Early Maladaptive Schemas, Depression, Distress and Discomfort Tolerance in Migraine Headache

Onen, Sinay; Günes, Aygül

doi:10.15761/0101-60830000000259

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Original Article • Arc. Clin. Psychiatr. 47 (6) • 2020 • https://doi.org/10.15761/0101-60830000000259 copy

Early Maladaptive Schemas, Depression, Distress and Discomfort Tolerance in Migraine Headache

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

Depression and maladaptive schemas were found to worsen the pain experience in individuals with chronic pain.

Objectives:

The aim of the present study was to evaluate the relationship between depressive symptoms, early maladaptive schemas, distress and discomfort tolerance in female patients with migraine.

Methods:

Seventy eight female migraine patients(37 depressed and 41 non-depressed subjects according to BDI scores) and 55 healthy controls were evaluated with Numeric Pain Rating Scale(NPRS),Beck Depression Inventory(BDI),Young Schema Questionnaire-Short Form-3(YSQ-SF-3),Discomfort Intolerance Scale(DIS) and Distress Tolerance Scale(DTS).

Results:

Distress and discomfort tolerance were lower in both migraine groups than control subjects. EMSs were higher in depressed migraine patients than in non-depressed migraine group and non-clinical controls. A positive correlation between BDI and YSQ-SF-3 scores(p<0.001), a negative correlation between BDI and DIS(p<0.01), and also a negative correlation between BDI and DTS(p<0.001) were found among migraine patients. Hierarchical regression analysis revealed that 20% of the depressive symptoms were explained with DIS scores, while explanatoriness raised up to 46% by addition of YSQ-SF-3 scores to the model.

Discussion:

Cognitive interventions for modifying EMSs and improving distress and discomfort tolerance might be added to the treatment strategies in female migraine patients.

Keywords:
Migraine; depression; schema; distress tolerance; discomfort intolerance

		Female Migraine Patients		Control Group n(%)	Chi-square	p
		Depressed BDI>17 (n=37)	Non-Depressed BDI≤17 (n=41)	Control Group n(%)	Chi-square	p
Education n(%)	Primary	29 (78.4)	29 (70.7)	41 (74.5)	0.65	0.957
	High	5 (13.5)	7 (17.1)	8 (14.5)
	Above	3 (8.1)	5 (12.2)	6 (10.9)
Income status n(%)	High	8 (21.6)	14 (34.1)	6 (10.9)	15.64	0.004^* * <0.01,
	Middle	25 (67.6)	26 (63.4)	49 (89.1)
	Low	4 (10.8)	1 (2.4)	0 (0)
Employment n(%)	Unemployed	19 (51.4)	22 (53.7)	3 (5.5)	52.31	<0.001^ <0.001,
	Worker	15 (40.5)	12 (29.3)	52 (94.5)
	Officer	2 (5.4)	3 (7.3)	0 (0)
	Retired	1(2.7)	2 (4.9)	0 (0)
	Other	0 (0)	2 (4.9)	0 (0)
Marital status n(%)	Single	34 (91.9)	36 (87.8)	35 (63.6)	23.33	<0.001^ <0.001,
	Married	1 (2.7)	3 (7.3)	20 (36.4)
	Divorced	2 (5.4)	2 (4.9)	0 (0)
Duration of disease n(%)	1-5 years	14 (37.8)	16 (39.0)	-	0.082	0.960
	5-10 years	11 (29.7)	11 (26.8)	-
	More than 10 years	12 (32.4)	14 (34.1)	-
Type of migraine n(%)	With aura	23 (62.2)	17 (41.5)	-	3.335	0.068
Type of migraine n(%)	Without aura	14 (37.8)	24 (58.5)	-	3.335	0.068
Migraine attack frequency n(%)	More than once per week	20 (54.1)	14 (34.1)	-	8.118	0.017^* * <0.01,
	More than once a month	17 (45.9)	20 (48.8)	-
	Less than once per month	0 (0)	7 (17.1)	-
Migraine attack duration n(%)	1-24 hours	10 (27.0)	14 (34.1)	-	0.463	0.496
Migraine attack duration n(%)	24-72 hours	27 (73.0)	27 (65.9)	-	0.463	0.496

