1998). In improver, headache patients have been suggested to use more maladaptive coping strategies (Wittrock and Myers 1998). Such coping patterns may especially involve the more than internal coping strategies of abstention and dissimulation (Wittrock and Myers 1998; Rollnik et al. 2001). Regarding coping patterns amidst youngsters with headache, studies have suggested such maladaptive strategies to be used more than commonly amid children and adolescents with headaches (Lanzi et al. 2001). Experimental studies have demonstrated that internalising strategies such as avoidance lead to increased distress while lark, representing a more externalising coping behaviour decreases the level of distress, even so, there are gaps in knowledge on coping and mental health bug in chronic headache among adolescents [(Compas et al. 2001) for review].

The present study aims to describe the prevalence and touch of chronic headache and mental health problems in adolescents using a well validated calibration, the forcefulness and difficulties questionnaire (SDQ) among a large representative (N = 19,985) sample of adolescents living in Norway. In addition, the aim was to compare the coping strategies favored by the different groups within an internal and external coping strategy framework.

Methods

Blueprint and participants

This cantankerous-exclusive health survey was undertaken in Akershus County, Kingdom of norway, an surface area including urban, suburban and rural areas, with clear differences in socio-economic status amidst the inhabitants.

Whole classes of pupils were selected to participate from randomly selected classes and schools in the county. The study included a total of xix,985 pupils from lower secondary schoolhouse (n = 9414) and upper secondary school (north = 10,571), aged 13–19 years. The total response percentage was 82. Questionnaires were filled out at school, under the supervision of the instructor. A letter asking for parental consent with one reminder was sent to parents, prior to the study. The pupils that were invited to the written report merely did not participate, were primarily either abode from schoolhouse, on a school-trip or their teacher was off piece of work.

Measures

Four health groups were defined based on the two dependent variables chronic headaches and mental wellness problems. The groups were: "chronic headaches without mental health problems" (CH), "chronic headaches with simultaneous mental health problems" (CHMH), "mental wellness bug without chronic headaches" (MH) and a control group with neither chronic headache, nor mental health problems. The statistical analyses were done as a multinomial logistic assay, with presence of each of the above defined health groups fix as the dependent variable.

Chronic headache was assessed by the question "During the past 6 months, how oftentimes have you had the post-obit complaints", where headache is included as ane of the complaints. The response possibilities were "virtually every twenty-four hour period", "more than once a week", "about every week", "about every month", "seldom or never". "Almost every mean solar day" was defined equally chronic headache in close accord with the definition of chronic headaches co-ordinate to the International Classification of Headache disorders, version 2 with chronic headache defined as more than half of the days with headache (Olesen and Steiner 2004).

Mental health problems were assessed using The strengths and difficulties questionnaires (SDQ) (Goodman 2011). We used four of the v original SDQ symptom scales, each with five items: emotional, deport, hyperactivity and peer problems. The question about headache symptoms in the emotional subscale was excluded to avoid confounding the exposure (headache) and the upshot (SDQ). Each detail has a three-point response calibration (0 = not true, 1 = somewhat true, 2 = certainly true). Responses were rated 2 to 0 for positively worded items, and inversely coded for negatively worded items. The three subscales with 5 items each were summed to get a maximum total score of x, whereas the emotion subscale with the headache question removed, summed to a maximum of eight. A total difficulties score was thus calculated based on adding the get-go four subscales scores, giving a total ranging from 0 to 38. It has previously been recommended to define iii population groups (Goodman 2011); normal (lowest 80 % of population), borderline (10 %) and aberrant/caseness (highest ten %). Farther, Van Roy (2008) redefined the cutting-offs to represent to Norwegian symptom reporting, keeping the suggested lxxx-ten-ten distribution. Since we removed one question from the SDQ, nosotros redefined cut-off points for the normal group every bit 0–xv, borderline scores from 16 to 19 and the aberrant group with scores from 20 to 38, corresponding as close to the Norwegian eighty-10-10 cut-offs as possible (Van Roy et al. 2008). These values were for logistic regression further dichotomised into normal versus borderline/abnormal, which is a standard method of analysis (Goodman 2011).

To appraise the impact of the mental health trouble in everyday life, the extended version of the SDQ was used including 5 questions apropos overall distress and social impairment. Responses were coded into 0 = no/piddling, 1 = quite a lot, 2 = a great deal. The five items generate an affect score, ranging from 0 to x. A total impact score of 1 is defined as deadline, and a score of 2 or more than defines abnormal/caseness (Goodman 2011). These values were for logistic regression further dichotomised into normal versus deadline/abnormal. We decided to restrict the definition of mental health problems to those exhibiting both symptoms of problems as measured past the SDQ symptom score, and additionally showing indications of overall distress and social impairment. Thus a new variable was made that summed the dichotomous symptom score and the dichotomous impact score (Goodman 2011). The resulting variable was further dichotomised. To qualify equally having a mental health problem, the participants thus had to exist borderline or abnormal for both the total symptom score and the bear upon score. The Cronbach'due south alpha for the 19 questions of SDQ total symptoms excluding the headache question was found to exist 0.78.

