Background: Resilience is the ability of an individual to positively adapt to adverse conditions. It can be conceived as a dynamic two-dimensional construct involving exposure to adversity and positive adaptation outcomes. Some evidence suggests that individuals' cognitive, emotional, and behavioral responses to pain are important in determining their long-term health. Particularly, self-efficacy and pain acceptance are evaluated as key elements of resilience; they also provide a secure foundation for adaptive behaviors linked to lasting well-being and good quality of life, highlighting the negative impact of a "non-resilient" assessment such as pain catastrophizing. It is of considerable interest to understand whether the level of resilience and the presence of adverse events in adolescents with primary headache differ from their peers without headache, both from a treatment and prevention perspective. Study Objective: The primary goal was to assess whether there were differences in resilience levels between patients with primary headache and a control group, whether the presence of adverse life events was greater in patients with headache compared to controls, and whether the presence of such events influenced resilience levels. The secondary objective was to study the presence of resilience differences between subjects with migraine and those with tension-type headache. The final purpose of the study was to analyze whether there were differences between patients with chronic (both migraine and tension-type) and episodic headaches. Materials and Methods: The research is part of a large multicenter project focused on analyzing the relationship between headache and resilience. This study involves several centers in Italy and aims to explore resilience levels in adolescents aged 14 to 18, both with and without primary headache, in relation to levels of psychopathology and trauma. A total of 238 adolescents (14-18 years) were involved in this study, divided into a Case Group consisting of 50 subjects diagnosed with primary headache and a Control Group including another 188 subjects without a headache diagnosis. All participants completed the YSR to assess behavioral competence and behavioral problems, the CD-RISC to assess resilience, and the ITEM-Revised to detect traumatic events. Results: Adolescents with headaches are at greater risk of developing psychopathologies compared to healthy peers, having scored higher on the YSR test. Specifically, of the four types of headaches considered, migraine patients had statistically significant and more pathological values in the internalizing (p = 0.0004) and externalizing (p = 0.0001) domains of the test. Subjects with chronic forms (migraine and tension-type headache) also scored higher on the YSR (p = 0.001 for internalizing problems and p = 0.001 for externalizing problems). The differences between the two groups in the total CD-RISC and ITEM22 scores were not significant for all three points of the study. Conclusion: The results indicated that although there were no statistically significant differences in resilience levels between the two groups, coping levels were higher in patients compared to controls. Adolescents with headaches exhibited higher levels of psychopathology than healthy peers, particularly in migraine and chronic forms. This suggests that the presence of chronic migraine may be a predisposing factor for the onset of psychopathologies.
Presupposti: La resilienza può essere definita come la capacità dell’individuo di adattarsi in maniera positiva ad una condizione avversa. Essa può essere concepita come un costrutto bidimensionale dinamico che coinvolge l’esposizione alle avversità e gli esiti positivi dell’adattamento).Alcune prove suggeriscono che le risposte cognitive, emotive e comportamentali dell’individuo verso il dolore sono importanti nel determinare la loro salute a lungo termine. Vengono valutate in particolare l’autoefficacia e l’accettazione del dolore come elementi chiave della resilienza; inoltre esse costituiscono delle basi sicure per comportamenti adattivi collegati ad un benessere duraturo e ad una buona qualità della vita, evidenziando l’impatto negativo di una valutazione “non resiliente” come la catastrofizzazione del dolore. È di notevole interesse comprendere se il livello di resilienza e la presenza di eventi avversi negli adolescenti con cefalea primaria sia differente rispetto ai coetanei senza cefalea, sia in un’ottica di trattamento che di prevenzione. Scopo dello studio: L’obiettivo primario consisteva nel valutare se sussistevano differenze nei livelli di resilienza in pazienti con cefalea primaria e un gruppo di controllo, se la presenza di eventi di vita avversi fosse maggiore nei pazienti con cefalea rispetto ai controlli e se la presenza di tali eventi influenzasse i livelli di resilienza. L’obiettivo secondario si basava sullo studio della presenza di differenze di resilienza fra soggetti con emicrania e soggetti con cefalea tensiva. L’ultimo proposito dello studio era quello di analizzare se sussistevano differenze tra pazienti affetti da cefalee (sia di tipo emicranico che tensivo) croniche ed episodiche. Materiali e metodi: La ricerca fa parte di un ampio progetto multicentrico focalizzato sull'analisi della relazione tra cefalea e resilienza. Questo studio coinvolge diversi centri in Italia e mira a esplorare i livelli di resilienza in soggetti adolescenti tra i 14 e i 18 anni di età, con e senza cefalea primaria, in