Lifestyle behaviors and illness related factors as predictors of recurrent headache in US adolescents

Purpose. Successful management of recurrent headache among adolescents requires an understanding of the lifestyle behaviors (skipping meals, water intake, tobacco use, alcohol use, and physical activity) and illness related factors (depression, somatic complaints, insomnia and obesity) reported to be associated with this headache type. This study describes a multivariate model demonstrating how lifestyle behaviors and illness related factors work together to predict recurrent headache in an adolescent population.;Method. A descriptive, cross-sectional, secondary analysis using survey data from the National Longitudinal Study of Adolescent Health (Add Health) (1996) will be reported. Add Health is a large database providing a nationally representative sample of adolescents (ages 11--17, n=13,570). The database evaluated adolescent headache and is inclusive of all the predictors specific to this study. Add Health was obtained from the UNC Carolina Population Center after an IRB Security Plan was approved. Frequency analysis and forward logistic regression were performed using each of the lifestyle behaviors and illness related factors.;Results. Approximately 26% of the adolescents experienced recurrent headache. Recurrent headache was reported by 19% of males and 26% of females. A multivariate model was developed that demonstrated how lifestyle behaviors and illness related factors predict recurrent headache in adolescents. Main effects demonstrated that the odds of having recurrent headache were significantly associated with gender (OR .36, CI .32, .42), chest pain (OR 2, CI 1.8, 2.9), depression (OR 1.87, CI 1.6, 2.2), insomnia (OR 2.03, CI 1.6, 2.5), muscle and joint pain (OR 1.9, CI 1.6, 2.1), skipping breakfast 3 or more times a week (OR 1.2, CI 1.08, 1.33), and skipping lunch one or more times a week (OR 1.14, CI 1.02, 1.27). The main effect of race was significant for Hispanics (OR .59, CI .46, .75), African Americans (OR .62, CI .53, .72), and Asians (OR .42, CI .29, .61). Significant results were found when comparing no sports activity with sports activity 5 or more times a week (OR 1.17, CI 1.0042, 1.3714) as well as when comparing sports activity 1 or more times a week with sports activity 5 or more times a week (OR 1.28, CI 1.06, 1.56). The final model consisted of the following predictors: chest pain, muscle and joint pain, skip breakfast three or more times a week, skip lunch one or more times a week, and physical activity. The interactions of gender and age group, race and smoke regularly and depression and insomnia were also included in the final model.;Conclusion. Providing evidence to clinicians that lifestyle behaviors and illness related factors are associated with adolescent recurrent headache may improve overall headache assessment and may result in a more comprehensive plan of treatment. Future studies include development of interventions based upon the reported model and subsequent evaluation of the effectiveness of such interventions on adolescent recurrent headache

Gender Differences In the Associations of Multiple Psychiatric and Chronic Conditions With Major Depressive Disorder Among Patients With Opioid Use Disorder

Purpose: The study examined the associations of multiple psychiatric and chronic conditions with the self-reported history of major depressive disorder (MDD) among patients with opioid use disorder (OUD) and tested whether the associations differed by gender. Methods: We conducted a secondary data analysis of baseline data from a clinical trial including 1,646 participants with OUD, of which 465 had MDD. A variable cluster analysis was used to classify chronic medical and psychiatric conditions. Multivariable logistic regression analyses were used to estimate their associations with MDD in subjects with OUD. Results: Nine variables were divided into three clusters: cluster 1 included heart condition, hypertension, and liver problems; cluster 2 included gastrointestinal (GI) problems and head injury, and cluster 3 included anxiety disorder, bipolar disorder, and schizophrenia. The overall prevalence of MDD in participants with OUD was 28.3% (22.8% for males and 39.5% for females). Gender, anxiety disorder, schizophrenia, liver problems, heart condition, GI problems, and head injury were significantly associated with MDD. Gender-stratified analyses showed that bipolar disorder, liver problems and individuals with one chronic condition were associated with MDD only in males, whereas heart condition, hypertension, and GI problems were associated with MDD only in females. In addition, anxiety disorder, head injury, individuals with one or more than two psychiatric conditions, and individuals with more than two chronic conditions were associated with MDD regardless of gender. Conclusions: Treatment plans in patients with OUD should not only address MDD but also co-morbid psychiatric and chronic medical conditions that occur with MDD