Coping strategies were assessed by the scenario: "What practise yous practise/what happens when you are burdened by painful thoughts and feelings?" We used seven items (Table1), each with 3 chiselled answers (0 = not truthful, 1 = somewhat truthful and ii = certainly true). We divided coping into four internal (ICS1, ICS2, ICS3 and ICS4) and three external (ECS1, ECS2 and ECS3) coping strategies (see Tabular array1). These were treated equally independent variables. The correlation between the coping variables was tested past Pearson's r and found not to be substantial, ranging from 0 to 0.28. Confounders adjusted for in the analyses were gender, grade, socioeconomic status, living with both parents or not, subjective schoolhouse-related stress and nation of origin (separated as western or non-western). For the variable coping strategies, missing information ranged between 937 and 1459 of the total number (xix,985).

Table 1

Listing of coping strategies [internal (ICS) and external (ECS) coping strategies]

		Due north (%)
ICS 1—Continue painful thoughts and feelings inside	No	15,875 (84.v)
	Yes	2919 (15.5)
ICS 2—Work more than with other things to avert thinking bad thoughts	No	xiv,106 (75.three)
	Yeah	4615 (24.7)
ICS 3—Using abusive substances when having bad thoughts or feelings	No	17,809 (95.eight)
	Yes	772 (4.2)
ICS 4—Try to talk oneself out of problems	No	xvi,574 (89.0)
	Yes	2044 (xi.0)
ECS 1—Visit health care service when having bad thoughts or feelings	No	eighteen,225 (98.4)
	Yeah	301 (one.6)
ECS ii—Speak with family when having bad thoughts or feelings	No	fourteen,256 (75.6)
	Yes	4600 (24.iv)
ECS 3—Speak with friends when having bad thoughts or feelings	No	9355 (49.1)
	Yes	9693 (50.9)

No is defined as either not true or somewhat truthful, whereas yeah is equivalent to certainly true

Ethics

Participation was voluntary, all questionnaires were bearding, and based on individual informed consent. Pupils in secondary schools had parental consent. The health survey was conducted later approval from the Regional Ideals Commission.

Statistical analyses

All preliminary analyses were performed by the Statistical Packet for Social Sciences (SPSS) version 22.0. Confirmatory factor analysis (CFA) operations were then conducted using maximum likelihood (ML) estimation by means of Analysis of Moment Structures (AMOS version 22) (Arbuckle 2013).

Multinomial logistic regression analyses were used to estimate the associations between chronic headache and mental health groups (CH, CHMH, MH) and the independent variables as compared to the command group. The analyses were stratified by health group. All analyses were controlled for historic period, gender, socioeconomic status, living with both parents or non, subjective school-related stress and nation of origin. Due to a complex sampling design with county and class every bit unit, logistic regression analyses were performed using the SPSS module, complex samples, which corrects estimates of standard errors bookkeeping for sampling design (Osborne 2011). Odds ratio [with 95 % confidence interval (CI)] was used to estimate effect, for multiple comparisons Bonferroni corrected p values (p < 0.0017) were used to avoid the take a chance of mass significance. Cases were removed if at least ane variable was missing (listwise deletion). The significance level was set to p < 0.05 and effect estimates reported Beta with SE. All variables were checked for multicollinearity. Tolerance should not be to a higher place 0.x and VIF should be beneath 10 (Pallant 2010). These assumptions were non violated for any variables in the analyses.

To evaluate the coping strategy profiles, we performed CFAs (Bollen 2014) using data from each of the different subgroups. The analyses were run by means of ML estimation.

As the χ² has been shown to be problematic for assessing model fit in large samples (Byrne 2013; Cheung and Rensvold 2002; Hirschfeld and von Brachel 2014; Hooper et al. 2008), model fit was primarily assessed using the root mean square error of approximation (RMSEA) with values of 0.08, 0.05 and 0, and the comparative fit alphabetize (CFI), with values 0.90, 0.95 and 1.0 demonstrating reasonable, close and exact fit, respectively.

Invariance testing was conducted past multi-group CFAs using ML estimation in AMOS 22. This method employs successive analyses where constraints to the models are added consecutively. Nosotros used the baseline, unconstrained model, with i factor loading constrained to unity. Skillful model fit at this stage and significant factor loadings is indicative of configural invariance (Hirschfeld and von Brachel 2014). In addition, the weak (metric) model was used. Invariance at this level implies that the regression slopes are invariant across groups and implies that the same latent variables are being measured across groups. ΔCFI was used with a cut-off ≤0.01 indicating invariance betwixt subgroups (Byrne 2013; Hirschfeld and von Brachel 2014; Hooper et al. 2008; Meade et al. 2008).

Results

Prevalence

To examination for representativity of the sample, the prevalence of some of the control variables were compared to national averages for 2002 (Statistics Norway 2015). The results indicated that there were identical prevalence of males and females (M = 51 %; F = 49 %) in both sample and national values; near identical prevalence of those with Norwegian national identity (84.7 % nationwide versus 84.6 in this sample); while prevalence of those living with both parents was slightly higher in the sample (67.five %) than the nationwide values of 62.ane %.

3.7 % of participants (due north = 717) met the criteria for CH, 1.1 % (due north = 212) for CHMH and 5.5 % (n = 1049) for MH, whereas 89.seven % are in the control group (N = 17,143) (thus a full Northward = 19,121 after missing values for illness criteria were removed). Of the 929 adolescents with chronic headaches, 23 % thus had comorbid mental wellness problems compared with a v.eight % prevalence of mental wellness problems among those without chronic headache. The relative gamble (RR) of having chronic headaches when also having mental health problems was 4.ii (95 % CI: 3.6–four.eight) while the RR of having mental wellness problems when as well having chronic headaches was iv.0 (95 % CI: 3.5–4.5). Tables2 and ​ iii show the prevalence of the demographic variables and the coping strategies in the 3 groups: CH, CHMH and MH.