relazione ai livelli di psicopatologia e traumi. Un totale di 238 adolescenti (14-18 anni) sono stati coinvolti in questo studio, suddivisi in Gruppo dei casi, costituito da 50 soggetti con diagnosi di cefalea primaria e Gruppo di Controllo, comprendente altri 188 soggetti senza una diagnosi di cefalea. Tutti i partecipanti hanno completato il YSR per valutare la competenza comportamentale e i problemi comportamentali, la CD-RISC per valutare la resilienza e l'ITEM-Revised per rilevare gli eventi traumatici. Risultati: Gli adolescenti affetti da cefalea presentano un maggior rischio di sviluppo di psicopatologie rispetto ai coetanei sani, avendo ottenuto punteggi più alti al test YSR. Nello specifico delle quattro tipologie di cefalee considerate, è risultato che i pazienti emicranici hanno valori statisticamente significativi e più tendenti al patologico nei campi internalizzanti (p =0.0004) ed esternalizzanti (p = 0.0001) del suddetto test. Anche i soggetti affetti da forme croniche (emicrania e cefalea) hanno raggiunto punteggi più alti all’YSR (rispettivamente p = 0.001 per i problemi internalizzanti e p = 0.001 per gli esternalizzanti). Le differenze tra i due gruppi nel punteggio totale del CD-RISC e dell’ITEM22 non sono risultati significativi per tutti e tre i punti dello studio effettuato. Conclusione: I risultati hanno indicato che, sebbene non ci fossero differenze statisticamente significative nei livelli di resilienza tra i due gruppi, i livelli di coping risultano più alti nei pazienti rispetto ai controlli. Gli adolescenti con cefalea hanno presentato livelli maggiori di psicopatologia rispetto ai coetanei sani, in particolare nelle forme emicraniche e in quelle croniche. Ciò suggerisce che la presenza di emicrania cronica potrebbe essere un fattore predisponente l'insorgenza di psicopatologie.
CAPACITA’ DI ADATTAMENTO E RESILIENZA NEGLI ADOLESCENTI AFFETTI DA CEFALEA PRIMARIA: UNO STUDIO PROSPETTICO CASO-CONTROLLO
LOCALLO, MARTINA
2023/2024
Abstract
Background: Resilience is the ability of an individual to positively adapt to adverse conditions. It can be conceived as a dynamic two-dimensional construct involving exposure to adversity and positive adaptation outcomes. Some evidence suggests that individuals' cognitive, emotional, and behavioral responses to pain are important in determining their long-term health. Particularly, self-efficacy and pain acceptance are evaluated as key elements of resilience; they also provide a secure foundation for adaptive behaviors linked to lasting well-being and good quality of life, highlighting the negative impact of a "non-resilient" assessment such as pain catastrophizing. It is of considerable interest to understand whether the level of resilience and the presence of adverse events in adolescents with primary headache differ from their peers without headache, both from a treatment and prevention perspective. Study Objective: The primary goal was to assess whether there were differences in resilience levels between patients with primary headache and a control group, whether the presence of adverse life events was greater in patients with headache compared to controls, and whether the presence of such events influenced resilience levels. The secondary objective was to study the presence of resilience differences between subjects with migraine and those with tension-type headache. The final purpose of the study was to analyze whether there were differences between patients with chronic (both migraine and tension-type) and episodic headaches. Materials and Methods: The research is part of a large multicenter project focused on analyzing the relationship between headache and resilience. This study involves several centers in Italy and aims to explore resilience levels in adolescents aged 14 to 18, both with and without primary headache, in relation to levels of psychopathology and trauma. A total of 238 adolescents (14-18 years) were involved in this study, divided into a Case Group consisting of 50 subjects diagnosed with primary headache and a Control Group including another 188 subjects without a headache diagnosis. All participants completed the YSR to assess behavioral competence and behavioral problems, the CD-RISC to assess resilience, and the ITEM-Revised to detect traumatic events. Results: Adolescents with headaches are at greater risk of developing psychopathologies compared to healthy peers, having scored higher on the YSR test. Specifically, of the four types of headaches considered, migraine patients had statistically significant and more pathological values in the internalizing (p = 0.0004) and externalizing (p = 0.0001) domains of the test. Subjects with chronic forms (migraine and tension-type headache) also scored higher on the YSR (p = 0.001 for internalizing problems and p = 0.001 for externalizing problems). The differences between the two groups in the total CD-RISC and ITEM22 scores were not significant for all three points of the study. Conclusion: The results indicated that although there were no statistically significant differences in resilience levels between the two groups, coping levels were higher in patients compared to controls. Adolescents with headaches exhibited higher levels of psychopathology than healthy peers, particularly in migraine and chronic forms. This suggests that the presence of chronic migraine may be a predisposing factor for the onset of psychopathologies.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/66803