	Depressed Migraine Patients BDI>17 (n=37)	Non-depressed Migraine Patients BDI≤17 (n=41)	Control Group (n=55)	F	p
	Mean/Sd	Mean/Sd	Mean/Sd	F	p
BDI^a a = MP with Depression>MP without Depression>Control Group,	25.65±7.37	9.61±4.14	7.51±3.89	151.02	<0.001^ <0.001
DIS-total^b b = MP with Depression, MP without Depression < Control Group,	20.14±7.28	23.78±7.23	25.95±11.87	4.18	0.017
DIS-Tolerance^b b = MP with Depression, MP without Depression < Control Group,	9.86±4.88	12.32±5.16	15.44±7.80	8.82	<0.001^ <0.001
DIS-Avoidance^c c = MP with Depression, MP without Depression, Control Group,	10.27±5.05	11.41±4.64	10.87±4.42	0.58	0.560
DTS-total^b b = MP with Depression, MP without Depression < Control Group,	38.84±11.31	46.46±12.38	58.67±17.98	21.22	<0.001^ <0.001
DTS-Tolerance^b b = MP with Depression, MP without Depression < Control Group,	23.08±8.41	28.22±8.83	34.40±10.91	15.63	<0.001^ <0.001
DTS-Regülasyon^b b = MP with Depression, MP without Depression < Control Group,	8.32±3.11	8.12±3.63	12.84±3.21	31.17	<0.001^ <0.001
DTS-Self-Efficacy^d d = MP with Depression<MP without Depression<Control group,	7.76±2.30	9.39±2.64	12.13±3.19	28.58	<0.001^ <0.001
YSQ-SF-3 total^e e = MP with Depression>MP without Depression, Control Group,	271.59±62.60	208.53±44.68	189.07±62.12	23.61	<0.001^ <0.001
Emotional Deprivation^e e = MP with Depression>MP without Depression, Control Group,	14.57±5.97	9.93±5.32	11.64±5.09	7.26	0.001^* * <0.01,
Failure to Achieve^e e = MP with Depression>MP without Depression, Control Group,	16.86±7.05	10.80±3.93	11.82±4.86	14.57	<0.001^ <0.001
Pessimism^e e = MP with Depression>MP without Depression, Control Group,	18.05±5.00	12.17±5.04	10.71±5.05	24.75	<0.001^ <0.001
Social Isolation/Alienation^e e = MP with Depression>MP without Depression, Control Group,	21.51±6.93	14.80±5.71	13.00±5.00	24.85	<0.001^ <0.001
Emotional Inhibition^e e = MP with Depression>MP without Depression, Control Group,	13.86±5.74	11.12±5.54	10.95±4.13	4.21	0.017
Approval Seeking^f f = MP with Depression, MP without Depression> Control Group.	21.38±6.47	18.49±6.42	13.36±5.66	20.22	<0.001^ <0.001
Dependence/Incompetence^e e = MP with Depression>MP without Depression, Control Group,	23.68±7.30	16.12±5.53	16.29±4.47	22.83	<0.001^ <0.001
Enmeshment/Insufficient Self-Control^f f = MP with Depression, MP without Depression> Control Group.	21.49±6.96	19.12±6.04	13.73±5.10	20.83	<0.001^ <0.001
Self-Sacrifice^a a = MP with Depression>MP without Depression>Control Group,	20.24±5.66	16.93±5.15	12.47±5.69	22.68	<0.001^ <0.001
Abandonment^e e = MP with Depression>MP without Depression, Control Group,	12.84±5.71	9.27±4.15	10.64±5.00	5.05	0.008^* * <0.01,
Self-Punitiveness^f f = MP with Depression, MP without Depression> Control Group.	22.27±7.09	19.24±6.40	12.24±5.28	32.44	<0.001^ <0.001
Defectiveness/Shame^e e = MP with Depression>MP without Depression, Control Group,	13.27±5.93	9.02±3.19	11.60±4.72	8.14	<0.001^ <0.001
Vulnerability to Harm^e e = MP with Depression>MP without Depression, Control Group,	14.68±4.95	10.46±4.69	10.85±4.14	10.34	<0.001^ <0.001
Unrelenting Standardsc	8.73±3.96	8.78±3.23	7.75±2.67	1.56	0.213

	1	2	3	4
1-NPRS	-
2-BDI	0.03
3-DIS	-0.08	-0.31^* * <0.01,
4-DTS	0.19	-0.37^* * <0.01,	0.21
5-YSQ-SF-3	-0.02	0.62^ <0.001.	-0.10	-0.42^ <0.001.

Migraine group (n=78)						95% Confidence Interval
Predictor	R2	Adjusted R2	B	SE	Beta	LL	UL
Step 1
DIS			-0.33	0.14	-0.25^* * <0.05,	-0.61	-0.05
DTS			-0.25	0.08	-0.32^ <0.01,	-0.42	-0.09
	0.20^* ***** <0.001,	0.17^* ***** <0.001,
Step 2
DIS			-0.32	0.11	-0.24^ <0.01,	-0.55	-0.09
DTS			-0.06	0.07	-0.08	-0.22	0.08
YSQ-SF-3			0.09	0.01	0.56^* ***** <0.001,	0.06	0.12
	0.46^* ***** <0.001,	0.43^* ***** <0.001,
Control group (n=55)
Step 1
DIS			0.12	0.04	0.31^* * <0.05,	0.01	0.19
DTS			-0.05	0.03	-0.24	-0.11	0.00
	0.10	0.07
Step 2
DIS			0.12	0.04	0.37^* * <0.05,	0.02	0.21
DTS			-0.05	0.03	-0.27	-0.12	0.00
YSQ-SF-3			-0.01	0.00	-0.19	-0.02	0.00
	0.14	0.09^* * <0.05,

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[1] Address for correspondence: Sinay Onen, Department of Pscyhiatry, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mh. Emniyet Cd. Yıldırım, Bursa 16310, Turkey. Telephone: +90 505 212 01 73; Fax: +90 224 366 04 16; E-mail: sinayonen@hotmail.com