Table 2

Comparison of coping strategies [internal (ICS) and external (ECS) coping strategies] between headache and mental health groups

		Command Due north (%)	CH N (%)	CHMH N (%)	MH North (%)
ICS i—Keep painful thoughts and feelings inside	No	14,202 (86.8)a	510 (75.8)c	94 (46.v)d	643 (63.9)b
	Yes	2155 (13.2)a	163 (24.2)c	108 (53.v)d	363 (36.1)b
ICS 2—Piece of work more with other things to avoid thinking bad thoughts	No	12,475 (76.3)a	464 (69.8)b	131 (65.8)b	668 (68.0)b
	Yes	3868 (23.7)a	201 (thirty.2)b	68 (34.2)b	314 (32.0)b
ICS 3—Using abusive substances when having bad thoughts or feelings	No	fifteen,727 (97.0)a	598 (92.0)c	160 (79.2)d	862 (86.5)b
	Yes	489 (three.0)a	52 (8.0)c	42 (20.8)d	134 (xiii.5)b
ICS 4—Try to talk oneself out of problems	No	14,756 (90.8)a	520 (78.8)b	124 (61.four)c	745 (74.nine)b
	Yes	1502 (9.2)a	140 (21.2)b	78 (38.6)c	249 (25.1)b
ECS one—Visit health intendance service when having bad thoughts or feelings	No	15,999 (98.eight)a	629 (96.3)b	183 (91.5)c	949 (95.vi)b,c
	Yes	199 (1.2)a	24 (iii.7)b	17 (8.5)c	44 (4.iv)b,c
ECS 2—Speak with family when having bad thoughts or feelings	No	12,308 (74.9)a	519 (77.eight)a,c	171 (85.5)b,c	873 (87.2)b
	Yes	4123 (25.1)a	148 (22.2)a,c	29 (14.v)b,c	128 (12.8)b
ECS three—Speak with friends when having bad thoughts or feelings	No	8004 (48.2)a	320 (47.6)a	128 (64.0)b	627 (62.ii)b
	Yep	8592 (51.8)a	352 (52.iv)a	72 (36.0)b	381 (37.eight)b

Table 3

Prevalence (%) of background variables and independent variables in the groups: command group CH, MH and CHMH

	Control group	CH	CHMH	MH
Sex
Boy	52.0a	xxx.ivc	31.ixc	41.8b
Daughter	48.0a	69.sixc	68.onec	58.2b
Grade
8th class LSS	17.3a	16.8a,c	10.0b,c	eleven.nineb
9th class LSS	15.viia	16.2a	nineteen.0a	fifteen.onea
10th grade LSS	14.5a	14.ia	13.3a	12.8a
1st class USS	24.twoa	27.1a,b	29.9a,b	27.viiib
2d grade USS	xvi.6a	14.sevena	xviii.0a	18.2a
third grade USS	eleven.7a	11.0a	10.0a	fourteen.twoa
How well off is your family?
Very good	13.3a	14.fivea	11.viiia	11.ia
Good	48.ixa	41.viic	27.0b	32.0b
Medium	31.2a	30.6a	37.9a,b	37.0b
Not very good	5.4a	9.viib	12.3b	13.6b
Poorly	one.ia	3.4c	x.9b	half dozen.3b
Lives with both parents
Yeah	69.1a	lx.ivc	51.2b,c	53.3b
No	30.9a	39.half dozenc	48.eightb,c	46.7b
How stressed are you of school work?
Not at all	11.fivea	7.5b	eight.via,b	7.2b
A little	47.1a	28.vb	18.6c	23.ib,c
Pretty much	28.4a	33.9b	22.ninea	33.6b
Very much	xiii.0a	thirty.1b	l.0c	36.1b
Nation of origin
Western land (incl. Norway)	94.9a	93.sixa,b	93.ninea,b	91.3b
Asia/Afrika/Latin America	5.anea	6.foura,b	6.1a,b	8.sevenb

Chronic headaches without mental health problems

There was a human relationship between having chronic headaches, and using the internal coping strategies of keeping troubles inside, and using calumniating substances when bad thoughts and feelings create pressure (Tabular array4).

Table 4

Multivariate logistic regression assay examining the clan between the 3 groups: CH, CHMH, MH, and internal (ICS) and external (ECS) coping strategies

Coping strategy (reference "not true")	CH vs control OR (95 % CI)	CHMH vs command OR (95 % CI)	MH vs command OR (95 % CI)
N	15,828	15,463	xvi,487
ICS 1—Proceed painful thoughts and feelings within (reference "not true")	1.22 (1.15–one.29)*	2.96 (two.81–3.12)*	1.65 (1.58–1.73)*
ICS two—Work more with other things to avoid thinking bad thoughts	one.07 (1.05–1.08)*	0.80 (0.76–0.84)*	0.93 (0.89–0.98)
ICS three—Using abusive substances when having bad thoughts or feelings	i.46 (1.42–1.49)*	2.39 (2.25–2.53)*	1.90 (i.86–one.95)*
ICS 4—Try to talk oneself out of bug	1.32 (ane.29–one.37)*	two.00 (two.19–2.61)*	1.77 (1.73–i.eighty)*
ECS i—Visit health care service when having bad thoughts or feelings	1.47 (1.34–1.61)*	2.39 (two.nineteen–2.61)*	1.72 (i.65–1.79)*
ECS two—Speak with family when having bad thoughts or feelings	0.83 (0.80–0.86)*	0.68 (0.64–0.73)*	0.70 (0.66–0.74)*
ECS 3—Speak with friends when having bad thoughts or feelings	0.82 (0.78–0.85)*	0.69 (0.67–0.71)*	0.66 (0.64–0.68)*

The CH group also tended to utilize the internal coping strategy of talking themselves out of their problems, and the external coping strategy of visiting health care services, more and so than the control group. The CH subjects were less likely to use the external coping strategies of speaking with friends or family unit compared with the control grouping. The rank society of odds ratios for coping strategies used more than by the CH group was: visit health intendance services > using abusive substances > talk oneself out of problems > keeping painful thoughts or feelings within.

Chronic headaches with simultaneous mental health problems

The CHMH subjects were more than two times more likely to use the internal coping strategies of keeping painful thoughts or feelings within, using abusive substances and talking themselves out of their problems than the command grouping (Tableiv). The probability was two times college for using the external coping strategy of visiting health care services when bad thoughts and feelings were nowadays among the CHMH group, compared with the control group. In comparison with the CH group, the CHMH grouping was significantly more likely to employ the internal coping strategies of keeping painful thoughts or feelings within, using abusive substances and talking oneself out of problems. The CHMH group was likewise less likely to utilise the internal coping strategy of working more with other things. The CHMH group tended to utilize the external coping strategy of speaking with family less compared with the CH group (not significant) (Tableiv). The rank gild of odds ratios for coping strategies used more than by this group was: proceed painful thoughts or feelings inside > using abusive substances > visit wellness intendance service > talk oneself out of problems. Speaking with others (both friends and family) and doing other things were fiddling used strategies in this group.

Mental health bug without chronic headaches

The MH group used the internal coping strategy of keeping painful thoughts or feelings inside to a greater extent, compared with the command group (Table4). The odds of using abusive substances every bit a coping strategy increased by a gene of 1.ix in the MH grouping, compared with the command group. There was a trend among the MH group to utilize the external coping strategies of talking themselves out of problems, and seeking assist from health care services when bad thoughts and feelings were present, compared to the command group. The rank gild of odds ratios used more by this group was: using abusive substances > talk oneself out of bug > visit health intendance service > keep painful thoughts or feelings inside. Speaking with others (friends and family unit) was also here a less used strategy than in the control population.

Effects of demographic variables on master outcomes (Table3)

Proportion of adolescents classified as CH or CHMH significantly decreased with increasing age, whereas proportions with MH alone increased with age. Female person gender was a pregnant factor associated with more frequent caseness in all 3 issue groups. Living situation (i.e. living with both parents as opposed to not) was a pregnant factor associated with less frequent caseness in all three consequence groups. Socioeconomic status was a significant factor associated with more frequent MH, CH and CHMH with decreasing family income. Experienced school stress was a significant gene associated with more frequent MH, CH and CHMH. Having a not-Western nation of origin was only significantly associated with higher MH. These demographic parameters were used every bit possible confounders and were adjusted for in main outcome analyses.

Coping strategy profiles in the unlike health groups

The results of the Confirmatory Gene Assay (CFA) for each grouping is shown in Fig.1, which presents the standardized coefficients of the unconstrained model for the entire population. Table5 presents the values for each of the subgroups,MH, CH and CHMH. Using calumniating substances consistently loaded less on the latent variable "internal coping strategies" than the other three related variables. The relative weight of these remaining three internal strategies were much closer to each other for all groups. Keeping painful thoughts and feelings inside was about strongly related to existence in the CH group. Among the factor loadings related to the latent variable, external coping strategy, the strongest loading for all groups was towards speaking with family. The groups differed substantially in loadings of the individual strategies. The model showed moderate fit. The differences in the pattern of internal and external strategies used by the four groups were significant as tested by invariance testing (data not shown) and using the value of <0.01 as cut-off for ∆CFI.

Comparison of standardized factor loadings of private coping strategies on latent internal (ICS) and external (ECS) coping strategies in the unconstrained model

Table v

Standardized factor loadings for all seven items of coping strategies in a two factor model for each population subgroup (Northward = 19,121)

	Control	CH	CHMH	MH
Northward	17,143	717	212	1049
ICS 1—Keep painful thoughts and feelings within	0.53	0.60	0.48	0.44
ICS two—Work more with other things to avert thinking bad thoughts	0.47	0.52	0.50	0.43
ICS 3—Using abusive substances when having bad thoughts or feelings	0.fourteen	0.15	0.12	0.13
ICS 4—Try to talk oneself out of problems	0.45	0.48	0.42	0.50
ECS one—Visit health intendance service when having bad thoughts or feelings	0.xviii	0.30	0.23	0.28
ECS 2—Speak with family when having bad thoughts or feelings	0.66	0.72	1.twoscore	0.82
ECS 3—Speak with friends when having bad thoughts or feelings	0.41	0.40	0.13	0.29
χ2	2870
CFI	0.615
RMSEA	0.051

ICS internal coping strategy, ECS external coping strategy, CFI comparative fit index, RMSEA root mean square mistake of approximation

Discussion

The electric current written report examined the relationship between chronic headaches and coping strategies in adolescents. Chronic headaches among youth were associated with a college risk of having mental health bug and vice versa. Our results suggest that dissimilar coping strategies were used amongst the four groups. Mental wellness impact is similar in groups with mental health issues whether or not they have chronic headaches, while youth without mental health problems reported lower bear on, closer to that of the control group.

The present study is based on a large sample size and the response rate was high (82 %). Akershus county in the s eastward office of Norway, where the report took place is representative for the nation every bit a whole compared to national data (Statistics Norway 2015). The questionnaire was aimed at a wide clarification of health in youth and was not specific to the disease category of chronic headaches. Therefore, respondents could not know the purpose of the present report, namely mapping chronic headache disorders in adolescents. Chronic headache was measured with one unproblematic question about several complaints during the past 6 months where headache was 1 of the complaints. Based on this question, we practice not get data about important aspects of the headache: duration of the headache and how strong the headache is. Furthermore, the quantification (number of days of headache per month) which is an important criterion in the classification of headache, is imprecise here. Thus nosotros cannot merits to have precise clinical headache diagnoses as footing for our study. On the other hand, as stated above, few if whatsoever headache studies have focused on coping strategies in the detail that we accept hither. The criteria used to define the presence of mental health issues were strengthened to require the simultaneous presence of both abnormal or borderline symptom score and impact in SDQ (Goodman 2001). Several studies show that SDQ is a useful and valid tool for identifying mental health complications amongst children and adolescents (Goodman 2011; Mathai et al. 2004). Nosotros take therefore called to use this tool though in that location is so far no consensus on the optimal instrument. Studies are ongoing which search for improved instruments for assessing relevant psychological factors in chronic headache such as the "stagnation scale" (Innamorati et al. 2015). As described in the introduction, the various axes for measuring coping strategies are thus nether debate. Though our coping strategy questions are not validated confronting other measures, nosotros advise that they may notwithstanding be useful as defined. This study is based on self-report, and there is no clinical validation of the answers. We have no data concerning use of medication in connection with headaches, which may be of importance in relation both to contact with wellness services and other internal versus external coping strategies. On the other hand, it is more difficult to assign a headache diagnosis in children, partly because of the paediatric age (Seshia et al. 2010) and different diagnostic methods that accept been used, making comparison difficult (Lipton et al. 2011).

The 6-month prevalence of chronic headaches (three.7 %) was considerably higher than that found in other studies amidst young people (Seshia et al. 2010). Possible explanations for the discrepancy, as compared with our report, may be: (1) different definitions of chronic headache, (2) variations in measuring instruments, (3) variations in the specified fourth dimension frame for the headache, and (4) older age group in our report (13–19 years). Our information are based on self-evaluation which may also contribute to this divergence. In improver, smaller sample sizes may give more uncertain estimates. We found that the relative risk (RR) of having chronic headaches when having mental health problems and vice versa was nearly 4. However, a cross-sectional study such as ours cannot answer the "craven and egg" effect, thus our results underline the need for prospectively designed studies with emphasis on prognosis and etiological factors.

The prevalence of mental health bug among those with chronic headaches was found to exist 23 %. A written report past Wang and colleagues (Wang et al. 2007) reported psychiatric disorders in almost half of the 121 Taiwanese school children anile 12–14 years with chronic headaches. Other studies take found psychiatric disorders in 64–90 % of patients with chronic headaches (Puca 2000; Verri et al. 1998). Differences across studies in the prevalence of psychiatric comorbidity in patients with chronic headaches may be due to the measuring instrument used to ascertain psychological functioning. However, compared with controls without chronic headache, our information prove that the prevalence of mental health issues in youth with chronic headache is high. We have focused on a group of adolescents, who, in addition to having chronic headache complaints, also accept psychological issues. Few studies have examined the differences in coping strategies in adolescents with chronic headaches with or without comorbid psychiatric disorders. Previous studies have establish that patients with chronic headache prove an overall avoidance coping blueprint (Rollnik et al. 2001), associated with increased psychological problems (Seiffge-Krenke 2000). It is likely that adolescents are even more inclined to apply less mature coping strategies when having chronic headaches with comorbid mental health problems. This is in accordance with our study.

The CHMH group in the present study used internal coping strategies, to a larger caste than the two other groups. These findings are similar to Jorgensen and Dusek (Jorgensen and Dusek 1990), where less psychologically adjusted adolescents used less mature coping strategies like alcohol use and minimizing the problem to a greater degree. Ebata and Moos (Ebata and Moos 1991) had a similar finding in a longitudinal study of life stressors, social resources and coping amongst adolescents aged 12–xviii, where depressed adolescents and adolescents with behave disorder used more than avoidance coping mechanisms than salubrious adolescents. In dissimilarity, Murberg and Bru (Murberg and Bru 2005) did non find an effect of problem-focused coping strategies on symptoms of low among Norwegian adolescents. Lanzi and colleagues (Lanzi et al. 2001) establish that headache sufferers internalized their feelings, which to some extent may seem to support our findings. The CH group was more than probable to use other strategies, compared to the CHMH group. According to Compas and colleagues (Compas et al. 2001), distraction decreased the levels of distress and intrusive thoughts. Thus our data suggests that the presence of mental health problems in adolescents with chronic headaches make the youth less able to distract themselves from troubled thoughts.

External coping strategies were used less usually in the CHMH group compared to the control group with the exception of visiting wellness care services. Visiting health care services can be considered an external coping strategy, and contradicts studies proverb that adolescents struggling with mental health problems evidence an overall coping strategy of avoidance (Chan 1995; Seiffge-Krenke 2000; Ebata and Moos 1991). This may, yet, reflect the low threshold in Norway for visiting wellness units, since they are placed in or most schools. Speaking with family unit and friends were trivial used coping strategies in all groups, specially in the groups with mental health problems, and may reflect social isolation in adolescents struggling with mental health issues with or without chronic headaches. Co-ordinate to Martin and Theunissen (Martin and Theunissen 1993), adults with chronic headaches score significantly lower on social back up, compared to not-headache subjects, which can exist an indicator that chronic headache sufferers are less able to seek support from family or peers. The report by Murberg and Bru (Murberg and Bru 2005) institute decreased levels of symptoms of depression in Norwegian adolescents that seek parental support in stressful situations. According to the latter written report, the importance of the external coping strategies seeking parental or friend back up are essential for mental health amongst adolescents. Our information suggests information technology may exist fifty-fifty more important when having the boosted burden of a chronic headache.

Categorising coping strategies into 2 dimensions, eastward.k. internal versus external coping, has been criticized (Holen et al. 2012). It has been suggested that the studies practice not fairly distinguish between the types of emotional coping strategies. Some plant that a strategy based on emotion-focused coping is only related to risk if the employ of other coping strategies is limited, others suggest that children who are flexible in their use of coping strategies have improve mental wellness outcomes. The most contempo studies on coping in children suggest that flexible employ of 3 or more than coping strategies may be advantageous (Holen et al. 2012). This study did bespeak however, that coping strategy profiles used were significantly dissimilar between all groups.

Conclusion

In this study we have found that adolescents with chronic headaches show more frequent mental health problems than those without chronic headaches. The group of adolescents having both chronic headaches and mental health problems announced to be the well-nigh vulnerable population. Compared to adolescents without mental health issues, adolescents with chronic headaches that have simultaneous mental health problems, to a greater extent employ internal coping strategies and to a bottom degree seek support in their social networks. Efforts should exist made by school and health services, and in local communities to promote the use of external coping strategies in high-hazard groups having both chronic headache and mental health problems. Exactly how this could be done requires further prospective, longitudinal follow-upwards studies of such issue-adapted treatment including a focus both on headache load, psychopathology and coping.

Authors' contributions

SH planned the overall project together with JCA and RKR, was responsible for the main information analysis and for preparing the first draft of the manuscript, JCA was responsible for the database and for the main support in the planning and execution of the statistical analyses of the data, RKR was the chief tutor for SH throughout and contributed importantly with the population health perspective, CL, whose main enquiry focus is chronic headache and behavioural handling, was involved in the planning of the project, supported in the analysis and was the senior principal author of the paper. All authors contributed in the interpretation, editing of the last manuscript. All authors read and approved the terminal manuscript.

Acknowledgements

Nosotros thank the Norwegian Foundation for Health and Rehabilitation for financial support to the Health survey this study is based on. The Health survey was performed in cooperation with the Norwegian Service Enquiry Centre, at present incorporated in the Norwegian Knowledge Centre for Health Services. This enquiry was made possible by the Section of Health Surveillance and Prevention at the Norwegian Institute of Public Health, which gave us access to their data and enabled united states of america to perform this analysis.

Competing interests

The authors declare that they take no competing interests.

Contributor Information

Silje Hartberg, Electronic mail: moc.liamg@grebtrahs.

Jocelyne Clench-Aas, Email: on.ihf@saa-hcnelc.enylecoj.

Ruth Kjærsti Raanaas, Email: on.ubmn@saanaar.htur.

Christofer Lundqvist, Phone: +4747278881, E-mail: on.oiu.nisidem@tsivqdnul.c.a.

References

• Arbuckle JL. IBM SPSS Amos 22 user's guide. Crawfordville: Amos Development Corporation; 2013. [Google Scholar]
• Baskin SM, Lipchik GL, Smitherman TA. Mood and feet disorders in chronic headache. Headache J Caput Confront Pain. 2006;46(s3):S76–S87. doi: x.1111/j.1526-4610.2006.00559.x. [PubMed] [CrossRef] [Google Scholar]
• Blaauw BA, Dyb M, Hagen K, Holmen TL, Linde 1000, Wentzel-Larsen T, Zwart J-A. The relationship of anxiety, depression and behavioral problems with recurrent headache in belatedly adolescence—a Immature-Hunt follow-upward report. J Headache Pain. 2015;xvi(1):10. doi: 10.1186/1129-2377-16-10. [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]
• Bollen BM. Structural equations with latent variables. New York: Wiley; 2014. [Google Scholar]
• Byrne BM. Structural equation modeling with AMOS: basic concepts, applications, and programming. New York: Routledge; 2013. [Google Scholar]
• Chan DW. Depressive symptoms and coping strategies among Chinese adolescents in Hong Kong. J Youth Adolesc. 1995;24(3):267–279. doi: ten.1007/BF01537596. [CrossRef] [Google Scholar]
• Cheung GW, Rensvold RB. Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model. 2002;9(2):233–255. doi: 10.1207/S15328007SEM0902_5. [CrossRef] [Google Scholar]
• Compas BE, Connor-Smith JK, Saltzman H, Thomsen AH, Wadsworth ME. Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull. 2001;127(1):87. doi: x.1037/0033-2909.127.1.87. [PubMed] [CrossRef] [Google Scholar]
• Ebata AT, Moos RH. Coping and adjustment in distressed and salubrious adolescents. J Appl Dev Psychol. 1991;12(1):33–54. doi: 10.1016/0193-3973(91)90029-4. [CrossRef] [Google Scholar]
• Gentili C, Panicucci P, Guazzelli M. Psychiatric comorbidity and chronicisation in primary headache. J Headache Pain. 2005;vi(four):338–340. doi: 10.1007/s10194-005-0226-half dozen. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Gladstein J. Children and adolescents with chronic daily headache. Curr Pain Headache Rep. 2004;8(1):71–75. doi: x.1007/s11916-004-0043-7. [PubMed] [CrossRef] [Google Scholar]
• Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40(xi):1337–1345. doi: 10.1097/00004583-200111000-00015. [PubMed] [CrossRef] [Google Scholar]
• Goodman R (2011) Information for researchers and professionals about the strengths and difficulties questionnaires. Youth in listen. http://www.sdqinfo.org. Accessed 2 Dec 2015
• Guidetti Five. Psychiatric comorbidity in chronic daily headache: pathophysiology, etiology, and diagnosis. Curr Hurting Headache Rep. 2002;vi(6):492–497. doi: 10.1007/s11916-002-0069-7. [PubMed] [CrossRef] [Google Scholar]
• Guidetti V, Galli F, Cerutti R, Fabrizi P. Chronic daily headache in developmental ages: diagnostic problems. J Headache Pain. 2000;one(1):S89–S93. doi: 10.1007/s101940070033. [CrossRef] [Google Scholar]
• Hirschfeld G, von Brachel R. Multiple-group confirmatory cistron analysis in R-A tutorial in measurement invariance with continuous and ordinal indicators. Prac Appraise Res Eval. 2014;19(seven):two. [Google Scholar]
• Holen S, Lervåg A, Waaktaar T, Ystgaard M. Exploring the associations betwixt coping patterns for everyday stressors and mental wellness in young schoolchildren. J Sch Psychol. 2012;50(ii):167–193. doi: ten.1016/j.jsp.2011.10.006. [PubMed] [CrossRef] [Google Scholar]
• Hooper D, Coughlan J, Mullen One thousand. Structural equation modelling: guidelines for determining model fit. J Charabanc Res Methods. 2008;half-dozen:53–60. [Google Scholar]
• Innamorati Grand, Pompili Grand, Erbuto D, Ricci F, Migliorati K, Lamis D, Amore K, Girardi P, Martelletti P. Psychometric properties of the stagnation scale in medication overuse headache patients. J Headache Pain. 2015;16(i):one–9. doi: 10.1186/1129-2377-xvi-1. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Jorgensen RS, Dusek JB. Boyish adjustment and coping strategies. J Pers. 1990;58(iii):503–513. doi: ten.1111/j.1467-6494.1990.tb00240.ten. [PubMed] [CrossRef] [Google Scholar]
• Krogh A-B, Larsson B, Linde M (2015) Prevalence and disability of headache amidst Norwegian adolescents: a cross-exclusive school-based report. Cephalalgia, 0333102415573512 [PubMed]
• Lanzi G, Zambrino C, Ferrari-Ginevra O, Termine C, D'arrigo Due south, Vercelli P, De Silvestri A, Guglielmino C. Personality traits in babyhood and adolescent headache. Ceph Int J Headache. 2001;21(1):53–sixty. doi: 10.1046/j.1468-2982.2001.00144.10. [PubMed] [CrossRef] [Google Scholar]
• Lazarus RS, Folkman Due south. Stress, appraisal, and coping. New York: Springer; 1984. [Google Scholar]
• Lipton RB, Manack A, Ricci JA, Chee East, Turkel CC, Winner P. Prevalence and burden of chronic migraine in adolescents: results of the chronic daily headache in adolescents study (C-dAS) Headache J Head Face Hurting. 2011;51(five):693–706. doi: 10.1111/j.1526-4610.2011.01885.x. [PubMed] [CrossRef] [Google Scholar]
• Martin PR, Theunissen C. The role of life result stress, coping and social support in chronic headaches. Headache J Caput Face Pain. 1993;33(6):301–306. doi: ten.1111/j.1526-4610.1993.hed3306301.ten. [PubMed] [CrossRef] [Google Scholar]
• Mathai J, Anderson P, Bourne A. Comparing psychiatric diagnoses generated past the strengths and difficulties questionnaire with diagnoses made by clinicians. Aust Due north Z J Psychiatry. 2004;38(8):639–643. doi: 10.1080/j.1440-1614.2004.01428.x. [PubMed] [CrossRef] [Google Scholar]
• Meade AW, Johnson EC, Braddy Pow. Ability and sensitivity of alternative fit indices in tests of measurement invariance. J Appl Psychol. 2008;93(3):568–592. doi: 10.1037/0021-9010.93.3.568. [PubMed] [CrossRef] [Google Scholar]
• Murberg TA, Bru E. The role of coping styles as predictors of depressive symptoms among adolescents: a prospective study. Scand J Psychol. 2005;46(four):385–393. doi: 10.1111/j.1467-9450.2005.00469.10. [PubMed] [CrossRef] [Google Scholar]
• Olesen J, Steiner T. The international nomenclature of headache disorders, second edn (ICDH-II) J Neurol Neurosurg Psychiatry. 2004;75(6):808–811. doi: 10.1136/jnnp.2003.031286. [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]
• Osborne JW. Best practices in using big, complex samples: the importance of using appropriate weights and design effect compensation. Prac Assess Res Eval. 2011;16(12):7. [Google Scholar]
• Pallant J. SPSS survival transmission: a step by footstep guide to data assay using SPSS. 4. Crows Nest: Allen and Unwin; 2010. [Google Scholar]
• Pompili M, Serafini M, Di Cosimo D, Dominici 1000, Innamorati M, Lester D, Forte A, Girardi Due north, De Filippis Due south, Tatarelli R, Martelletti P. Psychiatric comorbidity and suicide adventure in patients with chronic migraine. Neuropsychiatr Dis Treat. 2010;half dozen:81–91. doi: ten.2147/NDT.S8467. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]
• Powers SW, Gilman DK, Hershey Advertizing. Headache and psychological functioning in children and adolescents. Headache J Head Face Pain. 2006;46(9):1404–1415. doi: x.1111/j.1526-4610.2006.00583.ten. [PubMed] [CrossRef] [Google Scholar]
• Pratt CC, Schmall 5, Wright S, Cleland M. Family relations. Fam Health Care. 1985;34(ane):27–33. [Google Scholar]
• Puca F. Psychological and social stressors and psychiatric comorbidity in patients with migraine without aura from headache centers in Italy: a comparison with tension-type headache patients. J Headache Pain. 2000;i(1):17–25. doi: 10.1007/s101940050005. [CrossRef] [Google Scholar]
• Rollnik JD, Karst M, Fink M, Dengler R. Coping strategies in episodic and chronic tension-blazon headache. Headache J Head Confront. 2001;41(3):297–302. doi: ten.1046/j.1526-4610.2001.111006297.10. [PubMed] [CrossRef] [Google Scholar]
• Seiffge-Krenke I. Causal links betwixt stressful events, coping style, and adolescent symptomatology. J Adolesc. 2000;23(half dozen):675–691. doi: ten.1006/jado.2000.0352. [PubMed] [CrossRef] [Google Scholar]
• Seshia SS, Wang Southward-J, Abu-Arafeh I, Hershey Advertisement, Guidetti Five, Winner P, Wöber-Bingöl Ç. Chronic daily headache in children and adolescents: a multi-faceted syndrome. Can J Neurol Sci. 2010;37(half dozen):769–778. [PubMed] [Google Scholar]
• Statistics Kingdom of norway, 2015. https://world wide web.ssb.no/statistikkbanken. Accessed 2 Dec 2015
• Steiner TJ, Martelletti P. Aids for direction of common headache disorders in primary care. J Headache Pain. 2007;8(1):2. [PubMed] [Google Scholar]
• Steiner T, Birbeck G, Jensen R, Katsarava Z, Stovner L, Martelletti P. Headache disorders are tertiary cause of disability worldwide. J Headache Pain. 2015;16(one):1–three. doi: 10.1186/s10194-015-0544-two. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Stovner LJ, Zwart JA, Hagen K, Terwindt G, Pascual J. Epidemiology of headache in Europe. Eur J Neurol. 2006;13(4):333–345. doi: x.1111/j.1468-1331.2006.01184.x. [PubMed] [CrossRef] [Google Scholar]
• Stovner Fifty, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA. The global brunt of headache: a documentation of headache prevalence and disability worldwide. Ceph Int J Headache. 2007;27(iii):193–210. doi: x.1111/j.1468-2982.2007.01288.x. [PubMed] [CrossRef] [Google Scholar]
• Van Roy B, Veenstra M, Clench-Aas J. Construct validity of the five-factor strengths and difficulties questionnaire (SDQ) in pre-, early on, and late adolescence. J Child Psychol Psychiatry. 2008;49(12):1304–1312. doi: 10.1111/j.1469-7610.2008.01942.x. [PubMed] [CrossRef] [Google Scholar]
• Verri A, Proietti CA, Galli C, Granella F, Sandrini M, Nappi M (1998) Psychiatric comorbidity in chronic daily headache. Ceph Int J Headache eighteen:45 [PubMed]
• Wang S-J, Juang M-D. Psychiatric comorbidity of chronic daily headache: impact, handling, outcome, and hereafter studies. Curr Pain Headache Rep. 2002;6(six):505–510. doi: x.1007/s11916-002-0071-0. [PubMed] [CrossRef] [Google Scholar]
• Wang S-J, Juang K-D, Fuh J-L, Lu S-R. Psychiatric comorbidity and suicide gamble in adolescents with chronic daily headache. Neurology. 2007;68(18):1468–1473. doi: ten.1212/01.wnl.0000260607.90634.d6. [PubMed] [CrossRef] [Google Scholar]
• Wittrock DA, Myers TC. The comparison of individuals with recurrent tension-type headache and headache-free controls in physiological response, appraisal, and coping with stressors: a review of the literature. Ann Behav Med. 1998;xx(ii):118–134. doi: ten.1007/BF02884458. [PubMed] [CrossRef] [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688278/